Predictors That Identify Complications Such As Anastomotic Leak in Colorectal Surgery: A Systematic Review

Abstract

Leakage of the anastomotic site is considered to be one of the most serious complications after colon and rectal surgery. It is associated with increased mortality, morbidity, and longer hospital stays. This systematic review examines the need for blood markers such as C-reactive protein (CRP), procalcitonin (PCT), albumin, and various other molecular markers that assist in their propensity to diagnose anastomotic leakage (AL) early after surgery. Utilizing PubMed and Google Scholar as resources and including the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for the articles, and studies over the last five years were included. A total of 12 studies have been discussed, and most articles suggest CRP as an excellent indicator. CRP compared to Dutch leakage scores (DLS) and PCT studies suggest that the three combinations improve the predictable outcome of AL. In addition, CRP and PCT have been shown to diagnose AL early in the postoperative period. Other studies include the role of markers of oxidative stress markers, Interleukin-6, Interleukin-10, and other molecular markers in the peritoneal drain which are predictive for identifying AL after three days postoperatively (POD-3). Overall, CRP has proven to be a reliable standard indicator of diagnosis. This is because the postoperative elevation of this protein indicates a problem of leakage with clinical symptoms. Other blood parameters are useful for diagnosis as well, but the limitations are the lack of appropriate studies and the number of randomized controlled trials in this area of ​​study.

Aplicación de la puntuación de fuga del colon en la cirugía colorrectal del lado izquierdo

“…Early detection of leakage at the anastomotic site helps in the early detection, treatment, and prevention of post-operative complications, sepsis, and mortality. There are different strategies for identifying AL using different markers, including C-reactive protein (CRP), white cell count (WCC), and procalcitonin (PCT) [19][20][21] . CRP is being studied as a specific early protein marker for postoperative complications.…”

“…The tendency for CRP usually increases 48 h after surgery. A steady trend showing increased inflammatory markers, such as CRP, WCC, and PCT would suggest looking out for an AL with the clinical features [19][20][21] . Their levels between post-operative days 3 and 7 are carefully taken into consideration as they could be the predictor of the leak 21 .…”

“…A steady trend showing increased inflammatory markers, such as CRP, WCC, and PCT would suggest looking out for an AL with the clinical features [19][20][21] . Their levels between post-operative days 3 and 7 are carefully taken into consideration as they could be the predictor of the leak 21 . The post-operative trajectories of these inflammatory markers are very useful tools to predict AL after colorectal surgery 21 .…”

“…Their levels between post-operative days 3 and 7 are carefully taken into consideration as they could be the predictor of the leak 21 . The post-operative trajectories of these inflammatory markers are very useful tools to predict AL after colorectal surgery 21 . Nevertheless; despite the usefulness of these inflammatory markers, they are postoperatively determined, as opposed to the CLS items, in which most of them are pre-operative registered and the rest of them are measured during surgery.…”

The analysis of fecal calprotectin as a diagnostic marker for anastomotic leakage after rectal cancer surgery: a pilot study

“…A recent systematic review of biomarkers for the detection of AL after colorectal surgery showed that CRP and procalcitonin (common inflammatory markers) could be reliable markers for the prediction of AL [ 14 ]. Other candidate markers, including oxidative stress markers and inflammatory biomarkers, such as interleukinj-6 or interleukin-10 from blood and/or drainage fluid samples have been also introduced [ 14 ]. However, these markers are still far from being applied in clinical practice.…”