Systematic review of the role of biomarkers in diagnosing anastomotic leakage following colorectal surgery

Su'a, BU; Mikaere, HL; Rahiri, Jamie‐Lee; Bissett, Ian P.; Hill, Andrew

doi:10.1002/bjs.10487

Cited by 77 publications

(77 citation statements)

References 69 publications

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“…CRP was evaluated in a recent systematic review by Su'a et al . who concluded that the CRP level was generally raised significantly days before the clinical diagnosis of AL . The reported cut‐off values for CRP ranged from 94 to 190 mg/l for postoperative days 3–4.…”

Section: Discussionmentioning

confidence: 99%

“…Su'a et al also observed differences in the increase of different biomarkers at different time points during the postoperative period [21]. Whilst this group demonstrated an increase in biomarkers for ischaemia immediately after surgery, the increase in markers for inflammation (e.g.…”

Section: Al Pathophysiologymentioning

confidence: 91%

“…A new and modified DULK score based on fewer clinical parameters may have higher predictive values for AL but needs to be prospectively evaluated [20]. CRP was evaluated in a recent systematic review by Su'a et al who concluded that the CRP level was generally raised significantly days before the clinical diagnosis of AL [21]. The reported cut-off values for CRP ranged from 94 to 190 mg/l for postoperative days 3-4.…”

Section: Previous Studies Of Clinical Score and Crp For Almentioning

confidence: 99%

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Detection of early anastomotic leakage by intraperitoneal microdialysis after low anterior resection for rectal cancer: a prospective cohort study

et al. 2019

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Aim Anastomotic leakage (AL) is a common and serious complication following sphincter‐preserving surgery for rectal cancer. Early detection and intervention can improve clinical outcomes. The aim of this prospective cohort study was to compare intraperitoneal microdialysis with a clinical scoring system for early detection of AL. Method A microdialysis catheter was anchored near the anastomosis at low anterior resection (LAR) for rectal cancer. Peritoneal fluid samples were analysed (lactate, pyruvate, glucose and glycerol concentration) 4‐hourly and compared with a daily clinical leak score (DULK = Dutch leakage). At day 7 a pelvic CT with rectal contrast enema was performed to establish if there had been a radiological leak. Results In this two‐centre study, 129 patients [median age 65 (26–82) years; 60.5% male] underwent LAR. The leak rate was 27% (grade A, n = 11; grade B, n = 12; grade C, n = 12). Receiver operator characteristic analysis demonstrated a lactate cut‐off value of 9.8 mm and had 77% sensitivity, 82% specificity, 78% accuracy, a positive predictive value (PPV) of 58, a negative predictive value (NPV) of 88 (CI 79–94) and an area under the curve (AUC) of 0.9 for AL. This compared with a clinical score ≥ 4, which had 57% sensitivity, 79% specificity, 71% accuracy, a PPV of 46, a NPV of 82 and an AUC of 0.7 for AL. The mean day for a positive test when using delta lactate ≥ 6.3 mm was 1.6 days and for leak score ≥ 4 it was 3.3 days (NS). Conclusion When AL occurs, intraperitoneal lactate concentration increases over time, and at a certain cut‐off has a higher sensitivity, specificity, accuracy, PPV and NPV than a clinical scoring system.

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Section: Discussionmentioning

confidence: 99%

Section: Al Pathophysiologymentioning

confidence: 91%

Section: Previous Studies Of Clinical Score and Crp For Almentioning

confidence: 99%

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Detection of early anastomotic leakage by intraperitoneal microdialysis after low anterior resection for rectal cancer: a prospective cohort study

et al. 2019

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“…Anastomotic leak (AL) is one of the most dreaded complications following major colorectal surgery. Reported AL rates range from 3% to 27%, and this is associated with significant morbidity and mortality . The early diagnosis of AL is difficult due to its variable clinical course particularly in the early postoperative period.…”

Section: Introductionmentioning

confidence: 99%

“…The early diagnosis of AL is difficult due to its variable clinical course particularly in the early postoperative period. Furthermore, in a modern optimized perioperative care setting, patients may be discharged before clinical features of AL become apparent …”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of procalcitonin for the early diagnosis of anastomotic leakage after colorectal surgery: a meta‐analysis

Su’a

Tutone

MacFater

et al. 2019

ANZ Journal of Surgery

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Background: Anastomotic leakage (AL) is a dreaded complication following colorectal surgery. Procalcitonin is one of many biomarkers studied and research has suggested that it has improved accuracy for the diagnosis of AL compared with other inflammatory biomarkers such as C-reactive protein. This meta-analysis was conducted to evaluate the accuracy of procalcitonin in the early diagnosis of AL following colorectal surgery. Methods: MEDLINE, Embase and PubMed were searched for studies evaluating procalcitonin in the context of AL following colorectal surgery in the elective setting. The literature was reviewed using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. Quality of the studies was assessed using the Quality Assessment Diagnostic Accuracy Studies (QUADAS)-2 tool. Meta analyses were conducted using area under the receiver operating characteristic curves for day 3, 4 and 5 post-surgery as a diagnostic test to detect AL. Results: A total of eight studies were analysed. Results showed that the highest diagnostic accuracy for procalcitonin is on day 5 post surgery. The reported optimal cut-off values ranged from 0.25 to 680 ng/mL from postoperative day 3 to 5, with reported negative predictive values ranging from 95% to 100%, and positive predictive values of up to 34%. The highest area under the receiver operating characteristic curve was 0.88 on postoperative day 5. Conclusion: Procalcitonin is a useful negative test for AL following elective colorectal surgery. However, as an isolated test, it is not useful in detecting AL.© 2019 Royal Australasian College of Surgeons ANZ J Surg 90 (2020) 675-680ANZJSurg.com

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Serum and peritoneal biomarkers for the early prediction of symptomatic anastomotic leakage in patients following laparoscopic low anterior resection: A single‐center prospective cohort study

Tan

Liu

et al. 2023

Cancer Reports

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Background Anastomotic leakage (AL) is one of the common complications after rectal cancer surgery. This study aimed to evaluate the combination of biomarkers for the early prediction of symptomatic AL after surgery. Methods A prospective cohort study evaluated the serum and peritoneal biomarkers of patients who underwent laparoscopic low anterior resection (Lap LAR) from November 1, 2021, to May 1, 2022. Multivariate‐penalized logistic regression was performed to explore the independent biomarker with a P‐value <.1, and receiver operating characteristic (ROC) curve was used to analyze the area under the curve (AUC), sensitivity, and specificity of the independent biomarkers. A predictive model for symptomatic AL was built based on the independent biomarkers and was visualized with a nomogram. The calibration curve with the concordance index (c‐index) was further applied to evaluate the efficacy of the predictive model. Results A total of 157 patients were included in this study, and 7 (4.5%) were diagnosed with symptomatic AL. C‐reactive protein/album ratio (CAR) on postoperative day 1 and systemic immune‐inflammation index (SII) and peritoneal interleukin‐6 (IL‐6) on postoperative day 3 were proven to be independent predictors for the early prediction of symptomatic AL. The optimal cutoff values of CAR, SII, and peritoneal IL‐6 were 1.04, 916.99, and 26430.09 pg/ml, respectively. Finally, the nomogram, including these predictors, was established, and the c‐index of this nomogram was 0.812, indicating that the nomogram could be used for potential clinical reference. Conclusion The combination of CAR, SII, and peritoneal IL‐6 might contribute to the early prediction of symptomatic AL in patients following Lap LAR. Given the limitations of this study and the emergence of other novel biomarkers, multicenter prospective studies are worthy of further exploration.

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Systematic review of the role of biomarkers in diagnosing anastomotic leakage following colorectal surgery

Abstract: Peritoneal drain fluid and systemic biomarkers are poor predictors of AL after colorectal surgery. Combinations of these biomarkers showed improvement in predictive accuracy.

Cited by 77 publications

References 69 publications

Detection of early anastomotic leakage by intraperitoneal microdialysis after low anterior resection for rectal cancer: a prospective cohort study

Detection of early anastomotic leakage by intraperitoneal microdialysis after low anterior resection for rectal cancer: a prospective cohort study

Diagnostic accuracy of procalcitonin for the early diagnosis of anastomotic leakage after colorectal surgery: a meta‐analysis

Serum and peritoneal biomarkers for the early prediction of symptomatic anastomotic leakage in patients following laparoscopic low anterior resection: A single‐center prospective cohort study

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