Markers of Perioperative Bowel Complications in Colorectal Surgery Patients

Colorectal cancer is a clinical condition whose treatment often involves intestinal resection. Such treatment frequently results in two major gastrointestinal complications after surgery: anastomotic leakage and prolonged ileus. Anastomotic leakage is a serious complication which, more often than not, is diagnosed late; to date, C-reactive protein is the only available diagnostic marker. A monocentric, prospective, open case-control study was performed in patients(n=117)undergoing colorectal surgery. Intestinal fatty acid binding protein (i-FABP), citrulline, D-lactate, exhaled hydrogen,Escherichia coligenomic DNA, and ischemia modified albumin (IMA) were determined preoperatively, postoperatively, and on the following four consecutive days. Bacterial DNA was not detected in any sample, and i-FABP and D-lactate lacked any distinct potential to detect postoperative bowel complications. Exhaled breath hydrogen content showed unacceptably low sensitivity. However, citrulline turned out to be a specific marker for prolonged ileus on postoperative days 3-4. Using a cut-off value of 20 μmol/L, a sensitivity and specificity of ~75% was achieved on postoperative day 4. IMA was found to be an efficient predictor of anastomosis leak by calculating the difference between preoperative and postoperative values. This test had 100% sensitivity and 80% specificity and 100% negative and 20% positive predictive value.

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Increased serum levels of C-reactive protein precede anastomotic leakage in colorectal surgery

Revista Brasileira de Coloproctologia ◽

10.1590/s0101-98802010000100015 ◽

2010 ◽

Vol 30 (1) ◽

pp. 95-95

Author(s):

Luis Cláudio Pandini

Keyword(s):

Colorectal Surgery ◽

Anastomotic Leakage ◽

Serum Levels ◽

C Reactive Protein ◽

Reactive Protein

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Monitoring of procalcitonin but not interleukin-6 is useful for the early prediction of anastomotic leakage after colorectal surgery

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2016-0736 ◽

2017 ◽

Vol 55 (7) ◽

Cited By ~ 3

Author(s):

Urszula Zielińska-Borkowska ◽

Naser Dib ◽

Wiesław Tarnowski ◽

Tomasz Skirecki

Keyword(s):

Colorectal Surgery ◽

Anastomotic Leakage ◽

Interleukin 6 ◽

Early Recognition ◽

Surgical Trauma ◽

Serum Samples ◽

Elective Colorectal Surgery ◽

Surgical Infections ◽

Bowel Diseases ◽

The Difference

AbstractBackground:Early recognition of patients who have developed anastomotic leakage (AL) after colorectal surgery is crucial for the successful treatment of this complication. The aim of this study was to assess the usefulness of the assessment of procalcitonin (PCT) and interleukin-6 (IL-6) levels in the prognosis of AL.Methods:This observational study included 157 patients who underwent major elective colorectal surgery. The most common indications for surgery were cancer and inflammatory bowel diseases. Serum samples were obtained directly before surgery (D0) and 1 day (D1) after surgery, and the relationships between the serum concentrations of PCT and IL-6 and development of AL were assessed.Results:In total, 10.2% of patients developed post-surgical infections due to AL. PCT levels on D1 were significantly higher in patients who developed AL [2.73 (1.40–4.62)] than in those who recovered without complications [0.2 (0.09–0.44)]. The area under the ROC curve for PCT on D1 was 0.94, 95% CI (0.89–0.98). The sensitivity and specificity of the prediction of an infection were 87% and 87%, respectively, for PCT on D1, which was higher than 1.09 ng/mL. The increase in PCT concentration between D0 and D1 was significantly higher in patients with AL (p<0.001). Patients who developed AL had higher concentrations of IL-6 on D1, but the difference was not significant (p=0.28).Conclusions:This study confirms that surgical trauma increases serum PCT concentrations and that the concentration of PCT on D1 can predict AL after colorectal surgery. However, IL-6 is not a good early marker for developing AL.

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