Anastomotic leak: genetic aspects of prediction and choice of surgical treatment tactics.

Abstract

Aim: To improve the treatment results of patients with anastomotic leaks by studying genetic predisposition. Materials and Methods: The object of this prospective study were 17 patients with anastomotic leaks. A group of 80 practically healthy people was tested as control. Real-time PCR was used to investigate polymorphisms: C-1306 →T (MMP2), rs243865 та G303→A (TIMP2), rs9900972.To assess the state of connective tissue metabolism. Free oxyproline in blood serum and the level of glycosaminoglycans (GAG) in urine were studied. Results: Having investigated the relationship of some clinical and laboratory indicators of patients with postoperative complications with the genotypes of the studied polymorphisms, we found data indicating the pathogenetic significance of the C/C allele of the MMP-2 gene (C-1306→T) and the G/G variant of the TIMP gene 2 (G303→A) as a risk factor for the failure of anastomotic sutures, which, unlike other groups of genetic polymorphisms, are statistically reliably accompanied by hypoproteinemia, elevated indicators of markers of protein catabolism, namely free blood oxyproline and urine GAGs. Thus, in the research group with AL, the carriers of the homozygous CC genotype of the MMP2 gene had significantly lower levels of total serum protein. Indicators of urinary GAGs and free oxyproline were almost three times higher than those of carriers of the minor TT genotype. Conclusions: Molecular genetic research is a new promising direction for the development of modern personalized diagnostic criteria and models for predicting the development and course of postoperative abdominal complications, in particular, anastomotic leaks.