Abstract
PurposeAnastomotic leakage constitutes a dreaded complication after colorectal surgery, leading to increased morbidity and mortality as well as prolonged hospitalization. Most leakages become clinically apparent about 8 days after surgery; however, early detection is quintessential to reduce complications and to improve patients’ outcome. We therefore investigated the significance of specific protein expression profiles as putative biomarkers, indicating anastomotic leakage.MethodsIn this single-center prospective cohort study serum and peritoneal fluid samples—from routinely intraoperatively inserted drainages—of colorectal cancer patients were collected 3 days after colorectal resection. Twenty patients without anastomotic leakage and 18 patients with an anastomotic leakage and without other complications were included. Protein expression of seven inflammatory markers in serum and peritoneal fluid was assessed by multiplex ELISA and correlated with patients’ clinical data.ResultsMonocyte chemoattractant protein 2 (CCL8/MCP-2), leukemia-inhibiting factor (LIF), and epithelial-derived neutrophil-activating protein (CXCL5/ENA-78) were significantly elevated in peritoneal fluid but not in serum samples from patients subsequently developing anastomotic leakage after colorectal surgery. No expressional differences could be found between grade B and grade C anastomotic leakages.ConclusionMeasurement 3 days after surgery revealed altered protein expression patterns of the inflammatory markers CCL8/MCP2, LIF, and CXCL5/ENA-78 in peritoneal fluid from patients developing anastomotic leakage after colorectal surgery. Further studies with a larger patient cohort with inclusion of different variables are needed to evaluate their potential as predictive biomarkers for anastomotic leakage.
Highlights
Anastomotic leakage (AL) after colorectal surgery constitutes a dreaded complication after colorectal surgery [1]
Male patients (p = 0.046) and patients with a rectal anastomosis (p = 0.016) revealed a significantly increased risk of an anastomotic leakage, whereas there was no correlation between age (p = 0.492), BMI (p = 0.587); T (p = 0.253), N (p = 0.582), and M (p = 0.106) category; R status (p = 0.485); grading (p = 0.085); or receipt of neoadjuvant radio-/chemotherapy (p = 0.804) and the occurrence of an anastomotic leakage
The present study reveals altered expression of CCL8/MCP-2, CXCL5/ENA-78, and leukemia-inhibiting factor (LIF) in peritoneal fluid samples of patients with an anastomotic leakage after colorectal surgery
Summary
Anastomotic leakage (AL) after colorectal surgery constitutes a dreaded complication after colorectal surgery [1]. Grade A is called a radiologic leakage meaning the patient has no clinical symptoms or increased infectious values in the blood test. This kind of anastomotic leakage entails no active therapeutic intervention. As acute-phase proteins, cytokines or chemokines, respectively, were synthesized in the liver and at the site of inflammation, protein levels taken from pelvic drain fluid represent the local milieu and could be more specific for the detection of an anastomotic leakage [21]. To investigate markers for AL, we analyzed a panel of inflammatory markers in sera and peritoneal fluid from the abdominal drain on the third postoperative day from patients with and without CAL after colorectal surgery due to colorectal cancer. We hypothesize that the above named inflammatory markers - measured in the peritoneal fluid - could predict the occurrence of an anastomotic leakage after colorectal surgery already on the third postoperative day, prior to the mean occurrence at the eight postoperative day
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