Abstract
BackgroundPostoperative colorectal anastomotic leakage (CAL) is a devastating complication following colorectal resection. However, the diagnosis of anastomotic leakage is often delayed because the current methods of identification are unable to achieve 100% clinical sensitivity and specificity. This meta-analysis aimed to evaluate the predictive value of peritoneal fluid cytokines in the detection of CAL following colorectal surgery.MethodsA comprehensive search was conducted on PubMed, Embase, Cochrane Library, and Web of Science before June 2021 to retrieve studies regarding peritoneal fluid cytokines as early markers of CAL. Pooled analyses of interleukin (IL)-1β, IL-6, IL-10, and tumor necrosis factor (TNF) were performed. The means (MD) and standard deviations (SD) of the peritoneal fluid cytokines were extracted from the included studies. Review Manager Software 5.3 was used for data analysis.ResultsWe included eight studies with 580 patients, among which 85 (14.7%) and 522 (44.5%) were evaluated as the CAL and non-CAL groups, respectively. Compared to the non-CAL group, the CAL group had significantly higher peritoneal IL-6 levels on postoperative day (POD) 1–3 (P = 0.0006, 0.0002, and 0.002, respectively) and slightly higher TNF levels on POD 4 (P = 0.0002). Peritoneal levels of IL-1β and IL-10 were not significantly different between the two groups in this study.ConclusionPeritoneal IL-6 levels can be a diagnostic marker for CAL following colorectal surgery, whereas the value of TNF needs further exploration in the future.Systematic Review Registration[https://www.crd.york.ac.uk/prospero/#myprospero], PROSPERO (CRD42021274973)
Highlights
Postoperative colorectal anastomotic leakage (CAL) is a devastating complication occurring in 1%–20% of cases after colorectal surgery (1)
Peritoneal IL-6 levels can be a diagnostic marker for CAL following colorectal surgery, whereas the value of tumor necrosis factor (TNF) needs further exploration in the future
The studies of Ugraset al. (19) and Alonso et al (20) met the inclusion criteria, they were not included in the analysis because the peritoneal cytokine levels reported by Ugraset al. (19) were 10–1000 times higher than those in the included studies, and those reported by Alonso et al (20) were 50–100 times lower
Summary
Postoperative colorectal anastomotic leakage (CAL) is a devastating complication occurring in 1%–20% of cases after colorectal surgery (1). It is associated with increased costs, in-patient time, and inhospital mortality, and reoperation may be needed (2). A retrospective study found that a 2.5-day delay in the detection of anastomotic leakage increased mortality rates from 24% to 39% (5), which means that many patients with early-stage CAL are left undetected until significant disease progression. The diagnosis of anastomotic leakage is often delayed because the current methods of identification are unable to achieve 100% clinical sensitivity and specificity This meta-analysis aimed to evaluate the predictive value of peritoneal fluid cytokines in the detection of CAL following colorectal surgery
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