Anastomotic Leakage Research Articles

Minimally Invasive Transhiatal Esophagectomy Using Antegrade Inversion Technique in Esophageal Cancer: 10-Year Experience from a Tertiary Care Center.

Background: Esophageal cancer surgery aims for curative intent but carries high complication rates. Transthoracic esophagectomy is the dominant approach, however, transhiatal esophagectomy (THE) offers selective advantages in certain clinical scenarios. Minimally invasive THE (MI-THE) is an evolving technique with limited data. Methods: This retrospective study reviewed 38 patients with esophageal cancer who underwent MI-THE using "Antegrade Inversion Technique" between 2013 and 2023 at a tertiary care center. Perioperative outcomes were analyzed. Data were presented as mean with standard deviation, median with interquartile range, and percentages. Results: Most patients (86.8%) had early-stage cancer. Median operative time was 375 minutes, hospital stay was 8 days, and intensive care unit stay was 3 days. All patients achieved a negative resection margin. Pleural effusion (57.9%) was the most common complication, followed by pneumothorax (31.6%) and surgical site infection (15.8%). Anastomotic leak rate was 13.2%. There was no mortality. Conclusions: MI-THE appears safe and feasible with encouraging perioperative outcomes, particularly for early-stage disease and high-risk patients. While potentially offering advantages over open THE, further research is needed to definitively establish its role compared to traditional approaches.

Impact of Surgeon Specialization on Outcomes in Emergency Colorectal Surgery: A Systematic Review and Meta-Analysis.

Colorectal emergencies represent a large proportion of acute general surgical workload and carry significant mortality. Identify the influence of surgeon specialization on mortality and other outcomes in emergency colorectal surgery. Systematic searches of Ovid MEDLINE, Ovid EMBASE, and Cochrane electronic databases were performed for studies published from 1 January 1990 to 27 August 2023. Studies were included investigating outcomes in emergency colorectal surgery for adults, comparing colorectal against non-colorectal surgeon specialization. Exclusion criteria were: (1) publications studying primarily pediatric populations; (2) studies incorporating patients who had undergone surgery prior to 1990; (3) studies only published in abstract form or non-English language. Primary outcomes were 30-day mortality and in-hospital mortality. Secondary outcomes were rates of anastomotic leak, reintervention, primary anastomosis, and laparoscopic approach. Of 7676 studies identified, 155 were selected for full-text review and 21 studies were included for quantitative analysis. Eleven studies showed improved 30-day (OR 0.64, 95% CI 0.60-0.68, p < 0.0001) and in hospital mortality (OR 0.66, 95% CI 0.49-0.89, p = 0.007) with colorectal specialization. There was a significantly higher rate of primary anastomosis (OR 2.95, 95% CI 2.02-4.31, p < 0.0001) and use of laparoscopic surgery (OR 2.38, 95% CI 1.42-4.00, p = 0.001) amongst specialized colorectal surgeons. Specialization was also associated with a significant reduction in any stoma formation (OR 0.52, 95% CI 0.28-0.98, p = 0.04). No significant difference was observed for anastomotic leak (OR 0.70, 95% CI 0.45-1.07, p = 0.10) or reintervention rates (OR 0.78, 95% CI 0.55-1.10, p = 0.16). Heterogeneity exists within the included patient populations and definitions of colorectal specialization observed in different countries. Emergency colorectal surgery undertaken by specialized colorectal surgeons is associated with significantly improved post-operative mortality, lower rates of stoma formation and increased rates of primary anastomosis and minimally invasive surgery. CRD42022300541.

Indocyanine Green Fluorescence Angiography (ICG-FA) in the management of intestinal injuries following penetrating abdominal trauma: a case-control study comparing postoperative outcomes.

The surgical management of penetrating hollow visceral injuries includes primary repair or exteriorization. Tissue perfusion at the site of gastrointestinal suture repair may be challenging to assess and is vulnerable to local energy transfer-related injury, micro- or macro-circulatory insufficiency, or splanchnic vasoconstriction for various reasons. Breakdown of suture lines can lead to potentially life-threatening complications. The intraoperative use of Indocyanine Green Fluorescence Angiography (ICG-FA) may reduce the risk of postoperative morbidity and mortality by ensuring optimal tissue perfusion at the chosen site of suture repair. We conducted a retrospective review of the postoperative complications, length of Intensive Care (ICU) stay, and length of hospital stay in patients undergoing laparotomy, with and without ICG-FA for penetrating abdominal trauma at a Level One Trauma Center in Cape Town, South Africa. One hundred patients were included in the study, of which 20 underwent laparotomy with ICG-FA, and 80 did not. The overall complication rate was significantly lower in the ICG-FA group (OR 0.336, p-value=0.0412). The anastomotic leak rates in the ICG-FA and control groups were 0% and 6.25%, respectively (p-value=0.5799). Revision surgery was required in 2 and 14 patients in the ICG-FA and control groups, respectively (OR 0.524, p-value=0.516). The mean length of stay in hospital showed no statistical difference, 8.6 and 5.3 days for the ICG-FA and control groups, respectively (p-value=0.092). The mean length of ICU stay was 6.3 and 2.3 days for the ICG-FA and control groups, respectively (p-value=0.1642). Lower levels of overall postoperative complications and lower rates of revision surgery in patients undergoing laparotomy with ICG-FA are promising. Non-significant findings regarding the relationship between the usage of ICG-FA and anastomotic leak rates suggest the need for larger randomized studies.

Research Perspective on "Impact of anastomotic leakage after colorectal cancer surgery on Quality of Life: A Systematic Review".

Research Perspective on "Impact of anastomotic leakage after colorectal cancer surgery on Quality of Life: A Systematic Review".

Innovative needle-assisted technique for intracorporeal anastomosis: Simplifying closure of common enterotomy in laparoscopic gastrointestinal surgery.

Intracorporeal anastomosis offers notable advantages over extracorporeal techniques, including reduced tissue manipulation leading to faster recovery and potentially lower risks of surgical site infections and complications. However, it also involves several challenges, such as increased operative time and the need for experienced assistants and multiple trocars. Our novel technique addresses these problems. We present a novel approach for closing common enterotomies during intracorporeal anastomosis by using a linear stapler. This technique involves the use of a 6-cm straight needle, which facilitates closure of the common enterotomy. The technique can be performed independently by a single surgeon without the need for additional trocars or assistants. This technique was applied for 20 patients undergoing laparoscopic gastrointestinal surgery between June 2023 and February 2024. The median age of the enrolled patients was 65years, with laparoscopic right hemicolectomy with intracorporeal ileocolostomy being the most common procedure (60% of cases). The median anastomosis time was 22.5min. No occurrence of anastomotic leakage was reported, and only one patient (5%) developed temporary postoperative bowel obstruction, which was managed conservatively. Our technique enables efficient and safe closure of common enterotomies during intracorporeal anastomosis, minimizing reliance on additional trocars and experienced assistants. It simplifies the procedure and ensures fullthickness stapling, potentially reducing the likelihood of complications. Because of its broad applicability across various laparoscopic surgeries, this technique offers substantial benefits and is worth recommending for intracorporeal anastomosis.

Comparative analysis of the safety and effectiveness of robotic natural orifice specimen extraction versus laparoscopic surgery for colorectal tumors through systematic review and meta-analysis.

The purpose of this study and meta-analysis was to evaluate the perioperative and oncologic results of robotic NOSE versus laparoscopic surgery for colorectal tumors. We plan to perform an extensive electronic search on PubMed, CNKI, Embase, and the Cochrane Library to find research articles published from the beginning of the databases until July 2024 that examine the comparison between robotic natural orifice specimen extraction and laparoscopic surgery in patients with colorectal cancer. Both English and Chinese literature will be included. Literature screening will strictly follow predetermined criteria for inclusion and exclusion, specifically targeting randomized controlled trials and cohort studies. The evaluation of quality will be conducted with the Newcastle-Ottawa Scale (NOS). Review Manager 5.4.1 will be utilized to perform a meta-analysis of data gathered from the studies that are included. The ultimate evaluation included seven past cohort studies with a total of 1117 participants (545 who had robotic NOSE and 572 who had laparoscopic surgery). Patients who had robotic NOSE experienced notable enhancements in LOHS, time to first flatus, time to start the liquid diet, EBL, and postoperative ileus when compared to patients undergoing laparoscopic colorectal surgery. There were no notable discrepancies noted in terms of surgical duration, total complications, lymph node collection, and anastomotic leakage between the two methods. In conclusion, the use of robotic technology for extracting specimens through natural body openings in colorectal surgery is considered to be safe and achievable. It offers notable advantages over laparoscopic surgery, including reduced hospital stay, earlier time to first flatus and liquid intake, decreased EBL, and lower incidence of postoperative ileus.

Effective use of semi-elemental diet in managing anastomotic leakage after surgery for esophageal stricture

Anastomotic leakage occurs in ±10% of patients after surgery for esophageal stricture. Management often requires re-surgery, which increases morbidity and mortality. This case report shows successful conservative management of anastomotic leakage with semi-elemental diet.

Complications associated with loop ileostomy reversal delayed greater than twelve months.

Diverting loop ileostomy is performed after colectomy to allow for anastomotic healing, and prevention of pelvic sepsis when an anastomotic leak occurs. There is no consensus on the optimal timing of ileostomy closure, and there is limited data on complications associated with ileostomy closure greater than 12 months after creation. The aim of this study is to investigate outcomes of delayed loop ileostomy closure greater than 12 months after creation. Patients undergoing loop ileostomy closure between 2013 and 2023 at Carilion Medical Center, in Roanoke, VA were reviewed. Cohorts compared were defined as Control Group (closure < 4 months) and Delayed Group (closure > 12 months). Demographics and outcomes were compared. Statistical comparisons were performed using either Wilcoxon rank sum test, Pearson's Chi-squared test or Fisher's exact test. Statistical modeling included binary logistic regression for 30-day readmissions and a generalized linear modeling for days till bowel function returns. Adjusted odds ratios, confidence intervals, and p-values were calculated. There were 135 patients in the Control Group and 19 patients in the Delayed Group. Demographics were similar between the groups except for a higher percentage of patients with diabetes, renal failure and history of cancer in Delayed Group (all p < 0.05). Operative time was longer for Delayed loop ileostomy closure (p < 0.05). Patients in the Delayed Group demonstrated a higher hospital readmission rate within 30 days (p < 0.05). Both groups had similar return of bowel function on post-operative day 2, similar length of stay, and similar rates of postoperative ileus (p = NS). Delayed loop ileostomy closure more than 12 months after creation does not delay return of bowel function but may lead to higher hospital readmission rates within 30 days.

Robotic Versus Laparoscopic Gastrectomy for Gastric Cancer: The Largest Systematic Reviews of 68,755 Patients and Meta-analysis.

This meta-analysis aimed to compare the efficacy of robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) in treating gastric cancer (GC). A comprehensive literature search across PubMed, MEDLINE, and Web of Science identified 86 eligible studies, including 68,755 patients (20,894 in the RG group and 47,861 in the LG group). The analysis revealed that RG was associated with superior outcomes in several areas: more lymph nodes were harvested, intraoperative blood loss was reduced, postoperative hospital stays were shorter, and the time to first flatus and oral intake was shortened (all p<0.001). Additionally, RG resulted in lower incidences of conversion to open surgery (OR=0.62, p=0.004), reoperation (OR=0.68, p=0.010), overall postoperative complications (OR=0.82, p<0.001), severe complications (OR=0.65, p<0.001), and pancreatic complications (OR=0.60, p=0.004). However, RG had longer operative times and higher costs (both p<0.001). No significant differences were found between RG and LG in terms of resection margin distance, mortality, anastomotic leakage, or recurrence rates. RG is a safe and effective surgical option for patients of GC, but further improvements in operative duration and costs are needed.

Risk Reduction of Severe Anastomotic Leakage by Evaluation of Blood Perfusion Using Indocyanine Green After Minimally Invasive Esophagectomy Followed by Narrow Gastric Tube Reconstruction

Risk Reduction of Severe Anastomotic Leakage by Evaluation of Blood Perfusion Using Indocyanine Green After Minimally Invasive Esophagectomy Followed by Narrow Gastric Tube Reconstruction

Synthesis and characterization of core-shell magnetic molecularly imprinted polymer nanocomposites for the detection of interleukin-6.

Interleukin-6 (IL-6) belongs to the cytokine family and plays a vital role in regulating immune response, bone maintenance, body temperature adjustment, and cell growth. The overexpression of IL-6 can indicate various health complications, such as anastomotic leakage, cancer, and chronic diseases. Therefore, the availability of highly sensitive and specific biosensing platforms for IL-6 detection is critical. In this study, for the first time, epitope-mediated IL-6-specific magnetic molecularly imprinted core-shell structures with fluorescent properties were synthesized using a three-step protocol, namely, magnetic nanoparticle functionalization, polymerization, and template removal following thorough optimization studies. The magnetic molecularly imprinted polymers (MMIPs) were characterized using dynamic and electrophoretic light scattering (DLS and ELS), revealing a hydrodynamic size of 169.9 nm and zeta potential of +17.1 mV, while Fourier transform infrared (FTIR) spectroscopy and fluorescence spectroscopy techniques showed characteristic peaks of the polymer and fluorescent tag, respectively. Scanning electron microscopy (SEM) and high-resolution transmission electron microscopy (HRTEM) investigations confirmed the successful encapsulation of the magnetic core within the ca. 5-nm-thick polymeric shell. The MMIP-based electrochemical sensing platform achieved a limit of detection of 0.38 pM within a linear detection range of 0.38-380 pM, indicating high affinity (dissociation constant KD = 1.6 pM) for IL-6 protein in 50% diluted serum samples. Moreover, comparative investigations with the non-imprinted control polymer demonstrated an imprinting factor of 4, confirming high selectivity. With multifunctional features, including fluorescence, magnetic properties, and target responsiveness, the synthesized MMIPs hold significant potential for application in various sensor techniques as well as imaging.

Pre-Operative Gastroesophageal Reflux Does Not Affect 30-Day Outcomes in Patients Undergoing Revisional Bariatric Surgery to Single Anastomosis Duodeno-Ileal Bypass (SADI): An Analysis of 933 Metabolic and Bariatric Accreditation and Quality Improvement Program Patients.

Background: The use of a single anastomosis duodeno-ileal bypass (SADI) as a revisional procedure in patients with pre-operative GERD is not well understood. Thirty-day outcomes in patients with pre-existing GERD undergoing revision with an SADI have not been previously reported. Methods: The Metabolic and Bariatric Accreditation and Quality Improvement Program registry was consulted to identify patients undergoing revisional bariatric surgery with an SADI between 2020 and 2021. Our analysis sought to determine if preoperative GERD had significant impact on thirty-day outcomes. Bivariate and multivariable logistic regression analyses were used to identify independent predictors of 30-day morbidity. Results: Preoperative GERD was seen in 342 patients (36.7%). Preoperative GERD was not associated with anastomotic leak (2.5% non-GERD cohort vs. 1.2% GERD cohort; p = 0.2) nor bleeding (1% non-GERD cohort vs. 1.8% GERD cohort; p = 0.33). There was no difference in thirty-day readmission (5.6% vs. 5.9%, p = 0.9), reintervention (2.4% vs. 1.2%, p = 0.2), or reoperation (3.6% vs. 2.05%; p = 0.19) rates. The multivariable regression analysis revealed that a history of myocardial infarction was associated with a significantly elevated risk of serious complication (OR 12.2; 95% CI 2.79-53.23; p = 0.001), as was dyslipidemia (OR 2.2; 95% CI 1.04-4.56; p = 0.04). Conclusions: Pre-operative GERD does not have any association with anastomotic leak, bleeding, thirty-day readmission, reintervention, or reoperation in patients undergoing revisional bariatric surgery to SADI. A history of myocardial infarction and dyslipidemia are independent predictors of post-operative thirty-day morbidity, irrespective of the presence of preoperative GERD.

Delta-CT radiomics based model for predicting postoperative anastomotic leakage following radical resection of esophageal squamous cell carcinoma.

To predict postoperative anastomotic leakage (AL) following radical resection of esophageal squamous cell carcinoma (ESCC) based on clinical data and preoperative enhanced Computed tomography(CT) radiomics of the esophagus. We retrospectively analyzed the clinicopathological and radiological data of 213 patients with ESCC who received radical resection at Xiangyang No.1 People's Hospital from July 2011 to February 2024. 3D slicer software was used in combination with Lasso extraction and 10-fold cross-validation to extract texture parameters from contrast-enhanced CT images and generate Delta-Radscores. Several models were built using logistic regression to predict postoperative AL in ESCC. In the training set, the univariate analysis confirmed that duration of surgery, surgical method, delta radscore 1, delta radscore 2, contrast enhancement patterns, peripheral lymph node metastasis, post thoracotomy pulmonary infection(PTPI), and hot pot were risk factors for ESCC-AL (P<0.05 for both). The multivariate analysis showed that delta radscore 1, delta radscore 2, PTPI, and hot pot were independent risk factors for AL (P<0.05 for all). These results were verified by the XGboost machine learning model. The combinational model based on all of the above risk factors [AUC 0.900, OR 0.0282, 95%CI 0.841-0.943] outperformed either the clinical model[AUC 0.759, OR 0.0392, 95%0.683-0.825,P<0.05] or the imaging model[AUC 0.869, OR 0.0335, 95%0.804-0.918,P=0.1277] alone in predictive efficacy. The decision curve proved that the combinational model had a higher clinical net benefit. The nomogram generated via the combinational model simplified the predictive process. The same predictions were verified in the testing set. Delta radscore 1, delta radscore 2, PTPI, and hot pot were related to ESCC-AL. The novel nomogram created using enhanced CT radiomics informed perioperative management and improved the survival quality of ESCC patients.

New linear stapled semimechanical esophagogastric anastomosis with invagination

Objective. Development and implementation esophagogastric linear stapled semimechanical anastomosis with invagination. Material and methods. Seromuscular stitches are applied over 4 cm on both sides to the lateral surfaces of the esophagus posterior wall and gastric graft posterior wall, towards their edges. The posterior wall of the anastomosis is sutured and cutted with a linear stapler on 30–40 mm deep. The anterior wall sutured with a linear stapler. The next layer of sutures on the anastomosis anterior wall invaginates the anastomos and the esophageal stump into the gastric graft. Results. There was no early postoperative mortality. Average I. Lewis minimally invasive esophagectomy time was 353 minutes (245–470 minutes). The average volume of blood loss was 114 mL (50–200 mL). No patient faced an anastomotic leak. Anastomotic stricture occurred in 5 patients (19.2%) during 21 days to 6 months of follow-up. There were no anastomosis-related complications above Clavien-Dindo grade II. Conclusions. Linear stapled semimechanical anastomosis with invagination has proven both clinical and technical advantages of its use.

A novel circumferential continuous reinforcing suture for anastomosis after laparoscopic resection for rectal cancer and sigmoid cancer: a retrospective case-controlled study.

This study aimed to investigate the effectiveness of a novel method for anastomosis reinforcement to minimize the occurrence of anastomotic complications after surgical resection of rectal and sigmoid cancer. We recruited 378 patients who underwent laparoscopic rectal anterior resection of rectal cancer and sigmoid cancer in SYSUCC. The occurrence rates of intraoperative bleeding, operation time, and postoperative anastomotic complications were compared between the treatment group receiving anastomotic reinforcement and the control group without anastomotic reinforcement. The incidence of anastomotic leakage in the treatment group was significantly lower than that in the control group (1.59% vs. 11.64%, p < 0.001). Following the application of inverse probability of treatment weighting (IPTW) to adjust for factors influencing the occurrence of anastomotic leakage, the incidence of anastomotic leakage remained significantly lower in the treatment group compared to the control group (2.54% vs. 12.08%, p < 0.001). The circumferential continuous anastomosis reinforcing suture method, recommended for laparoscopic surgery for rectal and sigmoid cancer, has the potential to effectively minimize the occurrence of anastomotic complications.

Efficacy of lymph node dissection around the inferior mesenteric artery with preservation of the left colic artery for rectal cancer

AbstractObjectiveWe investigated how Japanese D3 dissection with left colic artery (LCA) preservation affects anastomotic leakage after anterior resection with anastomosis for rectal cancer, based on the leak rate. The correlation between LCA preservation, survival, and cancer recurrence after resection was also analyzed.Summary and Background DataIt remains unclear how LCA preservation affects the anastomotic leak rate and oncological outcomes after resection remains unclear. Some reports suggested that anastomotic leakage increases local recurrence and decreases cancer‐specific survival.MethodsIn this study, we enrolled and analyzed 457 patients who underwent radical resection of rectal cancer in the period October 2011 through December 2016. The attending surgeon decided preoperatively and registered whether to preserve the LCA. This trial was registered under the UMIN‐CTR Identifier UMIN000006160.ResultsD3 with LCA preservation was successfully completed in 218 (89.3%) of the 244 patients registered in this group, whereas D3 without LCA preservation was successfully completed in all 213 patients registered in this group. After propensity score matching, the anastomotic leakage rate was 7.86% (11/140) after D3 with LCA preservation and 7.14% (10/140) after D3 without LCA preservation. The overall survival rates were 90.1% and 89.3%, and the recurrence‐free survival rates were 77.6% and 77.3%, respectively.ConclusionsOur findings suggest that LCA preservation has no effect on the incidence of anastomotic leakage after rectal resection with anastomosis using DST and that oncological outcomes may not be affected.

Anastomotic leaks in colorectal surgery

A leakage of acolorectal anastomosis represents asevere complication in visceral surgery. An anastomotic insufficiency (AI) is apotentially life-threatening complication for patients that carries ahigh risk of subsequent complications and long-term stoma care. Numerous factors influence the risk of AI. Knowing and being able to estimate these factors are essential for successful treatment in colorectal surgery as they help determine the surgical strategy. The recognition of an AI can be challenging for practitioners due to the variability in the clinical presentation. If the presence of AI is suspected appropriate diagnostic measures must therefore be taken. If an AI has occurred acolorectal specialist should definitely be involved in the treatment as this can significantly reduce further complications and the rate of permanent stomas.

Minimally invasive vs open vs hybrid esophagectomy for esophageal cancer: a systematic review and network meta-analysis.

Robot-assisted minimally invasive esophagectomy (RAMIE) for esophageal carcinoma has emerged as the contemporary alternative to conventional laparoscopic minimally invasive (LMIE), hybrid (HE) and open (OE) surgical approaches. No single study has compared all four approaches with a view to postoperative outcomes. A systematic search of electronic databases was undertaken. A network meta-analysis was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-network meta-analysis guidelines. Statistical analysis was performed using R and Shiny. Seven randomised controlled trials (RCTs) with 1063 patients were included. Overall, 32.9% of patients underwent OE (350/1063), 11.0% underwent HE (117/1063), 34.0% of patients underwent LMIE (361/1063), and 22.1% of patients underwent RAMIE (235/1063). OE had the lowest anastomotic leak rate 7.7% (27/350), while LMIE had the lowest pulmonary 10.8% (39/361), cardiac 0.56% (1/177) complications, re-intervention rates 5.08% (12/236), 90-day mortality 1.05% (2/191), and shortest length of hospital stay (mean 11.25days). RAMIE displayed the lowest 30-day mortality rate at 0.80% (2/250). There was a significant increase in pulmonary complications for those undergoing OE (OR 3.63 [95% confidence interval: 1.4-9.77]) when compared to RAMIE. LMIE is a safe and feasible option for esophagectomy when compared to OE and HE. The upcoming RCTs will provide further data to make a more robust interrogation of the surgical outcomes following RAMIE compared to conventional open surgery to determine equipoise or superiority of each approach as the era of minimally invasive esophagectomy continues to evolve (International Prospective Register of Systematic Reviews Registration: CRD42023438790).

Efficacy of endoscopic vacuum therapy in esophageal luminal defects: a systematic review and meta-analysis.

Endoscopic vacuum-assisted closure (EVAC) is a novel technique used to repair esophageal perforation and leaks. Varying data have been reported on the overall success rate of EVAC. We aimed to conduct a metanalysis of the available data on the clinical success rate of EVAC. Electronic databases were searched for publications addressing the efficacy of EVAC in esophageal luminal defects. Pooling was conducted using both fixed and random-effects models. The overall clinical success of EVAC therapy was considered the primary outcome, whereas, overall complication rates, need for adjunct therapy, and mortality were considered secondary outcomes. In total, 366 patients were included in the study. On pooled analysis, the mean age was 66 years with 68.32% of patients being men. Overall pooled clinical success rate of EVAC therapy was 87.95%. Upon subgroup analysis, the pooled clinical success rate of postsurgical anastomotic leak and transmural esophageal perforation were found to be 86.57% and 88.89%, respectively. The all-cause hospital mortality was 14% and 4.2% in patients with esophageal perforation and EVAC, respectively. This study demonstrates that EVAC therapy has a high overall clinical success rate, with low mortality. EVAC therapy seems to be a promising procedure with excellent outcomes in patients with luminal esophageal defects.

LABORATORY PREDICTORS FOR DIAGNOSING COLORECTAL ANASTOMOTIC LEAKAGE.

An important concern in oncological coloproctology is colorectal anastomotic leakage (AL), which occurs in 3.5%-21% of patients. Predicting the occurrence of failure based on the results of laboratory markers can be decisive for the treatment of this complication. To improve the early diagnosis of AL by establishing combinations and threshold values of laboratory markers - predictors of the inflammatory process. The prospective study, conducted from 2020 to 2023, included 213 rectal cancer patients who underwent low anterior resection after neoadjuvant chemoradiotherapy. The inflammatory biomarkers were assessed before surgery and on the 3rd, 5th, and 7th days of the postoperative period. AL diagnosed in 25 (11.74%) patients by the grade of severity was as follows: A (radiological) in 7 (3.29%) patients; B (clinical) - 4 (1.88%); C (clinically expressed, peritonitis) - 11 (5.16%), and P (late) - 3 (1.41%) patients. The changes in the laboratory indicators of the inflammatory response such as С-reactive protein (CRP), procalcitonin (PCT), the counts of neutrophils (NEU), lymphocytes (LYM), platelets (PLT), and neutrophil/lymphocyte ratio (NLR) were significant only in B or C AL grades. Among them, only three indicators were identified as significant for predicting AL when assessed 24 h before the onset of this complication, namely LYM (threshold value ≤ 0.97 × 103/mm3, sensitivity 66.7% and specificity 81.3%, p < 0.001); PLT (threshold value > > 257 103/mm3, sensitivity 58.6%, and specificity 86.7%, p < 0.001); and NLR (threshold value > 4.42, sensitivity 58.1%, and specificity 86.7%, p < 0.001). The three-factor model based on these selected indicators was set up, and the prognosis index (Prog) was proposed with the decision threshold Progcrit = 2.23. The sensitivity of the model was 80% (95% CI 51.9%-95.7%), and the specificity - 74.2% (67.6%-80.2%). Based on the routine laboratory predictors used in the complex diagnosis of AL, B or C AL grades may be predicted allowing for the timely effective early diagnosis, medication, and surgical intervention..