Risk factors and inflammatory predictors for Anastomotic Leakage following Total Mesorectal Excision with defunctioning stoma

• Authors: Stanislav Chernyshov , Mikhail Alexeev , Evgeny Rybakov , Mikhail Tarasov , Yuri Shelygin , Irina Zarodniuk , Marina Sukhina

Abstracts

EN

Background: This study aims to examine the factors involved in anastomotic leak (AL) following low anterior resection and total mesorectal excision (LAR-TME) and to determine the usefulness of early measurement of the inflammatory biomarkers C-Reactive Protein (CRP) and Procalcitonin (PCT). Methods: One hundred patients undergoing LAR-TME with proximal diverting stoma were analysed between 2013 and 2016. Postoperative CRP and PCT levels were measured on the 3rd and 6th postoperative days. Results: There were 11 clinical leaks with a negative impact in univariate analysis on AL of male gender, larger and stenotic tumours, intraoperative blood loss > 200 mL, need for perioperative blood transfusion, postoperative anaemia and operating time exceeding 180 minutes. Upon multivariate analysis, only perioperative blood transfusion was an independent AL risk factor. Recorded CRP was higher in AL patients when compared with non-AL cases on both the 3rd postoperative day (152.4 mg/L vs 93 mg/L, respectively; P < 0.0001) and the 6th postoperative day (130.5 mg/L vs 68.2 mg/L; P < 0.0001). PCT levels also significantly differed between AL and non-AL cases on the 3rd postoperative day (0.5 ng/mL vs 0.2 ng/mL, respectively; P < 0.0001) and the 6th postoperative day (1.16 ng/mL vs 0.1 ng/mL, respectively; P < 0.0001). Both CRP and PCT showed high negative predictive values (NPV) for the diagnosis of AL on both postoperative days. Conclusion: Following low restorative proctectomy, high NPV of CRP and PCT measurements for the diagnosis of anastomotic leaks may assist decision-making for early hospital discharge.

Keywords

EN

Anastomotic Leak; Low Anterior Resection; C-Reactive Protein; Procalcitonin; Biomarkers

• Publisher: Index Copernicus International
• Journal: Polish Journal of Surgery
• Year: 2018
• Volume: 90(3)
• Pages: 31-36

Dates

published

2018-04-27

Contributors

author

Stanislav Chernyshov

author

Mikhail Alexeev

author

Evgeny Rybakov

author

Mikhail Tarasov

author

Yuri Shelygin

author

Irina Zarodniuk

author

Marina Sukhina

Identifiers

DOI

10.5604/01.3001.0011.8169