Risk factors and inflammatory predictors for Anastomotic Leakage following Total Mesorectal Excision with defunctioning stoma
Journal Title: Polish Journal of Surgery - Year 2018, Vol 90, Issue 3
Abstract
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 a proximal diverting stoma were analyzed between 2013 and 2016. Postoperative CRP and PCT levels were measured on the 3rd and the 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, the need for perioperative blood transfusion, postoperative anaemia and an operating time exceeding 180 minutes. On 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). The 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 an AL on both postoperative days. Conclusion: Following low restorative proctectomy, the high NPV of CRP and PCT measurements for the diagnosis of anastomotic leaks may assist decision-making for early hospital discharge. <br/><br/>
Authors and Affiliations
Stanislav Chernyshov, Mikhail Alexeev, Evgeny Rybakov, Yuri Shelygin, Irina Zarodniuk, Marina Sukhina
Keywords
Related Articles
- EP ID EP345903
- DOI 10.5604/01.3001.0011.8169
- Views 98
- Downloads 0
Splenic abscess with bleeding in a female patient following coronary artery bypass grafting and cholecystectomy – a case report and literature review
Splenic abscess is a potential complication of many disease entities which involve infections. Diagnostics are based on imaging studies. Treatment involves splenectomy and antibiotic therapy. In the case the abscess is l...
Anastomotic aneurysms after arterial reconstructive operations – literature review
Inhibition of PERK-dependent pro-adaptive signaling pathway as a promising approach for cancer treatment
Endoplasmic Reticulum (ER) is an organelle that is vital for cell growth and maintenance of homeostasis. Recent studies have reported that numerous human diseases, including cancer, are strictly connected to disruption o...
Quality of life of patients on chronic parenteral nutrition before and after gastrointestinal tract continuity restoration
The issue of the quality of life considering patients with a temporary or permanent intestinal stoma, as well as the necessity for chronic parenteral nutrition at home remain a poorly understood problem. Daily care of th...
Parietal strangulation of small intestine in femoral hernia site with symptoms of intestinal obstruction in patient with incidentally found small intestine tumor – a case report
Richter’s hernia (partial enterocele) is the strangulation/entrapment of only part of the circumference of the intestinal wall. It is relatively rare, and presents without mechanical obstruction – giving vague, non-speci...