• Humans
• Anastomotic Leak/diagnosis
• Anastomotic Leak/etiology
• Anastomotic Leak/blood
• Female
• Male
• Middle Aged
• Prospective Studies
• Aged
• Biomarkers/blood
• Adult
• Rectal Neoplasms/surgery
• Rectal Neoplasms/diagnosis
• Rectal Neoplasms/blood

• COLONIC BACTERIA
• COLONIC MICROFLORA
• COLORECTAL CANCER
• COLORECTAL SURGERY
• SURGICAL COMPLICATIONS

• Humans
• Colorectal Neoplasms/surgery
• Anastomotic Leak/etiology
• Gastrointestinal Microbiome
• Male
• Female
• Inflammation/etiology
• Aged
• Middle Aged

• C-reactive protein (CRP)
• anastomotic leakage
• biomarkers
• lactate dehydrogenase (LDH)
• neutrophil to lymphocyte ratio (NLR)
• surgery

• Humans
• Anastomotic Leak/diagnosis
• Anastomotic Leak/etiology
• Neutrophils/metabolism
• Colorectal Surgery
• Biomarkers
• C-Reactive Protein/analysis
• Lymphocytes/metabolism
• Drainage/adverse effects
• Retrospective Studies

• colorectal surgery
• ergonomics and/or human factors study
• image guided surgery

• anastomotic leakage
• biomarkers
• early prediction
• nomogram
• rectal cancer
• symptomatic

• Anastomotic leak
• C-reactive protein
• Colorectal surgery
• Procalcitonin

Leakage of the anastomotic site is considered to be one of the most serious complications after colon and rectal surgery. It is associated with increased mortality, morbidity, and longer hospital stays. This systematic review examines the need for blood markers such as C-reactive protein (CRP), procalcitonin (PCT), albumin, and various other molecular markers that assist in their propensity to diagnose anastomotic leakage (AL) early after surgery.

Utilizing PubMed and Google Scholar as resources and including the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for the articles, and studies over the last five years were included. A total of 12 studies have been discussed, and most articles suggest CRP as an excellent indicator. CRP compared to Dutch leakage scores (DLS) and PCT studies suggest that the three combinations improve the predictable outcome of AL. In addition, CRP and PCT have been shown to diagnose AL early in the postoperative period. Other studies include the role of markers of oxidative stress markers, Interleukin-6, Interleukin-10, and other molecular markers in the peritoneal drain which are predictive for identifying AL after three days postoperatively (POD-3).

Overall, CRP has proven to be a reliable standard indicator of diagnosis. This is because the postoperative elevation of this protein indicates a problem of leakage with clinical symptoms. Other blood parameters are useful for diagnosis as well, but the limitations are the lack of appropriate studies and the number of randomized controlled trials in this area of ​​study.

• C-reactive protein
• anastomotic leakage
• procalcitonin
• rectal cancer

The enhanced recovery after surgery (ERAS) program expedites patient recovery after major surgery. This study aimed to investigate the role of the triad of procalcitonin (PCT), C-reactive protein (CRP), and white blood cells (WBC) trajectories as a predictive biomarker for the anastomotic leak (AL) after colorectal surgery.

Patients who had colorectal anastomosis were prospectively included. Postoperative clinical and laboratory parameters and outcomes were collected and analyzed. The 5-day trajectories of PCT, CRP, and WBC were evaluated. Based on the trajectory of the three biomarkers, we compared patients with and without AL as detected during the first 30 days after surgery using the area under receiver operator characteristic curves (AUC) for logistic estimation.

This study included 205 patients, of whom 56% were men and 43.9% were women with a mean age of 56.4 ± 13.1 years. Twenty-two patients (10.7%) had AL; 77.3% underwent surgery, and 22.7% were treated with drainage and antibiotics. Procalcitonin was the best predictor for AL compared to CRP and WBC at three days postoperatively (AUC: 0.84, 0.76, 0.66, respectively). On day 5, a cutoff value of 4.93 ng/mL for PCT had the highest sensitivity, specificity, and negative predictive value. The predictive power of PCT was substantially improved when combined with either CRP or WBC, or both (AUC: 0.92, 0.92, 0.93, respectively).

The 5-day trajectories of combined CRP, PCT, and WBC had a better predictive power for AL than the isolated daily measurements. Combining the three parameters may be a reliable predictor of early patient discharge, which would be highly beneficial to ERAS programs.

• Aptamer
• Aptasensor
• C-reactive protein
• SELEX

Early diagnosis of anastomotic leakage (AL) after rectal surgery can reduce the adverse effects of AL, thereby reducing morbidity and mortality. Currently, there are no accepted indicators or effective scoring systems that can clearly identify patients at risk of anastomotic leakage.

A prospective study with assessment of the diagnostic accuracy of oxidative stress level (CAT, SOD, MDA) in serum and drain fluid compared to white blood cell count (WBC), C-reactive protein (CRP), and neutrophil percentage (NEUT) in prediction of AL in patients undergoing elective rectal surgery with anastomosis.

Most of the oxidative stress indicators we detected are of considerable significance in the diagnosis of anastomotic leakage. The level of MDA on postoperative day (POD)3 (areas under the curve (AUC): 0.831) and POD5 (AUC: 0.837) in the serum and on POD3 (AUC: 0.845) in the drain fluid showed the same excellent diagnostic accuracy as the level of CRP on the POD3 (AUC: 0.847) and POD5 (AUC: 0.896).

The overall level of oxidative stress in serum and drain fluid is a reliable indicator for the early diagnosis of anastomotic leakage after rectal surgery. More specifically, among the redox indicators analyzed, MDA has almost the same predictive value as CRP, which provides another useful biomarker for the early diagnosis of anastomotic leakage.

• C-reactive protein
• anastomotic leak
• complications
• open surgery
• rectal surgery

• Albumin
• Anastomotic leakage
• Biomarkers
• CRP
• Cancer
• Colorectal surgery

• Anastomotic leak
• C-reactive protein
• Colorectal surgery

• anastomotic leak
• biomarkers
• colorectal cancer
• intestinal anastomosis
• precision medicine

• EP/K-34510/1 Engineering and Physical Sciences Research Council
• NA Bowel and Cancer Research

• colorectal surgery
• emergency
• guideliness

• Colorectal Surgery
• Consensus
• Digestive System Surgical Procedures
• Emergency Service, Hospital
• Humans
• United Kingdom

• C-reactive protein-to-albumin ratio
• Colorectal cancer
• anastomotic leak
• risk factor

• Age Factors
• Aged
• Anastomotic Leak/blood
• Anastomotic Leak/etiology
• C-Reactive Protein/metabolism
• Colorectal Neoplasms/blood
• Colorectal Neoplasms/surgery
• Digestive System Surgical Procedures/adverse effects
• Digestive System Surgical Procedures/methods
• Female
• Humans
• Male
• Predictive Value of Tests
• Preoperative Period
• Retrospective Studies
• Serum Albumin, Human/metabolism

• Anastomotic fistula
• C-Reactive Protein
• Rectal surgery

• C-reactive protein
• fistula
• head and neck neoplasms
• laryngectomy
• post-operative period
• reconstructive surgical procedures
• wound healing

Our objective was to investigate the association between anastomotic leakage (AL) and hyponatremia after colorectal cancer surgery.

All anastomoses in colorectal cancer surgery performed in our hospital between January 2015 and December 2017 were retrospectively identified. According to the diagnostic criteria of AL, the patients were divided into an AL group and a no anastomotic leakage (NAL) group.

We reviewed records of 498 consecutive colorectal cancer patients. The total incidence of AL was 5.4%. Postoperative serum sodium levels differed significantly: 137.63 ± 4.29 and 139.81 ± 3.41 mmol/L in the AL and NAL groups, respectively. By using area under the receiver-operating characteristic (auROC) curves, we determined the optimum postoperative serum sodium cut-off to be 139.5 mmol/L and redefined hyponatremia as postoperative serum sodium <139.5 mmol/L. Redefined hyponatremia had an auROC of 0.65, corresponding to a 97.2% negative predictive value. The negative predictive value reached 99.1% when serum sodium level was combined with leukocytosis. Multivariable analysis found that redefined hyponatremia (odds ratio, 1.176) was an independent predictive factor for AL.

Redefined hyponatremia has good negative predictive value for AL diagnosis after colorectal cancer surgery and could be used as a marker to exclude the diagnosis.

• Hyponatremia
• anastomotic leakage
• biomarker
• colorectal cancer
• leukocytosis
• postoperative serum sodium level

• Anastomotic leakage
• C-reactive protein
• Crohn’s disease
• Hospital discharge
• Postoperative biomarkers

• Anastomotic leakage
• Colorectal surgery
• Meta-analysis
• Vascular calcification

• Anastomotic leakage
• biomarkers
• drain fluid
• early detection
• rectal resection

• C-reactive protein
• colonic anastomosis

• Rectal surgery
• anastomotic leakage
• intraperitoneal cytokines
• intraperitoneal microdialysis
• lactate pyruvate ratio

Intraoperative intraperitoneal chemotherapy is an emerging treatment modality for locally advanced rectal neoplasms. However, its impacts on postoperative complications remain unknown. Anastomotic leakage (AL) is one of the most common and serious complications associated with the anterior resection of rectal tumors. Therefore, we designed this study to determine the effects of intraoperative intraperitoneal chemotherapy on AL.

To investigate whether intraoperative intraperitoneal chemotherapy increases the incidence of AL after the anterior resection of rectal neoplasms.

This retrospective cohort study collected information from 477 consecutive patients who underwent an anterior resection of rectal carcinoma using the double stapling technique at our institution from September 2016 to September 2017. Based on the administration of intraoperative intraperitoneal chemotherapy or not, the patients were divided into a chemotherapy group (171 cases with intraperitoneal implantation of chemotherapy agents during the operation) or a control group (306 cases without intraoperative intraperitoneal chemotherapy). Clinicopathologic features, intraoperative treatment, and postoperative complications were recorded and analyzed to determine the effects of intraoperative intraperitoneal chemotherapy on the incidence of AL. The clinical outcomes of the two groups were also compared through survival analysis.

The univariate analysis showed a significantly higher incidence of AL in the patients who received intraoperative intraperitoneal chemotherapy, with 13 (7.6%) cases in the chemotherapy group and 5 (1.6%) cases in the control group (P = 0.001). As for the severity of AL, the AL patients who underwent intraoperative intraperitoneal chemotherapy tended to be more severe cases, and 12 (92.3%) out of 13 AL patients in the chemotherapy group and 2 (40.0%) out of 5 AL patients in the control group required a secondary operation (P = 0.044). A multivariate analysis was subsequently performed to adjust for the confounding factors and also showed that intraoperative intraperitoneal chemotherapy increased the incidence of AL (odds ratio = 5.386; 95%CI: 1.808-16.042; P = 0.002). However, the survival analysis demonstrated that intraoperative intraperitoneal chemotherapy could also improve the disease-free survival rates for patients with locally advanced rectal cancer.

Intraoperative intraperitoneal chemotherapy can improve the prognosis of patients with locally advanced rectal carcinoma, but it also increases the risk of AL following the anterior resection of rectal neoplasms.

• Anastomotic leakage
• Rectal neoplasms
• Lobaplatin
• Fluorouracil implants
• Postoperative complications
• Intraoperative intraperitoneal chemotherapy

Anastomotic leakage (AL), a serious complication after esophagectomy, might impair patient quality of life, prolong hospital stay, and even lead to surgery‐related death. The aim of this study was to show a novel decision model based on classification and regression tree (CART) analysis for the prediction of postoperative AL among patients who have undergone esophagectomy.

A total of 450 patients (training set: 356; test set: 94) with perioperative information were included. A decision tree model was established to identify the predictors of AL in the training set, which was validated in the test set. A receiver operating characteristic curve was also created to illustrate the diagnostic ability of the decision model.

A total of 12.2% (55/450) of the 450 patients suffered AL, which was diagnosed at median postoperative day 7 (range: 6–16). The decision tree model, containing surgical duration, postoperative lymphocyte count, and postoperative C‐reactive protein to albumin ratio, was established by CART analysis. Among the three variables, the postoperative C‐reactive protein to albumin ratio was identified as the most important indicator in the CART model with normalized importance of 100%. According to the results validated in the test set, the sensitivity, specificity, positive and negative predictive value, and diagnostic accuracy of the prediction model were 80%, 98.8%, 88.9%, 97.6%, and 96.8%, respectively. Moreover, the area under the receiver operating characteristic curve was 0.95.

The decision model based on CART analysis presented good performance for predicting AL, and might allow the early identification of patients at high risk.

• Anastomotic leak
• C-reactive protein
• decision tree
• esophagectomy
• logistic model

• Anastomotic leakage
• CRP
• Calprotectin
• Colorectal cancer surgery
• I-FABP
• NIRF
• Near-infrared fluorescence

• C-reactive protein
• fine tube bundles
• post-operative anastomotic leak
• source control

• mucin pools
• neoadjuvant treatment
• radiotherapy
• rectal cancer
• response

Anastomotic leakage continues to be one of the most serious complications following low anterior resections. Early diagnosis of a leak is difficult but critical to minimize morbidity and mortality.

To evaluate changes in serum concentrations of 27 different cytokines following low anterior resection, with the goal of finding new, early biomarkers of anastomotic leak.

This is a prospective observational study that includes 32 patients undergoing elective low anterior resection for rectal cancer. Blood samples were collected preoperatively and on postoperative day 3.

Five patients developed anastomotic leak (15%). On postoperative day 3, high-sensitivity C-reactive protein (hs-CRP), interleukin (IL)-6, and regulated on activation, normal T cell expressed and secreted (RANTES) were significantly higher in patients with anastomotic leak, while IL-9 and fibroblast growth factor (FGF) 2 were significantly lower. Analysis of relative changes in the concentration of cytokines from preoperative to postoperative day 3 revealed a significant increase of IL-6 and granulocyte-colony stimulating factor (G-CSF) in patients with an anastomotic leak. Upon receiver operating curve (ROC) analysis, the performance of hs-CRP was found to be excellent (AUC = 0.99), and performance of ΔIL-6, IL-6, RANTES, and FGF2 was good (AUC: 0.81–0.87). Patients who developed an anastomotic leak preoperatively had significantly lower levels of macrophage inflammatory protein-1 α (MIP-1α), monocyte chemotactic protein-1 (MCP-1), IL-8, FGF2, and G-CSF.

The single most accurate serum biomarker of anastomotic leakage continues to be hs-CRP. However, when analyzing relative changes of cytokine levels, ΔIL-6 appears to be a better leak predictor than CRP.

• anastomotic leak
• leak markers
• low anterior resection
• rectal cancer
• serum cytokines