Detection of Anastomotic Leakage Following Elective Colonic Surgery: Results of the Prospective Biomarkers and Anastomotic Leakage (BALL) Study

• Published in: The Journal of surgical research Vol. 273; pp. 85 - 92
• Main Authors: Su'a, Bruce, Milne, Tony, Jaung, Rebekah, Jin, James Z., Svirskis, Darren, Bissett, Ian P., Eglinton, Tim, Hill, Andrew G.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2022
• Subjects: Abdominal; Adult; Anastomotic leak; Anastomotic Leak - diagnosis; Anastomotic Leak - etiology; Biomarkers; C-Reactive Protein - metabolism; Colectomy - adverse effects; Colectomy - methods; Colorectal; Cytokines; Gastrointestinal; Humans; Inflammation; Interleukin-10; Interleukin-6; Perioperative care; Surgery; Perioperative care; Colorectal; Cytokines; Surgery; Biomarkers; Inflammation; Gastrointestinal; Abdominal; Anastomotic leak
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2021.12.019

Anastomotic leakage (AL) is an infrequent but life-threatening surgical complication following colorectal surgery. Early diagnosis remains clinically difficult but is a necessity to reduce associated morbidity and mortality. Clinical review and radiological modalities for the diagnosis of leakage remain non-specific and often only detect AL once it is well developed. Inflammatory biomarkers however have shown promise in early pre-clinical detection of leakage following colorectal surgery. A multi-center, prospective observational study was conducted across four public hospitals in Auckland and Christchurch, New Zealand. Consecutive adults undergoing elective colectomy were initially recruited over a 3-y period. Perioperative blood samples were collected to measure interleukin (IL)-6, IL-1β, tumor necrosis factor α, IL-10, C-reactive protein (CRP), leukocyte and neutrophil counts. Statistical analysis was performed to compare patients with an uncomplicated recovery with patients with AL. Sixteen patients developed AL (5.7%), diagnosed at a median post-operative (POD) day 7. CRP and IL-6 were consistently elevated in the early post-operative period in patients with AL, and had the best diagnostic accuracy on POD 3 (area under the curve 0.70; P = 0.02) and POD 1 (area under the curve 0.69; P = 0.02), respectively. IL-10, once adjusted for body mass index and surgical approach, was the sole biomarker significantly elevated in patients with AL on POD 4. Early post-operative elevations of CRP and IL-6 provide utility for early detection of AL after elective colectomy. Application of these inflammatory biomarkers and their combinations in daily practice warrants further investigation.