Is early detection of anastomotic leakage possible by intraperitoneal microdialysis and intraperitoneal cytokines after anterior resection of the rectum for cancer?
OBJECTIVE
This prospective study assessed methods of detecting intraperitoneal ischemia and inflammatory response in patients with and without postoperative complications after anterior resection of the rectum.


METHODS
In 23 patients operated on with anterior resection of the rectum for rectal carcinoma, intraperitoneal lactate, pyruvate, and glucose levels were monitored postoperatively for six days by using microdialysis with catheters applied in two locations: intraperitoneally near the anastomosis, and in the central abdominal cavity. A reference catheter was placed subcutaneously in the pectoral region. Cytokines, interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-alpha, were measured in intraperitoneal fluid by means of a pelvic drain for two postoperative days.


RESULTS
The intraperitoneal lactate/pyruvate ratio near the anastomosis was higher on postoperative Day 5 (P = 0.029) and Day 6 (P = 0.009) in patients with clinical anastomotic leakage (n = 7) compared with patients without leakage (n = 16). The intraperitoneal levels of IL-6 (P = 0.002; P = 0.012, respectively) and IL-10 (P = 0.002; P = 0.041, respectively) were higher on postoperative Days 1 and 2 in the leakage group, and TNF-alpha was higher in the leakage group on Day 1 (P = 0.011). In-hospital clinical anastomotic leakage was diagnosed on median Day 6, and leakage after hospital discharge on median Day 20.


CONCLUSIONS
The intraperitoneal lactate/pyruvate ratio and cytokines, IL-6, IL-10, and TNF-alpha, were increased in patients who developed symptomatic anastomotic leakage before clinical symptoms were evident.
Matthiessen
Peter
P
Department of Surgery, Orebro University Hospital, Orebro, Sweden. peter.matthiessen@orebroll.se
Strand
Ida
I
Jansson
Kjell
K
Törnquist
Cathrine
C
Andersson
Magnus
M
Rutegård
Jörgen
J
Norgren
Lars
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D001826:Body Fluids / Q000737:chemistry*; D016207:Cytokines / Q000032:analysis*; D005260:Female; D006801:Humans; D016753:Interleukin-10 / Q000032:analysis; D015850:Interleukin-6 / Q000032:analysis; D007773:Lactates / Q000032:analysis; D008297:Male; D017551:Microdialysis / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis; D011184:Postoperative Period; D011446:Prospective Studies; D011773:Pyruvates / Q000032:analysis; D012004:Rectal Neoplasms / Q000601:surgery*; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D016207:Cytokines; D015850:Interleukin-6; D007773:Lactates; D011773:Pyruvates; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10