title: Is microvessel density correlated with anastomotic leakage after low anterior resection?
abstract: OBJECTIVE
  Anastomotic leakage after low anterior resection may be the result of poor vascular supply from the proximal anastomotic loop. The purpose of this study was to investigate the correlation between colonic microvessel density and anastomotic breakdown.
  
  
  METHODS
  Between 2006 and 2009, a consecutive series of 81 patients underwent double-stapled low anterior resection followed by a colorectal anastomosis. Symptomatic anastomotic leakage occurred in 14 patients (17%). In these patients, microvascular density was determined by image analysis of CD-31-immunostained sections from the proximal resection site. The results were compared with a sample of the remaining 67 patients without anastomotic leakage closely matched for age, gender, ASA-classification, pathological stage and neoadjuvant treatment.
  
  
  RESULTS
  The mean percentage of anti-CD31 stained area, obtained from the proximal resection site was similar between patients with or without anastomotic leakage (4.0% +/- 1.8% versus 4.4% +/- 1.6% respectively, P = 0.53). With respect to neo-adjuvant therapy, no differences in the density of CD31 positive were observed (pre-operative radiotherapy = 4.3% +/- 1.8% versus pre-operative chemoradiotherapy 4.1% +/- 1.6%, P = 0.77). The mean vessel density reached borderline statistical significance in women (5.0% +/- 1.8%) compared to men (3.8% +/- 1.8%) (P = 0.06).
  
  
  CONCLUSIONS
  Microvessel density quantification with immunohistochemical analysis of CD31 expression of the proximal anastomotic region did not show any correlation with anastomotic leakage in the clinical setting.
authors.forename: Sander B
authors.initials: SB
authors.lastname: Schouten
authors.forename: Anthonius F J
authors.initials: AF
authors.lastname: De Bruin
authors.forename: Martijn P
authors.initials: MP
authors.lastname: Gosselink
authors.forename: Alex L
authors.initials: AL
authors.lastname: Nigg
authors.forename: Mat
authors.initials: M
authors.lastname: van Iterson
authors.forename: Katherina
authors.initials: K
authors.lastname: Biermann
authors.forename: Mike
authors.initials: M
authors.lastname: Kliffen
authors.forename: Erwin
authors.initials: E
authors.lastname: van der Harst
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000209:etiology*; D014408:Biomarkers, Tumor / Q000032:analysis; D059248:Chemoradiotherapy; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D055806:Microvessels; D008875:Middle Aged; D009367:Neoplasm Staging; D019408:Platelet Endothelial Cell Adhesion Molecule-1 / Q000032:analysis; D011183:Postoperative Complications / Q000209:etiology*; D012307:Risk Factors; D017792:Surgical Stapling; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D019408:Platelet Endothelial Cell Adhesion Molecule-1