title: Peritoneal Cytokine Levels Can Predict Anastomotic Leak on the First Postoperative Day.
abstract: BACKGROUND
  Accumulating evidence suggests that peritoneal cytokine concentrations may predict anastomotic leak after colorectal surgery, but previous studies have been underpowered.
  
  
  OBJECTIVE
  We aimed to test this hypothesis by using a larger prospectively collected data set.
  
  
  METHODS
  This study is an analysis of prospectively collected data.
  
  
  METHODS
  This study was conducted at 3 public hospitals in Auckland, New Zealand.
  
  
  METHODS
  Patients undergoing colorectal surgery recruited as part of 3 previous randomized controlled trials were included.
  
  
  METHODS
  Data on peritoneal and plasma levels of interleukin-6, interleukin-8, interleukin-10, and tumor necrosis factor-α on day 1 after colorectal surgery were reanalyzed to evaluate their predictive value for clinically important anastomotic leak. Area under receiver operating characteristic curve analysis was performed.
  
  
  RESULTS
  A total of 206 patients with complete cytokine data were included. The overall anastomotic leak rate was 8.3%. Concentration levels of peritoneal interleukin-6 and interleukin-10 on day 1 after colorectal surgery were predictive of anastomotic leak (area under receiver operating characteristic curve, 0.72 and 0.74; p = 0.006 and 0.004). Plasma cytokine levels of interleukin-6 were higher on day 1 after colorectal surgery in patients who had an anastomotic leak, but this was a poor predictor of anastomotic leak. Levels of other peritoneal and plasma cytokines were not predictive.
  
  
  CONCLUSIONS
  The study was not powered a priori for anastomotic leak prediction. Although the current data do suggest that peritoneal levels of interleukin-6 and interleukin-10 are predictive of leak, the discriminative value in clinical practice remains unclear.
  
  
  CONCLUSIONS
  Peritoneal levels of interleukin-6 and interleukin-10 on day 1 after colorectal surgery can predict clinically important anastomotic leak.
authors.affiliation: Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Tarik
authors.initials: T
authors.lastname: Sammour
authors.forename: Parry P
authors.initials: PP
authors.lastname: Singh
authors.forename: Kamran
authors.initials: K
authors.lastname: Zargar-Shoshtari
authors.forename: Bruce
authors.initials: B
authors.lastname: Su'a
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Hill
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000175:diagnosis* / Q000378:metabolism; D001202:Ascitic Fluid / Q000378:metabolism*; D003107:Colorectal Surgery; D016207:Cytokines / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011184:Postoperative Period; D012372:ROC Curve; D055815:Young Adult
chemical_list: D016207:Cytokines