title: Relation between postoperative ileus and anastomotic leakage after colorectal resection: a post hoc analysis of a prospective randomized controlled trial.
abstract: OBJECTIVE
  Anastomotic leakage (AL) following abdominal surgery is a critical determinant of postoperative recovery, of which the aetiology is largely unknown. Interestingly, interventions aimed at reducing the inflammatory response and postoperative ileus (POI) have an unexpected effect on AL. The aim of this study was to investigate the relation of POI with inflammation and AL after colorectal resection.
  
  
  METHODS
  A post hoc analysis of a prospective randomized controlled trial in which patients underwent a colorectal resection was performed. Patients undergoing a colorectal resection were stratified into having or not having POI. The incidence of AL and other clinical parameters was registered prospectively. Intestinal fatty acid binding protein (I-FABP, a marker for tissue damage) and the inflammatory response in plasma and colon tissue were determined.
  
  
  RESULTS
  AL was present in nine of 43 patients in the POI group, and in one of 65 in the group without POI (P < 0.001). There was a significant association between POI and AL (OR 12.57, 95% CI: 2.73-120.65; P = 0.0005). Patients with POI had significantly higher plasma levels of soluble tumour necrosis factor receptor 1 (TNFRSF1A) at 4 h postoperatively (0.89 ng/l, interquartile range 0.56) than patients without POI (0.80 ng/l, interquartile range 0.37; P = 0.04) and higher plasma levels of C-reactive protein on the second day postoperatively (234 ± 77 vs 163 ± 86 mg/l; P = 0.001). Patients who developed AL had significantly higher plasma levels of I-FABP compared with patients without AL at 24 h after onset of surgery.
  
  
  CONCLUSIONS
  POI is associated with a higher prevalence of AL and an increased inflammatory response.
authors.affiliation: Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.|Tytgat Institute for Liver and Intestinal Research, Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: E G
authors.initials: EG
authors.lastname: Peters
authors.affiliation: Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Dekkers
authors.affiliation: Tytgat Institute for Liver and Intestinal Research, Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: F W
authors.initials: FW
authors.lastname: van Leeuwen-Hilbers
authors.affiliation: Department of Surgery, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Daams
authors.affiliation: Department of Surgery, Zuyderland Medical Center, Sittard-Geleen, The Netherlands.
authors.forename: K W E
authors.initials: KWE
authors.lastname: Hulsewé
authors.affiliation: Tytgat Institute for Liver and Intestinal Research, Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: W J
authors.initials: WJ
authors.lastname: de Jonge
authors.affiliation: Institute MHeNS, Maastricht University, Maastricht, The Netherlands.
authors.forename: W A
authors.initials: WA
authors.lastname: Buurman
authors.affiliation: Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: M D P
authors.initials: MDP
authors.lastname: Luyer
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D002097:C-Reactive Protein / Q000032:analysis; D003082:Colectomy / Q000009:adverse effects*; D003108:Colonic Diseases / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D015179:Colorectal Neoplasms / Q000601:surgery; D050556:Fatty Acid-Binding Proteins / Q000032:analysis; D005260:Female; D006801:Humans; D045823:Ileus / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D050556:Fatty Acid-Binding Proteins; D002097:C-Reactive Protein
keywords: Anastomotic leakage; I-FABP; colorectal surgery; inflammation; postoperative ileus; surgical complications