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Redefined hyponatremia as a marker to exclude the diagnosis of anastomotic leakage after colorectal cancer surgery.

ABSTRACT: OBJECTIVE:Our objective was to investigate the association between anastomotic leakage (AL) and hyponatremia after colorectal cancer surgery. METHODS:All anastomoses in colorectal cancer surgery performed in our hospital between January 2015 and December 2017 were retrospectively identified. According to the diagnostic criteria of AL, the patients were divided into an AL group and a no anastomotic leakage (NAL) group. RESULTS:We reviewed records of 498 consecutive colorectal cancer patients. The total incidence of AL was 5.4%. Postoperative serum sodium levels differed significantly: 137.63?±?4.29 and 139.81?±?3.41?mmol/L in the AL and NAL groups, respectively. By using area under the receiver-operating characteristic (auROC) curves, we determined the optimum postoperative serum sodium cut-off to be 139.5?mmol/L and redefined hyponatremia as postoperative serum sodium <139.5?mmol/L. Redefined hyponatremia had an auROC of 0.65, corresponding to a 97.2% negative predictive value. The negative predictive value reached 99.1% when serum sodium level was combined with leukocytosis. Multivariable analysis found that redefined hyponatremia (odds ratio, 1.176) was an independent predictive factor for AL. CONCLUSIONS:Redefined hyponatremia has good negative predictive value for AL diagnosis after colorectal cancer surgery and could be used as a marker to exclude the diagnosis.

SUBMITTER: Zhang G

PROVIDER: S-EPMC7469735 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Redefined hyponatremia as a marker to exclude the diagnosis of anastomotic leakage after colorectal cancer surgery.

Zhang Guochao G Lian Rui R Sun Lichao L Liu Haibin H Wang Yan Y Zhou Lei L

The Journal of international medical research 20200801 8

<h4>Objective</h4>Our objective was to investigate the association between anastomotic leakage (AL) and hyponatremia after colorectal cancer surgery.<h4>Methods</h4>All anastomoses in colorectal cancer surgery performed in our hospital between January 2015 and December 2017 were retrospectively identified. According to the diagnostic criteria of AL, the patients were divided into an AL group and a no anastomotic leakage (NAL) group.<h4>Results</h4>We reviewed records of 498 consecutive colorecta ...[more]

PMID: 32865064

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Project description:BackgroundAnastomotic leakage (AL) is a severe complication after colorectal surgery. This study aimed to investigate a method for the early diagnosis of AL after surgical resection by analysing inflammatory factors (IFs) in peritoneal drainage fluid.MethodsAbdominal drainage fluid of patients with colorectal cancer who underwent resection between April 2017 and April 2018, were prospectively collected in the postoperative interval. Six IFs, including interleukin (IL)-1β, IL-6, IL-10, tumour necrosis factor (TNF)-α, matrix metalloproteinase (MMP)2, and MMP9, in drainage were determined by multiplex immunoassay to investigate AL (in patients undergoing resection and anastomosis) and pelvic collection (in patients undergoing abdominoperineal resection). Sparreboom and colleagues' prediction model was first evaluated for AL/pelvic collection, followed by a new IF-based score system (AScore) that was developed by a least absolute shrinkage and selection operator (LASSO) regression, for the same outcomes. The model performance was tested for the area under the curve (AUC), sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV).ResultsOut of 123 patients eligible, 119 patients were selected, including 12 patients with AL/pelvic collection. Sparreboom and colleagues' prediction model was documented with the best diagnostic efficacy on postoperative day 3 (POD3), with an AUC of 0.77. After optimization, AScore on POD3 increased the AUC to 0.83 and on POD1 showed the best diagnostic efficiency, with an AUC of 0.88. Based on the Youden index, the cut-off value of AScore on POD1 was set as -2.46 to stratify patients into low-risk and high-risk groups for AL/pelvic collection. The model showed 90.0 per cent sensitivity, 69.7 per cent specificity, 98.4 per cent NPV, and 25.0 per cent PPV.ConclusionsThe early determination of IFs in abdominal drainage fluid of patients undergoing colorectal surgery could be useful to predict AL or pelvic collection.

Project description:OBJECTIVE:Near-infrared fluorescence (NIRF) imaging using indocyanine green (ICG) might help reduce anastomotic leakage (AL) after colorectal surgery. This pilot study aims to analyze whether a relation exists between measured fluorescence intensity (FI) and postoperative inflammatory markers of AL, C-reactive protein (CRP), Intestinal fatty-acid binding protein (I-FABP), and calprotectin, to AL, in order to evaluate the potential of FI to objectively predict AL. METHODS:Patients scheduled for anastomotic colorectal cancer surgery were eligible for inclusion in this prospective pilot study. During surgery, at three time points (after bowel devascularization; before actual transection; after completion of anastomosis) a bolus of 0.2 mg/kg ICG was administered intravenously for assessment of bowel perfusion. FI was scored in scale from 1 to 5 based on the operating surgeon's judgment (1?=?no fluorescence visible, 5?=?maximum fluorescent signal). The complete surgical procedure was digitally recorded. These recordings were used to measure FI postoperatively using OsiriX imaging software. Serum CRP, I-FABP, and calprotectin values were determined before surgery and on day 1, 3, and 5 postoperative; furthermore, the occurrence of AL was recorded. RESULTS:Thirty patients (n?=?19 males; mean age 67 years; mean BMI 27.2) undergoing either laparoscopic or robotic anastomotic colorectal surgery were included. Indication for surgery was rectal-(n?=?10), rectosigmoid-(n?=?2), sigmoid-(n?=?10), or more proximal colon carcinomas (n?=?8). Five patients (16.7%) developed AL (n?=?2 (6.6%) grade C according to the definition of the International Study group of Rectal Cancer). In patients with AL, the maximum fluorescence score was given less often (P?=?0.02) and a lower FI compared to background FI was measured at 1st assessment (P?=?0.039). However, no relation between FI and postoperative inflammatory parameters could be found. CONCLUSION:Both subjective and measured FI seem to be related to AL. In this study, no relation between FI and inflammatory serum markers could yet be found.

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Redefined hyponatremia as a marker to exclude the diagnosis of anastomotic leakage after colorectal cancer surgery.

Publications

Redefined hyponatremia as a marker to exclude the diagnosis of anastomotic leakage after colorectal cancer surgery.

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