Document Detail

Is early detection of anastomotic leakage possible by intraperitoneal microdialysis and intraperitoneal cytokines after anterior resection of the rectum for cancer?
MedLine Citation:
PMID:  17763907     Owner:  NLM     Status:  MEDLINE    
PURPOSE: 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.
Peter Matthiessen; Ida Strand; Kjell Jansson; Cathrine Törnquist; Magnus Andersson; Jörgen Rutegård; Lars Norgren
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  50     ISSN:  0012-3706     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-11-08     Completed Date:  2008-01-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1918-27     Citation Subset:  IM    
Department of Surgery, Orebro University Hospital, Orebro, Sweden.
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MeSH Terms
Aged, 80 and over
Anastomosis, Surgical / adverse effects*
Body Fluids / chemistry*
Cytokines / analysis*
Interleukin-10 / analysis
Interleukin-6 / analysis
Lactates / analysis
Microdialysis / methods*
Middle Aged
Postoperative Complications / diagnosis
Postoperative Period
Prospective Studies
Pyruvates / analysis
Rectal Neoplasms / surgery*
Tumor Necrosis Factor-alpha / analysis
Reg. No./Substance:
0/Cytokines; 0/Interleukin-6; 0/Lactates; 0/Pyruvates; 0/Tumor Necrosis Factor-alpha; 130068-27-8/Interleukin-10

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