Prediction of Anastomotic Leakage in Colorectal Surgeries Using Biomarkers

Introduction: With the advent of minimal access surgery and standardized recovery protocols, patients with colorectal disease are recovering more quickly after surgery. Despite these significant advances, anastomotic leakage remains one of the most feared complications following colorectal surgery, with rates ranging from 3-27 percent depending on risk factors. Anastomotic leakage may be defined as clinical signs of peritonitis and/or clinical evidence of free fecal fluid within abdomen or emerging from drain site. Some studies concluded that biomarkers like 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. Aims and Objectives: To assess sensitivity and specificity of systemic (CRP, leukocytes, pro calcitonin) and peritoneal drain-fluid bio-markers interleukin-6, interleukin-10, tumor necrosis factor- (IL-6, IL-10, TNF- ) in early prediction of anastomotic leak following colo-rectal surgeries. To co-relate rise in levels of biomarkers and severity of clinical symptoms in patients who have undergone colo-rectal surgeries. Methodology: The current study was a prospective observational study conducted on 60 patients over a two-year period in the Postgraduate Department of Surgery, Government Medical College, Srinagar, after obtaining proper ethical clearance. All patients who under-went varied colo-rectal procedures for different indications were observed closely in post-operative period and their systemic as well as drain fluid markers were sent for estimation on days 1-7 post-operatively and results obtained there-of were analysed using SPSS V 22. Results: The mean age was 54.87±11.901 years with 44 patients (73.3%) were males & 16 patients (26.7%) were females. Among systemic makers: the mean CRP level was 2.7800±0.500 mg/L, the mean total leukocyte count was 10.783±0.940 thousands & the mean serum procalcitonin level was 0.365±0.1385 ng/ml. Among peritoneal fluid drain bio-makers, the mean IL-6 level was 3551.066±1311.965 pg/ml, the mean IL-10 level was 628.533±460.358 pg/ml & the mean TNF-a level was 16.391±6.736 pg/ml. The anastomotic leak after colo-rectal surgery was noted in 16 patients (26.7%). In our study, there was a significant correlation between the rise in levels of peritoneal drain fluid biomarkers and the severity of clinical symptoms, but there was no significant correlation between the rise in levels of systemic markers and the severity of clinical symptoms in patients who had colo-rectal surgeries. Conclusion: After colorectal surgery, systemic biomarkers are poor predictors of anastomotic leak. However, peritoneal fluid drain biomarkers have a high sensitivity and specificity in predicting anastomotic leak.