Key result
Combined drain fluid IL-6 and CRP accurately detects post-operative anastomotic leaks within 48 hours.
Why the study?
Anastomotic leaks after colorectal cancer resection cause significant morbidity and mortality, prompting evaluation of peritoneal biomarkers using an automated immunoassay system for earlier diagnosis.
Does a peritoneal biomarker signature in post-surgical drain fluid detect anastomotic leaks within 48 hours of colorectal resection in patients undergoing anterior resection for rectal cancer?
Observational (n=42)
No
Does a peritoneal biomarker signature in post-surgical drain fluid detect anastomotic leaks within 48 hours of colorectal resection in patients undergoing anterior resection for rectal cancer?
A simple immune signature (IL-6 and CRP) in surgical drain fluid could accurately diagnose an anastomotic leak at 48 hours post-operatively using widely available instrumentation.
May support earlier anastomotic leak detection after colorectal surgery; leaves open clinical utility pending prospective validation.
Background The optimal treatment of colorectal cancer is surgical resection and primary anastomosis. Anastomotic leak can affect up to 20% of patients and creates significant morbidity and mortality, a leak is based on clinical suspicion and subsequent radiology. Peritoneal biomarkers have shown diagnostic utility in other medical conditions and could be useful in providing earlier diagnosis. This pilot study was designed to assess the practical utility of peritoneal biomarkers after abdominal surgery utilising an automated immunoassay system in routine use for quantifying cytokines. Method Patients undergoing an anterior resection for a rectal cancer diagnosis were recruited. A peritoneal drain was placed in the proximity of the anastomosis during surgery, and peritoneal fluid was collected at day 1 and 2 post-operatively, and analysed using the Siemens IMMULITE platform for IL-1β, IL-6, IL-10, CXCL8, TNF-α and CRP. Results 42 patients were recruited. Anastomotic leak was detected in 4 patients and a further 5 patients had other intra-abdominal complications. The IMMULITE platform was able to provide robust and reliable results from the analysis of the peritoneal fluid. A metric based on the combination of peritoneal IL-6 and CRP levels was able to accurately diagnose three anastomotic leaks, whilst correctly classifying all negative control patients including those with other complications. Conclusion This pilot study has demonstrated that a simple immune signature in surgical drain fluid could accurately diagnose an anastomotic leak at 48 hours post-operatively using instrumentation that is already widely available in diagnostic laboratories.
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Cuff et al. (2022) conducted an observational in Colorectal cancer (n=42). Peritoneal drain fluid biomarkers (IL-6 and CRP) vs. Uncomplicated recovery was evaluated on Detection of anastomotic leak using a combined metric of peritoneal IL-6 and CRP levels. A combined metric of peritoneal IL-6 and CRP levels in surgical drain fluid accurately diagnosed anastomotic leaks within 48 hours post-operatively, correctly classifying all negative controls.
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