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Inflammatory biomarker signatures in post-surgical drain fluid may detect anastomotic leaks within 48 hours of colorectal resection

Cuff, Simone ORCID:, Reeves, Nicola, Lewis, Eifion, Jones, Eleri, Baker, Sarah ORCID:, Karategos, Athanasios, Morris, Rachel, Torkington, Jared and Eberl, Matthias ORCID: 2023. Inflammatory biomarker signatures in post-surgical drain fluid may detect anastomotic leaks within 48 hours of colorectal resection. Techniques in Coloproctology 10.1007/s10151-023-02841-y

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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.

Item Type: Article
Date Type: Published Online
Status: Published
Schools: Medicine
Publisher: Springer
ISSN: 1123-6337
Funders: Wellcome Trust
Related URLs:
Date of First Compliant Deposit: 3 July 2023
Date of Acceptance: 22 June 2023
Last Modified: 03 Oct 2023 07:59

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