Cargando…

A multicentre cohort study of serum and peritoneal biomarkers to predict anastomotic leakage after rectal cancer resection

AIM: Anastomotic leakage (AL) is one of the most feared complications after rectal resection. This study aimed to assess a combination of biomarkers for early detection of AL after rectal cancer resection. METHOD: This study was an international multicentre prospective cohort study. All patients rec...

Descripción completa

Detalles Bibliográficos
Autores principales: Sparreboom, C. L., Komen, N., Rizopoulos, D., Verhaar, A. P., Dik, W. A., Wu, Z., van Westreenen, H. L., Doornebosch, P. G., Dekker, J. W. T., Menon, A. G., Daams, F., Lips, D., van Grevenstein, W. M. U., Karsten, T. M., Bayon, Y., Peppelenbosch, M. P., Wolthuis, A. M., D'Hoore, A., Lange, J. F.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6973162/
https://www.ncbi.nlm.nih.gov/pubmed/31344302
http://dx.doi.org/10.1111/codi.14789
_version_ 1783489990070632448
author Sparreboom, C. L.
Komen, N.
Rizopoulos, D.
Verhaar, A. P.
Dik, W. A.
Wu, Z.
van Westreenen, H. L.
Doornebosch, P. G.
Dekker, J. W. T.
Menon, A. G.
Daams, F.
Lips, D.
van Grevenstein, W. M. U.
Karsten, T. M.
Bayon, Y.
Peppelenbosch, M. P.
Wolthuis, A. M.
D'Hoore, A.
Lange, J. F.
author_facet Sparreboom, C. L.
Komen, N.
Rizopoulos, D.
Verhaar, A. P.
Dik, W. A.
Wu, Z.
van Westreenen, H. L.
Doornebosch, P. G.
Dekker, J. W. T.
Menon, A. G.
Daams, F.
Lips, D.
van Grevenstein, W. M. U.
Karsten, T. M.
Bayon, Y.
Peppelenbosch, M. P.
Wolthuis, A. M.
D'Hoore, A.
Lange, J. F.
author_sort Sparreboom, C. L.
collection PubMed
description AIM: Anastomotic leakage (AL) is one of the most feared complications after rectal resection. This study aimed to assess a combination of biomarkers for early detection of AL after rectal cancer resection. METHOD: This study was an international multicentre prospective cohort study. All patients received a pelvic drain after rectal cancer resection. On the first three postoperative days drain fluid was collected daily and C‐reactive protein (CRP) was measured. Matrix metalloproteinase‐2 (MMP2), MMP9, glucose, lactate, interleukin 1‐beta (IL1β), IL6, IL10, tumour necrosis factor alpha (TNFα), Escherichia coli, Enterococcus faecalis, lipopolysaccharide‐binding protein and amylase were measured in the drain fluid. Prediction models for AL were built for each postoperative day using multivariate penalized logistic regression. Model performance was estimated by the c‐index for discrimination. The model with the best performance was visualized with a nomogram and calibration was plotted. RESULTS: A total of 292 patients were analysed; 38 (13.0%) patients suffered from AL, with a median interval to diagnosis of 6.0 (interquartile ratio 4.0–14.8) days. AL occurred less often after partial than after total mesorectal excision (4.9% vs 15.2%, P = 0.035). Of all patients with AL, 26 (68.4%) required reoperation. AL was more often treated by reoperation in patients without a diverting ileostomy (18/20 vs 8/18, P = 0.03). The prediction model for postoperative day 1 included MMP9, TNFα, diverting ileostomy and surgical technique (c‐index = 0.71). The prediction model for postoperative day 2 only included CRP (c‐index = 0.69). The prediction model for postoperative day 3 included CRP and MMP9 and obtained the best model performance (c‐index = 0.78). CONCLUSION: The combination of serum CRP and peritoneal MMP9 may be useful for earlier prediction of AL after rectal cancer resection. In clinical practice, this combination of biomarkers should be interpreted in the clinical context as with any other diagnostic tool.
format Online
Article
Text
id pubmed-6973162
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-69731622020-01-27 A multicentre cohort study of serum and peritoneal biomarkers to predict anastomotic leakage after rectal cancer resection Sparreboom, C. L. Komen, N. Rizopoulos, D. Verhaar, A. P. Dik, W. A. Wu, Z. van Westreenen, H. L. Doornebosch, P. G. Dekker, J. W. T. Menon, A. G. Daams, F. Lips, D. van Grevenstein, W. M. U. Karsten, T. M. Bayon, Y. Peppelenbosch, M. P. Wolthuis, A. M. D'Hoore, A. Lange, J. F. Colorectal Dis Original Articles AIM: Anastomotic leakage (AL) is one of the most feared complications after rectal resection. This study aimed to assess a combination of biomarkers for early detection of AL after rectal cancer resection. METHOD: This study was an international multicentre prospective cohort study. All patients received a pelvic drain after rectal cancer resection. On the first three postoperative days drain fluid was collected daily and C‐reactive protein (CRP) was measured. Matrix metalloproteinase‐2 (MMP2), MMP9, glucose, lactate, interleukin 1‐beta (IL1β), IL6, IL10, tumour necrosis factor alpha (TNFα), Escherichia coli, Enterococcus faecalis, lipopolysaccharide‐binding protein and amylase were measured in the drain fluid. Prediction models for AL were built for each postoperative day using multivariate penalized logistic regression. Model performance was estimated by the c‐index for discrimination. The model with the best performance was visualized with a nomogram and calibration was plotted. RESULTS: A total of 292 patients were analysed; 38 (13.0%) patients suffered from AL, with a median interval to diagnosis of 6.0 (interquartile ratio 4.0–14.8) days. AL occurred less often after partial than after total mesorectal excision (4.9% vs 15.2%, P = 0.035). Of all patients with AL, 26 (68.4%) required reoperation. AL was more often treated by reoperation in patients without a diverting ileostomy (18/20 vs 8/18, P = 0.03). The prediction model for postoperative day 1 included MMP9, TNFα, diverting ileostomy and surgical technique (c‐index = 0.71). The prediction model for postoperative day 2 only included CRP (c‐index = 0.69). The prediction model for postoperative day 3 included CRP and MMP9 and obtained the best model performance (c‐index = 0.78). CONCLUSION: The combination of serum CRP and peritoneal MMP9 may be useful for earlier prediction of AL after rectal cancer resection. In clinical practice, this combination of biomarkers should be interpreted in the clinical context as with any other diagnostic tool. John Wiley and Sons Inc. 2019-08-09 2020-01 /pmc/articles/PMC6973162/ /pubmed/31344302 http://dx.doi.org/10.1111/codi.14789 Text en © 2019 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Articles
Sparreboom, C. L.
Komen, N.
Rizopoulos, D.
Verhaar, A. P.
Dik, W. A.
Wu, Z.
van Westreenen, H. L.
Doornebosch, P. G.
Dekker, J. W. T.
Menon, A. G.
Daams, F.
Lips, D.
van Grevenstein, W. M. U.
Karsten, T. M.
Bayon, Y.
Peppelenbosch, M. P.
Wolthuis, A. M.
D'Hoore, A.
Lange, J. F.
A multicentre cohort study of serum and peritoneal biomarkers to predict anastomotic leakage after rectal cancer resection
title A multicentre cohort study of serum and peritoneal biomarkers to predict anastomotic leakage after rectal cancer resection
title_full A multicentre cohort study of serum and peritoneal biomarkers to predict anastomotic leakage after rectal cancer resection
title_fullStr A multicentre cohort study of serum and peritoneal biomarkers to predict anastomotic leakage after rectal cancer resection
title_full_unstemmed A multicentre cohort study of serum and peritoneal biomarkers to predict anastomotic leakage after rectal cancer resection
title_short A multicentre cohort study of serum and peritoneal biomarkers to predict anastomotic leakage after rectal cancer resection
title_sort multicentre cohort study of serum and peritoneal biomarkers to predict anastomotic leakage after rectal cancer resection
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6973162/
https://www.ncbi.nlm.nih.gov/pubmed/31344302
http://dx.doi.org/10.1111/codi.14789
work_keys_str_mv AT sparreboomcl amulticentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT komenn amulticentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT rizopoulosd amulticentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT verhaarap amulticentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT dikwa amulticentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT wuz amulticentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT vanwestreenenhl amulticentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT doorneboschpg amulticentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT dekkerjwt amulticentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT menonag amulticentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT daamsf amulticentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT lipsd amulticentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT vangrevensteinwmu amulticentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT karstentm amulticentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT bayony amulticentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT peppelenboschmp amulticentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT wolthuisam amulticentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT dhoorea amulticentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT langejf amulticentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT sparreboomcl multicentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT komenn multicentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT rizopoulosd multicentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT verhaarap multicentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT dikwa multicentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT wuz multicentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT vanwestreenenhl multicentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT doorneboschpg multicentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT dekkerjwt multicentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT menonag multicentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT daamsf multicentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT lipsd multicentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT vangrevensteinwmu multicentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT karstentm multicentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT bayony multicentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT peppelenboschmp multicentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT wolthuisam multicentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT dhoorea multicentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection
AT langejf multicentrecohortstudyofserumandperitonealbiomarkerstopredictanastomoticleakageafterrectalcancerresection