ArticleColorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland2020
A multicentre cohort study of serum and peritoneal biomarkers to predict anastomotic leakage after rectal cancer resection.
Article in Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 7 of them syntheses that pooled it.
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Who cites it
23 citing papers in PubMed, 7 syntheses or guidelines pooled it, 39 citations in OpenAlex.
- The Diagnostic Role of Tumor and Inflammatory Biomarkers in Ascitic Fluid: A Systematic Review.Medicina (Kaunas, Lithuania) · 2025Pooled it
- Collagenase-producing bacteria are common in anastomotic leakage after colorectal surgery: a systematic review.International journal of colorectal disease · 2023Pooled it
- Peritoneal cytokines as a predictor of colorectal anastomotic leaks on postoperative day 1: a systematic review and meta-analysis.Techniques in coloproctology · 2022Pooled it
- C-reactive protein can predict anastomotic leak in colorectal surgery: a systematic review and meta-analysis.International journal of colorectal disease · 2021Pooled it
- Matrix metalloproteinase-9 in relation to patients with complications after colorectal surgery: a systematic review.International journal of colorectal disease · 2021Pooled it
- Peritoneal Cytokines as Early Biomarkers of Colorectal Anastomotic Leakage Following Surgery for Colorectal Cancer: A Meta-Analysis.Frontiers in oncology · 2021Pooled it
- CRP in Drain Fluid as a Predictive Marker of Anastomotic Leak in Colorectal Surgery: A Systematic Review of the Literature.In vivo (Athens, Greece)Pooled it
- Review
- IMMUNOREACT 4: Peritumoral Microenvironment Associated with Anastomotic Leaks After Surgery for Rectal Cancer.Cancers · 2026Article
- Machine Learning Models Using Post-operative CRP Trends to Predict Colorectal Anastomotic Leak: A Pilot Study.Cureus · 2025Article
- Peritoneal fluid indocyanine green test for diagnosis of gut leakage in anastomotic leakage rats and colorectal surgery patients.World journal of gastrointestinal surgery · 2024Article
- Article
- Ileocolonic Healing after Small Ileocecal Resection in Mice: NOD2 Deficiency Impairs Anastomotic Healing by Local Mechanisms.Journal of clinical medicine · 2023Article
- Serum and peritoneal biomarkers for the early prediction of symptomatic anastomotic leakage in patients following laparoscopic low anterior resection: A single-center prospective cohort study.Cancer reports (Hoboken, N.J.) · 2023Article
- A novel scoring system for the early detection of anastomotic leakage: bedside leak score-a pilot study.Frontiers in surgery · 2023Article
- The Significance of Blood and Peritoneal Fluid Biochemical Markers in Identifying Early Anastomotic Leak following Colorectal Resection-Findings from a Single-Center Study.Medicina (Kaunas, Lithuania) · 2022Article
- Development of a Connected Sensor System in Colorectal Surgery: User-Centered Design Case Study.JMIR human factors · 2022Article
- The Science of Anastomotic Healing.Seminars in colon & rectal surgery · 2022Article
- Early diagnosis of anastomotic leakage after colorectal cancer surgery using an inflammatory factors-based score system.BJS open · 2022Article
- Early Diagnosis of Anastomotic Leakage After Gastric Cancer Surgery Via Analysis of Inflammatory Factors in Abdominal Drainage.Annals of surgical oncology · 2022Article
Corrections and comments
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Authors and funding
19 authors at 12 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimAnastomotic 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.
methodThis 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.
resultsA 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).
conclusionThe 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.
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