Prokalcitonin je jedan od prediktivnih faktora dehiscence kolorektalne anastomoze

  • Jugoslav Djeri Department of General and Abdominal Surgery, University Clinical Center Banja Luka
  • Jovan Ćulum Clinic “S-tetik” Banja Luka, RS, BiH, Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
  • Zoran Aleksić University Clinical Center of Republic of Srpska
  • Dalibor Šaran University Clinical Center of Republic of Srpska
  • Romana Rajić University Clinical Center of Republic of Srpska

Sažetak


Background/Aim: Dehiscence of the colorectal anastomosis is one of the most serious complications in digestive surgery that is still present in a large percentage today, which significantly increases the cost of treatment and can lead to death. Due to all the above, early detection of anastomotic dehiscence is very
important, as well as the decision on surgical treatment. Procalcitonin (PCT) is thought to be an important marker of inflammation and sepsis. Aim of this paper was to confirm PCT as a marker of great sensitivity in early diagnosis of anastomotic leakage.
Methods: The study included patients who underwent surgery for colorectal cancer in the period from 2016 to 2020. Patients were operated according to an elective protocol and with an open surgical approach. In patients, PCT values were measured on the 2nd and 4th postoperative day (POD) to determine the
association between elevated PCT values and the onset of dehiscence of the colorectal anastomosis.
Results: A study was conducted in 118 patients in whom a stapler colorectal anastomosis was created. Colorectal anastomosis dehiscence occurred in 10 patients. In 4 patients with dehiscence, no re-surgical intervention was required, but they were taken care of by conservative methods. Repeated surgery was performed in 6 patients. In all patients with dehiscence, there was a multiple increase in the value of PCT above normal.
Conclusion: PCT has high sensitivity and specificity (85 and 74 %, respectively) as a marker in dehiscence of colorectal anastomosis. In this study it was found that PCT values were significantly correlated with the dehiscence of anastomosis 2nd POD and especially 4th POD.

Reference

Gessler B, Eriksson O, Angenete E. Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery. Int J Colorectal Dis 2017;32:549–56.

van Rooijen SJ, Huisman D, Stuijvenberg M, Stens J, Roumen RMH, Daams F, et al. Intraoperative modifiable risk factors of colorectal anastomotic leakage: Why surgeons and anesthesiologists should act together. Int J Surg 2016 Dec;36(Pt A):183-200.

Krarup PM, Jorgensen LN, Andreasen AH, Harling H; Danish Colorectal Cancer Group. A nationwide study on anastomotic leakage after colonic cancer surgery. Colorectal Di. 2012 Oct;14(10):e661-7.

Jestin P, Påhlman L, Gunnarsson U. Risk factors for anastomotic leakage after rectal cancer surgery: a case-control study. Colorectal Dis 2008 Sep;10(7):715-21.

Deng K, Zhang J, Jiang X, Feng S. [Factors associated with anastomotic leakage after anterior resection in rectal cancer]. Zhonghua Wei Chang Wai Ke Za Zhi 2018 Apirl 25;21(4):425-30. Chinese..

Lunder M, Janic M, Sabovic M. Prevention of vascular complication in diabetes mellitus patients: focus on the arterial wall. Curr Vasc Pharmacol 2019;17(1):6-15.

Giaccaglia V, Salvi PF, Cunsolo GV, Sparagna A, Antonelli MS, Nigri G, et al. Procalcitonin, as an early biomarker of colorectal anastomotic leak, facilitates enhanced recovery after surgery. J Crit Care 2014 Aug;29(4):528-32.

Limper M, de Kruif MD, Duits AJ, Brandjes DP, van Gorp EC. The diagnostic role of procalcitonin and other biomarkers in discriminating infectious from non-infectious fever. J Infect 2010 Jun;60(6):409-16.

Meisner M. Procalcitonin (PCT) A new, innovative infection parameter. Biochemical and clinical aspects. 3rd revised and extended edition. Stuttgart: Thieme; 2000.

Yang SK, Xiao L, Zhang H, Xu XX, Song PA, Liu FY, et al. Significance of serum procalcitonin as biomarker for detection of bacterial peritonitis: a systematic review and meta-analysis. BMC Infect Dis 2014 Aug 22;14:452. doi: 10.1186/1471-2334-14-452.

Maruna P, Nedelníková K, Gürlich R. Physiology and genetics of procalcitonin. Physiol Res 2000;49 Suppl 1:S57-61.

Meisner M, Tschaikowsky K, Palmaers T, Schmidt J. Comparison of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS. Crit Care. 1999;3(1):45-50.

Gessler B, Eriksson O, Angenete E, Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery. Int J Colorectal Dis 2017;32:549-56.

Teoh CM, Gunasegaram T, Chan KY, Sukumar N, Sagap I. Review of risk factors associated with the anastomosis leakage in anterior resection in Hospital Universiti Kebangsaan Malaysia. Med J Malaysia 2005 Aug;60(3):275-80.

Garcia-Granero A, Frasson M, Flor-Lorente B, Blanco F, Puga R, Carratalá A, et al. Procalcitonin and C-reactive protein as early predictors of anastomotic leak in colorectal surgery: a prospective observational study. Dis Colon Rectum 2013 Apr;56(4):475-83.

Doeksen A, Tanis PJ, Vrouenraets BC, Lanschot van JJ, Tets van WF. Factors determining delay in relaparotomy for anastomotic leakage after colorectal resection. World J Gastroenterol 2007 Jul 21;13(27):3721-5.

BalcI C, Sungurtekin H, Gürses E, Sungurtekin U, Kaptanoglu B. Usefulness of procalcitonin for diagnosis of sepsis in the intensive care unit. Crit Care 2003 Feb;7(1):85-90.

Kørner H, Nielsen HJ, Søreide JA, Nedrebø BS, Søreide K, Knapp JC. Diagnostic accuracy of C-reactive protein for intraabdominal infections after colorectal resections. J Gastrointest Surg 2009 Sep;13(9):1599-606.

Woeste G, Müller C, Bechstein WO, Wullstein C. Increased serum levels of C-reactive protein precede anastomotic leakage in colorectal surgery. World J Surg 2010 Jan;34(1):140-6.

Meisner M, Tschaikowsky K, Hutzler A, Schick C, Schüttler J. Postoperative plasma concentrations of procalcitonin after different types of surgery. Intensive Care Med 1998 Jul;24(7):680-4.

Giaccaglia V, Salvi PF, Antonelli MS, Nigri G, Pirozzi F, Casagranda Bet al. Procalcitonin reveals early dehiscence in colorectal surgery: The PREDICS study. Ann Surg 2016 May;263(5):967-72.

Sarbinowski R, Arvidsson S, Tylman M, Oresland T, Bengtsson A. Plasma concentration of procalcitonin and systemic inflammatory response syndrome after colorectal surgery. Acta Anaesthesiol Scand 2005 Feb;49(2):191-6.

Lagoutte N, Facy O, Ravoire A, Chalumeau C, Jonval L, Rat P, et al. C-reactive protein and procalcitonin for the early detection of anastomotic leakage after elective colorectal surgery: pilot study in 100 patients. J Visc Surg 2012 Oct;149(5):e345-9.

Tatsuoka T, Okuyama T, Takeshita E, Oi H, Noro T, Mitsui T, et al. Early detection of infectious complications using C-reactive protein and the procalcitonin levels after laparoscopic colorectal resection: a prospective cohort study. Surg Today 2021 Mar;51(3):397-403.

Takakura Y, Hinoi T, Egi H, Shimomura M, Adachi T, Saito Y, et al. Procalcitonin as a predictive marker for surgical site infection in elective colorectal cancer surgery. Langenbecks Arch Surg 2013 Aug;398(6):833-9.

Abu Elyazed MM, El Sayed Zaki M. Value of procalcitonin as a biomarker for postoperative hospital-acquired pneumonia after abdominal surgery. Korean J Anesthesiol 2017 Apr;70(2):177-83.

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2022/06/29
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