C-reaktivni protein u drenažnoj tečnosti kao pokazatelj dehiscencije anastomoze nakon resekcije kolona i rektuma
Sažetak
Uvod/Cilj. Smatra se da je C-reaktivni protein (CRP) indikator postoperativnih komplikacija u abdominalnoj hirurgiji. Cilj rada bio je da se utvrdi značaj serijskog merenja vrednosti CRP u drenažnoj tečnosti u detekciji dehiscencije anastomoze kod bolesnika sa resekcijom kolona i rektuma. Metode. Vrednosti CRP u serumu i drenažnoj tečnosti kod 150 bolesnika sa kolorektalnom resekcijom i primarnom anastomozom određivane su prvog, trećeg, petog i sedmog postoperativnog dana. Vrednosti CRP u serumu i drenažnoj tečnosti upoređivane su između grupa bolesnika bez komplikacija operativnog lečenja i sa dehiscencijom anastomoze. Rezultati. Klinički manifestnu dehiscenciju anastomoze imalo je 15 bolesnika, dva (4,2%) sa kolokoloničnom i 13 (12,6%) sa kolorektalnom anastomozom. Srednje vrednosti CRP su bile veće kod bolesnika sa dehiscencijom anastomoze nego kod bolesnika bez komplikacija i u serumu i u drenažnoj tečnosti, sa statistički najznačajnijim razlikama petog i sedmog postoperativnog dana (p < 0,001). Korelaciona analiza pokazala je postojanje pozitivne korelacije između vrednosti CRP u serumu i drenažnoj tečnosti kod obe grupe bolesnika. Najznačajnije vrednosti CRP u detekciji dehiscencije anastomoze dobijene su petog i sedmog postoperativnog dana i za serum i za drenažnu tečnost. Kod 80% bolesnika sa dehiscencijom anastomoze CRP u drenažnoj tečnosti bio je iznad 53 mg/L petog i 42 mg/L sedmog postoperativnog dana. Specifičnost metode bila je 77% za peti i 83% za sedmi postoperativni dan. Kod svih bolesnika sa CRP iznad 108 mg/L petog i 93 mg/L sedmog postoperativnog dana registrovana je dehiscencija anastomoze. Zaključak. Serijsko merenje vrednosti CRP u drenažnoj tečnosti pouzdano je u detekciji dehiscencije anastomoze kod obolelih sa kolorektalnom resekcijom. Najznačajnije vrednosti dobijene su petog i sedmog postoperativnog dana i u pozitivnoj su korelaciji sa vrednostima registrovanim u serumu.
Reference
Buchs NC, Gervaz P, Secic M, Bucher P, Mugnier-Konrad B, Morel P. Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Int J Colorectal Dis 2008; 23(3): 265−70.
Trencheva K, Morrissey KP, Wells M, Mancuso CA, Lee SW, Sonoda T, et al. Identifying important predictors for anastomotic leak after colon and rectal resection: prospective study on 616 patients. Ann Surg 2013; 257(1): 108−13.
Nesbakken A, Nygaard K, Lunde OC. Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer. Br J Surg 2001; 88(3): 400−4.
Koperna T. Cost-effectiveness of Defunctioning Stomas in Low Anterior Resections for Rectal Cancer. Arch Surg 2003; 138(12): 1334−8.
Walker KG, Bell SW, Rickard MJ, Mehanna D, Dent OF, Chapuis PH, et al. Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer. Ann Surg 2004; 240(2): 255−9.
Ptok H, Marusch F, Meyer F, Schubert D, Gastinger I, Lippert H. Impact of anastomotic leakage on oncological outcome after rectal cancer resection. Br J Surg 2007; 94(12): 1548−54.
Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg 2011; 253(5): 890−9.
Peeters KC, Tollenaar RA, Marijnen CA, Klein KE, Steup WH, Wiggers T, et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg 2005; 92(2): 211−6.
Jestin P, Påhlman L, Gunnarsson U. Risk factors for anastomotic leakage after rectal cancer surgery: a case-control study. Colorectal Dis 2008; 10(7): 715−21.
Komen N, Dijk J, Lalmahomed Z, Klop K, Hop W, Kleinrensink G, et al. After-hours colorectal surgery: a risk factor for anastomotic leakage. Int J Colorectal Dis 2009; 24(7): 789−95.
Matthiessen P, Hallböök O, Rutegård J, Simert G, Sjödahl R. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg 2007; 246(2): 207−14.
Kostić Z, Panišić M, Milev B, Mijušković Z, Slavković D, Ignjatović M. Diagnostic value of serial measurement of C-reactive protein in serum and matrix metalloproteinase-9 in drainage fluid in the detection of infectious complications and anastomotic leakage in patients with colorectal resection. Vojnosanit Pregl 2015; 72(10): 889–98.
Welsch T, Müller SA, Ulrich A, Kischlat A, Hinz U, Kienle P, et al. C-reactive protein as early predictor for infectious postoperative complications in rectal surgery. Int J Colorectal Dis 2007; 22(12): 1499−507.
Matthiessen P, Henriksson M, Hallböök O, Grunditz E, Norén B, Arbman G. Increase of serum C-reactive protein is an early indicator of subsequent symptomatic anastomotic leakage after anterior resection. Colorectal Dis 2008; 10(1): 75−80.
Miki C, Mohri Y, Toiyama Y, Araki T, Tanaka K, Inoue Y, et al. Glasgow Prognostic Score as a predictive factor differentiating surgical site infection and remote infection following colorectal cancer surgery. Br J Cancer 2009; 101(9): 1648−9.
Moyes LH, Leitch EF, McKee RF, Anderson JH, Horgan PG, McMillan DC. Preoperative systemic inflammation predicts postoperative infectious complications in patients undergoing curative resection for colorectal cancer. Br J Cancer 2009; 100(8): 1236−9.
Cong Z, Fu C, Wang H, Liu L, Zhang W, Wang H. Influencing factors of symptomatic anastomotic leakage after anterior resection of the rectum for cancer. World J Surg 2009; 33(6): 1292−7.
Daams F, Luyer M, Lange JF. Colorectal anastomotic leakage: aspects of prevention, detection and treatment. World J Gastroenterol 2013; 19(15): 2293−7.
Shiomi A, Ito M, Saito N, Hirai T, Ohue M, Kubo Y, et al. The indications for a diverting stoma in low anterior resection for rectal cancer: a prospective multicentre study of 222 patients from Japanese cancer centers. Colorectal Dis 2011; 13(12): 1384−9.
Rickert A, Willeke F, Kienle P, Post S. Management and outcome of anastomotic leakage after colonic surgery. Colorectal Dis 2009; 12(10): 216−23.
Krarup PM, Jorgensen LN, Andreasen AH, Harling H. A nationwide study on anastomotic leakage after colonic cancer surgery. Colorectal Dis 2012; 14(10): 661−7.
Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 2010; 147(3): 339−51.
Kingham TP, Pachter PL. Colonic anastomotic leak: risk factors, diagnosis, and treatment. J Am Coll Surg 2009; 208(2): 268−78.
Alves A, Panis Y, Trancart D, Regimbeau J, Pocard M, Valleur P. Factors associated with clinically significant anastomotic leakage after large bowel resection: multivariate analysis of 707 patients. World J Surg 2002; 26(4): 499−502.
Thornton M, Joshi H, Vimalachandran C, Heath R, Carter P, Gur U, et al. Management and outcome of colorectal anastomotic leaks. Int J Colorectal Dis 2011; 26(3): 313−20.
Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis 2004; 39(2): 206−17.
Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 1999; 340(6): 448−54.
Vigushin DM, Pepys MB, Hawkins PN. Metabolic and scintigraphic studies of radioiodinated human C-reactive protein in health and disease. J Clin Invest 1993; 91(4): 1351−7.
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; 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; 34(1): 140−6.
MacKay GJ, Molloy RG, O'Dwyer PJ. C-reactive protein as a predictor of postoperative infective complications following elective colorectal resection. Colorectal Dis 2011; 13(5): 583−7.
Ortega-Deballon P, Radais F, Facy O, D'Athis P, Masson D, Charles PE, et al. C-reactive protein is an early predictor of septic complications after elective colorectal surgery. World J Surg 2010; 34(4): 808−14.
Karliczek A, Jesus EC, Matos D, Castro AA, Atallah AN, Wiggers T. Drainage or nondrainage in elective colorectal anastomosis: a systematic review and meta-analysis. Colorectal Dis 2006; 8(4): 259−65.
Tsujinaka S, Konishi F. Drain vs No Drain After Colorectal Surgery. Indian J Surg Oncol 2011; 2(1): 3−8.
Komen N, de Bruin RW, Kleinrensink GJ, Jeekel J, Lange JF. Anastomotic leakage, the search for a reliable biomarker. A review of the literature. Colorectal Dis 2008; 10(2): 109−15.
Warschkow R, Tarantino I, Torzewski M, Näf F, Lange J, Steffen T. Diagnostic accuracy of C-reactive protein and white blood cell counts in the early detection of inflammatory complications after open resection of colorectal cancer: a retrospective study of 1,187 patients. Int J Colorectal Dis 2011; 26(11): 1405−13.