Endotoxin in drainage fluid as an early and predictive marker of anastomotic leakage after colorectal surgery.

PURPOSE: To assess the predictive value of the endotoxin (ET) assay for the detection of anastomotic leakage (AL) after colorectal surgery (CRS).

METHODS

ET levels in the drainage fluid were measured using endotoxin scattering photometry (ET-ESP) and turbidimetric (ET-TUB) assays on postoperative day (POD) zero, POD1 and POD3, comparing tumor necrosis factor (TNF)-α.

RESULTS

AL was observed in 8 (4.9%) of the 162 patients. ET-ESP, ET-TUB, and TNF-α levels on POD0 and serum C-reactive protein (CRP) on POD1 were significantly elevated in the AL group. The area under the receiver operating characteristic curve (AUROC) for ET-ESP level (0.903) on POD0 showed early and better predictive performance for AL compared to that for ET-TUB (0.869, p = 0.230) and TNF-α (0.758, p = 0.034) levels on POD0; the AUROC for CRP level (0.711) on POD1 was inferior to other parameters. In subgroup analysis, five (3.7%) of 136 patients with colorectal cancer (CRC) developed AL. Additionally, the ET-ESP level on POD0 showed relatively good predictive performance for AL after CRC (AUROC: ET-ESP [0.871], ET-TUB [0.840], and TNF-α [0.737] on POD0).

CONCLUSION

ET levels in drainage fluid, especially those measured using ESP, on POD0 may have an early predictive ability to detect AL post-CRS.