Role of indexed oxygen delivery in anastomotic insufficiencies in elective laparoscopic colorectal resections for cancer: a prospective observational cohort study.

Colorectal cancer is the third most frequently diagnosed neoplasm in the world. Surgical resection is the cornerstone of therapy and the outcome is closely related to the quality of preoperative staging, surgical technique, occurrence of complications, and proper multidisciplinary treatment of the patient. The minimally invasive technique led to a significant reduction in general and local complications, but the most important and frequent local complication, anastomotic leakage (AL), is still an unresolved problem. This observational study aimed to evaluate the role of indexed oxygen delivery (DO2I) in the genesis of anastomotic leakage in patients undergoing elective laparoscopic resection surgery for colorectal cancer. Patients referred to the Department of General Surgery of the S. Eugenio Hospital in Rome, suffering from neoplasia of the colon-rectum, were enrolled. Intraoperatively, in addition to complete noninvasive monitoring, noninvasive hemodynamic monitoring was applied for cardiac output calculation. Non-invasive monitoring for oxyphoretic and haemoglobin calculation was also applied. The DO2I was calculated and the patients were divided into three groups (A, B, C). 3 cases of AL were observed. Patients who developed anastomotic leakage had lower than average DO2I values, in one case the lowest value observed in the entire series of cases. Patients with low DO2I had the highest incidence of postoperative surgical complications and anastomosis failure. Analysis of these data suggests a relationship between the incidence and severity of AL and the mean DO2I. A systematic proactive optimization of DO2I could be associated to a reduction of anastomotic leakage rate.