Significant elevation of carcinoembryonic antigen levels in abdominal drains after colorectal surgery may indicate early anastomotic dehiscence


      • There is no clinical marker for early detection of anastomotic leak after colorectal surgery.
      • In this study, we found that postoperative peritoneal drain fluid CEA levels of patients with early anastomotic leaks were significantly elevated compared to patients who had later leaks, other postoperative complications, or uneventful recovery (P < .001).
      • These high CEA levels (above 1,000 ng/mL) were evident as early as 6 hours after surgery and throughout postoperative days 1 to 2.
      • In conclusion, elevated drain CEA following colorectal surgery indicates anastomotic dehiscence but not predict late leaks.



      Anastomotic leak after colorectal surgery is a severe complication leading to major postoperative morbidity and mortality. Leaks typically present on the 5th to 6th postoperative days; however, early anastomotic dehiscence occurs occasionally. This study evaluated carcinoembryonic antigen (CEA) levels in abdominal drains after colorectal resection to assess its potential as an early marker to predict anastomotic leaks.


      This prospective study included 105 patients undergoing elective colorectal surgery. Fluids from the patients' abdominal drain system were sampled daily for up to 3 days after surgery and evaluated for CEA levels.


      Early anastomotic dehiscence occurred in 3 patients (2.8%) and was associated with a significant elevation of CEA in drain fluids (above 1,000 ng/mL). However, in patients who developed late leaks (7 patients, 6.7%) no significant elevation of CEA was observed.


      Significant elevation of CEA levels in abdominal drains in the early postoperative period may indicate early anastomotic dehiscence.


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        • Hyman N.
        • Manchester T.L.
        • Osler T.
        • et al.
        Anastomotic leaks after intestinal anastomosis. It's later than you think.
        Ann Surg. 2007; 245: 254-258
        • Cini C.
        • Wolthuis A.
        • D'Hoore A.
        Peritoneal fluid cytokines and matrix metalloproteinases as early markers of anastomotic leakage in colorectal anastomosis: a literature review and meta-analysis.
        Colorectal Dis. 2013; 15: 1070-1077
        • Ellebaek Pedersen M.
        • Qvist N.
        • Bisgaard C.
        • et al.
        Peritoneal microdialysis. Early diagnosis of anastomotic leakage after low anterior resection for rectosigmoid cancer.
        Scand J Surg. 2009; 98: 148-154
        • Komen N.
        • Slieker J.
        • Willemsen P.
        • et al.
        Acute phase proteins in drain fluid: a new screening tool for colorectal anastomotic leakage? The APPEAL study: analysis of parameters predictive for evident anastomotic leakage.
        Am J Surg. 2014; 208: 317-323
        • Novis B.H.
        • Gluck E.
        • Thomas P.
        • et al.
        Serial levels of CA 19-9 and CEA in colonic cancer.
        J Clin Oncol. 1986; 4: 987-993
        • Kim Y.
        • Lee S.
        • Park S.
        • et al.
        Gastrointestinal tract cancer screening using fecal carcinoembryonic antigen.
        Ann Clin Lab Sci. 2003; 33: 32-38
        • Berkovich L.
        • Shpitz B.
        • Ghinea R.
        • et al.
        Evaluation of peritoneal CEA levels following colorectal cancer surgery.
        J Surg Oncol. 2014; 110: 458-462
        • Salvans S.
        • Mayol X.
        • Alonso S.
        • et al.
        Postoperative peritoneal infection enhances migration and invasion capacities of tumor cells in vitro: an insight into the association between anastomotic leak and recurrence after surgery for colorectal cancer.
        Ann Surg. 2014; 260: 939-943
        • Thompson S.K.
        • Chang E.Y.
        • Jobe B.A.
        Clinical review: healing in gastrointestinal anastomoses, part I.
        Microsurgery. 2006; 26 (review): 131-136
        • Thornton F.J.
        • Barbul A.
        Healing in the gastrointestinal tract.
        Surg Clin North Am. 1997; 77: 549-573

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