Highlights
- •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.
Abstract
Background
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.
Methods
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.
Results
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.
Conclusions
Significant elevation of CEA levels in abdominal drains in the early postoperative
period may indicate early anastomotic dehiscence.
Keywords
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References
- Anastomotic leaks after intestinal anastomosis. It's later than you think.Ann Surg. 2007; 245: 254-258
- 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
- Peritoneal microdialysis. Early diagnosis of anastomotic leakage after low anterior resection for rectosigmoid cancer.Scand J Surg. 2009; 98: 148-154
- 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
- Serial levels of CA 19-9 and CEA in colonic cancer.J Clin Oncol. 1986; 4: 987-993
- Gastrointestinal tract cancer screening using fecal carcinoembryonic antigen.Ann Clin Lab Sci. 2003; 33: 32-38
- Evaluation of peritoneal CEA levels following colorectal cancer surgery.J Surg Oncol. 2014; 110: 458-462
- 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
- Clinical review: healing in gastrointestinal anastomoses, part I.Microsurgery. 2006; 26 (review): 131-136
- Healing in the gastrointestinal tract.Surg Clin North Am. 1997; 77: 549-573
Article info
Publication history
Published online: June 13, 2016
Received in revised form:
March 5,
2016
Received:
December 1,
2015
Footnotes
There were no relevant financial relationships or any sources of support in the form of grants, equipment, or drugs.
The authors declare no conflicts of interest.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
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- RE: “Significant elevation of carcinoembryonic antigen levels in abdominal drains after colorectal surgery may indicate early anastomotic dehiscence” – Berkovich et alThe American Journal of SurgeryVol. 213Issue 6
- PreviewGiven the morbidity and mortality associated with anastomotic leaks, innovative research into predictive markers is welcomed. There are many positive aspects to the study including the prospective nature and inclusion of a range of patients; despite the small sample size. The methodology of sample collection and the data was presented well, with results appearing significant. As stated in the paper, this original study will hopefully encourage further research to include larger sample size.
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