Prediction and diagnosis of colorectal anastomotic leakage: A systematic review of literature

Table 3 Drain fluid analysis

Aauthor	Type ofstudy	Loe	n (CAL /non-CAL)	Colorectal/rectum	Stapled/handsewn anastomosis	Study subject/tool	Main outcome	Onset CAL (POD)
Bertram et al[36]	Pro	4	3/28	Colorectal	?	Cytokines	No correlation between IL-6, TNF-alpha and CAL	5.3
Herwig et al[34]	Pro	3b	12/24	Colorectal	?	Cytokines	IL-6 and TNF-alpha elevated from POD 1 in CAL	5.8
Yamamoto et al[35]	Pro	3b	7/90	Colorectal	Stapled	Cytokines	IL-1beta, IL-6, TNF-alpha elevated from POD 3 in CAL	5-8
Ugras et al[32]	Pro	3b	4/34	Colorectal	Both	Cytokines	IL-6, IL-10, TNF-alpha elevated from POD 1 in CAL	6
Fouda et al[31]	Pro	3b	8/56	Rectum	Both	Cytokines	IL-6, IL-10 elevated from POD 1 in CAL, TNF-alpha elevated from POD 2 in CAL	6
Mattiessen et al[33]	Pro	3b	7/23	Rectum	?	Microdialysis, cytokines	L/P-ratio elevated at POD 5/6 in CAL; IL-6, IL-10, TNF-alpha elevated from POD 1 in CAL	Early CAL: 6 Late CAL: 20
Ellebaek et al[37]	Pro	3b	4/50	Colorectal	?	Microdialysis	Mean L/P-ratio higher in CAL,	Early CAL: 5-10 Late CAL: 20
Tsujinaka et al[38]	Pro	3b	21/196	Rectum	Both	Drainproduction	15/21 Patients with CAL had changes in drain content	7
Eckmann et al[39]	Retro	3b	30/306	Rectum	Stapled	Drainproduction	80% of leakages were indicated by drain, 40% of which prior to clinical symptoms	?
Millan et al[40]	Pro	3b	6/90	Colorectal	Stapled	Intramucosal pH	Intramucosal pH < 7.28 on POD1 increases risk of CAL 22 fold	?
Junger et al[41]	Pro	3b	3/22	Colorectal	Both, biodegradable ring	LPS	Excretion of LPS and LPS concentration is higher at POD 3 in CAL	6,7
Miller et al[42]	Pro	2b	2/42	Rectum	Stapled	Lysozym activity	No correlation between lysozyme activity and CAL	?

Pro: Prospective; Retro: Retrospective; Loe: Level of evidence; CAL: Colorectal anastomotic leakage; LPS: Lipopolysaccharides; IL: Interleukin; TNF: Tumour necrosis factor; POD: Postoperative day.