• Intraoperative colonoscopy
• Multisegment colectomy
• SMCRC
• Synchronous colorectal cancer
• Tibetan patient

• Humans
• Anastomotic Leak/diagnosis
• Anastomotic Leak/etiology
• Male
• Female
• Middle Aged
• Prospective Studies
• Drainage
• Rectal Neoplasms/surgery
• Rectal Neoplasms/diagnosis
• Aged
• Bile Acids and Salts/blood
• Bile Acids and Salts/analysis
• Bile Acids and Salts/metabolism
• Patient Discharge
• Minimally Invasive Surgical Procedures/adverse effects
• Early Diagnosis
• Adult
• C-Reactive Protein/analysis
• Predictive Value of Tests

• Humans
• Female
• Prospective Studies
• Male
• Middle Aged
• Biomarkers/blood
• Biomarkers/analysis
• Postoperative Complications/etiology
• Anastomosis, Surgical/adverse effects
• Aged
• L-Lactate Dehydrogenase/analysis
• L-Lactate Dehydrogenase/blood
• Ascitic Fluid/metabolism
• Lactic Acid/blood
• Lactic Acid/analysis
• Immunoglobulin A/analysis
• Immunoglobulin A/blood
• Colorectal Neoplasms/surgery
• Surgical Wound Dehiscence/etiology
• Adult
• Serum Albumin/analysis

• Anastomotic leakage model
• Diagnostic technique
• Diagnostic test
• Gut leakage
• Indocyanine green

• Anastomotic leakage
• Bacterial collagenase
• Colorectal surgery
• Complications
• Gut microbiome

• Humans
• Anastomotic Leak/etiology
• Colorectal Surgery/adverse effects
• Digestive System Surgical Procedures
• Collagenases
• Bacteria

• Department of Surgery, Holbæk Hospital
• House of Research, Holbæk Hospital
• The Research Foundation of Region Zealand
• The Vissing Foundation
• The Danish Cancer Society
• Dagmar Marshalls Foundation

• biomarkers
• colon
• interleukin-10
• meta-analysis
• rectum
• review

• Humans
• Interleukin-10
• Anastomotic Leak/diagnosis
• Anastomotic Leak/etiology
• Reproducibility of Results
• Cytokines
• Biomarkers
• Colorectal Neoplasms/surgery

• Partial mesorectal excision (PME)
• Rectal cancer
• Systematic review
• Total mesorectal excision (TME)
• Tumour-specific mesorectal excision (TSME)

• Humans
• Rectal Neoplasms/surgery
• Rectal Neoplasms/pathology
• Postoperative Complications/epidemiology
• Postoperative Complications/surgery
• Retrospective Studies
• Systematic Reviews as Topic
• Anastomotic Leak/epidemiology
• Anastomotic Leak/surgery
• Treatment Outcome
• Rectum/surgery
• Rectum/pathology
• Laparoscopy

• anastomosis
• anastomotic leakage
• colon cancer
• colorectal cancer
• colorectal surgery
• scoring systems

• Humans
• Anastomotic Leak/epidemiology
• Anastomotic Leak/etiology
• Colorectal Surgery
• Hernia, Inguinal/surgery
• Digestive System Surgical Procedures

• Swedish state
• Mary von Sydow's Foundation
• Knut and Alice Wallenberg Foundation
• Swedish Society of Medicine

• Crohn’s disease
• NOD2
• anastomosis
• ileocecal healing
• matrix
• matrix metalloproteinase
• microbiome
• muramy-dipeptide

• BE 6292/1-1 Deutsche Forschungsgemeinschaft

• anastomotic leakage
• biomarkers
• early prediction
• nomogram
• rectal cancer
• symptomatic

• Anastomotic leak
• C-reactive protein
• Colorectal surgery
• Procalcitonin

Background and Objectives: The aim of our study was to evaluate the value of leukocyte, C reactive protein (CRP), procalcitonin, lactate, and carcinoembryonic antigen (CEA) in blood and peritoneal fluid in early recognition of anastomotic leak (AL) after colorectal resections. Materials and Methods: Our pilot prospective cohort study was conducted at the abdominal surgery department at University Medical Center Ljubljana. A total of 43 patients who underwent open or laparoscopic colorectal resection because of benign or malignant etiology were enrolled. All of the patients had primary anastomosis without stoma formation. Results: Three patients in our patient group developed AL (7%). We found a statistically significant elevation of serum lactate levels in patients that developed AL compared to those who did not but noted no statistically relevant difference in the blood or peritoneal fluid levels of other biochemical markers. Conclusions: Elevated lactate levels may be considered a promising biomarker for the early diagnosis of AL, but more research on bigger patient groups is warranted.

• anastomosis
• anastomotic leak
• biochemical markers
• carcinoembryonic antigen
• colorectal surgery
• lactate
• peritoneal fluid

To explore the risk factors of anastomotic leakage (AL) after laparoscopic anterior resection (AR) of rectal cancer and establish a nomogram prediction model.

Clinical and surgical data of patients who underwent AR of rectal cancer at Sichuan Cancer Hospital from January 2017 to December 2020 were retrospectively collected. Univariate and multivariate logistic regression analyses were used to screen the independent risk factors of AL after AR. A nomogram risk prediction model was established based on the selected independent risk factors and the predictive performance of nomogram was evaluated.

A 1013 patients undergoing laparoscopic AR were included, of which 67 had AL, with an incidence of 6.6%. Univariate and multivariate logistic regression analyses showed that male gender, tumors distance from the anus verge of ≤ 5cm, tumors distance from the anus verge of 5–10cm, circumferential tumor growth, operation time ≥ 240min, and no diverting stoma were independent risk factors for AL after AR. A nomogram prediction model was established based on these results. The calibration curve showed that the predicted occurrence probability of the nomogram model was in good agreement with the actual occurrence probability. The area under the receiver operating characteristic (ROC) curve was 0.749.

The nomogram prediction model based on the independent risk factors of patients undergoing AL after AR can effectively predict the probability of AL.

Postoperative colorectal anastomotic leakage (CAL) is a devastating complication following colorectal resection. However, the diagnosis of anastomotic leakage is often delayed because the current methods of identification are unable to achieve 100% clinical sensitivity and specificity. This meta-analysis aimed to evaluate the predictive value of peritoneal fluid cytokines in the detection of CAL following colorectal surgery.

A comprehensive search was conducted on PubMed, Embase, Cochrane Library, and Web of Science before June 2021 to retrieve studies regarding peritoneal fluid cytokines as early markers of CAL. Pooled analyses of interleukin (IL)-1β, IL-6, IL-10, and tumor necrosis factor (TNF) were performed. The means (MD) and standard deviations (SD) of the peritoneal fluid cytokines were extracted from the included studies. Review Manager Software 5.3 was used for data analysis.

We included eight studies with 580 patients, among which 85 (14.7%) and 522 (44.5%) were evaluated as the CAL and non-CAL groups, respectively. Compared to the non-CAL group, the CAL group had significantly higher peritoneal IL-6 levels on postoperative day (POD) 1–3 (P = 0.0006, 0.0002, and 0.002, respectively) and slightly higher TNF levels on POD 4 (P = 0.0002). Peritoneal levels of IL-1β and IL-10 were not significantly different between the two groups in this study.

Peritoneal IL-6 levels can be a diagnostic marker for CAL following colorectal surgery, whereas the value of TNF needs further exploration in the future.

[https://www.crd.york.ac.uk/prospero/#myprospero], PROSPERO (CRD42021274973)

• National Natural Science Foundation of China
• Beijing Municipal Natural Science Foundation

• amylase
• anastomotic leak
• biomarker
• drain fluid
• rectal cancer
• rectal resection

• anastomotic leakage
• colorectal cancer
• gut microbiota
• prevention
• risk factor

Anastomotic leakage (AL) is a severe complication after colorectal surgery. This study aimed to investigate a method for the early diagnosis of AL after surgical resection by analysing inflammatory factors (IFs) in peritoneal drainage fluid.

Abdominal drainage fluid of patients with colorectal cancer who underwent resection between April 2017 and April 2018, were prospectively collected in the postoperative interval. Six IFs, including interleukin (IL)-1β, IL-6, IL-10, tumour necrosis factor (TNF)-α, matrix metalloproteinase (MMP)2, and MMP9, in drainage were determined by multiplex immunoassay to investigate AL (in patients undergoing resection and anastomosis) and pelvic collection (in patients undergoing abdominoperineal resection). Sparreboom and colleagues’ prediction model was first evaluated for AL/pelvic collection, followed by a new IF-based score system (AScore) that was developed by a least absolute shrinkage and selection operator (LASSO) regression, for the same outcomes. The model performance was tested for the area under the curve (AUC), sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV).

Out of 123 patients eligible, 119 patients were selected, including 12 patients with AL/pelvic collection. Sparreboom and colleagues’ prediction model was documented with the best diagnostic efficacy on postoperative day 3 (POD3), with an AUC of 0.77. After optimization, AScore on POD3 increased the AUC to 0.83 and on POD1 showed the best diagnostic efficiency, with an AUC of 0.88. Based on the Youden index, the cut-off value of AScore on POD1 was set as −2.46 to stratify patients into low-risk and high-risk groups for AL/pelvic collection. The model showed 90.0 per cent sensitivity, 69.7 per cent specificity, 98.4 per cent NPV, and 25.0 per cent PPV.

The early determination of IFs in abdominal drainage fluid of patients undergoing colorectal surgery could be useful to predict AL or pelvic collection.

• Anastomotic Leak/diagnosis
• Anastomotic Leak/etiology
• Colorectal Neoplasms/surgery
• Colorectal Surgery
• Digestive System Surgical Procedures
• Early Detection of Cancer
• Humans

• Anastomosis
• Anastomotic leak
• Colorectal cancer surgery
• Cytokines
• Peritoneal drain

• anastomotic leak
• biomarkers
• colorectal surgery
• drain fluid
• umbrella systematic review

• Colorectal cancer
• Fluorescence-guided surgery
• Of vital structures
• Sentinel lymph node imaging
• Tumour imaging
• imaging of perfusion

A successful innovative medical device is not only technically challenging to develop but must also be readily usable to be integrated into health care professionals’ daily practice. Through a user-centered design (UCD) approach, usability can be improved. However, this type of approach is not widely implemented from the early stages of medical device development.

The case study presented here shows how UCD may be applied at the very early stage of the design of a disruptive medical device used in a complex hospital environment, while no functional device is available yet. The device under study is a connected sensor system to detect colorectal anastomotic leakage, the most detrimental complication following colorectal surgery, which has a high medical cost. We also aimed to provide usability guidelines for the initial design of other innovative medical devices.

UCD was implemented by actively involving health care professionals and all the industrial partners of the project. The methodology was conducted in 2 European hospitals: Grenoble-Alpes University Hospital (France) and Erasmus Medical Center Rotterdam (the Netherlands). A total of 6 elective colorectal procedures and 5 ward shifts were observed. In total, 4 workshops were conducted with project partners and clinicians. A formative evaluation was performed based on 5 usability tests using nonfunctional prototype systems. The case study was completed within 12 months.

Functional specifications were defined for the various components of the medical device: device weight, size, design, device attachment, and display module. These specifications consider the future integration of the medical device into current clinical practice (for use in an operating room and patient follow-up inside the hospital) and interactions between surgeons, nurses, nurse assistants, and patients. By avoiding irrelevant technical development, this approach helps to promote cost-effective design.

This paper presents the successful deployment over 12 months of a UCD methodology for the design of an innovative medical device during its early development phase. To help in reusing this methodology to design other innovative medical devices, we suggested best practices based on this case.

• Anastomotic leak
• C-reactive protein
• Colorectal surgery

• Anastomotic leakage
• Colorectal surgery
• Complications
• Matrix metalloproteinase

• Anastomosis, Surgical
• Anastomotic Leak/etiology
• Animals
• Colorectal Surgery/adverse effects
• Digestive System Surgical Procedures
• Humans
• Matrix Metalloproteinase 9

• University Medical Center Rotterdam (Erasmus MC)