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©2014 Baishideng Publishing Group Co.
World J Gastrointest Surg. Feb 27, 2014; 6(2): 14-26
Published online Feb 27, 2014. doi: 10.4240/wjgs.v6.i2.14
Published online Feb 27, 2014. doi: 10.4240/wjgs.v6.i2.14
Table 1 Clinical methods
Author | Type ofstudy | Loe | n (CAL/non-CAL) | Colorectal/rectum | Stapled/handsewn anastomosis | Study subject/tool | Se | Sp | PPV | NPV | ROC | Main outcome | |
Dekker et al[22] | Pro | 3b | 10/121 | Colorectal | ? | Leakage score | - | - | - | - | 0.95 | OR = 1.74 for leakage score predictive of CAL | |
den Dulk et al[23] | Pro | 2b | 21/223 | Colorectal | Both | Leakage score | - | - | - | - | - | Delay of treatment reduced from 4 d to 1.5 d | |
Sutton et al[18] | Pro | 3b | 22/398 | Colorectal | ? | Clinical symptoms | 0.33 | 0.97 | 0.59 | 0.93 | Over 40% of patients with cardiac event has CAL | ||
Haase et al[19] | Pro | 4 | 3/40 | Colorectal | ? | Clinical symptoms | - | - | - | - | - | No difference in heart rate variability between CAL and non-CAL | |
Ghariani et al[17] | Retro | 3b | 23/314 | Colon | ? | Clinical symptoms | - | - | - | - | - | Respiratory, neurological disorders and bloating precipitate CAL | |
Bellows et al[16] | Retro | 3b | 25/311 | Colorectal | ? | Clinical symptoms | Respiratory symptoms | 0.52 | 0.84 | 0.22 | 0.95 | - | Respiratory, neurological disorders and abdominal pain and distension precipitate CAL |
Neurology symptoms | 0.24 | 0.97 | 0.4 | 0.94 | - | ||||||||
Abdominal pain and distension | 0.52 | 0.83 | 0.21 | 0.95 | - | ||||||||
Nesbakken et al[20] | Pro | 3b | 5/56 | Rectum | ? | Clinical symptoms | Daily assessment by surgeon | 0.50 | 0.89 | 0.5 | 0.89 | - | 50% of CAL is silent |
Tang et al[21] | Pro | 3b | 10/195 | Rectum | Both | Digital rectal examination | 0.98 | - | - | - | - | As valuable as WSCE before stoma closure | |
Pettigrew et al[13] | Pro | 3b | 28/113 | Colorectal and general | ? | Risk prediction by surgeon | 0.38 | 0.91 | 0.56 | 0.82 | Highest predictive value for postop surg assessment | ||
Makela et al[14] | Retro | 3b | 44/88 | Rectum | Both | Risk prediction by surgeon | - | - | - | - | - | In 86% of pts with > 3 risk factors CAL occurs | |
Karliczek et al[15] | Pro | 3b | 26/191 | Colorectal | ? | Risk prediction by surgeon | High anastomosis | 0.38 | 0.46 | - | - | - | Low predictive value for prediction of CAL by surgeon |
Low anastomosis | 0.62 | 0.52 | - | - | - |
Table 2 Laboratory tests
Author | Type of study | Loe | n (CAL/non-CAL) | Colorectal/rectum | Stapled/handsewn anastomosis | Study subject/tool | Cut-off value | Se | Sp | PPV | NPV | ROC | Main outcome | OnsetCAL(POD) |
Slotwinksi et al[29] | Pro | 3b | 2/16 | Colorectal | ? | sTNF-R1, IL-1RA/-6/-8/-10, CRP | - | - | - | - | - | - | TNF higher at POD 1 in CAL | ? |
Iversen et al[30] | Pro | 3b | 17/341 | Colorectal | Both | s-Fibrin, TAT-complex, PT-f1/-2 | - | - | - | - | - | - | PT-f1/-2, TAT-complex, s-Fibrin higher at POD 1/2 in CAL | 7 |
Woeste et al[25] | Retro | 3b | 26/342 | Colorectal | Both | CRP | - | - | - | - | - | - | CRP higher from POD 3 to POD 7 in CAL | 8,7 |
Warschkow et al[24] | Meta | 3a | ?/1832 | Colorectal | Both | CRP | 135 mg/L at POD 4 | 0.680 | 0.830 | 0.560 | 0.89 | - | CRP < 135 mg/L at POD 4 discharge is safe | ? |
Kornerin et al[24] | Retro | 3b3 | 18/231 | Colorectal | Both | CRP | 190 mg/L at POD 3 | 0.820 | 0.730 | - | - | 0.820 | Persisting elevation of CRP is indicative for CAL | 8 |
Mackayin et al[24] | Pro | 3b3 | 5/160 | Colorectal | ? | CRP | 145 mg/L at POD 4 | 0.850 | 0.860 | 0.610 | 0.96 | - | CRP > 145 mg/L at POD 4 is highly predictive for CAL | ? |
Ortegain et al[24] | Pro | 3b3 | 21/133 | Colorectal | Both | CRP | 125 mg/L at POD 4 | 0.820 | 0.960 | - | - | - | CRP > 125 mg/L at POD 4 discharge is not safe | 6 |
Welschin et al[24] | Pro | 3b3 | 22/961 | Rectum | Staples | CRP | 140 mg/L at POD 3 | 0.802 | 0.812 | 0.862 | - | - | Persisting elevation of CRP is indicative for CAL | 8 |
Warschkowin et al[24] | Retro | 3b3 | 89/1115 | Colorectal | ? | CRP | 143 mg/L at POD 4 | 0.750 | 0.710 | 0.190 | 0.97 | - | Use CRP as screening at POD 4 | 9 |
Platt et al[26] | Pro | 3b | 26/454 | Colorectal | Both | CRP | 190 mg/L at POD 3 | 0.772 | 0.802 | - | - | 0.892 | CRP at POD 3 is useful for predicting CAL | 6-8 |
Matthiessen et al[27] | Pro | 3b | 9/33 | Rectum | ? | CRP | - | - | - | - | - | - | CRP higher from POD 2 in CAL | 8 |
Almeida et al[28] | Retro | 3b | 24/149 | Colorectal | ? | CRP | 140 mg/L at POD 3 | 0.780 | 0.860 | - | - | - | CRP sign higher from POD 2 in CAL | 7 |
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 | ? |
Table 4 Intra-operative techniques
Author | Type of study | Loe | n (CAL/non-CAL | Colorectal/rectum | Stapled/handsewn anastomosis | Test | Testper-formed | Test + | Intra-operative correction | CAL test+ | Test - | CAL test- | Test not per-formed | CALtest not per-formed | Mainoutcome |
Beard et al[43] | Pro | 1b | 13/145 | Colorectal | Both | ALT | 73 | 18 | 18 | 3 | 55 | 0 | 70 | 10 | ALT and preoperative repair reduce risk of AL |
Davies et al[44] | Pro | 3b | 4/33 | Rectum | ? | ALT | 33 | 6 | 6 | 1 | 27 | 3 | - | - | LT helpful to reduce leakage rate |
Dixon et al[45] | Retro | 3b | 2/202 | Rectum | Both | ALT | 119 | 5 | 5 | 0 | 114 | 0 | - | - | Leaks were avoided |
Gilbert et al[46] | Retro | 3b | 1/21 | Colorectal | Handsewn | ALT | 21 | 5 | 5 | 1 | 16 | 0 | - | - | ALT facilitates IOR |
Lazorthes et al[47] | Pro | 3b | 3/82 | Colorectal | Stapled, doughnut complete 68 | ALT | 68 | 0 | 0 | 0 | 68 | 3 | - | - | High NPV for ALT |
Stapled, doughnut incomplete 14 | 14 | 4 | 4 | 0 | 10 | 0 | - | - | |||||||
Ricciardi et al[48] | Retro | 3b | 48/998 | Colorectal | Both | ALT | 825 | 65 | 65 | 5 | 760 | 29 | 173 | 14 | ALT for leftsided anastomosis |
Schmidt et al[49] | Pro | 3b | 68/933 | Rectum | Both | ALT | 260 | 47 | 42 | 5 | 213 | 22 | 36 | 4 | Risk of AL is unrelated to ALT |
Wheeler et al[50] | Pro | 4 | 7/102 | Colorectal | ? | ALT | 99 | 21 | 21 | 2 | 85 | 2 | - | - | LT facilitates IOR |
Yalin et al[51] | Po | 3b | 1/23 | Colo-rectal | Stapled | ALT | 21 | 5 | 5 | 1 | 16 | 0 | - | - | LT facilitates IOR |
Griffith et al[54] | Pro | 4 | 2/60 | Colorectal | Stapled | ALT | 60 | 11 | 11 | 0 | 49 | 2 | - | - | ALT facilitates IOR |
Sakanoue et al[55] | Pro | 3b | 4/70 | Rectum | ? | ALT | 35 | 2 | 2 | 0 | 33 | 0 | 35 | 4 | Useful for intraoperative decision making |
Smith et al[53] | Pro | 4 | 7/229 | Colon | Both | ALT | 229 | 16 | 16 | 0 | 213 | 7 | - | - | After IOR no CAL occurred |
Lanthaler et al[56] | Pro | 3b | 6/122 | Colorectal | Stapled | IOE | 73 | 5 | 5 | 0 | 68 | 4 | 49 | 2 | ALT prevents early leak |
Li et al[57] | Pro | 3b | 2/244 | Rectum | Stapled | IOE | 107 | 11 | 11 | 0 | 96 | 0 | 137, 30 IOC1 | 2/137, 1/30 | Routine IOE and selective IOE equal results |
Shamiyeh et al[58] | Pro | 3b | 7/253 | Rectum | Stapled | IOE | 85 | 2 | 2 | 0 | 83 | 1 | 253 | 4 | Routine IOE does not reduce CAL |
Ishihara et al[52] | Pro | 4 | 1/73 | Rectum | Stapled | IOE and ALT | 73 | 4 | 4 | 0 | 69 | 1 | - | - | ALT recommended |
Ambrosetti et al[59] | Pro | 4 | 2/200 | Colorectal | Both | Doppler ultra-sound | Doppler facilitates IOR | ||||||||
Vignali et al[60] | Pro | 3b | 8/55 | Colorectal | Stapled | Laser doppler | - | - | - | - | - | - | - | - | Reduction in microperfusion increases risk of CAL |
Kudszus et al[61] | Retro | 3b | 22/402 | Colorectal | Both | LFA | 201 | 28 | 28 | 8 | - | - | 201 | 15 | LFA reduces reoperation rate for AL, most prominent in handsewn |
Hirano et al[62] | Pro | 4 | 1/20 | Colorectal | ? | Near infrared spectro-scopy | StO2 < 60% in CAL | ||||||||
Novell et al[64] | Pro | 3b | 275 | Colorectal | Both | Obser-vation of marginal artery bleeding | Pulsatile flow: lower incidence CAL | ||||||||
Sheridan et al[65] | Pro | 3b | 5/50 | Colon | ? | Tissue pO2 measurement | Reduced anastomotic pO2 predictive CAL | ||||||||
Karliczek et al[63] | Pro | 3b | 14/77 | Colorectal | ? | Visible light spectro-scopy | pO2 could predict CAL |
Table 5 Radiology
Author | Type of study | Loe | n (CAL/non-CAL) | Colorectal/rectum | Stapled/handsewn anastomosis | Study tool | Se | Sp | PPV | NPV | Main outcome |
Eckmann et al[77] | Retro | 3b | 30/306 | Rectum | Stapled | CT | - | - | - | - | 29 of 30 CAL detected by CT |
Power et al[78] | Retro | 3b | 17/50 | Colorectal | ? | CT | 0.30 | 0.90 | 0.58 | 0.74 | Peri-anastomotic located fluid containing air found in CAL |
Gouya et al[75] | Retro | 3b | 10/195 | Rectum | ? | CT | - | - | 1.00 | 1.00 | CT has role in predicting CAL |
DuBrow et al[68] | Retro | 3b | 35/75 | Rectum | ? | CT | - | - | - | - | 30% of pts with CAL have presacral abnormalities |
Nicksa et al[73] | Retro | 4 | 36 CAL | Rectum | ? | CT | 0.12 | - | - | - | Low percentage true positives |
Doeksen et al[67] | Retro | 3b | 68/429 | Colorectal | ? | CT | 0.54 | 0.78 | 0.68 | 0.66 | Interobserver variability 10% |
Nesbakken et al[20] | Pro | 3b | 5/56 | Rectum | ? | CT | 0.57 | 1.00 | - | - | 94% accuracy of CT for detection of CAL |
Severini et al[74] | Retro | 3b | 12/175 | Rectum | ? | WSCE | - | - | - | - | 2 CAL out of 78 positive WSCE, low predictive value |
Hoffmann et al[70] | Retro | 3b | 5/51 | Colorectal | Both | WSCE | 0.20 | 0.85 | 0.13 | 0.91 | WSCE not recommended for routine use |
Markham et al[72] | Retro | 3b | 1/136 | Rectum | Handsewn | WSCE | 1.00 | 0.57 | 0.02 | 1.00 | WSCE no contribution to surgical management |
Kalady et al[71] | Retro | 3b | 8/211 | Rectum | ? | WSCE | 0.88 | 1.00 | 1.00 | 0.99 | WSCE does not provide additional information |
Akyol et al[66] | Pro | 3b | 12/233 | Colorectal | Both | WSCE | 0.52 | 0.87 | 0.30 | 0.94 | WSCE provides little useful clinical information |
Haynes et al[69] | Retro | 3b | 14/117 | Colorectal | Both | WSCE | 0.71 | 0.86 | 0.42 | 0.96 | WSCE not recommended for routine use |
Gouya et al[75] | Retro | 3b | 10/195 | Rectum | ? | WSCE | - | - | 1.00 | 0,98 | WSCE is recommended for routine use |
Nicksa et al[73] | Retro | 4 | 36 CAL | Rectum | ? | WSCE | 0.88 | - | - | - | WSCE superior to CT |
Doeksen et al[67] | Retro | 3b | 68/429 | Colorectal | ? | WSCE | 0.68 | 0.94 | 0.91 | 0.76 | Interobserver variability 13% |
Nesbakken et al[20] | Pro | 3b | 5/56 | Rectum | ? | WSCE | 0.60 | 1.00 | - | - | 93% accuracy of WSCE for detection of CAL |
Williams et al[76] | Retro | 4 | 10/31 | Rectum | Stapled | X-ray | 0.90 | 1.00 | 1.00 | 0.95 | Staple line dehiscence in 9/10 patients with CAL |
Tang et al[79] | Pro | 4 | 2/64 | Colorectal | ? | X-ray | - | - | - | - | Increase free air after POD 5 higher chance CAL |
- Citation: Daams F, Wu Z, Lahaye MJ, Jeekel J, Lange JF. Prediction and diagnosis of colorectal anastomotic leakage: A systematic review of literature. World J Gastrointest Surg 2014; 6(2): 14-26
- URL: https://www.wjgnet.com/1948-9366/full/v6/i2/14.htm
- DOI: https://dx.doi.org/10.4240/wjgs.v6.i2.14