Anastomotic leakage, the search for a reliable biomarker. A review of the literature.

BACKGROUND: Colorectal anastomotic leakage (AL) is a severe complication leading to severe infection, sepsis and sometimes death. At present the diagnosis is made clinically, usually at 6-8 days after surgery. An objective biomarker reflecting the intra-abdominal milieu surrounding the anastomosis would be a useful additional diagnostic tool to make the diagnosis of AL before its clinical presentation. This review aims to assess the current status of the search for such a biomarker in peritoneal fluid.

METHOD: A literature search was carried out, using MEDLINE, PubMed and the Cochrane library, for all publications concerning human peritoneal fluid in relation to postoperative complications in general, and, more specific, anastomotic leakage after colorectal surgery.

RESULTS: Analysis of several immune parameters, tissue repair parameters, parameters for ischaemia and microbiological composition of peritoneal fluid show that these can be determined reliably in the fluid, albeit with a large variance. Furthermore the data show that changes in concentration of these parameters precede AL and other postoperative complications by several days.

CONCLUSION: The results of the review demonstrate that it is possible to distinguish between patients with and without AL by measuring biomarkers in fluid from the peritoneal drain. Prospective studies with larger numbers of patients should, however, be performed and additional biomarkers should be studied to explore the full diagnostic potential of this approach.