Zhang Feng, Qiao Song, Yao Ning, Li Chunqiao, Weber Marie-Christin, Jefferies Benedict, Friess Helmut, Reischl Stefan, Neumann Philipp-Alexander
Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), 81675 Munich, Germany.
Department of General Surgery, Tongren Municipal People's Hospital of Guizhou Medical University (GMU), Tongren 554300, China.
Diagnostics (Basel). 2022 Nov 22;12(12):2902. doi: 10.3390/diagnostics12122902.
Reliable markers to predict or diagnose anastomotic leakage (AL) of stapled circular anastomoses following colorectal resections are an important clinical need. Here, we aim to quantitatively investigate the morphology of anastomotic rings as an early available prognostic marker for AL and compare them to established inflammatory markers. We perform a prospective single-center cohort study, including patients undergoing stapled circular anastomosis between August 2020 and August 2021. The predictive value of the anastomotic ring configuration and the neutrophil-to-lymphocyte ratio (NLR) regarding anastomotic leakage is examined by ROC analyses and compared to the C-reactive protein (CRP) as an established marker. We included 204 patients, of which 19 suffered from anastomotic leakage (LEAK group), while in 185 patients the anastomoses healed well (HEAL group). The minimal height of the anastomotic rings as a binary classifier had a good ROC-AUC of 0.81 but was inferior to the NLR at postoperative day (POD) 5, with an excellent ROC-AUC of 0.93. Still, it was superior to the NLR at POD 3 (0.74) and the CRP at POD 3 (ROC-AUC 0.54) and 5 (ROC-AUC 0.70). The minimal height of the anastomotic rings as indicator for technically insufficient anastomoses is a good predictor of AL, while postoperatively the NLR was superior to the CRP in prediction of AL.
预测或诊断结直肠切除术后吻合器圆形吻合口漏（AL）的可靠标志物是一项重要的临床需求。在此，我们旨在定量研究吻合环的形态，将其作为AL的早期可用预后标志物，并与已确立的炎症标志物进行比较。我们开展了一项前瞻性单中心队列研究，纳入2020年8月至2021年8月期间接受吻合器圆形吻合术的患者。通过ROC分析检验吻合环形态和中性粒细胞与淋巴细胞比值（NLR）对吻合口漏的预测价值，并与作为已确立标志物的C反应蛋白（CRP）进行比较。我们纳入了204例患者，其中19例发生吻合口漏（漏组），185例患者吻合口愈合良好（愈合组）。作为二元分类器的吻合环最小高度具有良好的ROC-AUC，为0.81，但在术后第5天不如NLR，NLR的ROC-AUC极佳，为0.93。不过，它仍优于术后第3天的NLR（0.74）以及术后第3天（ROC-AUC 0.54）和第5天（ROC-AUC 0.70）的CRP。作为技术上吻合不充分指标的吻合环最小高度是AL的良好预测指标，而术后NLR在预测AL方面优于CRP。
