Skip to main content
Log in

The Predictive Value of Pulse Wave Velocity for Anastomotic Leakage After Colorectal Surgery

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Arterial perfusion defects are a risk factor for anastomotic leakage (AL) following colorectal surgery. Measuring arterial stiffness using pulse wave velocity (PWV) is known to reflect the performance of the arterial network. The objective of this study was to assess the predictive value of PWV for AL after colorectal surgery.

Methods

A prospective monocentric study was conducted on all consecutive patients who underwent colorectal surgery scheduled between March 1, 2016 and May 1, 2017. Patients were divided into two groups according to the PWV which was measured preoperatively using the pOpmètre® device: PWV+ (PWV > 10 m/s) and PWV− (PWV ≤ 10 m/s). We then compared the PWV+ and PWV− groups. The primary endpoint was the AL rate.

Results

A total of 96 patients were studied, including 60 in the PWV− group and 36 in the PWV+ group. Patients in the PWV+ group were more at risk of presenting with AL than those in the PWV− group (6.25 vs 0%) (p = 0.002). There was no difference in immediate postoperative complications between the two groups apart from the length of hospital stay. PWV predicted the appearance of AL with a sensitivity of and a negative predictive value of 100%.

Conclusion

Measuring PWV could be a used as a predictive examination in the early detection of AL after colorectal surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Angelucci GP, Sinibaldi G, Orsaria P et al (2013) Morbidity and mortality after colorectal surgery for cancer. Surg Sci 04:520

    Article  Google Scholar 

  2. Alves A, Panis Y, Mathieu P et al (2005) Postoperative mortality and morbidity in French patients undergoing colorectal surgery: results of a prospective multicenter study. Arch Surg 140:278–283

    Article  PubMed  Google Scholar 

  3. Paun BC, Cassie S, MacLean AR et al (2010) Postoperative complications following surgery for rectal cancer. Ann Surg 251:807–818

    Article  PubMed  Google Scholar 

  4. Grant MC, Yang D, Wu CL et al (2017) Impact of enhanced recovery after surgery and fast track surgery pathways on healthcare-associated infections: results from a systematic review and meta-analysis. Ann Surg 265:68–79

    Article  PubMed  Google Scholar 

  5. Shetiwy M, Fady T, Shahatto F et al (2017) Standardizing the protocols for enhanced recovery from colorectal cancer surgery: Are we a step closer to ideal recovery? Ann Coloproctol 33:86–92

    Article  PubMed  PubMed Central  Google Scholar 

  6. Economic Impact of Anastomotic Leaks in Colectomy Procedures in the USA: 2005–2009. SAGES Abstract archives. SAGES. Cited 2017 Nov 19. https://www.sages.org/meetings/annual-meeting/abstracts-archive/economic-impact-of-anastomotic-leaks-in-colectomy-procedures-in-the-usa-2005-2009/

  7. Midura EF, Hanseman D, Davis BR et al (2015) Risk factors and consequences of anastomotic leak after colectomy: a national analysis. Dis Colon Rectum 58:333–338

    Article  PubMed  Google Scholar 

  8. den Dulk M, Noter SL, Hendriks ER et al (2009) Improved diagnosis and treatment of anastomotic leakage after colorectal surgery. Eur J Surg Oncol 35:420–426

    Article  Google Scholar 

  9. Platell C, Barwood N, Dorfmann G et al (2007) The incidence of anastomotic leaks in patients undergoing colorectal surgery. Colorectal Dis 9:71–79

    Article  CAS  PubMed  Google Scholar 

  10. Lipska MA, Bissett IP, Parry BR et al (2006) Anastomotic leakage after lower gastrointestinal anastomosis: men are at a higher risk. ANZ J Surg 76:579–585

    Article  PubMed  Google Scholar 

  11. Choi H-K, Law W-L, Ho JWC (2006) Leakage after resection and intraperitoneal anastomosis for colorectal malignancy: analysis of risk factors. Dis Colon Rectum 49:1719–1725

    Article  PubMed  Google Scholar 

  12. Hamzaoğlu I, Karahasanoğlu T, Aydin S et al (1998) The effects of hyperbaric oxygen on normal and ischemic colon anastomoses. Am J Surg 176:458–461

    Article  PubMed  Google Scholar 

  13. Komen N, Dijk J-W, Lalmahomed Z et al (2009) After-hours colorectal surgery: a risk factor for anastomotic leakage. Int J Colorectal Dis 24:789–795

    Article  PubMed  PubMed Central  Google Scholar 

  14. Sørensen LT, Jørgensen T, Kirkeby LT et al (1999) Smoking and alcohol abuse are major risk factors for anastomotic leakage in colorectal surgery. Br J Surg 86:927–931

    Article  PubMed  Google Scholar 

  15. Kruschewski M, Rieger H, Pohlen U et al (2007) Risk factors for clinical anastomotic leakage and postoperative mortality in elective surgery for rectal cancer. Int J Colorectal Dis 22:919–927

    Article  PubMed  Google Scholar 

  16. Post IL, Verheijen PM, Pronk A et al (2012) Intraoperative blood pressure changes as a risk factor for anastomotic leakage in colorectal surgery. Int J Colorectal Dis 27:765–772

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Alivon M, Vo-Duc Phuong T, Vignon V et al (2015) A novel device for measuring arterial stiffness using finger-toe pulse wave velocity: validation study of the pOpmètre®. Arch Cardiovasc Dis 108:227–234

    Article  PubMed  Google Scholar 

  18. Ben-Shlomo Y, Spears M, Boustred C et al (2014) Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol 63:636–646

    Article  PubMed  Google Scholar 

  19. Van Bortel LM, Laurent S, Boutouyrie P et al (2012) Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity. J Hypertens 30:445–448

    Article  CAS  PubMed  Google Scholar 

  20. Zhang Y, Agnoletti D, Xu Y et al (2014) Carotid-femoral pulse wave velocity in the elderly. J Hypertens 32:1572–1576

    Article  CAS  PubMed  Google Scholar 

  21. Mancia G, Fagard R, Narkiewicz K et al (2013) 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 34:2159–2219

    Article  PubMed  Google Scholar 

  22. Rahbari NN, Weitz J, Hohenberger W et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147:339–351

    Article  PubMed  Google Scholar 

  23. Horan TC, Gaynes RP, Martone WJ et al (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control 20:271–274

    Article  CAS  PubMed  Google Scholar 

  24. Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  25. Sammour T, Cohen L, Karunatillake AI et al (2017) Validation of an online risk calculator for the prediction of anastomotic leak after colon cancer surgery and preliminary exploration of artificial intelligence-based analytics. Tech Coloproctol 21:869–877

    Article  CAS  PubMed  Google Scholar 

  26. Safar ME (2017) Arterial stiffness as a risk factor for clinical hypertension. Nat Rev Cardiol 15:97–105

    Article  PubMed  Google Scholar 

  27. Rencuzogullari A, Benlice C, Valente M et al (2017) Predictors of anastomotic leak in elderly patients after colectomy: nomogram-based assessment from the American College of Surgeons National Surgical Quality Program Procedure-targeted cohort. Dis Colon Rectum 60:527–536

    Article  PubMed  Google Scholar 

  28. Eveno C, Latrasse V, Gayat É et al (2016) Colorectal anastomotic leakage can be predicted by abdominal aortic calcification on preoperative CT scans: a pilot study. J Visc Surg 153:253–257

    Article  CAS  PubMed  Google Scholar 

  29. Vignali A, Gianotti L, Braga M et al (2000) Altered microperfusion at the rectal stump is predictive for rectal anastomotic leak. Dis Colon Rectum 43:76–82

    Article  CAS  PubMed  Google Scholar 

  30. Silvestri M, Dobrinja C, Scomersi S et al (2017) Modifiable and non-modifiable risk factors for surgical site infection after colorectal surgery: a single-center experience. Surg Today 48:338–345

    Article  PubMed  Google Scholar 

  31. Guinier D, Mantion GA, Alves A et al (2007) Risk factors of unplanned readmission after colorectal surgery: a prospective, multicenter study. Dis Colon Rectum 50:1316–1323

    Article  CAS  PubMed  Google Scholar 

  32. Alves A, Panis Y, Trancart D et al (2002) Factors associated with clinically significant anastomotic leakage after large bowel resection: multivariate analysis of 707 patients. World J Surg 26:499–502. https://doi.org/10.1007/s00268-001-0256-4

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

Author’s contribution

VA: conception, design, analysis and interpretation of data, manuscript author, provided feedback on the manuscript, drafted the article, and revised it critically with regard to important intellectual content. Final approval of the version to be published. JR: conception, design, analysis and interpretation of data, manuscript author, provided feedback on the manuscript, drafted the article, and revised it critically with regard to important intellectual content. Final approval of the version to be published. LE: provided care for study patients, provided feedback on the manuscript, drafted the article, and revised it critically regarding important intellectual content. Final approval of the version to be published. LNP: provided care for study patients, provided feedback on the manuscript, drafted the article, and revised it critically regarding important intellectual content. Final approval of the version to be published. CC: provided care for study patients, provided feedback on the manuscript, drafted the article, and revised it critically with regard to important intellectual content. Final approval of the version to be published. ME: methodology, statistical analysis and interpretation, provided feedback on the manuscript. Final approval of the version to be published. DE: provided care for study patients, provided feedback on the manuscript, drafted the article, and revised it critically regarding important intellectual content. Final approval of the version to be published. HA: conception, design, analysis and interpretation of data, manuscript author, provided feedback on the manuscript, drafted the article, and revised it critically with regard to important intellectual content. Final approval of the version to be published.

Corresponding author

Correspondence to A. Venara.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest associated with this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Venara, A., Jaouen, R., Lermite, E. et al. The Predictive Value of Pulse Wave Velocity for Anastomotic Leakage After Colorectal Surgery. World J Surg 43, 252–259 (2019). https://doi.org/10.1007/s00268-018-4757-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-018-4757-9

Navigation