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.
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References
Angelucci GP, Sinibaldi G, Orsaria P et al (2013) Morbidity and mortality after colorectal surgery for cancer. Surg Sci 04:520
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
Paun BC, Cassie S, MacLean AR et al (2010) Postoperative complications following surgery for rectal cancer. Ann Surg 251:807–818
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
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
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/
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
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
Platell C, Barwood N, Dorfmann G et al (2007) The incidence of anastomotic leaks in patients undergoing colorectal surgery. Colorectal Dis 9:71–79
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
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
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
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
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
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
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
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
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
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
Zhang Y, Agnoletti D, Xu Y et al (2014) Carotid-femoral pulse wave velocity in the elderly. J Hypertens 32:1572–1576
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
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
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
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
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
Safar ME (2017) Arterial stiffness as a risk factor for clinical hypertension. Nat Rev Cardiol 15:97–105
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
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
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
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
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
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
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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.
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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
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DOI: https://doi.org/10.1007/s00268-018-4757-9