Skip to main content

Advertisement

SpringerLink
Log in

Early Prediction of Anastomotic Leak in Colorectal Cancer Surgery by Intramucosal pH

  • Published:
Diseases of the Colon & Rectum

Purpose

Adequate oxygenation is necessary for anastomotic healing, and ischemia has been found to be one of the most important factors in anastomotic leakage. This study was designed to assess the value of early postoperative intramucosal pH measurements for the prediction of anastomotic leakage in patients with colorectal anastomosis.

Methods

A prospective study of 90 patients with rectal or sigmoid cancer with primary anastomosis was conducted. In all patients intramucosal pH was determined by using tonometry at the anastomotic and gastric levels during the first 24 and 48 hours postoperatively. Seven other variables also were tested by univariate and multivariate analysis for any association with anastomotic leakage.

Results

The rate of clinical anastomotic leakage was 6.6 percent. Multivariate analysis showed that only the intramucosal pH at the anastomosis was an independent factor for the development of anastomotic leakage. The risk of leakage was 22 times higher in patients with an anastomotic intramucosal pH < 7.28 in the first 24 hours after surgery.

Conclusions

Measurement of anastomotic intramucosal pH in the early postoperative period can more accurately predict the risk of anastomotic leakage and benefit those patients who would need additional measures to improve the viability of the anastomosis.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References

  1. ND Karanjia AP Corder P Bearn RJ Heald (1994) ArticleTitleLeakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum Br J Surg 81 1224–1226 Occurrence Handle1:STN:280:DyaK2M%2FktFWltg%3D%3D Occurrence Handle7953369

    CAS  PubMed  Google Scholar 

  2. A Laxamana MJ Solomon Z Cohen SM Feinberg HS Stern RS McLeod (1995) ArticleTitleLong-term results of anterior resection using the double-stapling technique Dis Colon Rectum 38 1246–1250 Occurrence Handle10.1007/BF02049147 Occurrence Handle1:STN:280:DyaK287gtFGmsA%3D%3D Occurrence Handle7497834

    Article  CAS  PubMed  Google Scholar 

  3. A Vignali VW Fazio IC Lavery et al. (1997) ArticleTitleFactors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1014 patients J Am Coll Surg 185 105–113 Occurrence Handle10.1016/S1072-7515(97)00018-5 Occurrence Handle1:STN:280:DyaK2szptVWgtQ%3D%3D Occurrence Handle9249076

    Article  CAS  PubMed  Google Scholar 

  4. R Golub RW Golub R Cantu HD Stein (1997) ArticleTitleA multivariate analysis of factors contributing to leakage of intestinal anastomoses J Am Coll Surg 184 364–372 Occurrence Handle1:STN:280:DyaK2s3lsFegtg%3D%3D Occurrence Handle9100681

    CAS  PubMed  Google Scholar 

  5. RJ Heald BJ Moran RD Ryall R Sexton JK MacFarlane (1998) ArticleTitleRectal cancer: the Basingstoke experience of total mesorectal excision: 1978–1997 Arch Surg 133 894–899 Occurrence Handle10.1001/archsurg.133.8.894 Occurrence Handle1:STN:280:DyaK1cznsFOrsQ%3D%3D Occurrence Handle9711965

    Article  CAS  PubMed  Google Scholar 

  6. E Rullier C Laurent JL Garrelon P Michel J Saric M Parneix (1998) ArticleTitleRisk factors for anastomotic leakage afterresection of rectal cancer Br J Surg 85 355–358 Occurrence Handle10.1046/j.1365-2168.1998.00615.x Occurrence Handle1:STN:280:DyaK1c7ptVaruw%3D%3D Occurrence Handle9529492

    Article  CAS  PubMed  Google Scholar 

  7. RT Poon KW Chu JW Ho CW Chan WL Law J Wong (1999) ArticleTitleProspective evaluation of selective defunctioning stoma for low anterior resection with total mesorectal excision World J Surg 23 463–468 Occurrence Handle10.1007/PL00012331 Occurrence Handle1:STN:280:DyaK1M7oslenug%3D%3D Occurrence Handle10085394

    Article  CAS  PubMed  Google Scholar 

  8. LT Sorensen T Jorgensen LT Kirkeby J Skovdal B Vennits B Wille-Jorgensen (1999) ArticleTitleSmoking and alcohol abuse are major risk factors for anastomotic leakage in colorectal surgery Br J Surg 86 927–931 Occurrence Handle10.1046/j.1365-2168.1999.01165.x Occurrence Handle1:STN:280:DyaK1MzkvVKmsQ%3D%3D Occurrence Handle10417567

    Article  CAS  PubMed  Google Scholar 

  9. WI Law KW Chu JW Ho CW Chan (2000) ArticleTitleRisk factors foranastomotic leakage after low anterior resection with total mesorectal excision Am J Surg 179 92–96 Occurrence Handle10.1016/S0002-9610(00)00252-X Occurrence Handle1:STN:280:DC%2BD3cvhs1Cktw%3D%3D Occurrence Handle10773140

    Article  CAS  PubMed  Google Scholar 

  10. F Marusch A Koch U Schmidt et al. (2002) ArticleTitleValue of a protective stoma in low anterior resections for rectal cancer Dis Colon Rectum 45 1164–1171 Occurrence Handle10.1007/s10350-004-6384-9 Occurrence Handle12352230

    Article  PubMed  Google Scholar 

  11. WE Longo KS Virgo FE Johnson et al. (1998) ArticleTitleOutcome after proctectomy for rectal cancer in Department of Veterans Affairs Hospitals: a report from the National Surgical Quality Improvement Program Ann Surg 228 64–70 Occurrence Handle10.1097/00000658-199807000-00010 Occurrence Handle1:STN:280:DyaK1czjsVWnsQ%3D%3D Occurrence Handle9671068

    Article  CAS  PubMed  Google Scholar 

  12. FJ Thornton A Barbul (1997) ArticleTitleHealing in the gastrointestinal tract Surg Clin North Am 77 549–573 Occurrence Handle10.1016/S0039-6109(05)70568-5 Occurrence Handle1:STN:280:DyaK2szjvVehsg%3D%3D Occurrence Handle9194880

    Article  CAS  PubMed  Google Scholar 

  13. BJ Moran RJ Heald (2001) ArticleTitleRisk factors for, and management of anastomotic leakage in rectal surgery Colorectal Dis 3 135–137 Occurrence Handle10.1046/j.1463-1318.2001.00210.x Occurrence Handle1:STN:280:DC%2BD3s3msFSisQ%3D%3D Occurrence Handle12791007

    Article  CAS  PubMed  Google Scholar 

  14. EH Bergofsky (1964) ArticleTitleDetermination of Tissue O2 tensions byhollow visceral tonometers: effect of breathing enriched O2 mixtures J Clin Invest 43 193–200 Occurrence Handle1:CAS:528:DyaF2cXosFSrtg%3D%3D Occurrence Handle14162528 Occurrence Handle10.1172/JCI104904

    Article  CAS  PubMed  Google Scholar 

  15. N Maynard D Bihari R Beale et al. (1993) ArticleTitleAssessment of splanchnic oxygenation by gastric tonometry in patients with acute circulatory failure JAMA 270 1203–1210 Occurrence Handle10.1001/jama.270.10.1203 Occurrence Handle1:STN:280:DyaK3szmtVeqsA%3D%3D Occurrence Handle8355382

    Article  CAS  PubMed  Google Scholar 

  16. T Gys A Hubens H Neels LF Lauwers R Peeters (1988) ArticleTitlePrognostic value of gastric intramural pH in surgical intensive care patients Crit Care Med 16 1222–1224 Occurrence Handle1:STN:280:DyaL1M%2Flt1ejsA%3D%3D Occurrence Handle3191738

    CAS  PubMed  Google Scholar 

  17. G Gutierrez F Palizas G Doglio et al. (1992) ArticleTitleGastric intramucosal pH as a therapeutic index of tissue oxygenation in critically ill patients Lancet 339 195–199 Occurrence Handle10.1016/0140-6736(92)90002-K Occurrence Handle1:STN:280:DyaK387hsVGlsw%3D%3D Occurrence Handle1346170

    Article  CAS  PubMed  Google Scholar 

  18. T Tarui A Murata Y Watanabe et al. (1999) ArticleTitleEarlier prediction of anastomotic insufficiency after thoracic esophaguectomy by intramucosal pH Crit Care Med 27 1824–1831 Occurrence Handle10.1097/00003246-199909000-00020 Occurrence Handle1:STN:280:DyaK1MvjsFCguw%3D%3D Occurrence Handle10507605

    Article  CAS  PubMed  Google Scholar 

  19. M Bjorck B Hedberg (1994) ArticleTitleEarly detection of major complications after abdominal aortic surgery: predictive value of sigmoid colon and gastric intramucosal pH monitoring Br J Surg 81 25–30 Occurrence Handle1:STN:280:DyaK2c7kslSruw%3D%3D Occurrence Handle8313112

    CAS  PubMed  Google Scholar 

  20. RG Fiddian-Green (1992) ArticleTitleTonometry: theory and applications Intensive Care World 9 60–65 Occurrence Handle1:STN:280:DyaK3sbgt1Ogsg%3D%3D Occurrence Handle10148010

    CAS  PubMed  Google Scholar 

  21. AC Vahl EN Ozkayak-Yilmaz SH Nauta et al. (1997) ArticleTitleEndoluminal pulse oximetry combined with tonometry to monitor the perfusion of the sigmoid during and after resection of abdominal aortic aneurysm Cardiovasc Surg 5 65–70 Occurrence Handle10.1016/S0967-2109(96)00047-6 Occurrence Handle1:STN:280:DyaK2szgtFOntQ%3D%3D Occurrence Handle9158125

    Article  CAS  PubMed  Google Scholar 

  22. RG Fiddian-Green NM Gantz (1987) ArticleTitleTransient episodes of sigmoid ischemia and their relation to infection from intestinal organisms after abdominal aortic operations Crit Care Med 15 835–839 Occurrence Handle1:STN:280:DyaL2szgtlSqsA%3D%3D Occurrence Handle3621957 Occurrence Handle10.1097/00003246-198709000-00007

    Article  CAS  PubMed  Google Scholar 

  23. CV Soong MI Halliday JM Hood BJ Rowlands AA Barros D'Sa (1995) ArticleTitleEffect of low-dose dopamine on sigmoid colonic intramucosal pH in patients undergoing elective abdominal aortic aneurysm repair Br J Surg 82 912–915 Occurrence Handle1:STN:280:DyaK2Mzns1Wnug%3D%3D Occurrence Handle7648106

    CAS  PubMed  Google Scholar 

  24. D Bergqvist M Björck (1997) ArticleTitleBowel ischemia after aortoiliac surgery Br J Surg 84 593–594 Occurrence Handle10.1046/j.1365-2168.1997.02755.x Occurrence Handle1:STN:280:DyaK2szhsFOgtg%3D%3D Occurrence Handle9171739

    Article  CAS  PubMed  Google Scholar 

  25. T Klok FL Moll JA Leusink DJ Theunissen CM Gerrits C Keijer (1996) ArticleTitleThe relationship between sigmoidal intramucosal pH and intestinal arterial occlusion during aortic reconstructive surgery Eur J Vasc Endovasc Surg 11 304–307 Occurrence Handle10.1016/S1078-5884(96)80076-1 Occurrence Handle1:STN:280:DyaK287ot1entQ%3D%3D Occurrence Handle8601240

    Article  CAS  PubMed  Google Scholar 

  26. P Kienle J Weitz S Reinshagen et al. (2001) ArticleTitleAssociation of decreased perfusion of the ileoanal pouch mucosa with early postoperative pouchitis and local septic complications Arch Surg 136 1124–1130 Occurrence Handle10.1001/archsurg.136.10.1124 Occurrence Handle1:STN:280:DC%2BD3MrlvFWitA%3D%3D Occurrence Handle11585503

    Article  CAS  PubMed  Google Scholar 

  27. WH Isbister N Sanea ParticleAl (2002) ArticleTitlePOSSUM: a re-evaluation in patients undergoing surgery for rectal cancer. The Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity ANZ J Surg 72 421–425 Occurrence Handle10.1046/j.1445-2197.2002.02436.x Occurrence Handle12121162

    Article  PubMed  Google Scholar 

  28. A Vignali L Gianotti M Braga G Radaelli L Malvezzi V Carlo ParticleDi (2000) ArticleTitleAltered microperfusion at the rectal stump is predictive for rectal anastomotic leak Dis Colon Rectum 43 76–82 Occurrence Handle10.1007/BF02237248 Occurrence Handle1:STN:280:DC%2BD3c3ntFagtA%3D%3D Occurrence Handle10813128

    Article  CAS  PubMed  Google Scholar 

  29. JT Mäkelä H Kiviniemi K Laitinen (2003) ArticleTitleRisk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis Dis Colon Rectum 46 653–660 Occurrence Handle10.1007/s10350-004-6627-9 Occurrence Handle12792443

    Article  PubMed  Google Scholar 

  30. JH Vironen L Halme P Sainio et al. (2002) ArticleTitleNew approaches in the management of rectal carcinoma result in reduced local recurrence rate and improved survival Eur J Surg 168 158–164 Occurrence Handle10.1080/110241502320127775 Occurrence Handle12182241

    Article  PubMed  Google Scholar 

  31. A Bolognese M Cardi IA Muttillo A Barbarosos T Bocchetti S Valabrega (2000) ArticleTitleTotal mesorectal excision for surgical treatment of rectal cancer J Surg Oncol 74 21–23 Occurrence Handle10.1002/1096-9098(200005)74:1<21::AID-JSO5>3.0.CO;2-6 Occurrence Handle1:STN:280:DC%2BD3czitFCksg%3D%3D Occurrence Handle10861603

    Article  CAS  PubMed  Google Scholar 

  32. PJ Hainsworth MJ Egan WJ Cuncliffe (1997) ArticleTitleEvaluation of a policy of total mesorectal excision for rectal and rectosigmoid cancers Br J Surg 84 652–656 Occurrence Handle10.1046/j.1365-2168.1997.02638.x Occurrence Handle1:STN:280:DyaK2szhsFOnuw%3D%3D Occurrence Handle9171754

    Article  CAS  PubMed  Google Scholar 

  33. RJ Aitken (1996) ArticleTitleMesorectal excision for rectal cancer Br J Surg 83 214–216 Occurrence Handle10.1046/j.1365-2168.1996.02057.x Occurrence Handle1:STN:280:DyaK283ks12lug%3D%3D Occurrence Handle8689166

    Article  CAS  PubMed  Google Scholar 

  34. A Fawcett M Shembekar R Vashisht RG Springall DM Nott (1995) ArticleTitleColonic microvascular disease and anastomotic dehiscence Br J Surg 82 1544–1573

    Google Scholar 

  35. TE Pakkastie JT Ovaska ES Pekkala et al. (1997) ArticleTitleA randomized study of colostomies in low colorectal anastomoses Eur J Surg 163 929–933 Occurrence Handle1:STN:280:DyaK1c7gvFGjsg%3D%3D Occurrence Handle9449446

    CAS  PubMed  Google Scholar 

  36. AM Averbach D Chang P Koslowe PH Sugarbaker (1996) ArticleTitleAnastomotic leak after double-stapled low colorectal resection. An analysis of risk factors Dis Colon Rectum 39 780–787 Occurrence Handle10.1007/BF02054444 Occurrence Handle1:STN:280:DyaK283ptVGltQ%3D%3D Occurrence Handle8674371

    Article  CAS  PubMed  Google Scholar 

  37. A Shandall R Lowndes HL Young (1985) ArticleTitleColonic anastomotic healing and oxygen tension Br J Surg 72 606–609 Occurrence Handle1:STN:280:DyaL2M3otFWlsw%3D%3D Occurrence Handle3896373

    CAS  PubMed  Google Scholar 

  38. R Locke CJ Hauser WC Shoemaker (1984) ArticleTitleThe use of surface oximetry to assess bowel viability Arch Surg 119 1252–1256 Occurrence Handle1:STN:280:DyaL2M%2FksF2nuw%3D%3D Occurrence Handle6497627

    CAS  PubMed  Google Scholar 

  39. A Senagore JW Milsom RK Walshaw R Dunstan P Mazier IH Chaudry (1990) ArticleTitleIntramural pH: a quantitative measurement for predicting colorectal anastomotic healing Dis Colon Rectum 33 175–179 Occurrence Handle10.1007/BF02134174 Occurrence Handle1:STN:280:DyaK3c7otlKnsQ%3D%3D Occurrence Handle2178894

    Article  CAS  PubMed  Google Scholar 

  40. RF Chung (1987) ArticleTitleBlood flow in colonic anastomosis. Effect ofstapling and suturing Ann Surg 206 335–339 Occurrence Handle1:STN:280:DyaL2szisFWlug%3D%3D Occurrence Handle3307654

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, Colorectal Surgery Unit, Hospital Clinico Universitario, Valencia, Spain

    Monica Millan M.D., Ph.D., Eduardo García-Granero M.D., Ph.D., Blas Flor M.D., Ph.D., Stephanie García-Botello M.D. & Salvador Lledo M.D., Ph.D.

  2. Avda Primado Reig 58-15, Valencia, 46010, Spain

    Monica Millan M.D., Ph.D.

Authors
  1. Monica Millan M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eduardo García-Granero M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Blas Flor M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephanie García-Botello M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Salvador Lledo M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Monica Millan M.D., Ph.D..

Additional information

Reprints are not available.

About this article

Cite this article

Millan, M., García-Granero, E., Flor, B. et al. Early Prediction of Anastomotic Leak in Colorectal Cancer Surgery by Intramucosal pH. Dis Colon Rectum 49, 595–601 (2006). https://doi.org/10.1007/s10350-006-0504-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-006-0504-7

Key words

Search

Navigation