Anastomotic leakage after rectal resections for cancer is a severe complication that affects both functional and oncological results of surgical treatment. Incidence of anastomotic leakage is described in a wide range of 2% to 21%. Risk factors for anastomotic leakage are well known, but it is not yet available strong predictor or a useful scoring system, which could clearly identify the patient's risk for the formation of anastomotic leakage. One of the new method which should be useful for early detection of the patient with developing complications, is level of neopterin, tryptophan and their derivatives in body fluids.Methods:
This prospective study included patients who underwent elective resection of rectum for carcinoma at Surgical Department, University Hospital, Hradec Kralove, Czech Republic. The basic condition for inclusion was rectal anastomosis made by double stapling technique. Levels of neopterin, tryptophan, kynurenin and their ratios were determined before operation, and the following 6 days in venous blood, urine and fluid from the abdominal drain. Furthermore, standard demographic, oncological, therapeutic and clinical data were observed. Subsequently, a statistical analysis was performed.Results:
Total, 42 patients were included in study. In 16 (38.1%) patients was detected failure in the healing of the anastomosis. Grade A of leakage was found in 7 (43.8%) patients, grade B in 5 (31.2%) patients and 4 (25.0%) patients had a leak grade C. Significant differences between groups of patients without complications and with anastomotic complications was found only in case of mesorectal excision extent (partial versus total), P = 0.015. There were no differences in the serum levels of neopterin, tryptophan and kynurenin. Significant differences between groups were found in neopterin/kynurenin ratio in urine; for preoperative period was neopterine/kreatinin ratio 139.5 μmol/mmol in group with leakage, in group without complications neopterine/kreatinin ratio was 114.8 μmol/mmol, P = 0.037. Same results were observed when neopterin/kreatinin ratio was studiedaltogether. Mean of neopterin/kreatinin ratio was 185.1 μmol/mmol in group with leakage and 142.8 μmol/mmol in group without complication, P = 0.012. Also in the fluid from drain was higher mean value of neopterin in the group with complications (49.03 μmol), in the group without complications was this value 27.89, P = 0.048.Conclusions:
Presented study has demonstrated that neopterin's high levels in the urine before surgery could be interpreted as a risk for development of the anastomotic leakage. Also pathological levels of neopterin in the urine and in the fluid from abdominal drain could be useful for early identifying of the anastomotic leakage in the postoperative period before its clinical development.