Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
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Acidic Pelvic Drainage as a Predictive Factor For Anastomotic Leakage after Surgery for Patients with Rectal Cancer

  • Yang, Liu (Colorectal Cancer Center, the affiliated Jiangsu Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research) ;
  • Huang, Xin-En (Department of Chemotherapy, the affiliated Jiangsu Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research) ;
  • Xu, Lin (Department of Thoracic Surgery, the affiliated Jiangsu Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research) ;
  • Zhou, Xin (Colorectal Cancer Center, the affiliated Jiangsu Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research) ;
  • Zhou, Jian-Nong (Colorectal Cancer Center, the affiliated Jiangsu Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research) ;
  • Yu, Dong-Sheng (Colorectal Cancer Center, the affiliated Jiangsu Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research) ;
  • Li, Dong-Zheng (Colorectal Cancer Center, the affiliated Jiangsu Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research) ;
  • Guan, Xin (Colorectal Cancer Center, the affiliated Jiangsu Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research)
  • Published : 2013.09.30
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Abstract

Purpose: To demonstrate the value of sequential determinations of pelvic drainage in the identification of increased risk of anastomotic leakage (AL) after anterior resection for rectal cancer with a double stapling technique. Patients and Methods: Between January 2004 and December 2011, data for the daily postoperative pH of pelvic drainage fluid in 753 consecutive patients with rectal cancer who initially underwent anterior resection with a double stapling technique were reviewed. All patients experienced a total mesorectal excision. Patients with anastomotic leakage (Group AL, n=57) were compared to patients without leakage (Group nAL, n=696). Patients with perioperatively abdominopelvic implants that were likely to affect pH value (determined at $25^{\circ}C$) other than leakage were excluded. Mean postoperative values were compared. Results: Anastomotic leakage was noted in 57 (7.6%) of 753 patients with rectal cancer. The diagnosis of AL was made between the $6^{th}$ and $12^{th}$ postoperative day (POD; mean $8^{th}$ POD). There was no significance of the daily average values of pH on POD1 & 2 in group AL while a significantly sharp declining mean pH value reached its diagnostic point of AL (p<0.001) on POD3. A cut-off value of 6.978 on the $3^{rd}$ POD maximized the sensitivity (98.7.0%) and specificity (94.7%) in assessing the risk of leakage. Conclusion: According to these results, an early and persistent declining of pH value of pelvic drainage fluid after rectal surgery with anastomosis, is a marker of AL. A cut-off value of 6.798 determined at $25^{\circ}C$ on POD3 maximizes sensitivity and specificity.

Keywords

References

  1. 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
  2. Attard JA, Raval MJ, Martin GR, et al (2005). The effects of systemic hipoxia on colon anastomotic healing: an animal model. Dis Colon Rectum, 48, 1460-70. https://doi.org/10.1007/s10350-005-0047-3
  3. Bellows CF, Webber LS, Albo D, et al (2009). Early predictors of anastomotic leaks after colectomy. Tech Coloproctol, 13, 41-47. https://doi.org/10.1007/s10151-009-0457-7
  4. Benz M, Werz O, Jacob R, et al (1997). pH-dependent regulation of leukocyte 5-lipoxygenase activity in inflammatory exudates by albumin. Inflamm Res, 46, 366-72. https://doi.org/10.1007/s000110050203
  5. Bertelsen CA, Andreasen AH, Jorgensen T, et al (2010). Anastomotic leakage after anterior resection for rectal cancer: risk factors. Colorectal Dis, 12, 37-43.
  6. Bokey EL, Chapuis PH, Fung C (1995). Postoperative morbidity and mortality following resection of the colon and rectum for cancer. Dis Colon Rectum, 38, 480-7. https://doi.org/10.1007/BF02148847
  7. Carbonell T, Ródenas J, Alfaro V, et al (2002). Extracellular pH affects inflammatory cell production of superoxide and nitric oxide. J Physiol Biochem, 58, 115-20. https://doi.org/10.1007/BF03179847
  8. Chen G, Shen ZL, Wang L, et al (2013). Hsa-miR-181a-5p expression and effects on cell proliferation in gastric cancer. Asian Pac J Cancer Prev, 14, 3871-5. https://doi.org/10.7314/APJCP.2013.14.6.3871
  9. Covington AK, Bates RG, Durst RA (1985). Definitions of pH scales, standard reference values, measurement of pH, and related terminology. Pure Appl Chem, 57, 531-42.
  10. Dahlen SE, Bjork J, Hedqvist P, et al (1981). Leukotrienes promote plasma leakage and leukocyte adhesion in postcapillary venules: in vivo effects with relevance to the acute inflammatory response. Proc Natl Acad Sci U S A, 78, 3887-91. https://doi.org/10.1073/pnas.78.6.3887
  11. Dai XZ, Yin HT, Sun LF, et al (2013). Potential therapeutic efficacy of curcumin in liver cancer. Asian Pac J Cancer Prev, 14, 3855-9. https://doi.org/10.7314/APJCP.2013.14.6.3855
  12. Deng QQ, Huang XE, Ye LH, et al (2013).Phase II trial of Loubo${\circledR}$ (Lobaplatin) and pemetrexed for patients with metastatic breast cancer not responding to anthracycline or taxanes. Asian Pac J Cancer Prev, 14, 413-7. https://doi.org/10.7314/APJCP.2013.14.1.413
  13. Doeksen A, Tanis PJ, Vrouenraets BC, et al (2007). Factors determining delay in relaparotomy for anastomotic leakage after colorectal resection. World J Gastroenterol, 13, 3721-5. https://doi.org/10.3748/wjg.v13.i27.3721
  14. Donald W, Edlow, Walter H, et al (1971). The pH of Inflammatory Exudates. Exp Biol Med, 137, 1328-32. https://doi.org/10.3181/00379727-137-35782
  15. Eriksen MT, Wibe A, Norstein J, et al (2005). Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients. Colorectal Dis, 7, 51-7. https://doi.org/10.1111/j.1463-1318.2004.00700.x
  16. Fazio VW, Zutshi M, Remzi FH, et al (2007). A randomized multicenter trial to compare long-term functional outcome, quality of life, and complications of surgical procedures for low rectal cancers. Ann Surg, 246, 481-490. https://doi.org/10.1097/SLA.0b013e3181485617
  17. Gao LL, Huang XE, Zhang Q, et al (2011). 14.A Cisplatin and vinorelbine (NP) regimen as a postoperative adjuvant chemotherapy for completely resected breast cancers in China: final results of a phase II clinical trial. Asian Pac J Cancer Prev, 12, 77-80.
  18. Garcia-Granero A, Frasson M, Flor-Lorente B, et al (2013). Procalcitonin and C-reactive protein as early predictors of anastomotic leak in colorectal surgery: a prospective observational study. Dis Colon Rectum, 56, 475-83. https://doi.org/10.1097/DCR.0b013e31826ce825
  19. Gong P, Huang XE, Chen CY, et al (2012). Comparison on complications of peripherally inserted central catheters by ultrasound guide or conventional method in cancer patients. Asian Pac J Cancer Prev, 13, 1873-5. https://doi.org/10.7314/APJCP.2012.13.5.1873
  20. Gu M, Li SY, Huang XE, et al (2013). A phase II study on continuous infusional paclitaxel and 5-Fu as first-line chemotherapy for patients with advanced esophageal cancer. Asian Pac J Cancer Prev, 13, 5587-91. https://doi.org/10.7314/APJCP.2012.13.11.5587
  21. Hackam DJ, Grinstein S, Nathens A, et al (1996). Exudative neutrophils show impaired pH regulation compared with circulating neutrophils. Arch Surg, 131, 1296-301. https://doi.org/10.1001/archsurg.1996.01430240050006
  22. Huang XE, Li CG, Li Y, et al (2011). Weekly TP regimen as a postoperative adjuvant chemotherapy for completely resected breast cancer in China: final result of a phase II trial. Asian Pac J Cancer Prev, 12, 2797-2800.
  23. Huang XE, Wei GL, Huo JG, et al (2013). Intrapleural or intraperitoneal lobaplatin for treatment of patients with malignant pleural effusion or ascites. Asian Pac J Cancer Prev, 14, 2611-4. https://doi.org/10.7314/APJCP.2013.14.4.2611
  24. Jemal A, Bray F, Center MM, et al (2011). Global cancer statistics. Ca Cancer J Clin, 61, 69-90. https://doi.org/10.3322/caac.20107
  25. Lagoutte N, Facy O, Ravoire A, et al (2012). C-reactive protein and procalcitonin for the early detection of anastomotic leakage after elective colorectal surgery: pilot study in 100 patients. J Visc Surg, 149, 345-9. https://doi.org/10.1016/j.jviscsurg.2012.09.003
  26. Law WL, Choi HK, Lee YM, et al (2007). Anastomotic leakage is associated with poor long-term outcome in patients after curative colorectal resection for malignancy. J Gastrointest Surg, 11, 8-15. https://doi.org/10.1007/s11605-006-0049-z
  27. Lee WS, Yun SH, Roh YN, et al (2008). Risk factors and clinical outcome for anastomotic leakage after total mesorectal excision for rectal cancer. World J Surg, 32, 1124-9. https://doi.org/10.1007/s00268-007-9451-2
  28. Li CG, Huang XE, Li Y, et al (2011). Clinical observations on safety and efficacy of OxyContin$^{\circledR}$ administered by rectal route in treating cancer related pain. Asian Pac J Cancer Prev, 12, 2477-8.
  29. Li CG, Huang XE, Xu L, et al (2012). Clinical application of serum tumor associated material (TAM) from non-small cell lung cancer patients. Asian Pac J Cancer Prev, 13, 301-4. https://doi.org/10.7314/APJCP.2012.13.1.301
  30. Li CG, Huang XE, Li Y, et al (2011). Phase II trial of irinotecan plus nedaplatin (INP) in treating patients with extensive stage small cell lung cancer. Asian Pac J Cancer Prev, 12, 487-90.
  31. Li Y, Yan PW, Huang XE, et al (2011). MDR1 gene C3435T polymorphism is associated with clinical outcomes in gastric cancer patients treated with postoperative adjuvant chemotherapy. Asian Pac J Cancer Prev, 12, 2405-09.
  32. Liu J, Huang XE, Tian GY, et al (2013). Phase II study on safety and efficacy of Yadanzi${\circledR}$ (Javanica oil emulsion injection) combined with chemotherapy for patients with gastric cancer. Asian Pac J Cancer Prev, 14, 2009-12. https://doi.org/10.7314/APJCP.2013.14.3.2009
  33. Liu W, Li SY, Huang XE, et al (2012). Inhibition of tumor growth in vitro by a combination of extracts from rosa roxburghii tratt and fagopyrum cymosum. Asian Pac J Cancer Prev, 13, 2409-14. https://doi.org/10.7314/APJCP.2012.13.5.2409
  34. Liu YC, Zhou SB, Gao F, et al (2013). Phase II study on breast conservative surgery plus chemo- and radiotherapy in treating Chinese patients with early staged breast cancer. Asian Pac J Cancer Prev, 14, 3747-50. https://doi.org/10.7314/APJCP.2013.14.6.3747
  35. Liu YC, Zhou SB, Gao F, et al (2013). Chemotherapy and late course three dimensional conformal radiotherapy for treatment of patients with stage III non- small cell lung cancer. Asian Pac J Cancer Prev, 14, 2663-5. https://doi.org/10.7314/APJCP.2013.14.4.2663
  36. Lu YY, Huang XE, Xu L, et al (2013). Potential predictors of sensitivity to pemetrexed as first-line chemotherapy for patients with advanced non-squamous NSCLC. Asian Pac J Cancer Prev, 14, 2005-8. https://doi.org/10.7314/APJCP.2013.14.3.2005
  37. Martinez D, Vermeulen M, Trevani A, et al (2006). Extracellular acidosis induces neutrophil activation by a mechanism dependent on activation ofphosphatidylinositol 3-kinase/Akt and ERK pathways. J Immunol, 176, 1163-71. https://doi.org/10.4049/jimmunol.176.2.1163
  38. Martinez D, Vermeulen M, von Euw E, et al (2007). Extracellular acidosis triggers the maturation of human dendritic cells and the production of IL-12. J Immunol, 179, 1950-9. https://doi.org/10.4049/jimmunol.179.3.1950
  39. Matthiessen P, Henriksson M, Hallbook O, et al (2008). Increase of serum C-reactive protein is an early indicator of subsequent symptomatic anastomotic leakage after anterior resection. Colorectal Dis, 10, 75-80.
  40. Mileski WJ, Joehl RJ, Rege RV, et al (1988). Treatment of anastomotic leakage following low anterior resection. Arch Surg, 123, 968-71. https://doi.org/10.1001/archsurg.1988.01400320054011
  41. Millan M, Garcia-Granero E, Flor B, et al (2006). Early prediction of anastomotic leak in colorrectal cancer surgery by intramucosal pH. Dis Colon Rectum, 49, 595-601. https://doi.org/10.1007/s10350-006-0504-7
  42. Ortega-Deballon P, Facy O, Binquet C (2013). C-reactive protein and procalcitonin as predictors of anastomotic leak. Dis Colon Rectum, 56, 395.
  43. Ortega-Deballon P, Radais F, Facy O, d'Athis P, et al (2010). C-reactive protein is an early predictor of septic complications after elective colorectal surgery. World J Surg, 34, 808-14. https://doi.org/10.1007/s00268-009-0367-x
  44. Park SY, Bae DJ, Kim MJ, et al (2012). Extracellular low pH modulates phosphatidylserine-dependent phagocytosis in macrophages by increasing stabilin-1 expression. J Biol Chem, 287, 11261-71. https://doi.org/10.1074/jbc.M111.310953
  45. Paun BC, Cassie S, MacLean AR, et al (2010). Postoperative complications following surgery for rectal cancer. Ann Surg, 251, 807-818. https://doi.org/10.1097/SLA.0b013e3181dae4ed
  46. Riss S, Stremitzer S, Riss K, et al (2011). Pelvic organ function and quality of life after anastomotic leakage following rectal cancer surgery. Wien Klin Wochenschr, 123, 53-57. https://doi.org/10.1007/s00508-010-1514-y
  47. Shandall A, Lowndes R, Young HL (1985). Colonic anastomotic healing and oxigen tension. Br J Surg, 72, 606-9. https://doi.org/10.1002/bjs.1800720808
  48. Sheridan WG, Lowndes RH, Young HL (1987). Tissue oxygen tension as a predictor of colonic anastomotic healing. Dis Colon Rectum, 30, 867-71. https://doi.org/10.1007/BF02555426
  49. Shu J, Li CG, Liu YC, et al (2012). Comparison of Serum Tumor Associated Material (TAM) with Conventional Biomarkers in Cancer Patients. Asian Pac J Cancer Prev, 13, 2399-403. https://doi.org/10.7314/APJCP.2012.13.5.2399
  50. Sun MQ, Meng AF, Huang XE, et al (2013). Comparison of psychological influence on breast cancer patients between breast-conserving surgery and modified radical mastectomy. Asian Pac J Cancer Prev, 14, 149-52. https://doi.org/10.7314/APJCP.2013.14.1.149
  51. Wu XY, Huang XE, You SX, et al (2013). Phase II study of pemetrexed as second or third line combined chemotherapy in patients with colorectal cancer. Asian Pac J Cancer Prev, 14, 2019-22. https://doi.org/10.7314/APJCP.2013.14.3.2019
  52. Trevani AS, Andonegui G, Giordano M, et al (1999). Extracellular acidification induces human neutrophil activation. J Immunol, 162, 4849-57.
  53. Tjandra JJ, Kilkenny JW, Buie WD, et al (2005). Standards practice task force; American society of colon and rectal surgeons. Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum, 48, 411-423. https://doi.org/10.1007/s10350-004-0937-9
  54. Veenhof AA, Kropman RH, Engel AF, et al (2007). Preoperative radiation therapy for locally advanced rectal cancer: a comparison between two different time intervals to surgery. Int J Colorectal Dis, 22, 507-513. https://doi.org/10.1007/s00384-006-0195-5
  55. Welsch T, Müller SA, Ulrich A, et al (2007). C-reactive protein as early predictor for infectious postoperative complications in rectal surgery. Int J Colorectal Dis, 22, 1499-507. https://doi.org/10.1007/s00384-007-0354-3
  56. Wei GL, Huang XE, Huo JG, et al (2013). Phase II study on pemetrexed-based chemotherapy in treating patients with metastatic gastric cancer not responding to prior palliative chemotherapy. Asian Pac J Cancer Prev, 14, 2703-6. https://doi.org/10.7314/APJCP.2013.14.5.2703
  57. Woeste G, Muller C, Bechstein WO, et al (2010). Increased serum levels of Creactive protein precede anastomotic leakage in colorectal surgery. World J Surg, 34, 140-6. https://doi.org/10.1007/s00268-009-0304-z
  58. Xu JW, Li CG, Huang XE, 10. et al (2011). Ubenimex capsule improves general performance and chemotherapy related toxicity in advanced gastric cancer cases. Asian Pac J Cancer Prev, 12, 985-7.
  59. Xu HX, Huang XE, Li Y, et al (2011). A clinical study on safety and efficacy of Aidi injection combined with chemotherapy. Asian Pac J Cancer Prev, 12, 2233-6.
  60. Xu HX, Huang XE, Qian ZY, et al (2011). Clinical observation of Endostar${\circledR}$ combined with chemotherapy in advanced colorectal cancer patients. Asian Pac J Cancer Prev, 12, 3087-90.
  61. Xu T, Xu ZC, Zou Q, Yu B, Huang XE (2012). P53 Arg72Pro polymorphism and bladder cancer risk--meta-analysis evidence for a link in Asians but not Caucasians. Asian Pac J Cancer Prev, 13, 2349-54. https://doi.org/10.7314/APJCP.2012.13.5.2349
  62. Xu X, Wang L, Xu HQ, Huang XE, et al (2013). Clinical comparison between paclitaxel liposome (Lipusu${\circledR}$) and paclitaxel for treatment of patients with metastatic gastric cancer. Asian Pac J Cancer Prev, 14, 2591-4. https://doi.org/10.7314/APJCP.2013.14.4.2591
  63. Yan PW, Huang XE, Yan F, et al (2011). Influence of MDR1 gene codon 3435 polymorphisms on outcome of platinum-based chemotherapy for advanced non small cell lung cancer. Asian Pac J Cancer Prev, 12, 2291-4.
  64. Yang L, Huang XE, Zhou JN (2013). Risk assessment on anastomotic leakage after rectal cancer surgery: an analysis of 753 patients. Asian Pac J Cancer Prev, 14, 4447-53. https://doi.org/10.7314/APJCP.2013.14.7.4447
  65. Yin HT, Zhang DG, Wu XL (2013). In vivo evaluation of curcumin-loaded nanoparticles in a A549 xenograft mice model. Asian Pac J Cancer Prev, 14, 409-12. https://doi.org/10.7314/APJCP.2013.14.1.409
  66. Yin HT, Tian QZ, Guan L (2013). In vitro and in vivo Evaluation of the Antitumor Efficiency of Resveratrol Against Lung Cancer. Asian Pac J Cancer Prev, 14, 1703-6. https://doi.org/10.7314/APJCP.2013.14.3.1703
  67. Yu DS, Huang XE, Zhou JN, et al (2012). Comparative study on the value of anal preserving surgery for aged people with low rectal carcinoma in Jiangsu, China. Asian Pac J Cancer Prev, 13, 2339-40. https://doi.org/10.7314/APJCP.2012.13.5.2339
  68. Zhang LQ, Huang XE, Wang J (2011). The cyclin D1 G870A polymorphism and colorectal cancer susceptibility: a metaanalysis of 20 populations. Asian Pac J Cancer Prev, 12, 81-5.
  69. Zhan YP, Huang XE, Cao J et al (2012),, Clinical study on safety and efficacy of Qinin$^{\circledR}$ (cantharidin sodium) injection combined with chemotherapy in treating patients with gastric cancer. Asian Pac J Cancer Prev, 13, 4773-6. https://doi.org/10.7314/APJCP.2012.13.9.4773
  70. Zhan YP, Huang XE, Cao J, et al (2012). Clinical safety and efficacy of Kanglaite${\circledR}$ (Coix Seed Oil) injection combined with chemotherapy in treating patients with gastric cancer. Asian Pac J Cancer Prev, 13, 5319-21. https://doi.org/10.7314/APJCP.2012.13.10.5319
  71. Zhang XZ, Huang XE, Xu YL, et al (2012). Phase II study on voriconazole for treatment of Chinese patients with malignant hematological disorders and invasive aspergillosis. Asian Pac J Cancer Prev, 13, 2415-8. https://doi.org/10.7314/APJCP.2012.13.5.2415

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