An early detector of anastomosis leakage following colorectal cancer surgery in intensive care

İbrahim Mungan1* Erdal Birol Bostancı2 Erbil Türksal3 Büşra Tezcan4 Sema Turan4
Show Less
1 Kocaeli Darica Farabi Training and Research Hospital, Department of Intensive Care Unit, Darica, Kocaeli, Türkiye
2 Ankara Training and Research City Hospital, Department of Gastrointestinal Surgery, Ankara, Türkiye
3 Ankara Keçiören Training and Research Hospital, Department of Anesthesiology, Ankara, Türkiye
4 Ankara Training and Research City Hospital, Department of Intensive Care Unit, Ankara, Türkiye
CP 2023, 5(1), 2374
Submitted: 18 January 2023 | Accepted: 21 March 2023 | Published: 31 March 2023
© 2023 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )

Colorectal cancer, comprising 10% of global cancer cases, often leads to anastomosis leakage (AL), a significant post-operative complication. Previous research on AL has highlighted the inflammatory response as a common risk factor and a potential diagnostic tool. This study aimed to investigate the inflammatory markers linked to AL and their prospective use as predictors of AL. This retrospective study was conducted in the intensive care unit of a state hospital in Ankara, Turkey. AL was detected through computed tomography and clinical evaluation (e.g., peritonitis and clinical deterioration). Inflammatory markers, including C-reactive protein and neutrophil-to-lymphocyte ratio (NLR), were examined in this study. A total of 410 patients were included in this study, among whom AL was observed in 26 cases (6.3%). The pre-operative levels of inflammatory markers did not differ between AL-positive and AL-negative groups, whereas the post-operative levels significantly differed between the groups (P < 0.05), particularly regarding post-operative NLR levels (P < 0.001). The predictive power of the difference in NLR was more prominent than the other inflammatory markers. In addition, the area under the curve of the NLR difference was sufficient to effectively predict AL. As the manifestation of AL signs and symptoms often occur in the later stages of inflammation, the early detection of inflammatory marker changes could signal the pre-emptive development of AL and enhance its management. In summation, the findings of this study further established the clinical potential of inflammatory markers for the early detection of AL, albeit requiring validation and support from additional prospective studies.

Colorectal cancer
Anastomosis leakage
Inflammatory marker
Early detection
  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7-30. doi: 10.3322/caac.21590


  1. Ong SY, Tan ZZX, Teo NZ, Ngu JCY. Surgical considerations for the “perfect” colorectal anastomosis. J Gastrointest Oncol. 2023;14(5):2243-2248. doi: 10.21037/jgo-23-41


  1. Bailon-Cuadrado M, Perez-Saborido B, Sanchez-Gonzalez J, Rodriguez-Lopez M, Mayo-Iscar A, Pacheco-Sanchez D. A new dimensional-reducing variable obtained from original inflammatory scores is highly associated to morbidity after curative surgery for colorectal cancer. Int J Colorectal Dis. 2018;33(9):1225-1234. doi: 10.1007/s00384-018-3100-0


  1. Ellebæk MB, Rahr HB, Boye S, Fristrup C, Qvist N. Detection of early anastomotic leakage by intraperitoneal microdialysis after low anterior resection for rectal cancer: A prospective cohort study. Colorectal Dis. 2019;21(12):1387-96. doi: 10.1111/codi.14781


  1. Wang Y. Imaging diagnosis and imaging risk factors of anastomotic leakage after rectal cancer surgery. Zhonghua Wei Chang Wai Ke Za Zhi. 2018;21(4):404-408. doi: 10.3760/cma.j.issn.1671-0274.2018.04.009


  1. Liu Y, Wang G, Liu X, et al. A scoring system to predict the risk of anastomotic leakage in patients with patients with rectal cancer older than 60 years. Zhonghua Wei Chang Wai Ke Za Zhi. 2018;21(4):437-441. doi: 10.3760/cma.j.issn.1671-0274.2018.04.015


  1. Alsaleh A, Pellino G, Christodoulides N, Malietzis G, Kontovounisios C. Hyponatremia could identify patients with intrabdominal sepsis and anastomotic leak after colorectal surgery: A systematic review of the literature. Updates Surg. 2019;71(1):17-20. doi: 10.1007/s13304-019-00627-2


  1. Ge W, Chen G. The value of biomarkers in early diagnosis of anastomotic leak following colorectal tumor resection: A review of the literature between 2012 and 2017. Oncotarget. 2017;5. doi: 10.18632/oncotarget.23604


  1. Gohil R, Rishi M, Tan BHL. Pre-operative serum albumin and neutrophil-lymphocyte ratio are associated with prolonged hospital stay following colorectal cancer surgery. Br J Med Med Res. 2014;4(1):481-487. doi: 10.9734/BJMMR/2014/5444#sthash.FpqnVF8X.dpuf


  1. Weiser MR. AJCC 8th edition: Colorectal cancer. Ann Surg Oncol. 2018;25(6):1454-1455. doi: 10.1245/s10434-018-6462-1


  1. Duraes LC, Stocchi L, Steele SR, et al. The relationship between clavien-dindo morbidity classification and oncologic outcomes after colorectal cancer resection. Ann Surg Oncol. 2018;25(1):188-196. doi: 10.1245/s10434-017-6142-6


  1. Li YW, Lian P, Huang B, et al. Very early colorectal anastomotic leakage within 5 post-operative days: A more severe subtype needs relaparatomy. Sci Rep. 2017;7:39936. doi: 10.1038/srep39936


  1. van Rooijen SJ, Jongen AC, Wu ZQ, et al. Definition of colorectal anastomotic leakage: A consensus survey among Dutch and Chinese colorectal surgeons. World J Gastroenterol. 2017;23(33):6172-6180. doi: 10.3748/wjg.v23.i33.6172


  1. Popescu G, Bancu Ș, Sala D, Neagoe RM, Mureșan M. Prediction and early identification of anastomotic leaks after colorectal surgery. J Surg. 2018;14(1):23-27. doi: 10.7438/1584-9341-14-1-4


  1. Ge W, Chen G. Anastomotic leakage following colorectal surgery: Definition, diagnosis and treatment. Int J Clin Exp Med. 2019;12(1):186-193.


  1. den Dulk M, Noter SL, Hendriks ER, et al. Improved diagnosis and treatment of anastomotic leakage after colorectal surgery. Eur J Surg Oncol. 2009;35:420-426. doi: 10.1016/j.ejso.2008.04.009


  1. Elinav E, Nowarski R, Thaiss CA, Hu B, Jin C, Flavell RA. Inflammation-induced cancer: Crosstalk between tumours, immune cells and microorganisms. Nat Rev Cancer. 2013;13(11):759-771. doi: 10.1038/nrc3611


  1. Herrod PJJ, Boyd-Carson H, Doleman B, et al. Quick and simple; psoas density measurement is an independent predictor of anastomotic leak and other complications after colorectal resection. Tech Coloproctol. 2019;23:129-134. doi: 10.1007/s10151-019-1928-0


  1. Mungan İ, Dicle ÇB, Bektaş Ş, et al. Does the preoperative platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio predict morbidity after gastrectomy for gastric cancer? Mil Med Res. 2020;7:9. doi: 10.1186/s40779-020-00234-y


  1. Iversen H, Ahlberg M, Lindqvist M, Buchli C. Changes in clinical practice reduce the rate of anastomotic leakage after colorectal resections. World J Surg. 2018;42(7):2234-2241. doi: 10.1007/s00268-017-4423-7


  1. Josse JM, Cleghorn MC, Ramji KM, et al. The neutrophil-to-lymphocyte ratio predicts major perioperative complications in patients undergoing colorectal surgery. Colorectal Dis. 2016;18(7):O236-O242. doi: 10.1111/codi.13373


  1. Forget P, Dinant V, De Kock M. Is the neutrophil-to-lymphocyte ratio more correlated than C-reactive protein with postoperative complications after major abdominal surgery? PeerJ. 2015;3:e713. doi: 10.7717/peerj.713


  1. Oberhofer D, Juras J, Pavicić AM, RancićZurić I, Rumenjak V. Comparison of C-reactive protein and procalcitonin as predictors of postoperative infectious complications after elective colorectal surgery. Croat Med J. 2012;53(6):612-619. doi: 10.3325/cmj.2012.53.612


  1. Lyu Z, Wu D, Cai G, et al. Use of C response protein in predicting postoperative anastomotic leakage in patients with rectal cancer. Zhonghua Wei Chang Wai Ke Za Zhi. 2018;21(4):442-447. doi: 10.3760/cma.j.issn.1671-0274.2018.04.016


  1. Qian W, Ge XX, Wu J, et al. Prognostic evaluation of resectable colorectal cancer using platelet-associated indicators. Oncol Lett. 2019;18(1):571-580. doi: 10.3892/ol.2019.10388
Conflict of interest
The authors declare that they have no competing interests.
Back to top
Cancer Plus, Electronic ISSN: 2661-3840 Print ISSN: 2661-3832, Published by AccScience Publishing