Abstract
PURPOSE: To assess the predictive value of the endotoxin (ET) assay for the detection of anastomotic leakage (AL) after colorectal surgery (CRS). METHODS: ET levels in the drainage fluid were measured using endotoxin scattering photometry (ET-ESP) and turbidimetric (ET-TUB) assays on postoperative day (POD) zero, POD1 and POD3, comparing tumor necrosis factor (TNF)-α. RESULTS: AL was observed in 8 (4.9%) of the 162 patients. ET-ESP, ET-TUB, and TNF-α levels on POD0 and serum C-reactive protein (CRP) on POD1 were significantly elevated in the AL group. The area under the receiver operating characteristic curve (AUROC) for ET-ESP level (0.903) on POD0 showed early and better predictive performance for AL compared to that for ET-TUB (0.869, p = 0.230) and TNF-α (0.758, p = 0.034) levels on POD0; the AUROC for CRP level (0.711) on POD1 was inferior to other parameters. In subgroup analysis, five (3.7%) of 136 patients with colorectal cancer (CRC) developed AL. Additionally, the ET-ESP level on POD0 showed relatively good predictive performance for AL after CRC (AUROC: ET-ESP [0.871], ET-TUB [0.840], and TNF-α [0.737] on POD0). CONCLUSION: ET levels in drainage fluid, especially those measured using ESP, on POD0 may have an early predictive ability to detect AL post-CRS.