The Predictive Value of Pulse Wave Velocity for Anastomotic Leakage After Colorectal Surgery
Corresponding Author
A. Venara
- [email protected]
- 00 33 2 41 35 35 25
Department of Visceral and Endocrine Surgery, CHU Angers, Angers University Hospital, 4 Rue Larrey, 49933 Angers Cedex 9, France
Angers Medical University, Angers, France
INSERM U1235- TENS, The Enteric Nervous System in Gut and Brain Disorders, Institute of Digestive Tract Disorders, (Institut des maladies de l’appareil digestif), 1 Rue Gaston Veil 44035, Nantes, France
Tel.: 00 33 2 41 35 35 25, [email protected]Search for more papers by this authorR. Jaouen
Department of Visceral and Endocrine Surgery, CHU Angers, Angers University Hospital, 4 Rue Larrey, 49933 Angers Cedex 9, France
Angers Medical University, Angers, France
Search for more papers by this authorE. Lermite
Department of Visceral and Endocrine Surgery, CHU Angers, Angers University Hospital, 4 Rue Larrey, 49933 Angers Cedex 9, France
Angers Medical University, Angers, France
Search for more papers by this authorP. Le Naoures
Department of Visceral and Endocrine Surgery, CHU Angers, Angers University Hospital, 4 Rue Larrey, 49933 Angers Cedex 9, France
Search for more papers by this authorC. Casa
Department of Visceral and Endocrine Surgery, CHU Angers, Angers University Hospital, 4 Rue Larrey, 49933 Angers Cedex 9, France
Search for more papers by this authorE. Mirallié
Department of Visceral and Endocrine Surgery, Nantes University Hospital, 1 Place Alexis Ricordeau, 44000 Nantes, France
Search for more papers by this authorE. Duchalais
INSERM U1235- TENS, The Enteric Nervous System in Gut and Brain Disorders, Institute of Digestive Tract Disorders, (Institut des maladies de l’appareil digestif), 1 Rue Gaston Veil 44035, Nantes, France
Department of Visceral and Endocrine Surgery, Nantes University Hospital, 1 Place Alexis Ricordeau, 44000 Nantes, France
Search for more papers by this authorA. Hamy
Department of Visceral and Endocrine Surgery, CHU Angers, Angers University Hospital, 4 Rue Larrey, 49933 Angers Cedex 9, France
Angers Medical University, Angers, France
Search for more papers by this authorCorresponding Author
A. Venara
- [email protected]
- 00 33 2 41 35 35 25
Department of Visceral and Endocrine Surgery, CHU Angers, Angers University Hospital, 4 Rue Larrey, 49933 Angers Cedex 9, France
Angers Medical University, Angers, France
INSERM U1235- TENS, The Enteric Nervous System in Gut and Brain Disorders, Institute of Digestive Tract Disorders, (Institut des maladies de l’appareil digestif), 1 Rue Gaston Veil 44035, Nantes, France
Tel.: 00 33 2 41 35 35 25, [email protected]Search for more papers by this authorR. Jaouen
Department of Visceral and Endocrine Surgery, CHU Angers, Angers University Hospital, 4 Rue Larrey, 49933 Angers Cedex 9, France
Angers Medical University, Angers, France
Search for more papers by this authorE. Lermite
Department of Visceral and Endocrine Surgery, CHU Angers, Angers University Hospital, 4 Rue Larrey, 49933 Angers Cedex 9, France
Angers Medical University, Angers, France
Search for more papers by this authorP. Le Naoures
Department of Visceral and Endocrine Surgery, CHU Angers, Angers University Hospital, 4 Rue Larrey, 49933 Angers Cedex 9, France
Search for more papers by this authorC. Casa
Department of Visceral and Endocrine Surgery, CHU Angers, Angers University Hospital, 4 Rue Larrey, 49933 Angers Cedex 9, France
Search for more papers by this authorE. Mirallié
Department of Visceral and Endocrine Surgery, Nantes University Hospital, 1 Place Alexis Ricordeau, 44000 Nantes, France
Search for more papers by this authorE. Duchalais
INSERM U1235- TENS, The Enteric Nervous System in Gut and Brain Disorders, Institute of Digestive Tract Disorders, (Institut des maladies de l’appareil digestif), 1 Rue Gaston Veil 44035, Nantes, France
Department of Visceral and Endocrine Surgery, Nantes University Hospital, 1 Place Alexis Ricordeau, 44000 Nantes, France
Search for more papers by this authorA. Hamy
Department of Visceral and Endocrine Surgery, CHU Angers, Angers University Hospital, 4 Rue Larrey, 49933 Angers Cedex 9, France
Angers Medical University, Angers, France
Search for more papers by this authorA. Venara and R. Jaouen have contributed equally to this work.
Abstract
Background
Arterial perfusion defects are a risk factor for anastomotic leakage (AL) following colorectal surgery. Measuring arterial stiffness using pulse wave velocity (PWV) is known to reflect the performance of the arterial network. The objective of this study was to assess the predictive value of PWV for AL after colorectal surgery.
Methods
A prospective monocentric study was conducted on all consecutive patients who underwent colorectal surgery scheduled between March 1, 2016 and May 1, 2017. Patients were divided into two groups according to the PWV which was measured preoperatively using the pOpmètre® device: PWV+ (PWV > 10 m/s) and PWV− (PWV ≤ 10 m/s). We then compared the PWV+ and PWV− groups. The primary endpoint was the AL rate.
Results
A total of 96 patients were studied, including 60 in the PWV− group and 36 in the PWV+ group. Patients in the PWV+ group were more at risk of presenting with AL than those in the PWV− group (6.25 vs 0%) (p = 0.002). There was no difference in immediate postoperative complications between the two groups apart from the length of hospital stay. PWV predicted the appearance of AL with a sensitivity of and a negative predictive value of 100%.
Conclusion
Measuring PWV could be a used as a predictive examination in the early detection of AL after colorectal surgery.
References
- 1AngelucciGP, SinibaldiG, OrsariaP et al. Morbidity and mortality after colorectal surgery for cancer. Surg Sci (2013) 04: 52010.4236/ss.2013.411101
10.4236/ss.2013.411101 Google Scholar
- 2AlvesA, PanisY, MathieuP et al. Postoperative mortality and morbidity in French patients undergoing colorectal surgery: results of a prospective multicenter study. Arch Surg (2005) 140: 278–28310.1001/archsurg.140.3.27815781793
- 3PaunBC, CassieS, MacLeanAR et al. Postoperative complications following surgery for rectal cancer. Ann Surg (2010) 251: 807–81810.1097/SLA.0b013e3181dae4ed20395841
- 4GrantMC, YangD, WuCL et al. Impact of enhanced recovery after surgery and fast track surgery pathways on healthcare-associated infections: results from a systematic review and meta-analysis. Ann Surg (2017) 265: 68–7910.1097/SLA.000000000000170328009729
- 5ShetiwyM, FadyT, ShahattoF et al. Standardizing the protocols for enhanced recovery from colorectal cancer surgery: Are we a step closer to ideal recovery?. Ann Coloproctol (2017) 33: 86–9210.3393/ac.2017.33.3.8628761868
- 6 Economic Impact of Anastomotic Leaks in Colectomy Procedures in the USA: 2005-2009. SAGES Abstract archives. archives. Cited 2017 Nov 19. https://www.sages.org/meetings/annual-meeting/abstracts-archive/economic-impact-of-anastomotic-leaks-in-colectomy-procedures-in-the-usa-2005-2009/
- 7MiduraEF, HansemanD, DavisBR et al. Risk factors and consequences of anastomotic leak after colectomy: a national analysis. Dis Colon Rectum (2015) 58: 333–33810.1097/DCR.000000000000024925664712
- 8den DulkM, NoterSL, HendriksER et al. Improved diagnosis and treatment of anastomotic leakage after colorectal surgery. Eur J Surg Oncol (2009) 35: 420–42610.1016/j.ejso.2008.04.009
- 9PlatellC, BarwoodN, DorfmannG et al. The incidence of anastomotic leaks in patients undergoing colorectal surgery. Colorectal Dis (2007) 9: 71–7910.1111/j.1463-1318.2006.01002.x17181849
- 10LipskaMA, BissettIP, ParryBR et al. Anastomotic leakage after lower gastrointestinal anastomosis: men are at a higher risk. ANZ J Surg (2006) 76: 579–58510.1111/j.1445-2197.2006.03780.x16813622
- 11ChoiH-K, LawW-L, HoJWC Leakage after resection and intraperitoneal anastomosis for colorectal malignancy: analysis of risk factors. Dis Colon Rectum (2006) 49: 1719–172510.1007/s10350-006-0703-217051321
- 12HamzaoğluI, KarahasanoğluT, AydinS et al. The effects of hyperbaric oxygen on normal and ischemic colon anastomoses. Am J Surg (1998) 176: 458–46110.1016/S0002-9610(98)00234-79874433
- 13KomenN, DijkJ-W, LalmahomedZ et al. After-hours colorectal surgery: a risk factor for anastomotic leakage. Int J Colorectal Dis (2009) 24: 789–79510.1007/s00384-009-0692-419301016
- 14SørensenLT, JørgensenT, KirkebyLT et al. Smoking and alcohol abuse are major risk factors for anastomotic leakage in colorectal surgery. Br J Surg (1999) 86: 927–93110.1046/j.1365-2168.1999.01165.x10417567
- 15KruschewskiM, RiegerH, PohlenU et al. Risk factors for clinical anastomotic leakage and postoperative mortality in elective surgery for rectal cancer. Int J Colorectal Dis (2007) 22: 919–92710.1007/s00384-006-0260-017260142
- 16PostIL, VerheijenPM, PronkA et al. Intraoperative blood pressure changes as a risk factor for anastomotic leakage in colorectal surgery. Int J Colorectal Dis (2012) 27: 765–77210.1007/s00384-011-1381-722297862
- 17AlivonM, Vo-Duc PhuongT, VignonV et al. A novel device for measuring arterial stiffness using finger-toe pulse wave velocity: validation study of the pOpmètre®. Arch Cardiovasc Dis (2015) 108: 227–23410.1016/j.acvd.2014.12.00325682547
- 18Ben-ShlomoY, SpearsM, BoustredC et al. Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol (2014) 63: 636–64610.1016/j.jacc.2013.09.06324239664
- 19Van BortelLM, LaurentS, BoutouyrieP et al. Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity. J Hypertens (2012) 30: 445–44810.1097/HJH.0b013e32834fa8b022278144
- 20ZhangY, AgnolettiD, XuY et al. Carotid-femoral pulse wave velocity in the elderly. J Hypertens (2014) 32: 1572–157610.1097/HJH.000000000000018724721930
- 21ManciaG, FagardR, NarkiewiczK et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J (2013) 34: 2159–221910.1093/eurheartj/eht15123771844
- 22RahbariNN, WeitzJ, HohenbergerW et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery (2010) 147: 339–35110.1016/j.surg.2009.10.01220004450
- 23HoranTC, GaynesRP, MartoneWJ et al. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control (1992) 20: 271–27410.1016/S0196-6553(05)80201-91332552
- 24DindoD, DemartinesN, ClavienP-A Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg (2004) 240: 205–21310.1097/01.sla.0000133083.54934.ae15273542
- 25SammourT, CohenL, KarunatillakeAI et al. Validation of an online risk calculator for the prediction of anastomotic leak after colon cancer surgery and preliminary exploration of artificial intelligence-based analytics. Tech Coloproctol (2017) 21: 869–87710.1007/s10151-017-1701-129080956
- 26SafarME Arterial stiffness as a risk factor for clinical hypertension. Nat Rev Cardiol (2017) 15: 97–10510.1038/nrcardio.2017.15529022570
- 27RencuzogullariA, BenliceC, ValenteM et al. Predictors of anastomotic leak in elderly patients after colectomy: nomogram-based assessment from the American College of Surgeons National Surgical Quality Program Procedure-targeted cohort. Dis Colon Rectum (2017) 60: 527–53610.1097/DCR.000000000000078928383453
- 28EvenoC, LatrasseV, GayatÉ et al. Colorectal anastomotic leakage can be predicted by abdominal aortic calcification on preoperative CT scans: a pilot study. J Visc Surg (2016) 153: 253–25710.1016/j.jviscsurg.2016.03.00727118170
- 29VignaliA, GianottiL, BragaM et al. Altered microperfusion at the rectal stump is predictive for rectal anastomotic leak. Dis Colon Rectum (2000) 43: 76–8210.1007/BF0223724810813128
- 30SilvestriM, DobrinjaC, ScomersiS et al. Modifiable and non-modifiable risk factors for surgical site infection after colorectal surgery: a single-center experience. Surg Today (2017) 48: 338–34510.1007/s00595-017-1590-y28948367
- 31GuinierD, MantionGA, AlvesA et al. Risk factors of unplanned readmission after colorectal surgery: a prospective, multicenter study. Dis Colon Rectum (2007) 50: 1316–132310.1007/s10350-007-0310-x17665252
- 32AlvesA, PanisY, TrancartD et al. Factors associated with clinically significant anastomotic leakage after large bowel resection: multivariate analysis of 707 patients. World J Surg (2002) 26: 499–50210.1007/s00268-001-0256-411910487
