Monitoring perioperative serum albumin can identify anastomotic leakage in colorectal cancer patients with curative intent.

Abstract

BACKGROUND:

Preoperative hypoalbuminemia is a well-known risk factor for anastomotic leakage after colorectal surgery, but the association between perioperative albumin level and anastomotic leakage has not been fully investigated in curative colorectal cancer (CRC) patients.

METHODS:

In total, 200 CRC patients (Stage I-III) undergoing curative laparoscopic surgery between January 2004 and December 2013 were enrolled in this study. We collected data on surgical factors, perioperative levels of serum albumin and inflammatory markers, and perioperative factors affecting hypoalbuminemia from 196 CRC patients to assess the relation to anastomotic leakage.

RESULTS:

Anastomotic leakage occurred in 11 cases (5.6%) and the frequency was higher in rectal cancer patients (p = 0.0044). There was no significant difference of preoperative serum albumin level between the anastomotic leakage group (AL) and the nonanastomotic leakage group (NAL). Postoperative serum albumin levels in AL were significantly lower than in NAL [postoperative day (POD) 0, p = 0.0004; POD1, p = 0.0001; POD3, p = 0.0004; and POD7, p = 0.0021]. On multivariate analysis, lower average level of serum albumin on POD1 and POD3 {odds ratio (OR) [95% confidence interval (CI)] = 7.53 (1.60-55.80), p = 0.0095}, higher average level of serum white blood cells on POD1 and POD3 [OR (95% CI) = 7.24 (1.40-59.25), p = 0.0165], and surgery for rectal cancer [OR (95% CI) = 15.18 (3.26-93.99), p = 0.0004] were independent risk factors for anastomotic leakage.

CONCLUSION:

Lower early postoperative serum albumin levels are a potentially valuable indicator of anastomotic leakage in CRC patients undergoing curative surgery.

• Authors: Tadanobu Shimura, Yuji Toiyama, Junichiro Hiro, Hiroki Imaoka, Hiroyuki Fujikawa, Minako Kobayashi, Masaki Ohi, Yasuhiro Inoue, Yasuhiko Mohri, Masato Kusunoki
• Journal: Asian journal of surgery (Asian J Surg) Vol. 41 Issue 1 Pg. 30-38 (Jan 2018) ISSN: 0219-3108 [Electronic] Netherlands
• PMID: 27451010 (Publication Type: Journal Article)
• Copyright: Copyright © 2016. Published by Elsevier Taiwan.

Chemical References

• Biomarkers
• Serum Albumin

Topics

• Adult
• Aged
• Aged, 80 and over
• Anastomotic Leak (blood, diagnosis, etiology)
• Biomarkers (blood)
• Colorectal Neoplasms (surgery)
• Female
• Humans
• Hypoalbuminemia (blood, complications, diagnosis)
• Laparoscopy
• Male
• Middle Aged
• Perioperative Care (methods)
• Retrospective Studies
• Risk Factors
• Serum Albumin (metabolism)