Peritoneal fluid biomarkers in the detection of colorectal anastomotic leaks: a systematic review

Emma C. Wright, Patricia Connolly, Mark Vella, Susan Moug

Research output: Contribution to journalArticlepeer-review

19 Citations (Scopus)


Purpose Anastomotic leak (AL) in colorectal surgery leads to significant morbidity, mortality and poorer oncological outcomes. Diagnosis of AL is frequently delayed as current methods of detection are not 100% sensitive or specific. ‘Biomarkers’, such as cytokines and markers of ischaemia, from the milieu of the anastomosis may aid early detection. This paper aims to review the evidence for their role in AL detection, allowing identification of targets for future research. Methods A systematic review was performed using PubMed, MEDLINE and Cochrane Library databases. Papers concerning detection or prediction of AL with biomarkers were identified. References within the papers were used to identify further relevant articles. Results Research has taken place in small cohorts with varying definitions of AL. Lactate has consistently been shown to be elevated in patients with intra-abdominal complications and ALs. pH on post-operative day 3 showed excellent specificity. Despite mixed results, a meta-analysis found that the cytokines tumour necrosis factor-α and interleukin-6 were elevated early in AL. Detection of bacteria in drain fluid by RT-PCR has good specificity but a high rate of false positives.
Original languageEnglish
Pages (from-to)935–945
Number of pages11
JournalInternational Journal of Colorectal Disease
Early online date12 Apr 2017
Publication statusPublished - Jul 2017


  • anastomotic leakage
  • lactate
  • colorectal surgery


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