Early detection of anastomotic leak in intraperitoneal fluid after colorectal surgery

Background: Anastomotic leak (AL) represents serious complications of colorectal surgery and significantly influences patients’ morbidity and mortality. We investigated whether the analysis of lactate and pyruvate in the peritoneal fluid can help detect AL earlier than the current non-specific biochemical examination. Methods: Fifty-four adult patients (median age: 52 years) with colorectal carcinoma were enrolled in this prospective study. Patients were divided into the following three groups: group B – patients without AL after resection, group D – patients with AL after resection, and control group C – patients after palliative surgery without resection. We measured the concentration of lactate and pyruvate and calculated the lactate/pyruvate ratio in the peritoneal fluid of patients for the first 7 days after surgery. Results: The most significant difference was recorded between groups D and C (P˂0.001). Statistically significant differences were observed in the concentration of lactate between group B and group D over 7 days, except on the first postoperative day (P˂0.001). Upon comparison of groups B and D and groups C and D, the lactate/pyruvate ratio showed the most significant difference on the second postoperative day (P=0.002). Conclusion: High levels of lactate and lactate/pyruvate ratio allows early identification of AL as early as 2 days after surgery.