# Endotoxin in drainage fluid as an early and predictive marker of anastomotic leakage after colorectal surgery

## TL;DR

This study shows that measuring endotoxin in drainage fluid early after colorectal surgery can predict anastomotic leakage more effectively than other markers.

## Contribution

The study demonstrates that endotoxin levels measured by scattering photometry on the day of surgery are a strong early predictor of anastomotic leakage.

## Key findings

- Endotoxin levels measured by ET-ESP on POD0 showed the best predictive performance for anastomotic leakage.
- ET-ESP outperformed ET-TUB and TNF-α in predicting anastomotic leakage after colorectal surgery.
- ET-ESP also showed good predictive ability specifically for patients with colorectal cancer.

## Abstract

To assess the predictive value of the endotoxin (ET) assay for the detection of anastomotic leakage (AL) after colorectal surgery (CRS).

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.

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).

ET levels in drainage fluid, especially those measured using ESP, on POD0 may have an early predictive ability to detect AL post-CRS.