Early detection of deep pelvic surgical site infection by microdialysis after abdominoperineal resection for locally advanced rectal cancer.

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Techniques in Coloproctology Pub Date : 2025-05-29 DOI:10.1007/s10151-025-03156-w

J Asvall, H Haugaa, S G Larsen, T F R Skarholt, B M Botnen, K Flatmark, T I Tønnessen, E B Thorgersen

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引用次数: 0

Abstract

Background: Patients with locally advanced rectal cancer (LARC) treated with (chemo)-radiotherapy before abdominoperineal resection (APR) are at high risk of developing pelvic organ/space surgical site infection (O/S-SSI). This increases morbidity and prolongs length of stay. Vague symptoms delay diagnosis. In microdialysis, thin catheters are placed in tissue enabling monitoring of metabolism. We hypothesize that local metabolic changes related to O/S-SSI might be detected by microdialysis.

Methods: In a prospective observational study, 38 patients who underwent open APR for LARC were analysed. At the end of surgery microdialysis catheters were placed in remnant tissue of the pelvic floor. Postoperatively, metabolic parameters including lactate, pyruvate, glucose and glycerol were measured, and the lactate-to-pyruvate (L/P) ratio was calculated. Out of 38 patients, 12 (32%) developed O/S-SSI.

Results: O/S-SSI was diagnosed median 9 (range 6-17) days after surgery. On the day of surgery, mean lactate in the O/S-SSI group was 6.0 mmol/L, whereas it was 3.6 mmol/L in the no-O/S-SSI group. ROC analysis (AUC = 0.73), with cut-point lactate 5.7, detected O/S-SSI with 92% sensitivity and 65% specificity. Overall mean lactate was 1.9 mmol/L higher in the O/S-SSI group than in the no-O/S-SSI group (P = 0.002). Overall mean L/P ratio was 34 units higher in the O/S-SSI group (P = 0.001).

Conclusions: In patients developing pelvic O/S-SSI, tissue lactate and L/P ratio measured by microdialysis were significantly higher and evident already from the day of surgery, 9 days prior to diagnosis, with high negative predictive value and moderate positive predictive value. Local monitoring using microdialysis may aid detection of O/S-SSI.

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局部进展期直肠癌腹会阴切除术后微透析早期检测深盆腔手术部位感染。

背景：局部晚期直肠癌（LARC）患者在腹会阴切除术（APR）前接受（化疗）放疗是发生盆腔器官/间隙手术部位感染（O/S-SSI）的高危患者。这增加了发病率，延长了住院时间。症状模糊延误诊断。在微透析中，细导管被放置在组织中以监测新陈代谢。我们假设与O/S-SSI相关的局部代谢变化可能通过微透析检测到。方法：在一项前瞻性观察研究中，对38例LARC患者进行了开放式APR分析。手术结束时，在盆底残余组织中放置微透析导管。术后测定乳酸、丙酮酸、葡萄糖、甘油等代谢指标，计算乳酸/丙酮酸（L/P）比值。38例患者中，12例（32%）发展为O/S-SSI。结果：O/S-SSI在手术后9天（6-17天）被诊断。手术当日，O/S-SSI组平均乳酸水平为6.0 mmol/L，而无O/S-SSI组为3.6 mmol/L。ROC分析（AUC = 0.73）， cut-point lactate为5.7，检测O/S-SSI的灵敏度为92%，特异性为65%。O/S-SSI组总体平均乳酸水平比无O/S-SSI组高1.9 mmol/L （P = 0.002）。总体平均L/P比O/S-SSI组高34个单位（P = 0.001）。结论：在发生盆腔O/S-SSI的患者中，微透析测量的组织乳酸和L/P比值从手术当天（诊断前9天）就已经明显升高，具有较高的阴性预测值和中等阳性预测值。局部微透析监测有助于O/S-SSI的检测。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Techniques in Coloproctology GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.30

自引率

9.10%

发文量

176

审稿时长

1 months

期刊介绍： Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.