{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T23:43:46Z","timestamp":1790725426910,"version":"4.1.0"},"reference-count":45,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,8,9]],"date-time":"2019-08-09T00:00:00Z","timestamp":1565308800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004374","name":"Medtronic","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004374","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>Anastomotic leakage (AL) is one of the most feared complications after rectal resection. This study aimed to assess a combination of biomarkers for early detection of AL after rectal cancer resection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>This study was an international multicentre prospective cohort study. All patients received a pelvic drain after rectal cancer resection. On the first three postoperative days drain fluid was collected daily and C\u2010reactive protein (CRP) was measured. Matrix metalloproteinase\u20102 (MMP2), MMP9, glucose, lactate, interleukin 1\u2010beta (IL1\u03b2), IL6, IL10, tumour necrosis factor alpha (TNF\u03b1), <jats:italic>Escherichia coli<\/jats:italic>,<jats:italic> Enterococcus faecalis<\/jats:italic>, lipopolysaccharide\u2010binding protein and amylase were measured in the drain fluid. Prediction models for AL were built for each postoperative day using multivariate penalized logistic regression. Model performance was estimated by the <jats:italic>c<\/jats:italic>\u2010index for discrimination. The model with the best performance was visualized with a nomogram and calibration was plotted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 292 patients were analysed; 38 (13.0%) patients suffered from AL, with a median interval to diagnosis of 6.0 (interquartile ratio 4.0\u201314.8) days. AL occurred less often after partial than after total mesorectal excision (4.9% <jats:italic>vs<\/jats:italic> 15.2%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.035). Of all patients with AL, 26 (68.4%) required reoperation. AL was more often treated by reoperation in patients without a diverting ileostomy (18\/20 <jats:italic>vs<\/jats:italic> 8\/18, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.03). The prediction model for postoperative day 1 included MMP9, TNF\u03b1, diverting ileostomy and surgical technique (<jats:italic>c<\/jats:italic>\u2010index\u00a0=\u00a00.71). The prediction model for postoperative day 2 only included CRP (<jats:italic>c<\/jats:italic>\u2010index\u00a0=\u00a00.69). The prediction model for postoperative day 3 included CRP and MMP9 and obtained the best model performance (<jats:italic>c<\/jats:italic>\u2010index\u00a0=\u00a00.78).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The combination of serum CRP and peritoneal MMP9 may be useful for earlier prediction of AL after rectal cancer resection. In clinical practice, this combination of biomarkers should be interpreted in the clinical context as with any other diagnostic tool.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.14789","type":"journal-article","created":{"date-parts":[[2019,7,25]],"date-time":"2019-07-25T20:09:26Z","timestamp":1564085366000},"page":"36-45","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["A multicentre cohort study of serum and peritoneal biomarkers to predict anastomotic leakage after rectal cancer resection"],"prefix":"10.1111","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4606-6895","authenticated-orcid":false,"given":"C. 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A.","family":"Dik","sequence":"additional","affiliation":[{"name":"Department of Immunology Laboratory Medical Immunology Erasmus MC \u2013 University Medical Center Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Z.","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Surgery Erasmus MC \u2013 University Medical Centre Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. L.","family":"van Westreenen","sequence":"additional","affiliation":[{"name":"Department of Surgery Isala Zwolle The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. G.","family":"Doornebosch","sequence":"additional","affiliation":[{"name":"Department of Surgery IJsselland Ziekenhuis Capelle aan den Ijssel The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. W. 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