Systemic coagulation activation and anastomotic leakage after colorectal cancer surgery

PURPOSE: The aim of the present study was to study whether patients develop ing anastomotic leakage after colorectal resections for colorectal cancer h ave laboratory signs of an altered hemostatic balance in the systemic circu lation, preoperatively and postoperatively, causing an impaired healing pro cess. METHODS: Patients operated on for colorectal cancer were studied. Sev enteen consecutive patients with anastomotic leakage and 17 patients withou t anastomotic leakage were matched according to age, gender, tumor stage, a nd localization of tumor. Hemostatic balance was estimated preoperatively a nd at one, two, and seven days and at three months after surgery by plasma levels of sensitive markers of coagulation activation and fibrinolysis, Le. , prothrombin fragment I + 2, thrombin-antithrombin complexes, soluble fibr in, tissue-type plasminogen activator activity, and plasminogen activator i nhibitor Type 1. RESULTS: Preoperatively, the hemostatic balance was compar able in patients with and without anastomotic leakage. In the early postope rative period, patients developing anastomotic leakage exhibited signs of s ystemic coagulation activation, i.e., elevated plasma levels of prothrombin fragment I + 2, thrombin-antithrombin complexes, soluble fibrin, and plasm inogen activator inhibitor Type 1. The observed coagulation activation appe ared before the anastomotic leakage became clinically evident. More patient s with anastomotic leakage received perioperative blood transfusions than p atients without leakage, despite the fact that duration of surgery and intr aoperative blood loss were comparable in the two groups. CONCLUSIONS: Enhan ced coagulation activity was observed postoperatively in patients developin g anastomotic leakage after colorectal resections for colorectal cancer. Su ch a hypercoagulable state may contribute to the development of anastomotic leakage by facilitating formation of microthromboses in the perianastomoti c area.