The development of novel biomarker techniques for the early detection of colorectal anastomotic breakdown

Wright, Emma Claire (2019) The development of novel biomarker techniques for the early detection of colorectal anastomotic breakdown. MD thesis, University of Glasgow.

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Abstract

Anastomotic leak (AL) following colorectal surgery leads to significant morbidity, mortality and poorer oncological outcomes. Diagnosis of AL is frequently delayed as current methods of detection are not 100% sensitive or specific. Recent work has illustrated that local biomarkers from the perianastomotic environment may have the ability to detect AL early. A literature review undertaken as part of this project identified lactate and pH as the most promising biomarkers. Advances in biosensor technology means that the development of a degradable or removal biosensor for AL represents an exciting possibility. With the ultimate aim of developing such a sensor, this study aimed to determine the stability of lactate and pH in peritoneal fluid, further assess their usefulness as biomarkers of AL and other complications after surgery and compare their performance to that of commonly used blood biomarkers in detecting AL and other complications following colorectal surgery. Peritoneal fluid lactate was found to be stable over 24 hours, except if the fluid had a high WCC. For pH, clinically significant changes were detected after 1 hour. As there were no ALs in the study it was not possible to determine the usefulness of lactate and pH in relation to this complication. Although the difference was not statistically significant, pH generally rose over the first 3 days post-operatively in patients making an uncomplicated recovery. Lactate did not appear to be useful in predicting post-operative complications but it was thought that this was related to the method by which lactate was measured and that further study of lactate was merited. Blood biomarkers were superior to perianastomotic lactate and pH at predicting post-operative complications but they lacked specificity and significant differences were only apparent at 5 days following surgery. Overall, the work has contributed to our understanding of the stability of lactate and pH in peritoneal fluid, highlighted trends in pH in post-operative patients that merit further investigation and has illustrated the limitations of blood biomarkers. In addition, it has provided insight into how further studies in the area should be conducted and which questions need to be addressed next in order to pursue the eventual aim of developing a biosensor for the early detection of AL.

Item Type: Thesis (MD)
Qualification Level: Doctoral
Keywords: Colorectal, anastomosis, complication, leak.
Subjects: R Medicine > RD Surgery
Colleges/Schools: College of Medical Veterinary and Life Sciences
Supervisor's Name: Moug, Ms Susan
Date of Award: 2019
Depositing User: Dr Emma Wright
Unique ID: glathesis:2019-76741
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 03 Dec 2019 17:30
Last Modified: 05 Mar 2020 21:07
Thesis DOI: 10.5525/gla.thesis.76741
URI: http://theses.gla.ac.uk/id/eprint/76741
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