Mannan-Binding Lectin As A Preoperative Predictor Of Postoperative Septic Complications In Colorectal Surgery Patients
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Objectives : The study aimed to estimate preoperative Mannan-binding lectin (MBL) serum levels in patients assigned for elective colorectal surgeries and to assess its relation with the frequency of postoperative (PO) septic complications and the possibility for predicting patients liable to such complications. Patients & Methods : The study included 30 patients assigned to undergo elective colonic resection and anastomosis for varied indications. Preoperative assessment included full general and abdominal examination, laboratory investigations, abdominal ultrasonographic examination and colonoscopy and biopsy taking in cases with colon cancer. All patients underwent abdominal CT for assessment of tumor location and size and the extent of local spread and nodal status. The study included 10 healthy subjects with cross-matched age and sex and donated blood as control group. Patients were evaluated daily throughout their hospital stay for the development of systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis or septic shock and were categorized according to Bone's criteria into Free PO, SIRS and Sepsis groups. Two blood samples were collected the day prior to (5-0) and on the 3rd day after surgery (S-1) for estimation of serum C-reactive protein (CRP) and MBL levels. Results: The study included 30 patients; 19 patients with primary colon cancer, 7 patients had diverticulosis, 1 patient had intussuscepting right colonic mass and 3 patients had rectal prolapse. All patients passed smooth intraoperative course with no intraoperative complications and all lesions were operable and resectable with a mean duration of surgery of 210-±24.7 minutes. Left hemicolectomy with colocolic anastomosis (end-to-end) was performed in 16 patients, right hemicolectomy with ileo-transverse in 8 patients and low-anterior resection with end-to-end colorectal anastomosis in 6 patients. Seventeen patients (56.7%) patients passed smooth PO course (Free PO group), 6 patients (20%) developed SIRS (SIRS group) and 7 patients had septic complications (Sepsis group). Three patients had wound complications, 2 patients had localized pelvic peritonitis that managed conservatively in one and the other had anastomotic line dehiscence and was re-admitted to the theater for drainage and creation of palliative proximal colostomy. Two patients died; one patient developed septic shock secondary to sever chest infection diagnosed as community-acquired pneumonia and the other developed acute myocardial infarction with a total morbidity and mortality rates of 43.3% and 6.7%, respectively. Postoperative (S-1) serum CRP was significantly higher compared to both control and S-0 levels with non-significant difference between SO and control levels. Patients developed SIRS or Septic complications had significantly higher PO serum CRP levels compared to Free PO group. Preoperative serum MBL was non-significantly lower in studied patients as total and in Free PO and SIRS groups compared to control levels. Patients developed PO septic complication had significantly lower preoperative serum MBL levels compared to control levels.j.Serum MBL levels estimated 3-days PO were non-significantly higher in Free PO group, and were nonsigni ficantly lower in SIRS group compared to their preoperative levels, but still non-significantly law . er compared to control levels. PO serum MBL levels in Sepsis group were significantly lower compared to both control, Free PO and SIRS groups but were non-significantly lower compared to their preoperative levels. There was a negative significant correlation between the frequency of occurrence of PO morbidities and preoperative serum MBL levels. Using ROC analysis, AUC was significantly (p=0.03) different from the null hypothesis for the possibility of development of PO morbidity using preoperative serum MBL as independent predictor. Conclusion : Decreased preoperative serum MBL indicated immune compromization and could predict the liability for postoperative sepsis especially life-threatening septic complications and it is recommended to be estimated prior to major surgeries to define such patients.