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Elevated intraperitoneal matrix metalloproteinases-8 and -9 in patients who develop anastomotic leakage after rectal cancer surgery: a pilot study
Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences.
Department of Surgery, Örebro University Hospital, Örebro, Sweden.
Department of Surgery, Örebro University Hospital, Örebro, Sweden.
Department of Surgery, Örebro University Hospital, Örebro, Sweden.
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2010 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 12, no 7, e93-e98 p.Article in journal (Refereed) Published
Abstract [en]

Objective  Experimental studies suggest that matrix metalloproteinase (MMP) enzymes mediate the early tissue breakdown that leads to a decrease in intestinal anastomotic strength. Patients with upregulation of MMPs in intestinal biopsies have an increased rate of anastomotic leakage. We measured MMPs and their inhibitors [tissue inhibitors of metalloproteinases (TIMPs)] in postoperative intraperitoneal fluid after rectal cancer surgery, and hypothesized that they would be elevated in patients who later would develop anastomotic leakage.

Method  Twenty-nine patients with rectal carcinoma underwent low anterior resection of the rectum for cancer. Intraperitoneal fluid was collected via a pelvic drain at a median of 4 h postoperatively. MMP-1, -2, -3, -7, -8, -9 and -13 were determined using particle-based multiplex flow-cytometry. TIMP-1 and -2 were measured by enzyme-linked immunosorbent assays. MMP-9 was considered the main outcome variable.

Results  Ten patients developed anastomotic leakage. These patients had increased intraperitoneal MMP-9 [median difference (m.d.) 29%; P = 0.03] and MMP-8 (m.d. 58%; P = 0.02), compared with patients who did not develop leakage. There were no differences between the groups for other MMPs and TIMPs.

Conclusion  Matrix metalloproteinase-8 and -9 appear to have an important role in the development of anastomotic leakage and may be promising pharmacological targets to protect anastomotic integrity. We suggest further investigation of MMPs as markers for anastomotic leakage.

Place, publisher, year, edition, pages
Chichester, West Sussex, United Kingdom: Wiley-Blackwell, 2010. Vol. 12, no 7, e93-e98 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-18074DOI: 10.1111/j.1463-1318.2009.01908.xISI: 000208355900014OAI: diva2:214302
Available from: 2009-05-04 Created: 2009-05-04 Last updated: 2014-10-01Bibliographically approved

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Pasternak, BjörnAspenberg, Per
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