Changes of the extracellular matrix as a risk factor for anastomotic leakage after large bowel surgery

Despite improved surgical techniques, anastomotic leakage remains as a serious complication in colorectal surgery, producing increased morbidity and mortality. This prospective study was initiated to test the hypothesis that preexisting disorders in the extracellular matrix (ECM) may be a factor inf...

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Bibliographic Details
Published in:	Surgery Vol. 137; no. 2; pp. 229 - 234
Main Authors:	Stumpf, Michael, Klinge, Uwe, Wilms, Arnulf, Zabrocki, Robert, Rosch, Rafael, Junge, Karsten, Krones, Carsten, Schumpelick, Volker
Format:	Journal Article
Language:	English
Published:	New York, NY Mosby, Inc 01-02-2005 Elsevier
Subjects:	Anastomosis, Surgical - adverse effects Biological and medical sciences Collagen Type I - metabolism Collagen Type III - metabolism Collagenases - metabolism Colon - surgery Extracellular Matrix - metabolism General aspects Humans Intestine, Large - surgery Matrix Metalloproteinase 1 - metabolism Matrix Metalloproteinase 13 Matrix Metalloproteinase 2 - metabolism Matrix Metalloproteinase 9 - metabolism Medical sciences Postoperative Complications - etiology Postoperative Complications - metabolism Prospective Studies Rectum - surgery Risk Factors Medicine Treatment Surgery Risk factor Gut Extracellular matrix Epidemiology
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Summary:	Despite improved surgical techniques, anastomotic leakage remains as a serious complication in colorectal surgery, producing increased morbidity and mortality. This prospective study was initiated to test the hypothesis that preexisting disorders in the extracellular matrix (ECM) may be a factor influencing the onset of anastomotic wound healing complications. In this prospective study of 119 patients with colorectal anastomoses, 30 clinical parameters with possible influence on anastomotic complications were evaluated. From all patients, samples of macroscopically intact colonic tissue were obtained at the index operation. Crosspolarization microscopy was performed to analyze the collagen type I/III ratio, and immunohistochemical studies were done to determine the expression of matrix metalloproteinase (MMP) 1, 2, 9, and 13. The patients with uncomplicated postoperative healing were compared with those developing anastomotic leakage. Patients with impaired anastomotic healing exhibited a significantly lower collagen type I/III ratio compared with the controls. Significantly higher expression of MMP-1 and MMP-2 in the mucosal layers and of MMP-2 and MMP-9 in the submucosal layers was found in the normal bowel wall of the leakage group. These findings were statistically independent from the clinical parameters. The present study confirms the hypothesis that disturbances of the ECM play a role in the pathogenesis of anastomotic leakage after large bowel surgery.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0039-6060 1532-7361
DOI:	10.1016/j.surg.2004.07.011