Peritoneal cytokines as early markers of peritonitis following surgery for colorectal carcinoma: A prospective study

This study was to investigate if measurement of peritoneal cytokines is valuable for an early diagnosis of peritonitis following colorectal surgery. One hundred consecutive patients who were to undergo elective resection for carcinoma of the sigmoid colon or the rectum were investigated. Abdominal exudate was obtained from a drainage tube daily after surgery for measuring interleukin (IL)-1β, IL-6 and tumour necrosis factor (TNF)-α. The relationship between peritoneal cytokine levels during the first 3 days after surgery and the development of peritonitis was investigated. Eight patients developed postoperative peritonitis due to anastomotic leakage and pelvic abscess, which was diagnosed on postoperative days 5–8. Peritoneal cytokine levels on postoperative days 1 and 2 were not significantly different between the 8 patients who developed peritonitis and 92 patients who did not: day 1, IL-1β P = 0.32, IL-6 P = 0.45, TNF-α P = 0.85; day 2, IL-1β P = 0.26, IL-6 P = 0.68, TNF-α P = 0.22. In contrast, the cytokine levels on day 3 were significantly higher in patients who developed peritonitis as compared with patients who did not: IL-1β P = 0.008, IL-6 P < 0.0001, TNF-α P = 0.0001. The cytokines significantly increased during the first 3 days in patients who developed peritonitis: IL-1β P = 0.049, IL-6 P = 0.03, TNF-α P = 0.01, while significantly decreased in patients who did not: IL-1β P < 0.0001, IL-6 P < 0.0001, TNF-α P < 0.0001. The outcomes of this investigation showed that the rise in peritoneal IL-1β, IL-6 and TNF-α levels may be an additional early diagnostic predictor of intraabdominal complications following colorectal surgery.

Research highlights
► Peritoneal cytokine (IL-1β, IL-6 and TNF-α) levels on postoperative days 1 and 2 were not significantly different between patients who developed peritonitis and patients who did not.
► The peritoneal cytokine levels on day 3 were significantly higher in patients who developed peritonitis as compared with patients who did not.
► The peritoneal cytokine levels significantly increased during the first 3 days in patients who developed peritonitis, while significantly decreased in patients who did not.
► The rise in peritoneal cytokine levels may be an additional early diagnostic predictor of intraabdominal complications following colorectal surgery.