RT Journal Article SR Electronic T1 Utility of Drain Fluid Culture and Gram Stain in Early Intervention for Occult Anastomotic Leakage in Colorectal Cancer JF Anticancer Research JO Anticancer Res FD International Institute of Anticancer Research SP 3091 OP 3098 DO 10.21873/anticanres.15797 VO 42 IS 6 A1 TETSURO TOMINAGA A1 TAKASHI NONAKA A1 SHOSABURO OYAMA A1 YUMA TAKAMURA A1 SHINTARO HASHIMOTO A1 TOSHIO SHIRAISHI A1 TERUMITSU SAWAI A1 TAKESHI NAGAYASU YR 2022 UL http://ar.iiarjournals.org/content/42/6/3091.abstract AB Background/Aim: Although occult leakage after colorectal surgery does not usually cause critical illness, it can cause long-term complications that decrease the quality of life of patients. There is currently no established diagnostic, treatment, or follow-up method for occult leakage. We assessed the risk factors of occult leakage and examined the efficacy of drain fluid culture and Gram staining for its early detection and appropriate treatment intervention. Patients and Methods: Data from 243 consecutive colorectal cancer patients who underwent resection with reconstruction by the double stapling technique between 2016 and 2020 were reviewed. Results: Sixteen (6.6%) patients had postoperative occult leakage. Multivariate analysis revealed that preoperative treatment was significantly associated with occult leakage (odds ratio=12.423; 95% confidence interval=4.095 to 17.680; p<0.001). Among the 16 patients, 1 experienced stenosis, and none experienced a fistula or chronic sinus. Drain fluid samples of 34 patients (14.0%) were Gram stainpositive, and those of 76 patients (31.3%) were culturepositive. The positive and negative predictive values of drain fluid culture were 18.4% and 98.7%, respectively, and those of Gram staining were 38.2% and 98.6%, respectively, for occult leakage. Among cases with occult leakage, more than two bacterial species were detected in 71.5% of the cultures. Antibiograms indicated that the three major species tended to be resistant to cephem antibiotics, which are used for prophylaxis, but susceptible to carbapenem antibiotics, which are used for empiric therapy. Conclusion: Drain fluid culture and Gram staining may enable early detection and appropriate treatment intervention for occult leakage.