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Early Identification of Surgical Complications to Reduce Life-Threatening Side Effects

Colorectal cancer is the third most common cancer detected in Australia and is the second highest cause of cancer mortality. 77% of patients diagnosed with rectal cancers in Queensland undergo substantial bowel surgery to remove tumours.

Crucial to all intestinal surgeries is the construction and subsequent healing of the anastomosis (the join between two ends of the bowel). When the anastomosis does not heal properly, a leak can occur. Anastomotic leak is associated with substantially increased short term morbidity, mortality and length of hospital stay. Furthermore, anastomotic leak after surgery for cancer is associated with poorer long term survival, cancer specific survival, disease free survival and with an increased risk of local recurrence.

Currently, anastomotic leaks are diagnosed at a later stage with presentation of clinical symptoms and secondary complications. Research is desperately needed to determine the effectiveness of a commonly used radiological contrast solution, Gastrografin, as an early indicator of anastomotic leak.

The validation of Gastrografin to detect anastomotic leak after intestinal surgery: The Gastrografin Flush Study (GUSH)

Lead Researcher: A/Prof David Clark
Associate Researcher: Dr Damien Peterson

A/Prof David Clark is conducting a world-first research project to determine whether Gastrografin – a contrast agent containing iodine that is commonly used in CT scans – can be used to detect anastomotic leaks early.

60 patients who are undergoing bowel resection surgery at The Wesley Hospital, St Andrew’s War Memorial Hospital, Royal Brisbane and Women’s Hospital and St Vincent’s Private Hospital will be enrolled in the research project. While the majority of patients will be having bowel surgery as a treatment for cancer, patients with endometriosis and diverticulitis will also be enrolled. Placement of a pelvic drain and intestinal tube will occur during surgery in accordance with routine care to minimise side effects.

It is standard of care for the tube that is placed in the patient’s intestine during surgery to be flushed with a saline solution four times each day to prevent blockage. In this research project, diluted Gastrografin will be used instead of the saline solution to flush the intestinal tube. Researchers will then collect samples of fluid from the pelvic drain to see whether any of the Gastrografin flushed through the intestinal tube is present in the pelvic drain fluid, thus indicating the presence of an anastomotic leak.

To determine whether Gastrografin is present in drain fluid, samples will be analysed by a dual energy CT scanner, which is able to specifically measure the atomic number of various chemicals. This analysis takes only 30 seconds which means that rapid results can be available to clinicians, who can then provide early intervention to patients if an anastomotic leak is detected.

Early intervention of anastomotic leak is crucial in preventing life-threatening complications. It could mean that patients may not need to spend up to five days in intensive care, or have to go back to the operating theatre for corrective surgery, or require a colostomy bag to supplement bowel function. It could mean that patients only need to stay in hospital for three days, rather than two weeks.

 

Impact

This research study will determine whether Gastrografin is effective in detecting anastomotic leaks in order to provide early intervention to patients. This could result in a significant reduction in life-threatening side effects, an improvement to quality of life and a reduction in healthcare costs associated with intestinal surgery. Results from this research project – which will inform a large phase III clinical trial – are expected within a year of commencing the research.

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