Matrix metalloproteinase-9 in relation to patients with complications after colorectal surgery: a systematic review
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REVIEW
Matrix metalloproteinase-9 in relation to patients with complications after colorectal surgery: a systematic review Pim Edomskis 1 & Max R. Goudberg 1 & Cloë L. Sparreboom 1 & Anand G. Menon 2 Andre D’Hoore 3 & Johan F. Lange 1,2
&
Albert M. Wolthuis 3 &
Accepted: 21 August 2020 # The Author(s) 2020
Abstract Purpose Anastomotic leakage (AL) is the most severe complication following colorectal resection and is associated with increased mortality. The main group of enzymes responsible for collagen and protein degradation in the extracellular matrix is matrix metalloproteinases. The literature is conflicting regarding anastomotic leakage and the degradation of extracellular collagen by matrix metalloproteinase-9 (MMP-9). In this systematic review, the possible correlation between anastomotic leakage after colorectal surgery and MMP-9 activity is investigated. Methods Embase, MEDLINE, Cochrane, and Web of Science databases were searched up to 3 February 2020. All published articles that reported on the relationship between MMP-9 and anastomotic leakage were selected. Both human and animal studies were found eligible. The correlation between MMP-9 expression and anastomotic leakage after colorectal surgery. Results Seven human studies and five animal studies were included for analysis. The human studies were subdivided into those assessing MMP-9 in peritoneal drain fluid, intestinal biopsies, and blood samples. Five out of seven human studies reported elevated levels of MMP-9 in patients with anastomotic leakage on different postoperative moments. The animal studies demonstrated that MMP-9 activity was highest in the direct vicinity of an anastomosis. Moreover, MMP-9 activity was significantly reduced in areas further proximally and distally from the anastomosis and was nearly or completely absent in uninjured tissue. Conclusion Current literature shows some relation between MMP-9 activity and colorectal AL, but the evidence is inconsistent. Innovative techniques should further investigate the value of MMP-9 as a clinical biomarker for early detection, prevention, or treatment of AL. Keywords Anastomotic leakage . Matrix metalloproteinase . Colorectal surgery . Complications
Introduction This paper is not based on a previous communication to a society or meeting. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00384-020-03724-6) contains supplementary material, which is available to authorized users. * Pim Edomskis [email protected] 1
Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
2
Department of Surgery, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands
3
Departmenf of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
Anastomotic leakage (AL) is the most feared complication following colorectal surgery and is associated with increased short- and long-term morbidity and mortality [1]. The reported incidence of AL varies between 6 and 8% after colon resection and between 7 and 20% after
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