Assessing risk factors for elevated creatine kinase levels as an indicator of compartment syndrome following laparoscopic or robot-assisted colorectal cancer surgery in the lithotomy-trendelenburg position

Kusunoki, Chikako; Uemura, Mamoru; Takeda, Mitsunobu; Sekido, Yuki; Hata, Tsuyoshi; Hamabe, Atsushi; Ogino, Takayuki; Miyoshi, Norikatsu; Kagawa, Yoshinori; Tei, Mitsuyoshi; Eguchi, Hidetoshi; Doki, Yuichiro

doi:https://doi.org/10.1007/s00464-024-11209-8

Assessing risk factors for elevated creatine kinase levels as an indicator of compartment syndrome following laparoscopic or robot-assisted colorectal cancer surgery in the lithotomy-trendelenburg position

Kusunoki, Chikako; Uemura, Mamoru; Takeda, Mitsunobu et al.

Surgical Endoscopy, 2024, 38, 6139-6145

Number of Access:1,664（2025-08-14 06:45 Counts）

Identifier to cite or link to this item: https://hdl.handle.net/11094/98274

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Title	Assessing risk factors for elevated creatine kinase levels as an indicator of compartment syndrome following laparoscopic or robot-assisted colorectal cancer surgery in the lithotomy-trendelenburg position
Creator	CreatorName Kusunoki, Chikako
	NRID 1000010528483 1000010528483 ORCID 0000-0001-6285-5619 0000-0001-6285-5619 researchmap permalink mamoruuemura mamoruuemura Scopus Author ID 36796497400 36796497400 CreatorName Uemura, Mamoru
	NRID 1000090768962 1000090768962 researchmap permalink takeda27832 takeda27832 CreatorName Takeda, Mitsunobu
	NRID 1000000781709 1000000781709 researchmap permalink 00781709 00781709 Scopus Author ID 57193691322 57193691322 CreatorName Sekido, Yuki
	NRID 1000080749747 1000080749747 researchmap permalink tsuyoshi_hata tsuyoshi_hata Scopus Author ID 57189996374 57189996374 CreatorName Hata, Tsuyoshi
	NRID 1000060621034 1000060621034 ORCID 0000-0001-5535-3514 0000-0001-5535-3514 researchmap permalink hamabe_atsushi hamabe_atsushi CreatorName Hamabe, Atsushi
	NRID 1000050597458 1000050597458 researchmap permalink togino04 togino04 Scopus Author ID 57200254430 57200254430 CreatorName Ogino, Takayuki
	NRID 1000020528624 1000020528624 researchmap permalink nor nor Scopus Author ID 9242781300 9242781300 CreatorName Miyoshi, Norikatsu
	NRID 1000080571364 1000080571364 ORCID 0000-0001-6876-4507 0000-0001-6876-4507 researchmap permalink Yoshinori-kagawa Yoshinori-kagawa CreatorName Kagawa, Yoshinori
	CreatorName Tei, Mitsuyoshi
	NRID 1000090542118 1000090542118 researchmap permalink abcdabcdabcd abcdabcdabcd Scopus Author ID 7101627772 7101627772 CreatorName Eguchi, Hidetoshi
	NRID 1000020291445 1000020291445 researchmap permalink ydoki3251 ydoki3251 Scopus Author ID 7006390687 7006390687 CreatorName Doki, Yuichiro
Subject	Colorectal surgery
	Creatine kinase (CK)
	Lithotomy position
	Well leg compartment syndrome (WLCS)
Description	The version of record of this article, first published in Surgical Endoscopy, is available online at Publisher’s website: https://doi.org/10.1007/s00464-024-11209-8.
Abstract	Background: Well-leg compartment syndrome (WLCS) can occur due to compression and lower limb circulation disturbances caused by the surgical position during the procedure. Although rare, with an incidence of 1 in 3500 surgeries performed in the lithotomy position, it can lead to serious complications. Therefore, prevention and early diagnosis are critical. Symptoms of WLCS, such as leg pain, swelling, paresthesia, and serum creatine kinase (CK) levels are useful for diagnosis. This study aimed to investigate the risk factors for postoperative CK elevation in laparoscopic or robot-assisted colorectal cancer surgery performed in the lithotomy-Trendelenburg position. Methods: Postoperative CK levels were measured in 178 patients who underwent laparoscopic or robot-assisted colorectal cancer surgery between February 2022 and March 2023. We compared patient backgrounds, short-term outcomes, and thigh/calf circumferences between patients with CK levels ≥ 250 (n = 62) and those with CK levels < 250 (n = 116). We investigated risk factors for elevated CK levels using both univariate and multivariate analyses. Results: Four patients with CK levels of 22405 U/L, 4685 U/L, 4050 U/L, and 3824 U/L reported symptoms, which improved with conservative treatment. The following independent prognostic factors were identified by multivariate analysis: male sex (odds ratio [OR], 4.403; 95% CI, 1.960 to 9.892), rectal surgery (OR, 2.779; 95% CI, 1.249 to 6.184), continuous head-down position duration ≥ 180 min (OR, 3.523; 95% CI, 1.552 to 7.997), and preoperative calf circumference ≥ 33 cm (OR, 2.482; 95% CI, 1.154 to 5.339). Conclusions: Risk factors for CK elevation after colorectal cancer surgery in the lithotomy position include male sex, rectal surgery, an extended continuous head-down position without position changes, and a larger preoperative calf circumference. This study highlights the potential importance of intraoperative position changes every 3 h for preventing elevated CK levels, although the preventive effect was not specifically examined.
Publisher	Springer
Source Title	Surgical Endoscopy
Volume (Issue)	38
Page	6139-6145
Date of Issued	2024-08-30
Language	English
Handle URL	https://hdl.handle.net/11094/98274
PISSN	09302794
eISSN	14322218
Relation.isIdenticalTo	DOI (Publisher Version) https://doi.org/10.1007/s00464-024-11209-8
Access Rights	open access
CopyRight	This article is licensed under a Creative Commons Attribution 4.0 International License.
oaire:version	Version of Record
Category	学術雑誌論文 Journal Article

Resource Type	journal article
Local Type	Journal Article
DCTERMS.bibliographicCitation	Surgical Endoscopy. 2024, 38, p. 6139-6145
DC.title	Assessing risk factors for elevated creatine kinase levels as an indicator of compartment syndrome following laparoscopic or robot-assisted colorectal cancer surgery in the lithotomy-trendelenburg position
DC.creator	Kusunoki, Chikako
	Uemura, Mamoru
	Takeda, Mitsunobu
	Sekido, Yuki
	Hata, Tsuyoshi
	Hamabe, Atsushi
	Ogino, Takayuki
	Miyoshi, Norikatsu
	Kagawa, Yoshinori
	Tei, Mitsuyoshi
	Eguchi, Hidetoshi
	Doki, Yuichiro
DC.publisher	Springer
DC.language' scheme='DCTERMS.RFC1766	English
DCTERMS.issued' scheme='DCTERMS.W3CDTF	2024-08-30
DC.identifier	https://doi.org/10.1007/s00464-024-11209-8
DC.subject	Colorectal surgery
	Creatine kinase (CK)
	Lithotomy position
	Well leg compartment syndrome (WLCS)
DC.description	The version of record of this article, first published in Surgical Endoscopy, is available online at Publisher’s website: https://doi.org/10.1007/s00464-024-11209-8.
DCTERMS.abstract	Background: Well-leg compartment syndrome (WLCS) can occur due to compression and lower limb circulation disturbances caused by the surgical position during the procedure. Although rare, with an incidence of 1 in 3500 surgeries performed in the lithotomy position, it can lead to serious complications. Therefore, prevention and early diagnosis are critical. Symptoms of WLCS, such as leg pain, swelling, paresthesia, and serum creatine kinase (CK) levels are useful for diagnosis. This study aimed to investigate the risk factors for postoperative CK elevation in laparoscopic or robot-assisted colorectal cancer surgery performed in the lithotomy-Trendelenburg position. Methods: Postoperative CK levels were measured in 178 patients who underwent laparoscopic or robot-assisted colorectal cancer surgery between February 2022 and March 2023. We compared patient backgrounds, short-term outcomes, and thigh/calf circumferences between patients with CK levels ≥ 250 (n = 62) and those with CK levels < 250 (n = 116). We investigated risk factors for elevated CK levels using both univariate and multivariate analyses. Results: Four patients with CK levels of 22405 U/L, 4685 U/L, 4050 U/L, and 3824 U/L reported symptoms, which improved with conservative treatment. The following independent prognostic factors were identified by multivariate analysis: male sex (odds ratio [OR], 4.403; 95% CI, 1.960 to 9.892), rectal surgery (OR, 2.779; 95% CI, 1.249 to 6.184), continuous head-down position duration ≥ 180 min (OR, 3.523; 95% CI, 1.552 to 7.997), and preoperative calf circumference ≥ 33 cm (OR, 2.482; 95% CI, 1.154 to 5.339). Conclusions: Risk factors for CK elevation after colorectal cancer surgery in the lithotomy position include male sex, rectal surgery, an extended continuous head-down position without position changes, and a larger preoperative calf circumference. This study highlights the potential importance of intraoperative position changes every 3 h for preventing elevated CK levels, although the preventive effect was not specifically examined.
DC.rights	This article is licensed under a Creative Commons Attribution 4.0 International License.
DC.format	98274
citation_title	Assessing risk factors for elevated creatine kinase levels as an indicator of compartment syndrome following laparoscopic or robot-assisted colorectal cancer surgery in the lithotomy-trendelenburg position
citation_author	Kusunoki, Chikako
	Uemura, Mamoru
	Takeda, Mitsunobu
	Sekido, Yuki
	Hata, Tsuyoshi
	Hamabe, Atsushi
	Ogino, Takayuki
	Miyoshi, Norikatsu
	Kagawa, Yoshinori
	Tei, Mitsuyoshi
	Eguchi, Hidetoshi
	Doki, Yuichiro
citation_publisher	Springer
citation_language	English
citation_date	2024-08-30
citation_journal_title	Surgical Endoscopy
citation_volume	38
citation_firstpage	6139
citation_lastpage	6145
citation_doi	https://doi.org/10.1007/s00464-024-11209-8
citation_public_url	https://hdl.handle.net/11094/98274

Assessing risk factors for elevated creatine kinase levels as an indicator of compartment syndrome following laparoscopic or robot-assisted colorectal cancer surgery in the lithotomy-trendelenburg position

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