P-OGC79 Post-operative NUn score as a prognostic tool for anastomotic leak after Oesophagectomy

Abstract

Abstract Background Anastomotic leak (AL) after esophagectomy is still quite high with incidence reported between 5 and 20%. Early detection of AL will enable patient rescue and the remedial measures may decrease the associated significant morbidity and improve quality of life. Oesophagectomy is also associated with other infective complications such as respiratory infections and collections in the abdomen or chest. Noble and Underwood (NUn) published the NUn score combining blood-borne markers of systemic inflammatory response to define risk of anastomotic leak and major complications following oesophageal resection. This study aims to validate the ability of NUn score to identify AL specifically. Methods A total of 113 patients who underwent esophagectomy for oesophageal cancer over 11 years from 2011 to early 2021 in our centre were selected for this study from a prospectively maintained database. Patients with leaks (n = 11) were identified by reviewing their case records, electronic records, endoscopy and radiological results. Patients with missing values were excluded. Postoperative 7-day (POD) biochemical data that included white cell count (WCC), C-reactive protein (CRP) and Albumin were used to calculate NUn score. Sensitivity and Specificity of NUn score with a cut-off value of > 10 was calculated using the ROC curve analysis using SPSS. Results A total of 99 patients were included, among which 10 patients had anastomotic leaks (AL). Overall mean of NUn of patients with AL was 10.25 vs 9.95 without AL. NUn scores for day 1 to 7 are shown in the table in figure 1. NUn with the highest AUC was Day 7 (0.664 [CI 0.499 – 0.829]; p = 0.09), with 70% sensitivity and 57.3% specificity. The trends in WCC, CRP and albumin levels over 7 days were also not helpful in differentiating patients with AL. Conclusions In this study, the trends in rising WCC, CRP and decreasing albumin were not helpful in diagnosing anastomotic leaks specifically. The NUn score had a sensitivity of 70% on day 7. Procalcitonin, blood urea nitrogen or interleukin levels may help, and further studies are being planned. This study shows that current biochemical parameters can complement but not replace careful and regular medical examination and early radiological or endoscopic evaluation if an AL is suspected.