Abstract
BackgroundSerum C-reactive protein (CRP) level can be an indicator of the early stage of infectious complications. However, its utility in advanced esophageal cancer patients who receive radical esophagectomy with two- or three-field lymph node dissection with perioperative steroid therapy and enhanced recovery after surgery (ERAS) care is unclear.MethodsThe present study retrospectively examined 117 consecutive esophageal cancer patients who received neoadjuvant chemotherapy followed by radical esophagectomy. All patients received perioperative steroid therapy and ERAS care. The utility of the CRP value in the early detection of serious infectious complications (SICs) was evaluated based on the area under the receiver operating characteristic curve (AUC). Univariate and multivariate logistic regression analyses were performed to identify the risk factors for SICs.ResultsSICs were observed in 20 patients (17.1%). The CRP level on postoperative day (POD) 4 had superior diagnostic accuracy for SICs (AUC 0.778). The cut-off value for CRP was determined to be 4.0 mg/dl. A multivariate analysis identified CRP ≥ 4.0 mg/dl on POD 4 (odds ratio, 18.600; 95% confidence interval [CI], 4.610–75.200) and three-field lymph node dissection (odds ratio, 7.950; 95% CI, 1.900–33.400) as independent predictive factors.ConclusionsCRP value on POD 4 may be useful for predicting SICs in esophageal cancer patients who receive radical esophagectomy with perioperative steroid therapy and ERAS care. This result may encourage the performance of imaging studies to detect the focus and thereby lead to the early medical and/or surgical intervention to improve short-term outcomes.
Highlights
Serum C-reactive protein (CRP) level can be an indicator of the early stage of infectious complications
The patients met the following inclusion criteria: (1) histologically proven primary esophageal squamous cell carcinoma located at thoracic esophagus, (2) clinical stage I to III disease as evaluated using the 7th edition of the tumor-node-metastasis classification established by the Union for International Cancer Control [16], and (3) neoadjuvant chemotherapy followed by curative resection with radical lymph node dissection
Excluding 3 patients with no survival information available, 7 patients who were not diagnosed with squamous cell carcinoma, 74 patients who did not receive neoadjuvant chemotherapy, and 7 patients who did not receive curative resection, one hundred and seventeen of these patients were eligible for the present study (56.3%)
Summary
Serum C-reactive protein (CRP) level can be an indicator of the early stage of infectious complications. Its utility in advanced esophageal cancer patients who receive radical esophagectomy with two- or three-field lymph node dissection with perioperative steroid therapy and enhanced recovery after surgery (ERAS) care is unclear. Preoperative chemo(radio)therapy and surgery have been established as the standard treatment for locally advanced esophageal cancer [1, 2]. Infectious complications (ICs) can be lethal if the initiation of effective treatment is delayed. The early clinical features of ICs are nonspecific and difficult to distinguish from normal postoperative inflammatory responses associated with surgical invasion [5]. ICs are often diagnosed after patients develop apparent clinical symptoms. To improve the short-term outcomes, approaches other than symptom observation must be adopted for the early detection of ICs
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
