Abstract
IntroductionAmong the many possible postoperative complications, anastomotic leakage (AL) is the most common and serious. Therefore, the purpose of this study was to explore the ability of various inflammatory and nutritional markers to predict postoperative AL in patients after esophagectomy.MethodsA total of 273 patients were retrospectively evaluated and enrolled into this study. Perioperative, surgery-related, tumor-related and laboratory tests data were extracted and analyzed. The discriminatory ability and optimal cut-off value was evaluated according to the receiver operating characteristic (ROC) curve analysis. Univariate and multivariate analyses were performed to access the potential risk factors for AL.ResultsThe overall incidence of AL was 12.5% (34/273). C-reactive protein-to-albumin ratio (CRP/ALB ratio) [AUC 0.943 (95% confidence interval (CI) = 0.911–0.976, p < 0.001)] and operation time [AUC 0.747 (95% CI = 0.679–0.815, p < 0.001)] had the greatest discrimination on AL prediction. Multivariate analysis demonstrated that CRP/ALB ratio and operation time were two independent risk factors for AL, and CRP/ALB ratio (OR = 102.909, p < 0.001) had an advantage over operation time (OR = 9.363, p = 0.020; Table 3).ConclusionOperation time and postoperative CRP/ALB ratio were two independent predictive indexes for AL. Postoperative CRP/ALB ratio greater than 3.00 indicated a high risk of AL. For patients with abnormal postoperative CRP/ALB ratio, early non-operative treatment or surgical intervention are needed to reduce the serious sequelae of AL.
Highlights
Among the many possible postoperative complications, anastomotic leakage (AL) is the most common and serious
(1) Perioperative data including gender, age, body mass index (BMI), preoperative chemotherapy and/or radiotherapy history, smoking history, thoracic operation history, preoperative comorbidities; (2) The surgery-related data including American Society of Anesthesiologists (ASA) score, the type of surgery, the duration of operation and nutritional pathway; (3) The tumor-related data including tumor location, tumor histology, tumor differentiation and pathological stages which were classified according to the 8th edition of the TNM classification system [21]; (4) Laboratory tests data were measured on the third postoperative day (POD 3), including white blood cell, lymphocyte, monocyte, neutrocyte, red blood cell, albumin, hemoglobin, thrombocyte, C-reactive protein and glucose
The occurrence of AL was significantly associated with low ASA score (U = 3205, z = − 2.452, p = 0.014), open operation (p = 0.006), long operation time (p < 0.001), abnormal level of postoperative albumin (p < 0.001), hemoglobin (Hb) (p = 0.015), C-reactive protein (CRP) (p < 0.001), C-reactive protein to albumin ratio (CRP/ ALB ratio) (p < 0.001) and prognostic nutritional index (PNI) (p = 0.034)
Summary
The purpose of this study was to explore the ability of various inflammatory and nutritional markers to predict postoperative AL in patients after esophagectomy. Among the many possible postoperative complications, anastomotic leakage (AL) is the most common and serious [3]. Its incidence is gradually decreasing due to the continuous improvement of surgical methods and the gradual popularization of new technologies such as video-assisted or robot-assisted thoracic surgery, AL still occurs in 8.5–25.6% of patients after esophagectomy [4,5,6,7,8,9]. Accurate prediction of the occurrence and prompt prevention of AL are essential to accelerate the recovery of patients, improve their quality of life and prolong their life survival
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