Abstract
BackgroundEarly diagnosis of anastomotic leakage (AL) after esophageal resection is crucial for the successful management of this complication. Inflammatory serological markers are indicators of complications during the postoperative course. The aim of the present study was to evaluate the prognostic value of routine inflammatory markers to predict anastomotic leakage after transthoracic esophageal resection.MethodsData from all consecutive patients undergoing transthoracic esophageal resection between January 2010 and December 2016 were analyzed from a prospective database. Besides clinicodemographic parameters, C-reactive protein, white blood cell count and albumin were analyzed and the Noble/Underwood (NUn) score was calculated to evaluate their predictive value for postoperative anastomotic leakage. Diagnostic accuracy was measured by sensitivity, specificity, and negative and positive predictive values using area under the receiver operator characteristics curve.ResultsOverall, 233 patients with transthoracic esophageal resection were analyzed, 30-day mortality in this group was 3.4%. 57 patients (24.5%) suffered from AL, 176 patients were in the AL negative group. We found significant differences in WBCC, CRP and NUn scores between patients with and without AL, but the analyzed markers did not show an independent relevant prognostic value. For CRP levels below 155 mg/dl from POD3 to POD 7 the negative predictive value for absence of AI was > 80%. Highest diagnostic accuracy was detected for CRP levels on 4th POD with a cut-off value of 145 mg/l reaching negative predictive value of 87%.ConclusionsIn contrast to their prognostic value in other surgical procedures, CRP, WBCC and NUn score cannot be recommended as independent markers for the prediction of anastomotic leakage after transthoracic esophageal resection. CRP is an accurate negative predictive marker and discrimination of AL and no-AL may be helpful for postoperative clinical management.Trial registration The study was approved by the local ethical committee (S635-2013).
Highlights
Diagnosis of anastomotic leakage (AL) after esophageal resection is crucial for the successful management of this complication
The present study aimed to evaluate and validate the prognostic value of C-reactive protein (CRP) level, white blood cell count (WBCC), and Noble and Underwood (NUn) score in detecting AL in a well-defined cohort after transthoracic esophageal resection
Patient characteristics We evaluated 233 consecutive patients who underwent elective transthoracic esophageal resection at our institution between January 2010 and December 2016
Summary
Diagnosis of anastomotic leakage (AL) after esophageal resection is crucial for the successful management of this complication. The aim of the present study was to evaluate the prognostic value of routine inflammatory markers to predict anastomotic leakage after transthoracic esophageal resection. Surgery for locally advanced esophageal carcinoma is performed according to tumor localization relative to the gastroesophageal junction and using any of the following approaches: transhiatal, transthoracic (Ivor Lewis procedure), or tri-incisional esophagectomy (McKeown procedure [1]). Anastomotic leakage (AL) is the most fatal and frequent cause of postoperative mortality [10]. The incidence of AL following esophageal resection varies widely, but it has been reported to reach as high as 53% [10,11,12,13,14,15,16,17,18,19,20]. A gold standard for diagnosing and managing leakage has not yet been established
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