Abstract
Anastomotic leakage (AL) following gastroesophageal cancer surgery remains a serious postoperative complication. This systematic review aims to provide an overview of investigated biomarkers for the early detection of AL following esophagectomy, esophagogastrectomy and gastrectomy. All published studies evaluating the diagnostic accuracy of biomarkers predicting AL following gastroesophageal resection for cancer were included. The Embase, Medline, Cochrane Library, PubMed and Web of Science databases were searched. Risk of bias and applicability were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) 2 tool. Twenty-four studies evaluated biomarkers in the context of AL following gastroesophageal cancer surgery. Biomarkers were derived from the systemic circulation, mediastinal and peritoneal drains, urine and mediastinal microdialysis. The most commonly evaluated serum biomarkers were C-reactive protein and leucocytes. Both proved to be useful markers for excluding AL owing to its high specificity and negative predictive values. Amylase was the most commonly evaluated peritoneal drain biomarker and significantly elevated levels can predict AL in the early postoperative period. The associated area under the receiver operating characteristic (AUROC) curve values ranged from 0.482 to 0.994. Current biomarkers are poor predictors of AL after gastroesophageal cancer surgery owing to insufficient sensitivity and positive predictive value. Further research is needed to identify better diagnostic tools to predict AL.
Highlights
Surgical resection is considered the mainstay of treatment for the management of advanced cancer of the esophagus, gastroesophageal junction and stomach [1,2]
Several different biomarkers are involved in the early detection of Anastomotic leakage (AL) after gastroesophageal surgery for cancer
These biomarkers are poor predictors of AL owing to inadequate sensitivity and positive predictive value
Summary
Surgical resection is considered the mainstay of treatment for the management of advanced cancer of the esophagus, gastroesophageal junction and stomach [1,2]. Despite continual advancements in the multimodal treatment of these cancers, AL remains a common postoperative complication with incidences ranging from 0 to 40 per cent [8,9,10,11,12,13]. Preoperative weight loss, perioperative blood loss, and longer operative time have been shown to be persistent risk factors across different studies [16,18,19,20]. It remains, difficult to individually predict AL in each patient
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