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Minimally invasive esophagectomy in the prone position improves postoperative outcomes: role of C-reactive protein as an indicator of surgical invasiveness

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Abstract

Background

The aim of the study was to assess serum C-reactive protein (CRP) level immediately after minimally invasive esophagectomy (MIE) as a surrogate of surgical invasiveness in patients who underwent esophagectomy.

Methods

In total, 104 patients were enrolled in the study: 37 patients underwent MIE in the left lateral decubitus position (MIE-LP) and 67 patients underwent MIE in the prone position (MIE-PP). Serum CRP levels were assessed on POD 1, 3, 5, and 7 after MIE, and were compared with surgical outcomes and duration of systemic inflammatory response syndrome (SIRS) to investigate less invasiveness of the MIE.

Results

Reduced serum CRP level on POD 1 was associated with PP during MIE (P < 0.001) and decreased blood loss (P = 0.03). MIE-PP was identified as a significant independent predictor of reduced CRP level on POD 1 (odds ratio 3.65, P = 0.042). CRP level on POD 7 was associated with gender (P = 0.02), position of MIE (P = 0.011), blood loss (P = 0.02), and respiratory complications and/or anastomotic leakage (P < 0.001). Postoperative respiratory and/or anastomotic complication was identified as a significant predictor of elevated serum CRP level on POD 7 (odds ratio 3.44, P = 0.048). Shorter duration of SIRS was shown in the patients with reduced serum CRP level on POD 1 and 7 (P = 0.03 and P < 0.001, respectively).

Conclusion

Serial assessments of serum CRP level immediately after MIE may be a possible indicator that can reflect surgical invasiveness and postoperative complications.

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Authors and Affiliations

  1. Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Kazuo Koyanagi

  2. Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Japan

    Soji Ozawa

  3. Cancer Care Center, Kawasaki Saiwai Hospital, Kawasaki, Japan

    Yuji Tachimori

Authors
  1. Kazuo Koyanagi
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  2. Soji Ozawa
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  3. Yuji Tachimori
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Corresponding author

Correspondence to Kazuo Koyanagi.

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Ethical Statement

This work followed the guidelines set forth in the Helsinki Declaration of 1975, as revised in 2000, concerning Human and Animal Rights. This article does not contain human or animal subjects performed by any authors. This was a retrospective study approved by the institutional review board of the National Cancer Center Hospital.

Conflict of interest

There are no financial or other relations that could lead to a conflict of interest.

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Koyanagi, K., Ozawa, S. & Tachimori, Y. Minimally invasive esophagectomy in the prone position improves postoperative outcomes: role of C-reactive protein as an indicator of surgical invasiveness. Esophagus 15, 95–102 (2018). https://doi.org/10.1007/s10388-017-0602-8

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  • DOI: https://doi.org/10.1007/s10388-017-0602-8

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