Langenbeck's Archives of Surgery

, Volume 403, Issue 2, pp 235–244 | Cite as

Utility of C-reactive protein as predictive biomarker of anastomotic leak after minimally invasive esophagectomy

  • Emanuele Asti
  • Gianluca Bonitta
  • Matteo Melloni
  • Stefania Tornese
  • Pamela Milito
  • Andrea Sironi
  • Elena Costa
  • Luigi Bonavina
ORIGINAL ARTICLE

Abstract

Background

Early detection of anastomotic leakage after esophagectomy has the potential to reduce morbidity and mortality. Prompt suspicion of leak may help to exclude patients from fast-track protocols, thereby avoiding early oral feeding and early hospital discharge which could aggravate the prognosis of a clinically occult leak.

Patients and methods

Observational retrospective cohort study. Patients with diagnosis of esophageal cancer who underwent elective minimally invasive esophagectomy were included. The following data were collected: age, gender, BMI, comorbidities, ASA score, tumor histology, TNM staging, use of neo-adjuvant therapy, type of operation, operative time, morbidity, and 90-day mortality. A panel of biomarkers including C-reactive protein (CRP), procalcitonin (PCT), white blood cells (WBC), and percentage of neutrophils (PN) were measured at baseline and on postoperative days 3, 5, and 7.

Results

Two hundred forty-three patients operated between 2012 and 2017 were included in the study. Anastomotic leakage occurred in 29 patients. There was a statistical association over time between anastomotic leakage and CRP (p < 0.001), PCT (p < 0.001), WBC (p = 0.019), and PN (p = 0.007). The cut-off value of CRP on POD 5 was 8.3 mg/dL, AUC = 0.818, negative LR = 0.176.

Conclusions

Increased serum CRP, PCT, WBC, and PN after minimally invasive esophagectomy are associated with anastomotic leakage. A CRP value lower than 8.3 mg/dL, combined with reassuring clinical and radiological signs, may be useful to exclude leakage on postoperative day 5.

Keywords

Esophagus Esophagectomy Anastomotic leakage C-reactive protein 

Notes

Acknowledgements

This work was supported by AIRES (Associazione Italiana Ricerca Esofago).

Authors’ contribution

Authorship EA, GB, MM, ST, PM, AS, EC, and LB participated in the acquisition, analysis, or interpretation of data for the work and drafting or revising it critically for important intellectual content; gave final approval of the version to be published; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity in any part of the work are appropriately investigated and resolved.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with 1964 Helsinki declaration and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

423_2018_1663_MOESM1_ESM.docx (19 kb)
ESM 1 (DOCX 19 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San DonatoUniversity of MilanSan Donato Milanese (Milano)Italy

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