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C-reactive protein identifies patients at low risk of anastomotic leak after esophagectomy

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Abstract

Purpose

Fast-track protocols are increasingly used after digestive surgery. After esophagectomy, the gravity and the fear of anastomotic leak may be an obstacle to generalization of such protocols. C-reactive protein (CRP) might be a reliable tool to identify patients at low risk of anastomotic leak after esophagectomy, so that they can be safely included in a fast-track program. The aim of our retrospective bicentric study is to evaluate the interest of C-reactive protein measurement for the early diagnosis of anastomotic leak after esophagectomy.

Methods

Patients having undergone Ivor-Lewis procedure between January 2009 and September 2017 were included in this bicentric retrospective study. CRP values were recorded between postoperative day 3 (POD 3) and postoperative day 5 (POD 5). All postoperative complications were recorded, and the primary endpoint was anastomotic leak.

Results

We included 585 patients. Among them, 241 (41.2%) developed infectious complications and 69 patients (11.8%) developed anastomotic leak. CRP had the best predictive value on POD 5 (AUC = 0.74; 95% CI: 0.67–0.81). On POD 5, a cut-off value of 130 mg/L yielded a sensitivity of 87%, a specificity of 51%, and a negative predictive value of 96% for the detection of anastomotic leak.

Conclusions

CRP may help in identifying patients at very low risk of anastomotic leak after esophagectomy. Patients with CRP values < 130 mg/L on POD 5 can safely undertake an enhanced recovery protocol.

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Acknowledgements

This paper is dedicated to the memory of Professor Christophe Mariette (surgeon from Lille) who was involved at the very beginning of this study. The authors thank Professor Christine Binquet for his help in statistics, Professor Pascal Hammel for his advice, and Professor Abe Fingerhut for English-editing.

Funding

This work was supported by grants from the Agence Nationale de la Recherche (LabEx LipSTIC, ANR-11-LABX-0021) as well as from the Bourgogne-Franche-Comté Region, the Fond Européen de Développement Regional (FEDER), and the Dijon-Bourgogne University Hospital.

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Authors and Affiliations

  1. Department of Digestive and Oncological Surgery, Dijon-Bourgogne University Hospital, Univ. Bourgogne-Franche-Comté, 14 rue Paul Gaffarel, F-21000, Dijon, France

    Paul Rat, Olivier Facy, Patrick Rat & Pablo Ortega-Deballon

  2. Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Univ. Lille, F-59000, Lille, France

    Guillaume Piessen, Marguerite Vanderbeken & Alexandre Chebaro

  3. Univ. Bourgogne-Franche-Comté, UMR LNC, Dijon, France

    Olivier Facy, Patrick Rat & Pablo Ortega-Deballon

  4. Inserm, U1231, Équipe CADIR, Dijon, France

    Olivier Facy, Patrick Rat & Pablo Ortega-Deballon

  5. LabEx LipSTIC, Dijon-Bourgogne, University Hospital, Univ. Bourgogne-Franche-Comté, Dijon, France

    Cyril Boisson

  6. Dijon-Bourgogne University Hospital, Dijon, France

    Cyril Boisson

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  1. Paul Rat
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  2. Guillaume Piessen
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  3. Marguerite Vanderbeken
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  4. Alexandre Chebaro
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  5. Olivier Facy
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  8. Pablo Ortega-Deballon
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by Paul Rat, Marguerite Vanderbeken, and Alexandre Chebaro. Analysis and interpretation of data were performed by Paul Rat, Guillaume Piessen, Olivier Facy, Patrick Rat, Cyril Boisson, and Pablo Ortega-Deballon. The first draft of the manuscript was written by Paul Rat and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Paul Rat.

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Rat, P., Piessen, G., Vanderbeken, M. et al. C-reactive protein identifies patients at low risk of anastomotic leak after esophagectomy. Langenbecks Arch Surg 407, 3377–3386 (2022). https://doi.org/10.1007/s00423-022-02703-5

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