, Volume 15, Issue 2, pp 95–102 | Cite as

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

  • Kazuo Koyanagi
  • Soji Ozawa
  • Yuji Tachimori
Original Article



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.


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.


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).


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


C-reactive protein Minimally invasive esophagectomy Esophageal cancer 


Compliance with ethical standards

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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Copyright information

© The Japan Esophageal Society and Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Esophageal SurgeryNational Cancer Center HospitalTokyoJapan
  2. 2.Department of Gastroenterological SurgeryTokai University School of MedicineIseharaJapan
  3. 3.Cancer Care CenterKawasaki Saiwai HospitalKawasakiJapan

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