Prognostic value of inflammatory markers for detecting anastomotic leakage after esophageal resection
Abstract Background Early diagnosis of anastomotic leakage (AL) after esophageal resection is crucial for the successful management of this complication. Inflammatory serological markers are indicators of complications during the postoperative course. The aim of the present study was to evaluate the...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-12-01
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| Series: | BMC Surgery |
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| Online Access: | https://doi.org/10.1186/s12893-020-00995-2 |
| _version_ | 1818329807957524480 |
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| author | Lukas F. Liesenfeld Peter Sauer Markus K. Diener Ulf Hinz Thomas Schmidt Beat P. Müller-Stich Thilo Hackert Markus W. Büchler Anja Schaible |
| author_facet | Lukas F. Liesenfeld Peter Sauer Markus K. Diener Ulf Hinz Thomas Schmidt Beat P. Müller-Stich Thilo Hackert Markus W. Büchler Anja Schaible |
| author_sort | Lukas F. Liesenfeld |
| collection | DOAJ |
| description | Abstract Background Early diagnosis of anastomotic leakage (AL) after esophageal resection is crucial for the successful management of this complication. Inflammatory serological markers are indicators of complications during the postoperative course. The aim of the present study was to evaluate the prognostic value of routine inflammatory markers to predict anastomotic leakage after transthoracic esophageal resection. Methods Data from all consecutive patients undergoing transthoracic esophageal resection between January 2010 and December 2016 were analyzed from a prospective database. Besides clinicodemographic parameters, C-reactive protein, white blood cell count and albumin were analyzed and the Noble/Underwood (NUn) score was calculated to evaluate their predictive value for postoperative anastomotic leakage. Diagnostic accuracy was measured by sensitivity, specificity, and negative and positive predictive values using area under the receiver operator characteristics curve. Results Overall, 233 patients with transthoracic esophageal resection were analyzed, 30-day mortality in this group was 3.4%. 57 patients (24.5%) suffered from AL, 176 patients were in the AL negative group. We found significant differences in WBCC, CRP and NUn scores between patients with and without AL, but the analyzed markers did not show an independent relevant prognostic value. For CRP levels below 155 mg/dl from POD3 to POD 7 the negative predictive value for absence of AI was > 80%. Highest diagnostic accuracy was detected for CRP levels on 4th POD with a cut-off value of 145 mg/l reaching negative predictive value of 87%. Conclusions In contrast to their prognostic value in other surgical procedures, CRP, WBCC and NUn score cannot be recommended as independent markers for the prediction of anastomotic leakage after transthoracic esophageal resection. CRP is an accurate negative predictive marker and discrimination of AL and no-AL may be helpful for postoperative clinical management. Trial registration The study was approved by the local ethical committee (S635-2013). |
| first_indexed | 2024-12-13T12:53:56Z |
| format | Article |
| id | doaj.art-338ee37c04764331a6268953e960dd74 |
| institution | Directory Open Access Journal |
| issn | 1471-2482 |
| language | English |
| last_indexed | 2024-12-13T12:53:56Z |
| publishDate | 2020-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Surgery |
| spelling | doaj.art-338ee37c04764331a6268953e960dd742022-12-21T23:45:14ZengBMCBMC Surgery1471-24822020-12-0120111110.1186/s12893-020-00995-2Prognostic value of inflammatory markers for detecting anastomotic leakage after esophageal resectionLukas F. Liesenfeld0Peter Sauer1Markus K. Diener2Ulf Hinz3Thomas Schmidt4Beat P. Müller-Stich5Thilo Hackert6Markus W. Büchler7Anja Schaible8Department of Surgery, Heidelberg University HospitalDepartment of Gastroenterology, Heidelberg University HospitalDepartment of Surgery, Heidelberg University HospitalDepartment of Surgery, Heidelberg University HospitalDepartment of Surgery, Heidelberg University HospitalDepartment of Surgery, Heidelberg University HospitalDepartment of Surgery, Heidelberg University HospitalDepartment of Surgery, Heidelberg University HospitalDepartment of Surgery, Heidelberg University HospitalAbstract Background Early diagnosis of anastomotic leakage (AL) after esophageal resection is crucial for the successful management of this complication. Inflammatory serological markers are indicators of complications during the postoperative course. The aim of the present study was to evaluate the prognostic value of routine inflammatory markers to predict anastomotic leakage after transthoracic esophageal resection. Methods Data from all consecutive patients undergoing transthoracic esophageal resection between January 2010 and December 2016 were analyzed from a prospective database. Besides clinicodemographic parameters, C-reactive protein, white blood cell count and albumin were analyzed and the Noble/Underwood (NUn) score was calculated to evaluate their predictive value for postoperative anastomotic leakage. Diagnostic accuracy was measured by sensitivity, specificity, and negative and positive predictive values using area under the receiver operator characteristics curve. Results Overall, 233 patients with transthoracic esophageal resection were analyzed, 30-day mortality in this group was 3.4%. 57 patients (24.5%) suffered from AL, 176 patients were in the AL negative group. We found significant differences in WBCC, CRP and NUn scores between patients with and without AL, but the analyzed markers did not show an independent relevant prognostic value. For CRP levels below 155 mg/dl from POD3 to POD 7 the negative predictive value for absence of AI was > 80%. Highest diagnostic accuracy was detected for CRP levels on 4th POD with a cut-off value of 145 mg/l reaching negative predictive value of 87%. Conclusions In contrast to their prognostic value in other surgical procedures, CRP, WBCC and NUn score cannot be recommended as independent markers for the prediction of anastomotic leakage after transthoracic esophageal resection. CRP is an accurate negative predictive marker and discrimination of AL and no-AL may be helpful for postoperative clinical management. Trial registration The study was approved by the local ethical committee (S635-2013).https://doi.org/10.1186/s12893-020-00995-2Esophageal carcinomaEsophageal resectionAnastomotic leakageWhite blood cell countC-reactive proteinNun score |
| spellingShingle | Lukas F. Liesenfeld Peter Sauer Markus K. Diener Ulf Hinz Thomas Schmidt Beat P. Müller-Stich Thilo Hackert Markus W. Büchler Anja Schaible Prognostic value of inflammatory markers for detecting anastomotic leakage after esophageal resection BMC Surgery Esophageal carcinoma Esophageal resection Anastomotic leakage White blood cell count C-reactive protein Nun score |
| title | Prognostic value of inflammatory markers for detecting anastomotic leakage after esophageal resection |
| title_full | Prognostic value of inflammatory markers for detecting anastomotic leakage after esophageal resection |
| title_fullStr | Prognostic value of inflammatory markers for detecting anastomotic leakage after esophageal resection |
| title_full_unstemmed | Prognostic value of inflammatory markers for detecting anastomotic leakage after esophageal resection |
| title_short | Prognostic value of inflammatory markers for detecting anastomotic leakage after esophageal resection |
| title_sort | prognostic value of inflammatory markers for detecting anastomotic leakage after esophageal resection |
| topic | Esophageal carcinoma Esophageal resection Anastomotic leakage White blood cell count C-reactive protein Nun score |
| url | https://doi.org/10.1186/s12893-020-00995-2 |
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