Prognostic value of inflammatory markers for detecting anastomotic leakage after esophageal resection
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RESEARCH ARTICLE
Open Access
Prognostic value of inflammatory markers for detecting anastomotic leakage after esophageal resection Lukas F. Liesenfeld1* , Peter Sauer2, Markus K. Diener1, Ulf Hinz1, Thomas Schmidt1, Beat P. Müller‑Stich1, Thilo Hackert1, Markus W. Büchler1 and Anja Schaible1
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 post‑ operative 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 sensitiv‑ ity, 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 post‑ operative clinical management. Trial registration The study was approved by the local ethical committee (S635-2013). Keywords: Esophageal carcinoma, Esophageal resection, Anastomotic leakage, White blood cell count, C-reactive protein, Nun score
*Correspondence: [email protected]‑heidelberg.de 1 Department of Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany Full list of author information is available at the end of the article
Background Despite advancements in chemotherapy and radiotherapy, surgery remains the only curative treatment option for locally advanced esophageal carcinoma [1]. However, multimodality neoadjuvant regimens are also crucial as they can increase rates of R0 resections, pathological
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