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C-Reactive Protein as a Negative Predictive Marker for Anastomotic Leakage After Minimally Invasive Esophageal Surgery

BACKGROUND: Serum C-reactive protein (CRP) is commonly used by surgeons to raise suspicion of anastomotic leakage and other infectious complications, but most studies on optimal cut-off values are retrospective with a small sample of patients. The aim of this study was to determine the accuracy and...

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Autores principales: Hagens, Eliza R. C., Feenstra, Minke L., Lam, Wing C., Eshuis, W. J., Lameris, W., van Berge Henegouwen, Mark I., Gisbertz, Suzanne S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10310558/
https://www.ncbi.nlm.nih.gov/pubmed/37103558
http://dx.doi.org/10.1007/s00268-023-07013-5
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author Hagens, Eliza R. C.
Feenstra, Minke L.
Lam, Wing C.
Eshuis, W. J.
Lameris, W.
van Berge Henegouwen, Mark I.
Gisbertz, Suzanne S.
author_facet Hagens, Eliza R. C.
Feenstra, Minke L.
Lam, Wing C.
Eshuis, W. J.
Lameris, W.
van Berge Henegouwen, Mark I.
Gisbertz, Suzanne S.
author_sort Hagens, Eliza R. C.
collection PubMed
description BACKGROUND: Serum C-reactive protein (CRP) is commonly used by surgeons to raise suspicion of anastomotic leakage and other infectious complications, but most studies on optimal cut-off values are retrospective with a small sample of patients. The aim of this study was to determine the accuracy and optimal cut-off value of CRP for anastomotic leakage in patients following esophagectomy for cancer. MATERIALS AND METHODS: Consecutive minimally invasive esophagectomy for esophageal cancer patients was included in this prospective study. Anastomotic leakage was confirmed if a defect or leakage of oral contrast was seen on a CT scan, by endoscopy or if saliva was draining from the neck incision. Diagnostic accuracy of CRP was assessed by receiver operator curve (ROC) analysis. Youden’s index was adopted to determine the cut-off value. RESULTS: A total of 200 patients were included between 2016 and 2018. Postoperative day 5 showed the highest area under the ROC (0.825) and optimal cut-off value of 120 mg/L. This resulted in a sensitivity of 75%, specificity of 82%, negative predicting value of 97%, and positive predicting value of 32%. CONCLUSIONS: CRP on postoperative day 5 can be used as a negative predictor for and can be used as a marker to raise suspicion of anastomotic leakage following esophagectomy for esophageal cancer. When CRP exceeds 120 mg/L on postoperative day 5, additional investigations should be considered.
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spelling pubmed-103105582023-07-01 C-Reactive Protein as a Negative Predictive Marker for Anastomotic Leakage After Minimally Invasive Esophageal Surgery Hagens, Eliza R. C. Feenstra, Minke L. Lam, Wing C. Eshuis, W. J. Lameris, W. van Berge Henegouwen, Mark I. Gisbertz, Suzanne S. World J Surg Original Scientific Report BACKGROUND: Serum C-reactive protein (CRP) is commonly used by surgeons to raise suspicion of anastomotic leakage and other infectious complications, but most studies on optimal cut-off values are retrospective with a small sample of patients. The aim of this study was to determine the accuracy and optimal cut-off value of CRP for anastomotic leakage in patients following esophagectomy for cancer. MATERIALS AND METHODS: Consecutive minimally invasive esophagectomy for esophageal cancer patients was included in this prospective study. Anastomotic leakage was confirmed if a defect or leakage of oral contrast was seen on a CT scan, by endoscopy or if saliva was draining from the neck incision. Diagnostic accuracy of CRP was assessed by receiver operator curve (ROC) analysis. Youden’s index was adopted to determine the cut-off value. RESULTS: A total of 200 patients were included between 2016 and 2018. Postoperative day 5 showed the highest area under the ROC (0.825) and optimal cut-off value of 120 mg/L. This resulted in a sensitivity of 75%, specificity of 82%, negative predicting value of 97%, and positive predicting value of 32%. CONCLUSIONS: CRP on postoperative day 5 can be used as a negative predictor for and can be used as a marker to raise suspicion of anastomotic leakage following esophagectomy for esophageal cancer. When CRP exceeds 120 mg/L on postoperative day 5, additional investigations should be considered. Springer International Publishing 2023-04-27 2023 /pmc/articles/PMC10310558/ /pubmed/37103558 http://dx.doi.org/10.1007/s00268-023-07013-5 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Scientific Report
Hagens, Eliza R. C.
Feenstra, Minke L.
Lam, Wing C.
Eshuis, W. J.
Lameris, W.
van Berge Henegouwen, Mark I.
Gisbertz, Suzanne S.
C-Reactive Protein as a Negative Predictive Marker for Anastomotic Leakage After Minimally Invasive Esophageal Surgery
title C-Reactive Protein as a Negative Predictive Marker for Anastomotic Leakage After Minimally Invasive Esophageal Surgery
title_full C-Reactive Protein as a Negative Predictive Marker for Anastomotic Leakage After Minimally Invasive Esophageal Surgery
title_fullStr C-Reactive Protein as a Negative Predictive Marker for Anastomotic Leakage After Minimally Invasive Esophageal Surgery
title_full_unstemmed C-Reactive Protein as a Negative Predictive Marker for Anastomotic Leakage After Minimally Invasive Esophageal Surgery
title_short C-Reactive Protein as a Negative Predictive Marker for Anastomotic Leakage After Minimally Invasive Esophageal Surgery
title_sort c-reactive protein as a negative predictive marker for anastomotic leakage after minimally invasive esophageal surgery
topic Original Scientific Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10310558/
https://www.ncbi.nlm.nih.gov/pubmed/37103558
http://dx.doi.org/10.1007/s00268-023-07013-5
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