Erin H Baker1, Joshua S Hill1, Mark K Reames1, James Symanowski1, Susie C Hurley1, Jonathan C Salo1. 1. 1 Department of Surgery, 2 Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC 28203, USA ; 3 Department of Surgery, Sanger Heart and Vascular Institute, Charlotte, NC 28203, USA ; 4 Department of Cancer Biostatistics, Levine Cancer Institute, 5 Levine Cancer Institute, Carolinas Medical Center, Charlotte Levine Cancer Institute, NC 28204, USA.
Abstract
BACKGROUND: Anastomotic leak following esophagectomy is associated with significant morbidity and mortality. As hospital length of stay decreases, the timely diagnosis of leak becomes more important. We evaluated CT esophagram, white blood count (WBC), and drain amylase levels in the early detection of anastomotic leak. METHODS: The diagnostic performance of CT esophagram, drain amylase >800 IU/L, and WBC >12,000/µL within the first 10 days after surgery in predicting leak at any time after esophagectomy was calculated. RESULTS: Anastomotic leak occurred in 13 patients (13%). CT esophagram performed within 10 days of surgery diagnosed six of these leaks with a sensitivity of 0.54. Elevation in drain amylase level within 10 days of surgery diagnosed anastomotic leak with a sensitivity of 0.38. When the CT esophagram and drain amylase were combined, the sensitivity rose to 0.69 with a specificity of 0.98. WBC elevation had a sensitivity of 0.92, with a specificity of 0.34. Among 30 patients with normal drain amylase and a normal WBC, one developed an anastomotic leak. CONCLUSIONS: Drain amylase adds to the sensitivity of CT esophagram in the early detection of anastomotic leak. Selected patients with normal drain amylase levels and normal WBC may be able to safely forgo CT esophagram.
BACKGROUND:Anastomotic leak following esophagectomy is associated with significant morbidity and mortality. As hospital length of stay decreases, the timely diagnosis of leak becomes more important. We evaluated CT esophagram, white blood count (WBC), and drain amylase levels in the early detection of anastomotic leak. METHODS: The diagnostic performance of CT esophagram, drain amylase >800 IU/L, and WBC >12,000/µL within the first 10 days after surgery in predicting leak at any time after esophagectomy was calculated. RESULTS:Anastomotic leak occurred in 13 patients (13%). CT esophagram performed within 10 days of surgery diagnosed six of these leaks with a sensitivity of 0.54. Elevation in drain amylase level within 10 days of surgery diagnosed anastomotic leak with a sensitivity of 0.38. When the CT esophagram and drain amylase were combined, the sensitivity rose to 0.69 with a specificity of 0.98. WBC elevation had a sensitivity of 0.92, with a specificity of 0.34. Among 30 patients with normal drain amylase and a normal WBC, one developed an anastomotic leak. CONCLUSIONS: Drain amylase adds to the sensitivity of CT esophagram in the early detection of anastomotic leak. Selected patients with normal drain amylase levels and normal WBC may be able to safely forgo CT esophagram.
Authors: Johan L Dikken; Anneriet E Dassen; Valery E P Lemmens; Hein Putter; Pieta Krijnen; Lydia van der Geest; Koop Bosscha; Marcel Verheij; Cornelis J H van de Velde; Michel W J M Wouters Journal: Eur J Cancer Date: 2012-03-27 Impact factor: 9.162
Authors: Smita Sihag; Cameron D Wright; John C Wain; Henning A Gaissert; Michael Lanuti; James S Allan; Douglas J Mathisen; Christopher R Morse Journal: Eur J Cardiothorac Surg Date: 2012-02-15 Impact factor: 4.191
Authors: Ninh T Nguyen; Patrick Donohue Rudersdorf; Brian R Smith; Kevin Reavis; Xuan-Mai T Nguyen; Michael J Stamos Journal: J Gastrointest Surg Date: 2011-09-09 Impact factor: 3.452
Authors: John R Doty; Jorge D Salazar; Arlene A Forastiere; Elisabeth I Heath; Lawrence Kleinberg; Richard F Heitmiller Journal: Ann Thorac Surg Date: 2002-07 Impact factor: 4.330
Authors: J M Findlay; R C Tilson; A Harikrishnan; B Sgromo; R E K Marshall; N D Maynard; R S Gillies; M R Middleton Journal: Dis Esophagus Date: 2014-06-04 Impact factor: 3.429
Authors: Wesley A Papenfuss; Moshim Kukar; Kristopher Attwood; Venkata R Kakarla; Soni Chousleb; Steven N Hochwald; Steven J Nurkin Journal: J Surg Oncol Date: 2014-05-29 Impact factor: 3.454
Authors: Toni Lerut; Johnny Moons; Willy Coosemans; Dirk Van Raemdonck; Paul De Leyn; Herbert Decaluwé; Georges Decker; Philippe Nafteux Journal: Ann Surg Date: 2009-11 Impact factor: 12.969
Authors: C A De Pasqual; J Weindelmayer; S Laiti; R La Mendola; M Bencivenga; L Alberti; S Giacopuzzi; G de Manzoni Journal: Updates Surg Date: 2019-08-13
Authors: Lucia Romano; Antonio Giuliani; Marino Di Furia; Danilo Meloni; Giovanni Cianca; Antonella Mattei; Fabiana Fiasca; Emilio Tonelli; Francesco Carlei; Mario Schietroma Journal: Med Princ Pract Date: 2021-06-22 Impact factor: 1.927
Authors: Vladimir Prochazka; Filip Marek; Lumir Kunovsky; Roman Svaton; Martina Farkasova; Martin Potrusil; Petr Moravcik; Zdenek Kala Journal: J Minim Access Surg Date: 2019 Jan-Mar Impact factor: 1.407
Authors: Lukas F Liesenfeld; Peter Sauer; Markus K Diener; Ulf Hinz; Thomas Schmidt; Beat P Müller-Stich; Thilo Hackert; Markus W Büchler; Anja Schaible Journal: BMC Surg Date: 2020-12-09 Impact factor: 2.102