Benjamin Babic1, Evangelos Tagkalos1, Ines Gockel2, Florian Corvinus1, Edin Hadzijusufovic1, Maria Hoppe-Lotichius1, Hauke Lang1, Pieter Christiaan van der Sluis1, Peter Philipp Grimminger3. 1. Department of General-, Visceral- and Transplant-Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany. 2. Department of Visceral-, Transplant-, Thoracic-, and Vascular-Surgery and Department of Operative Medicine, University Hospital of Leipzig, Leipzig, Germany. 3. Department of General-, Visceral- and Transplant-Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany. Electronic address: peter.grimminger@unimedizin-mainz.de.
Abstract
BACKGROUND: With the introduction of minimally invasive esophagectomy, postoperative complications rates have decreased. Daily laboratory tests are used to screen patients for postoperative complications. The course of inflammatory indicators after esophagectomy after different surgical approaches has not been described yet. The aim of the study was to describe the postoperative C-reactive protein (CRP) and leukocyte levels after different surgical approaches for esophagectomy and relate it to postoperative complications. METHODS: Between 2010 and 2018, 217 consecutive patients underwent thoracoabdominal esophagectomy with gastric conduit reconstruction. Blood tests to assess CRP and leukocytes were performed daily in all patients. Differences between treatment groups were analyzed with a linear mixed model. All postoperative complications were recorded in a prospective database. Prognostic factors were analyzed using multivariate logistic regression modeling. RESULTS: The study evaluated 4 different esophagectomy techniques: open (n = 57), hybrid (n = 53), totally minimally invasive (n = 52), and robot-assisted minimally invasive (n = 55). The increase of inflammatory indicators was significantly higher after open esophagectomy on the first 2 postoperative days compared with the 3 minimally invasive procedures (P < .001). Postoperative CRP values exceeding 200 mg/L on the second postoperative day and open esophagectomy were independently associated with postoperative complications. CONCLUSIONS: Open esophagectomy results in significantly higher CRP and leukocyte values compared with hybrid, minimally invasive, and robot-assisted minimally invasive esophagectomy. Open esophagectomy and a CRP increase on the second postoperative day above 200 mg/L are independent positive predictors for postoperative complications in multivariate analysis.
BACKGROUND: With the introduction of minimally invasive esophagectomy, postoperative complications rates have decreased. Daily laboratory tests are used to screen patients for postoperative complications. The course of inflammatory indicators after esophagectomy after different surgical approaches has not been described yet. The aim of the study was to describe the postoperative C-reactive protein (CRP) and leukocyte levels after different surgical approaches for esophagectomy and relate it to postoperative complications. METHODS: Between 2010 and 2018, 217 consecutive patients underwent thoracoabdominal esophagectomy with gastric conduit reconstruction. Blood tests to assess CRP and leukocytes were performed daily in all patients. Differences between treatment groups were analyzed with a linear mixed model. All postoperative complications were recorded in a prospective database. Prognostic factors were analyzed using multivariate logistic regression modeling. RESULTS: The study evaluated 4 different esophagectomy techniques: open (n = 57), hybrid (n = 53), totally minimally invasive (n = 52), and robot-assisted minimally invasive (n = 55). The increase of inflammatory indicators was significantly higher after open esophagectomy on the first 2 postoperative days compared with the 3 minimally invasive procedures (P < .001). Postoperative CRP values exceeding 200 mg/L on the second postoperative day and open esophagectomy were independently associated with postoperative complications. CONCLUSIONS: Open esophagectomy results in significantly higher CRP and leukocyte values compared with hybrid, minimally invasive, and robot-assisted minimally invasive esophagectomy. Open esophagectomy and a CRP increase on the second postoperative day above 200 mg/L are independent positive predictors for postoperative complications in multivariate analysis.
Authors: Rune B Strandby; Rikard Ambrus; Linea L Ring; Nikolaj Nerup; Niels H Secher; Jens P Goetze; Michael P Achiam; Lars B Svendsen Journal: Local Reg Anesth Date: 2021-03-02
Authors: Martin Reichert; Maike Lang; Joern Pons-Kühnemann; Michael Sander; Winfried Padberg; Andreas Hecker Journal: Perioper Med (Lond) Date: 2022-09-14
Authors: Benjamin Babic; Dolores T Müller; Jin-On Jung; Lars M Schiffmann; Paula Grisar; Thomas Schmidt; Seung-Hun Chon; Wolfgang Schröder; Christiane J Bruns; Hans F Fuchs Journal: Surg Endosc Date: 2022-05-03 Impact factor: 3.453