Ismail Labgaa1, Styliani Mantziari1, Maxime Genety2, Jessie A Elliott3, Satoshi Kamiya4, Marianne C Kalff5, Michaël Winiker1, Jérôme Pasquier6, Pierre Allemann1, Marguerite Messier2, Mark I van Berge Henegouwen5, Magnus Nilsson4, John V Reynolds3, Guillaume Piessen2, Martin Hübner1, Nicolas Demartines, Markus Schäfer1. 1. Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Switzerland. 2. Department of Digestive and Oncological Surgery, University of Lille, Claude Huriez University Hospital, Lille, France. 3. Department of Surgery, Trinity Translational Medicine Institute, St. James's Hospital, Dublin, Ireland. 4. Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden. 5. Department of Surgery, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands. 6. Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland.
Abstract
BACKGROUND AND OBJECTIVES: Serum albumin perioperative decrease (∆Alb) may reflect the magnitude of the physiological stress induced by surgery. Studies highlighted its value to predict adverse postoperative outcomes, but data in esophageal surgery are scant. This study aimed to investigate the role of ∆Alb to predict major complications after esophagectomy for cancer. METHODS: Multicenter retrospective study conducted in five high-volume centers, including consecutive patients undergoing an esophagectomy for cancer between 2006 and 2017. Patients were randomly assigned to a training (n = 696) and a validation (n = 350) cohort. Albumin decrease was calculated on postoperative day 1 and defined as ΔAlb. The primary endpoint was major complications according to Clavien classification. RESULTS: In the training cohort, esophagectomy induced a rapid drop of albumin. Cut-off of ΔAlb was established at 11 g/L and allowed to distinguish patients with adverse outcomes. On multivariable analysis, ΔAlb was identified as an independent predictor of major complications (OR, 1.06; 95% CI, 1.01-1.11; p = .014). Higher BMI and laparoscopy were associated with lower ΔAlb. Analysis of the validation cohort provided consistent findings. CONCLUSIONS: ΔAlb appeared as a promising biomarker after oncological esophagectomy, allowing prediction of potential adverse outcomes.
BACKGROUND AND OBJECTIVES: Serum albumin perioperative decrease (∆Alb) may reflect the magnitude of the physiological stress induced by surgery. Studies highlighted its value to predict adverse postoperative outcomes, but data in esophageal surgery are scant. This study aimed to investigate the role of ∆Alb to predict major complications after esophagectomy for cancer. METHODS: Multicenter retrospective study conducted in five high-volume centers, including consecutive patients undergoing an esophagectomy for cancer between 2006 and 2017. Patients were randomly assigned to a training (n = 696) and a validation (n = 350) cohort. Albumin decrease was calculated on postoperative day 1 and defined as ΔAlb. The primary endpoint was major complications according to Clavien classification. RESULTS: In the training cohort, esophagectomy induced a rapid drop of albumin. Cut-off of ΔAlb was established at 11 g/L and allowed to distinguish patients with adverse outcomes. On multivariable analysis, ΔAlb was identified as an independent predictor of major complications (OR, 1.06; 95% CI, 1.01-1.11; p = .014). Higher BMI and laparoscopy were associated with lower ΔAlb. Analysis of the validation cohort provided consistent findings. CONCLUSIONS: ΔAlb appeared as a promising biomarker after oncological esophagectomy, allowing prediction of potential adverse outcomes.
Authors: John V Reynolds; Noel E Donlon; Jessie A Elliott; Brendan Moran; Hugo Temperley; Tim S Nugent; Maria Davern; Sinead King; Melissa Conroy; Joanne Lysaght; Narayanasamy Ravi; Carmel Ryan; Stephen Finn; Suzanne Norris; Clare L Donohoe Journal: World J Surg Date: 2022-10-20 Impact factor: 3.282
Authors: Gaëtan-Romain Joliat; Arnaud Schoor; Markus Schäfer; Nicolas Demartines; Martin Hübner; Ismail Labgaa Journal: Perioper Med (Lond) Date: 2022-02-15