Paul Rat1, Guillaume Piessen2, Marguerite Vanderbeken2, Alexandre Chebaro2, Olivier Facy3,4,5, Patrick Rat3,4,5, Cyril Boisson6,7, Pablo Ortega-Deballon3,4,5. 1. Department of Digestive and Oncological Surgery, Dijon-Bourgogne University Hospital, Univ. Bourgogne-Franche-Comté, 14 rue Paul Gaffarel, F-21000, Dijon, France. paul.rat@chu-dijon.fr. 2. Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Univ. Lille, F-59000, Lille, France. 3. Department of Digestive and Oncological Surgery, Dijon-Bourgogne University Hospital, Univ. Bourgogne-Franche-Comté, 14 rue Paul Gaffarel, F-21000, Dijon, France. 4. Univ. Bourgogne-Franche-Comté, UMR LNC, Dijon, France. 5. Inserm, U1231, Équipe CADIR, Dijon, France. 6. LabEx LipSTIC, Dijon-Bourgogne, University Hospital, Univ. Bourgogne-Franche-Comté, Dijon, France. 7. Dijon-Bourgogne University Hospital, Dijon, France.
Abstract
PURPOSE: Fast-track protocols are increasingly used after digestive surgery. After esophagectomy, the gravity and the fear of anastomotic leak may be an obstacle to generalization of such protocols. C-reactive protein (CRP) might be a reliable tool to identify patients at low risk of anastomotic leak after esophagectomy, so that they can be safely included in a fast-track program. The aim of our retrospective bicentric study is to evaluate the interest of C-reactive protein measurement for the early diagnosis of anastomotic leak after esophagectomy. METHODS: Patients having undergone Ivor-Lewis procedure between January 2009 and September 2017 were included in this bicentric retrospective study. CRP values were recorded between postoperative day 3 (POD 3) and postoperative day 5 (POD 5). All postoperative complications were recorded, and the primary endpoint was anastomotic leak. RESULTS: We included 585 patients. Among them, 241 (41.2%) developed infectious complications and 69 patients (11.8%) developed anastomotic leak. CRP had the best predictive value on POD 5 (AUC = 0.74; 95% CI: 0.67-0.81). On POD 5, a cut-off value of 130 mg/L yielded a sensitivity of 87%, a specificity of 51%, and a negative predictive value of 96% for the detection of anastomotic leak. CONCLUSIONS: CRP may help in identifying patients at very low risk of anastomotic leak after esophagectomy. Patients with CRP values < 130 mg/L on POD 5 can safely undertake an enhanced recovery protocol.
PURPOSE: Fast-track protocols are increasingly used after digestive surgery. After esophagectomy, the gravity and the fear of anastomotic leak may be an obstacle to generalization of such protocols. C-reactive protein (CRP) might be a reliable tool to identify patients at low risk of anastomotic leak after esophagectomy, so that they can be safely included in a fast-track program. The aim of our retrospective bicentric study is to evaluate the interest of C-reactive protein measurement for the early diagnosis of anastomotic leak after esophagectomy. METHODS: Patients having undergone Ivor-Lewis procedure between January 2009 and September 2017 were included in this bicentric retrospective study. CRP values were recorded between postoperative day 3 (POD 3) and postoperative day 5 (POD 5). All postoperative complications were recorded, and the primary endpoint was anastomotic leak. RESULTS: We included 585 patients. Among them, 241 (41.2%) developed infectious complications and 69 patients (11.8%) developed anastomotic leak. CRP had the best predictive value on POD 5 (AUC = 0.74; 95% CI: 0.67-0.81). On POD 5, a cut-off value of 130 mg/L yielded a sensitivity of 87%, a specificity of 51%, and a negative predictive value of 96% for the detection of anastomotic leak. CONCLUSIONS: CRP may help in identifying patients at very low risk of anastomotic leak after esophagectomy. Patients with CRP values < 130 mg/L on POD 5 can safely undertake an enhanced recovery protocol.
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