Abstract
Abstract
Introduction
Early detection of anastomotic leaks following esophagectomy has the potential to reduce hospital length of stay and mortality. The aim of this study was to compare the predictive value of pleural drain amylase and serum C-reactive protein for the early diagnosis of leak.
Methods
A retrospective observational cohort study was conducted on 121 patients who underwent Ivor Lewis esophagectomy and intrathoracic gastric conduit reconstruction. Pleural drain amylase levels were measured daily until postoperative day (POD) 5 and compared with CRP values measured on POD 3, 5, and 7. Specificity and sensitivity for both tests, and the respective ROC curves, were calculated.
Results
Anastomotic leak occurred in 12 patients. There was a significant statistical association between pleural drain amylase and serum CRP levels and the presence of anastomotic leakage. Pleural drain amylase cutoff of 209 IU/L on POD 2 yielded a sensitivity of 75% and a specificity of 94% (AUC = 0.813), whereas CRP cutoff value of 22.5 mg/dL on POD 3 yielded a sensitivity of 56% and a specificity of 92% (AUC = 0.772). The negative likelihood ratio of pleural drain amylase was 0.27 and 0.12 on POD 2 and 5, respectively. There was no statistically significant difference between ROC curves of amylase and CRP on POD 3 and 5 (p = 0.79 and p = 0.14, respectively).
Conclusions
Pleural drain amylase seems more efficient than serum CRP for early detection of esophago-gastric anastomotic leak. The practice of monitoring drain amylase and CRP may allow safer implementation of enhanced postoperative recovery pathway.
Publisher
Springer Science and Business Media LLC
Reference18 articles.
1. Moon SW, Kim J, Cho DG, Park JK (2019) Early detection of complications: anastomotic leakage. J Thorac Dis 11(Suppl 5):S805–S811
2. Grimminger P, Goense L, Gockel I et al (2018) Diagnosis, assessment, and management of surgical complications following esophagectomy. Ann New York Acad Sci 1434:254–273
3. Cools-Lartigue J, Andalib A, Abo-Alsaud A et al (2014) Routine contrast esophagram has minimal impact on the postoperative management of patients undergoing esophagectomy for esophageal cancer. Ann Surg Oncol 21:2573–2579
4. Aiolfi A, Asti E, Rausa E, Bonavina G, Bonitta G, Bonavina L (2018) Use of C-reactive protein for the early prediction of anastomotic leak after esophagectomy: systematic review and Bayesian meta-analysis. PLoS ONE 13(12):e0209272
5. Machens A, Busch C, Bause H, Izbicki JR (1996) Gastric tonometry and drain amylase analysis in the detection of cervical oesophagogastric leakage. Br J Surg 83:1608–1615
Cited by
1 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献