C-Reactive Protein as Predictor for Infectious Complications after Robotic and Open Esophagectomies

Abstract

Introduction: The value of C-reactive protein (CRP) as a predictor of anastomotic leakage (AL) after esophagectomy has been addressed by numerous studies. Despite its increasing application, robotic esophagectomy (RAMIE) has not been considered separately yet in this context. We, therefore, aimed to evaluate the predictive value of CRP in RAMIE. Material and Methods: Patients undergoing RAMIE or completely open esophagectomy (OE) at our University Center were included. Clinical data, CRP- and Procalcitonin (PCT)-values were retrieved from a prospectively maintained database and evaluated for their predictive value for subsequent postoperative infectious complications (PIC) (AL, gastric conduit leakage or necrosis, pneumonia, empyema). Results: Three hundred and five patients (RAMIE: 160, OE: 145) were analyzed. PIC were noted in 91 patients on postoperative day (POD) 10 and 123 patients on POD 30, respectively. Median POD of diagnosis of PIC was POD 8. Post-operative CRP-values in the robotic-group peaked one and two days later, respectively, and converged from POD 5 onward compared to the open-group. In the group with PIC, CRP-levels in the robotic-group were initially lower and started to differ significantly from POD 3 onward. In the open-group, increases were already noticed from POD 3 on. Procalcitonin levels did not differ. Best Receiver operating curve (ROC)-results were on POD 4, highest negative predictive values at POD 5 (RAMIE) and POD 4 (OE) with cut-off values of 70 mg/L and 88.3 mg/L, respectively. Conclusion: Post-operative CRP is a good negative predictor for PIC, after both RAMIE and OE. After RAMIE, CRP peaks later with a lower cut-off value.

Is Robotic Surgery the Future for Resectable Esophageal Cancer?: A Systematic Literature Review of Oncological and Clinical Outcomes

“… 53 The incidence of postoperative pneumonia ranged from 0% to 45.4%; however, the literature varied in its definition and criteria influencing treatment decisions. 42 Notably, Meredith et al reported no significant difference in the incidence of pneumonia between patients undergoing open, robotic or conventional minimally invasive esophagectomy. 52 In comparison, three studies reported an incidence of postoperative pneumonia of >30%, despite all patients undergoing laparoscopic and robotic phases, suggesting a multifactorial aetiology for postoperative pneumonia.…”

“…With sufficient experience, centres may then be able to match higher-volume American and Chinese units. 42 – 49 …”

“… 34 Pneumonia is a common cause of morbidity after esophagectomy and poor pain control is a major causative factor. 42 , 52 Smaller incisions required in robotic esophagectomy and the reduced nerve injury result in less pain after surgery, better respiratory effort and reduced risk of pneumonia. Tsunoda et al demonstrated a lower rate of pulmonary complications (18%, p = 0.006) among patients who underwent robot-assisted esophagectomy compared with conventional minimally invasive esophagectomy (44%).…”

Development and performance assessment of novel machine learning models for predicting postoperative pneumonia in aneurysmal subarachnoid hemorrhage patients: external validation in MIMIC-IV

“…Hypoalbuminemia in patients with aSAH not only reduces the level of immune protein and obstructs the repair of the mucosal barrier, leading to increased susceptibility to infection, but also exacerbates brain edema after subarachnoid hemorrhage, ultimately worsening motor function impairment in patients ( 32 , 35 ). Some recent experimental findings additionally indicate that albuminemia mediates its neuroprotection through neurovascular remodeling and reducing cerebral lesions ( 36 – 38 ). A pilot study revealed that 1.25 g/kg/day albumin treatment was safe in SAH patients and might produce a better outcome ( 37 ).…”

Development and external validation of a nomogram for predicting postoperative pneumonia in aneurysmal subarachnoid hemorrhage

“…CRP is a well-known biomarker of systemic inflammation ( 29 ). An increasing body of evidence suggests that CRP can predict various postoperative infections ( 30 – 32 ). Our study also indicated that monitoring serum CRP levels can be useful in predicting POP in patients with aSAH.…”