C-reactive Protein Levels After Esophagectomy Are Associated With Increased Surgical Trauma and Complications

Babic, Benjamin; Tagkalos, Evangelos; Gockel, Ines; Corvinus, Florian; Hadzijusufoviç, Edin; Hoppe‐Lotichius, Maria; Lang, Hauke; Sluis, Pieter C. van der; Grimminger, Peter

doi:10.1016/j.athoracsur.2019.12.016

Cited by 22 publications

(29 citation statements)

References 23 publications

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“…If this holds true, LAE should be favored whenever possible. Similar conclusions can be drawn from the recent study by Babic et al [54]. Here the open esophagectomy approach resulted in higher levels of inflammatory markers (CRP and blood leukocytes) during the first two postoperative days compared to minimally invasive approaches including the hybrid one.…”

Section: Discussionsupporting

confidence: 88%

“…Here the open esophagectomy approach resulted in higher levels of inflammatory markers (CRP and blood leukocytes) during the first two postoperative days compared to minimally invasive approaches including the hybrid one. In the their analysis Babic et al evaluated high early postoperative CRP values as positive predictive factors for the development of postoperative overall as well as pulmonary complications [54]. Another variable, which was significantly different between both the OE and LAE group in the present study, was intraoperative blood loss.…”

Section: Discussionmentioning

confidence: 46%

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Early Respiratory Impairment and Pneumonia after Hybrid Laparoscopically Assisted Esophagectomy—A Comparison with the Open Approach

Reichert

Lang

Hecker

et al. 2020

JCM

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Patients undergoing esophageal cancer surgery are at high risk of developing severe pulmonary complications. Beneficial effects of minimally invasive esophagectomy had been discussed recently, but the incidence of perioperative respiratory impairment remains unclear. This is a retrospective single-center cohort study of patients, who underwent open (OE) or laparoscopically assisted, hybrid minimally invasive abdomino-thoracic esophagectomy (LAE) for cancer regarding respiratory impairment (PaO2/FiO2 ratio (P/FR) < 300 mmHg) and pneumonia. No differences were observed in the cumulative incidence of reduced P/FR between OE and LAE patients. Of note, until postoperative day (POD) 2, P/FR did not differ among both groups. Thereafter, the rate of patients with respiratory impairment was higher after OE on POD 3, 5, and 10 (p ≤ 0.05) and tended being higher on POD 7 and 9 (p ≤ 0.1). Although the duration of LAE procedure was slightly longer (total: p = 0.07, thoracic part: p = 0.004), the duration of surgery (Spearman’s rank correlation coefficient (rsp) = −0.267, p = 0.006), especially of laparotomy (rsp = −0.242, p = 0.01) correlated inversely with respiratory impairment on POD 3 after OE. Pneumonia occurred on POD 5 (1–25) and 8.5 (3–14) after OE and LAE, respectively, with the highest incidence after OE (p = 0.01). In conclusion, respiratory impairment and pulmonary complications occur frequently after esophagectomy. Although early respiratory impairment is independent of the surgical approach, postoperative pneumonia rate is reduced after LAE.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 46%

Early Respiratory Impairment and Pneumonia after Hybrid Laparoscopically Assisted Esophagectomy—A Comparison with the Open Approach

Reichert

Lang

Hecker

et al. 2020

JCM

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“…To date, ∆Alb has been reported to be associated with overall complications 10,12 . This study highlighted its value for anticipating major adverse events, an important stake of postoperative course in major surgery 18 …”

Section: Discussionmentioning

confidence: 85%

“…Serum CRP has been identified as a negative predictor of anastomotic leakage with the best diagnostic accuracy at POD 2, 3, and 6 23 . Published cut‐offs for CRP show a wide range from >200 mg/ml on POD 2 18 or >209 mg/ml on POD 2 23 to >111 mg/L on POD 4 24 . Thus, while CRP levels are commonly measured in daily practice, there is still no universally accepted threshold to detect postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have suggested postoperative albumin drop (∆Alb) as a marker of surgical stress, associated with the risk of postoperative complications after major abdominal surgery 12–16 . It is already predictive within the first 6–24 h after surgery and was more robust than other inflammatory biomarkers currently used in daily practice, such as C‐reactive protein, which reaches a postoperative peak between postoperative day (POD) 2 and 3 17,18 . Albumin as an early predictor of postoperative complications after oncological esophagectomy was reported by Ryan et al in 2007 14 ; however, validation by a large‐scale study was necessary to recommend its use in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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Early postoperative decrease of albumin is an independent predictor of major complications after oncological esophagectomy: A multicenter study

Labgaa

Mantziari

Genety

et al. 2020

Journal of Surgical Oncology

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Background and ObjectivesSerum 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.MethodsMulticenter 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.ResultsIn 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.ConclusionsΔAlb appeared as a promising biomarker after oncological esophagectomy, allowing prediction of potential adverse outcomes.

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C-reactive protein identifies patients at low risk of anastomotic leak after esophagectomy

Rat

Piessen

Vanderbeken

et al. 2022

Langenbecks Arch Surg

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C-reactive Protein Levels After Esophagectomy Are Associated With Increased Surgical Trauma and Complications

Cited by 22 publications

References 23 publications

Early Respiratory Impairment and Pneumonia after Hybrid Laparoscopically Assisted Esophagectomy—A Comparison with the Open Approach

Early Respiratory Impairment and Pneumonia after Hybrid Laparoscopically Assisted Esophagectomy—A Comparison with the Open Approach

Early postoperative decrease of albumin is an independent predictor of major complications after oncological esophagectomy: A multicenter study

C-reactive protein identifies patients at low risk of anastomotic leak after esophagectomy

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