Risk Assessment Using a Novel Score to Predict Anastomotic Leak and Major Complications after Oesophageal Resection

Noble, Fergus; Curtis, Nathan; Harris, Scott; Kelly, Jamie; Bailey, Ian; Byrne, James P.; Underwood, Tim

doi:10.1007/s11605-012-1867-9

Cited by 84 publications

(94 citation statements)

References 35 publications

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“…Therefore, the evaluation and management must be tailored according to the existence of anastomotic leak (1,5-7). There are many prior studies evaluating anastomotic leak after esophagectomy (4,9,10,14,16). The literature suggests that elevated CRP after esophagectomy is a marker that can be used for early detection of postoperative complications after esophagectomy (11,17,18).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, evaluation and management should be different according to the existence of an anastomotic leak (1,(5)(6)(7)(8). Prior studies have evaluated the early prediction of anastomotic leak after esophagectomy using laboratory findings (9)(10)(11)(12). However, there were few studies addressing the prediction of anastomotic leak after esophagectomy in patients who have received neoadjuvant therapy (NT).…”

Section: Introductionmentioning

confidence: 99%

“…Other studies have also evaluated laboratory values in the early prediction of anastomotic leak after esophagectomy (10,12,17). However, there has not been extensive investigation of the prediction of anastomotic leak after esophagectomy using routine laboratory findings in patients who have undergone NT.…”

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confidence: 99%

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C-reactive protein for the early prediction of anastomotic leak after esophagectomy in both neoadjuvant and non-neoadjuvant therapy case: a propensity score matching analysis

Park¹,

Kim²,

Moon³

2017

J. Thorac. Dis.

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Background: Anastomotic leak is one of most significant causes of mortality after esophagectomy. Therefore, it is clinically valuable to detect anastomotic leak early after esophagectomy in esophageal cancer. The purpose of this study is to investigate the associations between routine postoperative laboratory findings and anastomotic leak and to analyze the laboratory findings to find out an independent predictive marker for anastomotic leak.In addition, this study compares cases treated with neoadjuvant therapy (NT) and those without (non-NT). Methods:We retrospectively assessed the medical records of 201 consecutive cases that met this study's criteria from January 2009 to December 2016. All patients underwent curative and complete esophagectomy for intra-thoracic esophageal cancer. We compiled and analyzed routine laboratory findings from the day before surgery to the eighth postoperative day on a daily basis. Routine laboratory tests consisted of 26 separate tests, including complete blood cell counts, blood chemistries, as well as erythrocyte sedimentation rate and C-reactive protein (CRP). Barium esophagogram with chest computed tomography (CT) was performed on the seventh postoperative day to evaluate the presence of an anastomotic leak.Results: A total of 45 of 201 patients underwent NT. Anastomotic leaks were found in 23 (11.4%) of 201 patients (8 patients in NT and 15 patients in non-NT). White blood cell (WBC) from the second postoperative day (P=0.031, P=0.006, P=0.007, P=0.007, P=0.041, and P=0.003, respectively) and CRP from the third postoperative day (P=0.012, P<0.001, P=0.014, P<0.001, P=0.001, and P=0.006, respectively) were associated with anastomotic leak in non-NT; however, only CRP on the third, fifth, sixth, and seventh postoperative days (P=0.041, P=0.037, P=0.002, and P=0.003, respectively) was associated with anastomotic leak in NT. The CRP level on the third postoperative day was a significant independent predictive marker of anastomotic leak (P=0.041, odd ratio (OR) 1.056, 95% confidential interval (CI): 1.002-1.113) and had a significant diagnostic cutoff value for the development of anastomotic leak (non-NT: cutoff value 17.12 mg/dL, sensitivity 69.2%, specificity 78.1%, P<0.001, area 0.822; NT: cutoff value 16.42 mg/dL, sensitivity 80.0%, specificity 70.0 %, P=0.042, area 0.7104).Conclusions: There were divergent laboratory findings reflective of anastomotic leak between patients who underwent NT and those who did not. The CRP level on the third postoperative day had a significant cutoff value for early detection of anastomotic leak after esophagectomy in both NT and non-NT groups.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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C-reactive protein for the early prediction of anastomotic leak after esophagectomy in both neoadjuvant and non-neoadjuvant therapy case: a propensity score matching analysis

Park¹,

Kim²,

Moon³

2017

J. Thorac. Dis.

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“…All leaks with less than 20 mm were solved endoscopically. Technical and clinical success was higher when time between surgery and SEMS placement was lower, even though without statistical significance (respectively, 10 days [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] vs. 48 days , p = 0.228 and 12 days [8][9][10][11][12][13][14][15][16][17][18][19][20][21] vs. 20 days , p = 0.374) (Fig. 1).…”

Section: Sems Placement and Adverse Eventsmentioning

confidence: 99%

“…Clinical manifestations vary depending on the location of the leak and time elapsing from the perforation or rupture. Fever, systemic inflammatory response syndrome, and abnormal C-reactive protein, white blood cell count, and albumin are indicators of postoperative esophageal leak (8,9).…”

Section: Introductionmentioning

confidence: 99%

Self-expanding metal stents in postoperative esophageal leaks

Rodrigues‐Pinto¹,

Pereira²,

Ribeiro³

et al. 2016

Rev Esp Enferm Dig

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Background: Postoperative esophageal leaks have a high morbidity and mortality. Self-expanding metal stents (SEMS) have been used as an alternative to re-operation.Aim: Evaluating predictors of success of SEMS in postoperative esophageal leaks.Methods: Retrospective study of patients with postoperative esophageal leaks referred for SEMS placement in a reference center during a period of 3 years. Technical success was defined as closure of the leak in barium swallow at 15 days. Clinical success was considered as endoscopic and/or radiographic confirmation of closure after stent removal.Results: Thirteen patients placed SEMS. Median follow-up was 58 days. Leaks had a median size of 20 mm. Time between surgery and SEMS placement was 20 days. One patient died 2 days after SEMS placement and one had worsening of the fistula after SEMS expansion. Time till stent migration was 9 days. Technical success was achieved in 9 of 11 patients, with clinical success without recurrence in 5 patients. All leaks with less than 20 mm were solved endoscopically. Technical and clinical success was higher when time between surgery and SEMS placement was lower, even though without statistical significance (respectively, p = 0.228 and 0.374). In the 8 patients who died during follow-up, median survival was 59 days.Conclusions: Technical success of SEMS was higher than 80%; however, due to high morbidity and mortality, only 45% of patients had their stent removed. Lower time from diagnosis to SEMS placement and leak size less than 20 mm may be associated with better results.

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Management and outcomes of anastomotic leaks after oesophagectomy

Dent

Griffin

Jones

et al. 2016

British Journal of Surgery

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Risk Assessment Using a Novel Score to Predict Anastomotic Leak and Major Complications after Oesophageal Resection

Abstract: Blood-borne markers of the systemic inflammatory response are predictors of AL and major complications after oesophageal resection. When combined they may categorise a patient's risk of developing a serious complication with higher sensitivity and specificity.

Cited by 84 publications

References 35 publications

C-reactive protein for the early prediction of anastomotic leak after esophagectomy in both neoadjuvant and non-neoadjuvant therapy case: a propensity score matching analysis

C-reactive protein for the early prediction of anastomotic leak after esophagectomy in both neoadjuvant and non-neoadjuvant therapy case: a propensity score matching analysis

Self-expanding metal stents in postoperative esophageal leaks

Management and outcomes of anastomotic leaks after oesophagectomy

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