Use of C-reactive protein for the early prediction of anastomotic leak after esophagectomy: Systematic review and Bayesian meta-analysis

Abstract

BackgroundEarly suspicion, diagnosis, and timely treatment of anastomotic leak after esophagectomy is essential. Retrospective studies have investigated the role of C-reactive protein (CRP) as early marker of anastomotic leakage. The aim of this systematic review and meta-analysis was to evaluate the predictive value of CRP after esophageal resection.MethodsA literature search was conducted to identify all reports including serial postoperative CRP measurements to predict anastomotic leakage after elective open or minimally invasive esophagectomy. Fully Bayesian meta-analysis was carried out using random-effects model for pooling diagnostic accuracy measures along with CRP cut-off values at different postoperative day.ResultsFive studies published between 2012 and 2018 met the inclusion criteria. Overall, 850 patients were included. Ivor-Lewis esophagectomy was the most common surgical procedure (72.3%) and half of the patients had squamous-cell carcinoma (50.4%). The estimated pooled prevalence of anastomotic leak was 11% (95% CI = 8–14%). The serum CRP level on POD3 and POD5 had comparable diagnostic accuracy with a pooled area under the curve of 0.80 (95% CIs 0.77–0.92) and 0.83 (95% CIs 0.61–0.96), respectively. The derived pooled CRP cut-off values were 17.6 mg/dl on POD 3 and 13.2 mg/dl on POD 5; the negative likelihood ratio were 0.35 (95% CIs 0.096–0.62) and 0.195 (95% CIs 0.04–0.52).ConclusionAfter esophagectomy, a CRP value lower than 17.6 mg/dl on POD3 and 13.2 mg/dl on POD5 combined with reassuring clinical and radiological signs may be useful to rule-out leakage. In the context of ERAS protocols, this may help to avoid contrast radiological studies, anticipate oral feeding, accelerate hospital discharge, and reduce costs.

The emerging predictive role of C-reactive protein after ventral hernia repair with mesh

“…We congratulate the authors for the idea to investigate the postoperative CRP predictive value in the diagnosis of ICs after mesh-reinforced ventral hernioplasty. This paper strengthens and broadens this concept previously investigated in other general surgery settings [2][3][4]. After carefully reading, CRP seems to be a useful biomarker to rule out postoperative ICs.…”

Systematic Review of the Role of Biomarkers in Predicting Anastomotic Leakage Following Gastroesophageal Cancer Surgery

“…Similar to CRP, the accuracy of leucocytes as a biomarker for AL lies in excluding rather than indicating this postoperative complication [36,37,74]. Similar conclusions were drawn by a recently published systematic review and meta-analysis by Aolfi and colleagues, who also concluded that CRP may be a useful marker to rule out leakage with reassuring clinical and radiological signs [77].…”

Low-fat/high-fibre diet prehabilitation improves anastomotic healing via the microbiome: an experimental model

“…It may be important to recognize that the current recommendation of enhanced recovery programmes specifically suggests ‘solid’ food to be provided to patients after surgery. Therefore, it may be time to consider the consumption of customary unprocessed foodstuffs beyond their effect on BMI, serum protein markers and other standard nutritional parameters.…”