Goh Sean L, De Silva Ramesh P, Dhital Kumud, Gett Rohan M
Royal Prince Alfred Hospital, Sydney, Australia
Faculty of Medicine, The University of New South Wales, Sydney, Australia.
Interact Cardiovasc Thorac Surg. 2015 Jan;20(1):107-13. doi: 10.1093/icvts/ivu324. Epub 2014 Sep 25.
A best evidence topic was written according to a structured protocol. The question addressed was: in patients undergoing oesophagectomy for oesophageal malignancy, is low serum albumin associated with postoperative complications? Altogether, 87 papers were found using the reported search, of which 16 demonstrated the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. This paper includes 2 level 2 papers, 12 level 3 papers and 2 level 4 papers. All the papers compared either all or some of the following postoperative complications: mortality, morbidity, anastomotic leak, respiratory and non-respiratory complications, and length of hospital stay. Eleven of the 16 papers found an association between low serum albumin and postoperative complications. Of these, one study showed that low serum albumin combined with low fibrinogen levels (FA score) was predictive of postoperative recurrence of oesophageal cancer. Another study showed that when combined with white cell count and C-reactive protein (CRP, NUn score), serum albumin had a high diagnostic accuracy for major complications after postoperative day 3. The largest study compared the in-hospital mortality in 7227 patients who underwent oesophageal surgery for malignancy. The percentage of in-hospital mortality was associated with low serum albumin (<15.0 vs >35.0 g/l, 21.0 vs 11.3%, P <0.001). Five of the 16 papers found no significant association between low serum albumin and postoperative complications. Of these papers, one showed that low serum albumin was not an independent risk factor, while four others found no association between low serum albumin with respiratory complications, anastomotic leak and postoperative mortality. Instead, these studies found other factors responsible for postoperative complications such as: CRP, smoking, disease duration, malnutrition and low T-cell levels. Taken together, while low serum albumin is associated with postoperative complications, opinion regarding the prognostic value of low serum albumin and nutritional support remains conflicted. Because of the confounding factors encountered in these studies, the clinician should consider the finding of low serum albumin in patients, together with disease and surgical factors to provide optimal care for these patients.
根据结构化协议撰写了一篇最佳证据主题文章。所探讨的问题是：在接受食管癌切除术治疗食管恶性肿瘤的患者中，低血清白蛋白是否与术后并发症相关？通过报告的检索共找到87篇论文，其中16篇提供了回答该临床问题的最佳证据。现将这些论文的作者、期刊、发表日期、国家、研究的患者群体、研究类型、相关结局及结果制成表格。本文包括2篇2级论文、12篇3级论文和2篇4级论文。所有论文均比较了全部或部分以下术后并发症：死亡率、发病率、吻合口漏、呼吸和非呼吸并发症以及住院时间。16篇论文中有11篇发现低血清白蛋白与术后并发症之间存在关联。其中，一项研究表明低血清白蛋白与低纤维蛋白原水平（FA评分）相结合可预测食管癌术后复发。另一项研究表明，血清白蛋白与白细胞计数和C反应蛋白（CRP，NUn评分）相结合时，对术后第3天之后的主要并发症具有较高的诊断准确性。规模最大的一项研究比较了7227例接受食管癌手术治疗的患者的院内死亡率。院内死亡率百分比与低血清白蛋白相关（<15.0 vs >35.0 g/l，21.0% vs 11.3%，P<0.001）。16篇论文中有5篇发现低血清白蛋白与术后并发症之间无显著关联。在这些论文中，一篇表明低血清白蛋白不是独立危险因素，而其他4篇则未发现低血清白蛋白与呼吸并发症、吻合口漏及术后死亡率之间存在关联。相反，这些研究发现了导致术后并发症的其他因素，如：CRP、吸烟、病程、营养不良和低T细胞水平。总体而言，虽然低血清白蛋白与术后并发症相关，但关于低血清白蛋白的预后价值及营养支持的观点仍存在分歧。由于这些研究中存在混杂因素，临床医生应综合考虑患者低血清白蛋白的检查结果以及疾病和手术因素，为这些患者提供最佳治疗。
