Gordon Alexandra C, Cross Andrea J, Foo Elizabeth W, Roberts Ross H
Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.
ANZ J Surg. 2018 Mar;88(3):223-227. doi: 10.1111/ans.13681. Epub 2016 Jul 25.
Post-operative C-reactive protein (CRP) has been investigated as a predictor of anastomotic leak (AL) following colorectal surgery, but its role in oesophago-gastric surgery is not yet established.
Clinical data and post-operative CRP values of patients who underwent elective oesophago-gastric resection between January 2004 and July 2014 were analysed retrospectively. Only patients with an oesophageal anastomosis were included. AL was defined as leakage of contrast material seen on imaging or a leak confirmed intraoperatively on return to theatre.
One hundred and forty-five patients were identified. Of the 145 patients, 13 (9%) developed AL. The CRP on post-operative days (POD) 2, 3 and 6 had the greatest diagnostic accuracy, with an area under the curve of 0.82, 0.80 and 0.91 respectively. Using a cut-off value of 209 mg/L on POD 2, the sensitivity was 100%, the specificity was 61%, the positive predictive value (PPV) was 21% and the negative predictive value (NPV) was 100%. Using a cut-off value of 190 mg/L on POD 3, the sensitivity was 100%, the specificity was 59%, the PPV was 21% and the NPV was 100%. Using a cut-off value of 154 mg/L on POD 6, the sensitivity was 100%, the specificity was 78%, the PPV was 29% and the NPV was 100%.
Post-operative CRP is an accurate negative predictive test for the development of AL following oesophago-gastric surgery. It may help to discriminate between patients with a high risk of leak and those in which AL is unlikely to occur.
术后C反应蛋白（CRP）已被研究作为结直肠手术后吻合口漏（AL）的预测指标，但其在食管胃手术中的作用尚未明确。
回顾性分析2004年1月至2014年7月期间接受择期食管胃切除术患者的临床资料和术后CRP值。仅纳入行食管吻合术的患者。AL定义为影像学检查发现造影剂渗漏或术中返回手术室时确认的渗漏。
共确定145例患者。在这145例患者中，13例（9%）发生了AL。术后第2天、第3天和第6天的CRP具有最高的诊断准确性，曲线下面积分别为0.82、0.80和0.91。术后第2天采用209 mg/L的临界值，敏感性为100%，特异性为61%，阳性预测值（PPV）为21%，阴性预测值（NPV）为100%。术后第3天采用190 mg/L的临界值，敏感性为100%，特异性为59%，PPV为21%，NPV为100%。术后第6天采用154 mg/L的临界值，敏感性为100%，特异性为78%，PPV为29%，NPV为100%。
术后CRP是食管胃手术后发生AL的准确阴性预测指标。它可能有助于区分漏出风险高的患者和不太可能发生AL的患者。
