Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Switzerland.
Department of Digestive and Oncological Surgery, University of Lille, Claude Huriez University Hospital, Lille, France.
J Surg Oncol. 2021 Feb;123(2):462-469. doi: 10.1002/jso.26317. Epub 2020 Dec 1.
Serum 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.
Multicenter 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.
In 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.
ΔAlb appeared as a promising biomarker after oncological esophagectomy, allowing prediction of potential adverse outcomes.
血清白蛋白围手术期下降（ΔAlb）可能反映手术引起的生理应激程度。研究强调了其预测术后不良结局的价值，但在食管手术中数据较少。本研究旨在探讨ΔAlb 在预测癌症患者接受食管癌手术后主要并发症中的作用。
在五个大容量中心进行的多中心回顾性研究，包括 2006 年至 2017 年间连续接受食管癌切除术的患者。患者被随机分配到训练（n=696）和验证（n=350）队列。术后第 1 天计算白蛋白下降，定义为ΔAlb。主要终点为根据 Clavien 分类的主要并发症。
在训练队列中，食管癌切除术导致白蛋白迅速下降。ΔAlb 的截断值设定为 11g/L，可区分不良结局患者。多变量分析显示，ΔAlb 是主要并发症的独立预测因子（OR，1.06；95%CI，1.01-1.11；p=0.014）。较高的 BMI 和腹腔镜手术与较低的ΔAlb 相关。验证队列的分析提供了一致的结果。
ΔAlb 似乎是一种很有前途的肿瘤食管癌术后生物标志物，可预测潜在的不良结局。
