Department of Digestive and Oncological Surgery, Dijon-Bourgogne University Hospital, Univ. Bourgogne-Franche-Comté, 14 rue Paul Gaffarel, F-21000, Dijon, France.
Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Univ. Lille, F-59000, Lille, France.
Langenbecks Arch Surg. 2022 Dec;407(8):3377-3386. doi: 10.1007/s00423-022-02703-5. Epub 2022 Oct 8.
Fast-track protocols are increasingly used after digestive surgery. After esophagectomy, the gravity and the fear of anastomotic leak may be an obstacle to generalization of such protocols. C-reactive protein (CRP) might be a reliable tool to identify patients at low risk of anastomotic leak after esophagectomy, so that they can be safely included in a fast-track program. The aim of our retrospective bicentric study is to evaluate the interest of C-reactive protein measurement for the early diagnosis of anastomotic leak after esophagectomy.
Patients having undergone Ivor-Lewis procedure between January 2009 and September 2017 were included in this bicentric retrospective study. CRP values were recorded between postoperative day 3 (POD 3) and postoperative day 5 (POD 5). All postoperative complications were recorded, and the primary endpoint was anastomotic leak.
We included 585 patients. Among them, 241 (41.2%) developed infectious complications and 69 patients (11.8%) developed anastomotic leak. CRP had the best predictive value on POD 5 (AUC = 0.74; 95% CI: 0.67-0.81). On POD 5, a cut-off value of 130 mg/L yielded a sensitivity of 87%, a specificity of 51%, and a negative predictive value of 96% for the detection of anastomotic leak.
CRP may help in identifying patients at very low risk of anastomotic leak after esophagectomy. Patients with CRP values < 130 mg/L on POD 5 can safely undertake an enhanced recovery protocol.
快速康复方案在消化道手术后越来越多地被应用。在食管切除术后，吻合口漏的严重性和担忧可能成为推广此类方案的障碍。C 反应蛋白（CRP）可能是一种可靠的工具，可用于识别食管切除术后吻合口漏风险较低的患者，以便安全地将其纳入快速康复方案。本回顾性的、双中心研究的目的是评估 C 反应蛋白测量在食管切除术后吻合口漏早期诊断中的作用。
本双中心回顾性研究纳入了 2009 年 1 月至 2017 年 9 月期间接受 Ivor-Lewis 手术的患者。在术后第 3 天（POD 3）和术后第 5 天（POD 5）记录 CRP 值。记录所有术后并发症，主要终点为吻合口漏。
我们共纳入了 585 例患者。其中，241 例（41.2%）发生感染性并发症，69 例（11.8%）发生吻合口漏。CRP 在术后第 5 天的预测价值最佳（AUC=0.74；95%CI：0.67-0.81）。在术后第 5 天，130mg/L 的截断值对吻合口漏的检测具有 87%的敏感性、51%的特异性和 96%的阴性预测值。
CRP 可能有助于识别食管切除术后吻合口漏风险极低的患者。术后第 5 天 CRP 值<130mg/L 的患者可安全地进行强化康复方案。
