Richter Florian, Mehdorn Anne-Sophie, Fedders Thorben, Reichert Benedikt, Egberts Jan-Hendrik, Becker Thomas, Pochhammer Julius
Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Hospital Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, Building C, 24105 Kiel, Germany.
Department of Surgery, Israelit Hospital, Orchideenstieg 14, 22297 Hamburg, Germany.
J Clin Med. 2022 Sep 26;11(19):5654. doi: 10.3390/jcm11195654.
The value of C-reactive protein (CRP) as a predictor of anastomotic leakage (AL) after esophagectomy has been addressed by numerous studies. Despite its increasing application, robotic esophagectomy (RAMIE) has not been considered separately yet in this context. We, therefore, aimed to evaluate the predictive value of CRP in RAMIE.
Patients undergoing RAMIE or completely open esophagectomy (OE) at our University Center were included. Clinical data, CRP- and Procalcitonin (PCT)-values were retrieved from a prospectively maintained database and evaluated for their predictive value for subsequent postoperative infectious complications (PIC) (AL, gastric conduit leakage or necrosis, pneumonia, empyema).
Three hundred and five patients (RAMIE: 160, OE: 145) were analyzed. PIC were noted in 91 patients on postoperative day (POD) 10 and 123 patients on POD 30, respectively. Median POD of diagnosis of PIC was POD 8. Post-operative CRP-values in the robotic-group peaked one and two days later, respectively, and converged from POD 5 onward compared to the open-group. In the group with PIC, CRP-levels in the robotic-group were initially lower and started to differ significantly from POD 3 onward. In the open-group, increases were already noticed from POD 3 on. Procalcitonin levels did not differ. Best Receiver operating curve (ROC)-results were on POD 4, highest negative predictive values at POD 5 (RAMIE) and POD 4 (OE) with cut-off values of 70 mg/L and 88.3 mg/L, respectively.
Post-operative CRP is a good negative predictor for PIC, after both RAMIE and OE. After RAMIE, CRP peaks later with a lower cut-off value.
众多研究探讨了C反应蛋白（CRP）作为食管切除术后吻合口漏（AL）预测指标的价值。尽管其应用日益广泛，但在这方面，机器人辅助食管切除术（RAMIE）尚未被单独考虑。因此，我们旨在评估CRP在RAMIE中的预测价值。
纳入在我们大学中心接受RAMIE或完全开放食管切除术（OE）的患者。从一个前瞻性维护的数据库中检索临床数据、CRP和降钙素原（PCT）值，并评估它们对随后术后感染性并发症（PIC）（AL、胃管道漏或坏死、肺炎、脓胸）的预测价值。
分析了305例患者（RAMIE：160例，OE：145例）。分别在术后第10天和第30天，91例和123例患者出现PIC。PIC诊断的中位术后天数为术后第8天。机器人手术组术后CRP值分别在1天和2天后达到峰值，与开放手术组相比，从术后第5天起趋于一致。在发生PIC的组中，机器人手术组的CRP水平最初较低，从术后第3天起开始显著不同。在开放手术组中，从术后第3天起就已观察到CRP升高。降钙素原水平无差异。最佳受试者工作特征曲线（ROC）结果在术后第4天，术后第5天（RAMIE）和第4天（OE）的最高阴性预测值，截断值分别为70 mg/L和88.3 mg/L。
术后CRP是RAMIE和OE术后PIC的良好阴性预测指标。RAMIE术后，CRP峰值出现较晚，截断值较低。
