Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
World J Surg. 2023 Aug;47(8):1995-2002. doi: 10.1007/s00268-023-07013-5. Epub 2023 Apr 27.
Serum C-reactive protein (CRP) is commonly used by surgeons to raise suspicion of anastomotic leakage and other infectious complications, but most studies on optimal cut-off values are retrospective with a small sample of patients. The aim of this study was to determine the accuracy and optimal cut-off value of CRP for anastomotic leakage in patients following esophagectomy for cancer.
Consecutive minimally invasive esophagectomy for esophageal cancer patients was included in this prospective study. Anastomotic leakage was confirmed if a defect or leakage of oral contrast was seen on a CT scan, by endoscopy or if saliva was draining from the neck incision. Diagnostic accuracy of CRP was assessed by receiver operator curve (ROC) analysis. Youden's index was adopted to determine the cut-off value.
A total of 200 patients were included between 2016 and 2018. Postoperative day 5 showed the highest area under the ROC (0.825) and optimal cut-off value of 120 mg/L. This resulted in a sensitivity of 75%, specificity of 82%, negative predicting value of 97%, and positive predicting value of 32%.
CRP on postoperative day 5 can be used as a negative predictor for and can be used as a marker to raise suspicion of anastomotic leakage following esophagectomy for esophageal cancer. When CRP exceeds 120 mg/L on postoperative day 5, additional investigations should be considered.
外科医生通常会使用血清 C 反应蛋白（CRP）来怀疑吻合口漏和其他感染性并发症，但大多数关于最佳截断值的研究都是回顾性的，且患者样本量较小。本研究旨在确定 CRP 在食管癌患者接受食管癌根治术后吻合口漏的准确性和最佳截断值。
连续纳入 2016 年至 2018 年接受微创食管癌切除术的患者。如果 CT 扫描显示有缺陷或造影剂漏出、内镜检查显示或颈部切口有唾液流出，则可确诊吻合口漏。通过受试者工作特征（ROC）曲线分析评估 CRP 的诊断准确性。采用约登指数确定截断值。
共纳入 200 例患者。术后第 5 天的 ROC 曲线下面积最高（0.825），最佳截断值为 120mg/L。这导致敏感性为 75%，特异性为 82%，阴性预测值为 97%，阳性预测值为 32%。
术后第 5 天的 CRP 可作为吻合口漏的阴性预测指标，并可作为标记物，提示食管癌根治术后吻合口漏。当术后第 5 天 CRP 超过 120mg/L 时，应考虑进一步检查。
