Use of C-reactive protein for the early prediction of anastomotic leak after esophagectomy: Systematic review and Bayesian meta-analysis
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Aiolfi, Alberto
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Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
Aiolfi, Alberto
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Asti, Emanuele
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Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
Asti, Emanuele
[1
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Rausa, Emanuele
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Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
Rausa, Emanuele
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Bonavina, Giulia
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Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
Bonavina, Giulia
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Bonitta, Gianluca
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Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
Bonitta, Gianluca
[1
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Bonavina, Luigi
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Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
Bonavina, Luigi
[1
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[1] Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
Background Early suspicion, diagnosis, and timely treatment of anastomotic leak after esophagectomy is essential. Retrospective studies have investigated the role of C-reactive protein (CRP) as early marker of anastomotic leakage. The aim of this systematic review and meta-analysis was to evaluate the predictive value of CRP after esophageal resection. Methods A literature search was conducted to identify all reports including serial postoperative CRP measurements to predict anastomotic leakage after elective open or minimally invasive esophagectomy. Fully Bayesian meta-analysis was carried out using random-effects model for pooling diagnostic accuracy measures along with CRP cut-off values at different postoperative day. Results Five studies published between 2012 and 2018 met the inclusion criteria. Overall, 850 patients were included. Ivor-Lewis esophagectomy was the most common surgical procedure (72.3%) and half of the patients had squamous-cell carcinoma (50.4%). The estimated pooled prevalence of anastomotic leak was 11% (95% CI = 8-14%). The serum CRP level on POD3 and POD5 had comparable diagnostic accuracy with a pooled area under the curve of 0.80 (95% CIs 0.77-0.92) and 0.83 (95% CIs 0.61-0.96), respectively. The derived pooled CRP cut-off values were 17.6 mg/dl on POD 3 and 13.2 mg/dl on POD 5; the negative likelihood ratio were 0.35 (95% CIs 0.096-0.62) and 0.195 (95% CIs 0.04-0.52). Conclusion After esophagectomy, a CRP value lower than 17.6 mg/dl on POD3 and 13.2 mg/dl on POD5 combined with reassuring clinical and radiological signs may be useful to rule-out leakage. In the context of ERAS protocols, this may help to avoid contrast radiological studies, anticipate oral feeding, accelerate hospital discharge, and reduce costs.
机构:
Cent Manchester & Manchester Childrens Univ Hosp, Dept Paediat Gastroenterol, Booth Hall Childrens Hosp, Manchester M9 7AA, Lancs, EnglandCent Manchester & Manchester Childrens Univ Hosp, Dept Paediat Gastroenterol, Booth Hall Childrens Hosp, Manchester M9 7AA, Lancs, England
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Univ Milan, Dept Biomed Sci Hlth, IRCCS Policlin San Donato, Div Gen Surg, I-20097 San Donato Milanese, Milano, ItalyUniv Milan, Dept Biomed Sci Hlth, IRCCS Policlin San Donato, Div Gen Surg, I-20097 San Donato Milanese, Milano, Italy
Asti, E.
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Sozzi, M.
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Bonitta, G.
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Univ Milan, Dept Biomed Sci Hlth, IRCCS Policlin San Donato, Div Gen Surg, I-20097 San Donato Milanese, Milano, ItalyUniv Milan, Dept Biomed Sci Hlth, IRCCS Policlin San Donato, Div Gen Surg, I-20097 San Donato Milanese, Milano, Italy
Bonitta, G.
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Bernardi, D.
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Univ Milan, Dept Biomed Sci Hlth, IRCCS Policlin San Donato, Div Gen Surg, I-20097 San Donato Milanese, Milano, ItalyUniv Milan, Dept Biomed Sci Hlth, IRCCS Policlin San Donato, Div Gen Surg, I-20097 San Donato Milanese, Milano, Italy
Bernardi, D.
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Bonavina, L.
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Univ Milan, Dept Biomed Sci Hlth, IRCCS Policlin San Donato, Div Gen Surg, I-20097 San Donato Milanese, Milano, ItalyUniv Milan, Dept Biomed Sci Hlth, IRCCS Policlin San Donato, Div Gen Surg, I-20097 San Donato Milanese, Milano, Italy
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Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
Bonavina, Luigi
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Asti, Emanuele
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Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
Asti, Emanuele
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Sironi, Andrea
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Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
Sironi, Andrea
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Bernardi, Daniele
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Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
Bernardi, Daniele
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Aiolfi, Alberto
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Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
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Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
Bonavina, Luigi
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Scolari, Federica
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Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
Scolari, Federica
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Aiolfi, Alberto
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Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
Aiolfi, Alberto
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Bonitta, Gianluca
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Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
Bonitta, Gianluca
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Sironi, Andrea
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Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
Sironi, Andrea
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Saino, Greta
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Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
Saino, Greta
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Asti, Emanuele
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Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
机构:
Cent Manchester & Manchester Childrens Univ Hosp, Dept Paediat Gastroenterol, Booth Hall Childrens Hosp, Manchester M9 7AA, Lancs, EnglandCent Manchester & Manchester Childrens Univ Hosp, Dept Paediat Gastroenterol, Booth Hall Childrens Hosp, Manchester M9 7AA, Lancs, England
机构:
Univ Milan, Dept Biomed Sci Hlth, IRCCS Policlin San Donato, Div Gen Surg, I-20097 San Donato Milanese, Milano, ItalyUniv Milan, Dept Biomed Sci Hlth, IRCCS Policlin San Donato, Div Gen Surg, I-20097 San Donato Milanese, Milano, Italy
Asti, E.
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Sozzi, M.
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Bonitta, G.
论文数: 0引用数: 0
h-index: 0
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Univ Milan, Dept Biomed Sci Hlth, IRCCS Policlin San Donato, Div Gen Surg, I-20097 San Donato Milanese, Milano, ItalyUniv Milan, Dept Biomed Sci Hlth, IRCCS Policlin San Donato, Div Gen Surg, I-20097 San Donato Milanese, Milano, Italy
Bonitta, G.
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Bernardi, D.
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Univ Milan, Dept Biomed Sci Hlth, IRCCS Policlin San Donato, Div Gen Surg, I-20097 San Donato Milanese, Milano, ItalyUniv Milan, Dept Biomed Sci Hlth, IRCCS Policlin San Donato, Div Gen Surg, I-20097 San Donato Milanese, Milano, Italy
Bernardi, D.
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Bonavina, L.
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Univ Milan, Dept Biomed Sci Hlth, IRCCS Policlin San Donato, Div Gen Surg, I-20097 San Donato Milanese, Milano, ItalyUniv Milan, Dept Biomed Sci Hlth, IRCCS Policlin San Donato, Div Gen Surg, I-20097 San Donato Milanese, Milano, Italy
机构:
Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
Bonavina, Luigi
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Asti, Emanuele
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机构:
Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
Asti, Emanuele
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Sironi, Andrea
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Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
Sironi, Andrea
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Bernardi, Daniele
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Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
Bernardi, Daniele
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Aiolfi, Alberto
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Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
机构:
Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
Bonavina, Luigi
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Scolari, Federica
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Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
Scolari, Federica
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Aiolfi, Alberto
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Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
Aiolfi, Alberto
;
Bonitta, Gianluca
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机构:
Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
Bonitta, Gianluca
;
Sironi, Andrea
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机构:
Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
Sironi, Andrea
;
Saino, Greta
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Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
Saino, Greta
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Asti, Emanuele
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Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, ItalyUniv Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy