Use of C-reactive protein for the early prediction of anastomotic leak after esophagectomy: Systematic review and Bayesian meta-analysis

被引:53
作者
Aiolfi, Alberto [1 ]
Asti, Emanuele [1 ]
Rausa, Emanuele [1 ]
Bonavina, Giulia [1 ]
Bonitta, Gianluca [1 ]
Bonavina, Luigi [1 ]
机构
[1] Univ Milan, IRCCS Policlin San Donato, Dept Biomed Sci Hlth, Div Gen Surg, Milan, Italy
关键词
MINIMALLY-INVASIVE-ESOPHAGECTOMY; INFLAMMATORY RESPONSE SYNDROME; ENHANCED RECOVERY; INFECTIOUS COMPLICATIONS; LIKELIHOOD RATIOS; CLINICAL PATHWAY; REGRESSION; OUTCOMES; HYBRID;
D O I
10.1371/journal.pone.0209272
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
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.
引用
收藏
页数:13
相关论文
共 45 条
[1]   Meta-analysis of the predictive value of C-reactive protein for infectious complications in abdominal surgery [J].
Adamina, M. ;
Steffen, T. ;
Tarantino, I. ;
Beutner, U. ;
Schmied, B. M. ;
Warschkow, R. .
BRITISH JOURNAL OF SURGERY, 2015, 102 (06) :590-598
[2]   Understanding diagnostic tests 2: likelihood ratios, pre- and post-test probabilities and their use in clinical practice [J].
Akobeng, Anthony K. .
ACTA PAEDIATRICA, 2007, 96 (04) :487-491
[3]  
[Anonymous], R LANG ENV STAT COMP
[4]  
[Anonymous], ARXIV E PRINTS
[5]   Esophagectomy in patients with liver cirrhosis: a systematic review and Bayesian meta-analysis [J].
Asti, E. ;
Sozzi, M. ;
Bonitta, G. ;
Bernardi, D. ;
Bonavina, L. .
JOURNAL OF VISCERAL SURGERY, 2018, 155 (06) :453-464
[6]   Utility of C-reactive protein as predictive biomarker of anastomotic leak after minimally invasive esophagectomy [J].
Asti, Emanuele ;
Bonitta, Gianluca ;
Melloni, Matteo ;
Tornese, Stefania ;
Milito, Pamela ;
Sironi, Andrea ;
Costa, Elena ;
Bonavina, Luigi .
LANGENBECKS ARCHIVES OF SURGERY, 2018, 403 (02) :235-244
[7]   Predictive factors for post-operative respiratory infections after esophagectomy for esophageal cancer: outcome of randomized trial [J].
Biere, Surya Say ;
Henegouwen, Mark I. van Berge ;
Bonavina, Luigi ;
Rosman, Camiel ;
Roig Garcia, Josep ;
Gisbertz, Suzanne S. ;
van der Peet, Donald L. ;
Cuesta, Miguel A. .
JOURNAL OF THORACIC DISEASE, 2017, 9 :S861-S867
[8]   Hybrid and total minimally invasive esophagectomy: how I do it [J].
Bonavina, Luigi ;
Asti, Emanuele ;
Sironi, Andrea ;
Bernardi, Daniele ;
Aiolfi, Alberto .
JOURNAL OF THORACIC DISEASE, 2017, 9 :S761-S772
[9]   Early outcome of thoracoscopic and hybrid esophagectomy: Propensity-matched comparative analysis [J].
Bonavina, Luigi ;
Scolari, Federica ;
Aiolfi, Alberto ;
Bonitta, Gianluca ;
Sironi, Andrea ;
Saino, Greta ;
Asti, Emanuele .
SURGERY, 2016, 159 (04) :1073-1081
[10]   Fast-track rehabilitation program and conventional care after esophagectomy: a retrospective controlled cohort study [J].
Cao, Shouqiang ;
Zhao, Guibin ;
Cui, Jian ;
Dong, Qing ;
Qi, Sihua ;
Xin, Yanzhong ;
Shen, Baozhong ;
Guo, Qingfeng .
SUPPORTIVE CARE IN CANCER, 2013, 21 (03) :707-714