High serum lactate as an adjunct in the early prediction of anastomotic leak following oesophagectomy

Ip, Brian; Ng, Ka Ting; Packer, Simon; Paterson-Brown, Simon; Couper, Graeme

doi:10.1016/j.ijsu.2017.08.027

Cited by 24 publications

(32 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The analysis of individual complication grades builds on the results of a recent systematic review, allowing a more in‐depth picture of how complications affect overall survival and disease recurrence. Similar rates of complications and anastomotic leak have been reported in other recent Western cohorts. It is worth noting that the present series included learning curves for minimally invasive oesophagectomy, and a possible increase in leak rate as a result of the vascular endothelial growth factor inhibitors used in patients who took part in the ST03 trial.…”

Section: Discussionsupporting

confidence: 74%

Impact of postoperative complications on survival after oesophagectomy for oesophageal cancer

et al. 2020

View full text Add to dashboard Cite

Background: Recent evidence suggests that complications after oesophagectomy may decrease shortand long-term survival of patients with oesophageal cancer. This study aimed to analyse the impact of complications on survival in a Western cohort. Methods: Complications after oesophagectomy were recorded for all patients operated on between January 2006 and February 2017, with severity defined using the Clavien-Dindo classification. Associations between complications and overall and recurrence-free survival were assessed using univariable and multivariable Cox regression models. Results: Of 430 patients, 292 (67⋅9 per cent) developed postoperative complications, with 128 (39⋅8 per cent) classified as Clavien-Dindo grade III or IV. No significant associations were detected between Clavien-Dindo grade and either tumour (T) (P = 0⋅071) or nodal (N) status (P = 0⋅882). There was a significant correlation between Clavien-Dindo grade and ASA fitness grade (P = 0⋅032). In multivariable analysis, overall survival in patients with Clavien-Dindo grade I complications was similar to that in patients with no complications (hazard ratio (HR) 0⋅97, P = 0⋅915). However, patients with grade II and IV complications had significantly shorter overall survival than those with no complications: HR 1⋅64 (P = 0⋅007) and 1⋅74 (P = 0⋅013) respectively. Conclusion: Increasing severity of complications after oesophagectomy was associated with decreased overall survival. Prevention of complications should improve survival.Funding information Queen Elizabeth Hospital Birmingham Charity (Upper Gastrointestinal Fund) Upper G.I. Blues of the consensus reporting guidelines on oesophageal complications 11 , a lack of standardization of complication reporting made understanding the relationship between complications and long-term survival difficult.

show abstract

Section: Discussionsupporting

confidence: 74%

Impact of postoperative complications on survival after oesophagectomy for oesophageal cancer

et al. 2020

View full text Add to dashboard Cite

show abstract

“…1,2) Esophagectomy is still considered as the primary curative treatment for esophageal cancer. [1][2][3][4] With the continuous development of minimally invasive technology, the approach of minimally invasive esophagectomy (MIE) has been widely used. 3) According to several previous studies, MIE is associated with lower in-hospital mortality, morbidity of postoperative complications, and postoperative hospital stays than open esophagectomy.…”

Section: Introductionmentioning

confidence: 99%

“…2,4,6,7) Among these, anastomotic tissue hypoperfusion is regarded as the major risk factor of anastomotic leakage. 2,4,8,9) Despite several advances in surgical treatment and perioperative care in recent years, the incidence of CAL after esophagectomy still remained high, ranging from 8 to 35%. 2,[10][11][12][13][14][15] CAL after esophagectomy is associated with high postoperative mortality.…”

Section: Introductionmentioning

confidence: 99%

“…2,[10][11][12][13][14][15] CAL after esophagectomy is associated with high postoperative mortality. 2,4) Previous studies have identified various risk factors for CAL, such as neoadjuvant chemotherapy, 4,15,16) chronic obstructive pulmonary disease (COPD), 2) smoker at diagnosis, 6) pneumonia, 17,18) calcification of arteries, 9,19) diabetes mellitus, 2,6,20) body mass index (BMI), 1) and arrhythmia. 2,6,19,21) Some risk factors still remained controversial and so accurate prediction of risk groups for CAL remained very difficult.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Risk Factors of Cervical Anastomotic Leakage after McKeown Minimally Invasive Esophagectomy: Focus on Preoperative and Intraoperative Lung Function

Gao

Wang

et al. 2021

ATCS

View full text Add to dashboard Cite

Background: Cervical anastomotic leakage (CAL) is one of the most common complications that occur minimally invasive esophagectomy (MIE). It is associated with high postoperative mortality. Some risk factors still remained controversial and so accurate prediction of risk groups for CAL remained very difficult. This study aimed to identify the risk factors of CAL after McKeown MIE to predict the accuracy of the technique as early as possible. Material and Methods: A total of 129 patients with esophageal cancer who underwent McKeown MIE at the Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University, between January 2018 and June 2019 were retrospectively reviewed. Multivariate logistic regression analysis was used to identify the risk factors for CAL and receiver operating characteristic (ROC) curve analysis was used to predict the accuracy for each quantitative data variable and determine the cutoff value. Results: There were statistically significant differences between Group CAL and Group NCAL in FEV 1 (p = 0.031), neoadjuvant chemotherapy (p = 0.001), intraoperative minimum PaCO 2 (p = 0.002), and hospital stays (p <0.001). In multivariate logistic regression, FEV 1 (OR = 0.440, p = 0.047), neoadjuvant chemotherapy (OR = 4.425, p = 0.003), and intraoperative minimum PaCO 2 (OR = 1.14, p <0.001) were identified to be three risk factors of CAL. The ROC curve analysis showed that FEV 1 <2.18L (p = 0.029) and intraoperative minimum PaCO 2 >45.5 mmHg (p = 0.002) demonstrated good accuracy. Conclusion: FEV 1 , neoadjuvant chemotherapy, and intraoperative minimum PaCO 2 in arterial blood gas (ABG) were considered as risk factors of CAL after McKeown MIE for esophageal cancer. Preoperative FEV 1 <2.18L and intraoperative minimum PaCO 2 >45.5 mmHg in ABG showed good accuracy in predicting risk factors for CAL.

show abstract

“…In this context, the route of reconstruction, the length of the gastric conduit, body mass index (BMI), comorbidities, active smoking history, surgical technique for the anastomosis and the time interval of resuming oral intake following esophagogastrostomy have been described [1,5,[8][9][10][11][12][13][14]. In addition, postoperative laboratory parameters were used to predict the risk of anastomotic dehiscence [15][16][17].…”

mentioning

confidence: 99%

A nomogram illustrating the probability of anastomotic leakage following cervical esophagogastrostomy

et al. 2020

View full text Add to dashboard Cite

Background Early diagnosis of anastomotic dehiscence following cervical esophagogastrostomy may become difficult. Estimation of an individual probability could help to establish preventive and diagnostic measures. The predictive impact of epidemiological, surgery-related data and laboratory parameters on the development of anastomotic dehiscence was investigated in the immediate perioperative period. Methods Retrospective study in 412 patients with cervical esophagogastrostomy following esophagectomy. Epidemiological data, risk factors, underlying disease, pre-treatment- and surgery-related data, C-reactive protein and albumin levels pre-and post-operatively were evaluated. We applied univariable and multivariable logistic regression analysis and developed a nomogram for individual risk assessment. Results There were 345 male, 67 female patients, mean aged 61.5 years; 284 had orthotopic, 128 retrosternal gastric pull-up; 331 patients had carcinoma, 81 non-malignant disease. Mean duration of operation was 184 min; 235 patients had manual, 113 mechanical and 64 semi-mechanical suturing; 76 patients (18.5%) developed anastomotic dehiscence clinically evident at mean 11.4 days after surgery. In univariable testing young age, retrosternal conduit transposition, manual suturing, high body mass index, high ASA and high postoperative levels of C-reactive protein were predictors for anastomotic leakage. These six parameters which had yielded a p < 0.1 in the univariable analysis, were entered into a multivariable analysis and a nomogram allowing the determination of the patient’s individual risk was created. Conclusion By using the nomogram as a supportive measure in the perioperative management, the patient’s individual probability of developing an anastomotic leak could be quantified which may help to take preventive measures improving the outcome.

show abstract

High serum lactate as an adjunct in the early prediction of anastomotic leak following oesophagectomy

Abstract: A serum lactate of >1.7 mmol/l on day 2 should raise the possibility of a potential AL. Such patients should be selected for more intensive monitoring, optimization and selective gastroscopy.

Cited by 24 publications

References 21 publications

Impact of postoperative complications on survival after oesophagectomy for oesophageal cancer

Impact of postoperative complications on survival after oesophagectomy for oesophageal cancer

Risk Factors of Cervical Anastomotic Leakage after McKeown Minimally Invasive Esophagectomy: Focus on Preoperative and Intraoperative Lung Function

A nomogram illustrating the probability of anastomotic leakage following cervical esophagogastrostomy

Contact Info

Product

Resources

About