Systemic inflammatory response syndrome as a predictor of anastomotic leakage after esophagectomy

Tsujimoto, Hironori; Ono, Satoshi; Takahata, Risa; Hiraki, Shuichi; Yaguchi, Yoshihisa; Kumano, Isao; Matsumoto, Yusuke; Yoshida, Kazumichi; Aiko, Satoshi; Ichikura, Takashi; Yamamoto, Junji; Hase, Kazuo

doi:10.1007/s00595-011-0049-9

Cited by 28 publications

(34 citation statements)

References 21 publications

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“…Other studies have confirmed this suggestion [1, 16, 23, 28, 53, 54]. The results of the present meta-analysis confirm these results demonstrating that average values of CRP differ between patients with and without infectious complications.…”

Section: Discussionsupporting

confidence: 89%

“…Nevertheless, this discrepancy between types of abdominal surgery can only exist in the first 2 days due to the short half-life of CRP (19 h). The trend where CRP values tend to normalize in patients without infectious complications around POD 3 has been demonstrated for various types of surgery [1, 16, 23, 28, 53, 54]. The major advantage of combining different types of abdominal surgery is that a much larger sample size was reached resulting in more precise estimates.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Diagnostic value of C-reactive protein to rule out infectious complications after major abdominal surgery: a systematic review and meta-analysis

Gans

Atema

Dieren

et al. 2015

Int J Colorectal Dis

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PurposeInfectious complications occur frequently after major abdominal surgery and have a major influence on patient outcome and hospital costs. A marker that can rule out postoperative infectious complications (PICs) could aid patient selection for safe and early hospital discharge. C-reactive protein (CRP) is a widely available, fast, and cheap marker that might be of value in detecting PIC. Present meta-analysis evaluates the diagnostic value of CRP to rule out PIC following major abdominal surgery, aiding patient selection for early discharge.MethodsA systematic literature search of Medline, PubMed, and Cochrane was performed identifying all prospective studies evaluating the diagnostic value of CRP after abdominal surgery. Meta-analysis was performed according to the PRISMA statement.ResultsTwenty-two studies were included for qualitative analysis of which 16 studies were eligible for meta-analysis, representing 2215 patients. Most studies analyzed the value of CRP in colorectal surgery (eight studies). The pooled negative predictive value (NPV) improved each day after surgery up to 90 % at postoperative day (POD) 3 for a pooled CRP cutoff of 159 mg/L (range 92–200). Maximum predictive values for PICs were reached on POD 5 for a pooled CRP cutoff of 114 mg/L (range 48–150): a pooled sensitivity of 86 % (95 % confidence interval (CI) 79–91 %), specificity of 86 % (95 % CI 75–92 %), and a positive predictive value of 64 % (95 % CI 49–77 %). The pooled sensitivity and specificity were significantly higher on POD 5 than on other PODs (p < 0.001).ConclusionInfectious complications after major abdominal surgery are very unlikely in patients with a CRP below 159 mg/L on POD 3. This can aid patient selection for safe and early hospital discharge and prevent overuse of imaging.Electronic supplementary materialThe online version of this article (doi:10.1007/s00384-015-2205-y) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Diagnostic value of C-reactive protein to rule out infectious complications after major abdominal surgery: a systematic review and meta-analysis

Gans

Atema

Dieren

et al. 2015

Int J Colorectal Dis

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“…Esophagectomy, in and of itself, appears to have a heighted influence on the postoperative inflammatory cascade compared to other cancer operations,(20–22) independent of infectious or inflammatory complications. (23) In addition, several studies have shown that baseline upregulation of tumor inflammation-associated genes, inflammatory markers, and inflammation-based preoperative prognostic scores are predictive of worse prognosis. (24–31) This increase in cytokines and inflammatory molecules is present as much as 2 years prior to diagnosis.…”

Section: Commentmentioning

confidence: 99%

Cancer Recurrence After Esophagectomy: Impact of Postoperative Infection in Propensity-Matched Cohorts

Tam

Luketich

Winger

et al. 2016

The Annals of Thoracic Surgery

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Background Postoperative infection increases cancer recurrence and worsens survival for colorectal cancer, but the relationship after esophagectomy for esophagogastric adenocarcinoma is not well-defined. We aimed to determine whether recurrence and survival after minimally invasive esophagectomy for esophagogastric adenocarcinoma were influenced by postoperative infection using propensity-matched analysis. Methods We abstracted data for 810 patients (1997–2010) and defined exposure as at least one in-hospital/30-day infectious complication (n=206; 25%). Using 29 pretreatment/intraoperative variables, patients were propensity score matched (caliper=0.05). Time-to-cancer recurrence and survival (Kaplan-Meier curves, Breslow test), and associated factors (Cox regression with shared frailty) were assessed. Results After propensity-matching (n=167 pairs), median bias across propensity score variables was reduced from 12.9% (p<0.001) to 4.4% (p=1.000). Postoperative infection was not associated with rate (n=60 versus 63; McNemar’s p=0.736) or time to recurrence in those who recurred (median 10.7 versus 11.1 months; Wilcoxon signed-rank p-value=0.455), but was associated with shorter overall survival (n=124 versus 102 deaths; median 26 versus 41 months, Breslow p=0.002). After adjusting for age, body mass index, neoadjuvant therapy, sex, comorbidity score, positive resection margins, pathologic stage, R0 resection and recurrence, postoperative infection was associated with a 44% greater hazard for death (HR 1.44; 95% CI 1.10–1.89). Conclusions In patients with esophagogastric adenocarcinoma, post-esophagectomy infections were not associated with increased rate or earlier time to recurrence when baseline characteristics associated with infection risk were balanced using propensity-matching. Despite this, overall survival was shorter in patients with infectious complications. After adjusting for other important survival predictors, post-esophagectomy continued to be independently associated with worse survival.

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“…All leaks with less than 20 mm were solved endoscopically. Technical and clinical success was higher when time between surgery and SEMS placement was lower, even though without statistical significance (respectively, 10 days [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] vs. 48 days , p = 0.228 and 12 days [8][9][10][11][12][13][14][15][16][17][18][19][20][21] vs. 20 days , p = 0.374) (Fig. 1).…”

Section: Sems Placement and Adverse Eventsmentioning

confidence: 99%

“…Clinical manifestations vary depending on the location of the leak and time elapsing from the perforation or rupture. Fever, systemic inflammatory response syndrome, and abnormal C-reactive protein, white blood cell count, and albumin are indicators of postoperative esophageal leak (8,9).…”

Section: Introductionmentioning

confidence: 99%

Self-expanding metal stents in postoperative esophageal leaks

Rodrigues‐Pinto¹,

Pereira²,

Ribeiro³

et al. 2016

Rev Esp Enferm Dig

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Background: Postoperative esophageal leaks have a high morbidity and mortality. Self-expanding metal stents (SEMS) have been used as an alternative to re-operation.Aim: Evaluating predictors of success of SEMS in postoperative esophageal leaks.Methods: Retrospective study of patients with postoperative esophageal leaks referred for SEMS placement in a reference center during a period of 3 years. Technical success was defined as closure of the leak in barium swallow at 15 days. Clinical success was considered as endoscopic and/or radiographic confirmation of closure after stent removal.Results: Thirteen patients placed SEMS. Median follow-up was 58 days. Leaks had a median size of 20 mm. Time between surgery and SEMS placement was 20 days. One patient died 2 days after SEMS placement and one had worsening of the fistula after SEMS expansion. Time till stent migration was 9 days. Technical success was achieved in 9 of 11 patients, with clinical success without recurrence in 5 patients. All leaks with less than 20 mm were solved endoscopically. Technical and clinical success was higher when time between surgery and SEMS placement was lower, even though without statistical significance (respectively, p = 0.228 and 0.374). In the 8 patients who died during follow-up, median survival was 59 days.Conclusions: Technical success of SEMS was higher than 80%; however, due to high morbidity and mortality, only 45% of patients had their stent removed. Lower time from diagnosis to SEMS placement and leak size less than 20 mm may be associated with better results.

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Systemic inflammatory response syndrome as a predictor of anastomotic leakage after esophagectomy

Abstract: The SIRS scoring system is valuable for evaluating the severity of systemic inflammatory response caused by anastomosis leakage, and may serve as an indicator for prompt management.

Cited by 28 publications

References 21 publications

Diagnostic value of C-reactive protein to rule out infectious complications after major abdominal surgery: a systematic review and meta-analysis

Diagnostic value of C-reactive protein to rule out infectious complications after major abdominal surgery: a systematic review and meta-analysis

Cancer Recurrence After Esophagectomy: Impact of Postoperative Infection in Propensity-Matched Cohorts

Self-expanding metal stents in postoperative esophageal leaks

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