Journal Article

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

Aiolfi, Alberto, Asti, Emanuele, Bonavina, Giulia, Bonitta, Gianluca, Bonavina, Luigi, Rausa, Emanuele

2018

Overview

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. 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. 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). 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.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Analysis / Anastomotic Leak - diagnosis / Anastomotic Leak - etiology / Bayes Theorem / Bayesian analysis / Biomarkers / Biomarkers - blood / C-reactive protein / C-Reactive Protein - analysis / Diagnostic systems / Endoscopy / Esophageal cancer / Esophageal surgery / Esophagectomy / Esophagus / Gastrointestinal surgery / Health aspects / Humans / Identification methods / Leakage / Likelihood ratio / Medical prognosis / Medicine and Health Sciences / Meta-analysis / Minimally invasive surgery / Model accuracy / Mortality / Patients / Physical Sciences / Postoperative Complications - diagnosis / Predictions / Proteins / Ratios / Research and Analysis Methods / Sepsis / Software / Squamous cell carcinoma / Studies / Surgery / Systematic review / Taiwan