Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Nov 17;8(11):2005.
doi: 10.3390/jcm8112005.

Systematic Review of the Role of Biomarkers in Predicting Anastomotic Leakage Following Gastroesophageal Cancer Surgery

Cornelius Maarten de Mooij  1 , Martijn Maassen van den Brink  1 , Audrey Merry  2 , Thais Tweed  1 , Jan Stoot  1
Affiliations
Review

Systematic Review of the Role of Biomarkers in Predicting Anastomotic Leakage Following Gastroesophageal Cancer Surgery

Cornelius Maarten de Mooij et al. J Clin Med. .

Abstract

Anastomotic leakage (AL) following gastroesophageal cancer surgery remains a serious postoperative complication. This systematic review aims to provide an overview of investigated biomarkers for the early detection of AL following esophagectomy, esophagogastrectomy and gastrectomy. All published studies evaluating the diagnostic accuracy of biomarkers predicting AL following gastroesophageal resection for cancer were included. The Embase, Medline, Cochrane Library, PubMed and Web of Science databases were searched. Risk of bias and applicability were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) 2 tool. Twenty-four studies evaluated biomarkers in the context of AL following gastroesophageal cancer surgery. Biomarkers were derived from the systemic circulation, mediastinal and peritoneal drains, urine and mediastinal microdialysis. The most commonly evaluated serum biomarkers were C-reactive protein and leucocytes. Both proved to be useful markers for excluding AL owing to its high specificity and negative predictive values. Amylase was the most commonly evaluated peritoneal drain biomarker and significantly elevated levels can predict AL in the early postoperative period. The associated area under the receiver operating characteristic (AUROC) curve values ranged from 0.482 to 0.994. Current biomarkers are poor predictors of AL after gastroesophageal cancer surgery owing to insufficient sensitivity and positive predictive value. Further research is needed to identify better diagnostic tools to predict AL.

Keywords: anastomotic leakage; biomarkers; upper gastrointestinal tract.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) flow diagram showing selection of articles for review. AL, anastomotic leakage.
Figure 2
Figure 2
Quality assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Proportion of studies with low, high, or unclear risk of bias.
See this image and copyright information in PMC

References

    1. Gupta B., Kumar N. Worldwide incidence, mortality and time trends for cancer of the oesophagus. Eur. J. Cancer. Prev. 2017;26:107–118. doi: 10.1097/CEJ.0000000000000249. - DOI - PubMed
    1. Yamamoto M., Rashid O.M., Wong J. Surgical management of gastric cancer: The East vs. West perspective. J. Gastrointest. Oncol. 2015;6:79–88. doi: 10.3978/j.issn.2078-6891.2014.097. - DOI - PMC - PubMed
    1. Carboni F., Valle M., Federici O., Levi Sandri G.B., Camperchioli I., Lapenta R., Assisi D., Garofalo A. Esophagojejunal anastomosis leakage after total gastrectomy for esophagogastric junction adenocarcinoma: Options of treatment. J. Gastrointest. Oncol. 2016;7:515–522. doi: 10.21037/jgo.2016.06.02. - DOI - PMC - PubMed
    1. Robb W.B., Messager M., Goere D., Pichot-Delahaye V., Lefevre J.H., Louis D., Guiramand J., Kraft K., Mariette C., FREGAT Working Group–FRENCH Predictive factors of postoperative mortality after junctional and gastric adenocarcinoma resection. JAMA Surg. 2013;148:624–631. doi: 10.1001/jamasurg.2013.63. - DOI - PubMed
    1. Turrentine F.E., Denlinger C.E., Simpson V.B., Garwood R.A., Guerlain S., Agrawal A., Friel C.M., LaPar D.J., Stukenborg G.J., Jones R.S. Morbidity, mortality, cost, and survival estimates of gastrointestinal anastomotic leaks. J. Am. Coll. Surg. 2015;220:195–206. doi: 10.1016/j.jamcollsurg.2014.11.002. - DOI - PubMed