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. 2022 Dec;407(8):3377-3386.
doi: 10.1007/s00423-022-02703-5. Epub 2022 Oct 8.

C-reactive protein identifies patients at low risk of anastomotic leak after esophagectomy

Paul Rat  1 , Guillaume Piessen  2 , Marguerite Vanderbeken  2 , Alexandre Chebaro  2 , Olivier Facy  3   4   5 , Patrick Rat  3   4   5 , Cyril Boisson  6   7 , Pablo Ortega-Deballon  3   4   5
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C-reactive protein identifies patients at low risk of anastomotic leak after esophagectomy

Paul Rat et al. Langenbecks Arch Surg. 2022 Dec.

Abstract

Purpose: Fast-track protocols are increasingly used after digestive surgery. After esophagectomy, the gravity and the fear of anastomotic leak may be an obstacle to generalization of such protocols. C-reactive protein (CRP) might be a reliable tool to identify patients at low risk of anastomotic leak after esophagectomy, so that they can be safely included in a fast-track program. The aim of our retrospective bicentric study is to evaluate the interest of C-reactive protein measurement for the early diagnosis of anastomotic leak after esophagectomy.

Methods: Patients having undergone Ivor-Lewis procedure between January 2009 and September 2017 were included in this bicentric retrospective study. CRP values were recorded between postoperative day 3 (POD 3) and postoperative day 5 (POD 5). All postoperative complications were recorded, and the primary endpoint was anastomotic leak.

Results: We included 585 patients. Among them, 241 (41.2%) developed infectious complications and 69 patients (11.8%) developed anastomotic leak. CRP had the best predictive value on POD 5 (AUC = 0.74; 95% CI: 0.67-0.81). On POD 5, a cut-off value of 130 mg/L yielded a sensitivity of 87%, a specificity of 51%, and a negative predictive value of 96% for the detection of anastomotic leak.

Conclusions: CRP may help in identifying patients at very low risk of anastomotic leak after esophagectomy. Patients with CRP values < 130 mg/L on POD 5 can safely undertake an enhanced recovery protocol.

Keywords: Anastomotic leak; C-reactive protein; Esophageal cancer; Esophagectomy.

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