C-reactive protein and drain amylase: their utility in ruling out anastomotic leakage after minimally invasive Ivor-Lewis esophagectomy

Abstract

Introduction

Anastomotic leakage (AL) is one of the most feared complications after esophagectomy for esophageal cancer. We investigated the role of serum C-reactive protein (CRP) and drain amylase levels in the early detection of AL.

Methods

This is a retrospective study of 193 patients who underwent a minimally invasive Ivor-Lewis procedure between January 2017 and October 2021. Mean CRP and median drain amylase levels between patients with and without AL were compared during the first five postoperative days (POD). ROC curves on POD 3, 4 and 5 were plotted to calculate cut-off values for CRP.

Results

In 30 of the 193 patients (16%), AL was diagnosed with a median time to diagnosis of 9 days. Mean CRP was significantly higher in patients with AL on POD 3, 4 and 5. Cut-off values of 59, 110 and 106 mg/L had a high sensitivity of 93%, 90% and 90% on POD 3, 4 and 5. No difference in median drain amylase levels was observed.

Conclusions

CRP levels with a cut-off point of 110 mg/L on POD 4 do not improve earlier detection of AL, but have a high sensitivity for excluding AL. The value of drain amylase in the first 5 days after surgery is limited.

Keywords:

• Amylase
• C-reactive protein
• anastomotic leak
• esophagectomy
• minimally invasive surgical procedures

Statement of ethics

This study protocol was approved by the Institutional Ethical Review Board (L1049.2020) and the requirement for informed consent was waived due to the retrospective and anonymized nature of the data.

Disclosure statement

The authors have no relevant financial or non-financial interests to disclose.

Author contributions

S.S., T.K. and R.M. contributed to the study design. T.K. coordinated the ethical approval. S.S. was responsible for data collection, analysis and wrote the manuscript under the supervision of R.M, I.M, J.H. All authors discussed the results and commented on the manuscript.

Data availability

Data supporting the findings of this study are available within the article and supplementary file. Further enquiries can be directed to the corresponding author.

Additional information

Funding

The authors did not receive any funding.