[Are leukocytes and CRP early indicators for anastomotic leakage after esophageal resection?].
BACKGROUND
Anastomotic leaks represent the most common severe postoperative complications after esophagectomy. In this study standard inflammatory laboratory parameters [leukocytes, C-reactive protein (CRP)] were evaluated as indicators for anastomotic leakage after esophagectomy.


METHODS
Between 1 / 1997 and 12 / 2006 a total of 558 patients with esophageal cancer underwent an Ivor-Lewis esophagectomy. Among these patients, all those (n = 50, 8.9 %) suffering from an anastomotic leak were matched to 50 patients without anastomotic leakage. Leukocytes, CRP level and clinical parameters (body temperature, cardiac / respiratory problems, wound secretion) were retrospectively analysed at short-term intervals in both groups.


RESULTS
Patients with anastomotic leaks showed significant continuously increased CRP levels and leukocyte counts from the second or, respectively, 5 (th) postoperative day onwards compared to patients without anastomotic leaks. Using a stepwise regression, an 80 % sensitivity for leakage detection has been calculated by a cut-off value for CRP set at 13.5 mg / dL from day 2 onwards or, respectively, for leukocytes at 10.5 Gpt / L from day 8 onwards. Concomitantly, patients with anastomotic leaks suffered significantly more from respiratory problems and abdominal pain.


CONCLUSIONS
CRP appears to be a reliable and predictable indicator for anastomotic leakage after esophagectomy and should, therefore, be routinely used as a screening marker to provide a reason for extended diagnosis.
Deitmar
S
S
Klinik und Poliklinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Münster, Germany.
Anthoni
C
C
Palmes
D
D
Haier
J
J
Senninger
N
N
Brüwer
M
M
D000230:Adenocarcinoma / Q000601:surgery; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D002097:C-Reactive Protein / Q000032:analysis*; D003627:Data Interpretation, Statistical; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis*; D012189:Retrospective Studies; D013997:Time Factors
D002097:C-Reactive Protein