C-Reactive Protein Indicates Early Stage of Postoperative Infectious Complications in Patients Following Minimally Invasive Esophagectomy

Abstract Aim With the introduction of minimally invasive access in centers for esophageal surgery, complications as well as mortality rates decreased. Laboratory tests are used routinely to screen patients for postoperative complications as early as possible. Still, the course of several laboratory parameters after esophagectomy following different surgical approaches has not been described yet and thus, reference values do not exist. Nowadays, the interpretation of inflammatory markers depends on the expertise of the medical staff. The aim of this study is to evaluate the development of CRP and leukocytes after thoracoabdominal esophagectomy following four different surgical approaches. Background & Methods 217 consecutive patients receiving a thoracoabdominal esophagectomy with either open, hybrid, totally minimally invasive or robot-assisted minimally invasive technique between 2008 and 2018 have been evaluated. Daily blood tests regarding C-reactive protein (CRP) and leukocytes have been performed daily in all patients. Data was collected prospectively and analyzed depending on the postoperative course and the surgical approach. Results There is a natural increase of leukocytes and CRP with peak values on the 2nd postoperative day (POD) after thoracoabdominal esophagectomy following all surgical approaches. The increase of inflammatory parameters is significantly higher after open esophagectomy on the first three postoperative days compared to the three minimally invasive procedures. Furthermore, postoperative CRP values > 200 mg/l on the 2nd postoperative day as well as an open esohagectomy are independently associated with postoperative complications. Conclusion The development of postoperative inflammatory laboratory parameters after esophagectomy is significantly depending on the surgical approach. Open esophagectomy results in significantly higher CRP and leukocyte values compared to the hybrid esophagectomy, minimally invasive esophagectomy and robot assisted minimally invasive esophagectomy. Open esophagectomy and an increase of CRP on the 2nd postoperative day above 200 mg/l are an independent positive predictor for postoperative complications in multivariate analysis.

Download Full-text

Role of Interleukin 6 in Prediction of Early Complications After Minimally Invasive Esophagectomy – A Pilot Study

10.21203/rs.3.rs-698752/v1 ◽

2021 ◽

Author(s):

Sivaraman kumarasamy ◽

Hemanth Kumar ◽

Vishal Sharma ◽

Harshal Mandavdhare ◽

Sant Ram ◽

...

Keyword(s):

Minimally Invasive ◽

Anastomotic Leak ◽

Interleukin 6 ◽

Minimally Invasive Esophagectomy ◽

Characteristic Curve ◽

Infectious Complications ◽

Significant Morbidity ◽

Roc Curve Analysis ◽

Invasive Esophagectomy ◽

Major Complications

Abstract INTRODUCTION: Infectious complications following esophagectomy are associated with significant morbidity. Early prediction of these complications may mitigate significant morbidity and mortality METHODS: Patients undergoing minimally invasive esophagectomy for carcinoma esophagus between January 2019 to June 2020 were included in the study. All patients underwent standard preoperative investigations and preparation. Post-operative complications including infectious complications were recorded. Association of postoperative serum interleukin 6 (IL-6) levels with postoperative complications were analysed. RESULTS: A total of twenty-two participants were included in the study (median age; 51 years, 13(%) male). The tumor site was middle 1/3rd of esophagus in 13 (59.1 %), lower 1/3rd of esophagus in 9 (40.9 %). The tumor histology was squamous cell carcinoma in all patients. Eight (36.4 %) patients developed Major complications and five of them developed anastomotic leak. IL 6 levels was significantly higher on POD 3 in patients who developed major complications (p = 0.009) and anastomotic leak (p = 0.031). At receiver operating characteristic curve (ROC curve) analysis an IL 6 cut-off level of 36.4 pg/ml on POD 3 yielded a sensitivity of 87 % and a specificity of 79 % for the prediction of major complication and cut-off level of 44.3 pg/ml on POD 3 yielded a sensitivity of 80 % and a specificity of 82 % for the prediction of anastomotic leak. CONCLUSION: A high postoperative IL 6 level helps in the prediction of major complications and cervical esophagogastric anastomotic leak.

Download Full-text

Faculty Opinions recommendation of The impact of tidal volume on pulmonary complications following minimally invasive esophagectomy: a randomized and controlled study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718095813.793484608 ◽

2013 ◽

Author(s):

Andreas Hoeft

Keyword(s):

Minimally Invasive ◽

Tidal Volume ◽

Minimally Invasive Esophagectomy ◽

Pulmonary Complications ◽

Controlled Study ◽

Invasive Esophagectomy ◽

The Impact

Download Full-text

European consensus on essential steps of Minimally Invasive Ivor Lewis and McKeown Esophagectomy through Delphi methodology

Surgical Endoscopy ◽

10.1007/s00464-021-08304-5 ◽

2021 ◽

Author(s):

Yassin Eddahchouri ◽

◽

Frans van Workum ◽

Frits J. H. van den Wildenberg ◽

Mark I. van Berge Henegouwen ◽

...

Keyword(s):

Minimally Invasive ◽

Expert Panel ◽

Minimally Invasive Esophagectomy ◽

Round Table ◽

Round Table Discussion ◽

Ivor Lewis ◽

Delphi Methodology ◽

Invasive Esophagectomy ◽

European Consensus ◽

Mckeown Esophagectomy

Abstract Background Minimally invasive esophagectomy (MIE) is a complex and technically demanding procedure with a long learning curve, which is associated with increased morbidity and mortality. To master MIE, training in essential steps is crucial. Yet, no consensus on essential steps of MIE is available. The aim of this study was to achieve expert consensus on essential steps in Ivor Lewis and McKeown MIE through Delphi methodology. Methods Based on expert opinion and peer-reviewed literature, essential steps were defined for Ivor Lewis (IL) and McKeown (McK) MIE. In a round table discussion, experts finalized the lists of steps and an online Delphi questionnaire was sent to an international expert panel (7 European countries) of minimally invasive upper GI surgeons. Based on replies and comments, steps were adjusted and rephrased and sent in iterative fashion until consensus was achieved. Results Two Delphi rounds were conducted and response rates were 74% (23 out of 31 experts) for the first and 81% (27 out of 33 experts) for the second round. Consensus was achieved on 106 essential steps for both the IL and McK approach. Cronbach’s alpha in the first round was 0.78 (IL) and 0.78 (McK) and in the second round 0.92 (IL) and 0.88 (McK). Conclusions Consensus among European experts was achieved on essential surgical steps for both Ivor Lewis and McKeown minimally invasive esophagectomy.

Download Full-text