Are leukocytes and CRP early indicators for anastomotic leakage after esophageal resection?

• Published in: Zentralblatt für Chirurgie Vol. 134; no. 1; p. 83
• Main Authors: Deitmar, S, Anthoni, C, Palmes, D, Haier, J, Senninger, N, Brüwer, M
• Format: Journal Article
• Language: German
• Published: Germany 01.02.2009
• Subjects: Adenocarcinoma - surgery; Aged; Anastomosis, Surgical - adverse effects; C-Reactive Protein - analysis; Data Interpretation, Statistical; Esophageal Neoplasms - surgery; Esophagectomy - adverse effects; Female; Humans; Leukocyte Count; Male; Middle Aged; Postoperative Complications - diagnosis; Retrospective Studies; Time Factors
• ISSN: 0044-409X
• DOI: 10.1055/s-0028-1098768

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. 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. 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. 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.