Prognostic Value of Chest-Tube Amylase Versus C-Reactive Protein as Screening Tool for Detection of Early Anastomotic Leaks after Ivor Lewis Esophagectomy

Luca Giulini, Attila Dubecz, N. Solymosi, Julian Tank, Marcus Renz, Lucas Thumfart, Hubert J. Stein

Research output: Contribution to journalArticle

Abstract

Intrathoracic anastomotic leaks after esophagectomy are a significant cause of morbidity and death. Early detection and timely management are crucial. This study evaluates the effectiveness of daily drain amylase levels in detecting early leaks after esophagectomy compared with C-reactive protein (CRP). Materials and Methods: Between June 2015 and September 2017, 126 esophagectomies were performed in our department. Amylase levels were collected in 80 of these patients, as long right-sided chest tubes were in place. Mostly, chest tubes were removed before postoperative day (POD) 5. CRP levels were measured daily. Early leaks were defined as occurring with the chest tubes in place. According to the obtained receiver operating characteristics curves, amylase levels >335 U/L, and CRP >30 mg/dL were considered positive. Sensitivity and specificity for both drain amylase and CRP were calculated. Results: Overall anastomotic leak rate was 7.5% (6/80). An early disruption occurred in 4 of 80 patients (5%). Three patients had a positive amylase level and none a positive CRP on POD 1. These 3 patients had on POD 2 a positive CRP. The fourth patient presented at POD 2 bilious secretion in the chest tubes. He showed normal amylase and CRP levels on POD 1. Sensitivity and specificity for amylase level and CRP within the first 3 PODs were 0.75 and 0.98 versus 0.75 and 0.85, respectively. The patients with leak were reoperated at POD 2. They were all discharged between PODs 15 and 19. Conclusions: Amylase level after esophagectomy is a more accurate screening tool for detection of early leaks than CRP. It could facilitate their detection up to 24 hours earlier than CRP.

Original languageEnglish
Pages (from-to)192-197
Number of pages6
JournalJournal of Laparoendoscopic and Advanced Surgical Techniques
Volume29
Issue number2
DOIs
Publication statusPublished - Feb 1 2019

Fingerprint

Chest Tubes
Anastomotic Leak
Esophagectomy
Amylases
C-Reactive Protein
Sensitivity and Specificity
ROC Curve
Cause of Death
Morbidity

Keywords

  • anastomotic leakage
  • C-reactive protein
  • chest-tube amylase
  • esophageal cancer
  • esophagectomy

ASJC Scopus subject areas

  • Surgery

Cite this

Prognostic Value of Chest-Tube Amylase Versus C-Reactive Protein as Screening Tool for Detection of Early Anastomotic Leaks after Ivor Lewis Esophagectomy. / Giulini, Luca; Dubecz, Attila; Solymosi, N.; Tank, Julian; Renz, Marcus; Thumfart, Lucas; Stein, Hubert J.

In: Journal of Laparoendoscopic and Advanced Surgical Techniques, Vol. 29, No. 2, 01.02.2019, p. 192-197.

Research output: Contribution to journalArticle

@article{0665cedfe0ab457184d0f97ca54eb571,
title = "Prognostic Value of Chest-Tube Amylase Versus C-Reactive Protein as Screening Tool for Detection of Early Anastomotic Leaks after Ivor Lewis Esophagectomy",
abstract = "Intrathoracic anastomotic leaks after esophagectomy are a significant cause of morbidity and death. Early detection and timely management are crucial. This study evaluates the effectiveness of daily drain amylase levels in detecting early leaks after esophagectomy compared with C-reactive protein (CRP). Materials and Methods: Between June 2015 and September 2017, 126 esophagectomies were performed in our department. Amylase levels were collected in 80 of these patients, as long right-sided chest tubes were in place. Mostly, chest tubes were removed before postoperative day (POD) 5. CRP levels were measured daily. Early leaks were defined as occurring with the chest tubes in place. According to the obtained receiver operating characteristics curves, amylase levels >335 U/L, and CRP >30 mg/dL were considered positive. Sensitivity and specificity for both drain amylase and CRP were calculated. Results: Overall anastomotic leak rate was 7.5{\%} (6/80). An early disruption occurred in 4 of 80 patients (5{\%}). Three patients had a positive amylase level and none a positive CRP on POD 1. These 3 patients had on POD 2 a positive CRP. The fourth patient presented at POD 2 bilious secretion in the chest tubes. He showed normal amylase and CRP levels on POD 1. Sensitivity and specificity for amylase level and CRP within the first 3 PODs were 0.75 and 0.98 versus 0.75 and 0.85, respectively. The patients with leak were reoperated at POD 2. They were all discharged between PODs 15 and 19. Conclusions: Amylase level after esophagectomy is a more accurate screening tool for detection of early leaks than CRP. It could facilitate their detection up to 24 hours earlier than CRP.",
keywords = "anastomotic leakage, C-reactive protein, chest-tube amylase, esophageal cancer, esophagectomy",
author = "Luca Giulini and Attila Dubecz and N. Solymosi and Julian Tank and Marcus Renz and Lucas Thumfart and Stein, {Hubert J.}",
year = "2019",
month = "2",
day = "1",
doi = "10.1089/lap.2018.0656",
language = "English",
volume = "29",
pages = "192--197",
journal = "Journal of Laparoendoscopic and Advanced Surgical Techniques - Part A",
issn = "1092-6429",
publisher = "Mary Ann Liebert Inc.",
number = "2",

}

TY - JOUR

T1 - Prognostic Value of Chest-Tube Amylase Versus C-Reactive Protein as Screening Tool for Detection of Early Anastomotic Leaks after Ivor Lewis Esophagectomy

AU - Giulini, Luca

AU - Dubecz, Attila

AU - Solymosi, N.

AU - Tank, Julian

AU - Renz, Marcus

AU - Thumfart, Lucas

AU - Stein, Hubert J.

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Intrathoracic anastomotic leaks after esophagectomy are a significant cause of morbidity and death. Early detection and timely management are crucial. This study evaluates the effectiveness of daily drain amylase levels in detecting early leaks after esophagectomy compared with C-reactive protein (CRP). Materials and Methods: Between June 2015 and September 2017, 126 esophagectomies were performed in our department. Amylase levels were collected in 80 of these patients, as long right-sided chest tubes were in place. Mostly, chest tubes were removed before postoperative day (POD) 5. CRP levels were measured daily. Early leaks were defined as occurring with the chest tubes in place. According to the obtained receiver operating characteristics curves, amylase levels >335 U/L, and CRP >30 mg/dL were considered positive. Sensitivity and specificity for both drain amylase and CRP were calculated. Results: Overall anastomotic leak rate was 7.5% (6/80). An early disruption occurred in 4 of 80 patients (5%). Three patients had a positive amylase level and none a positive CRP on POD 1. These 3 patients had on POD 2 a positive CRP. The fourth patient presented at POD 2 bilious secretion in the chest tubes. He showed normal amylase and CRP levels on POD 1. Sensitivity and specificity for amylase level and CRP within the first 3 PODs were 0.75 and 0.98 versus 0.75 and 0.85, respectively. The patients with leak were reoperated at POD 2. They were all discharged between PODs 15 and 19. Conclusions: Amylase level after esophagectomy is a more accurate screening tool for detection of early leaks than CRP. It could facilitate their detection up to 24 hours earlier than CRP.

AB - Intrathoracic anastomotic leaks after esophagectomy are a significant cause of morbidity and death. Early detection and timely management are crucial. This study evaluates the effectiveness of daily drain amylase levels in detecting early leaks after esophagectomy compared with C-reactive protein (CRP). Materials and Methods: Between June 2015 and September 2017, 126 esophagectomies were performed in our department. Amylase levels were collected in 80 of these patients, as long right-sided chest tubes were in place. Mostly, chest tubes were removed before postoperative day (POD) 5. CRP levels were measured daily. Early leaks were defined as occurring with the chest tubes in place. According to the obtained receiver operating characteristics curves, amylase levels >335 U/L, and CRP >30 mg/dL were considered positive. Sensitivity and specificity for both drain amylase and CRP were calculated. Results: Overall anastomotic leak rate was 7.5% (6/80). An early disruption occurred in 4 of 80 patients (5%). Three patients had a positive amylase level and none a positive CRP on POD 1. These 3 patients had on POD 2 a positive CRP. The fourth patient presented at POD 2 bilious secretion in the chest tubes. He showed normal amylase and CRP levels on POD 1. Sensitivity and specificity for amylase level and CRP within the first 3 PODs were 0.75 and 0.98 versus 0.75 and 0.85, respectively. The patients with leak were reoperated at POD 2. They were all discharged between PODs 15 and 19. Conclusions: Amylase level after esophagectomy is a more accurate screening tool for detection of early leaks than CRP. It could facilitate their detection up to 24 hours earlier than CRP.

KW - anastomotic leakage

KW - C-reactive protein

KW - chest-tube amylase

KW - esophageal cancer

KW - esophagectomy

UR - http://www.scopus.com/inward/record.url?scp=85061351940&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85061351940&partnerID=8YFLogxK

U2 - 10.1089/lap.2018.0656

DO - 10.1089/lap.2018.0656

M3 - Article

VL - 29

SP - 192

EP - 197

JO - Journal of Laparoendoscopic and Advanced Surgical Techniques - Part A

JF - Journal of Laparoendoscopic and Advanced Surgical Techniques - Part A

SN - 1092-6429

IS - 2

ER -