Sind Leukozyten und C-reaktives Protein geeignete Parameter als Frühindikatoren der Anastomoseninsuffizienz nach Ösophagusresektion?[1]

Zusammenfassung

Hintergrund: Anastomoseninsuffizienzen nach Ösophagusresektion stellen eine potenziell lebensbedrohliche Komplikation dar. Durch frühzeitige Diagnostik und Therapie kann die Letalität verringert werden. Ziel dieser Studie war es, die Bedeutung von Standardentzündungsparametern im Serum [Leukozytenzahl, C-reaktives Protein (CRP)] als Indikator für eine Anastomoseninsuffizienz zu untersuchen. Patienten und Methode: Zwischen 1 / 1997 und 12 / 2006 wurden 558 Patienten mit Ösophaguskarzinom mittels Zweihöhleneingriff und intrathorakaler Anastomose operiert. Aus diesem Kollektiv wurden alle Patienten (n = 50, 8.9 %) mit Anastomoseninsuffizienz und 50 Patienten ohne Anastomoseninsuffizienz verglichen. Im früh-postoperativen Verlauf wurden Entzündungsparameter (Leukozyten und CRP) sowie klinische Parameter (Körpertemperatur, kardiale und respiratorische Störungen, Wund- und Dränagesekretion) retrospektiv analysiert. Ergebnisse: Bei Patienten mit Anastomoseninsuffizienz nach Ösophagusresektion konnten signifikant erhöhte Leukozyten- und CRP-Werte im Vergleich zu Patienten ohne Anastomoseninsuffizienz ab dem fünften bzw. zweiten postoperativen Tag nachgewiesen werden. Die schrittweise Regressionsanalyse zeigte eine 80 %-Sensitivität für das Auftreten einer Anastomoseninsuffizienz bei einem Cut-off-Wert von 13,5 mg / dl für das CRP ab dem 2. bzw. 10,5 Gpt / l für Leukozyten ab dem 8. postoperativen Tag. Ferner wiesen Patienten mit Anastomoseninsuffizienz häufiger respiratorische Probleme oder Schmerzen im Abdomen auf. Schlussfolgerung: In der Frühdiagnostik der Anastomoseninsuffizienz nach Ösophagusresektion ist das CRP im Gegensatz zur Bestimmung der Leukozyten im Serum ein zuverlässiger und sensitiver Screening-Parameter, dessen Erhöhung Anlass zu weiterer Diagnostik geben sollte.

Abstract

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. Patients and 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. Conclusion: 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.

Ösophagusresektion - Anastomoseninsuffizienz - Entzündungsparameter

esophageal resection - anastomotic leakage - serum parameters

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1 Präsentation der Daten auf dem „123. Kongress der Deutschen Gesellschaft für Chirurgie“