CRP to albumin ratio may predict anastomotic leakage after esophagectomy in esophageal cancer: Study

Japan: A recent study by Dr. Atsushi Sugimoto and the team reported that preoperative CRP to albumin ratio in patients undergoing esophagectomy for thoracic esophageal squamous cell carcinoma may independently predict postoperative anastomotic leakage (AL). The study is published in the BMC Surgery journal.

Postoperative AL in esophageal cancer is associated not only with increased medical costs and prolonged hospital stay but also with poor prognosis. Previous studies have shown the use of various inflammation-based and/or nutritional markers for predicting postoperative complications. However, none of the studies have documented specific AL predictors for esophageal cancer. 

Against the above background Atsushi Sugimoto, Osaka City University Graduate School of Medicine, Osaka, Japan, and colleagues aimed to evaluate predictors of AL after esophagectomy for thoracic esophageal cancer, with a focus on preoperative inflammation-based and/or nutritional markers.

The study was designed as a retrospective study and analyzed 295 patients who underwent radical esophagectomy for thoracic esophageal squamous cell carcinoma between June 2007 and July 2020. As inflammation-based and/or nutritional markers, Onodera prognostic nutritional index, C-reactive protein (CRP)-to-albumin ratio (CAR), and modified Glasgow prognostic score were investigated. Optimal cut-off values of inflammation-based and/or nutritional markers for AL were determined by receiver operating characteristic curves. Predictors for AL were analyzed by logistic regression modeling.

The results of the study were found to be

• AL was observed in 34 patients (11.5%). In univariate analyses, preoperative body mass index (≥ 22.1 kg/m2).

• Serum albumin level (≤ 3.8 g/dL), serum CRP level (≥ 0.06 mg/dL), CAR (≥ 0.0139), operation time (> 565 min) and blood loss (≥ 480 mL) were identified as predictors of AL.

• Multivariate analyses revealed higher preoperative CAR (≥ 0.0139) as an independent predictor of AL.

Dr. Sugimoto and the team concluded that "Preoperative CAR may provide a useful predictor of AL after esophagectomy for thoracic esophageal squamous cell carcinoma."

For further information: Sugimoto, A., Toyokawa, T., Miki, Y. et al. Preoperative C-reactive protein to albumin ratio predicts anastomotic leakage after esophagectomy for thoracic esophageal cancer: a single-center retrospective cohort study. BMC Surg 21, 348 (2021). https://doi.org/10.1186/s12893-021-01344-7