Early postoperative decrease of albumin is an independent predictor of major complications after oncological esophagectomy: A multicenter study.
biomarker
cancer
esophagus
surgical oncology
Journal
Journal of surgical oncology
ISSN: 1096-9098
Titre abrégé: J Surg Oncol
Pays: United States
ID NLM: 0222643
Informations de publication
Date de publication:
Feb 2021
Feb 2021
Historique:
received:
05
10
2020
revised:
07
11
2020
accepted:
14
11
2020
pubmed:
9
12
2020
medline:
5
3
2021
entrez:
8
12
2020
Statut:
ppublish
Résumé
Serum albumin perioperative decrease (∆Alb) may reflect the magnitude of the physiological stress induced by surgery. Studies highlighted its value to predict adverse postoperative outcomes, but data in esophageal surgery are scant. This study aimed to investigate the role of ∆Alb to predict major complications after esophagectomy for cancer. Multicenter retrospective study conducted in five high-volume centers, including consecutive patients undergoing an esophagectomy for cancer between 2006 and 2017. Patients were randomly assigned to a training (n = 696) and a validation (n = 350) cohort. Albumin decrease was calculated on postoperative day 1 and defined as ΔAlb. The primary endpoint was major complications according to Clavien classification. In the training cohort, esophagectomy induced a rapid drop of albumin. Cut-off of ΔAlb was established at 11 g/L and allowed to distinguish patients with adverse outcomes. On multivariable analysis, ΔAlb was identified as an independent predictor of major complications (OR, 1.06; 95% CI, 1.01-1.11; p = .014). Higher BMI and laparoscopy were associated with lower ΔAlb. Analysis of the validation cohort provided consistent findings. ΔAlb appeared as a promising biomarker after oncological esophagectomy, allowing prediction of potential adverse outcomes.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
Serum albumin perioperative decrease (∆Alb) may reflect the magnitude of the physiological stress induced by surgery. Studies highlighted its value to predict adverse postoperative outcomes, but data in esophageal surgery are scant. This study aimed to investigate the role of ∆Alb to predict major complications after esophagectomy for cancer.
METHODS
METHODS
Multicenter retrospective study conducted in five high-volume centers, including consecutive patients undergoing an esophagectomy for cancer between 2006 and 2017. Patients were randomly assigned to a training (n = 696) and a validation (n = 350) cohort. Albumin decrease was calculated on postoperative day 1 and defined as ΔAlb. The primary endpoint was major complications according to Clavien classification.
RESULTS
RESULTS
In the training cohort, esophagectomy induced a rapid drop of albumin. Cut-off of ΔAlb was established at 11 g/L and allowed to distinguish patients with adverse outcomes. On multivariable analysis, ΔAlb was identified as an independent predictor of major complications (OR, 1.06; 95% CI, 1.01-1.11; p = .014). Higher BMI and laparoscopy were associated with lower ΔAlb. Analysis of the validation cohort provided consistent findings.
CONCLUSIONS
CONCLUSIONS
ΔAlb appeared as a promising biomarker after oncological esophagectomy, allowing prediction of potential adverse outcomes.
Substances chimiques
Biomarkers, Tumor
0
Serum Albumin
0
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
462-469Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Pennathur A, Gibson MK, Jobe BA, Luketich JD. Oesophageal carcinoma. Lancet. 2013;381(9864):400-412.
Fitzmaurice C, Dicker D, Pain A, et al. The global burden of cancer 2013. JAMA Oncol. 2015;1(4):505-527.
Lagergren J, Smyth E, Cunningham D, Lagergren P. Oesophageal cancer. Lancet. 2017;390(10110):2383-2396.
Lordick F, Mariette C, Haustermans K, et al. Oesophageal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27(suppl 5):v50-v57.
Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet. 2012;379(9829):1887-1892.
Mariette C, Markar SR, Dabakuyo-Yonli TS, et al. Hybrid minimally invasive esophagectomy for esophageal cancer. N Engl J Med. 2019;380(2):152-162.
Fransen LFC, Berkelmans GHK, Asti E, et al. The effect of postoperative complications after minimally invasive esophagectomy on long-term survival: an International Multicenter Cohort Study [published online ahead of print January 14, 2020]. Ann Surg.
Markar S, Gronnier C, Duhamel A, et al. The impact of severe anastomotic leak on long-term survival and cancer recurrence after surgical resection for esophageal malignancy. Ann Surg. 2015;262(6):972-980.
Liou DZ, Serna-Gallegos D, Mirocha J, Bairamian V, Alban RF, Soukiasian HJ. Predictors of failure to rescue after esophagectomy. Ann Thorac Surg. 2018;105(3):871-878.
Labgaa I, Demartines N, Hubner M. Biomarkers capable to early predict postoperative complications: the grail. Ann Surg. 2017;266(6):e91-e92.
Labgaa I, Demartines N, Hubner M. Serum albumin: a promising biomarker to anticipate postoperative complications. Dis Colon Rectum. 2017;60(9):e616.
Hübner M, Mantziari S, Demartines N, Pralong F, Coti-Bertrand P, Schäfer M. Postoperative albumin drop is a marker for surgical stress and a predictor for clinical outcome: a pilot study. Gastroenterol Res Pract. 2016;2016:8743187-8743188.
Labgaa I, Joliat GR, Demartines N, Hübner M. Serum albumin is an early predictor of complications after liver surgery. Dig Liver Dis. 2016;48(5):559-561.
Ryan AM, Hearty A, Prichard RS, Cunningham A, Rowley SP, Reynolds JV. Association of hypoalbuminemia on the first postoperative day and complications following esophagectomy. J Gastrointest Surg. 2007;11(10):1355-1360.
Labgaa I, Joliat GR, Kefleyesus A, et al. Is postoperative decrease of serum albumin an early predictor of complications after major abdominal surgery? A prospective cohort study in a European centre. BMJ Open. 2017;7(4):e013966.
Liu ZJ, Ge XL, Ai SC, et al. Postoperative decrease of serum albumin predicts short-term complications in patients undergoing gastric cancer resection. World J Gastroenterol. 2017;23(27):4978-4985.
Mantziari S, Hübner M, Coti-Bertrand P, Pralong F, Demartines N, Schäfer M. A novel approach to major surgery: tracking its pathophysiologic footprints. World J Surg. 2015;39(11):2641-2651.
Babic B, Tagkalos E, Gockel I, et al. C-reactive protein levels after esophagectomy are associated with increased surgical trauma and complications. Ann Thorac Surg. 2020;109:1574-1583.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-213.
Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA. The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg. 2013;258(1):1-7.
Hastie T, Tibshirani R, Friedman J. The Elements of Statistical Learning. Springer Series in Statistics. New York: Springer; 2001:222.
Scarpa M, Cavallin F, Saadeh LM, et al. Hybrid minimally invasive esophagectomy for cancer: impact on postoperative inflammatory and nutritional status. Dis Esophagus. 2016;29(8):1064-1070.
Gordon AC, Cross AJ, Foo EW, Roberts RH. C-reactive protein is a useful negative predictor of anastomotic leak in oesophago-gastric resection. ANZ J Surg. 2018;88(3):223-227.
Miki Y, Toyokawa T, Kubo N, et al. C-reactive protein indicates early stage of postoperative infectious complications in patients following minimally invasive esophagectomy. World J Surg. 2017;41(3):796-803.
Muneoka Y, Ichikawa H, Kosugi S, et al. Hyperbilirubinemia predicts the infectious complications after esophagectomy for esophageal cancer. Ann Med Surg. 2019;39:16-21.
Nomura S, Tsujimoto H, Aosasa S, et al. Impact of angiotensin-converting enzyme 2 levels on postoperative pneumonia after esophagectomy. J Surg Res. 2018;224:200-206.