Evaluating the predictive values of inflammatory markers from blood test for anastomosis leak after gastroesophageal surgery

Abstract

Author(s): Seyyed Muhammad Mehdi Ghaffari Hamedani, Mina Alvandipour, Elmira Khodabakhsh, Kamyar Golriz, Reza Alizadeh Navaei

Background and Objective: Anastomotic leak is one of the most dangerous complications of gastrointestinal surgery, leading to significant morbidity and mortality. Early detection of leaks is crucial for reducing mortality, hospital stay duration, and postoperative complications. This study was designed to identify a suitable prognostic factor.

Materials and Methods: This cross-sectional study included fifteen patients selected for gastric and esophagogastric cancer surgery between April 2020 and April 2023. They underwent gastrectomy and primary anastomosis. Demographic information was collected. Complete Blood Count (CBC) and inflammatory markers were recorded preoperatively and on the third day postoperatively. Data analysis was divided into descriptive and inferential statistics. All data were analyzed using Statistical Package for Social Sciences (SPSS) version 24 statistical software, with a significance level of 0.05 for all tests considered.

Results: Three cases of anastomotic leakage post-surgery were reported. Significant statistical differences were observed between the two groups with and without anastomotic leakage in terms of Neutrophil to Lymphocyte Ratio (NLR) (2.67 ± 1.14 vs. 1.94 ± 1.06) and Systemic Inflammation Response Index (SIRI) (1.36 ± 1.02 vs. 0.87 ± 0.52) preoperatively (p<0.05). Additionally, on the third day post-surgery, significant statistical differences were found between the two groups in terms of leukocyte count (13.54 ± 2.89 vs. 9.47 ± 2.17), lymphocyte count (1.88 ± 1.10 vs. 2.95 ± 1.22), neutrophil count (9.14 ± 1.77 vs. 7.25 ± 1.08), CRP levels (54.12 ± 4.57 vs. 28.44 ± 2.13), NLR (4.86 ± 1.74 vs. 1.45 ± 0.94), and SIRI (3.88 ± 1.50 vs. 1.36 ± 0.78) (p<0.05). There were no significant differences in Platelet to Lymphocyte Ratio (PLR), Lymphocyte to Monocyte Ratio (LMR), and platelet count between the two groups preoperatively and on the third day postoperatively.

Conclusion: C-Reactive Protein (CRP) levels, leukocyte and neutrophil counts, as well as NLR and SIRI ratios on the third day post-surgery, have predictive value for anastomotic leakage.

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