Pleural Monitoring for Anastomotic Leakage After Transthoracic Esophagectomy for Cancer With Lactate, Lactate Dehydrogenase, Amylase, and Glucose

Background Anastomotic leakage (AL) after esophagectomy is a dreaded complication with significant morbidity and mortality. Early detection of this complication reduces impact on the patient physiology and thereby limits its negative outcomes. Currently accepted biomarkers for this complication are mostly in the serum (CRP, white cell count, albumin), and though pleural monitoring is patient friendly and none-invasive, amylase is currently the only investigated pleural biomarker for AL. In the explorative PLAN-A study, we investigated the predictive potential for AL of pleural biomarkers that are used in the characterization of parapneumonic effusions such as lactate, lactate dehydrogenase (LDH), and glucose. Methods Pleural fluid was prospectively collected after transthoracic esophagectomy for cancer until pleural drain removal, and analyzed for amylase, lactate, LDH, and glucose in the setting of the PLAN-A study, of which this abstract presents preliminary analyses at 66.6% (n = 40/60). Descriptive analyses are presented with median values and interquartile ranges (IQR), and plotted for the first 7 days postoperatively. To compare discriminative potentials to amylase, area between curves (ABC) was calculated for the first 5 days (≤5 days = early diagnosis) and scaled by the standard deviation of the medians. Separate analyses were performed for sides, and intrathoracic (IT)(n = 25;62.5%), or cervical anastomosis (n = 15;37.5%). Results 24 (60%) patients were operated with left thoracoabdominal, 12 (30%) with completely-minimally-invasive, and 4 (10%) with hybrid approach. There were 5 accounts of AL (12.5%): 3 intrathoracic and 2 cervical AL. 11 patients (27.5%) experienced Clavien-Dindo grade ≥ IIIa complications, with 1 in-hospital death (2.5%). In the plots of the IT-group, all markers showed discriminative ability (ABC 3.317–6.799), with best discriminators being right-sided lactate (ABC 6.799), left-sided lactate (ABC 6.117) and left-sided amylase (4.397). In the cervical-group, the markers seemed less predictive (ABC 1.062–4.559), with right-sided lactate (ABC 4.559), left-sided amylase (ABC 4.484), and left-sided LDH (ABC 3.849) as best discriminators. Conclusion Pleural lactate, glucose, and LDH seem promising biomarkers for anastomotic leakage in the postoperative period after transthoracic esophagectomy for cancer, with predictive values comparative to amylase. In-depth analysis of influencing factors such as other postoperative complications (e.g. pneumonia, empyema, conduit ischemia) are necessary, and planned at inclusion of 60 patients.