Key result
Elevated C-reactive protein had a pooled prevalence of 13.9% for predicting anastomotic leakage, but all evaluated biomarkers were poor predictors with insufficient predictive value and sensitivity.
Why the study?
The study was designed to evaluate published literature from 2016 to 2019 investigating the role of biomarkers in predicting anastomotic leakage following gastroesophageal cancer surgery.
Do postoperative biomarkers predict anastomotic leakage in patients undergoing gastroesophageal cancer surgery?
Meta-Analysis (n=1,892)
Do postoperative biomarkers predict anastomotic leakage in patients undergoing gastroesophageal cancer surgery?
Postoperative biomarkers such as CRP and procalcitonin have limited individual diagnostic accuracy for predicting anastomotic leakage after gastroesophageal surgery, though composite scores may offer improvement.
Biomarkers remain unreliable for early AL detection post-gastroesophageal resection; leaves open need for prospective trials of improved predictors.
Our systematic review and meta-analysis were designed to evaluate the published literature from 2016 to 2019 on which the role of biomarkers in predicting the anastomotic leakage (AL) in gastroesophageal cancer surgery was investigated. This extensive literature search was conducted on the principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), and Excerpta Medica dataBASE (EMBASE) were used to gather the relevant information. No restrictions were made on the type of biomarkers. Wald or likelihood ratio (LRT) fixed effect tests were used to estimate the pooled prevalence to generate the proportions with 95% confidence intervals (CI) and model-fitted weights. For analyzing heterogeneity, the Cochran Q test and I square test were used. The Egger regression asymmetry test and funnel plot were used for publication. In this meta-analysis, a total of 15 studies were recruited with 1892 patients undergoing the resection. The pooled elevated C-reactive protein (CRP) was observed as 13.9% ranging from 11.6% to 16.1%. The pooled prevalence of other biomarkers with AL was observed as 4.4%. Significant heterogeneity was observed between studies that reported CRP and other biomarkers (92% each with chi-squared values of 78.80 and 122.78, respectively). However, no significant publication was observed between studies (p=0.61 and p=0.11, respectively). We concluded our study on this note that different biomarkers are involved in the diagnosis of AL. However, all these biomarkers are poor predictors with insufficient predictive value and sensitivity.
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Alanazi et al. (2023) conducted a meta-analysis in Anastomotic leakage after gastrointestinal resection (n=1,892). Biomarkers (including C-reactive protein) was evaluated on Pooled prevalence of elevated C-reactive protein (CRP) associated with anastomotic leakage (95% CI 11.6-16.1). Elevated C-reactive protein had a pooled prevalence of 13.9% for predicting anastomotic leakage, but all evaluated biomarkers were poor predictors with insufficient predictive value and sensitivity.
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