Systemic inflammatory response syndrome as a predictor of anastomotic leakage after esophagectomy.
Summary of "Systemic inflammatory response syndrome as a predictor of anastomotic leakage after esophagectomy."
PURPOSE:
Esophageal anastomotic leakage is still a major cause of morbidity and mortality after esophagectomy. We conducted this study to elucidate how anastomotic leakage affects the systemic inflammatory response syndrome (SIRS) criteria.
METHODS:
The subjects of this retrospective study were 61 patients who underwent esophagectomy. We evaluated their preoperative status, the surgical procedures, and postoperative systemic response, including white blood cell count, heart rate, respiratory rate, body temperature, and laboratory data up to postoperative day (POD) 4.
RESULTS:
Anastomotic leakage developed in nine patients (14.8%) and was found on POD 7 on average. These patients had a significantly longer hospital stay than those without leakage. Although no difference was observed in postoperative changes of any of the SIRS criteria, the postoperative incidence of SIRS was significantly higher in the patients with anastomotic leakage on POD 4. The number of positive criteria for SIRS was also significantly higher in patients with anastomotic leakage than in those without leakage on PODs 3 and 4.
CONCLUSIONS:
The SIRS scoring system is valuable for evaluating the severity of systemic inflammatory response caused by anastomosis leakage, and may serve as an indicator for prompt management.
Affiliation
Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Japan, tsujihi@ndmc.ac.jp.
Journal Details
This article was published in the following journal.
Name: Surgery today
ISSN: 1436-2813
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22094435
- DOI: http://dx.doi.org/10.1007/s00595-011-0049-9
Medical and Biotech [MESH] Definitions
Systemic Inflammatory Response Syndrome
A systemic inflammatory response to a variety of clinical insults, characterized by two or more of the following conditions: (1) fever >38 degrees C or HYPOTHERMIA <36 degrees C; (2) TACHYCARDIA >90 beat/minute; (3) tachypnea >24 breaths/minute; (4) LEUKOCYTOSIS >12,000 cells/cubic mm or 10% immature forms. While usually related to infection, SIRS can also be associated with noninfectious insults such as TRAUMA; BURNS; or PANCREATITIS. If infection is involved, a patient with SIRS is said to have SEPSIS.
Sepsis
Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by HYPOTENSION despite adequate fluid infusion, it is called SEPTIC SHOCK.
Macrophage Activation Syndrome
A serious complication of childhood systemic inflammatory disorders that is thought to be caused by excessive activation and proliferation of T-LYMPHOCYTES and MACROPHAGES. It is seen predominantly in children with systemic onset JUVENILE IDIOPATHIC ARTHRITIS.
Immune Reconstitution Inflammatory Syndrome
Exuberant inflammatory response towards previously undiagnosed or incubating opportunistic pathogens. It is frequently seen in AIDS patients following HAART.
Anastomotic Leak
Breakdown of the connection and subsequent leakage of digestive system fluid from a SURGICAL ANASTOMOSIS of digestive system structures. Most common leakages are from breakdown of the sutured lines in gastrointestinal or bowel anastomosis.
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