Impact of the preoperative prognostic nutritional index as a predictor for postoperative complications after resection of locally recurrent rectal cancer

• Published in: BMC cancer Vol. 21; no. 1; p. 435
• Main Authors: Paku, Masakatsu, Uemura, Mamoru, Kitakaze, Masatoshi, Fujino, Shiki, Ogino, Takayuki, Miyoshi, Norikatsu, Takahashi, Hidekazu, Yamamoto, Hirofumi, Mizushima, Tsunekazu, Doki, Yuichiro, Eguchi, Hidetoshi
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 20.04.2021; BioMed Central; BMC
• Subjects: Aged; Biomarkers; Blood tests; Cancer; Cancer surgery; Cancer therapies; Care and treatment; Chemotherapy; Colorectal cancer; Combined Modality Therapy; Complications; Complications and side effects; Excision (Surgery); Female; Humans; Infections; Inflammation; Inflammation Mediators; Inflammatory index; Laboratories; Local recurrence; Lymphatic system; Lymphocytes; Male; Margins of Excision; Medical prognosis; Middle Aged; Neoplasm Recurrence, Local; Nutrition; Nutrition Assessment; Nutritional Status; Odds Ratio; Patients; Population; Postoperative complication; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Preoperative Period; Product/Service Evaluations; Prognosis; Rectal cancer; Rectal Neoplasms - complications; Rectal Neoplasms - diagnosis; Rectal Neoplasms - metabolism; Rectal Neoplasms - surgery; Rectum; Regression analysis; Relapse; Retrospective Studies; Risk Factors; ROC Curve; Sensitivity and Specificity; Severity of Illness Index; Statistics; Surgery; Tumors; Japan; Inflammatory index; Postoperative complication; Nutrition; Rectal cancer; Local recurrence
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-021-08160-5

Local recurrence is common after curative resections for rectal cancer. Surgical intervention is among the best treatment choices. However, achieving a negative resection margin often requires extensive pelvic organ resections; thus, the postoperative complication rate is quite high. Recent studies have reported that the inflammatory index could predict postoperative complications. This study aimed to validate the correlation between clinical factors, including inflammatory markers, and severe complications after surgery for local recurrent rectal cancer. This retrospective study included 99 patients that underwent radical resections for local recurrences of rectal cancer. Postoperative complications were graded according to the Clavien-Dindo classification. Grades ≥3 were defined as severe complications. Risk factors for severe complications were identified with univariate and multivariate logistic regression models and assessed with receiver-operating characteristic curves. Severe postoperative complications occurred in 38 patients (38.4%). Analyses of correlations between inflammatory markers and severe postoperative complications revealed that the strongest correlation was found between the prognostic nutrition index and severe postoperative complications. The receiver-operating characteristic analysis showed that the optimal prognostic nutrition index cut-off value was 42.2 (sensitivity: 0.790, specificity: 0.508). In univariate and multivariate analyses, a prognostic nutrition index ≤44.2 (Odds ratio: 3.007, 95%CI:1.171-8.255, p = 0.02) and a blood loss ≥2850 mL (Odds ratio: 2.545, 95%CI: 1.044-6.367, p = 0.04) were associated with a significantly higher incidence of severe postoperative complications. We found that a low preoperative prognostic nutrition index and excessive intraoperative blood loss were risk factors for severe complications after surgery for local recurrent rectal cancer.