The modified Glasgow Prognostic Score indicates an increased risk of anastomotic leakage after anterior resection for rectal cancer

• Published in: International journal of colorectal disease Vol. 38; no. 1; p. 200
• Main Authors: Golshani, Parisa, Park, Jennifer, Häggström, Jenny, Segelman, Josefin, Matthiessen, Peter, Lydrup, Marie-Louise, Rutegård, Martin
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 2023
• Subjects: Anastomotic leak; Anastomotic Leak - diagnosis; Anastomotic Leak - etiology; Cancer and Oncology; Cancer och onkologi; Clinical Medicine; Colorectal; colorectal-cancer; complications; curative resection; Gastroenterology; Gastroenterology & Hepatology; Hepatology; Humans; imputation; Inflammation; Inflammation - complications; Internal Medicine; Klinisk medicin; Medical and Health Sciences; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Proctology; Prognosis; r package; ratio; Rectal Neoplasms - complications; Rectal Neoplasms - surgery; Retrospective Studies; Surgery; Anastomotic leak; Inflammation; Colorectal
• ISSN: 1432-1262; 0179-1958; 1432-1262
• DOI: 10.1007/s00384-023-04496-5

Background Preoperative inflammation might cause and also be a marker for anastomotic leakage after anterior resection for rectal cancer. Available biomarker indices such as the modified Glasgow Prognostic Score (mGPS) or the C-reactive protein-to-albumin ratio (CAR) may be clinically useful for leakage assessment. Methods Patients who underwent anterior resection for rectal cancer during 2014–2018 from a multicentre retrospective cohort were included. Data from the Swedish Colorectal Cancer registry and chart review at each hospital were collected. In a subset of patients, preoperative laboratory assessments were available, constituting the exposures mGPS and CAR. Anastomotic leakage within 12 months was the outcome. Causally oriented analyses were conducted with adjustment for confounding, as well as predictive models. Results A total of 418 patients were eligible for analysis. Most patients had mGPS = 0 (84.7%), while mGPS = 1 (10.8%) and mGPS = 2 (4.5%) were less common. mGPS = 2 (OR: 4.11; 95% CI: 1.69–10.03) seemed to confer anastomotic leakage, while this was not seen for mGPS = 1 (OR 1.09; 95% CI: 0.53–2.25). A cut off point of CAR > 0.36 might be indicative of leakage (OR 2.25; 95% CI: 1.21–4.19). Predictive modelling using mGPS rendered an area-under-the-curve of 0.73 (95% CI: 0.67–0.79) at most. Discussion Preoperative inflammation seems to be involved in the development of anastomotic leakage after anterior resection for cancer. Inclusion into prediction models did not result in accurate leakage prediction, but high degrees of systemic inflammation might still be important in clinical decision-making.