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

Abstract

Background 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. Methods 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. Results 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. Conclusions 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.

Correlation of Presacral Tumour Recurrence with Tumour Metastasis and Long-Term Tumour Recurrence Risk in Patients with Rectal Cancer

“…However, extensive pelvic organ resection is usually needed to obtain a negative margin, which leads to a high incidence of postoperative complications, and serious complications will compromise the prognosis of patients. One study by Paku et al [27] has revealed that low preoperative nutritional prognosis index and excessive In our present study, after radical resection of RC, patients with presacral tumour recurrence showed a notably higher tumour metastasis rate and a notably higher longterm tumour recurrence rate than those without presacral tumour recurrence. According to the K-M curves, patients with presacral tumour recurrence had worse distant metastasis, total recurrence, and long-term recurrence than those without it.…”

“…However, extensive pelvic organ resection is usually needed to obtain a negative margin, which leads to a high incidence of postoperative complications, and serious complications will compromise the prognosis of patients. One study by Paku et al [ 27 ] has revealed that low preoperative nutritional prognosis index and excessive intraoperative blood loss are risk factors for severe postoperative complications of locally recurrent RC, which can improve the prevention of severe postoperative complications of locally recurrent RC to a certain extent.…”

Prognostic impact of prognostic nutritional index on renal cell carcinoma: A meta-analysis of 7,629 patients

“…Accumulating evidence has shown the association between prognostic nutritional index (PNI) and prognosis of various malignancies in recent years [ 8 – 12 ]. PNI is derived from the following formula: serum albumin (g/L) + 5 × peripheral lymphocyte count (10 9 /L), which both evaluates the nutrition and immunologic status of patients [ 9 ].…”

Prognostic nutrition index predicts short-term surgical complications in patients with rectal cancer after laparoscopic surgery

“…In a study on PNI in rectal cancer, Wang et al ( 14 ) found that preoperative PNI was an independent predictive factor in predicting permanent stoma in patients who underwent AR and defunctioning stoma. Paku et al ( 15 ) found that low preoperative PNI was a risk factor posing influence on postoperative major complications of locally recurrent rectal cancer. Xia et al ( 16 ) found that it is rewarding to use PNI to predict postoperative complications in patients with T1–2 rectal cancer.…”

“…However, current studies on PNI in rectal cancer are insufficient. PNI is associated with the permanent stoma rate after anterior resection and defunctioning stoma ( 14 ), postoperative complications of locally recurrent rectal cancer ( 15 ), and postoperative complications of early rectal cancer ( 16 ). However, regarding the connection between PNI and postoperative surgical complications after laparoscopic surgery for rectal cancer, seldom reports are published.…”