Risk scores as useful predictors of perioperative complications in patients with rectal cancer who received radical surgery

Abstract

BackgroundRectal cancer is associated with a higher rate of surgical complications. The ability to predict the risk of complications before treatment would facilitate the design of personalized treatment strategies optimally suited for each patient.MethodsWe retrospectively studied 260 patients with rectal cancer who underwent radical surgery to examine the relations between complications and 5 types of risk scores.ResultsComplications developed in 56 patients (21.5%). Nineteen patients had infectious complications, 16 had intestinal obstruction, and 12 had other complications. Twelve patients out of 187 patients who received low anterior resection had anastomotic leakage. Estimation of Physiologic Ability and Surgical Stress Comprehensive Risk Score (E-PASS CRS) and Neutrophil-to-lymphocyte Ratio (NLR) were significantly related to all complications, infectious complications, and anastomotic leakage. Surgical Apgar Score was significantly related to infectious complications. Prognostic Nutritional Index was significantly related to all complications and intestinal obstruction. Colorectal Physiologic and Operative Severity Score for the Enumeration of Mortality and Morbidity was significantly related to all complications, and infectious complications. A multivariate analysis showed that body-mass index, E-PASS CRS, and NLR were independent risk factors for anastomotic leakage. In particular, NLR was the only score that could be evaluated before surgery.ConclusionsFive types of risk scores were useful methods for evaluating the risks of complications in patients with rectal cancer. NLR is a score that can be evaluated before surgery and predicted the risk of anastomotic leakage, suggesting that it is useful for assessing the need for a diverting colostomy.

Blood cell count indexes as predictors of anastomotic leakage in elective colorectal surgery: a multicenter study on 1432 patients

“…This was confirmed also in the present study considering the rate of postoperative concomitant complications, length of stay, and 30-day mortality, which were significantly higher in patients with AL than in those with an uncomplicated postoperative course. The rate of AL in our series (7.4%) was similar to that reported in other recent articles [10,15]. AL patients in our study had lower mean BMI values in comparison to those without AL, and BMI was found to be an independent factor influencing AL in multivariate analysis; this result is somewhat unexpected, considering that obesity is traditionally considered one of the main risk factors of AL [21].…”

“…To our knowledge, this is the first study to evaluate the role of the dNLR, LMR, and PLR in predicting AL. These simple blood count indexes, together with the NLR and RDW, have been demonstrated to have a prognostic potential in several chronic pathological conditions, including colorectal cancer and colorectal liver metastases [22][23][24][25][26], and a potential role in predicting outcomes in surgical procedures [15][16][17][18][19][27][28][29]. NLR is the most studied index to this purpose.…”

“…Miyakita et al published a study on 260 patients with rectal cancer who underwent radical surgery to examine the relations between complications and 5 types of risk scores, including the preoperative NLR [15]. Complications developed in 56 patients (21.5%), and 18 patients with AL were encountered.…”

“…The authors evidenced that the levels of NLR calculated in blood samples obtained at initial presentation and before chemo-radiotherapy were significantly associated with surgical complications in general, and especially to AL. In particular, they established that a preoperative NLR cutoff point at 2.21 was an independent predictor of AL (p = 0.0089, odds ratio = 8.24) and that the sensitivity and specificity of the test at this cutoff point was 83% and 47%, respectively [15]. This cutoff value seems very low to invest a clinical role in detecting AL, and was lower from the median values observed in both patients with and without AL in our cohort; in addition, we did not detect any statistically significant difference in the preoperative values of NLR between the two groups of patients.…”

“…The latter has been demonstrated to be a prognostic factor in numerous diseases, including primary and metastatic colorectal cancer [11][12][13][14]. Furthermore, it has been associated with the outcomes of several types of surgical procedures, and with the onset of postoperative complications [15][16][17][18][19]. However, poor data are currently available regarding its role in predicting AL in colorectal surgery.…”