Miyakita Hiroshi, Sadahiro Sotaro, Saito Gota, Okada Kazutake, Tanaka Akira, Suzuki Toshiyuki
Department of Surgery, School of Medicine, Tokai University, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
Int J Clin Oncol. 2017 Apr;22(2):324-331. doi: 10.1007/s10147-016-1054-1. Epub 2016 Oct 25.
Rectal 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.
We retrospectively studied 260 patients with rectal cancer who underwent radical surgery to examine the relations between complications and 5 types of risk scores.
Complications 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.
Five 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.
直肠癌与较高的手术并发症发生率相关。在治疗前预测并发症风险的能力将有助于设计最适合每位患者的个性化治疗策略。
我们回顾性研究了260例行根治性手术的直肠癌患者，以检查并发症与5种风险评分之间的关系。
56例患者（21.5%）发生了并发症。19例患者发生感染性并发症，16例发生肠梗阻，12例发生其他并发症。187例行低位前切除术的患者中有12例发生吻合口漏。生理能力和手术应激综合风险评分（E-PASS CRS）及中性粒细胞与淋巴细胞比值（NLR）与所有并发症、感染性并发症及吻合口漏均显著相关。手术阿普加评分与感染性并发症显著相关。预后营养指数与所有并发症及肠梗阻显著相关。结直肠生理和手术严重程度评分系统（用于计算死亡率和发病率）与所有并发症及感染性并发症显著相关。多因素分析显示，体重指数、E-PASS CRS及NLR是吻合口漏的独立危险因素。特别是，NLR是唯一可在术前评估的评分。
5种风险评分是评估直肠癌患者并发症风险的有用方法。NLR是一种可在术前评估并预测吻合口漏风险的评分，表明其对评估是否需要行转流性结肠造口术有用。
