Department of Gastroenterological Surgery; Graduated School of Medicine, Osaka University, 2-2 E2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
BMC Cancer. 2021 Apr 20;21(1):435. 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.
直肠癌根治性切除术后常发生局部复发。手术干预是最佳治疗选择之一。然而，为了获得阴性切缘，往往需要广泛的盆腔器官切除，因此术后并发症发生率相当高。最近的研究报告称，炎症指标可以预测术后并发症。本研究旨在验证临床因素（包括炎症标志物）与局部复发性直肠癌手术后严重并发症的相关性。
本回顾性研究纳入 99 例接受局部复发性直肠癌根治性切除术的患者。根据 Clavien-Dindo 分级系统对术后并发症进行分级。分级≥3 定义为严重并发症。使用单因素和多因素逻辑回归模型识别严重并发症的危险因素，并使用受试者工作特征曲线进行评估。
38 例患者（38.4%）发生严重术后并发症。炎症标志物与严重术后并发症的相关性分析表明，预后营养指数与严重术后并发症的相关性最强。受试者工作特征分析显示，预后营养指数的最佳截断值为 42.2（灵敏度：0.790，特异性：0.508）。单因素和多因素分析显示，预后营养指数≤44.2（比值比：3.007，95%CI：1.171-8.255，p=0.02）和出血量≥2850mL（比值比：2.545，95%CI：1.044-6.367，p=0.04）与严重术后并发症的发生率显著相关。
我们发现术前低预后营养指数和术中大量失血是局部复发性直肠癌手术后严重并发症的危险因素。
