Ofluoğlu Cem Batuhan, Mülküt Fırat, Aydın İsa Caner, Başdoğan Mustafa Kağan, Aydın İbrahim
Department of Gastrointestinal Surgery, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, University of Health Sciences, Istanbul 34785, Turkey.
Department of General Surgery, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, University of Health Sciences, Istanbul 34785, Turkey.
J Clin Med. 2025 Mar 13;14(6):1937. doi: 10.3390/jcm14061937.
The management of locally advanced rectal cancer (LARC) has seen the emergence of total neoadjuvant therapy (TNT) as a promising approach. TNT has shown potential in enhancing tumor regression, increasing pathological complete response (pCR) rates, and improving the control of systemic disease. However, the impact of TNT on complications during and after surgery remains uncertain. This research aimed to assess surgical complications linked to TNT in comparison with conventional neoadjuvant chemoradiotherapy (nCRT). Additionally, this study explored the potential of the Prognostic Nutritional Index (PNI) as a predictor of surgical outcomes. A retrospective cohort study was conducted at Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, including patients with LARC who underwent either TNT or nCRT followed by curative excision (TME). Demographic data, perioperative complications, and tumor-related variables were also analyzed. The prognostic value of the PNI in predicting surgical complications was assessed using multivariate logistic regression analysis. Statistical significance was set at < 0.05. A total of 103 patients with LARC were included, of whom 38 (36.9%) received TNT and 65 (63.1%) underwent nCRT. TNT was associated with significantly higher rates of anastomotic leakage (13.2% vs. 6.2%, = 0.04) and wound infections (23.7% vs. 9.2%, = 0.02). The mean tumor size was significantly smaller in the TNT group (3.22 ± 1.10 cm) than in the nCRT group (3.65 ± 1.26 cm, = 0.02). The PNI was significantly lower in the TNT group (38.96 ± 5.54) than in the nCRT group (41.31 ± 4.65, = 0.03). Multivariate logistic regression analysis demonstrated that a lower PNI was independently associated with increased surgical complications (β = -1.09, = 0.028, 95% CI: -2.06--0.12). Although TNT demonstrates clear oncological benefits in LARC, it is associated with increased perioperative morbidity. Our findings suggest that the PNI is a valuable predictive biomarker of surgical complications in patients treated with TNT. Preoperative nutritional assessment and optimization may improve perioperative outcomes and mitigate the risks associated with TNT. Future prospective studies should explore targeted interventions to enhance the safety profile of TNT while preserving its oncological advantages.
局部晚期直肠癌（LARC）的治疗中，全新辅助治疗（TNT）已成为一种有前景的方法。TNT在增强肿瘤退缩、提高病理完全缓解（pCR）率以及改善全身疾病控制方面显示出潜力。然而，TNT对手术期间及术后并发症的影响仍不确定。本研究旨在评估与传统新辅助放化疗（nCRT）相比，TNT相关的手术并发症。此外，本研究还探讨了预后营养指数（PNI）作为手术结果预测指标的潜力。在Sancaktepe Şehit Prof. Dr. İlhan Varank培训与研究医院进行了一项回顾性队列研究，纳入接受TNT或nCRT后行根治性切除（TME）的LARC患者。还分析了人口统计学数据、围手术期并发症和肿瘤相关变量。使用多因素逻辑回归分析评估PNI对预测手术并发症的预后价值。设定统计学显著性为<0.05。共纳入103例LARC患者；其中38例（36.9%）接受TNT，65例（63.1%）接受nCRT。TNT组吻合口漏发生率（13.2%对6.2%，P = 0.04）和伤口感染发生率（23.7%对9.2%，P = 0.02）显著更高。TNT组的平均肿瘤大小（3.22±1.10 cm）显著小于nCRT组（3.65±1.26 cm，P = 0.02）。TNT组的PNI（38.96±5.54）显著低于nCRT组（41.31±4.65，P = 0.03）。多因素逻辑回归分析表明，较低的PNI与手术并发症增加独立相关（β=-1.09，P = 0.028，95%CI：-2.06--0.12）。尽管TNT在LARC中显示出明显的肿瘤学益处，但它与围手术期发病率增加相关。我们的研究结果表明，PNI是接受TNT治疗患者手术并发症的有价值预测生物标志物。术前营养评估与优化可能改善围手术期结局并降低与TNT相关的风险。未来的前瞻性研究应探索有针对性的干预措施，以提高TNT的安全性，同时保留其肿瘤学优势。
