Abstract
BackgroundThe aim of this study was to evaluate a series of blood count inflammation indexes in predicting anastomotic leakage (AL) in elective colorectal surgery.MethodsDemographic, pathologic, and clinical data of 1432 consecutive patients submitted to colorectal surgery in eight surgical centers were retrospectively evaluated. The neutrophil to lymphocyte (NLR), derived neutrophil to lymphocyte (dNLR), lymphocyte to monocyte (LMR), and platelet to lymphocyte (PLR) ratios were calculated before surgery and on the 1st and 4th postoperative days, in patients with or without AL.ResultsThere were 106 patients with AL (65 males, mean age 67.4 years). The NLR, dNLR, and PLR were significantly higher in patients with AL in comparison to those without, on both the 1st and 4th postoperative days, but significance was greater on the 4th postoperative day. An NLR cutoff value of 7.1 on this day showed the best area under the curve (AUC 0.744; 95% CI 0.719–0.768) in predicting AL.ConclusionsAmong the blood cell indexes of inflammation evaluated, NLR on the 4th postoperative day showed the best ability to predict AL. NLR is a low cost, easy to perform, and widely available index, which might be potentially used in clinical practice as a predictor of AL in patients undergoing elective colorectal surgery.
Highlights
The aim of this study was to evaluate a series of blood count inflammation indexes in predicting anastomotic leakage (AL) in elective colorectal surgery
We investigated the role of NLR and derived neutrophil to lymphocyte ratio as predictive markers of AL, along with the role of the lymphocyte to monocyte (LMR) and the platelet to lymphocyte (PLR) ratios, in 1432 patients with colorectal cancer who underwent elective surgical resection in eight different centers
Demographic and clinical data, including sex, age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, Charlson comorbidity index, localization and histology of the disease, as well as the stage of the disease according to the American Joint Committee on Cancer (AJCC) staging system (7th edition), were registered
Summary
The aim of this study was to evaluate a series of blood count inflammation indexes in predicting anastomotic leakage (AL) in elective colorectal surgery. Anastomotic leakage (AL) is one of the most severe complications in modern colorectal surgery. Anastomotic leakage represents the most common cause of unplanned reoperation in large colorectal surgery cohorts [3]. Early AL is caused by technical errors or defects, has a major clinical impact, and reoperation is often needed to treat it. AL occurs between the 5th and 8th postoperative days, and has a variable clinical presentation; minor leaks can be treated conservatively using drains to evacuate possible infectious collections, while major defects require re-intervention to clean the abdomen and restore the intestinal integrity or exteriorize the bowel [7]. The discovery of biomarkers able to predict AL early after colorectal surgery would bring consistent advantages in the management and outcomes of this complication
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