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

Paliogiannis, Panagiotis; Deidda, Simona; Maslyankov, Svilen; Paycheva, Tsvetelina; Farag, Ahmed; Mashhour, Abdrabou N.; Misiakos, Evangelos P.; Papaconstantinou, Dimitrios; Mik, Michał; Losinska, Joanna; Scognamillo, Fabrizio; Sanna, Fabio; Feo, Claudio F.; Cherchi, Gian Mario; Xidas, Andreas; Zinellu, Angelo; Restivo, Angelo; Zorcolo, Luigi

doi:10.1186/s12957-020-01856-1

Cited by 31 publications

(27 citation statements)

References 27 publications

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“…Consequently, the early prediction of esophageal AL is critical. Most studies show that esophageal AL is related to the increase of NLR on the fourth day after operation (10,11). Our study further confirmed that serum inflammatory indicators, excluding postoperative NLR, are related to esophageal AL and demonstrated that preoperative neutrophil and POD1-3 PLR are associated with esophageal AL.…”

Section: Discussionsupporting

confidence: 86%

“…reported that NLR is a useful predictor of AL with an AUC of 0.78 on POD (27). Paliogiannis and colleagues examined 1432 consecutive patients who underwent colorectal surgery and identified that a NLR cutoff value of 7.1 on POD 4 showed the best AUC in predicting AL (0.744; 95% CI: 0.719-0.768) (10). In another study of esophageal AL, mean NLR values demonstrated an increasing trend and were relatively high in the early postoperative period; conversely, a low NLR was associated with a high negative predictive value for AL (11).…”

Section: Discussionmentioning

confidence: 99%

“…Studies have shown that the peripheral blood NLR before gastric cancer resection is predictive of AL (9). Furthermore, in patients undergoing elective colorectal surgery, the NLR on the fourth postoperative day has shown predictive value for AL (10). Other studies have indicated higher mean values and elevated NLR in the early postoperative period to be correlated with esophageal anastomosis in patients.…”

Section: Delayed Diagnosis Of Al Can Negatively Influence Prognosismentioning

confidence: 99%

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Peripheral blood inflammation indices are effective predictors of anastomotic leakage in elective esophageal surgery

Wu¹,

Rao²,

Sang³

et al. 2021

J Gastrointest Oncol

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Background: This study investigated the predictive value of peripheral inflammatory indices, including neutrophil count, lymphocyte count, platelet count, neutrophil-to-lymphocyte ratio (NLR), and platelet-tolymphocyte ratio (PLR), in anastomotic leakage during elective esophageal surgery.Methods: This retrospective study included all patients who underwent esophagectomy for esophageal squamous cell carcinoma from 2016 to 2020 in our institution. The peripheral blood inflammatory indices were obtained on preoperative days 1-7 (PRD 1-7), and postoperative days 1-3 (POD 1-3) and 4-7 (POD 4-7). Univariate, multivariate logistic, and receiver operating characteristic curve analyses were conducted to evaluate the diagnostic value of these peripheral blood inflammatory indices.Results: A total of 198 patients were included in the study, and 25 (13%) patients experienced anastomotic leakage. Multivariate analyses identified diet, neutrophil count, and PLR on POD 1-3, and NLR on POD 4-7 as independent factors associated with anastomotic leakage. Using the receiver operating characteristic curve, the variable with the best area under curve was a neutrophil cutoff count of 4.1 [0.737; 95% CI: 0.639-0.835],with a sensitivity and specificity of 60.0% and 66.5%, respectively. This was followed by an NLR cutoff value of 9.5 on POD 4-7 (0.628; 95% CI: 0.505-0.752) and a cutoff PLR value of 220.1 on POD 1-3 (0.643; 95% CI: 0.536-0.750). Diet showed a poor result on the receiver operating characteristic curve analysis.Conclusions: Neutrophil count and PLR on POD 1-3 and NLR on POD 4-7 were shown to have predictive value for anastomotic leakage in elective esophageal surgery.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Delayed Diagnosis Of Al Can Negatively Influence Prognosismentioning

confidence: 99%

See 1 more Smart Citation

Peripheral blood inflammation indices are effective predictors of anastomotic leakage in elective esophageal surgery

Wu¹,

Rao²,

Sang³

et al. 2021

J Gastrointest Oncol

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“…Previous studies demonstrated that cancerous tissue would be infiltrated by numerous neutrophils which significantly increased in peripheral blood of cancer patients [ 31 , 32 ]. In the cancer microenvironment, TGF-β signaling can classify neutrophils into N1 and N2 phenotypes [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

The decreased platelet-to-lymphocyte ratio could predict a good prognosis in patients with oligometastatic colorectal cancer: a single-center cohort retrospective study

Huang

Cui

et al. 2021

World J Surg Onc

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Background Inflammation markers have an important effect on tumor proliferation, invasion, and metastasis. Oligometastatic disease (OMD) is an intermediate state between widespread metastases and locally confined disease, where curative strategies may be effective for some patients. We aimed to explore the predictive value of inflammatory markers in patients with oligometastatic colorectal cancer (OMCC) and build a nomogram to predict the prognosis of these patients. Methods Two hundred nine patients with OMCC were retrospectively collected in this study. The Kaplan-Meier survival curves and Cox regression analysis were used to estimate overall survival (OS) and progression-free survival (PFS). A multivariate Cox analysis model was utilized to establish the nomogram. The concordance index (C-index), calibration curve, and receiver operating characteristics (ROC) were established to verify the validity and accuracy of the prediction model. Results According to the multivariate analysis, decreased platelet-to-lymphocyte ratio (PLR) might independently improve OS in patients with OMCC (HR = 2.396, 95% CI 1.391–4.126, P = 0.002). Metastases of extra-regional lymph nodes indicated poor OS (HR = 2.472, 95% CI 1.247–4.903, P = 0.010). While the patients with early N stage had better OS (HR = 4.602, 95% CI 2.055–10.305, P = 0.001) and PFS (HR = 2.100, 95% CI 1.364–3.231, P = 0.007). Primary tumor resection (HR = 0.367, 95% CI 0.148–0.908, P = 0.030) and lower fibrinogen (HR = 2.254, 95% CI 1.246–4.078, P = 0.007) could significantly prolong the OS in patients with OMCC. PLR, metastases of extra-regional lymph nodes, N stage, primary tumor resection, and fibrinogen were used to make up the nomogram. The C-index and area under the curve (AUC) of the ROC in nomogram were 0.721 and 0.772 respectively for OS, showed good consistency between predictive probability of OS and actual survival. Conclusions Decreased PLR could predict a good prognosis in patients with OMCC. The nomogram including inflammatory factors and clinicopathological markers was credible and accurate to predict survivals in patients with OMCC.

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“…In ammatory markers are routinely measured in patients following colorectal surgery to monitor progress alongside clinical parameters. 1,2 Postoperative C-reactive protein (CRP) levels is particularly useful for the detection of signi cant postoperative complications. [3][4][5] While some physiological derangement is expected following operative intervention, absolute levels of in ammatory markers above expected thresholds, prolonged elevations or a second rise after an initial decline all encourage further investigation or intervention.…”

Section: Introductionmentioning

confidence: 99%

Preoperative C-reactive protein and other inflammatory markers as predictors of postoperative complications in patients with colorectal neoplasia

Alsaif

Rogers

Pua

et al. 2021

Preprint

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Background: Inflammatory markers are measured following colorectal surgery to detect postoperative complications. However, the association of these markers preoperatively with subsequent postoperative course has not yet been usefully studied. Aim: The aim of this study is to assess the ability of preoperative C-reactive protein (CRP) and other inflammatory marker measurements in the prediction of postoperative morbidity after elective colorectal surgery. Methods: This retrospective study catalogues 218 patients undergoing elective, potentially-curative surgery for colorectal neoplasia. Preoperative laboratory results of the full blood count (FBC), C-reactive protein (CRP) and carcinoembryonic antigen (CEA) were recorded. Multivariable analysis was performed to examine preoperative variables against 30-day postoperative complications by type and grade (Clavien-Dindo (CD)), adjusting for age, sex, BMI, smoking status, medical history, open versus laparoscopic operation, and tumor characteristics. Results: Elevated preoperative CRP (≥ 5 mg/L) was significantly predictive of all-cause mortality, with an OR of 17.0 (p < 0.001) and was the strongest factor to predict a CD morbidity grade ≥ 3 (OR 41.9, p < 0.001). Other factors predictive of CD morbidity grade ≥ 3 included smoking, elevated preoperative platelet count and elevated preoperative neutrophil-lymphocyte ratio (OR 15.6, 8.6 and 6.3 respectively, all p < 0.05). CRP values above 5.5 mg/L were indicative of all-cause morbidity (AUC=0.871), and values above 17.5 mg/L predicted severe complications (AUC=0.934). Conclusions: Elevated preoperative CRP predicts increased postoperative morbidity in this patient cohort. The results herein aid risk and resource stratification and encourage preoperative assessment of inflammatory propensity besides simple sepsis exclusion.

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

Cited by 31 publications

References 27 publications

Peripheral blood inflammation indices are effective predictors of anastomotic leakage in elective esophageal surgery

Peripheral blood inflammation indices are effective predictors of anastomotic leakage in elective esophageal surgery

The decreased platelet-to-lymphocyte ratio could predict a good prognosis in patients with oligometastatic colorectal cancer: a single-center cohort retrospective study

Preoperative C-reactive protein and other inflammatory markers as predictors of postoperative complications in patients with colorectal neoplasia

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