Risk scores as useful predictors of perioperative complications in patients with rectal cancer who received radical surgery

• Published in: International journal of clinical oncology Vol. 22; no. 2; pp. 324 - 331
• Main Authors: Miyakita, Hiroshi, Sadahiro, Sotaro, Saito, Gota, Okada, Kazutake, Tanaka, Akira, Suzuki, Toshiyuki
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01-04-2017; Springer Nature B.V
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - surgery; Adult; Aged; Aged, 80 and over; Anastomosis, Surgical; Anastomotic Leak; Cancer Research; Cancer surgery; Colorectal cancer; Digestive System Surgical Procedures - adverse effects; Female; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Neoplasm Staging; Oncology; Original; Original Article; Postoperative Complications; Prognosis; Rectal Neoplasms - surgery; Retrospective Studies; Risk Assessment - methods; Risk Factors; Surgical Oncology; Complication; Risk score; Anastomotic leakage; Rectal cancer
• ISSN: 1341-9625; 1437-7772
• DOI: 10.1007/s10147-016-1054-1

Background
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.
Methods
We retrospectively studied 260 patients with rectal cancer who underwent radical surgery to examine the relations between complications and 5 types of risk scores.
Results
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.
Conclusions
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.