DO NUTRITIONAL AND IMMUNOLOGICAL INDICES PREDICT POST-OPERATIVE COMPLICATIONS AFTER RECTAL RESECTION? A THREE-YEAR RETROSPECTIVE ANALYSIS
Rajeevan Philip Sridhar*, Rohin Mittal, Rajat Raghunath, Mark Ranjan Jesudason
General and Colorectal Surgery, Christian Medical College Vellore, Vellore, Tamil Nadu, India
Aim: Nutritional and immunological indices such as prognostic nutritional index(PNI), neutrophil-to-lymphocyte ratio(NLR), and platelet-to-lymphocyte ratio(PLR) have been used as predictors of post-operative complications. Literature is unclear about their usefulness. Additionally, there is no clear consensus on the cut-off values and the timing of the tests for these indices. We aimed to determine the role of PNI, NLR, and PLR in predicting post-operative complications in patients undergoing rectal resection.
Method: This is a retrospective analysis from a colorectal unit of a tertiary care teaching hospital. All consecutive patients undergoing rectal resection for rectal cancer between April 2018 and March 2021 were included. Data was collected from a prospectively maintained database and electronic hospital records. PNI, NLR, and PLR were calculated from blood tests available within two weeks of the operation, and all morbidity and mortality within 30 days were considered.
Results: 202 patients were included. 3 patients who did not have the necessary pre-operative blood test reports were excluded. Of the remaining 199, 142(71.4 %) were male. The mean age was 47.3 years (SD 13.9, Range 19 to 82). 75(37.7%) patients underwent open resection, 113 (55.8%) underwent laparoscopic resection, and 13(6.5%) had a conversion to open.
13.6%(n=27) had major morbidity (Clavien Dindo Grade 3,4,5) including one mortality. The mean PNI, NLR, and PLR were 49.9(SD 5.4, Range 30.4 to 67.8), 4.3(SD 3.3, Range 0.9 to 29.7), and 230.5(SD 146.8, Range 11.8 to 1440.8) respectively. Various factors associated with post-operative complications assessed include age, sex, stage of disease, neoadjuvant chemotherapy and radiotherapy, type of operation, surgical approach, and comorbidities. The mean PNI between the groups (no complication vs complication) was (49.6 vs 50.1, p =0.46) and the mean NLR between the same groups was (4.7 vs 3.8, p=0.056) and both were not significant. The mean PLR between the groups (256.3 vs 203.4, p=0.011) was found to be significant but significance was not elicited, when only major complications were considered. Hence, none of the indices were found to be a good predictor of post-operative complications in our study.
Conclusions: The role of nutritional and immunological indices PNI, NLR, and PLR is limited in predicting post-operative morbidity in rectal resection operations.
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