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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Serum nutritional predictive biomarkers and risk assessment for anastomotic leakage after laparoscopic surgery in rectal cancer patients
Paerhati Shayimu, Maitisaidi Awula, Chang-Yong Wang, Rexida Jiapaer, Yi-Peng Pan, Zhi-Min Wu, Yi Chen, Ze-Liang Zhao
Paerhati Shayimu, Ze-Liang Zhao, Department of Gastrointestinal Surgery, The Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
Maitisaidi Awula, Chang-Yong Wang, Department of General Surgery, Yutian County People’s Hospital, Hotan 848499, Xinjiang Uygur Autonomous Region, China
Rexida Jiapaer, Department of Ultrasound, The Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
Yi-Peng Pan, Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310020, Zhejiang Province, China
Zhi-Min Wu, Department of Otorhinolaryngology Head and Neck Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang 550003, Guizhou Province, China
Yi Chen, Department of Breast and Thyroid Surgery, The Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
Author contributions: Shayimu P, Awula M, Pan YP, Chen Y, and Zhao ZL designed the research study; Shayimu P, Wang CY, Jiapaer R, and Wu ZM performed the research; Shayimu P, Awula M, and Wang CY analyzed the data and wrote the manuscript. All authors have read and approve the final manuscript.
Supported by Natural Science Foundation of Xinjiang Uygur Autonomous Region, No. 2019D01C261.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the Affiliated Cancer Hospital of Xinjiang Medical University (Approval No. G-2021005).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at
zlzhao71@163.com. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ze-Liang Zhao, MD, PhD, Director, Doctor, Professor, Research Scientist, Department of Gastrointestinal Surgery, The Affiliated Cancer Hospital of Xinjiang Medical University, No. 789 Suzhou East Street, Xinshi District, Urumqi 830011, Xinjiang Uygur Autonomous Region, China.
zlzhao71@163.com
Received: April 25, 2024
Revised: August 8, 2024
Accepted: August 28, 2024
Published online: October 27, 2024
Processing time: 154 Days and 21.3 Hours
BACKGROUND
Anastomotic leakage (AL) is one of the severest complications after laparoscopic surgery for middle/low rectal cancer, significantly impacting patient outcomes. Identifying reliable predictive factors for AL remains a clinical challenge. Serum nutritional biomarkers have been implicated in surgical outcomes but are underexplored as predictive tools for AL in this setting. Our study hypothesizes that preoperative serum levels of prealbumin (PA), albumin (ALB), and transferrin (TRF), along with surgical factors, can accurately predict AL risk.
AIM
To determine the predictive value of preoperative serum nutritional biomarkers for rectal cancer AL following laparoscopic surgery.
METHODS
In the retrospective cohort study carried out at a tertiary cancer center, we examined 560 individuals who underwent laparoscopic procedures for rectal cancer from 2018 to 2022. Preoperative serum levels of PA, ALB, and TRF were measured. We employed multivariate logistic regression to determine the independent risk factors for AL, and a predictive model was constructed and evaluated using receiver operating characteristic curve analysis.
RESULTS
AL occurred in 11.96% of cases, affecting 67 out of 560 patients. Multivariate analysis identified PA, ALB, and TRF as the independent risk factor, each with an odds ratio of 2.621 [95% confidence interval (CI): 1.582-3.812, P = 0.012], 3.982 (95%CI: 1.927-4.887, P = 0.024), and 2.109 (95%CI: 1.162-2.981, P = 0.031), respectively. Tumor location (< 7 cm from anal verge) and intraoperative bleeding ≥ 300 mL also increased AL risk. The predictive model demonstrated an excellent accuracy, achieving an area under the receiver operating characteristic curve of 0.942, a sensitivity of 0.844, and a specificity of 0.922, demonstrating an excellent ability to discriminate.
CONCLUSION
Preoperative serum nutritional biomarkers, combined with surgical factors, reliably predict anastomotic leakage risk after rectal cancer surgery, highlighting their importance in preoperative assessment.
Core Tip: This study establishes a robust predictive model for anastomotic leakage in middle/low rectal cancer patients undergoing laparoscopic surgery, leveraging preoperative serum levels of prealbumin, albumin, and transferrin. Demonstrating a high precision with an area under the receiver operating characteristic curve of 0.942, this model underscores the critical role of nutritional status in preoperative assessments. By integrating these serum nutritional biomarkers, our approach enhances the prediction of postoperative complications and aids in refining pre-surgical strategies to enhance patient results.
