Early prediction of anastomotic leakage after rectal cancer surgery: Onodera prognostic nutritional index combined with inflammation-related biomarkers

doi:10.4240/wjgs.v17.i4.102862

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Apr 27, 2025 (publication date) through Apr 6, 2025

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Gastrointest Surg. Apr 27, 2025; 17(4): 102862
Published online Apr 27, 2025. doi: 10.4240/wjgs.v17.i4.102862

Table 1 Comparison of clinical data, n (%)

Characteristic	Anastomotic leakage group (n = 49)	No anastomotic leakage group (n = 385)	Statistic	P value
Age			0.96	0.3282¹
< 60	173 (44.9)	18 (37.5)
≥ 60	212 (55.1)	30 (62.5)
Gender			3.66	0.0562¹
Male	220 (57.1)	35 (71.4)
Female	165 (42.9)	14 (28.6)
BMI				0.2623²
< 18.5	11 (2.9)	4 (8.2)
18.5-24	169 (43.9)	22 (44.9)
24-28	159 (41.3)	19 (38.8)
≥ 28	46 (11.9)	4 (8.2)
Smoking			0.87	0.3522¹
No	268 (69.8)	31 (63.3)
Yes	116 (30.2)	18 (36.7)
Drinking			1.61	0.2042¹
No	308 (80.2)	43 (87.8)
Yes	76 (19.8)	6 (12.2)
History of hypertension			2.03	0.1552¹
No	295 (76.6)	33 (67.3)
Yes	90 (23.4)	16 (32.7)
Cardiac insufficiency				0.1333²
No	371 (96.4)	45 (91.8)
Yes	14 (3.6)	4 (8.2)
History of diabetes			3.97	0.0462¹
No	330 (85.7)	47 (95.9)
Yes	55 (14.3)	2 (4.1)
History of abdominal surgery			0.48	0.4872¹
No	289 (75.1)	39 (79.6)
Yes	96 (24.9)	10 (20.4)
ASA				0.4623²
1-2	369 (95.8)	46 (93.9)
3-4	16 (4.2)	3 (6.1)
Bowel obstruction				0.3133²
No	366 (95.1)	45 (91.8)
Yes	19 (4.9)	4 (8.2)
Black stool			0.04	0.8392¹
No	163 (42.3)	20 (40.8)
Yes	222 (57.7)	29 (59.2)
Differentiated degree				> 0.9993²
Poorly	33 (8.6)	4 (8.2)
Moderately	317 (82.3)	41 (83.7)
Well	35 (9.1)	4 (8.2)
Nerve invasion			1.01	0.3142¹
Negative	320 (83.3)	38 (77.6)
Positive	64 (16.7)	11 (22.4)
Intravascular tumor emboli			0.00	0.9552¹
Negative	313 (81.3)	40 (81.6)
Positive	72 (18.7)	9 (18.4)
T stage				0.4643²
T1	20 (5.2)	2 (4.2)
T2	59 (15.3)	4 (8.3)
T3	281 (73.0)	37 (77.1)
T4	25 (6.5)	5 (10.4)
N stage				0.5853²
N0	224 (58.2)	31 (63.3)
N1	101 (26.2)	9 (18.4)
N2	56 (14.5)	9 (18.4)
N3	4 (1.0)	0 (0.0)
Tumor stage			0.19	0.6592¹
1-2	223 (57.9)	30 (61.2)
3-4	162 (42.1)	19 (38.8)

¹Pearson's χ² test.

²Fisher's exact test.

BMI: Body mass index; ASA: American Society of Anesthesiologists.

Table 2 Haematological and serological indicators, n (%)

Indicators	Anastomotic leakage group (n = 49)¹	No anastomotic leakage group (n = 385)¹	Statistic	P value
WBC	6.00 (5.18, 7.29)	6.39 (4.63, 7.87)	9333.00	0.905²
Hb	135 (120, 148)	120 (103, 138)	12738.00	< 0.001²
Plt	244 (199, 292)	225 (195, 302)	9945.00	0.536²
LYM	1.83 (1.49, 2.23)	1.34 (1.13, 1.64)	14667.50	< 0.001²
NE	3.59 (2.88, 4.35)	4.05 (2.84, 5.76)	7957.50	0.075²
MONO	0.44 (0.34, 0.55)	0.51 (0.39, 0.64)	7374.00	0.013²
OPNI	50.5 (47.4, 53.2)	42.5 (39.3, 45.6)	16750.50	< 0.001²
NLR	1.94 (1.46, 2.59)	3.20 (2.03, 4.22)	4799.00	< 0.001²
PLR	131 (101, 173)	179 (123, 251)	5934.50	< 0.001²
CEA (%)			2.123	0.145³
Normal	238 (61.8)	25 (51.0)
High	147 (38.2)	24 (49.0)
CA199 (%)			0.002	0.965³
Normal	284 (73.8)	36 (73.5)
High	101 (26.2)	13 (26.5)

¹Median (IQR).

²Wilcoxon rank sum test.

³Pearson's χ² test.

WBC: White blood cells; Hb: Hemoglobin; Plt: Platelets; LYM: Lymphocytes; NE: Neutrophils; MONO: Monocytes; OPNI: Onodera prognostic nutrition index; NLR: Neutrophil-to-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio; CEA: Carcinoembryonic antigen; CA199: Carbohydrate antigen 199.

Table 3 Analysis of risk factors for anastomotic leakage

Variables	Univariate					Multivariate
Variables	β	SE	Z	P value	OR (95%CI)	β	SE	Z	P value	OR (95%CI)
Hb	-0.021	0.006	-3.634	< 0.001	0.980 (0.969-0.991)	0.001	0.008	0.127	0.899	1.001 (0.986-1.016)
LYM	-2.251	0.400	-5.625	< 0.001	0.105 (0.048-0.231)	0.455	0.743	0.613	0.540	0.634 (0.148-2.719)
MONO	1.882	0.702	2.681	0.007	6.567 (1.659-25.995)	1.109	1.119	0.991	0.322	3.031 (0.338-27.160)
NE	0.271	0.076	3.556	< 0.001	1.312 (1.129-1.523)	0.150	0.212	0.710	0.478	0.860 (0.568-1.303)
OPNI	-0.354	0.045	-7.781	< 0.001	0.702 (0.642-0.768)	-0.350	0.048	-7.227	< 0.001	0.705 (0.641-0.775)
NLR	0.609	0.114	5.337	< 0.001	1.838 (1.470-2.298)	0.488	0.147	3.317	< 0.001	1.628 (1.221-2.172)
PLR	0.008	0.002	4.348	< 0.001	1.008 (1.004-1.012)	-0.006	0.003	-2.026	0.043	0.994 (0.989-0.999)

Hb: Hemoglobin; LYM: Lymphocytes; MONO: Monocytes; NE: Neutrophils; OPNI: Onodera prognostic nutrition index; NLR: Neutrophil-to-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio.

Citation: Zhang ZY, Li KJ, Zeng XY, Wang K, Sulayman S, Chen Y, Zhao ZL. Early prediction of anastomotic leakage after rectal cancer surgery: Onodera prognostic nutritional index combined with inflammation-related biomarkers. World J Gastrointest Surg 2025; 17(4): 102862
URL: https://www.wjgnet.com/1948-9366/full/v17/i4/102862.htm
DOI: https://dx.doi.org/10.4240/wjgs.v17.i4.102862