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Preoperative Prognostic Nutritional Index was not predictive of short-term complications after laparoscopic resection for rectal cancer

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Abstract 

Background and aim

Prognostic Nutritional Index (PNI) is a useful tool to predict short-term results in patients undergoing surgery for gastrointestinal cancer. Few studies have addressed this issue in colorectal cancer or specifically in rectal cancer. We evaluated the prognostic relevance of preoperative PNI on morbidity of patients undergoing laparoscopic curative resection for rectal cancer (LCRRC).

Methods

PNI data and clinico-pathological characteristics of LCRRC patients (June 2005–December 2020) were evaluated. Patients with metastatic disease were excluded. Postoperative complications were evaluated using the Clavien–Dindo classification.

Results

A total of 182 patients were included in the analysis. Median preoperative PNI was 36.5 (IQR 32.8–41.2). Lower PNI was associated with females (p=0.02), older patients (p=0.0002), comorbidity status (p<0.0001), and those who did not receive neoadjuvant treatment (p=0.01). Post-operative complications occurred in 53 patients (29.1%), by the Clavien–Dindo classification: 40 grades I–II and 13 grades III–V. Median preoperative PNI was 35.0 (31.8–40.0) in complicated patients and 37.0 (33.0–41.5) in uncomplicated patients (p=0.09). PNI showed poor discriminative performance regarding postoperative morbidity (AUC 0.57) and was not associated with postoperative morbidity (OR 0.97) at multivariable analysis.

Conclusions

Preoperative PNI was not associated with postoperative morbidity after LCRRC. Further research should focus on different nutritional indicators or hematological/immunological biomarkers.

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Author information

Authors and Affiliations

  1. Department of General Surgery, Azienda ULSS 6 ‘Euganea’ Padova, Via Casa di Ricovero, 40, 35013, Cittadella, Padua, Italy

    Giuseppe Portale, Chiara Cipollari, Ylenia Spolverato, Diletta Di Miceli, Matteo Zuin, Antonio Mazzeo & Valentino Fiscon

  2. Independent Statistician, Solagna, Vicenza, Italy

    Francesco Cavallin

  3. Department of Oncology, Azienda ULSS 6 ‘Euganea’, Cittadella, Italy

    Alberto Morabito & Teodoro Sava

Authors
  1. Giuseppe Portale
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  2. Francesco Cavallin
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  3. Chiara Cipollari
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  4. Ylenia Spolverato
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  5. Diletta Di Miceli
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  6. Matteo Zuin
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  10. Valentino Fiscon
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Contributions

Giuseppe Portale, Matteo Zuin, and Diletta Di Miceli conceptualized the study and prepared the first draft of the manuscript. Ylenia Spolverato and Chiara Cipollari retrieved the data. Francesco Cavallin performed the data analysis. Alberto Morabito, Teodoro Sava, and Valentino Fiscon participated in the analysis and contributed to editing the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Giuseppe Portale.

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Portale, G., Cavallin, F., Cipollari, C. et al. Preoperative Prognostic Nutritional Index was not predictive of short-term complications after laparoscopic resection for rectal cancer. Langenbecks Arch Surg 408, 263 (2023). https://doi.org/10.1007/s00423-023-02962-w

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