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Clinical characteristics and predictors of permanent stoma in rectal cancer patients underwent anterior resections: the value of preoperative prognostic nutritional index

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Abstract

Objectives

This study was aimed to investigate the correlation between preoperative prognostic nutritional index (PNI) and permanent stoma (PS) in patients with defunctioning stoma (DS) after anterior resections and, based on it, to reveal the clinical value of PNI on clinical strategies about the selection of stoma location.

Methods

A total of 281 consecutive rectal cancer patients who accepted anterior resection and DS in the National Hepatobiliary and Enteric Surgery Research Center, Xiangya Hospital, Central South University from June 2008 to June 2018 were enrolled in this study. Receiver operating characteristic (ROC) curve for PNI was performed to discriminate PS. Univariate and multivariate analysis were conducted to identify the clinical characteristics and risk factors for PS. Specific reasons for patients with DS turned into PS were reviewed.

Results

ROC curve analysis defined PNI cutoff level of 45.85 corresponding to PS (area under the curve (AUC) = 0.71, 77% sensitivity, 56.9% specificity). Low PNI (OR = 3.23, P = 0.005), tumor crossing the peritoneal reflection (PR) (OR = 3.42, P = 0.003), postoperative distant metastasis (OR = 6.31, P < 0.001) were independently associated with PS. Besides, anastomotic complications (31.4%), poor oncological outcomes (35.3%), and personal preferences (33.3%) were the specific reasons for patients turning into PS.

Conclusions

Preoperative PNI is an independent prognostic factor to predict PS in patients who underwent anterior resection and DS. Therefore, combined with other clinical characteristics and predictors, preoperative measurements of PNI could provide a significant support for clinical decision on patients prepared to accept anterior resection and DS.

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Abbreviations

AUC:

Area under the curve

AV:

Distance from the anal verge to the tumor

CEA:

Carcinoembryonic antigen

DS:

Defunctioning stoma

Hb:

Hemoglobin

PNI:

Prognostic nutritional index

PR:

Peritoneal reflection

PS:

Permanent stoma

ROC:

Receiver operating characteristic

TS:

Temporary stoma

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Funding

This work was supported by Hunan Provincial key research and development foundation project (Grant no. 2015GK3002).

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Authors and Affiliations

  1. Department of Essential Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People’s Republic of China

    Xinyu Wang, Zhan Qu, Weisen Tang, Youming Deng & Weidong Liu

  2. Day Surgery Center, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People’s Republic of China

    Ran Tao

  3. Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, 410078, People’s Republic of China

    Gang Cheng

Authors
  1. Xinyu Wang
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  2. Gang Cheng
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  3. Ran Tao
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  4. Zhan Qu
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  5. Weisen Tang
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  6. Youming Deng
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  7. Weidong Liu
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Contributions

Conceptualization: DY, LW. Methodology: WX, CG, DY, LW. Data collection: WX, TR, QZ, TW. Data analysis and Illustration: WX, CG, TR, QZ, TW. Writing—original draft preparation: WX. Writing—review and editing: DY, LW. Funding acquisition: LW.

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Correspondence to Youming Deng or Weidong Liu.

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Wang, X., Cheng, G., Tao, R. et al. Clinical characteristics and predictors of permanent stoma in rectal cancer patients underwent anterior resections: the value of preoperative prognostic nutritional index. Int J Clin Oncol 25, 1960–1968 (2020). https://doi.org/10.1007/s10147-020-01743-5

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  • DOI: https://doi.org/10.1007/s10147-020-01743-5

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