Peripheral Blood Inflammation Indices Are Effective Predictors Of Anastomotic Leakage In Elective Esophageal Surgery

Objective:This study investigated the predictive value of peripheral inflammatory indices,including neutrophil count,lymphocyte count,platelet count,neutrophil-to-lymphocyte ratio(NLR),and platelet-to-lymphocyte ratio(PLR),in anastomotic leakage during elective esophageal surgery..Methods:This retrospective study included all patients who underwent esophagectomy for esophageal squamous cell carcinoma from 2016 to 2020 in our institution.The peripheral blood inflammatory indices were obtained on preoperative days 1-7(PRD 1-7),and postoperative days 1-3(POD 1-3)and 4-7(POD 4-7).Univariate,multivariate logistic,and receiver operating characteristic curve analyses were conducted to evaluate the diagnostic value of these peripheral blood inflammatory indices.Results:A total of 198 patients were included in the study,and 25(13%)patients experienced anastomotic leakage.Multivariate analyses identified diet,neutrophil count,and PLR on POD 1-3,and NLR on POD 4-7 as independent factors associated with anastomotic leakage.Using the receiver operating characteristic curve,the variable with the best area under curve was a neutrophil cutoff count of 4.1[0.737;95%CI 0.639-0.835],with a sensitivity and specificity of 60.0%and 66.5%,respectively.This was followed by an NLR cutoff value of 9.5 on POD 4-7(0.628;95%CI 0.505-0.752)and a cutoff PLR value of 220.1 on POD 1-3(0.643;95%Cl 0.536-0.750).Diet showed a poor result on the receiver operating characteristic curve analysis.Conclusion:Neutrophil count and PLR on POD 1-3 and NLR on POD 4-7 were shown to have predictive value for anastomotic leakage in elective esophageal surgery.