The Value Of Monitoring PNI And SII In Predicting Anastomotic Leakage After Laparoscopic Rectal Cancer Surgery

Objective:To investigate the early diagnostic value of prognostic nutritional index（PNI）and systemic immune-inflammation index（SII）in predicting anastomotic leakage（AL）in patients undergoing laparoscopic rectal cancer surgery.Methods:A total of 228 patients who underwent laparoscopic rectal cancer surgery in Department of Colorectal Surgery,The Second Hospital of Jilin University from January 2021 to December 2022 were included in this retrospective study.We divided the patients into AL group（n=20）and non-AL group（n=208）according to whether AL occurred or not,and compared the differences in PNI and SII between the two groups preoperatively and on the 3^rd and 5^th day postoperatively.The prediction value of PNI,SII,and their combination for AL were evaluated by the receiver operating characteristic（ROC）curve.The independent risk factors of postoperative AL in patients with rectal cancer were analyzed by multivariate logistic regression analysis Result:PNI was significantly lower in the AL group than that in the non-AL group on preoperative,postoperative day（POD）3 and on POD5（P=0.007,P<0.001,P=0.003）,and SII was significantly higher than that in the non-AL group on POD3（P<0.001）.ROC curve analysis showed that the area under the curve（AUC）values of PNI predicting AL on preoperative,POD 3 and POD 5 were 0.683,0.767 and 0.698,respectively,while the AUC value of SII predicting AL on POD 3 was 0.775.Further analysis showed that the AUC value of combined PNI and SII predicting AL on POD3 was 0.795.Multivariate logistic regression analysis showed that the distance between tumor and anal verge≤5 cm,preoperative PNI value≤46.05,PNI value≤34.85 on POD 3 and SII value>1712.65 on POD 3 were significantly associated with the occurrence of AL（all P<0.05）.Conclusion:The distance between tumor and anal verge≤5 cm,preoperative PNI value≤46.05,PNI value≤34.85 on POD 3,and SII value>1712.65 on POD 3 were independent risk factors for the development of AL.Combined PNI and SII testing on POD 3 helps to predict postoperative AL after laparoscopic rectal cancer surgery at an early stage and the accuracy of the combined test is higher than that of the test alone.