Predictive Value Of The Glasgow Prognostic Score And Neutrophil-to-lymphocyte Ratio For Postoperative Complication After Pancreaticoduodenectomy

Background:To date,Pancreaticoduodenectomy(PD)is the only recognized potentially curative therapy of pancreatic head carcinoma,holangiocarcinoma,and malignant duodenalneoplasms,which remain highly invasive and complicated procedures,due to the large number of surgical procedures and the complicated surgical reconstruction of the digestive tract,The complication rate was still as high as57%.Therefore,how to predict the occurrence of severe complications after PD in advance,and then intervene early for high-risk groups,has become the focus of treatment during the perioperative period of pancreaticoduodenectomy.Objective:To investigate the predictive significance of preoperative The Glasgow Prognostic Score(GPS),Controlling Nutritional Status(CONUT),Prognostic Nutritional Index(PNI)and Neutrophil-to-lymphocyte ratio(NLR)for Severe complication in the patients who received Pancreatoduodenectomy.Methods:The clinical data of 84 cases of patients who received pancreatoduodenectomy in the Taihe Hospital of Hubei University of Medicine were retrospectively analyzed.Receiver operating characteristic curve(ROC),Univariate analysis and multivariate analysis were used to conduct the predictive significance of preoperative GPS,CONUT,PNI and NLR for Severe complication after pancreaticoduodenectomy.Results:The incidence of postoperative severe complication(Clavien-Dindo classification grade III or higher)was 23.8%(n=20)in this cohort.In the univariate analysis,CONUT score,GPS,NLR,PNIand the pancreatic texture were associated with postoperative severe complications(P<0.05).Those show the significant difference in single factor analysis was further analyzed with ROC curve analysis to determine the optimal cutoff point.The cutoff point of NLR was 3.0[[area under curve AUC was0.68,specificity and sensitivity were 0.67 and 0.7,respectively],NLR was 3.0[[area under curve AUC was 0.68,specificity and sensitivity were 0.8 and 0.55,respectively].In the multivariate analysis,GPS of 1/2(OR2.659,95%CI=1.154-6.128,p=0.022),NLR>3(OR4.153,95%CI=1.240-13.909,p=0.021),pancreatic texture was soft(OR5.620,95%CI= 1.441-21.921,p=0.013)were independent risk factors for postoperative severe complications.Conclusion:GPS and the NLR were significantly associated with post-operative complications.It would be beneficial to predict the occurrence of serious complications after pancreaticoduodenectomy...