Application Value Of NLR Combined With PNI In The Early Auxiliary Diagnosis Of Anastomotic Leakage After Rectal Cancer

Objective : To explore the value of neutrophil/lymphocyte ratio(Neutrophil/lymphocyte ratio,NLR)and prognostic nutritional index(Prognostic nutritional index,PNI)in the early auxiliary diagnosis of anastomotic leakage(Anastomotic leakage,AL)after laparoscopic radical resection of rectal cancer,and to provide clinical theoretical basis for its early diagnosis and treatment.Methods:To retrospectively collect the general clinical data of patients with rectal cancer who were diagnosed in the Gastrointestinal Surgery Department of the First Hospital of Jiaxing City from January 2020 to December 2021.According to the inclusion and exclusion criteria,89 patients were ultimately determined and divided into AL group and non-AL group based on whether postoperative AL occurred.The serum neutrophil count lymphocyte count and serum albumin were collected before operation and on the 1st,3rd,5th and 7th day after the operation,and NLR and PNI were calculated.The differences of NLR and PNI levels between the two groups at different time points were compared.The accuracy of PNI,NLR and their combination in the early auxiliary diagnosis of AL was evaluated and compared according to the receiver operating characteristic curve(Receiver operating characteristic curve,ROC),and the sensitivity,specificity and cut-off value were calculated.Results : A total of 89 patients underwent laparoscopic radical resection of rectal cancer,and 13(14.6%)patients developed AL after the operation,including 3 cases of grade A anastomotic leakage,and 8 cases of grade B anastomotic leakage,and 2 cases of grade C anastomotic leakage.The diagnosis time was 4-10 days after the operation.There were no significant differences in gender,age,body mass index,operative time,intraoperative blood loss,maximum tumor diameter,hypertension,diabetes,smoking and drinking history between the two groups(P ﹥ 0.05).however,postoperative hospital stay,tumor distance from anal margin and preoperative ALB level were different,and the difference was statistically significant(P﹤0.05).All postoperative serum NLR in the AL group were higher than that in the non-Al group,and the PNI level were lower than that in the non-Al group.The AUC values of AL predicted by PNI,NLR alone and their combination on the 3rd postoperative day were 0.818,0.835 and 0.867,respectively.The AUC values of AL predicted by PNI,NLR alone and their combination on the 5th postoperative day were 0.845,0.825 and 0.885,respectively.The AUC values of combined detection were all higher than those of single detection.The sensitivity of combined detection was significantly increased on the third day after the operation.Conclusion : The combination of NLR and PNI is a valuable indicator for early postoperative auxiliary diagnosis of AL in laparoscopic rectal cancer patients,especially when NLR is greater than 10.75 and PNI is less than 37.8 on the third day after surgery,it is helpful for early auxiliary diagnosis of AL.