A Prospective Clinical Study Of CRP Combined With NLR In Early Prediction Of Anastomotic Leakage After Anterior Resection Of Rectal Cancer

Background and ObjectiveAnastomotic leakage is one of the most common serious complications after anterior resection of rectal cancer.However,there is still a lack of simple and specific indicators for early prediction of anastomotic leakage.As common inflammatory indicators,C-reactive protein(CRP)and Neutrophil-to-Lymphocyte ratio(NLR)can not only reflect the patient’s inflammatory status,but also be used to predict the occurrence of anastomotic leakage in the early stage.The purpose of this study was to improve the accuracy of early anastomotic leakage detection by detecting postoperative CRP and NLR.MethodsA total of 780 patients who underwent anterior resection of rectal cancer from January 2016 to December 2019 were included in our study.Blood routine and CRP were measured on the first,third and fifth days after surgery,and neutrophil counts were recorded and NLR values were calculated.The relationship between CRP,NLR and CRP combined with NLR and anastomotic leakage on the first,third and fifth days after surgery was analyzed,the receiver operating characteristic(ROC)curve was drawn,and the area under the curve(AUC)was calculated to evaluate the accuracy of predicting anastomotic leakage by CRP,NLR and CRP combined with NLR after surgery.Results1.A total of 780 patients were included in this study,65 patients had anastomotic leakage after surgery,and the incidence of anastomotic leakage was 8.3%.Anastomotic leakage occurred 4～14 days after operation,and the median time was 7 days.Among them,23 patients were cured by conservative treatment,38 underwent enterostomy,2 underwent Hartmann surgery,and 2 died of multiple organ failure.2.There was no statistically significant difference in NLR between patients with anastomotic leakage and patients with normal anastomotic healing on the 1st postoperative day,while CRP and NLR of patients with anastomotic leakage on the 1st postoperative day,the 3rd postoperative day,and the 5th postoperative day were all higher than those with normal anastomotic healing,and the difference was statistically significant.3.The ROC curve showed that when the cut-off point of CRP was 76.28 on the first day after surgery,the sensitivity,specificity and AUC of postoperative anastomotic leakage of rectal cancer were 84.37%,66.47%and 0.814,respectively.When the cut-off point of CRP was 122.24 on the 3rd day after surgery,the sensitivity to predict postoperative anastomotic leakage of rectal cancer was 84.62%,the specificity was 90.14%,and the AUC was 0.928.When the cut-off point of CRP was 87.2 on the 5th day after surgery,the sensitivity,specificity and AUC of postoperative anastomotic leakage were 100%,84.23%and 0.976.4.ROC curve showed that when the cut-off point of NLR was 10.7 on the 3rd day after surgery,the sensitivity,specificity and AUC of postoperative anastomotic leakage of rectal cancer were 78.46%,74.83%and 0.818,respectively,When the cut-off point of NLR was 8.2 on the 5th day after surgery,the sensitivity,specificity and AUC of postoperative anastomotic leakage were 67.69%,88.95%and 0.841 respectively.5.ROC curve showed that when CRP combined with NLR combined factor cut-off point was 0.08 on the first day after surgery,the sensitivity,specificity and AUC of predicting postoperative anastomotic leakage were 80%,75.38%and 0.808 respectively.When the combined factor cut-off point was 0.1 on the third day after surgery,the sensitivity,specificity and AUC of predicting postoperative anastomotic leakage were 84.62%,93.29%and 0.927,respectively.When the combined factor cut-off point was 0.12 on the 5th day after surgery,the sensitivity,specificity and AUC of predicting postoperative anastomotic leakage were 89.23%,94.97%and 0.977,respectively.Conclusions1.On the third day after surgery,CRP combined with NLR can accurately predict the occurrence of anastomotic leakage after rectal cancer surgery,increase the specificity of prediction,and improve the accuracy of early prediction of anastomotic leakage.2.On the fifth day after surgery,CRP combined with NLR can more accurately predict the occurrence of anastomotic leakage after surgery for rectal cancer.