Prospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2025; 17(4): 102934
Published online Apr 27, 2025. doi: 10.4240/wjgs.v17.i4.102934
Prediction of perioperative complications in colorectal cancer via artificial intelligence analysis of heart rate variability
Miao-Miao Ge, Li-Wen Wang, Jun Wang, Jiang Liu, Peng Chen, Xin-Xin Liu, Gang Wang, Guan-Wen Gong, Zhi-Wei Jiang
Miao-Miao Ge, Li-Wen Wang, Jiang Liu, Peng Chen, Xin-Xin Liu, Gang Wang, Guan-Wen Gong, Zhi-Wei Jiang, Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China
Li-Wen Wang, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong 000000, Hong Kong, China
Jun Wang, Department of General Surgery, Xuzhou Traditional Chinese Medicine Hospital, The Affiliated to Nanjing University of Chinese Medicine, Xuzhou 221000, Jiangsu Province, China
Co-first authors: Miao-Miao Ge and Li-Wen Wang.
Author contributions: Ge MM, Wang LW, Liu XX, Wang G, Gong GW and Jiang ZW designed the research; Ge MM, Wang LW, Wang J, Chen P, and Liu J performed the data analysis; Ge MM, Wang LW wrote the paper; Ge MM and Wang LW contributed equally to this work as co-first authors.
Supported by The Natural Science Foundation of Nanjing University of Chinese Medicine, No. XZR2021019; The Outstanding Young Doctor Program of Jiangsu Province of Chinese Medicine, No. 2023QB0140; Project of National Clinical Research Base of Traditional Chinese Medicine in Jiangsu Province, No. JD2022SZ18; and The Natural Science Foundation of Nanjing University of Chinese Medicine, No. KYCX21_1710.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine (Ethics Approval No. 2022NL-210-02).
Clinical trial registration statement: Registration number: ChiCTR2100054971 URL: https: //www.chictr.org.cn/showprojEN.html?proj = 134849.
Informed consent statement: All the individuals who participated in this study provided written informed consent prior to study enrollment.
Conflict-of-interest statement: The authors report no conflicts of interest in this work.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Data sharing statement: sharing statement: The data supporting the findings of this study are available from the corresponding author upon request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhi-Wei Jiang, MD, PhD, Chief Physician, Professor, Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China. surgery2024@126.com
Received: November 11, 2024
Revised: January 7, 2025
Accepted: February 8, 2025
Published online: April 27, 2025
Processing time: 138 Days and 16.7 Hours
Abstract
BACKGROUND

Heart rate variability (HRV) represents efferent vagus nerve activity, which is suggested to be related to fundamental mechanisms of tumorigenesis and to be a predictor of prognosis in various cancers. Therefore, this study hypothesized that HRV monitoring could predict perioperative complication (PC) in colorectal cancer (CRC) patients.

AIM

To investigate the prognostic value of HRV in hospitalized CRC patients.

METHODS

The observational studies included 87 patients who underwent CRC surgical procedures under enhanced recovery after surgery programs in a first-class hospital. The HRV parameters were compared between the PC group and the non PC (NPC) group from preoperative day 1 to postoperative day (Pod) 3. In addition, inflammatory biomarkers and nutritional indicators were also analyzed.

RESULTS

The complication rate was 14.9%. HRV was markedly abnormal after surgery, especially in the PC group. The frequency-domain parameters (including pNN50) and time-domain parameters [including high-frequency (HF)] of HRV were significantly different between the two groups postoperatively. The pNN50 was significantly greater at Pod1 in the PC group than that in the NPC group and returned to baseline at Pod2, suggesting that patients with complications exhibited autonomic nerve dysfunction in the early postoperative period. In the PC group, HFs were also enhanced from Pod1 and were significantly higher than in the NPC group; inflammatory biomarkers were significantly elevated at Pod2 and Pod3; the levels of nutritional indicators were significantly lower at Pod1 and Pod2; and the white blood cell count was slightly elevated at Pod3.

CONCLUSION

HRV is independently associated with postoperative complications in patients with CRC. Abnormal HRV could predicted an increased risk of postoperative complications in CRC patients. Continuous HRV could be used to monitor complications in patients with CRC during the perioperative period.

Keywords: Colorectal cancer; Heart rate variability; Complications; Perioperative period; Prediction

Core Tip: In this study, heart rate variability (HRV) was compared among 87 patients who underwent colorectal cancer (CRC) resection. Abnormal HRV predicted a greater risk of postoperative complications in CRC patients. Continuous HRV could be used to monitor complications in patients with CRC during the perioperative period.