Taşkin AK, Akar M, Turgut MS, Bilir B, Karademir E. Preoperative clinical and laboratory factors associated with early complications after low anterior resection: Exploratory analysis of the eosinophil/lymphocyte ratio. World J Gastrointest Surg 2026; 18(1): 114570 [DOI: 10.4240/wjgs.v18.i1.114570]
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Ali Kemal Taşkin, MD, Department of General Surgery, University of Health Science, Bursa Yuksek Ihtisas Training and Research Hospital, Ataevler mh. Yılmaz Akkılıç cd. No. 8, Mavi İnci Konakları, Bursa 16010, Türkiye. alik8161@hotmail.com
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Surgery
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Jan 27, 2026 (publication date) through Jan 29, 2026
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World Journal of Gastrointestinal Surgery
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Taşkin AK, Akar M, Turgut MS, Bilir B, Karademir E. Preoperative clinical and laboratory factors associated with early complications after low anterior resection: Exploratory analysis of the eosinophil/lymphocyte ratio. World J Gastrointest Surg 2026; 18(1): 114570 [DOI: 10.4240/wjgs.v18.i1.114570]
World J Gastrointest Surg. Jan 27, 2026; 18(1): 114570 Published online Jan 27, 2026. doi: 10.4240/wjgs.v18.i1.114570
Preoperative clinical and laboratory factors associated with early complications after low anterior resection: Exploratory analysis of the eosinophil/lymphocyte ratio
Ali Kemal Taşkin, Mustafa Suphi Turgut, Burak Bilir, Enes Karademir, Department of General Surgery, University of Health Science, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa 16010, Türkiye
Mustafa Akar, Department of Gastroenterology, University of Health Science, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa 16010, Türkiye
Author contributions: Taşkin AK wrote the original draft; Taşkin AK and Akar M designed the study and acquired funding; Taşkin AK, Akar M, and Turgut MS were responsible for developing the methodology; Akar M, Bilir B, and Karademir E participated in the formal analysis and investigation; Taşkin AK, Akar M, Turgut MS, Bilir B, and Karademir E participated in the review and editing.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Health Sciences University, Bursa Yuksek Ihtisas Training and Research Hospital (No. 2024-TBEK 2025/04-09).
Informed consent statement: The Ethics Committee of Health Sciences University, Bursa Yuksek Ihtisas Training and Research Hospital agreed to waive patient informed consent forms.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The data can be obtained from the corresponding author.
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: Ali Kemal Taşkin, MD, Department of General Surgery, University of Health Science, Bursa Yuksek Ihtisas Training and Research Hospital, Ataevler mh. Yılmaz Akkılıç cd. No. 8, Mavi İnci Konakları, Bursa 16010, Türkiye. alik8161@hotmail.com
Received: September 23, 2025 Revised: October 12, 2025 Accepted: November 17, 2025 Published online: January 27, 2026 Processing time: 120 Days and 17.9 Hours
Abstract
BACKGROUND
Rectal cancer is of particular importance among colorectal malignancies due to technical difficulties in surgical treatment and serious complications that can occur postoperatively.
AIM
To determine the probable factors affecting early postoperative complications in patients undergoing low anterior resection (LAR) for rectal cancer.
METHODS
This retrospective study included adult patients who underwent LAR for rectal cancer between January 1, 2018 and December 31, 2024. The patients were divided into two groups, those with and those without early postoperative complications. Complications developing within the first 30 days after LAR were considered early and complications developing after 30 days were considered late. The level of statistical significance in all statistical evaluations was set as P < 0.05.
RESULTS
A total of 105 patients underwent LAR for rectal cancer, comprising 66 (62.9%) males and 39 (37.1%) females with a mean age of 66 ± 12 years (28-85 years). Protective loop ileostomy was performed in 23 (21.9%) patients. The LAR was performed as open surgery in 63 (60%) patients and laparoscopically in 42 (40%) patients. The mean follow-up period was 46.44 ± 25 months (1-85 months) and the mean disease-free survival duration was 42.49 ± 24 months (1-85 months). Early postoperative complications were observed in 29 (27.6%) patients and late complications were observed in 14 (13.3%) patients. The most frequently seen early postoperative complication was anastomosis leakage in 10 (9.5%) patients. Advanced age, the presence of diabetes mellitus, advanced stage disease, increased preoperative eosinophil/lymphocyte ratio (ELR), and low preoperative albumin and hemoglobin levels were found to be significantly associated with early postoperative complications (P < 0.05). Patients who underwent open LAR surgery were observed to require longer hospitalization and developed more early complications than patients who underwent laparoscopic surgery.
CONCLUSION
Elevated preoperative ELR in patients undergoing LAR for rectal cancer may predict the development of early postoperative complications. Therefore, further studies are required to be able to establish the importance of the preoperative ELR.
Core Tip: This retrospective study, which included 105 patients with rectal cancer, evaluated the demographic, clinical, and preoperative laboratory data associated with early and late postoperative complications in patients who underwent low anterior resection (LAR) using two different surgical techniques (open and laparoscopic). For the first time, the significance of the preoperative eosinophil/lymphocyte ratio (ELR) on early postoperative complications was evaluated in this study; although this effect was found to be significant in univariate analysis, it was not found to be significant in logistic regression analysis. This result suggests that the relationship between the preoperative ELR and early postoperative complications in rectal cancer patients undergoing LAR should be investigated in prospective, well-designed studies.
Citation: Taşkin AK, Akar M, Turgut MS, Bilir B, Karademir E. Preoperative clinical and laboratory factors associated with early complications after low anterior resection: Exploratory analysis of the eosinophil/lymphocyte ratio. World J Gastrointest Surg 2026; 18(1): 114570
Rectal cancer constitutes approximately one-third of colorectal malignancies and continues to be an important health problem worldwide[1]. Rectal cancer is of particular importance among colorectal malignancies due to technical difficulties in surgical treatment and the effects on the quality of life of the patient[2,3]. In recent years, although local resection or low anterior resection (LAR) surgery alone may be sufficient in localized rectal cancers, LAR has been performed after neoadjuvant chemoradiotherapy (CRT) in advanced stage rectal cancers[4,5].
Despite the significant advances recorded in surgical techniques and perioperative management, serious complications can occur after LAR. These complications have a great impact on the length of hospital stay, costs, surgical efficacy, and patient prognosis. Both early (anastomosis leakage, subileus, bleeding, surgical site infection, ureter damage) and late (anastomosis narrowing) complications can occur following LAR. In severe cases, these complications can even result in death. Therefore, it is very important to determine the risk factors for complications in rectal cancer patients undergoing LAR and understand the effects of these on overall survival (OS)[6-8].
Postoperative complications develop due to many factors. Additional diseases, nutritional disorders, impaired wound healing, immune system dysfunction, demographic data, neoadjuvant CRT, histopathology, vascularization and stage of the tumor, the surgeon’s experience, the surgical technique applied, intraoperative or postoperative bleeding, and blood transfusions are important risk factors. In addition, proximity of the anastomosis to the anal verge, prolonged operating time, type of anastomosis, perfusion evaluations made with indocyanine green, and varying biochemical parameters are risk factors for anastomosis leakage[9-12].
Laparoscopic rectal cancer surgery was first performed by Jacobs in 1991, and this technique has increasingly spread throughout the world in recent years[13]. Advances in CRT used in the last 20 years, advances in surgical techniques, and improved quality of the materials used have significantly affected the survival rates of patients with rectal cancer[14]. However, long-term disease progression (local recurrence/metastasis) is still seen at a high rate[15].
In the literature, various factors have been determined to predict early and late complications, disease-free survival (DFS), and OS in rectal cancer patients undergoing LAR. These have been determined to be primarily neoadjuvant chemotherapy, age, preoperative carcinoembryonic antigen value, preoperative lymphocyte and albumin levels, the neutrophil/Lymphocyte ratio (NLR), prognostic nutritional index (PNI), distance of the tumor from the anal verge, tumor invasion to the intestinal wall, and tumor stage[16].
The aim of this study was to determine the probable factors affecting early postoperative complications in patients undergoing LAR for rectal cancer.
MATERIALS AND METHODS
This retrospective study included a total of 105 patients, aged 18-85 years, who underwent LAR for rectal cancer between January 1, 2018 and December 31, 2024 in the General Surgery Clinic of Bursa Yuksek Ihtisas Training and Research Hospital. All the patients attended regular follow-up examinations and all clinical follow-up data were available.
Patients were excluded from the study if they had undergone abdominoperineal resection for rectal cancer, if they had inflammatory bowel disease, anal carcinoma, had undergone repeated rectal surgical procedures, if a Hartmann procedure was performed together with LAR, or if they were aged > 85 years, did not attend follow-up examinations regularly, or if clinical follow-up data were not available.
The patients were separated into two groups, those with and without early postoperative complications. Patients were also divided into the open surgery group and the laparoscopic LAR group. Complications developing within the first 30 days after LAR were considered early, and complications developing after 30 days were considered late[17]. Early postoperative complications were defined as bleeding, anastomotic leakage, wound site infection, eventration, subileus, pleurisy, and acute renal failure, while late postoperative complications were defined as bridge ileus, anastomotic stricture, and recurrence. Computed tomography (CT) or pelvic magnetic resonance imaging (MRI) was used to detect complications. In all patients, the anastomosis was closed with a circular stapler (Covidien™, EEA™, Black Circular Stapler, 31 mm, United States).
The demographic, clinical, and laboratory data of the patients were retrieved from patient records and the hospital information management system. Tumor staging was determined according to the National Comprehensive Cancer Network Rectal Cancer TNM 2025 Guidelines[18]. The patients were divided into 3 groups according to the distance of the tumor from the anal verge determined during preoperative colonoscopy; tumors in the first 5 cm were categorized as low rectal cancer, those located 5-10 cm as mid, and tumors at 10-15 cm as upper rectal cancer. The PNI score of patients was calculated using the following formula: (10 × serum albumin g/dL) + (0.005 × lymphocyte count mm³)[19].
Anastomosis narrowing was diagnosed on the basis of the presence of one of the following: (1) Anastomosis through which a 12 mm colonoscope could not pass; (2) Anastomosis through which an index finger could not pass during digital rectal examination; and (3) Visualization of anastomotic narrowing (< 10 mm) on gastrointestinal fluoroscopy[20].
Time to emergence of postoperative local recurrence or distant metastasis was defined as DFS. Follow-up for recurrence or metastasis in patients who underwent LAR due to rectal cancer was performed with thoraco-abdominal CT and pelvic MRI. When recurrence or metastasis was suspected, positron emission tomography-CT was performed. Remission was accepted when no pathological findings were detected on CT and MRI scans and on clinical evaluation during a follow-up period of at least 12 months. Disease progression was considered when the presence of recurrence/metastasis on CT or MRI, or the emergence of recurrence on colonoscopy was found. The primary outcome of the study was defined as early postoperative complications, while the secondary outcomes were described as late-period complications and disease course.
Ethical approval
Approval for this study was granted by the Ethics Committee of Health Sciences University, Bursa Yuksek Ihtisas Training and Research Hospital (No. 2024-TBEK 2025/04-09). All the study procedures were in compliance with the Helsinki Declaration.
Statistical analysis
Data obtained in the study were analyzed statistically using Statistical Package for the Social Sciences v. 22.0 (SPSS Inc., Chicago, IL, United States). Conformity of the data to normal distribution was evaluated with the Kolmogorov-Smirnov test. Measurable parametric data are presented as arithmetic mean ± SD values, and categorical variables as n (%). Relationships between categorical variables were examined with the χ² test. In the comparisons of continuous variables between groups, the Independent Samples t-test was used. Factors that could affect early postoperative complications were evaluated using Binary Logistic Regression analysis. A value of P < 0.05 was accepted as statistically significant in all statistical evaluations.
RESULTS
In total, 105 patients underwent LAR for rectal cancer, comprising 66 (62.9%) males and 39 (37.1%) females, with a mean age of 66 ± 12 years (28-85 years) and a mean body mass index of 24.17. Of these patients, 22 (21%) were smokers, and diabetes mellitus (DM) was present in 25 (23.8%). Protective loop ileostomy was performed in 23 (21.9%) patients, and 26 (24.8%) patients received preoperative neoadjuvant CRT. The LAR was performed as open surgery in 63 (60%) patients and laparoscopically in 42 (40%). The mean follow-up period for all patients was 46.44 ± 25 months (1-85 months) with a mean DFS of 42.49 ± 24 months (1-85 months). Erythrocyte suspension replacement was administered to 38 (36.2%) patients. A PNI score of ≥ 45 was recorded for 19 (18.1%) patients and a PNI score < 45 for 86 (81.9%). Early postoperative complications were determined in 29 (27.6%) patients and late complications in 14 (13.3%). In the follow-up period, remission was observed in 76 (72.4%), progression in 13 (12.4%), and mortality in 16 (15.2%) patients. Of the 16 patients who died, 4 (3.8%) died within 30 days post-operation. All of these patients had postoperative anastomosis leakage. Of the 13 patients with progression, this was due to local recurrence in 5 (4.8%) and metastasis in 8 (7.6%). The pathology of all patients was adenocarcinoma and surgical margins were intact (Table 1).
Table 1 Demographic, clinical, and laboratory data of the patients (n = 105), n (%).
The mean age of the patient group with early complications was 72.41 ± 9.9 years, and in the group that did not develop early complications the mean age was 63.76 ± 11 years. The difference in age between the two groups was statistically significant (P = 0.001). The presence of DM was determined in 12 (41.4%) patients in the early complications group and in 16 (17.1%) patients in the group without early complications. The difference between these two groups in terms of DM was statistically significant (P = 0.009; Table 2).
Table 2 Comparisons of the demographic, clinical and preoperative laboratory data of the patients with and without early complications, n (%).
The distribution of tumor staging in the early complications group was determined to be stage 1: 2 (6.9%), stage 2: 9 (31%), stage 3: 18 (62.1%), and in the group without early complications this distribution was stage 0: 1 (1.3%), stage 1: 24 (31.6%), stage 2: 23 (30.3%), and stage 3: 28 (36.8%). A significant difference was observed between the groups in terms of stage classification (P = 0.035; Table 2).
The preoperative albumin level was 29.69 ± 4.9 g/L in the early complications group and 32.76 ± 5 g/L in the group without early complications, and the difference between the groups was statistically significant (P = 0.006). On postoperative day 1, the mean hemoglobin (Hb) level was 10.37 ± 1 g/dL in the early complications group and 11.15 ± 1.2 g/dL in the group without early complications, and the difference between the groups was statistically significant (P = 0.003). No significant difference was determined between the patient groups with and without early complications in terms of the preoperative NLR (P = 0.75), but on postoperative days 1 and 3, a significant difference was observed (P < 0.001, P = 0.003, respectively; Tables 2 and 3).
Table 3 Comparisons of the postoperative clinical course and laboratory data of the patients with and without early complications.
The preoperative ELR was 0.18 ± 0.1 in the early complications group and 0.11 ± 0.1 in the group without early complications, and the difference between the groups was statistically significant (P = 0.05). In the logistic regression analysis, the preoperative ELR was not found to have a significant effect on early complications. The mean PNI score was 36.70 ± 6.8 in the early complications group and 39.33 ± 5.9 in the group without early complications, with no significant difference between the groups (P = 0.055). In addition, no significant difference was observed between the patient groups with and without early complications in terms of remission, progression and mortality (P = 0.29; Tables 2 and 4).
Table 4 Evaluation of demographic, clinical, and preoperative laboratory data associated with early postoperative complications.
Following logistic regression analysis of the demographic, clinical, and preoperative laboratory data observed to be associated with early postoperative complications, only advanced age, low preoperative Hb, and open surgical technique were found to be related to early postoperative complications (Table 4).
In the comparisons of patients according to the type of surgery, mean age was 66.62 ± 12 years in the open LAR surgery group and 65.45 ± 9.9 years in the laparoscopic LAR surgery group, with no significant difference between the groups. Gender distribution was 44 (69.8%) males in the open group and 22 (52.4%) males in the laparoscopic group. The mean length of hospital stay was 10.97 ± 5.2 days in the open surgery group and 8.64 ± 2.9 days in the laparoscopic group, with no significant difference between the groups (P = 0.011; Table 5).
Table 5 Comparisons of demographic and clinical data between the open low anterior resection surgery and laparoscopic low anterior resection surgery groups, n (%).
Tumor staging was determined to be stage 1: 13 (20.6%), stage 2: 16 (25.4%), and stage 3: 34 (54%) in the open surgery group, and stage 0: 1 (2.4%), stage 1: 13 (31%), stage 2: 16 (38.1%), and stage 3: 12 (28.6%) in the laparoscopic surgery group, with a significant difference observed between the groups (P = 0.05). No statistically significant difference was found between these two groups in terms of the NLR preoperatively and on days 1 and 3 postoperatively. There was a statistically significant difference between the groups in terms of the ELR on postoperative days 1 and 3, and the preoperative lymphocyte-to-monocyte ratio (LMR) (P = 0.003, P = 0.016, respectively; Table 5).
Early complications were seen in 23 (36.5%) patients in the open surgery group and in 6 (14.3%) patients in the laparoscopic surgery group. The difference between the two groups was statistically significant (P = 0.01) and no significant difference was seen in terms of late complications. Disease course was recorded as remission in 40 (63.5%) patients, progression in 9 (14.3%), and mortality in 14 (22.2%) in the open surgery group, and remission in 36 (85.7%), progression in 4 (9.5%) and mortality in 2 (4.8%) in the laparoscopic LAR surgery group. The difference in disease course between the two groups was statistically significant (P = 0.02; Table 5).
DISCUSSION
For many years, LAR has been performed to obtain clinical improvement in patients with rectal cancer, and it is currently the best treatment method. However, despite advances in medicine, postoperative complications continue to be a clinical problem. Just as postoperative complications can affect healing and quality of life, they can also be life-threatening for patients. Therefore, various studies have been conducted on the factors affecting early complications in patients who have undergone surgery for rectal cancer. One of the most important aims of those studies was to determine the factors that can predict early postoperative complications[21-24].
The aim of the current study was to determine factors affecting early postoperative complications in patients who had undergone LAR for rectal cancer. The study results showed that advanced age, the presence of DM, advanced disease stage, elevated preoperative ELR, and low preoperative albumin and Hb values were associated with complications in the early postoperative period. It was also determined that patients who had undergone open LAR surgery required a longer hospital stay and developed more early complications than patients who had undergone laparoscopic LAR surgery.
In the study by Watanabe et al[25], the overall postoperative complication rate was 21.8%, and the mortality rate associated with anastomosis leakage was 3.1%. Various reports in the literature have stated that the postoperative anastomosis leakage rate in patients who have undergone LAR for rectal cancer was 1%-19%, the mortality rate due to anastomosis leakage was 10%-15%, postoperative bleeding rate was 6%, wound site infection was 5%-10%, and local recurrence was 2%-10%[6,7,15,26,27]. The rate of benign anastomosis narrowing following rectal cancer surgery has been reported to be 8.7%-13%[20]. In studies reported in the literature, no significant differences in OS, DFS, and survival without local recurrence was found between patients with and without anastomosis leakage in the long-term follow-up after rectal cancer surgery[28,29].
In the current study, the total early postoperative complication rate was 27.6% and the most frequently observed complication was anastomosis leakage in 10 (9.5%) patients, followed by wound site infection in 5 (4.8%) and eventration in 4 (3.8%). In all patients, postoperative bleeding was seen in only 2 (1.9%) patients, and 4 (3.8%) patients died in the early postoperative period. During the follow-up period, the mortality rate was 15.2% and the rate of postoperative anastomosis narrowing was 7.6%. Disease progression was observed in 13 (12.4%) patients, of which there was local recurrence in 5 (4.8%). In addition, no significant difference was observed between the groups with and without early postoperative complications in terms of OS, DFS, disease progression, and mortality rates. The results obtained in the present study were consistent with the data previously reported in the literature.
In a previous study, no significant difference was found between groups that underwent open surgery or laparoscopic surgery for rectal cancer in terms of mean length of hospital stay (7.3 days vs 7 days) and DFS[30]. In the current study, the total length of hospital stay was significantly shorter in the laparoscopic surgery group (8.64 days vs 10.97 days) and no significant difference in DFS was found between the two surgical techniques. Bonjer et al[31] reported that local recurrence, OS, and DFS rates after surgery in patients with rectal cancer were similar in open and laparoscopic surgery. The current study results showed no significant difference in recurrence, OS, and DFS rates.
In a meta-analysis by Chen et al[32], laparoscopic and open surgery for rectal cancer were compared, and although the laparoscopic groups had significantly fewer postoperative complications, less blood loss, and a shorter hospital stay, the open surgery groups had a shorter operating time. In addition, no significant differences in mortality, number of lymph nodes removed, recurrence, OS, and DFS were observed between the two surgical techniques. In the current study, the laparoscopic surgery group was found to have a significantly shorter hospital stay, a lower mortality rate, and a lower rate of early postoperative complications than the open surgery group. The most important reason for this was thought to be due to the significantly more advanced disease stage in the patients that underwent open surgery compared to the laparoscopic group.
In a previous study, the overall postoperative complication rate in patients who underwent LAR for rectal cancer was 22.3%, and patients with early postoperative complications had a longer stay in hospital than patients who did not develop early complications[33]. In another study, the overall complication rate was reported to be 25.4% after LAR surgery for rectal cancer patients, 24.3% of whom had received neoadjuvant CRT preoperatively. Although there were no differences in loop ileostomy, TNM tumor classification, number of lymph nodes removed, tumor differentiation status, and 5-year OS between the groups with and without complications, the group with complications had a significantly longer operating time, greater interoperative bleeding, a longer stay in hospital, and more local recurrence and shorter DFS in stage 1 patients[34]. In the current study, the mean age, rate of patients with DM, total length of hospital stay, and rate of grade 3 patients were found to be significantly higher in the group with early postoperative complications compared to those without early complications. However, no significant differences were found between the two groups in terms of tumor differentiation, total number of lymph nodes removed, progression status, preoperative CRT status, and DFS. These data were found to be consistent with data previously reported in the literature.
It is known that there is an increased predisposition to infectious diseases and delayed wound healing in patients with a low PNI score, which is calculated using the serum albumin level and lymphocyte count. In a previous study, the postoperative complication rate was 31.1% in patients who underwent surgery for colorectal cancer, and the PNI score was significantly lower in the group with complications than in the group without complications[35]. A meta-analysis reported that a low PNI score was associated with low OS and high postoperative complication rates in cancer patients[36]. Many studies have shown that cancer patients with anemia preoperatively experience more postoperative complications than those without preoperative anemia[37,38]. In the current study, the mean PNI score in the group with early postoperative complications was lower, at a level close to statistical significance (P = 0.055), than that in the group without early complications. In addition, the preoperative albumin and Hb values were significantly lower in the group with early postoperative complications compared to the group without complications. These results were found to be consistent with the literature.
Although many studies in the literature have reported that there is a relationship between the biochemical parameters associated with inflammation and postoperative outcomes after colorectal cancer surgery, the use of these parameters in clinical practice is still a subject of research[1,39,40]. It has been reported that lymphocytopenia contributes to tumor progression, and correspondingly lymphocytosis has been associated with longer OS in cancer patients[39]. Studies have also reported that the NLR and LMR are related to tumor stage[39,40]; however, there are also studies that do not support this[41]. Therefore, the NLR and LMR should not yet be considered as independent prognostic factors in colorectal cancer patients.
In a previous study, no significant difference in the preoperative NLR was observed between groups of operated rectal cancer patients with and without complications in the first 30 days postoperatively[42]. A preoperative high NLR was found to be associated with anastomosis leakage in another study[43]. The current study results showed that while there was no significant difference between the groups with and without early postoperative complications in terms of the preoperative NLR, the differences in the values on postoperative days 1 and 3 were statistically significant. In another study, preoperative low LMR was found to be predictive of postoperative infection after colorectal surgery[40]. Another study reported no difference between patient groups with and without anastomosis leakage for preoperative and postoperative day 1 and day 4 LMR[41]. The current study results showed no significant difference between the groups with and without complications in terms of preoperative, and postoperative days 1 and 3 LMR.
In a study of patients with endometrial cancer, a high preoperative ELR was associated with advanced disease stage[44]. In another study, the preoperative eosinophil value was determined to be lower in high-grade gliomas than in low-grade gliomas[45]. A high preoperative eosinophil level has also been shown to be associated with worse OS in patients with cervical squamous cell carcinoma[46]. To the best of our knowledge, no previous study has examined the relationship between preoperative or postoperative ELR with postoperative complications in colorectal cancers. In the current study, the preoperative ELR was significantly higher in the group with early postoperative complications than in the group without complications. However, in the binary logistic regression analysis the preoperative ELR did not have an effect on the development of early postoperative complications. This suggests that to be able to more clearly understand the importance of the preoperative ELR in rectal cancer patients, there is a need for further non-retrospective studies that include more patient groups.
Study limitations
There were some limitations in this study. First, due to the retrospective design, the data quality was not within the control of the researchers and there may have been unknown bias. Second, the exact amount of intraoperative blood loss was not known. Third, the number of patients was relatively low. Finally, the fact that patient data were collected from a single center may restrict the generalizability of the results.
CONCLUSION
The results of this study demonstrated that following univariate analysis, advanced age, the presence of DM, advanced disease stage, elevated preoperative ELR, open surgical technique, and low preoperative albumin and Hb values were associated with early postoperative complications in patients who had undergone LAR for rectal cancer. However, in the logistic regression analysis, the preoperative ELR was not observed to have an effect on the development of early postoperative complications. This suggests that there is a need for further prospective and well-designed studies to examine the relationship between the preoperative ELR and early postoperative complications in patients with rectal cancer.
Footnotes
Provenance and peer review: Unsolicited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Gastroenterology and hepatology
Country of origin: Türkiye
Peer-review report’s classification
Scientific Quality: Grade C
Novelty: Grade C
Creativity or Innovation: Grade D
Scientific Significance: Grade D
P-Reviewer: Demirli Atici S, MD, Türkiye S-Editor: Luo ML L-Editor: Webster JR P-Editor: Yu HG
Marginean SS, Zurzu M, Garofil D, Tigora A, Paic V, Bratucu M, Popa F, Surlin V, Cartu D, Strambu V, Radu PA. Evaluation of Key Risk Factors Associated with Postoperative Complications in Colorectal Cancer Surgery.J Mind Med Sci. 2025;12:22.
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