Preoperative prognostic nutritional index shows no significant prognostic value for short-term outcomes of anastomosis-leakage patients after cancerous esophagectomy.

Background: The relationship between preoperative nutritional and immunological status and long-term outcome after cancerous esophagectomy has been investigated widely. Growing evidence also demonstrated preoperative nutritional and immunological status also affects short-term outcome after surgery for esophageal cancer. However, the relationship between preoperative nutritional and immunological status and short-term outcome of anastomosis-leakage patients after cancerous esophagectomy was scarce. The aim of this study was to evaluate the association between preoperative prognostic nutritional index (PNI) and short-term outcome of anastomosis-leakage patients after surgery.

Methods: In this study, we retrospectively enrolled 90 patients who were confirmed to be esophageal cancer by preoperative biopsy or postoperative pathological review and also suffered postoperative anastomotic leakage from January 2014 to June 2017 at the Department of Thoracic Surgery, West China Hospital. Then we evaluated the association between PNI and short-term surgical outcome. The endpoints included postoperative mortality, postoperative hospital duration, postoperative intensive care unit (ICU) duration, hospitalization cost.

Results: The cut-off value of PNI was set at 49.83 in our study, patients with a preoperative PNI ≥49.83 were divided into high-PNI group, while those with a preoperative PNI <49.83 were classified into low-PNI group. For the postoperative anastomosis-leakage patients in the two groups, baseline characteristics were all comparable, and analysis revealed no significantly statistical difference between the two groups regarding mortality, postoperative hospital duration and postoperative ICU duration. Though mean hospital-duration cost (144,791.08±87,312.87 vs. 127,364.25±69,233.16) was more in the low-PNI group, there was still no significant difference demonstrated (P=0.297). There was no significant difference revealed between the subgroups of non-death patients from the two original groups concerning the endpoints, while the hospital-duration cost of the high-PNI group tended to be lower than low-PNI group (125,262.80±71,304.12 vs. 136,421.60±77,052.49, P=0.503).

Conclusions: Although in-hospital cost of high-PNI group tended to be lower than low-PNI group, preoperative PNI showed no significant prognostic value for short-outcomes of anastomosis-leakage patients after cancerous esophagectomy. More prospective studies were badly needed to provide more evidence in the future.