Prognostic value of hematological markers for anastomotic leakage diagnosed after postoperative day 5 following laparoscopic surgery for colorectal cancer

BACKGROUND: Anastomotic leakage (AL) is a common complication following colorectal cancer surgery, yet accurate and unified diagnostic criteria remain lacking. METHODS: This retrospective study included 360 patients who underwent laparoscopic colorectal resection with one-stage anastomosis at the First Affiliated Hospital of Kunming Medical University between October 2019 to December 2023. Hematocrit-to-albumin difference (HCT-ALB), neutrophil-to-albumin ratio (NAR), and neutrophil-to-lymphocyte ratio (NLR) on postoperative days (POD) 1, 3, and 5 were compared between patients with and without AL. This study specifically aimed to evaluate the predictive performance of these markers for AL occurring after POD 5. RESULTS: Compared to the non-AL group, the AL group exhibited significantly higher HCT-ALB, NAR, and NLR values on POD 3 and 5 (P < 0.05), except for NLR on POD 1. Multivariate analysis identified rectal tumor location, HCT-ALB and NLR on POD 3, and NAR and NLR on POD 5 as associated factors of AL, while preoperative ALB, HCT-ALB on POD1 and POD5, and NAR on POD1 and POD3 showed weaker associations (P > 0.05). The best predictors were NAR on POD 5 (AUC = 0.910, cut-off = 2.09) and NLR on POD 5 (AUC = 0.885, cut-off = 7.19). Due to the exploratory nature of this study and the potential for collinearity between these inflammatory markers, these results should be interpreted with caution. CONCLUSION: Tumor location (rectum), HCT-ALB and NLR on POD 3, and NAR and NLR on POD 5 may serve as reliable indicators for AL, thus enabling early identification and timely intervention to improve postoperative outcomes after colorectal surgery.