The value of perioperative neutrophil-to-lymphocyte ratio combined with the prognostic nutritional index for predicting anastomotic leakage after minimally invasive esophagectomy.

Background: Across the world, esophageal cancer is one of the most common malignant tumors of the digestive system. Anastomotic leakage is a severe complication after minimally invasive esophagectomy (MIE) for esophageal cancer. Research indicates that inflammation and immune system and nutritional status are linked to anastomotic leakage. Neutrophil-to-lymphocyte ratio (NLR) and prognostic nutrition index (PNI) reflect the inflammatory and nutritional status of the human body. The aim of this study is to investigate the value of perioperative NLR combined with the PNI to predict anastomotic leakage after MIE. Methods: A retrospective analysis was conducted on 232 patients who underwent MIE in The Affiliated Lihuili Hospital of Ningbo University from January 2019 to May 2023. Patients were divided into two groups based on the presence or absence of anastomotic leakage. Clinicopathological data and perioperative peripheral blood indices of the patients were collected, and the factors associated with postoperative anastomotic leakage were analyzed via univariate and multivariate logistic regression. Moreover, the value of NLR and PNI for predicting anastomotic leakage were evaluated using receiver operating characteristic (ROC) curves. Results: Anastomotic leakage occurred in 35 (15%) of 232 patients who underwent MIE. Multivariate logistic regression analysis identified a history of diabetes, higher NLR levels on postoperative days 3 and 5, and a lower PNI score on postoperative day 3 as independent risk factors of anastomotic leakage. ROC curve analysis indicated that NLR combined with PNI on postoperative day 3 had the best predictive value for anastomotic leakage, with an area under the curve (AUC) of 0.826, a sensitivity of 82.9%, and a specificity of 78.2%. Conclusions: Persistently high NLR levels and persistently low PNI levels in the postoperative period correlated with the development of anastomotic leakage after MIE, and NLR combined with the PNI on postoperative day 3 had the best predictive value for anastomotic leakage after MIE.