ArticleFrontiers in nutrition2026
Association between preoperative nutritional status and anastomotic leakage in patients undergoing rectal cancer surgery.
Article in Frontiers in nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Anastomotic leakage is a clinically important complication after rectal cancer surgery, and preoperative nutritional and inflammatory status may be associated with anastomotic healing. This study aimed to evaluate the association between preoperative nutritional status, particularly the prognostic nutritional index (PNI), and postoperative anastomotic leakage in patients undergoing rectal cancer surgery. Methods: This retrospective study included consecutive eligible patients who underwent rectal cancer surgery between January 2023 and December 2025. Anastomotic leakage within 30 days was identified according to International Study Group of Rectal Cancer criteria. Preoperative nutritional status was primarily assessed using PNI, with Nutritional Risk Screening 2002 (NRS-2002), serum nutritional markers, and C-reactive protein (CRP) evaluated as complementary measures. Propensity score matching (PSM), multivariable logistic regression, unmatched-cohort analysis, sequential adjustment, subgroup analyses, and receiver operating characteristic analysis were performed. Results: Among 2,468 patients, 308 developed anastomotic leakage. After 1:1 PSM, 308 patients with leakage and 308 without leakage were analyzed. Mean PNI was lower in patients with leakage (43.2 ± 5.1 vs. 46.8 ± 4.9; Conclusion: Lower preoperative PNI was independently associated with higher odds of postoperative anastomotic leakage after rectal cancer surgery. PNI may provide a readily available adjunct to multidimensional preoperative risk assessment but should not be considered a stand-alone predictor.
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