{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T06:12:00Z","timestamp":1778825520335,"version":"3.51.4"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Anastomotic leakage remains a major complication following rectal cancer surgery. Neoadjuvant therapy, while improving oncological outcomes, may negatively impact nutritional and immunological status. This study aimed to evaluate the predictive value of the Prognostic Nutritional Index (PNI) for anastomotic leakage in locally advanced rectal cancer patients treated with neoadjuvant therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>This retrospective study included 123 patients with locally advanced rectal cancer who underwent neoadjuvant therapy followed by curative resection with primary anastomosis between 2018 and 2024. PNI was calculated using preoperative serum albumin and lymphocyte count. ROC curve analysis determined the optimal PNI cutoff value. Univariate and multivariate logistic regression analyses identified independent predictors of anastomotic leakage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Anastomotic leakage occurred in 19 patients (15.4%). The optimal PNI cutoff was 51.25 (AUC\u2009=\u20090.756, sensitivity 78.9%, specificity 67.3%). In multivariate analysis, PNI was an independent predictor of anastomotic leakage (OR\u2009=\u20090.809, 95% CI: 0.696\u20130.941,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006). Coronary artery disease (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.038) and intraoperative blood transfusion (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001) were also identified as significant independent risk factors for anastomotic leakage.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Preoperative PNI is an independent predictor of anastomotic leakage in rectal cancer patients following neoadjuvant therapy. PNI may serve as a practical tool for preoperative risk stratification and guide clinical decision-making regarding nutritional optimization and surgical planning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1825596","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T05:44:10Z","timestamp":1778823850000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic nutritional index as a predictor of anastomotic leakage after rectal cancer surgery"],"prefix":"10.3389","volume":"13","author":[{"given":"Kaz\u0131m","family":"Duman","sequence":"first","affiliation":[{"name":"Ministry of Health, Sancaktepe \u015eehit Dr. \u0130lhan Varank Training and Research Hospital","place":["\u0130stanbul, T\u00fcrkiye"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J Clin."},{"key":"B2","doi-asserted-by":"publisher","first-page":"e688","DOI":"10.1097\/sla.0000000000005907","article-title":"Blood perfusion assessment by indocyanine green fluorescence imaging for minimally invasive rectal cancer surgery (EssentiAL trial): a randomized clinical trial","volume":"278","author":"Watanabe","year":"2023","journal-title":"Ann Surg."},{"key":"B3","doi-asserted-by":"publisher","first-page":"101708","DOI":"10.1016\/j.suronc.2022.101708","article-title":"Anastomotic leakage in colorectal cancer surgery","volume":"40","author":"Chiarello","year":"2022","journal-title":"Surg Oncol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"zrae089","DOI":"10.1093\/bjsopen\/zrae089","article-title":"Anastomotic leak after manual circular stapled left-sided bowel surgery: analysis of technology-, disease-, and patient-related factors","volume":"8","author":"Tong","year":"2024","journal-title":"BJS Open"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1283","DOI":"10.1002\/jso.25921","article-title":"The influence of anastomotic leakage for rectal cancer oncologic outcome: a systematic review and meta-analysis","volume":"121","author":"Yang","year":"2020","journal-title":"J Surg Oncol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1731","DOI":"10.1056\/NEJMoa040694","article-title":"Preoperative versus postoperative chemoradiotherapy for rectal cancer","volume":"351","author":"Sauer","year":"2004","journal-title":"N Engl J Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"873","DOI":"10.1016\/j.annonc.2024.06.019","article-title":"Total neoadjuvant therapy with mFOLFIRINOX versus preoperative chemoradiotherapy in patients with locally advanced rectal cancer: long-term results of the UNICANCER-PRODIGE 23 trial","volume":"35","author":"Conroy","year":"2024","journal-title":"Ann Oncol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/s1470-2045(20)30555-6","article-title":"Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial","volume":"22","author":"Bahadoer","year":"2021","journal-title":"Lancet Oncol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1195","DOI":"10.1007\/s10350-008-9368-3","article-title":"Neoadjuvant therapy and anastomotic leak after tumor-specific mesorectal excision for rectal cancer","volume":"51","author":"Martel","year":"2008","journal-title":"Dis Colon Rectum"},{"key":"B10","doi-asserted-by":"publisher","first-page":"2945","DOI":"10.1007\/s00423-022-02609-2","article-title":"Are risk factors for anastomotic leakage influencing long-term oncological outcomes after low anterior resection of locally advanced rectal cancer with neoadjuvant therapy? 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