Abstract

Background: The nutritional and inflammatory status of patients before surgery may affect recovery following gastrectomy, but the comparative predictability of composite indices is unclear. The present study aimed to assess the usefulness of the Controlling Nutritional Status (CONUT) score and systemic inflammatory indices for predicting major postoperative complications following gastrectomy for gastric cancer. Methods: A retrospective cohort of 348 patients with the intent of a curative gastrectomy was studied. Preoperative CONUT score, NLR and PLR were derived based on regular laboratory data. Complications were defined as Clavien-Dindo grade III or higher within 30 days as major complications. Optimal thresholds were obtained by receiver operating characteristic analyses and independent predictors were determined by using a multivariable logistic regression. Results: 9.3% of patients had major complications. An increased CONUT score and an increased neutrophilto-lymphocyte ratio were independently associated with the presence of major complications (adjusted odds ratio 2.86, 95% confidence interval 1.61-5.08 and adjusted odds ratio 2.13, 95% confidence interval 1.19-3.81 respectively). CONUT score had the highest discriminative power with an AUC of 0.73. Conclusion: The preoperative CONUT score has been demonstrated to be an independent predictor of major complications following gastrectomy and has performed better than individual inflammatory indices and to have potential for inclusion in a daily surgical risk assessment protocol.

Keywords: CONUT score, Gastric cancer, Gastrectomy, Neutrophil-to-lymphocyte ratio, Postoperative complications, Prognostic nutritional index