Background Postoperative complications afflict approximately 40% of patients undergoing colorectal cancer (CRC) surgery and adversely affect long-term oncological outcomes. Reliable perioperative risk stratification tools that are both clinically interpretable and actionable remain limited. Methods This retrospective cohort study enrolled 1,013 consecutive patients undergoing elective radical resection for histopathologically confirmed CRC at a single tertiary center. A nine-system composite complication endpoint was defined. Missing data were handled via multiple imputation by chained equations (MICE; m = 5). Candidate predictors were screened by univariable logistic regression and LASSO regularization; final predictors were entered into multivariable logistic regression with Rubin’s rules pooling. Model performance was assessed by AUC, bootstrap internal validation (1,000 iterations), Hosmer–Lemeshow calibration, and decision curve analysis (DCA). A nomogram was constructed for individualized risk estimation. Results Of 1,013 patients, 372 (36.7%) experienced ≥1 postoperative complication. LASSO selected eight independent predictors: NRS-2002 nutritional risk score (aOR 1.502, 95% CI 1.312–1.720), laparoscopic approach (aOR 0.457, 95% CI 0.297–0.702), intraoperative blood loss (aOR 1.002/mL), right colon tumor location (aOR 1.502), NLR (aOR 1.080/unit), operative time (aOR 1.002/min), hemoglobin, and total bilirubin. The model achieved an apparent AUC of 0.689 (bootstrap-corrected 0.680), satisfactory calibration (Hosmer–Lemeshow p = 0.709), and net clinical benefit across threshold probabilities of 10–90% on DCA. Sensitivity analyses confirmed robustness across four pre-specified scenarios (AUC range 0.666–0.715). Conclusion This LASSO-derived nomogram provides transparent, bedside-applicable risk stratification for postoperative composite complications in CRC surgery, identifying nutritional status as the dominant modifiable predictor and supporting targeted perioperative optimization.
Lu Wang, Shunshun Wang, Liqin Deng· Frontiers in Nutrition· 0 citations
Background Postoperative complications of colorectal cancer significantly impact prognosis and healthcare burdens. While the dynamic change from preoperative to the lowest albumin level on postoperative day 2 (ΔAlb) has been linked to complications, their predictive value remains controversial. This study aims to explore the relationship between ΔAlb and postoperative complications, and evaluates a multifactorial predictive model for severe complications. Methods This retrospective study analyzed 932 patients undergoing colorectal cancer resection (August 2020–April 2022). Data included preoperative/postoperative albumin levels, demographics, surgical/anesthetic details, and 30-day complications. ΔAlb’s association with severe complications was assessed via logistic regression, and a nomogram was developed. Results Severe complications (Clavien–Dindo III–V) occurred in 14.2% of patients. ΔAlb showed no significant association with severe complications in univariate (P = 0.185) or multivariate analysis and discriminated poorly on ROC analysis (AUC 0.536, 95% CI 0.479–0.593). In the final multivariable model using clinically dichotomised predictors, preoperative albumin <35 g/L (OR 2.05, 95% CI 1.29–3.25, P = 0.003) and POD2 nadir albumin <28.5 g/L (OR 1.55, 95% CI 1.01–2.38, P = 0.044) were independent risk factors. Other independent predictors were age >65 years (OR 2.14, P = 0.003), ASA ≥3 (OR 2.14, P = 0.001), preoperative NRS2002 ≥2 (OR 1.97, P = 0.028) and rocuronium dose ≥117.5 mg (OR 4.44, P<0.001). A nomogram integrating these factors showed good discrimination (apparent C-index 0.794; optimism-corrected 0.784 by 1000-sample bootstrapping), good calibration (Hosmer–Lemeshow P = 0.72) and net clinical benefit on decision-curve analysis. Conclusion ΔAlb alone has limited predictive value, whereas absolute preoperative albumin <35 g/L and POD2 nadir albumin <28.5 g/L are independent predictors of severe complications. A multifactorial model integrating these absolute albumin thresholds with age, ASA score, preoperative NRS2002 and rocuronium dose improves prediction (optimism-corrected C-index 0.78) compared with individual factors (AUC <0.7). Because rocuronium dose may also reflect surgical complexity and perioperative management, these associations require prospective, multicentre validation.
Lu Wang, Rui-Rui Lyu, Yue Ding et al.· Frontiers in Oncology· 0 citations