Relation between preoperative hypoproteinemia and postoperative complications in patients with rectal cancer: A real-world data study based on DACCA database_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIN Yuxin ^1,2 , WANG Hanshuo ^1,2 , Jialin·Huannixi ^1,2 , ZHANG Lexuan ^1,2 , WANG Liya ¹ ,  WANG Xiaodong ¹ , LI Li ³

1. Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. West China School of Medicine, Sichuan University, Chengdu 610041, P. R. China;
3. Department of General Surgery II, West China Hospital of Shangjin, Sichuan University, Chengdu 611731, P. R. China;

Corresponding author：

WANG Xiaodong, Email: wangxiaodong@wchscu.cn

Keywords：

rectal cancer; hypoproteinemia; complications; preoperative physical condition

DOI：

10.7507/1007-9424.202501126

Video：

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Objective To analyze the impact of preoperative hypoproteinemia on postoperative complications in patients with rectal cancer based on the current version of the Database from Colorectal Cancer (DACCA). Methods The patient information was extracted from the updated version of DACCA in April 2024 according to predefined inclusion criteria. The preoperative hypoproteinemia and incidence of complications were analyzed. The univariate and multivariate logistic regression analyses were performed to identify risk factors for complications in three postoperative periods (in-hospital, short-term, and long-term). The test level was α=0.05. Results A total of 1 440 patients with rectal cancer were included, 322 (22.4%) with preoperative hypoproteinemia and 1 118 (77.6%) without. Compared to the patients without preoperative hypoproteinemia, those with preoperative hypoproteinemia were older (P<0.001), had a lower body mass index (P<0.001), smaller tumor margins (P<0.05), and a higher proportion of patients with pTNM stage Ⅲ or Ⅳ (P<0.001). There were no statistically significant differences in the overall incidence of complications during the three postoperative periods (in-hospital, short-term, and long-term) between the patients with and without preoperative hypoproteinemia (χ²=0.399, P=0.280; χ²=0.298, P=0.585; χ²=1.416, P=0.234). Except for urinary retention, there were no significant differences in the incidence of specific complications between the two groups (P>0.05). The univariate and multivariate logistic regression analyses did not identify preoperative hypoproteinemia as a risk factor for postoperative complications (P>0.05). Conclusions The results of this study suggest that the incidence of preoperative hypoproteinemia is higher in patients with rectal cancer. Patients with preoperative hypoproteinemia tend to be older, have a lower body mass index, and a higher proportion of pTNM stage Ⅲ or Ⅳ. However, it was not found that preoperative hypoproteinemia is a risk factor for postoperative complications.

1.	Nacion AJD, Park YY, Yang SY, et al. Critical and challenging issues in the surgical management of low-lying rectal cancer. Yonsei Med J, 2018, 59(6): 703-716.
2.	Sturiale A, Martellucci J, Zurli L, et al. Long-term functional follow-up after anterior rectal resection for cancer. Int J Colorectal Dis, 2017, 32(1): 83-88.
3.	Gielen AHC, Heuvelings DJI, Sylla P, et al. Impact of anastomotic leakage after colorectal cancer surgery on quality of life: A systematic review. Dis Colon Rectum, 2025, 68(2): 154-170.
4.	Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: Pathogenesis and clinical significance. JPEN J Parenter Enteral Nutr, 2019, 43(2): 181-193.
5.	Wiedermann CJ. Hypoalbuminemia as surrogate and culprit of infections. Int J Mol Sci, 2021, 22(9): 4496. doi: 10.3390/ijms22094496.
6.	汪晓东, 李立. 数据库建设第一部分: 个人数据的标签与结构化. 中国普外基础与临床杂志, 2019, 26(3): 335-342.
7.	汪晓东, 刘健博, 李立. 数据库建设第三部分: 结直肠癌内外科合并症及术前体质状态的标签与结构化. 中国普外基础与临床杂志, 2019, 26(9): 1110-1115.
8.	汪晓东, 刘健博, 李立. 数据库建设第五部分: 结直肠癌的肿瘤特征—模块的设计(一). 中国普外基础与临床杂志, 2020, 27(3): 345-349.
9.	汪晓东, 刘健博, 李立. 数据库建设第五部分·结直肠癌的肿瘤特征—模块的设计(二). 中国普外基础与临床杂志, 2020, 27(4): 483-488.
10.	汪晓东, 刘健博, 李立. 数据库建设第六部分: 结直肠癌分期的标签与结构化. 中国普外基础与临床杂志, 2020, 27(7): 873-879.
11.	汪晓东, 刘健博, 孟鑫宇, 等. 数据库建设第八部分: 结直肠癌手术反应及围术期并发症的标签与结构化. 中国普外基础与临床杂志, 2021, 28(4): 508-511.
12.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
13.	Chen CB, Hammo B, Barry J, et al. Overview of Albumin Physiology and its Role in Pediatric Diseases. Curr Gastroenterol Rep, 2021, 23(8): 11.
14.	Ali AM, Kunugi H. Hypoproteinemia predicts disease severity and mortality in COVID-19: a call for action. Diagn Pathol, 2021, 16(1): 31.
15.	Kawai T, Chiba T, Onodera K, et al. Hypoproteinemia Associated with a Gigantic Odontogenic Tumor: A Report of 2 Cases. Am J Case Rep, 2022 Sep 2: 23: e937301.
16.	Truong A, Hanna MH, Moghadamyeghaneh Z, et al. Implications of preoperative hypoalbuminemia in colorectal surgery. World J Gastrointest Surg, 2016, 8(5): 353-362.
17.	焦成功. 结直肠恶性肿瘤围手术期血清白蛋白变化与手术风险的相关性研究. 贵州医科大学, 2022.
18.	Lohsiriwat V, Lohsiriwat D, Boonnuch W, et al. Pre-operative hypoalbuminemia is a major risk factor for postoperative complications following rectal cancer surgery. World J Gastroenterol, 2008, 14(8): 1248-1251.
19.	Ciorogar G, Bartos A, Bartos D, et al. Rectal cancer: factors predicting short outcomes after radical anterior resection. Annali italiani di chirurgia, 2017, 88: 505-13.
20.	Hardt J, Pilz L, Magdeburg J, et al. Preoperative hypoalbuminemia is an independent risk factor for increased high-grade morbidity after elective rectal cancer resection. Int J Colorectal Dis, 2017, 32(10): 1439-1446.
21.	Kudsk KA, Tolley EA, DeWitt RC, et al. Preoperative albumin and surgical site identify surgical risk for major postoperative complications. JPEN J Parenter Enteral Nutr, 2003, 27(1): 1-9.
22.	Zaharie F, Mocan L, Tomus C, et al. [Risk factors for anastomotic leakage following colorectal resection for cancer] [J]. Chirurgia(Bucharest, Romania : 1990), 2012, 107(1): 27-32.
23.	Pasic F, Salkic NN. Predictive score for anastomotic leakage after elective colorectal cancer surgery: a decision making tool for choice of protective measures. Surg Endosc, 2013, 27(10): 3877-3882.
24.	Harvey KB, Moldawer LL, Bistrian BR, et al. Biological measures for the formulation of a hospital prognostic index. Am J Clin Nutr, 1981, 34(10): 2013-2022.
25.	Sofić A, Rašić I, Halilović E, et al. Is preoperative hypoproteinemia associated with colorectal cancer stage and postoperative complications?. Med Glas (Zenica), 2021, 18(2): 450-455.
26.	Mbagwu C, Sloan M, Neuwirth A L, et al. Preoperative Albumin, Transferrin, and Total Lymphocyte Count as Risk Markers for Postoperative Complications After Total Joint Arthroplasty: A Systematic Review. Journal of the American Academy of Orthopaedic Surgeons Global research & reviews, 2020, 4(9): e19.00057.
27.	Høydahl Ø, Edna TH, Xanthoulis A, et al. The impact of age on rectal cancer treatment, complications and survival. BMC Cancer, 2022, 22(1): 975.
28.	Zeman M, Czarnecki M, Grajek M, et al. Evaluation of risk factors for postoperative complications in rectal cancer patients. Pol Przegl Chir, 2020, 92(5): 1-5.
29.	Jabbal IS, Spaulding AC, Lemini R, et al. Temporary vs. permanent stoma: factors associated with the development of complications and costs for rectal cancer patients. Int J Colorectal Dis, 2022, 37(4): 823-833.
30.	Bokey L, Chapuis PH, Dent OF. Impact of obesity on complications after resection for rectal cancer. Colorectal Dis, 2014, 16(11): 896-906.
31.	Zhao H, Liu G, Li Y, et al. Body fat ratio as a novel predictor of complications and survival after rectal cancer surgery. Front Nutr, 2024 Aug 9: 11: 1398807.
32.	Yang PF, Ang ZH, Badiani S, et al. Impact of obesity on patients undergoing surgery for rectal cancer in Australia and New Zealand. Int J Colorectal Dis, 2023, 38(1): 163.
33.	Lv Q, Shu XP, Peng D, et al. Predictors of complications after prophylactic ileostomy reversal for rectal cancer: A retrospective study. World J Gastrointest Surg, 2024, 16(5): 1354-1362.
34.	Hermanek P. pTNM and residual tumor classifications: problems of assessment and prognostic significance. World J Surg, 1995, 19(2): 184-190.
35.	Zhang L, Zheng W, Cui J, et al. Risk factors for nonclosure of defunctioning stoma and stoma-related complications among low rectal cancer patients after sphincter-preserving surgery. Chronic Dis Transl Med, 2020, 6(3): 188-197.
36.	Quintana JM, Anton-Ladislao A, Lázaro S, et al. Predictors of readmission and reoperation in patients with colorectal cancer. Support Care Cancer, 2020, 28(5): 2339-2350.

1. Nacion AJD, Park YY, Yang SY, et al. Critical and challenging issues in the surgical management of low-lying rectal cancer. Yonsei Med J, 2018, 59(6): 703-716.
2. Sturiale A, Martellucci J, Zurli L, et al. Long-term functional follow-up after anterior rectal resection for cancer. Int J Colorectal Dis, 2017, 32(1): 83-88.
3. Gielen AHC, Heuvelings DJI, Sylla P, et al. Impact of anastomotic leakage after colorectal cancer surgery on quality of life: A systematic review. Dis Colon Rectum, 2025, 68(2): 154-170.
4. Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: Pathogenesis and clinical significance. JPEN J Parenter Enteral Nutr, 2019, 43(2): 181-193.
5. Wiedermann CJ. Hypoalbuminemia as surrogate and culprit of infections. Int J Mol Sci, 2021, 22(9): 4496. doi: 10.3390/ijms22094496.
6. 汪晓东, 李立. 数据库建设第一部分: 个人数据的标签与结构化. 中国普外基础与临床杂志, 2019, 26(3): 335-342.
7. 汪晓东, 刘健博, 李立. 数据库建设第三部分: 结直肠癌内外科合并症及术前体质状态的标签与结构化. 中国普外基础与临床杂志, 2019, 26(9): 1110-1115.
8. 汪晓东, 刘健博, 李立. 数据库建设第五部分: 结直肠癌的肿瘤特征—模块的设计(一). 中国普外基础与临床杂志, 2020, 27(3): 345-349.
9. 汪晓东, 刘健博, 李立. 数据库建设第五部分·结直肠癌的肿瘤特征—模块的设计(二). 中国普外基础与临床杂志, 2020, 27(4): 483-488.
10. 汪晓东, 刘健博, 李立. 数据库建设第六部分: 结直肠癌分期的标签与结构化. 中国普外基础与临床杂志, 2020, 27(7): 873-879.
11. 汪晓东, 刘健博, 孟鑫宇, 等. 数据库建设第八部分: 结直肠癌手术反应及围术期并发症的标签与结构化. 中国普外基础与临床杂志, 2021, 28(4): 508-511.
12. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
13. Chen CB, Hammo B, Barry J, et al. Overview of Albumin Physiology and its Role in Pediatric Diseases. Curr Gastroenterol Rep, 2021, 23(8): 11.
14. Ali AM, Kunugi H. Hypoproteinemia predicts disease severity and mortality in COVID-19: a call for action. Diagn Pathol, 2021, 16(1): 31.
15. Kawai T, Chiba T, Onodera K, et al. Hypoproteinemia Associated with a Gigantic Odontogenic Tumor: A Report of 2 Cases. Am J Case Rep, 2022 Sep 2: 23: e937301.
16. Truong A, Hanna MH, Moghadamyeghaneh Z, et al. Implications of preoperative hypoalbuminemia in colorectal surgery. World J Gastrointest Surg, 2016, 8(5): 353-362.
17. 焦成功. 结直肠恶性肿瘤围手术期血清白蛋白变化与手术风险的相关性研究. 贵州医科大学, 2022.
18. Lohsiriwat V, Lohsiriwat D, Boonnuch W, et al. Pre-operative hypoalbuminemia is a major risk factor for postoperative complications following rectal cancer surgery. World J Gastroenterol, 2008, 14(8): 1248-1251.
19. Ciorogar G, Bartos A, Bartos D, et al. Rectal cancer: factors predicting short outcomes after radical anterior resection. Annali italiani di chirurgia, 2017, 88: 505-13.
20. Hardt J, Pilz L, Magdeburg J, et al. Preoperative hypoalbuminemia is an independent risk factor for increased high-grade morbidity after elective rectal cancer resection. Int J Colorectal Dis, 2017, 32(10): 1439-1446.
21. Kudsk KA, Tolley EA, DeWitt RC, et al. Preoperative albumin and surgical site identify surgical risk for major postoperative complications. JPEN J Parenter Enteral Nutr, 2003, 27(1): 1-9.
22. Zaharie F, Mocan L, Tomus C, et al. [Risk factors for anastomotic leakage following colorectal resection for cancer] [J]. Chirurgia(Bucharest, Romania : 1990), 2012, 107(1): 27-32.
23. Pasic F, Salkic NN. Predictive score for anastomotic leakage after elective colorectal cancer surgery: a decision making tool for choice of protective measures. Surg Endosc, 2013, 27(10): 3877-3882.
24. Harvey KB, Moldawer LL, Bistrian BR, et al. Biological measures for the formulation of a hospital prognostic index. Am J Clin Nutr, 1981, 34(10): 2013-2022.
25. Sofić A, Rašić I, Halilović E, et al. Is preoperative hypoproteinemia associated with colorectal cancer stage and postoperative complications?. Med Glas (Zenica), 2021, 18(2): 450-455.
26. Mbagwu C, Sloan M, Neuwirth A L, et al. Preoperative Albumin, Transferrin, and Total Lymphocyte Count as Risk Markers for Postoperative Complications After Total Joint Arthroplasty: A Systematic Review. Journal of the American Academy of Orthopaedic Surgeons Global research & reviews, 2020, 4(9): e19.00057.
27. Høydahl Ø, Edna TH, Xanthoulis A, et al. The impact of age on rectal cancer treatment, complications and survival. BMC Cancer, 2022, 22(1): 975.
28. Zeman M, Czarnecki M, Grajek M, et al. Evaluation of risk factors for postoperative complications in rectal cancer patients. Pol Przegl Chir, 2020, 92(5): 1-5.
29. Jabbal IS, Spaulding AC, Lemini R, et al. Temporary vs. permanent stoma: factors associated with the development of complications and costs for rectal cancer patients. Int J Colorectal Dis, 2022, 37(4): 823-833.
30. Bokey L, Chapuis PH, Dent OF. Impact of obesity on complications after resection for rectal cancer. Colorectal Dis, 2014, 16(11): 896-906.
31. Zhao H, Liu G, Li Y, et al. Body fat ratio as a novel predictor of complications and survival after rectal cancer surgery. Front Nutr, 2024 Aug 9: 11: 1398807.
32. Yang PF, Ang ZH, Badiani S, et al. Impact of obesity on patients undergoing surgery for rectal cancer in Australia and New Zealand. Int J Colorectal Dis, 2023, 38(1): 163.
33. Lv Q, Shu XP, Peng D, et al. Predictors of complications after prophylactic ileostomy reversal for rectal cancer: A retrospective study. World J Gastrointest Surg, 2024, 16(5): 1354-1362.
34. Hermanek P. pTNM and residual tumor classifications: problems of assessment and prognostic significance. World J Surg, 1995, 19(2): 184-190.
35. Zhang L, Zheng W, Cui J, et al. Risk factors for nonclosure of defunctioning stoma and stoma-related complications among low rectal cancer patients after sphincter-preserving surgery. Chronic Dis Transl Med, 2020, 6(3): 188-197.
36. Quintana JM, Anton-Ladislao A, Lázaro S, et al. Predictors of readmission and reoperation in patients with colorectal cancer. Support Care Cancer, 2020, 28(5): 2339-2350.

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Latest ArticlesRelation between preoperative hypoproteinemia and postoperative complications in patients with rectal cancer: A real-world data study based on DACCA database

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