THE ROLE OF NEUTROPHIL-TO-LYMPHOCYTE RATIO (NLR) IN THE DIAGNOSIS OF LOW COLORECTAL ANASTOMOSIS LEAKAGE
Anastomotic leakage (AL) following surgical interventions associated with total mesorectal excision (TME) and formation of fistula is the most common and dangerous complication of this kind of intervention, its incidence is 17 %. OBJECTIVE. Determine diagnostic value of Neutrophil-to-Lymphocyte Rato (NLR) in the diagnosis of low colorectal anastomosis leakage after low anterior resection (LAR). Patients and methods: 100 patients with epithelial tumors of rectum in the period 2013-2016 yy underwent surgery - LAR with colorectal anastomosis and preventive stoma. In patients without clinical symptomsrent genological study was performed in order to identify asymptomatic AL on day 7 after the surgery. An incidence of AL, difference in the levels of NLR in patients with AL and consistent anastomosis, we also assessed sensitivity, specificity, positive (PPV) and negative predictive value (NPV) of these markers. RESULTS. AL was diagnosed in 20 % (20/100): in 11 % (11/100) with clinical manifestations, in 9 % (9/100) - without them (contrast leakage according to X-ray examination). In the group of patients with anastomotic leakage, the median of NLR differed from that in patients without compromised integrity of anastomosis at both postoperative day 3 (7,1 vs 5,7, respectively, ((t-test) p=0,042) and postoperative day 6 (6,8 vs 4.4, respectively, ((t-test) p=0,004). Conclusion: an incidence of anastomotic leakage was 20 %, but only 11 % of the patients had clinical manifestations. Changes in the level of NLR in the postoperative period correlated with the fact of AL.