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Many recent scores based on the inflammatory response, such as Neutrophil Lymphocyte Ratio (NLR), Platelet Lymphocyte Ratio (PLR), Lymphocyte Monocyte Ratio (LMR) have been demonstrated to have a prognostic value in cancer patients. The ratio between neutrophils and lymphocytes is a very useful tool, most studies admitting its role as a prognostic marker in cancer. We made a retrospective study on 391 patients hospitalized and operated in emergency for complicated colorectal cancer in the Surgery II clinic of the "St. Ap. Andrei" from Galati, Romania, between 2008-2017. We demonstrated that the increased preoperative value of NLR was a negative prognostic factor for long-term survival in patients with complicated colorectal cancer (HR = 7.581, 95% CI = (6.358,9.039) (p = 0.000000)). The cut-off point is > 2.61, with sensitivity of 73.61 and specificity of 100.00. The mean survival time in patients with NLR < = 2.61 was 39,676, 95% CI = (37,189, 42,163) and in those with NLR > 2.61 it was 12,504, 95% CI = (11,747, 13,261), the difference between the survival time of patients with values ​​above the cutoff and below the cutoff being statistically significant (p = 0.000000, Log-Rank).

Background Anastomotic leak (AL) is a common but severe complication after oesophagectomy. It is unknown how to determine the severity of AL objectively at diagnosis. Determining leak severity may guide treatment decisions and improve future research. This study aimed to identify leak-related prognostic factors for mortality, and to develop a Severity of oEsophageal Anastomotic Leak (SEAL) score. Methods This international, retrospective cohort study in 71 centres worldwide included patients with AL after oesophagectomy between 2011 and 2019. The primary endpoint was 90-day mortality. Leak-related prognostic factors were identified after adjusting for confounders and were included in multivariable logistic regression to develop the SEAL score. Four classes of leak severity (mild, moderate, severe, and critical) were defined based on the risk of 90-day mortality, and the score was validated internally. Results Some 1509 patients with AL were included and the 90-day mortality rate was 11.7 per cent. Twelve leak-related prognostic factors were included in the SEAL score. The score showed good calibration and discrimination (c-index 0.77, 95 per cent c.i. 0.73 to 0.81). Higher classes of leak severity graded by the SEAL score were associated with a significant increase in duration of ICU stay, healing time, Comprehensive Complication Index score, and Esophagectomy Complications Consensus Group classification. Conclusion The SEAL score grades leak severity into four classes by combining 12 leak-related predictors and can be used to the assess severity of AL after oesophagectomy.

Background: The increased rates of postoperative mortality after emergency surgery for obstructive colon cancer (OCC) require the use of risk-stratification scores. The study purpose is to external validate the surgical risk calculator (SRC) and the AFC/OCC score and to create a score for risk stratification. Patients and methods: Overall, 435 patients with emergency surgery for OCC were included in this retrospective study. We used statistical methods suitable for the aimed purpose. Results: Postoperative mortality was 11.72%. SRC performance: strong discrimination (AUC = 0.864) and excellent calibration (11.80% predicted versus 11.72% observed); AFC/OCC score performance: adequate discrimination (AUC = 0.787) and underestimated mortality (6.93% predicted versus 11.72% observed). We identified nine predictors of postoperative mortality: age > 70 years, CHF, ECOG > 2, sepsis, obesity or cachexia, creatinine (aN) or platelets (aN), and proximal tumors (AUC = 0.947). Based on the score, we obtained four risk groups of mortality rate: low risk (0.7%)—0–2 factors, medium risk (12.5%)—3 factors, high risk (40.0%)—4 factors, very high risk (84.4%)—5–6 factors. Conclusions: The two scores were externally validated. The easy identification of predictors and its performance recommend the mortality score of the Clinic County Emergency Hospital of Galați/OCC for clinical use.

This study aimed to compare the postoperative and pathological outcomes between CROSS and FLOT in esophageal adenocarcinoma (EAC) patients from an international, multicenter cohort.Ongoing debate exists around optimum approach to locally advanced esophageal adenocarcinoma (EAC), with proponents for perioperative chemotherapy, such as FLOT, or multimodal therapy, in particular the CROSS regimen.Patients undergoing CROSS (n = 350) and FLOT (n = 368), followed by curative esophagectomy for EAC were identified from the Oesophagogastric Anastomosis Audit (OGAA).The 90-day mortality was higher after CROSS than FLOT (5% vs 1%, p = 0.005), even on adjusted analyses (odds ratio (OR): 3.97, CI95%: 1.34 - 13.67). Postoperative mortality in CROSS were related to higher pulmonary (74% vs 60%) and cardiac complications (42% vs 20%) compared to FLOT. CROSS was associated with higher pCR rates (18% vs 10%, p = 0.004) and margin-negative resections (93% vs 76%, p0.001) compared with FLOT. On adjusted analyses, CROSS was associated with higher pCR rates (OR: 2.05, CI95%: 1.26 - 3.34) and margin-negative resections (OR: 4.55, CI95%: 2.70 - 7.69) compared to FLOT.This study provides real-world data CROSS was associated with higher 90-day mortality than FLOT, related to cardio-pulmonary complications with CROSS. These warrant a further review into causes and mechanisms in selected patients, and at minimum suggest the need for strict radiation therapy quality assurance. Research into impact of higher pCR rates and R0 resections with CROSS compared to FLOT on long-term survival is needed.

OBJECTIVE This study aimed to characterize rates and management of anastomotic leak (AL) and conduit necrosis (CN) after esophagectomy in an international cohort. BACKGROUND Outcomes in patients with anastomotic complications of esophagectomy are currently uncertain. Optimum strategies to manage AL/CN are unknown, and have not been assessed in an international cohort. METHODS This prospective multicenter cohort study included patients undergoing esophagectomy for esophageal cancer between April 2018 and December 2018 (with 90 days of follow-up). The primary outcomes were AL and CN, as defined by the Esophageal Complications Consensus Group. The secondary outcomes included 90 day mortality and successful AL/CN management, defined as patients being alive at 90 day post-operatively, and requiring no further AL/CN treatment. RESULTS This study included 2247 esophagectomies across 137 hospitals in 41 countries. The AL rate was 14.2% (n = 319) and CN rate was 2.7% (n = 60). The overall 90-day mortality rate for patients with AL was 11.3%, and increased significantly with severity of AL (Type 1: 3.2% vs. Type 2: 13.2% vs. Type 3: 24.7%, p < 0.001); a similar trend was observed for CN. Of the 329 patients with AL/CN, primary management was successful in 69.6% of cases. Subsequent rounds of management lead to an increase in the rate of successful treatment, with cumulative success rates of 85.4% and 88.1% after secondary and tertiary management, respectively. CONCLUSION Patient outcomes worsen significantly with increasing AL and CN severity. Re-intervention after failed primary anastomotic complication management can be successful, hence surgeons should not be deterred from trying alternative management strategies.