The influence of serum cholinesterase level and sarcopenia on postoperative infectious complications in colorectal cancer surgery

Purpose: Cholinesterase is one of nutritional markers which has been associated with sarcopenia. The aim of the present study is to evaluate the relation between cholinesterase and postoperative infectious complications in patients undergoing colorectal resection for colorectal cancer. Methods: The study comprised 231 patients who had undergone colorectal resection for colorectal cancer. We retrospectively investigated the relation between preoperative serum cholinesterase level and postoperative infectious complications (Clavien-Dindo classification ≥ II). Univariate and multivariate analysis were performed to evaluate an independent risk factor for postoperative infectious complications. We then performed stratified analyses to assess the interaction between cholinesterase and clinical variables for predicting postoperative infectious complications. Results: In multivariate analysis, body mass index (P=0.010), serum cholinesterase level (P<0.01), sarcopenia (P=0.022) and blood loss (P<0.01) were independent risk factors for postoperative infectious complications. In the cholinesterase-low group, sarcopenia (P<0.01), organ space surgical site infections (P=0.043), pneumonia (P<0.01) and clostridium difficile colitis ((P=0.019) were higher compared with the cholinesterase-high group. In stratified analysis, the association between serum cholinesterase level and postoperative infectious complications differed by the status of sarcopenia (P interaction <0.01). Conclusion: Preoperative serum cholinesterase level may be useful to predict postoperative infectious complications in colorectal cancer surgery. The association differs by the status of sarcopenia, suggesting potential interaction among nutritional markers.