Association between preoperative HALP score and anastomotic leakage following colorectal cancer resection: A retrospective cohort study

Objective: Anastomotic leakage remains a major complication following colorectal surgery. This study aimed to evaluate the association between the preoperative hemoglobin, albumin, lymphocyte, and platelet (HALP) score and postoperative anastomotic leakage in patients undergoing colorectal cancer resection. Material and Methods: This single-center retrospective cohort study included 505 patients who underwent colorectal resection with primary anastomosis for stage II-III colorectal cancer. The association between preoperative HALP score and anastomotic leakage was evaluated using univariable analyses and receiver operating characteristic (ROC) analysis. A multivariable logistic regression model adjusted for age and tumor location was fitted, and Firth's penalized likelihood estimation was used for the adjusted analysis because of the limited number of events. The study is reported in accordance with the strengthening the reporting of observational studies in epidemiology statement. Results: Anastomotic leakage occurred in 18 patients (3.6%). Patients who developed leakage had significantly lower preoperative HALP scores than those without leakage [median 18.0 (10.8-33.3) vs. 34.5 (16.6-90.4); p<0.001]. ROC analysis demonstrated good discriminative ability (area under the curve =0.877; 95% confidence interval, 0.802-0.951; p<0.001). The Youden-derived cut-off value of 22.1 yielded a sensitivity of 72.2% and a specificity of 85.0%. In the Firth penalized multivariable logistic regression model, a higher HALP score remained independently associated with lower odds of anastomotic leakage after adjustment for age and tumor location (adjusted odds ratio, 0.83 per 1-unit increase; 95% confidence interval, 0.76-0.91; p<0.001). Given the limited number of leakage events, these findings should be interpreted as exploratory. Conclusion: Lower preoperative HALP scores were associated with postoperative anastomotic leakage. Because of the retrospective study design, these findings should be interpreted as exploratory and require confirmation in larger prospective multicenter studies.