Predictive Value of Preoperative Serum Prealbumin Levels for Postoperative Complications and Survival Outcomes in Patients Undergoing Surgery for Malignant Bowel Obstruction: A Comprehensive Analysis

Abstract Background Malignant bowel obstruction (MBO) is a common complication in advanced abdominal cancer patients, characterized by a high overall incidence and poor prognosis. Postoperative complications are particularly frequent, with a low postoperative survival rate. The preoperative nutritional status of patients, especially the prealbumin (PA) levels, is significantly correlated with postoperative issues and long-term prognosis. This study aimed to assess the predictive value of the preoperative prealbumin (PA) concentration for postoperative complications and long-term survival in patients with malignant bowel obstruction (MBO). Methods Single-factor and multifactor logistic regression analyses were performed to identify independent risk factors for severe complications and infectious complications. Moreover, univariate and multivariate stratified Cox regression analyses were employed to identify independent risk factors for overall survival (OS), and corresponding nomograms were created. Kaplan-Meier survival curves were generated for grouped data with statistically significant differences. The area under the curve (AUC) was compared to assess the testing efficacy of different nutritional indicators for severe postoperative complications. Results There was a statistically significant difference in the comparison of overall complications and infectious complications between the two groups for different Clavien-Dindo (CD) grades (p < 0.001). Specifically, the incidence of complications with CD grade ≥ 3 in the superlow PA group was higher (p<0.001), and a gradual increase in the severity of overall and postoperative infectious complications was observed with decreasing PA levels (p < 0.001). PA (p < 0.001) and intestinal stent placement (p = 0.015) were identified as independent influencing factors for early postoperative severe complications (CD grade ≥ 3), while PA was identified as an independent influencing factor for postoperative infectious complications (p < 0.001). Cox regression analysis stratified by TNM stage revealed that age, sex, surgical method, and postsurgical chemotherapy were independent predictors of OS. Compared to indicators such as the FPR and AFP, PA demonstrated the highest testing efficiency (AUC = 0.888). Conclusion Preoperative PA has significant predictive value for early postoperative complications and overall survival in patients with MBO, providing new insights into perioperative nutritional intervention and surgical approach selection for these patients.