The Inflammatory Biomarkers Prognostic Index (IBPI) obtained from standard preoperative blood tests predicts postoperative complications in patients undergoing pelvic exenteration for locally recurrent rectal cancer.

Pelvic exenteration (PE) for local recurrent rectal cancer (LRRC) is associated with high morbidity and mortality rates. Recent interest has focused on the relationship between the inflammatory response and outcomes in surgical oncology. The Inflammatory Biomarkers Prognostic Index (IBPI) was calculated and validated in retroperitoneal sarcoma (RPS) as a useful predictive tool for overall survival (OS) and postoperative complications. The study included all consecutive patients with LRRC who underwent surgery with curative intent between January 2009 and December 2025 at a tertiary cancer center.

The primary outcome is the correlation between the IBPI and 30-day postoperative complications measured with the Comprehensive Complications Index (CCI). The secondary outcomes were the correlation between the IBPI and 30-, 90-day or 1-year mortality, readmission or reoperation within 30 days after discharge and overall survival (OS). Sixty-six consecutive patients treated with PE for LRRC met the inclusion criteria and were analyzed. IBPI is highly predictive of postoperative complications (Coeff: 7.89, p = 0.008, 95% CI 2.14-13.63).

The correlation between IBPI and complications is even more significant when considering only severe complications (CCI >42.3%: OR 3.33, p = 0.006, 95% CI 1.40-7.90), particularly when IBPI>2 (OR 6.00, p = 0.003, 95% CI 1.82-19.80). The IBPI is an easily available score and can very well predict the occurrence of complications after pelvic exenteration for LRRC. Differently from RPS, IBPI did not demonstrate a prognostic role in terms of OS.