Abstract: Objective To investigate the predictive value of postoperative peripheral blood C-reactive protein/albumin ratio (CAR) for short-term complications following radical rectectomy for rectal cancer,and compare the predictive value of CAR versus c-reactive protein. Methods Clinical data about 284 patients undergoing radical rectectomy in the first medical center of Chinese PLA General Hospital from August 2013 to August 2018 were retrospectively analyzed.Univariate and multivariate analyses were performed to identify clinical factors predicting postoperative complications.The receiver operating characteristic (ROC) curves were plotted to evaluate and compare the accuracy of CAR and CRP in predicting early complications,and their cut-off values were calculated.According to the cut-off value of CAR,patients were divided into high CAR group and low CAR group.The complication incidences as well as average postoperative hospital stays between the two groups were compared. Results Of all the patients,58 (20.4%) cases developed postoperative complications.In univariate analysis,the correlations between early postoperative complications after radical rectectomy and sex,postoperative CRP and postoperative CAR were statistically significant (all P<0.05).Multivariate analysis identified that postoperative CAR was an independent risk factor for early postoperative complications (OR95% CI:9.4512.560-34.892,P=0.001).ROC curve analysis showed that the performance of CAR in predicting early postoperative complication was slightly higher than that of postoperative CRP (AUC:0.781 vs 0.766;sensitivity:0.741 vs 0.672;specificity:0.726 vs 0.743;positive predictive value:0.410 vs 0.402;negative predictive value:0.916 vs 0.898).The optimal cut-off value of CAR was 2.29.Compared with the low CAR group (CAR<2.29,n=179),the high CAR group (CAR≥2.29,n=105) had a higher incidence of mild and severe complications (mild:26.7% vs 6.7%,P<0.001;severe:14.3% vs 1.7%,P<0.001) and a longer postoperative hospital stay (MdIQR:98,13 d vs 98,11 d,P=0.024). Conclusion Postoperative CAR is an independent predictor for short-term complications following radical rectectomy for rectal cancer,and it is more suggestive for the occurrence of complications than CRP alone.