Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2024; 16(2): 438-450
Published online Feb 27, 2024. doi: 10.4240/wjgs.v16.i2.438
Preoperative neutrophil-to-lymphocyte ratio predicts symptomatic anastomotic leakage in elderly colon cancer patients: Multicenter propensity score-matched analysis
Chao-Yang Wang, Xiao-Long Li, Xiao-Long Ma, Xiong-Fei Yang, Yong-Yong Liu, Yong-Jiang Yu
Chao-Yang Wang, Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou 730000, Gansu Province, China
Xiao-Long Li, Yong-Jiang Yu, Department of Gastrointestinal Surgery, First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
Xiao-Long Ma, Department of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu Province, China
Xiong-Fei Yang, Department of Anorectology, Gansu Provincial People’s Hospital, Lanzhou 730000, Gansu Province, China
Yong-Yong Liu, Department of General Surgery, The Second Hospital Affiliated to Lanzhou University, Lanzhou 730000, Gansu Province, China
Author contributions: Wang CY and Li XL performed the study conceptualization and design, statistical analysis, and manuscript preparation; Wang CY, Ma XL, and Liu YY contributed to data acquisition; Yang XF, Liu YY, and Yu YJ contributed to data quality assessment; Li XL contributed to data interpretation; Wang CY drafted the initial manuscript; Yu YJ reviewed and revised the paper; and all authors have read and agreed to the published version of the manuscript.
Supported by the Natural Science Foundation of Gansu Province, China, No. 21JR1RA075 and No. 22JR5RA895; and Lanzhou Science and Technology Program, China, No. 2021-1-109.
Institutional review board statement: The study was reviewed and approved by the Medical Ethics Committee of the First Hospital of Lanzhou University (leading center of the study, approval No. LDYYLL-2023-363).
Informed consent statement: The requirement of informed consent was waived by the Medical Ethics Committee of the First Hospital of Lanzhou University due to the retrospective nature of the study and the absence of any risk.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data analyzed in this study is available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong-Jiang Yu, Doctor, MD, Academic Editor, Adjunct Professor, Chief Doctor, Professor, Department of Gastrointestinal Surgery, First Hospital of Lanzhou University, No. 1 Donggang West Road, Lanzhou 730000, Gansu Province, China. ylongy@163.com
Received: October 15, 2023
Peer-review started: October 15, 2023
First decision: December 6, 2023
Revised: December 18, 2023
Accepted: January 15, 2024
Article in press: January 15, 2024
Published online: February 27, 2024
Abstract
BACKGROUND

The neutrophil-to-lymphocyte ratio (NLR), a composite inflammatory biomarker, is associated with the prognosis in patients with colorectal tumors. However, whether the NLR can be used as a predictor of symptomatic postoperative anastomotic leakage (AL) in elderly patients with colon cancer is unclear.

AIM

To assess the role of the NLR in predicting the occurrence of symptomatic AL after surgery in elderly patients with colon cancer.

METHODS

Data from elderly colon cancer patients who underwent elective radical colectomy with anastomosis at three centers between 2018 and 2022 were retrospectively analyzed. Receiver operating characteristic curve analysis was performed to determine the best predictive cutoff value for the NLR. Twenty-two covariates were matched using a 1:1 propensity score matching method, and univariate and multivariate logistic regression analyses were used to determine risk factors for the development of postoperative AL.

RESULTS

Of the 577 patients included, 36 (6.2%) had symptomatic AL. The optimal cutoff value of the NLR for predicting AL was 2.66. After propensity score matching, the incidence of AL was significantly greater in the ≥ 2.66 NLR subgroup than in the < 2.66 NLR subgroup (11.5% vs 2.5%; P = 0.012). Univariate logistic regression analysis revealed statistically significant correlations between blood transfusion intraoperatively and within 2 d postoperatively, preoperative albumin concentration, preoperative prognostic nutritional index, and preoperative NLR and AL occurrence (P < 0.05); multivariate logistic regression analysis revealed that an NLR ≥ 2.66 [odds ratio (OR) = 5.51; 95% confidence interval (CI): 1.50-20.26; P = 0.010] and blood transfusion intraoperatively and within 2 d postoperatively (OR = 2.52; 95%CI: 0.88-7.25; P = 0.049) were risk factors for the occurrence of symptomatic AL.

CONCLUSION

A preoperative NLR ≥ 2.66 and blood transfusion intraoperatively and within 2 d postoperatively are associated with a higher incidence of postoperative symptomatic AL in elderly patients with colon cancer. The preoperative NLR has predictive value for postoperative symptomatic AL after elective surgery in elderly patients with colon cancer.

Keywords: Age, Colon cancer, Anastomotic leak, Neutrophil-to-lymphocyte ratio, Propensity score-matched

Core Tip: The relationship between the preoperative neutrophil-to-lymphocyte ratio (NLR) and postoperative symptomatic anastomotic leakage (AL) in elderly patients with colon cancer was investigated in this study primarily. The findings showed that a higher preoperative NLR corresponded to a greater incidence of postoperative symptomatic AL. Moreover, in elderly patients with colon cancer after elective surgery, the preoperative NLR may serve as a predictor of postoperative symptomatic AL.