Akihisa Matsuda, MD1, Satoshi Matsumoto, MD1, Nobuyuki Sakurazawa, MD1, Youichi Kawano, MD1, Kumiko Sekiguchi, MD1, Fumihiko Ando, MD1, Masao Miyashita, MD1, Eiji Uchida, MD2. 1Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba Japan, 2Department of Surgery, Nippon Medical School, Tokyo Japan
Backgrounds: Although minimally invasive surgeries have been widespread, postoperative infectious complication (POI), which can increase length of hospital stay, medical cost, and worse survival, is still a major concern among colorectal surgeons. Recent studies demonstrated that simple and low-cost systemic inflammation- and immunologic-based scores (SIIS), such as Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) could be prognostic factors for various cancers. There is recent evidence that relatively newly identified SIIS of the lymphocyte-to-monocyte ratio (LMR) is reported to be an independent predictor of long-term survival for patient underwent colorectal cancer surgery, and the predictive value is superior to established scores. However, the study evaluating LMR as a predictor of short-term postoperative outcomes is lacking. The aim of this study is to investigate the predictive potential of the preoperative LMR on postoperative infectious complications (POI) after laparoscopic colorectal cancer surgery. Methods: This is a retrospective single-institutional cohort study at Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital. Consecutive 211 patients underwent laparoscopic colorectal cancer surgery with primary tumor resection from Jan 2014-Aug 2015 were enrolled. Patients were categorized into two groups (non-POI: n=176) and POI: n=35). The relation of clinicopathologic variables and SIIS including NLR, PLR, and LMR with POI were analyzed and then multivariate logistic regression analysis was conducted. Receiving operator characteristic (ROC) curve analysis was used for determination of cutoff points of preoperative LMR.
Results: In univariate analysis of all patients, sex, body mass index, smoking, conversion to open surgery, surgery duration, transfusion, composite resection, blood albumin level, and preoperative LMR were significantly different between the groups. Other SIIS of NLR and PLR did not significantly differ. The lower LMR (cutoff 3.46), longer surgery duration, and smoking remained to be statistically significant for POI in multivariate analysis (LMR: odds ratio 3.97, 95% confidence interval 1.44-10.9, P=0.008). In the comparison of high and low LMR groups, the low LMR group had more advanced and aggressive tumor characteristics (size, depth, lymph node metastasis, and stage).
Conclusions: This is the first report that the lower LMR is a predictive factor for POI after laparoscopic colorectal cancer surgery, and it may provide additional information for treatment decisions to prevent POI.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80127
Program Number: P328
Presentation Session: Poster (Non CME)
Presentation Type: Poster