Predictive value of pre-operative blood markers in patients undergoing open and laparoscopic curative resection for colorectal cancer

INTRODUCTION: Individual risk prediction tools for post-operative morbidity assessments are increasingly becoming prominent. Blood markers obtained from peripheral blood are an essential part of the systemic inflammatory response and are good indicators of complications. The study aimed to cross-compare the ratio-based pre-operative laboratory parameters to predict post-operative complications (POCs) in patients with curative surgery for colorectal cancer.
METHODS: This retrospective cohort and single-center study evaluated the data of 323 colorectal cancer patients who underwent curative surgery between January 2007 and November 2019 in a tertiary hospital in Istanbul, Turkey. A receiver operating characteristic (ROC) curve was generated to evaluate the ability of laboratory values to predict clinically relevant POCs. The area under the curve was computed to compare the predictive power of the neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelet-lymphocyte ratio (PLR), and CRP-albumin ratio (CAR). Then, the cutoff points were selected as the stratifying values for all four indexes.
RESULTS: Complications developed in 109 (33.7%) of the patients postoperatively. Patients with POC had higher Charlson comorbidity index (CCI) scores and higher intra-operative bleeding. Length of hospital stay was also increased in the POC group. ROC curve analysis revealed that NLR was significantly effective in predicting POC, while LMR, PLR, and CAR were ineffective. According to multivariate analysis, CCI score ≥3, higher IOP-Bleeding, length of stay, and NLR ≥3.00 were independent risk factors influencing the POC.
DISCUSSION AND CONCLUSION: Pre-operative NLR was predictive for POI. LMR, PLR, and CAR did not have any prediction for POC. In addition, CCI score, IOP Bleeding, length of post-operative stay, and pre-operative NLR≥ 3.00 were found to be independent risk factors that influence the occurrence of POC.