LYMPHOCYTE-WHITE CELL COUNT RATIO AS A NOVEL MARKER OF MORBIDITY IN PATIENTS UNDERGOING ELECTIVE SURGERY FOR COLORECTAL CANCER
Jia Jun Ang*, Daryl K. Chia, Dedrick Kok Hong Chan
National University Health System (NUHS), Singapore, Singapore
BACKGROUND
Despite improvements in peri-operative optimization for elective colorectal surgery, some patients still experience poor outcomes. This study aims to determine if clinical and nutritional indices are associated with increased morbidity in a cohort of patients undergoing elective surgery for colorectal cancer.
METHODS
A prospective cohort of patients who underwent elective surgery for colorectal cancer was reviewed. Demographic data, preoperative indices and morbidity data were collected. Patients who had surgical site infections, anastomotic leak, prolonged ileus, urinary/pulmonary infections, venous thromboembolism or major cardiac events were considered to have clinically significant morbidity. Major morbidity was defined as Clavien-Dindo grade greater than three. Subgroup analysis was performed in patients with any morbidity, multiple morbidity (>1) and major morbidity using SPSS v23.0.
RESULTS
Of 177 patients, 31.6% (56/177) suffered at least one morbidity, 15.3% (27/177) had >1 morbidity, 7.9% (14/177) suffered major morbidity and 8.5% (15/177) anastomotic leaks were observed. Baseline demographic and clinical characteristics were similar between patient in the morbidity and no morbidity group. On univariate analysis, patients in the morbidity group were more likely to have received neoadjuvant therapy (Morbidity vs. No morbidity, 33.9% versus 14.0%, p=0.003), have a lower lymphocyte count (1.51±0.783 versus 1.84±0.894, p=0.015), lower lymphocyte/white cell count ratio (LWR) (0.22±0.09 versus 0.26±0.11, p=0.020) and have longer operative times (342.0±176.0 versus 264.8±112.6 min, p=0.001) (Table 2). The mean neutrophil/lymphocyte ratio (NLR) was higher in patients who experienced morbidity but did not reach statistical significance (4.43±6.06 versus 2.87±1.37, p=0.062). Patients who experienced any morbidity were also more likely to have undergone surgery lasting more than 270 minutes. 55.4% vs. 37.2%, p=0.033) (Table 2). Further multivariate analysis showed that only LWR <0.180 was associated with increased likelihood of any morbidity. (OR 2.5, 95% CI 1.2-5.3, p=0.018) On subgroup analysis, a lower LWR was also observed in patients who experienced >1 morbidity (0.213±0.092 versus 0.255±0.102, p=0.046) and major morbidity (0.188±0.099 versus 0.254±0.100, p=0.019).
CONCLUSION
Preoperative LWR was significantly lower in patients who suffered any morbidity, >1 morbidity and major morbidity after elective surgery for colorectal cancer. Patients who received neo-adjuvant therapy or had longer operative times were also more likely to experience any morbidity. Patients at high risk for morbidity may benefit from early identification and intervention.
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