Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio can Predict Post-operative Complications and Mortality in Patients with Operable Esophageal and Gastric Malignancies

Aims: Postoperative complications are a major concern following surgery for upper GI malignancies. Studies have shown that high levels of preoperative inflammatory markers have a poor prognosis. However, the relationship between preoperative platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR) and postoperative complications after curative resection is unclear. This study aimed to evaluate the efficacy of PLR and NLR in predicting clinical outcomes and postoperative complications in these patients.

Study Design: Single-center prospective observational study

Place and Duration of Study: Sample: Department of Surgical Gastroenterology, Tirunelveli Medical College, between January 2021 and December 2022.

Methodology: This single-center prospective study included 70 patients out of which 55 with gastric cancer underwent D2 gastrectomy and 15 with esophageal cancer underwent transhiatal esophagectomy. We evaluated the relationship between PLR and NLR and postoperative complications (≥grade 1 Clavien-Dindo classification). Using a receiver operating characteristic curve, the area under the curve (AUC) for each parameter was calculated and the power to predict postoperative complications was compared.

Results: 35.71% patients experienced postoperative complications. The AUC values of NLR (0.825) and PLR (0.161) were higher when compared to other preoperative tests in predicting postoperative complications. The optimal cut-off for NLR was 1.71 (sensitivity 96% and specificity 84.4%) and for PLR was 0.56 (sensitivity 20% and specificity 84.4%). Patients in the high NLR group had an increased incidence of complications when compared to the low NLR group. 74% in the low PLR group experienced complications, whereas only 11.6% in the high PLR group experienced grade 1 or higher complications.

Conclusion: Both NLR and PLR may serve as valuable indicators of potential postoperative complications for patients receiving surgery for operable gastric and esophageal cancers.