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Postoperative Elevation of the Neutrophil: Lymphocyte Ratio Predicts Complications Following Esophageal Resection

World Journal of Surgery volume 40, pages 1397–1403 (2016)Cite this article

Abstract

Background

Complications following esophagectomy are a significant source of morbidity. The aim of this study was to investigate the utility of the neutrophil:lymphocyte ratio (NLR) in the early identification of complications following esophagectomy, as compared to other routinely available parameters.

Methods

We performed a retrospective cohort study of patients undergoing Ivor-Lewis esophagectomy at a single centre. Baseline characteristics and complications occurring within the first 30 days of surgery were recorded. White blood cell counts and C-reactive protein (CRP) levels immediately following surgery (day 0) and over the subsequent three postoperative days were analysed.

Results

Sixty-five patients were included, of whom 29 (45 %) developed complications. The median NLR was similar among patients with and without a complicated recovery on day 0 (12.7 vs 13.6, p = 0.70) and day 1 (10.0 vs 9.3, p = 0.29). Patients who subsequently developed complications had a higher NLR on day 2 (11.8 vs 7.5, p < 0.001) and day 3 (9.0 vs 6.5, p = 0.001) compared to those whose recovery was uncomplicated. Receiver-operating-characteristic plots for the diagnostic performance of the NLR, neutrophil count, lymphocyte count and CRP level at each time point demonstrated that the NLR on day 2 had the greatest discriminatory ability in predicting complications, with an area under the curve of 0.83 (95 % CI 0.73–0.94). An NLR of >8.3 on day 2 had a sensitivity of 93 % and a specificity of 72 % for predicting complications.

Conclusion

The NLR is a simple and routinely available parameter which has a high sensitivity in the early detection of complications following esophagectomy.

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Affiliations

  1. Department of General Surgery, Queen’s Hospital, Rom Valley Way, Romford, RM7 0DG, UK

    Paul Vulliamy, Simon McCluney, Samrat Mukherjee, Luke Ashby & Thangadorai Amalesh

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  1. Paul Vulliamy
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  2. Simon McCluney
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  5. Thangadorai Amalesh
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Correspondence to Paul Vulliamy.

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Vulliamy, P., McCluney, S., Mukherjee, S. et al. Postoperative Elevation of the Neutrophil: Lymphocyte Ratio Predicts Complications Following Esophageal Resection. World J Surg 40, 1397–1403 (2016). https://doi.org/10.1007/s00268-016-3427-z

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Keywords

  • Lymphocyte Count
  • Differential White Blood Cell Count
  • Retrospective Observational Cohort Study
  • Great Discriminatory Ability
  • Complicated Recovery