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Preoperative Neutrophil-to-Lymphocyte Ratio may Predict Postoperative Pneumonia in Stage I–III Gastric Cancer Patients After Curative Gastrectomy: A Retrospective Study

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Abstract

Background

Several studies have demonstrated that diverse systemic inflammatory-based prognostic parameters predict a poor prognosis in patients with gastric cancer. However, few studies have focused on the relationships between postoperative complications and systemic inflammatory-based prognostic parameters after curative gastrectomy. We investigated the relationships between postoperative complications and these parameters and assessed the clinical utility of the parameters as predictors of postoperative complications in patients with stage I–III gastric cancer.

Methods

We retrospectively reviewed 300 patients who underwent curative gastrectomy for stage I–III gastric cancer. All postoperative complications were classified as infectious or noninfectious. We evaluated the relationships between postoperative complications and clinical factors, including systemic inflammatory-based prognostic parameters.

Results

In total, 101 patients (33.7%) had postoperative Clavien–Dindo grade II–IV complications, and 54 (18.0%) patients developed infectious complications including pancreatic fistula, pneumonia, anastomotic leak, intra-abdominal abscess, and cholecystitis. The relationships between postoperative complications and systemic inflammatory-based prognostic parameters were evaluated by the areas under the receiver operating characteristic curves. Postoperative pneumonia was identified as the most sensitive complication to the systemic inflammatory-based prognostic parameters. Multivariate analysis revealed that preoperative neutrophil-to-lymphocyte ratio (odds ratio, 14.621; 95% confidence interval, 1.160–184.348; p = 0.038) was an independent predictor of pneumonia.

Conclusions

Preoperative neutrophil-to-lymphocyte ratio may be a useful predictor of postoperative pneumonia in patients with stage I–III gastric cancer after curative gastrectomy.

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Acknowledgements

We thank Angela Morben, DVM, ELS, from Edanz Group (https://en-author-services.edanz.com/ac), for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare Ichikawa Hospital, 6-1-14 Kounodai, Ichikawa, Chiba, 272-0827, Japan

    Mikito Mori, Atsushi Hirano, Kazuo Narushima & Masahiro Yoshida

  2. Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan

    Mikito Mori, Kiyohiko Shuto, Chihiro Kosugi, Masato Yamazaki & Keiji Koda

Authors
  1. Mikito Mori
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  2. Kiyohiko Shuto
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  3. Atsushi Hirano
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  4. Kazuo Narushima
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  5. Chihiro Kosugi
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  6. Masato Yamazaki
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  7. Keiji Koda
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  8. Masahiro Yoshida
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Corresponding author

Correspondence to Mikito Mori.

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The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from each participant included in the study.

Human and animal rights

This study was approved by the Institutional Review Board of International University of Health and Welfare Ichikawa Hospital (Reference No. 89) and Teikyo University (Reference No. 18–171).

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Mori, M., Shuto, K., Hirano, A. et al. Preoperative Neutrophil-to-Lymphocyte Ratio may Predict Postoperative Pneumonia in Stage I–III Gastric Cancer Patients After Curative Gastrectomy: A Retrospective Study. World J Surg 45, 3359–3369 (2021). https://doi.org/10.1007/s00268-021-06264-4

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  • DOI: https://doi.org/10.1007/s00268-021-06264-4

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