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Background <p>Postoperative inflammation is critical determinant of recovery and outcomes in patients undergoing locally advanced rectal cancer (LARC) surgery. Early biomarkers such as neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR) ratios may predict short-term complications. This study aimed to assess association between postoperative NLR and PLR and early postoperative complications in LARC patients.</p> Methods <p>In this retrospective cohort study, 261 LARC patients undergoing curative-intent resection (2014–2024) at King Hussein Cancer Center were included. Postoperative Day 1 NLR and PLR were extracted from laboratory records, and 30-day complications from electronic medical records. Mann–Whitney U tests, logistic regression, and ROC curve analysis were used to assess the predictive value of these markers.</p> Results <p>Among 261 patients, 39.1% (<i>n</i> = 102) experienced at least one postoperative complication. The most frequent complications were stoma-related issues (24.1%), followed by surgical site infection (7.3%), anastomotic leak (3.4%), bleeding (3.1%), and venous thromboembolism (1.9%). Readmission and reoperation rates were 3.8% and 2.7%, respectively. Patients with complications had significantly higher inflammatory marker levels, including median NLR (4.92 vs. 2.88) and PLR (317.32 vs. 202.88), both <i>p</i> &lt; 0.001. ROC analysis identified cutoff points of 4.96 for NLR and 185.99 for PLR. In multivariable logistic regression, elevated NLR independently predicted postoperative complications (OR = 3.0; 95% CI: 1.56–5.76), adjusting for clinical and treatment-related factors. Subgroup analysis showed lower postoperative inflammatory markers among patients receiving total neoadjuvant therapy (TNT) compared with chemoradiotherapy (CCRT), and among those undergoing minimally invasive surgery (MIS) compared with open surgery (all <i>p</i> &lt; 0.001).</p> Conclusion <p>NLR and PLR are early predictors of postoperative complications in LARC surgery, while TNT and MIS reduce inflammatory response and complications. Monitoring these markers may improve risk stratification and patient management.</p>

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Early postoperative neutrophil to lymphocyte and platelet to lymphocyte ratios predict postoperative complications after curative surgery for locally advanced rectal cancer

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月16日

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  • Mahmoud Al-Masri,
  • Yasmin Safi,
  • Mohammad Almasri,
  • Ramiz Kardan,
  • Daliana Mustafa,
  • Bilal Kahalah,
  • Ola Ramadan,
  • Rama Almasri

摘要

Background

Postoperative inflammation is critical determinant of recovery and outcomes in patients undergoing locally advanced rectal cancer (LARC) surgery. Early biomarkers such as neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR) ratios may predict short-term complications. This study aimed to assess association between postoperative NLR and PLR and early postoperative complications in LARC patients.

Methods

In this retrospective cohort study, 261 LARC patients undergoing curative-intent resection (2014–2024) at King Hussein Cancer Center were included. Postoperative Day 1 NLR and PLR were extracted from laboratory records, and 30-day complications from electronic medical records. Mann–Whitney U tests, logistic regression, and ROC curve analysis were used to assess the predictive value of these markers.

Results

Among 261 patients, 39.1% (n = 102) experienced at least one postoperative complication. The most frequent complications were stoma-related issues (24.1%), followed by surgical site infection (7.3%), anastomotic leak (3.4%), bleeding (3.1%), and venous thromboembolism (1.9%). Readmission and reoperation rates were 3.8% and 2.7%, respectively. Patients with complications had significantly higher inflammatory marker levels, including median NLR (4.92 vs. 2.88) and PLR (317.32 vs. 202.88), both p < 0.001. ROC analysis identified cutoff points of 4.96 for NLR and 185.99 for PLR. In multivariable logistic regression, elevated NLR independently predicted postoperative complications (OR = 3.0; 95% CI: 1.56–5.76), adjusting for clinical and treatment-related factors. Subgroup analysis showed lower postoperative inflammatory markers among patients receiving total neoadjuvant therapy (TNT) compared with chemoradiotherapy (CCRT), and among those undergoing minimally invasive surgery (MIS) compared with open surgery (all p < 0.001).

Conclusion

NLR and PLR are early predictors of postoperative complications in LARC surgery, while TNT and MIS reduce inflammatory response and complications. Monitoring these markers may improve risk stratification and patient management.