Minimally Invasive Colectomy Contributes to Decreasing Postoperative Morbidity in Patients With High Naples...

The Naples prognostic score (NPS), based on nutritional and inflammatory status, may predict postoperative morbidity after colorectal cancer surgery. Minimally invasive colectomy (MIC) may improve short-term outcomes; however, whether MIC lowers morbidity in patients with a high NPS remains unknown. The current study examined the effects of NPS on postoperative morbidity after open colectomy (OC) and MIC.

This retrospective analysis included 139 patients who underwent OC and 117 who underwent MIC for colorectal cancer between January 2013 and March 2020. The NPS is a composite score calculated using albumin and cholesterol concentrations, and lymphocyte: monocyte and neutrophil: lymphocyte ratios. Patients were divided into three groups based on NPS. Groups 1-2 were defined as low-NPS and group 3 as the high-NPS group. The OC and MIC groups were further divided into two subgroups according to whether the NPS was high or low.

The high-NPS groups had significantly higher postoperative morbidity after OC [Clavien-Dindo classification (CDc) ≥II; p=0.022, CDc ≥IIIb; p=0.036]. Multivariate analysis demonstrated that high-NPS was an independent risk factor for postoperative complications (CDc ≥II: hazard ratio=2.40; 95% confidence interval=1.121-5.181; p=0.024 and CDc ≥IIIb: hazard ratio=4.19; 95% confidence interval=1.052-20.619; p=0.042]. Low-NPS did not affect postoperative morbidity after MIC (CDc ≥II; p=0.12, CDc ≥IIIb; p=0.51).

A high NPS led to postoperative morbidity after OC, but not after MIC. MIC may improve short-term outcomes, even in patients with a low NPS.