Association of preoperative systemic inflammation with postoperative complications after colon carcinoma resection

Systemic inflammation may predict poor postoperative outcomes after gastrointestinal cancer surgery. This study aimed to evaluate the association between the preoperative neutrophil-to-lymphocyte ratio and postoperative complications after colon carcinoma resection.

This study retrospectively analyzed all patients who underwent curative colon carcinoma resection at a single tertiary center in Finland between 2014 and 2024. The patients were stratified into low and high (≥4.0) neutrophil-to-lymphocyte ratio groups. Moreover, 90-day postoperative complications and their severity were recorded. Associations between the neutrophil-to-lymphocyte ratio and complications were evaluated using multivariable logistic regression models.

Of the 573 included patients, 232 (40.5%) experienced complications within 90 days, and 8 (1.4%) died. A high (≥4.0) neutrophil-to-lymphocyte ratio, observed in 101 (17.6%) patients, was associated with a significantly increased risk of severe (Clavien-Dindo IV and V) postoperative complications (odds ratio, 3.48; 95% CI, 1.57-7.75), a higher overall complication burden measured with the Comprehensive Complication Index (mean, 17.3 vs 10.7; P =.012), and a greater incidence of medical complications (33.7% vs 21.4%; P =.008). In the multivariable analyzes, a high preoperative neutrophil-to-lymphocyte ratio remained an independent predictor of postoperative complications.

Preoperative neutrophil-to-lymphocyte ratios ≥ 4.0 were associated with a higher risk of 90-day complications, particularly severe and nonsurgical events, after colon cancer resection.