Lymphocyte-to-monocyte Ratio Predicts Small-bowel Obstruction after Laparoscopic Colon Cancer Surgery

Small-bowel obstruction (SBO) is a postoperative complication caused by postcolorectal surgery adhesions. Laparoscopy reduces its incidence, and systemic inflammation may contribute to adhesion formation. This study aimed to determine if preoperative inflammation-based markers are associated with SBO development after laparoscopic colon cancer surgery.

This retrospective study included 539 patients who underwent elective laparoscopic colon cancer surgery from 2017 to 2021. Demographics, surgical variables, and preoperative inflammation-based markers-including C-reactive protein (CRP), white blood cell (WBC) count, platelet-to-lymphocyte ratio (PLR), the lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), and prognostic nutritional index (PNI)-were assessed. SBO was defined as a clinically and radiologically confirmed adhesive ileus.

Fifteen patients (2.8%) developed SBO. Receiver operating characteristic curve analysis was performed for BMI and all preoperative inflammatory markers. This analysis identified body mass index (BMI) ≤21.61, LMR ≤2.38, and NLR ≥3.07 as optimal cutoffs. CRP and WBC count showed low AUCs (0.560 and 0.580, respectively) and were not significant risk factors for SBO. Univariate analysis demonstrated that low BMI, low LMR, high NLR, stoma construction, and intra-abdominal infectious complications were significantly associated with SBO development. Multivariate logistic regression analysis identified low BMI (p = 0.022), low LMR (p = 0.047), and intra-abdominal infectious complications (p < 0.001) as independent predictors; PNI trend was not significant.

Low BMI, low LMR, and postoperative intra-abdominal infection were associated with postoperative SBO after minimally invasive colon cancer surgery.