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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.