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

Abstract Purpose: 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. Methods: 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 was a composite score calculated using albumin and cholesterol concentrations, and lymphocyte: monocyte and neutrophil: lymphocyte ratios. Patients were divided into three groups based on increasing 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. Results: 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). Conclusions: 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.