Predictive Significance Of Neutrophil-to-lymphocyte Ratio For Postoperative Complications After Laparoscopic Pancreaticoduodenectomy

Research background:Pancreaticoduodenectomy(PD)was considered as the standard operation for treating patients with resectable cancer of the pancreatic head,lower segment of bile duct and periampullary region.The application of laparoscopic PD(LPD)has been increased rapidly in recent years.The morbidity,mortality,and overall survival outcomes of LPD remains controversial in many studies.With the development of surgical techniques,mortality after PD has reduced significantly to lower than 5%in recent years.However,the morbidity rate of these procedures remains significant,which was as high as 38-44%.It has been proved that severe postoperative complications were associated with poor prognosis.Neutrophil-to-lymphocyte ratio(NLR)has been used as an inflammatory indicator to reflect systemic inflammatory response.NLR can predict morbidity after major abdominal surgery and colorectal surgery.However,application of NLR in patients undergoing LPD remained a lack of research supporting.Research purpose:We performed the analysis between inflammatory indicators and postoperative complications after LPD,and explored predictive significance of NLR for postoperative complications.We explored application of NLR in prevention and treatment of complications,found the ideal cut-off point for NLR,to guide the perioperative treatment.Research methods:The present study analyzed patients underwent LPD in a single center(Shandong Provincial Hospital,Jinan,China)from March 2017 to April 2021.The data of patients’characteristics,factors relating to operation,postoperative complications and histology of tumors were collected.And postoperative inflammatory indicators data for NLR,P-CRP,LMR and CAR on postoperative day(POD)1 and 3 were collected from peripheral blood tests.The efficacy of comprehensive complication index(CCI)and Clavien-Dindo classification was used to describe the postoperative complications of LPD.A ROC curve was created to analyze the measurement’s ability of the inflammatory indicators.Binary logistic regression was conducted for controlling confounding factors.Univariate and multivariate logistic regression analysis were performed to identify the risk factors of each common postoperative complications.Results:Of all 495 patients,the highest CDC grade 0 to V was 52.7%,7.1%,20.2%,14.1%,2.0%,1.8%,0.4%,1.6%respectively.The CCI of 171 patients(34.5%)were higher than 26.2.The rates of common complications such as bile leakage,postoperative pancreatic fistula,postoperative hemorrhage,delayed gastric emptying,and abdominal infection were 14.5%,26.5%,,13.9%,23.3%,38.8%respectively.AUC of NLR on POD3 was 0.647(95%CI:0.597～0.697,p<0.001),which showed highest value of discrimination ability to predict postoperative complications.In multivariate regression analysis,a high NLR levels on POD3(≥11.93)was independently related with occurrence of postoperative complications(OR:2.710,95%CI:1.851-3.968,P<0.001).A high NLR levels on PODS(≥11.93)was still statistically significant in POPF,abdominal infection and PPH(P<0.05)Conclusion:(1)A high NLR levels on POD3(≥11.93)was independently related with occurrence of postoperative complications.Timely treatments and therapeutic interventions are necessary to prevent postoperative complications when NLR increases.(2)CAR,NLR,LMR and P-CRP both showed ability to predict postoperative complications after LPD.And NLR showed highest value of discrimination ability in these inflammatory indicators.(3)A high NLR levels on POD3(≥11.93)was still statistically significant in POPF,abdominal infection and PPH.