BACKGROUND: The aim of this study is to investigate the role of the neutrophil-to-lymphocyte ratio (NLR) in predicting anastomotic leak (AL) after esophagectomy for esophageal adenocarcinoma. METHODS: This is a retrospective analysis of a prospectively collected database from the McGill University Health Center. It includes all patients with esophageal adenocarcinoma who underwent esophagectomy between 2005-2016. Patients with chronic infections, concurrent active malignancies and autoimmune conditions were excluded. NLR values were obtained on postoperative days (POD) 0, 1, 2, and 3. Receiver operating characteristic (ROC) study and multivariable logistic analysis were conducted to evaluate the diagnostic value of NLR. RESULTS: Three hundred and thirty patients were included in the study. Of those, 16% developed AL. Mean NLR values on POD 1, 2, and 3 were higher in patients with leaks (20 vs. 14 on POD1 p-value <0.001, 20 vs. 12 on POD2 p<0.001, and 19 vs. 10 on POD3 p<0.001). NLR value on POD3 was associated with AUC of 70% and a negative predictive value of 92.4%. Multivariable analyses identified higher ASA class, increasing NLR trend (between POD1 and POD3), POD1 NLR, POD2 NLR, and POD3 NLR as independent factors associated with AL. CONCLUSIONS: Patients who developed AL demonstrate higher mean NLR values in the early post-operative period with rising trends. Conversely a low NLR is associated with a high negative predictive value for AL. This simple metric allows risk stratification that may guide treatment decisions in esophagectomy patients.
BACKGROUND: The aim of this study is to investigate the role of the neutrophil-to-lymphocyte ratio (NLR) in predicting anastomotic leak (AL) after esophagectomy for esophageal adenocarcinoma. METHODS: This is a retrospective analysis of a prospectively collected database from the McGill University Health Center. It includes all patients with esophageal adenocarcinoma who underwent esophagectomy between 2005-2016. Patients with chronic infections, concurrent active malignancies and autoimmune conditions were excluded. NLR values were obtained on postoperative days (POD) 0, 1, 2, and 3. Receiver operating characteristic (ROC) study and multivariable logistic analysis were conducted to evaluate the diagnostic value of NLR. RESULTS: Three hundred and thirty patients were included in the study. Of those, 16% developed AL. Mean NLR values on POD 1, 2, and 3 were higher in patients with leaks (20 vs. 14 on POD1 p-value <0.001, 20 vs. 12 on POD2 p<0.001, and 19 vs. 10 on POD3 p<0.001). NLR value on POD3 was associated with AUC of 70% and a negative predictive value of 92.4%. Multivariable analyses identified higher ASA class, increasing NLR trend (between POD1 and POD3), POD1 NLR, POD2 NLR, and POD3 NLR as independent factors associated with AL. CONCLUSIONS:Patients who developed AL demonstrate higher mean NLR values in the early post-operative period with rising trends. Conversely a low NLR is associated with a high negative predictive value for AL. This simple metric allows risk stratification that may guide treatment decisions in esophagectomy patients.