Abstract
Purpose: The neutrophil-to-lymphocyte ratio (NLR) is a marker of inflammation that has been investigated as a prognostic factor in many diseases. We hypothesized that NLR would be lower in patients undergoing minimally invasive distal pancreatectomy (MIDP).Methods: Using a prospective database, we identified patients who underwent open or minimally invasive (laparoscopic/robotic) distal pancreatectomy and splenectomy from 2006 to 2018. Patients were grouped according to their type of surgery and matched by age, gender, and benign or malignant pathology. The NLR was calculated from a complete blood count with differential on the second postoperative day. Statistical calculations were performed in Stata (v13.0).Results: A total of 106 patients were included, with 53 MIDP and 53 open cases. MIDP was associated with a significantly lower postoperative NLR than open surgery (13.3 vs. 17.2, p = 0.01). NLR did not vary significantly between patients who developed complications and those who did not (15.4 vs. 15.3, p = 0.95). Patients undergoing MIDP had decreased length of postoperative hospital stay (4 days vs. 5 days, p = 0.003). Multivariable linear regression failed to find a significant decrease in NLR with the use of laparoscopy (p = 0.14) when accounting for age, body mass index, surgical blood loss, pathology, and operative time as covariates.Conclusion: The NLR is significantly decreased when performing MIDP versus open distal pancreatectomy, but correlation with clinical outcomes has yet to be proven.
Highlights
Excessive activation of the body’s own systemic inflammatory response has been negatively implicated in various disease processes
We hypothesized that neutrophil-to-lymphocyte ratio (NLR) would be lower in patients undergoing minimally invasive distal pancreatectomy (MIDP)
Demographics The study group consisted of 106 age, gender, and pathology-matched patients who underwent distal pancreatectomy and splenectomy during the study period (Table 1)
Summary
Excessive activation of the body’s own systemic inflammatory response has been negatively implicated in various disease processes. As measured by circulating levels of well-known biomarkers such as C-reactive protein (CRP) or erythrocyte sedimentation rate, is associated with increased postoperative complications and decreased cancerspecific survival.[1,2] Laparoscopic and robotic surgery have been associated with a decreased inflammatory response compared with laparotomy according to certain inflammatory markers such as IL-6, TNF-a, and CRP.[3]. There is no accepted ‘‘standard’’ for postoperative NLR as there are for other well-established measures of inflammation, and there have been no studies comparing postoperative NLR between different approaches to the same standard surgical technique, that is, distal pancreatectomy. We secondarily investigated the association between NLR and postoperative complications and outcomes
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