Abstract Aim Examining the relationship & outcome between pre operative Neutrophil:Lymphocyte Ratio, Neutrophil:Monocyte Ratio & Lymphocyte:Monocyte Ratio in a cohort of locally advanced complex pelvic tumours, involving the rectum, where the patients underwent resection with curative intent. Methods The retrospective data collected from 2013 to 2022. Cases where rectum resection was not involved were excluded. The Kaplan-Meier curve was employed to estimate the survival function, with overall survival defined as the duration from the date of the first surgery to the date of death from any cause. The final data input point was last attendance at the hospital or the date of death. Disease-free survival was calculated and disease recurrence was determined based on a combination of radiological, histopathological, and/or endoscopic results. Results The data encompassed 72 cases. The male-to-female ratio was 1:0.85. Kaplan-Meier curves were used to calculate over-all disease free survival. Our results from Neut:Lymph ratio did not show any significant correlation in overall survival and disease free survival. For Neut:Monocytes ratio, all cases in our cohort had high ratio but this comparison was not published elsewhere for our comparison. Finally, for Lymph:Monocytes, when compared to Gawiński’s data, our disease free survival was found to be significant at p<0.0425 suggesting that the likelihood of recurrence is high. Our overall survival did not have any significant findings. Conclusions In all cancer cases, the neutrophil-to-monocyte ratio consistently showed high averages, raising the question of whether this ratio could potentially serve as a more effective biomarker. The analysis remains a work in progress with further variables to compare.