Lymphocyte Count and Platelet Volume Predicts Postoperative Complications in Esophagectomy for Cancer: A Cohort Study

Abstract

BACKGROUND: Biomarkers from routine complete blood count are known predictive factors of long-term outcomes in cancer patients. The value of these biomarkers in the setting of trimodal therapy for esophageal cancer in predicting early postoperative outcomes is not studied. OBJECTIVE: The present study evaluated the value of cellular blood components changes during neoadjuvant chemoradiotherapy followed by curative intent esophagectomy for cancer in predicting postoperative mortality and morbidity. METHODS: A cohort of 149 consecutive patients that underwent chemoradiotherapy using platinum- and taxane-based regimens followed by esophagectomy was analyzed. Cellular components of blood collected before neoadjuvant therapy (period A) and before surgery (period B) were assessed for postoperative mortality and complications. Univariate and multivariate Cox regression models were applied to evaluate the independent prognostic significance of blood count variables. RESULTS: Postoperative morbidity was present in 46% of the patients. On multiple regression analysis platelet volume (B) (OR: 1.53; 95% CI: 1.2-2.33) was an independent predictor of general complications. Severe postoperative surgical complications were present in 17% of the patients. On multiple regression analysis, lymphocyte decrease between B-A periods (OR: 0.992; 95% CI: 0.990-0.997) was related to higher risk for severe complications. Cervical anastomotic leakage was present in 25.6% of the patients. On univariate analysis eosinophil count in A and B periods was related to cervical anastomotic leakage. For this outcome, multivariate joint model could not identify independent risk variables of cellular components of blood. The 30-day mortality rate was 7.4%. On univariate analysis, platelet count in period B was associated to higher risk for mortality. The multivariate joint model could not accurately predict mortality due to the few number of patients in the mortality group. CONCLUSION: This is the first study to assess the relationship between peripheral blood count variables changes during neoadjuvant chemoradiotherapy using a platinum- and taxane-based regimen followed by curative intent esophagectomy for cancer in predicting postoperative complications. The platelet volume prior to surgery is related to postoperative complications and the lymphocyte count change prior to surgery predicts severe postoperative complications in the setting of trimodal therapy for esophageal cancer.

Platelet to Lymphocyte Ratio is Correlated with a Delay in Feeding Resumption Following a Transhiatal Esophagectomy With Cervical Anastomosis

“…Overall morbidity in head and neck surgery is also re ected by elevated PLR and NLR, as reported by Maruyama et al [27]. In esophageal cancer, Vulliamy et al demonstrated that NLR can predict post-esophagectomy complications [28], however Testumi et al refuted such a claim [5].…”

“…Current research trends aim at identifying factors predictive of the postoperative course of patients undergoing major abdominal oncologic surgery to better anticipate adverse events and improve the quality of care these patients receive. The association between such factors and multiple solid tumors have been investigated, chief of which is AEG [3][4][5][6].…”

“…They are, however, not without controversy. Though hematologic tests and ratios re ective of clinical and subclinical in ammation such as the lymphocyte percentage, the neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) have been demonstrated to be signi cantly associated with adverse perioperative outcomes in some studies, other studies reveal no statistical signi cance [3,5,6].…”

Platelet to Lymphocyte Ratio is Correlated with a Delay in Feeding Resumption Following a Transhiatal Esophagectomy With Cervical Anastomosis

“…Tumor-associated in ammation is an emerging eld of interest and debate due to its implications on tumor progression and, subsequently, patient prognosis [3]. The association between such factors and multiple solid tumors has been investigated, with numerous studies done on AEG [4][5][6][7]. The conclusions of these studies, however, remain debatable.…”

“…The conclusions of these studies, however, remain debatable. Lymphocyte percentage, the neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR), which can be obtained from routine hematologic bloodwork, are markers of clinical and subclinical in ammation that have been both shown to be predictive of adverse perioperative outcomes in some studies and of no statistically signi cant utility in other studies [4,6,7].…”