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

Abstract

Introduction: The lymphocytic population, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are prognostic tools predictive of adverse outcomes for several solid tumors and oncologic surgeries, one of which is esophageal adenocarcinoma. Furthermore, delayed resumption of oral feeding postoperatively is associated with significant morbidity. Given the controversies regarding post-op nutritional support in these patients, this study investigates the prognostic role of the lymphocytic percentage, the NLR and the PLR in predicting prolonged length of hospital stay (LOHS) and ICU stay (LOICUS) as well as delayed oral feeding following transhiatal esophagectomy (THE) for adenocarcinoma of the esophagogastric junction (AEG). Methods: 40 consecutive patients who underwent transhiatal esophagectomy performed by a single surgeon for Siewert type II and type III adenocarcinoma of the esophagogastric junction at a tertiary referral center was selected. Retrospective data collection was performed from the patients’ medical records and statistical analysis was performed using Pearson correlation and Student’s T-test and Chi-square testing.Results: An increased LOHS was correlated with a lower preoperative lymphocyte percentage (p=0.043), higher NLR (p=0.010) and PLR (p=0.015), and an increased number of packed red blood cell (PRBCs) transfusions perioperatively (p=0.030). An increased LOICUS was correlated with a lower preoperative lymphocyte percentage (p=0.033), higher NLR (p=0.018) and PLR (p=0.044), an increased number of PRBCs transfusions (p=0.001) and patients’ comorbidities (p<0.05). A delay in feeding resumption was correlated with a lower preoperative lymphocyte percentage (p=0.022), higher NLR (p=0.004) and PLR (p=0.001), an increased PRBCs transfusions (p=0.001) and diabetes mellitus (p=0.033). Multivariate analysis with automatic linear modeling showed that only the preoperative PLR was a powerful predictor for the delay of feeding resumption (p<0.01).Conclusion: The lymphocyte percentage, PLR and NLR are found to be associated with prolonged hospitalization and ICU stay, delayed oral feeding following THE for Siewert type II and III AEG. We hope by this series, to have set, at least one preliminary cornerstone, in the creation of a prognostic model, capable of assessing the need for an intraoperative jejunostomy placement, in patients undergoing esophagectomy for distal esophageal carcinoma.

Prognostic Value of Preoperative Serological Biomarkers in Patients Undergoing Curative-Intent Cytoreductive Surgery for Colorectal Cancer Peritoneal Metastases

“…Neutrophils, on the other hand, can inhibit an adequate antitumoral response by suppressing the activity of lymphocytes, activated T-cells, and NK cells. 24 Therefore, a high NLR may reflect an immune state of decreased antitumoral activity, and increased tumoral stimulation via neutrophil- and macrophage-derived cytokines, interleukins, and tumor growth factors, 15 while a low NLR may be associated with an increased tumor immune surveillance, possibly mediated by tumor infiltrating lymphocytes (TILs). TILs are effective in delaying tumor progression by directly killing tumoral cells (CD8 + cytotoxic T lymphocytes), or by facilitating their detection and destruction (T helper lymphocytes, types 1 and 2), and have been shown to be predictive of good outcomes in many cancers.…”

Platelet-lymphocyte ratio and sepsis outcome in children

“…They showed an increased length of stay for patients with a higher pre-operation PLR value. 18 Even though previous studies did not concern sepsis patients, [17][18] PLR is a widely studied inflammation biomarker in a variety of diseases in which higher PLR value corresponds to a more severe inflammation process.…”