Relationship of Neutrophil-to-Lymphocyte Ratio with Anastomosis Leakage as Complication of Colorectal Surgery in Colorectal Cancer Patients

Yuliandar, Anang Auric; Dani, Muhammad Iwan; Suprapto, Bambang; Prihantono, Prihantono

doi:10.31782/ijcrr.2020.122213

Cited by 1 publication

(5 citation statements)

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“…After polling the data of 12 studies [ 4 , 15 – 25 ], we found that NLR levels were significantly higher in patients undergoing GI surgeries who developed AL than those who did not (random-effects model: SMD = 0.75, 95% CI = 0.11–1.38, p = 0.02). We used a random effect model in our meta-analysis, because a significant heterogeneity was observed across the studies (I 2 = 96.1%, p < 0.01; Fig.…”

Section: Resultsmentioning

confidence: 99%

“…We found no further relevant studies in grey literature and handsearching. After excluding irrelevant studies and duplicates, we included 12 studies in the present systematic review and meta-analysis for a total of 2940 patients undergoing GI surgeries, of whom 353 developed AL [4,[15][16][17][18][19][20][21][22][23][24][25]. The PRISMA flow diagram in Fig.…”

Section: Identification Of Relevant Studiesmentioning

confidence: 99%

“…In terms of study design, there were two prospective and 10 retrospective studies. Studies were conducted in China(n = 3) [17,18,25], Italy (n = 2) [19,22], Romania(n = 2) [4,20], Japan(n = 2) [23,24], Indonesia(n = 1) [15], Turkey(n = 1) [16], and Mexico(n = 1) [21]. So, there were six studies on white people, with 2106 patients, of whom 200 developed AL [4,16,[19][20][21][22], and six studies on East Asian people, with 834 patients, of whom 153 developed AL [15,17,18,[23][24][25].…”

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

“…Studies were conducted in China(n = 3) [17,18,25], Italy (n = 2) [19,22], Romania(n = 2) [4,20], Japan(n = 2) [23,24], Indonesia(n = 1) [15], Turkey(n = 1) [16], and Mexico(n = 1) [21]. So, there were six studies on white people, with 2106 patients, of whom 200 developed AL [4,16,[19][20][21][22], and six studies on East Asian people, with 834 patients, of whom 153 developed AL [15,17,18,[23][24][25]. Four studies, with 513 patients, of whom 67 developed AL, included patients undergoing gastric surgery [4,16,21,22], four studies, with 1783 patients, of whom 168 developed AL, included patients undergoing colorectal surgery [15,19,21,24], and four studies, including 644 patients, of whom 118 developed AL, were on esophageal surgery [17,18,23,25].…”

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

“…So, there were six studies on white people, with 2106 patients, of whom 200 developed AL [4,16,[19][20][21][22], and six studies on East Asian people, with 834 patients, of whom 153 developed AL [15,17,18,[23][24][25]. Four studies, with 513 patients, of whom 67 developed AL, included patients undergoing gastric surgery [4,16,21,22], four studies, with 1783 patients, of whom 168 developed AL, included patients undergoing colorectal surgery [15,19,21,24], and four studies, including 644 patients, of whom 118 developed AL, were on esophageal surgery [17,18,23,25]. All of them were written in English.…”

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

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Systematic review of the significance of neutrophil to lymphocyte ratio in anastomotic leak after gastrointestinal surgeries

Haghi,

Khanzadeh,

Sarejloo

et al. 2024

BMC Surg

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Introduction The inflammatory response is thought to be a critical initiator of epigenetic alterations. The neutrophil to lymphocyte ratio (NLR), a biomarker of inflammation, is computed by dividing the number of neutrophils by the number of lymphocytes. The primary goal of this systematic review and meta-analysis was to evaluate the pre-operative NLR of gastrointestinal surgery patients who had an anastomotic leak (AL) in comparison to those who did not AL. Methods We performed a comprehensive search for relevant papers published before May 4, 2022, using PubMed, Scopus, and Web of Science. Standardized mean difference (SMD) with a 95% confidence interval (CI) was pooled in meta-analysis to yield a summary estimate. We utilized the random-effects model to create pooled effects since we discovered a substantial heterogeneity level. For evaluating quality, the Newcastle-Ottawa scale (NOS) was implemented. Results The research comprised 12 studies with a total of 2940 individuals who had GI operations, 353 of whom went on to develop AL. We discovered that patients who had GI surgeries and acquired AL had significantly higher NLR levels than those who did not (random-effects model: SMD = 0.75, 95% CI = 0.11–1.38, p = 0.02). Patients with AL showed significantly higher NLR levels than control group in retrospective studies (SMD = 0.93, 95% CI = 0.20–1.66, p=0.01) but not in prospective studies (SMD = − 0.11, 95% CI = − 0.65–0.43, p = 0.69), according to the subgroup analysis based on research design. Subgroup analysis based on ethnicity yielded that white patients with AL exhibited significantly higher NLR values than the control group (SMD = 1.35, 95% CI = 0.01–2.68, p = 0.04) but this result was not applied to East Asian patients (SMD = 0.14, 95% CI = -0.13–0.41, p = 0.29). Conclusion Our research suggests a potential association between preoperative NLR and postoperative AL. However, it is essential to acknowledge the variability in the findings, with significantly higher NLR levels observed in retrospective studies and among white patients, but not consistently replicated in prospective studies and among East Asian patients. Further investigations with larger and more diverse cohorts are warranted to validate these findings and explore potential factors contributing to the observed discrepancies.

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Section: Resultsmentioning

confidence: 99%