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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 9/2017

01-09-2017 | Gastrointestinal Oncology

The Granulocyte-to-Lymphocyte Ratio as a Marker of Surgical Stress and a Predictor of Postoperative Infectious Complications After Gastric Cancer Surgery: An Analysis of Patients Enrolled in a Prospective Randomized Trial

Authors: Jun Lu, MD, PhD, Hao Liu, MD, PhD, Long-long Cao, MD, Chao-hui Zheng, MD, PhD, Ping Li, MD, PhD, Jian-wei Xie, MD, PhD, Jia-bin Wang, MD, PhD, Jian-xian Lin, MD, PhD, Qi-yue Chen, MD, Mi Lin, MD, Ru-hong Tu, MD, Guo-xin Li, MD, PhD, Chang-ming Huang, MD, PhD

Published in: Annals of Surgical Oncology | Issue 9/2017

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Abstract

Background

The granulocyte-to-lymphocyte ratio (GLR) in the blood may be a useful marker of surgical stress (SS) following surgery for cancer. The aim of the present study was to compare the SS by measuring the GLR, and further study the value of the GLR in predicting postoperative infectious complications (ICs).

Methods

Data from 201 gastric cancer patients at Fujian Medical University Union Hospital who were enrolled in our prospective randomized controlled trial were extracted for this study. Blood samples to perioperatively measure the GLR were routinely taken. Additional external validation was performed using the dataset (n = 135) from Nanfang Hospital who were enrolled in the same trial.

Results

Patients undergoing either laparoscopic or open resection showed a similar preoperative GLR, as well as similar GLRs, on postoperative days (PODs) 1 and 3. The GLR on POD 5 was lower in the laparoscopic group compared with the open group (p = 0.014), and the optimal predictive GLR thresholds of postoperative ICs in both the laparoscopic and open groups were the same on POD 5, i.e. 6.5 and 7.4, respectively. The GLR on POD 5 was identified as an independent factor for postoperative ICs in both the laparoscopic and open groups. Similar results were found in the validation dataset.

Conclusion

The GLR status not only correlates with SS but may also be a reliable predictor of ICs for gastric cancer patients after gastrectomy. The ideal GLR thresholds on POD 5 for ICs following laparoscopic and open gastrectomy are 6.5 and 7.4, respectively.
Appendix
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Literature
1.
Zeng YK, Yang ZL, Peng JS, Lin HS, Cai L. Laparoscopy-assisted versus open distal gastrectomy for early gastric cancer: evidence from randomized and nonrandomized clinical trials. Ann Surg. 2012;256:39–52.CrossRefPubMed
2.
Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J, et al. Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol. 2016;34:1350–7.CrossRefPubMed
3.
Dinarello CA. Interleukin-1 and the pathogenesis of the acute-phase response. N Engl J Med. 1984;311:1413–8.CrossRefPubMed
4.
Perlmutter DH, Dinarello CA, Punsal PI, Colten HR. Cachctin/tumor necrosis factor regulates hepatic acute-phase gene expression. J Clin Invest. 1986;78:1349–54.CrossRefPubMedPubMedCentral
5.
Meyer TA, Wang J, Tiao GM, Ogle CK, Fischer JE, Hasselgren PO. Sepsis and endotoxemia stimulate intestinal interleukin-6 production. Surgery. 1995;118:336–42.CrossRefPubMed
6.
Pritts T, Hungness E, Wang Q, Robb B, Hershko D, Hasselgren PO. Mucosal and enterocyte IL-6 production during sepsis and endotoxemia role of transcription factors and regulation by stress response. Am J Surg. 2002;183:372–83.CrossRefPubMed
7.
Tabuchi T, Shimazaki J, Satani T, Nakachi T, Watanabe Y. The perioperative granulocyte/lymphocyte ratio is a clinically relevant marker of SS in patients with colorectal cancer. Cytokine. 2011;53:243–48CrossRefPubMed
8.
Sah BK, Chen MM, Yan M, Zhu ZG. Reoperation for early postoperative complications after gastric cancer surgery in a Chinese hospital. World J Gastroenterol. 2010;16:98–103.PubMedPubMedCentral
9.
Anonymous. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14:113–23
10.
Sobin LH, Gospodarowicz MK, Wittekind C. International Union Against Cancer (UICC) TNM classification of malignant tumours. 7th ed. New York: Wiley-Liss; 2010.
11.
Hayashi T, Yoshikawa T, Aoyama T, Hasegawa S, Yamada T, Tsuchida K, et al. Impact of infectious complications on gastric cancer recurrence. Gastric Cancer. 2015;18:368–74.CrossRefPubMed
12.
Artinyan A, Orcutt ST, Anaya DA, et al. Infectious postoperative complications decrease long-term survival in patients under going curative surgery for colorectal cancer: a study of 12,075 patients. Ann Surg. 2015;261:497–505.CrossRefPubMed
13.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedPubMedCentral
14.
Vulliamy P, McCluney S, Mukherjee S, Ashby L, Amalesh T. Postoperative elevation of the neutrophil: lymphocyte ratio predicts complications following esophageal resection. World J Surg. 2016; 40:1397–403.CrossRefPubMed
15.
Hyun MH, Lee CH, Kwon YJ, Cho SI, Jang YJ, Kim DH, et al. Robot versus laparoscopic gastrectomy for cancer by an experienced surgeon: comparisons of surgery, complications, and surgical stress. Ann Surg Oncol. 2013;20:1258–65.CrossRefPubMed
16.
Okholm C, Goetze JP, Svendsen LB, Achiam MP. Inflammatory response in laparoscopic vs. open surgery for gastric cancer. Scand J Gastroenterol. 2014;49:1027–34.CrossRefPubMed
17.
Miyake H, Kawabata G, Gotoh A, Fujisawa M, Okada H, Arakawa S, et al. Comparison of surgical stress between laparoscopy and open surgery in the field of urology by measurement of humoral mediators. Int J Urol. 2002;9:329–33.CrossRefPubMed
18.
Jurczok A, Zacharias M, Wagner S, Hamza A, Fornara P. Prospective non-randomized evaluation of four mediators of the systemic response after extraperitoneal laparoscopic and open retropubic radical prostatectomy. BJU Int. 2007;99:1461–6.CrossRefPubMed
19.
Platt JJ, Ramanathan ML, Crosbie RA, Anderson JH, McKee RF, Horgan PG, et al. C-reactive protein as a predictor of postoperative infective complications after curative resection in patients with colorectal cancer. Ann Surg Oncol. 2012;19:4168–77CrossRefPubMed
20.
Lloyd AR, Oppenheim JJ. Poly’s lament: the neglected role of the polymorphonuclear neutrophil in the afferent limb of the immune response. Immunol Today. 1992;13:169–72.CrossRefPubMed
21.
Leung KL, Lai PB, Ho RL, Meng WC, Yiu RY, Lee JF, et al. Systemic cytokine response after laparoscopic-assisted resection of rectosigmoid carcinoma: a prospective randomized trial. Ann Surg. 2000;231:506–11.CrossRefPubMedPubMedCentral
22.
Adachi Y, Shiraishi N, Shiromizu A, Bandoh T, Aramaki M, Kitano S. Laparoscopy-assisted Billroth I gastrectomy compared with conventional open gastrectomy. Arch Surg. 2000;135:806–10.CrossRefPubMed
23.
Tokunaga M, Tanizawa Y, Bando E, Kawamura T, Terashima M. Poor survival rate in patients with postoperative intra-abdominal infectious complications following curative gastrectomy for gastric cancer. Ann Surg Oncol. 2013;20:1575–83.CrossRefPubMed
24.
Shishido Y, Fujitani K, Yamamoto K, Hirao M, Tsujinaka T, Sekimoto M. C-reactive protein on postoperative day 3 as a predictor of infectious complications following gastric cancer resection. Gastric Cancer. 2016;19:293–301.CrossRefPubMed
25.
Rettig TC, Verwijmeren L, Dijkstra IM, Boerma D, van de Garde EM, Noordzij PG. Postoperative interleukin-6 level and early detection of complications after elective major abdominal surgery. Ann Surg. 2016;263:1207–12.CrossRefPubMed
26.
Kim EY, Yim HW, Park CH, Song KY. C-reactive protein can be an early predictor of postoperative complications after gastrectomy for gastric cancer. Surg Endosc. 2017;31(1):445–54.CrossRefPubMed
Metadata
Title
The Granulocyte-to-Lymphocyte Ratio as a Marker of Surgical Stress and a Predictor of Postoperative Infectious Complications After Gastric Cancer Surgery: An Analysis of Patients Enrolled in a Prospective Randomized Trial
Authors
Jun Lu, MD, PhD
Hao Liu, MD, PhD
Long-long Cao, MD
Chao-hui Zheng, MD, PhD
Ping Li, MD, PhD
Jian-wei Xie, MD, PhD
Jia-bin Wang, MD, PhD
Jian-xian Lin, MD, PhD
Qi-yue Chen, MD
Mi Lin, MD
Ru-hong Tu, MD
Guo-xin Li, MD, PhD
Chang-ming Huang, MD, PhD
Publication date
01-09-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 9/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-5846-y

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