Neutrophil:Lymphocyte Ratio: Can we predict complications following hepatic resection for colorectal liver metastasis?


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Simon McCluney1,Alex Giakoustidis1,Angela Segler1,Juliane Bissel1,Roberto Valente1,Rob Hutchins1,Ajit Abraham1,Satyajit Bhattacharya1,Hemant Kocher1
1Barts Health NHS Trust



Approximately 30-50% of patients with colorectal cancer develop liver metastasis for which liver resection is the only hope for potential cure. However, hepatic resection is a major procedure with considerable morbidity. The aim of this study was to detect early complications by utilising the neutrophil: lymphocyte ratio (NLR).


We performed a retrospective cohort study of patients undergoing hepatic resection at a single institution between January 2008 and January 2016. Baseline demographics and complications within the 30 days following surgery were recorded. Pre – operative differential white cell counts and C-reactive protein up to post-operative day 7 were analysed.


188 operations were included in this study, with 148 individual patients. 157 specimens demonstrated histology consistent with colorectal liver metastases (CLM). Of all procedures, 47.3% had an associated complication, with 31.46% of these deemed major complications. The median NLR was 6.31 across the cohort, 5.44 for uncomplicated procedures, 7.0 for those who suffered complications and 10.65 for those with major complications. Median NLR was the best parameter for detecting major complications ahead of minor complications (AUC 0.74) as opposed to lymphocytes (AUC 0.65), neutrophils (AUC 0.60) and CRP (AUC 0.60). Furthermore, the diagnostic ability of median NLR increased further when predicting major complications versus an uncomplicated recovery (AUC 0.78), and it was the only significant parameter in predicting complications in the early post-operative period on post-operative days 2,3 and 4 (AUC 0.70, 0.72 & 0.75).


We have shown that the NLR is more sensitive and specific than WCC and CRP in detecting major complications following hepatic resection for CLM. It is significantly better than other markers in the early postoperative period (days 2-4), and this could be significant in improving patient outcomes as well as having financial implications.