Preoperative Blood Marker Linked to Anastomotic Leak in Gastrointestinal Surgery

A recent systematic review and meta-analysis published in the BMC Surgery unveiled a potential connection between preoperative blood markers and postoperative complications in gastrointestinal (GI) surgeries. The study encompassed 12 research papers with a total of 2940 GI surgery patients to investigate the role of the neutrophil to lymphocyte ratio (NLR) as a biomarker of inflammation.

The inflammatory response has been suspected for long as a crucial trigger for epigenetic alterations, the NLR which is calculated by dividing the number of neutrophils by the number of lymphocytes also emerged as a potential indicator. The primary focus of the research was on patients who experienced an anastomotic leak (AL) after GI surgery in comparison to those who did not.

The team conducted an extensive search by analyzing papers published before May 4, 2022, utilizing PubMed, Scopus, and Web of Science. The meta-analysis employed the random-effects model due to substantial heterogeneity. The quality evaluation was performed using the Newcastle-Ottawa scale (NOS).

Among the 2940 individuals studied, 353 developed AL after GI surgery. The findings revealed a significant correlation between higher preoperative NLR levels and the occurrence of AL (random-effects model: SMD = 0.75, 95% CI = 0.11–1.38, p = 0.02). 

By highlighting the importance of considering inflammatory biomarkers in assessing surgical risks, this study suggests a potential link between preoperative NLR levels and postoperative AL. But, caution is mandated due to variations in findings, specially higher NLR levels in retrospective studies and among white patients, which were not consistently replicated in prospective studies and among the East Asian patients.

These outcomes emphasize the need for further research with larger and more diverse cohorts to validate the results and explore factors that could contribute in discrepancies. This breakthrough could help reshape preoperative risk assessment and improve personalized approaches to GI surgeries by impacting the patient outcomes. 

Source:

Haghi, S. E., Khanzadeh, M., Sarejloo, S., Mirakhori, F., Hernandez, J., Dioso, E., Goutnik, M., Lucke-Wold, B., Ghaedi, A., & Khanzadeh, S. (2024). Systematic review of the significance of neutrophil to lymphocyte ratio in anastomotic leak after gastrointestinal surgeries. BMC Surgery, 24(1). https://doi.org/10.1186/s12893-023-02292-0