Ann Surg Treat Res.  2022 Sep;103(3):153-159. 10.4174/astr.2022.103.3.153.

The role of postoperative neutrophil-to-lymphocyte ratio as a predictor of postoperative major complications following total gastrectomy for gastric cancer

  • 1Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea


This study was performed to investigate the role of the perioperative neutrophil-to-lymphocyte ratio (NLR) as an early predictor of major postoperative complications after total gastrectomy for gastric cancer.
This single-center, retrospective study reviewed consecutive patients with gastric cancer who underwent total gastrectomy at a single institution from March 2009 to March 2021. The postoperative complications were graded according to the Clavien-Dindo classification. We analyzed the patient demographics and surgical outcomes according to the grade of postoperative complications in the major complications group (≥grade III) and the no major complications group (Results
Out of 212 patients (mean age, 64.1 years; 152 male [71.7%]), 63 (29.7%) underwent minimally invasive surgery. Twenty-five (11.8%) were in the major complications group and 187 (88.2%) were in the no major complications group. There was a significant difference in the NLR on POD 2 (16.54 vs. 8.83, P = 0.033) between the 2 groups. According to the receiver operating characteristic curve for the NLR on POD 2, the cutoff was calculated to be 9.6. In multivariate analysis, an NLR on POD 2 of ≥9.6 and an American Society of Anesthesiologists physical status classification of ≥III were statistically significant predictors of major postoperative complications.
Determination of the NLR on POD 2 is a simple and useful method for the early prediction of major complications after total gastrectomy for gastric cancer.


Biomarkers; Gastrectomy; Postoperative complications; Stomach neoplasms


  • Fig. 1 Receiver operating characterisitcs (ROC) curves for neutrophil-to-lymphocyte ratio on postoperative day 2 (area under the curve: 0.723, cutoff value: 9.6, P < 0.001; sensitivity: 64.0%; specificity: 67.9%).


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