Association of preoperative systemic inflammation with postoperative complications after colon carcinoma resection

Background Systemic inflammation may predict poor postoperative outcomes after gastrointestinal cancer surgery. This study aimed to evaluate the association between preoperative neutrophil-to-lymphocyte ratio and postoperative complications after colon carcinoma resection. Methods This study retrospectively analyzed all patients who underwent curative colon carcinoma resection at a single tertiary center in Finland between 2014 and 2024. The patients were stratified into low and high (≥ 4.0) neutrophil-to-lymphocyte ratio groups. Ninety-day postoperative complications and their severity were recorded. Associations between neutrophil-to-lymphocyte ratio and complications were evaluated using multivariable logistic regression models. Results Of the 573 included patients, 232 (40.5%) experienced complications within 90 days and 8 (1.4%) died. A high (≥ 4.0) neutrophil-to-lymphocyte ratio, observed in 101 (17.6%) patients, was associated with a significantly increased risk of severe (Clavien–Dindo IV–V) postoperative complications (OR 3.48, 95% c.i. 1.57–7.75), a higher overall complication burden measured with Comprehensive Complication Index (mean 17.3 vs 10.7; P = 0.012) and a greater incidence of medical complications (33.7% vs 21.4%; P = 0.008). In the multivariable analyses, the high preoperative neutrophil-to-lymphocyte ratio remained an independent predictor of postoperative complications. Conclusion Preoperative neutrophil-to-lymphocyte ratios ≥ 4.0 were associated with higher risk of 90-day complications, particularly severe and nonsurgical events, after colon cancer resection.