Preoperative clinical and laboratory factors associated with early complications after low anterior resection: Exploratory analysis of the eosinophil/lymphocyte ratio

Table 1 Demographic, clinical, and laboratory data of the patients (n = 105), n (%)

Variables	Value
Age (years) (mean ± SD)	66 ± 12
Gender, female/male	39/66 (37.1/62.9)
Body mass index (kg/m2,mean ± SD)	24.17 ± 2.2 (20-31)
Diabetes mellitus	25 (23.8)
Smoking	22 (21)
Protective loop ileostomy	23 (21.9)
Neoadjuvant chemoradiotherapy	26 (24.8)
Operation type
Open surgery	63 (60)
Laparoscopic surgery	42 (40)
Length of hospital stay (days) (mean ± SD)	10.04 ± 4.6 (5-29)
Follow-up period (months) (mean ± SD)	46.44 ± 25 (1-85)
Overall survival	89 (84.8)
Disease-free survival (months) (mean ± SD)	42.49 ± 24 (1-85)
Preoperative erythrocyte suspension replacement	38 (36.2)
Stage classification
Stage 0	1 (0.9)
Stage 1	26 (24.8)
Stage 2	32 (30.5)
Stage 3	46 (43.8)
Differentiation
Well-differentiated	48 (45.7)
Moderately differentiated	55 (52.4)
Poorly differentiated	2 (1.9)
Mass localization level
Lower	14 (13.3)
Middle	25 (23.8)
Upper	66 (62.9)
Prognostic nutritional index score
≥ 45	19 (18.1)
< 45	86 (81.9)
Presence of early complications	29 (27.6)
Bleeding	2 (1.9)
Anastomosis leakage	10 (9.5)
Wound site infection	5 (4.8)
Eventration	4 (3.8)
Subileus	3 (2.9)
Pleurisy	3 (2.9)
Acute renal failure	2 (1.9)
Presence of late complications	14 (13.3)
Bridge ileus	1 (0.9)
Anastomosis narrowing	8 (7.6)
Recurrence	5 (4.8)
Disease course
Remission	76 (72.4)
Progression	13 (12.4)
Mortality	16 (15.2)

Table 2 Comparisons of the demographic, clinical and preoperative laboratory data of the patients with and without early complications, n (%)

Variables	Patients with early complications (n = 29)	Patients without early complications (n = 76)	P value
Age (years) (mean ± SD)	72.41 ± 9.9	63.76 ± 11	0.001
Gender, female/male	12/19 (41.4/58.6)	27/49 (35.5/64.5)	0.579
Diabetes mellitus	12 (41.4)	13 (17.1)	0.009
Smoking	6 (20.71)	16 (21.1)	0.967
Body mass index (kg/m2, mean ± SD)	23.83 ± 2.5	24.3 ± 2.1	0.337
Operating time (minutes) (mean ± SD)	277.59 ± 71	279.67 ± 53	0.871
Removed LAP count (mean ± SD)	17.66 ± 5.7	16.30 ± 7.1	0.364
Metastasis LAP count (mean ± SD)	2.62 ± 3.5	1.18 ± 2.3	0.019
Surgical technique			0.013
Open	23 (79.3)	40 (52.6)
Laparoscopic	6 (20.7)	36 (47.4)
Protective loop ileostomy	7 (24.1)	16 (21.1)	0.733
Stage classification			0.035
Stage 0	0 (0)	1 (1.3)
Stage 1	2 (6.9)	24 (31.6)
Stage 2	9 (31)	23 (30.3)
Stage 3	18 (62.1)	28 (36.8)
Differentiation			0.313
Well-differentiated	10 (34.1)	38 (50)
Moderately differentiated	18 (62.1)	37 (48.7)
Poorly differentiated	1 (3.4)	1 (1.3)
Mass localization level			0.476
Lower	2 (6.9)	12 (15.8)
Middle	7 (24.1)	18 (23.7)
Upper	20 (69)	46 (60.5)
Neoadjuvant chemoradiotherapy	7 (24.1)	19 (25)	0.927
Albumin (g/L) (mean ± SD)	29.69 ± 4.9	32.76 ± 5	0.006
Hemoglobin (g/dL) (mean ± SD)	10.42 ± 1.5	11.9 ± 2	0.001
Neutrophil/Lymphocyte ratio (mean ± SD)	5.41 ± 3.3	5.22 ± 2.5	0.749
Eosinophil/Lymphocyte ratio (mean ± SD)	0.18 ± 0.1	0.11 ± 0.1	0.050
Lymphocyte/monocyte ratio (mean ± SD)	3.50 ± 1.9	3.05 ± 1.5	0.214
Prognostic nutritional index score (mean ± SD)	36.70 ± 6.8	39.33 ± 5.9	0.055

LAP: Lymphadenopathy.

Table 3 Comparisons of the postoperative clinical course and laboratory data of the patients with and without early complications

Variables	Patients with early complications (n = 29)	Patients without early complications (n = 76)	P value
Length of hospital stay (days) (mean ± SD)	13.17 ± 6.5	8.84 ± 2.8	< 0.001
Follow-up period (months) (mean ± SD)	43.52 ± 26	47.55 ± 25	0.472
Disease-free survival (months) (mean ± SD)	40.31 ± 26	43.32 ± 24	0.581
Hemoglobin (g/dL)
Postoperative day 1	10.37 ± 1	11.15 ± 1.2	0.003
Neutrophil/Lymphocyte ratio (mean ± SD)
Postoperative day 1 (mean ± SD)	13.75 ± 5.5	9.50 ± 3.7	< 0.001
Postoperative day 3 (mean ± SD)	10.06 ± 4.4	7.45 ± 3.6	0.003
Eosinophil/Lymphocyte ratio
Postoperative day 1 (mean ± SD)	0.04 ± 0.2	0.04 ± 0.1	0.993
Postoperative day 3 (mean ± SD)	0.17 ± 0.2	0.16 ± 0.2	0.923
Lymphocyte/monocyte ratio
Postoperative day 1 (mean ± SD)	2.02 ± 1.7	1.97 ± 1.2	0.869
Postoperative day 3 (mean ± SD)	2.40 ± 0.9	2.38 ± 0.8	0.927
Disease course			0.290
Remission	19 (65.5)	57 (75)
Progression	3 (10.3)	10 (13.2)
Mortality	7 (24.1)	9 (11.8)

Table 4 Evaluation of demographic, clinical, and preoperative laboratory data associated with early postoperative complications

Variables	β	SE	Wald	df	P value	Odds ratio	95%CI
							Lower	Upper
Age	0.095	0.032	9.005	1	0.003	1.100	1.034	1.171
Diabetes mellitus	-0.622	0.620	1.008	1	0.315	0.537	0.159	1.809
Metastasis lymphadenopathy count	0.069	0.130	0.284	1	0.594	1.072	0.830	1.384
Stage classification			2.157	3	0.540
Stage 1	-17.697	40192.970	0.000	1	1.000	0.000	0.000
Stage 2	-1.290	1.008	1.639	1	0.200	0.275	0.038	1.983
Stage 3	0.066	0.806	0.007	1	0.935	1.068	0.220	5.183
Albumin	-0.114	0.066	2.950	1	0.086	0.892	0.783	1.016
Hemoglobin	-0.429	0.163	6.955	1	0.008	0.651	0.474	0.896
Eosinophil/Lymphocyte ratio	2.207	1.758	1.576	1	0.209	9.086	0.290	284.751
Surgical technique	1.262	0.632	3.992	1	0.046	3.534	1.024	12.193
Constant	0.138	3.126	0.002	1	0.965	1.148

Table 5 Comparisons of demographic and clinical data between the open low anterior resection surgery and laparoscopic low anterior resection surgery groups, n (%)

Variables	Open surgery group (n = 63)	Laparoscopic surgery group (n = 42)	P value
Age (years) (mean ± SD)	66.62 ± 12	65.45 ± 9.9	0.62
Gender, female/male	19/44 (30.2/69.8)	20/22 (47.6/52.4)	0.07
Diabetes mellitus	19 (30.2)	6 (14.3)	0.06
Smoking	13 (20.6)	9 (21.4)	0.92
Body mass index (kg/m2, mean ± SD)	24.05 ± 2.3	24.36 ± 2.1	0.49
Operating time (minutes) (mean ± SD)	274.13 ± 59	286.55 ± 57	0.29
Length of hospital stay (days) (mean ± SD)	10.97 ± 5.2	8.64 ± 2.9	0.011
Follow-up period (months) (mean ± SD)	48.83 ± 25	42.86 ± 25	0.24
Disease-free survival (months) (mean ± SD)	43.83 ± 26	40.48 ± 22	0.50
Removed LAP count (mean ± SD)	16.48 ± 6.4	16.98 ± 7.3	0.71
Metastasis LAP count (mean ± SD)	1.89 ± 2.9	1.12 ± 2.5	0.17
Stage classification			0.05
Stage 0	0 (0)	1 (2.4)
Stage 1	13 (20.6)	13 (31)
Stage 2	16 (25.4)	16 (38.1)
Stage 3	34 (54)	12 (28.6)
Mass localization level			0.65
Lower	8 (12.7)	6 (14.3)
Middle	17 (27)	8 (19)
Upper	38 (60.3)	28 (66.7)
Protective loop ileostomy	12 (19)	11 (26.2)	0.38
Neoadjuvant chemoradiotherapy	13 (20.6)	13 (31)
Preoperative albumin (g/L) (mean ± SD)	31.4 ± 5.6	32.6 ± 4.4	0.25
Hemoglobin (g/dL)
Preoperative (mean ± SD)	11.42 ± 2.1	11.62 ± 1.8	0.61
Postoperative day 1 (mean ± SD)	10.93 ± 1.2	10.55 ± 1.1	0.92
Neutrophil/Lymphocyte ratio
Preoperative (mean ± SD)	4.9 ± 2.6	5.8 ± 2.8	0.09
Postoperative day 1 (mean ± SD)	10.6 ± 3.8	10.7 ± 5.7	0.96
Postoperative day 3 (mean ± SD)	8.3 ± 4.1	7.8 ± 3.8	0.49
Eosinophil/Lymphocyte ratio
Preoperative (mean ± SD)	0.12 ± 0.1	0.14 ± 0.01	0.52
Postoperative day 1 (mean ± SD)	0.006 ± 0.01	0.954 ± 0.22	0.003
Postoperative day 3 (mean ± SD)	0.11 ± 0.1	0.24 ± 0.2	0.003
Lymphocyte/monocyte ratio
Preoperative (mean ± SD)	3.4 ± 1.7	2.7 ± 1.2	0.016
Postoperative day 1 (mean ± SD)	2.1 ± 1.6	1.6 ± 0.5	0.08
Postoperative day 3 (mean ± SD)	2.4 ± 0.8	2.3 ± 0.8	0.52
Prognostic nutritional index score (mean ± SD)	38.44 ± 6.8	38.84 ± 5.3	0.75
Early complications	23 (36.5)	6 (14.3)	0.01
Late complications			0.87
None	54 (85.7)	37 (88.1)
Bridge ileus	1 (1.6)	0 (0)
Anastomosis narrowing	5 (7.9)	3 (7.1)
Recurrence	3 (4.8)	2 (4.8)
Disease course			0.02
Remission	40 (63.5)	36 (85.7)
Progression	9 (14.3)	4 (9.5)
Mortality	14 (22.2)	2 (4.8)

LAP: Lymphadenopathy.