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Neutrophil-Lymphocyte Ratio as a Predictor of Postoperative Outcomes after Robotic-Assisted Pulmonary Lobectomy
Jessica Cobb1, Sarah M. Cool1, Gregory Fishberger1, Collin Chase1, Ajay Varadhan1, Maykel Dolorit1, Emily Weeden1, Harrison Strang1, Diep Nguyen1, Rahul Mhaskar1, Joseph R. Garrett2, Carla C. Moodie2, Jacques P. Fontaine3, Jenna Tew2, Jobelle J.A.R. Baldonado3, Eric M. Toloza3.
1USF Morsani College of Medicine, Tampa, FL, USA, 2Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA, 3Department of Thoracic Oncology, Moffitt Cancer Center; Department of Surgery, University of South Florida Morsani College of Medicine; Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA.

Objective: We evaluated surgical outcomes after robotic-assisted video-thoracoscopic (RAVT) pulmonary lobectomy in patients with High immediate postoperative neutrophil-to-lymphocyte ratios (NLR) compared to Low/Normal ratios.
Methods: We retrospectively analyzed 412 patients who underwent RAVT pulmonary lobectomy by one surgeon over 10.8 years and who had NLR data available. Patients were grouped as having High NLR (≥5) or Low/Normal NLR (<5). Primary outcomes included skin-to-skin operative time, chest tube (CT) duration, and hospital length of stay (LOS). Secondary outcomes included intraoperative estimated blood loss (EBL), intraoperative and postoperative complications, and in-hospital mortality. Skin-to-skin operative time, EBL, CT duration, and hospital LOS were compared using Wilcoxon two-sample tests. Fisher’s Exact test was conducted when necessary.
Results: Three-hundred-fifty patients had High NLR, while 62 patients had Low/Normal NLR. Skin-to-skin operative times were significantly higher in High NLR patients (median 178 mins; IQR 63) compared to Low/Normal NLR patients (median 142.5 mins; IQR 46) (p<0.0001) (Table 1). CT duration was significantly higher with High NLR compared to Low/Normal NLR (median 4 [IQR 4] and 3 [IQR 2] days, respectively; p=0.0163). Median LOS was 4 days (IQR 3) in High NLR patients and 3 days (IQR 3) in Low/Normal NLR patients (p=0.0163). All other perioperative outcomes were statistically nonsignificant.
Conclusions: Skin-to-skin operative time, CT duration, and hospital LOS are significantly higher in patients with High immediate postoperative NLR compared to those with Low/Normal NLR. Patients with long operative times and high NLR should be investigated further in order to reduce CT duration and hospital LOS.



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