Minimally Invasive Colectomy Contributes to Decreasing Postoperative Morbidity in Patients With High Naples Prognostic Score.

[BACKGROUND/AIM] The Naples prognostic score (NPS), based on nutritional and inflammatory status, may predict postoperative morbidity after colorectal cancer surgery. Minimally invasive colectomy (MIC) may improve short-term outcomes; however, whether MIC lowers morbidity in patients with a high NPS remains unknown. The current study examined the effects of NPS on postoperative morbidity after open colectomy (OC) and MIC.

[PATIENTS AND METHODS] This retrospective analysis included 139 patients who underwent OC and 117 who underwent MIC for colorectal cancer between January 2013 and March 2020. The NPS is a composite score calculated using albumin and cholesterol concentrations, and lymphocyte: monocyte and neutrophil: lymphocyte ratios. Patients were divided into three groups based on NPS. Groups 1-2 were defined as low-NPS and group 3 as the high-NPS group. The OC and MIC groups were further divided into two subgroups according to whether the NPS was high or low.

[RESULTS] The high-NPS groups had significantly higher postoperative morbidity after OC [Clavien-Dindo classification (CDc) ≥II; =0.022, CDc ≥IIIb; =0.036]. Multivariate analysis demonstrated that high-NPS was an independent risk factor for postoperative complications (CDc ≥II: hazard ratio=2.40; 95% confidence interval=1.121-5.181; =0.024 and CDc ≥IIIb: hazard ratio=4.19; 95% confidence interval=1.052-20.619; =0.042]. Low-NPS did not affect postoperative morbidity after MIC (CDc ≥II; =0.12, CDc ≥IIIb; =0.51).

[CONCLUSION] A high NPS led to postoperative morbidity after OC, but not after MIC. MIC may improve short-term outcomes, even in patients with a low NPS.