Association between Neutrophil-Lymphocyte Ratio and Failure of Conservative Medical Treatment in Patients with Intestinal Obstruction Due to Abdominal Cancer
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Abstract
Background: Intestinal obstruction due to abdominal cancer is a common clinical problem, with an overall incidence ranging from 3% to 15%, with colorectal cancer and ovarian cancer being the most frequent. The diagnosis of this condition primarily relies on the patient’s established history of abdominal oncological disease, as well as radiological and laboratory tests, which are key factors in decision-making regarding the choice between conservative or radical treatment. The importance of these decisions has led to the need for the development of new evaluation strategies to guide treatment in this group of patients.
Objective: To determine the association between the neutrophil-lymphocyte ratio and the failure of conservative medical treatment in patients with intestinal obstruction due to abdominal cancer.
Materials and Methods: An associative study was conducted at the General Hospital of Zone No. 3 of the Instituto Mexicano del Seguro Social, Aguascalientes, México, from January 2017 to January 2024. The study included patients aged 18 to 100 years with a diagnosis of abdominal cancer and intestinal obstruction. After approval from the Local Health Research Committee and the Ethics Committee in Health Research, a review of the census from the General Surgery department was conducted to identify patients who met the inclusion criteria. The variables collected for the study were: sex, age, diagnosis of intestinal obstruction, type of abdominal cancer, time of onset of intestinal obstruction symptoms, and neutrophil-lymphocyte ratio. The neutrophil-lymphocyte ratio was calculated from the sample and correlated with the clinical outcome in relation to the success or failure of the medical treatment. The data was entered into an Excel spreadsheet and analyzed using the IBM SPSS statistical software.
Results: Of the 14 patients with intestinal obstruction and abdominal cancer, 8 were treated surgically and 6 conservatively. It was observed that a neutrophil-lymphocyte ratio ≥ 4 was associated with a higher likelihood of requiring surgical resolution.
Conclusion: An elevated neutrophil-lymphocyte ratio (≥4) was found to be associated with a greater likelihood of requiring surgical treatment, while patients with a neutrophil-lymphocyte ratio ≤ 3.9 tended to be treated conservatively. These results suggest that the neutrophil-lymphocyte ratio could be a useful marker to guide therapeutic decisions, although further studies are needed to strengthen its predictive value.
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References
I. Yu K, Liu L, Zhang X, Zhang Z, Rao B, Chen Y, et al. Surgical and Conservative Management of Malignant Bowel Obstruction: Outcome and Prognostic Factors. Cancer Manag Res. August 2020; Volume 12: 7797-803.
DOI: 10.2147/CMAR.S256219
II. Coco D, Leanza S, Fiume I. Small Bowel Obstruction: A Prognostic Score Index for Surgery – A Review. Gastroenterol Rev. 2022; 17(3): 177-82. DOI: 10.5114/pg.2022.118454
III. Henry JC, Pouly S, Sullivan R, Sharif S, Klemanski D, Abdel-Misih S, et al. A Scoring System for the Prognosis and Treatment of Malignant Bowel Obstruction. Surgery. October 2012; 152(4): 747-57. DOI: 10.1016/j.surg.2012.07.009
IV. Ng ZQ, Hsu V, Tee WWH, Tan JH, Wijesuriya R. Predictors for Success of Non-Operative Management of Adhesive Small Bowel Obstruction. World J Gastrointest Surg. June 27, 2023; 15(6): 1116-24.
DOI: 10.4240/wjgs.v15.i6.1116
V. Cho YJ, Park IS, Kim J, Cho HJ, Gwak GH, Yang KH, et al. Factors Predicting the Need for Early Surgical Intervention for Small Bowel Obstruction. Ann Coloproctology. August 31, 2020; 36(4): 223-8.
DOI: 10.3393/ac.2019.09.30
VI. Cato LD, Evans T, Ward S. A Single-Center Ten-Year Retrospective Cohort Study of Malignant Small Bowel Obstruction. Ann R Coll Surg Engl. November 2021; 103(10): 738-44.
DOI: 10.1308/rcsann.2021.0044
VII. Fackche NT, Johnston FM. Malignant Bowel Obstruction. Adv Surg. September 2021; 55: 35-48.
DOI: 10.1016/j.yasu.2021.05.003
VIII. Pujara D, Chiang YJ, Cormier JN, Bruera E, Badgwell B. Selective Approach for Patients with Advanced Malignancy and Gastrointestinal Obstruction. J Am Coll Surg. July 2017; 225(1): 53-9. DOI: 10.1016/j.jamcollsurg.2017.04.033
IX. Ghabisha S, Ahmed F, Altam A, Hassan F, Badheeb M. Small Bowel Obstruction in Virgin Abdomen: Predictors of Surgical Intervention Need in Resource-Limited Settings. J Multidiscip Healthc. December 2023; Volume 16: 4003-14.
DOI: 10.2147/JMDH.S441958
X. Loge L, Florescu C, Alves A, Menahem B. Radiation Enteritis: Diagnostic and Therapeutic Issues. J Visc Surg.December 2020; 157(6): 475-85.
DOI: https://doi.org/10.1016/j.jviscsurg.2020.08.012
XI. McCaffrey N, Asser T, Fazekas B, Muircroft W, Agar M, Clark K, et al. Health-Related Quality of Life in Patients with Inoperable Malignant Bowel Obstruction: Secondary Outcome from a Double-Blind, Parallel, Placebo-Controlled Randomised Trial of Octreotide. BMC Cancer. December 2020; 20(1): 1050.
DOI: https://doi.org/10.1186/s12885-020-07549-y
XII. Morris RS, Murphy P, Boyle K, Somberg L, Webb T, Milia D, et al. Bowel Ischemia Score Predicts Early Operation in Patients with Adhesive Small Bowel Obstruction. Am Surg. February 2022; 88(2): 205-11. DOI: 10.1177/0003134820988820
XIII. Luque García MJ. Factores pronósticos relacionados con la cirugía de la oclusión intestinal. [Madrid]: UNIVERSIDAD COMPLUTENSE DE MADRID; 2014.
XIV. Eto S, Kawahara H, Matsumoto T, Hirabayashi T, Omura N, Yanaga K. Preoperative Neutrophil–Lymphocyte Ratio Is a Predictor of Bowel Obstruction Due to Colorectal Cancer Growth. Anticancer Res. June 2019; 39(6): 3185-9.
DOI: 10.21873/anticanres.13456
XV. Wang S, Liu H, Wang Q, Cheng Z, Sun S, Zhang Y, et al. Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Are Effective Predictors of Prognosis in Patients with Acute Mesenteric Arterial Embolism and Thrombosis. Ann Vasc Surg. May 2018; 49: 115-22.
DOI: https://doi.org/10.1016/j.avsg.2018.01.059
XVI. Armengol Alonso A, Argüello Esparza EY, Gaytán Morales JF. [Program of Specific Action for Prevention and Control of Cancer.] Available at: https://www.gob.mx/cms/uploads/attachment/file/706943/PAE_CAN_cF.pdf. 2021.
XVII. Márquez Coronel JL, Saltos Carvajal JE, Triana Castro T. Prevalence of Intestinal Obstruction in Patients with Colon Cancer: A Single-Center Cross-Sectional Study. Oncol Ecuad. December 3, 2022; 32(3): 300-9. DOI: https://doi.org/10.33821/663
XVIII. Banting SP, Waters PS, Peacock O, Narasimhan V, Lynch AC, McCormick JJ, et al. Management of Primary and Metastatic Malignant Small Bowel Obstruction, Operate or Palliate: A Systematic Review. ANZ J Surg. March 2021; 91(3): 282-90.
DOI: 10.1111/ans.16188
XIX. Krouse RS. Malignant Bowel Obstruction. J Surg Oncol. July 2019; 120(1): 74-7.
DOI: 10.1002/jso.25451