Minimally invasive colectomy may contribute to low incidence of postoperative morbidity in patients with high Naples prognostic score

Minimally invasive colectomy may contribute to low incidence of postoperative morbidity in patients with high Naples prognostic score | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Minimally invasive colectomy may contribute to low incidence of postoperative morbidity in patients with high Naples prognostic score Taishi Yamane, Koichi Doi, Takayoshi Kaida, Yukiko Suzuki, Chihiro Matsumoto, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6952840/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: 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. 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 was a composite score calculated using albumin and cholesterol concentrations, and lymphocyte: monocyte and neutrophil: lymphocyte ratios. Patients were divided into three groups based on increasing 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; p=0.022, CDc ≥ IIIb; p=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; p=0.024 and CDc ≥ IIIb: hazard ratio 4.19; 95% confidence interval, 1.052–20.619; p=0.042). Low-NPS did not affect postoperative morbidity after MIC (CDc ≥ II; p=0.12, CDc ≥ IIIb; p=0.51). Conclusions: 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. colorectal cancer Naples prognostic score minimally invasive colectomy INTRODUCTION Colorectal cancer (CRC) is among the most prevalent cancers worldwide. The incidence of CRC is rapidly increasing [ 1 ]. Many risk factors for morbidity after CRC surgery have been reported, including patient background and surgical factors [ 2 ] [ 3 ]. Recently, a comprehensive prognostic score, the Naples prognostic score (NPS), calculated from serum albumin and total cholesterol concentrations, the lymphocyte-to-monocyte ratio (LMR), and the neutrophil-to-lymphocyte ratio (NLR), has been reported to be a powerful prognostic index for CRC complications [ 4 ]. A previous study reported that a high NPS was associated with postoperative morbidity after rectal cancer surgery [ 5 ]. However, the impact on short-term outcomes of surgical strategies was not investigated. Minimally invasive colectomy (MIC) is less invasive than open colectomy (OC) [ 6 ] and may improve short-term outcomes in patients with high NPS. Thus, the current study aimed to retrospectively evaluate the effects of the NPS on postoperative outcomes after OC and MIC. PATIENTS AND METHODS Patients This retrospective cohort study included 256 consecutive patients who underwent curative surgery for CRC at the Department of Surgery of the Miyazaki Prefectural Nobeoka Hospital between January 2013 and March 2020. The inclusion criteria were as follows: (1) pathologically-confirmed adenocarcinoma, (2) diagnosis of clinical stages I–III colorectal cancer, and (3) curative surgery. The exclusion criteria were as follows: (1) pathological stage IV disease and (2) missing data on clinicopathological characteristics. OC and MIC were performed in 139 and 117 patients, respectively. We further divided each OC and MIC group into two subgroups depending on whether the NPS was high or low. Short-term outcomes between patients with high- and low-NPS were compared in the OC and MIC groups using our institutional database. The ethics committee of our hospital approved the study procedure and waived the requirement for written informed consent (Registry Number 20190830-3). Naples prognostic score definitions The NPS was defined based on the following four parameters: serum albumin level, total cholesterol level, LMR, and NLR. As previously reported by Galizia et al., the cutoff values were 4 mg/dL for serum albumin, 180 mg/dL for total cholesterol, 2.96 for NLR, and 4.44 for LMR, respectively [4]. Patients with serum albumin, total cholesterol or LMR lower than the thresholds got one point; otherwise, they got zero. Patients with an NLR higher than 2.96 got one point, while those with a lower NLR got zero. The sum of the scores for each parameter comprised the NPS score. Patients were categorized into three groups according to the NPS: patients with an NPS of 0 were assigned to group 1, patients with an NPS of 1 or 2 to group 2, and patients with an NPS of 3 or 4 to group 3 (Table 1). Groups 1-2 were defined as the low-NPS and group 3 as the high-NPS group. Treatment strategy Lower alimentary canal endoscopy and thoracoabdominal computed tomography (CT) were routinely performed to determine the clinical stage before colectomy. The pathological findings were defined according to the tumor, node, metastasis classification (American Joint Committee on Cancer Staging Manual, 8th edition). The treatment strategy and follow-up evaluation were performed according to the 2019 Japanese Society for Cancer of the Colon and Rectum guidelines 2019 [7]. Primary resection with lymph node dissection was recommended for stages I–III CRC. MIC was defined as laparoscopic colectomy. Morbidity was defined as a Clavien–Dindo classification (CDc) ≥II [8]. Severe morbidity was defined as a CDc ≥IIIb, requiring endoscopic, radiological, or surgical intervention under general anesthesia. Statistical methods All data analyses were performed using JMP® software version 13.1 (SAS Institute, Cary, NC, USA). The clinicopathological characteristics and laboratory data of the two groups were compared using the chi-square test for categorical variables and the Mann–Whitney U test for continuous variables. Statistical significance was set at p<0.05. Logistic regression analysis was performed to estimate the hazard ratio (HR) with a 95% confidence interval (CI) for postoperative complication (CDc ≥ II and IIIb). The following clinical factors were adopted as risk factors for overall survival (OS): age at colectomy (≥70 vs. <70 years), sex (male vs. female), body mass index (≥25 vs. <25 kg/m2), NPS (high-NPS vs. low-NPS), tumor location (right-sided vs. left-sided), American Society of Anesthesiologists physical status (3 vs. 1, 2), pathological stage (stage III vs. stage 0, I, II), and comorbidity with diabetes mellitus (present vs. absent). We selected factors with a p-value ≤0.1 for subsequent multivariate analysis, and variables with a p-value <0.05 were recognized as independent risk factors. RESULTS Clinical features of patients who underwent open colectomy Table 2 shows the characteristics of patients who underwent OC, depending on whether the NPS was high or low. No significant differences were observed between high- and low-NPS groups. Short-term outcomes after open colectomy Table 3 demonstrates the short-term outcomes after OC, depending on whether the NPS was high or low. The high-NPS groups had significantly higher incidences of postoperative morbidities compared with the low-NPS groups after OC (Clavien-Dindo classification (CDc) ≥ II; p=0.022, CDc ≥ IIIb; p=0.036). Furthermore, patients with high NPS experienced significantly more frequent reoperations after OC (p=0.0052). Risk factors for any postoperative morbidities (CDc ≥ II) after open colectomy Table 4 shows the results of the univariate and multivariate analyses of risk factors for postoperative morbidities (CDc ≥ II) after OC. Multivariate analysis demonstrated that high-NPS was an independent risk factor for postoperative morbidities (CDc ≥ II) after OC (hazard ratio 2.40; 95% confidence interval, 1.121–5.181; p=0.024). Risk factors for severe postoperative morbidities (CDc ≥ IIIb) after open colectomy Table 5 shows the results of the univariate and multivariate analyses of risk factors for severe postoperative morbidities (CDc ≥ IIIb) after OC. Multivariate analysis demonstrated that high-NPS was an independent risk factor for severe postoperative morbidities (CDc ≥ IIIb) after OC (hazard ratio 4.19; 95% confidence interval, 1.052–20.619; p=0.042). Clinical features of patients who underwent minimally invasive colectomy Table 6 shows the characteristics of patients who underwent MIC, depending on whether the NPS was high or low. High-NPS was significantly correlated with older age. Those in the low-NPS groups. In addition, the high NPS group showed a trend toward a lower body mass index, which was not statistically significant. Short-term outcomes after minimally invasive colectomy Table 7 shows the short-term outcomes after MIC depending on whether the NPS score was high or low. No significant differences were observed in operative time, bleeding, or postoperative morbidities after MIC. DISCUSSION In this study, we demonstrated that a high NPS was an independent risk factor for postoperative morbidity after OC, but not after MIC. The NPS is an inflammation-based prognostic score developed as a marker for colorectal cancer by Galizia et al [ 4 ]. The NPS includes factors that reflect nutritional status (albumin and total cholesterol) and inflammation (NLR and LMR) and has emerged as a novel prognostic marker for various types of cancer, such as colorectal [ 4 ] [ 9 ] [ 10 ], lung [ 11 ], esophageal [ 12 ], and hepatocellular [ 13 ]. Recently, a high NPS was a risk factor for oncological postoperative morbidity. Hosoda et al. reported that high-NPS was associated with postoperative morbidity (CDc ≥ III) after liver resection for hepatocellular carcinoma [ 14 ]. Galizia et al. reported that a high NPS significantly correlated with postoperative morbidity after gastrectomy for gastric cancer [ 15 ]. Recently, high-NPS reportedly lead to postoperative morbidity (CDc ≥ III) after colectomy for rectal cancer [ 5 ]. However, to the best of our knowledge, no study has elucidated the superiority of MIC over OC for postoperative morbidity in colorectal cancer patients with a high NPS. OC is generally considered to be more invasive than MIC. Serum interleukin (IL)-6 and IL-10 levels after OC, which are commonly used to assess surgical stress, were significantly higher than those after MIC [ 6 ] [ 16 ]. In addition, C-reactive protein levels (CRP) after OC were also significantly higher than those after MIC [ 6 ] [ 17 ] [ 18 ]. McSorley et al. demonstrated that the magnitude of the postoperative systemic inflammatory response, as evidenced by CRP levels, was significantly associated with complications after colorectal cancer surgery [ 19 ]. NPS is valuable in predicting postoperative complications because it serves as an indicator of inflammation, malnutrition, and immunosuppression [ 14 ]. The higher invasiveness of OC compared to MIC might increase postoperative complications in colorectal cancer patients with a high NPS. Previous studies reported that high-NPS was correlated with severe postoperative morbidity (CDc ≥ III) after hepatectomy for hepatocellular carcinoma [ 14 ] and colectomy for rectal cancer [ 5 ]. Furthermore, a large cohort study showed that a high NPS was significantly associated with mortality and reoperation in patients undergoing colectomy for diverticulitis [ 20 ]. It also suggested a correlation between the NPS and CDc scores after colectomy for diverticulitis [ 20 ]. In the present study, high-NPS was significantly associated with severe postoperative morbidity (CDc ≥ IIIb) and reoperation after OC. Four cases of reoperation after OC (none after MIC) were noted, and the reasons were two anastomotic leakages, one abdominal dehiscence, and one postoperative bleeding. High NPS may lead to more severe complications after surgery because of increased inflammation, malnutrition, and immunosuppression. The lower invasiveness of MIC could yield various advantages during colectomy. A large cohort study demonstrated that MIC contributed to fewer postoperative complications than OC, specifically surgical site infections, urinary tract infections, and pneumonia [ 21 ]. A recent retrospective study investigating 69,418 colectomies from the Japanese Diagnosis Procedure Combination database suggested that MIC could contribute to decreasing the postoperative mortality rate, surgical morbidity rate, and postoperative length of stay [ 22 ]. In addition, a randomized controlled trial showed that MIC was associated with a lower incidence of long-term complications and a better quality of life in the first 12 months after surgery than OC [ 23 ]. In the current study, a novel advantage was suggested: MIC may not increase postoperative morbidity, even in patients with a high NPS. This study has several limitations. First, this was a single-center, retrospective study. Secondly, this study did not include robotic surgeries. Third, the observation period was relatively long. Thus, older patients may have been indicated for OC only and advances in perioperative management during the study period may have affected the incidence of postoperative morbidities. In conclusion, a high NPS was associated with postoperative complications after OC, but not after MIC. The reduced invasiveness of MIC may contribute to lower postoperative morbidity in patients with a high NPS. Declarations Acknowledgements The authors thank all the people who contributed to this work. Authors ´ contributions T. Yamane wrote the manuscript. K. Doi planed study concept and design. C. Matsumoto, T Kaida, Y Suzuki, F Kitamjura and H. Ishiodori collected the clinical data. S. Honda conducted critical revision of manuscript. M. Iwatsuki coordinated the study, oversaw collection and analysis of the results. All authors discussed the data and commented on the manuscript. Funding : There was no financial support for this research. Conflict of interest The authors declare that they have no conflict of interest. Ethics approval This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The ethics committee of our hospital approved the study procedure. Registry Number 20190830-3. Informed consent The requirement for written informed consent was waived. References Morgan E, Arnold M, Gini A et al (2023) Global burden of colorectal cancer in 2020 and 2040: incidence and mortality estimates from GLOBOCAN. Gut 72:338–344 Zarnescu EC, Zarnescu NO, Costea R (2021) Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery. Diagnostics (Basel, p 11 Benedek Z, Coroş MF (2023) The impact of sarcopenia on the postoperative outcome in colorectal cancer surgery. Med Pharm Rep 96:20–27 Galizia G, Lieto E, Auricchio A et al (2017) Naples Prognostic Score, Based on Nutritional and Inflammatory Status, is an Independent Predictor of Long-term Outcome in Patients Undergoing Surgery for Colorectal Cancer. Dis Colon Rectum 60:1273–1284 Sugimoto A, Fukuoka T, Nagahara H et al (2023) Predictive value of the Naples prognostic score on postoperative outcomes in patients with rectal cancer. Langenbecks Arch Surg 408:113 Hildebrandt U, Kessler K, Plusczyk T et al (2003) Comparison of surgical stress between laparoscopic and open colonic resections. Surg Endosc 17:242–246 Hashiguchi Y, Muro K, Saito Y et al (2020) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol 25:1–42 Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213 Park SH, Woo HS, Hong IK et al (2023) Impact of Postoperative Naples Prognostic Score to Predict Survival in Patients with Stage II-III Colorectal Cancer. Cancers (Basel) 15 Miyamoto Y, Hiyoshi Y, Daitoku N et al (2019) Naples Prognostic Score Is a Useful Prognostic Marker in Patients With Metastatic Colorectal Cancer. Dis Colon Rectum 62:1485–1493 Li S, Wang H, Yang Z et al (2021) Naples Prognostic Score as a novel prognostic prediction tool in video-assisted thoracoscopic surgery for early-stage lung cancer: a propensity score matching study. Surg Endosc 35:3679–3697 Feng JF, Zhao JM, Chen S et al (2021) Naples Prognostic Score: A Novel Prognostic Score in Predicting Cancer-Specific Survival in Patients With Resected Esophageal Squamous Cell Carcinoma. Front Oncol 11:652537 Xie YM, Lu W, Cheng J et al (2023) Naples Prognostic Score is an Independent Prognostic Factor in Patients Undergoing Hepatectomy for Hepatocellular Carcinoma. J Hepatocell Carcinoma 10:1423–1433 Hosoda K, Shimizu A, Kubota K et al (2025) Clinical significance of the Naples prognostic score in predicting short- and long-term postoperative outcomes of patients with hepatocellular carcinoma. World J Surg 49:502–511 Galizia G, Auricchio A, de Vita F et al (2019) Inflammatory and nutritional status is a predictor of long-term outcome in patients undergoing surgery for gastric cancer. Validation of the Naples prognostic score. Ann Ital Chir 90:404–416 Zawadzki M, Krzystek-Korpacka M, Gamian A et al (2017) Comparison of inflammatory responses following robotic and open colorectal surgery: a prospective study. Int J Colorectal Dis 32:399–407 Stavrou E, Tzanakis N, Spartalis E et al (2022) Comparison of Postoperative and Oncologic Outcomes in Laparoscopic and Open Right Colectomy for Colon Cancer: A 5-year Experience. Vivo 36:969–972 Kampman SL, Smalbroek BP, Dijksman LM et al (2023) Postoperative inflammatory response in colorectal cancer surgery: a meta-analysis. Int J Colorectal Dis 38:233 McSorley ST, Ramanathan ML, Horgan PG et al (2015) Postoperative C-reactive protein measurement predicts the severity of complications following surgery for colorectal cancer. Int J Colorectal Dis 30:913–917 Russell B, Zager Y, Mullin G et al (2023) Naples Prognostic Score to Predict Postoperative Complications After Colectomy for Diverticulitis. Am Surg 89:1598–1604 Bilimoria KY, Bentrem DJ, Merkow RP et al (2008) Laparoscopic-assisted vs. open colectomy for cancer: comparison of short-term outcomes from 121 hospitals. J Gastrointest Surg 12:2001–2009 Tajima T, Nagata J, Akiyama Y et al (2020) Open colectomy vs. laparoscopic colectomy in Japan: a retrospective study using real-world data from the diagnosis procedure combination database. Surg Today 50:1255–1261 Braga M, Frasson M, Vignali A et al (2005) Laparoscopic vs. open colectomy in cancer patients: long-term complications, quality of life, and survival. Dis Colon Rectum 48:2217–2223 Tables Tables 1 to 7 are available in the Supplementary Files section. Supplementary Files Table1.docx Table2.docx Table3.docx Table4.docx Table5.docx Table6.docx Table7.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6952840","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":475708398,"identity":"f1e2c04a-d23b-467b-a1b6-208cb003fb9c","order_by":0,"name":"Taishi Yamane","email":"data:image/png;base64,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","orcid":"","institution":"Kumamoto University: Kumamoto Daigaku","correspondingAuthor":true,"prefix":"","firstName":"Taishi","middleName":"","lastName":"Yamane","suffix":""},{"id":475708399,"identity":"8176c51f-fd7a-4521-a4f2-4f9d52ac5000","order_by":1,"name":"Koichi Doi","email":"","orcid":"","institution":"Miyazaki Kenritsu Nobeoka Byoin","correspondingAuthor":false,"prefix":"","firstName":"Koichi","middleName":"","lastName":"Doi","suffix":""},{"id":475708400,"identity":"dfb80ab0-dc9d-4b6f-8eac-c6ca5a3d53a1","order_by":2,"name":"Takayoshi Kaida","email":"","orcid":"","institution":"Miyazaki Kenritsu Nobeoka Byoin","correspondingAuthor":false,"prefix":"","firstName":"Takayoshi","middleName":"","lastName":"Kaida","suffix":""},{"id":475708401,"identity":"852dc683-126d-4594-bc59-4571e0911969","order_by":3,"name":"Yukiko Suzuki","email":"","orcid":"","institution":"Miyazaki Kenritsu Nobeoka Byoin","correspondingAuthor":false,"prefix":"","firstName":"Yukiko","middleName":"","lastName":"Suzuki","suffix":""},{"id":475708402,"identity":"0c8df624-0720-4b47-8162-47559fdef659","order_by":4,"name":"Chihiro Matsumoto","email":"","orcid":"","institution":"Miyazaki Kenritsu Nobeoka Byoin","correspondingAuthor":false,"prefix":"","firstName":"Chihiro","middleName":"","lastName":"Matsumoto","suffix":""},{"id":475708403,"identity":"b7b6d8b0-6840-45f9-98e3-52a04caf4eac","order_by":5,"name":"Fumimasa Kitamura","email":"","orcid":"","institution":"Miyazaki Kenritsu Nobeoka Byoin","correspondingAuthor":false,"prefix":"","firstName":"Fumimasa","middleName":"","lastName":"Kitamura","suffix":""},{"id":475708404,"identity":"70aa4592-0b49-4604-890c-964a0b52cb76","order_by":6,"name":"Hiroyuki Ishiodori","email":"","orcid":"","institution":"Miyazaki Kenritsu Nobeoka Byoin","correspondingAuthor":false,"prefix":"","firstName":"Hiroyuki","middleName":"","lastName":"Ishiodori","suffix":""},{"id":475708405,"identity":"88ebb99e-097f-4026-bfcf-35202e041a9a","order_by":7,"name":"Shinobu Honda","email":"","orcid":"","institution":"Miyazaki Kenritsu Nobeoka Byoin","correspondingAuthor":false,"prefix":"","firstName":"Shinobu","middleName":"","lastName":"Honda","suffix":""},{"id":475708406,"identity":"de75ca19-b29f-42d5-a0e4-25968ffe851a","order_by":8,"name":"Masaaki Iwatsuki","email":"","orcid":"","institution":"Kumamoto University: Kumamoto Daigaku","correspondingAuthor":false,"prefix":"","firstName":"Masaaki","middleName":"","lastName":"Iwatsuki","suffix":""}],"badges":[],"createdAt":"2025-06-23 05:13:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6952840/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6952840/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87615677,"identity":"f7a80b44-f960-47bf-897e-212a805519b7","added_by":"auto","created_at":"2025-07-26 01:17:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":386064,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6952840/v1/b561037a-1bcc-407f-9d55-4d6b9281f7eb.pdf"},{"id":85490029,"identity":"8d246389-af97-432a-afc4-3de3bc3c888b","added_by":"auto","created_at":"2025-06-26 12:45:50","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":17388,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6952840/v1/8e65ef3bcfd64ac1186e7926.docx"},{"id":85490028,"identity":"c0cdbe54-3876-4f0e-8db2-e575d82c31f8","added_by":"auto","created_at":"2025-06-26 12:45:50","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":19712,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.docx","url":"https://assets-eu.researchsquare.com/files/rs-6952840/v1/23117a9f09804a500a05f317.docx"},{"id":85490037,"identity":"a5f2b324-0985-4e02-a76d-c162750e8618","added_by":"auto","created_at":"2025-06-26 12:45:50","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":18390,"visible":true,"origin":"","legend":"","description":"","filename":"Table3.docx","url":"https://assets-eu.researchsquare.com/files/rs-6952840/v1/d2a2a282a1586183c76f4c24.docx"},{"id":85490036,"identity":"3cdd0ea1-1b2d-4885-b7a9-3880b7066df8","added_by":"auto","created_at":"2025-06-26 12:45:50","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":22302,"visible":true,"origin":"","legend":"","description":"","filename":"Table4.docx","url":"https://assets-eu.researchsquare.com/files/rs-6952840/v1/68ffdd71c58db244f7a10955.docx"},{"id":85491339,"identity":"125cdf37-b182-4d1c-9a4d-a1c687464fda","added_by":"auto","created_at":"2025-06-26 13:01:50","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":22302,"visible":true,"origin":"","legend":"","description":"","filename":"Table5.docx","url":"https://assets-eu.researchsquare.com/files/rs-6952840/v1/fe58abe1ee408d4a45425b53.docx"},{"id":85490030,"identity":"a07b587b-b707-40fd-8a22-315ebec71e20","added_by":"auto","created_at":"2025-06-26 12:45:50","extension":"docx","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":19974,"visible":true,"origin":"","legend":"","description":"","filename":"Table6.docx","url":"https://assets-eu.researchsquare.com/files/rs-6952840/v1/443318c4db9ad865759f7f19.docx"},{"id":85491050,"identity":"0a0dff9e-f637-4578-9a87-c724b8da9469","added_by":"auto","created_at":"2025-06-26 12:53:50","extension":"docx","order_by":7,"title":"","display":"","copyAsset":false,"role":"supplement","size":18403,"visible":true,"origin":"","legend":"","description":"","filename":"Table7.docx","url":"https://assets-eu.researchsquare.com/files/rs-6952840/v1/f319eddefeae576cf5ed3e04.docx"}],"financialInterests":"","formattedTitle":"Minimally invasive colectomy may contribute to low incidence of postoperative morbidity in patients with high Naples prognostic score","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eColorectal cancer (CRC) is among the most prevalent cancers worldwide. The incidence of CRC is rapidly increasing [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Many risk factors for morbidity after CRC surgery have been reported, including patient background and surgical factors [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRecently, a comprehensive prognostic score, the Naples prognostic score (NPS), calculated from serum albumin and total cholesterol concentrations, the lymphocyte-to-monocyte ratio (LMR), and the neutrophil-to-lymphocyte ratio (NLR), has been reported to be a powerful prognostic index for CRC complications [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. A previous study reported that a high NPS was associated with postoperative morbidity after rectal cancer surgery [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, the impact on short-term outcomes of surgical strategies was not investigated.\u003c/p\u003e \u003cp\u003eMinimally invasive colectomy (MIC) is less invasive than open colectomy (OC) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and may improve short-term outcomes in patients with high NPS. Thus, the current study aimed to retrospectively evaluate the effects of the NPS on postoperative outcomes after OC and MIC.\u003c/p\u003e"},{"header":"PATIENTS AND METHODS","content":"\u003cp\u003e\u003cem\u003ePatients\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective cohort study included 256 consecutive patients who underwent curative surgery for CRC at the Department of Surgery of the Miyazaki Prefectural Nobeoka Hospital between January 2013 and March 2020. The inclusion criteria were as follows: (1) pathologically-confirmed adenocarcinoma, (2) diagnosis of clinical stages I–III colorectal cancer, and (3) curative surgery. The exclusion criteria were as follows: (1) pathological stage IV disease and (2) missing data on clinicopathological characteristics. OC and MIC were performed in 139 and 117 patients, respectively. We further divided each OC and MIC group into two subgroups depending on whether the NPS was high or low. Short-term outcomes between patients with high- and low-NPS were compared in the OC and MIC groups using our institutional database. The ethics committee of our hospital approved the study procedure and waived the requirement for written informed consent (Registry Number 20190830-3).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNaples prognostic score definitions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe NPS was defined based on the following four parameters: serum albumin level, total cholesterol level, LMR, and NLR. As previously reported by Galizia et al., the cutoff values were 4 mg/dL for serum albumin, 180 mg/dL for total cholesterol, 2.96 for NLR, and 4.44 for LMR, respectively [4]. Patients with serum albumin, total cholesterol or LMR lower than the thresholds got one point; otherwise, they got zero. Patients with an NLR higher than 2.96 got one point, while those with a lower NLR got zero. The sum of the scores for each parameter comprised the NPS score. Patients were categorized into three groups according to the NPS: patients with an NPS of 0 were assigned to group 1, patients with an NPS of 1 or 2 to group 2, and patients with an NPS of 3 or 4 to group 3 (Table 1). Groups 1-2 were defined as the low-NPS and group 3 as the high-NPS group.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTreatment strategy\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eLower alimentary canal endoscopy and thoracoabdominal computed tomography (CT) were routinely performed to determine the clinical stage before colectomy. The pathological findings were defined according to the tumor, node, metastasis classification (American Joint Committee on Cancer Staging Manual, 8th edition). The treatment strategy and follow-up evaluation were performed according to the 2019 Japanese Society for Cancer of the Colon and Rectum guidelines 2019 [7]. Primary resection with lymph node dissection was recommended for stages I–III CRC. MIC was defined as laparoscopic colectomy. Morbidity was defined as a Clavien–Dindo classification (CDc) ≥II [8]. Severe morbidity was defined as a CDc ≥IIIb, requiring endoscopic, radiological, or surgical intervention under general anesthesia.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistical methods\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll data analyses were performed using JMP® software version 13.1 (SAS Institute, Cary, NC, USA). The clinicopathological characteristics and laboratory data of the two groups were compared using the chi-square test for categorical variables and the Mann–Whitney U test for continuous variables. Statistical significance was set at p\u0026lt;0.05. Logistic regression analysis was performed to estimate the hazard ratio (HR) with a 95% confidence interval (CI) for postoperative complication (CDc ≥ II and IIIb). The following clinical factors were adopted as risk factors for overall survival (OS): age at colectomy (≥70 vs. \u0026lt;70 years), sex (male vs. female), body mass index (≥25 vs. \u0026lt;25 kg/m2), NPS (high-NPS vs. low-NPS), tumor location (right-sided vs. left-sided), American Society of Anesthesiologists physical status (3 vs. 1, 2), pathological stage (stage III vs. stage 0, I, II), and comorbidity with diabetes mellitus (present vs. absent). We selected factors with a p-value ≤0.1 for subsequent multivariate analysis, and variables with a p-value \u0026lt;0.05 were recognized as independent risk factors.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cem\u003eClinical features of patients who underwent open colectomy\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 shows the characteristics of patients who underwent OC, depending on whether the NPS was high or low. No significant differences were observed between high- and low-NPS groups.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eShort-term outcomes after open colectomy\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 demonstrates the short-term outcomes after OC, depending on whether the NPS was high or low. The high-NPS groups had significantly higher incidences of postoperative morbidities compared with the low-NPS groups after OC (Clavien-Dindo classification (CDc) ≥ II; p=0.022, CDc ≥ IIIb; p=0.036). Furthermore, patients with high NPS experienced significantly more frequent reoperations after OC (p=0.0052).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRisk factors for any postoperative morbidities (CDc ≥ II) after open colectomy\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable 4 shows the results of the univariate and multivariate analyses of risk factors for postoperative morbidities (CDc ≥ II) after OC. Multivariate analysis demonstrated that high-NPS was an independent risk factor for postoperative morbidities (CDc ≥ II) after OC (hazard ratio 2.40; 95% confidence interval, 1.121–5.181; p=0.024).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRisk factors for severe postoperative morbidities (CDc ≥ IIIb) after open colectomy\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable 5 shows the results of the univariate and multivariate analyses of risk factors for severe postoperative morbidities (CDc ≥ IIIb) after OC. Multivariate analysis demonstrated that high-NPS was an independent risk factor for severe postoperative morbidities (CDc ≥ IIIb) after OC (hazard ratio 4.19; 95% confidence interval, 1.052–20.619; p=0.042).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eClinical features of patients who underwent minimally invasive colectomy\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable 6 shows the characteristics of patients who underwent MIC, depending on whether the NPS was high or low. High-NPS was significantly correlated with older age. Those in the low-NPS groups. In addition, the high NPS group showed a trend toward a lower body mass index, which was not statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eShort-term outcomes after minimally invasive colectomy\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable 7 shows the short-term outcomes after MIC depending on whether the NPS score was high or low. No significant differences were observed in operative time, bleeding, or postoperative morbidities after MIC.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this study, we demonstrated that a high NPS was an independent risk factor for postoperative morbidity after OC, but not after MIC.\u003c/p\u003e \u003cp\u003eThe NPS is an inflammation-based prognostic score developed as a marker for colorectal cancer by Galizia et al [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The NPS includes factors that reflect nutritional status (albumin and total cholesterol) and inflammation (NLR and LMR) and has emerged as a novel prognostic marker for various types of cancer, such as colorectal [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], lung [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], esophageal [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], and hepatocellular [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Recently, a high NPS was a risk factor for oncological postoperative morbidity. Hosoda et al. reported that high-NPS was associated with postoperative morbidity (CDc\u0026thinsp;\u0026ge;\u0026thinsp;III) after liver resection for hepatocellular carcinoma [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Galizia et al. reported that a high NPS significantly correlated with postoperative morbidity after gastrectomy for gastric cancer [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Recently, high-NPS reportedly lead to postoperative morbidity (CDc\u0026thinsp;\u0026ge;\u0026thinsp;III) after colectomy for rectal cancer [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, to the best of our knowledge, no study has elucidated the superiority of MIC over OC for postoperative morbidity in colorectal cancer patients with a high NPS.\u003c/p\u003e \u003cp\u003eOC is generally considered to be more invasive than MIC. Serum interleukin (IL)-6 and IL-10 levels after OC, which are commonly used to assess surgical stress, were significantly higher than those after MIC [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In addition, C-reactive protein levels (CRP) after OC were also significantly higher than those after MIC [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. McSorley et al. demonstrated that the magnitude of the postoperative systemic inflammatory response, as evidenced by CRP levels, was significantly associated with complications after colorectal cancer surgery [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. NPS is valuable in predicting postoperative complications because it serves as an indicator of inflammation, malnutrition, and immunosuppression [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The higher invasiveness of OC compared to MIC might increase postoperative complications in colorectal cancer patients with a high NPS.\u003c/p\u003e \u003cp\u003ePrevious studies reported that high-NPS was correlated with severe postoperative morbidity (CDc\u0026thinsp;\u0026ge;\u0026thinsp;III) after hepatectomy for hepatocellular carcinoma [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] and colectomy for rectal cancer [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Furthermore, a large cohort study showed that a high NPS was significantly associated with mortality and reoperation in patients undergoing colectomy for diverticulitis [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. It also suggested a correlation between the NPS and CDc scores after colectomy for diverticulitis [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In the present study, high-NPS was significantly associated with severe postoperative morbidity (CDc\u0026thinsp;\u0026ge;\u0026thinsp;IIIb) and reoperation after OC. Four cases of reoperation after OC (none after MIC) were noted, and the reasons were two anastomotic leakages, one abdominal dehiscence, and one postoperative bleeding. High NPS may lead to more severe complications after surgery because of increased inflammation, malnutrition, and immunosuppression.\u003c/p\u003e \u003cp\u003eThe lower invasiveness of MIC could yield various advantages during colectomy. A large cohort study demonstrated that MIC contributed to fewer postoperative complications than OC, specifically surgical site infections, urinary tract infections, and pneumonia [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. A recent retrospective study investigating 69,418 colectomies from the Japanese Diagnosis Procedure Combination database suggested that MIC could contribute to decreasing the postoperative mortality rate, surgical morbidity rate, and postoperative length of stay [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In addition, a randomized controlled trial showed that MIC was associated with a lower incidence of long-term complications and a better quality of life in the first 12 months after surgery than OC [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In the current study, a novel advantage was suggested: MIC may not increase postoperative morbidity, even in patients with a high NPS.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, this was a single-center, retrospective study. Secondly, this study did not include robotic surgeries. Third, the observation period was relatively long. Thus, older patients may have been indicated for OC only and advances in perioperative management during the study period may have affected the incidence of postoperative morbidities.\u003c/p\u003e \u003cp\u003eIn conclusion, a high NPS was associated with postoperative complications after OC, but not after MIC. The reduced invasiveness of MIC may contribute to lower postoperative morbidity in patients with a high NPS.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank all the people who contributed to this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u003c/strong\u003e\u003cstrong\u003e´\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eT. Yamane wrote the manuscript. K. Doi planed study concept and design. C. Matsumoto, T Kaida, Y Suzuki, F Kitamjura and H. Ishiodori collected the clinical data. S. Honda conducted critical revision of manuscript. M. Iwatsuki coordinated the study, oversaw collection and analysis of the results. All authors discussed the data and commented on the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eThere was no financial support for this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The ethics committee of our hospital approved the study procedure. Registry Number 20190830-3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe requirement for written informed consent was waived.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMorgan E, Arnold M, Gini A et al (2023) Global burden of colorectal cancer in 2020 and 2040: incidence and mortality estimates from GLOBOCAN. Gut 72:338\u0026ndash;344\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZarnescu EC, Zarnescu NO, Costea R (2021) Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery. Diagnostics (Basel, p 11\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBenedek Z, Coroş MF (2023) The impact of sarcopenia on the postoperative outcome in colorectal cancer surgery. Med Pharm Rep 96:20\u0026ndash;27\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGalizia G, Lieto E, Auricchio A et al (2017) Naples Prognostic Score, Based on Nutritional and Inflammatory Status, is an Independent Predictor of Long-term Outcome in Patients Undergoing Surgery for Colorectal Cancer. Dis Colon Rectum 60:1273\u0026ndash;1284\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSugimoto A, Fukuoka T, Nagahara H et al (2023) Predictive value of the Naples prognostic score on postoperative outcomes in patients with rectal cancer. Langenbecks Arch Surg 408:113\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHildebrandt U, Kessler K, Plusczyk T et al (2003) Comparison of surgical stress between laparoscopic and open colonic resections. Surg Endosc 17:242\u0026ndash;246\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHashiguchi Y, Muro K, Saito Y et al (2020) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol 25:1\u0026ndash;42\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205\u0026ndash;213\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePark SH, Woo HS, Hong IK et al (2023) Impact of Postoperative Naples Prognostic Score to Predict Survival in Patients with Stage II-III Colorectal Cancer. Cancers (Basel) 15\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiyamoto Y, Hiyoshi Y, Daitoku N et al (2019) Naples Prognostic Score Is a Useful Prognostic Marker in Patients With Metastatic Colorectal Cancer. Dis Colon Rectum 62:1485\u0026ndash;1493\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi S, Wang H, Yang Z et al (2021) Naples Prognostic Score as a novel prognostic prediction tool in video-assisted thoracoscopic surgery for early-stage lung cancer: a propensity score matching study. Surg Endosc 35:3679\u0026ndash;3697\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFeng JF, Zhao JM, Chen S et al (2021) Naples Prognostic Score: A Novel Prognostic Score in Predicting Cancer-Specific Survival in Patients With Resected Esophageal Squamous Cell Carcinoma. Front Oncol 11:652537\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXie YM, Lu W, Cheng J et al (2023) Naples Prognostic Score is an Independent Prognostic Factor in Patients Undergoing Hepatectomy for Hepatocellular Carcinoma. J Hepatocell Carcinoma 10:1423\u0026ndash;1433\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHosoda K, Shimizu A, Kubota K et al (2025) Clinical significance of the Naples prognostic score in predicting short- and long-term postoperative outcomes of patients with hepatocellular carcinoma. World J Surg 49:502\u0026ndash;511\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGalizia G, Auricchio A, de Vita F et al (2019) Inflammatory and nutritional status is a predictor of long-term outcome in patients undergoing surgery for gastric cancer. Validation of the Naples prognostic score. Ann Ital Chir 90:404\u0026ndash;416\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZawadzki M, Krzystek-Korpacka M, Gamian A et al (2017) Comparison of inflammatory responses following robotic and open colorectal surgery: a prospective study. Int J Colorectal Dis 32:399\u0026ndash;407\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStavrou E, Tzanakis N, Spartalis E et al (2022) Comparison of Postoperative and Oncologic Outcomes in Laparoscopic and Open Right Colectomy for Colon Cancer: A 5-year Experience. Vivo 36:969\u0026ndash;972\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKampman SL, Smalbroek BP, Dijksman LM et al (2023) Postoperative inflammatory response in colorectal cancer surgery: a meta-analysis. Int J Colorectal Dis 38:233\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcSorley ST, Ramanathan ML, Horgan PG et al (2015) Postoperative C-reactive protein measurement predicts the severity of complications following surgery for colorectal cancer. Int J Colorectal Dis 30:913\u0026ndash;917\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRussell B, Zager Y, Mullin G et al (2023) Naples Prognostic Score to Predict Postoperative Complications After Colectomy for Diverticulitis. Am Surg 89:1598\u0026ndash;1604\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBilimoria KY, Bentrem DJ, Merkow RP et al (2008) Laparoscopic-assisted vs. open colectomy for cancer: comparison of short-term outcomes from 121 hospitals. J Gastrointest Surg 12:2001\u0026ndash;2009\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTajima T, Nagata J, Akiyama Y et al (2020) Open colectomy vs. laparoscopic colectomy in Japan: a retrospective study using real-world data from the diagnosis procedure combination database. Surg Today 50:1255\u0026ndash;1261\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBraga M, Frasson M, Vignali A et al (2005) Laparoscopic vs. open colectomy in cancer patients: long-term complications, quality of life, and survival. Dis Colon Rectum 48:2217\u0026ndash;2223\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 7 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"colorectal cancer, Naples prognostic score, minimally invasive colectomy","lastPublishedDoi":"10.21203/rs.3.rs-6952840/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6952840/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis retrospective analysis included 139 patients who underwent OC and 117 who underwent MIC for colorectal cancer between January 2013 and March 2020. The NPS was a composite score calculated using albumin and cholesterol concentrations, and lymphocyte: monocyte and neutrophil: lymphocyte ratios. Patients were divided into three groups based on increasing 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The high-NPS groups had significantly higher postoperative morbidity after OC (Clavien–Dindo classification (CDc) ≥ II; p=0.022, CDc ≥ IIIb; p=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; p=0.024 and CDc ≥ IIIb: hazard ratio 4.19; 95% confidence interval, 1.052–20.619; p=0.042). Low-NPS did not affect postoperative morbidity after MIC (CDc ≥ II; p=0.12, CDc ≥ IIIb; p=0.51).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e 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.\u003c/p\u003e","manuscriptTitle":"Minimally invasive colectomy may contribute to low incidence of postoperative morbidity in patients with high Naples prognostic score","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-26 12:45:45","doi":"10.21203/rs.3.rs-6952840/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a7b87b5a-f190-4ad5-bfc0-40211d3f694e","owner":[],"postedDate":"June 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-26T01:09:11+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-26 12:45:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6952840","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6952840","identity":"rs-6952840","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}