Association between Neutrophil-Lymphocyte Ratio and Failure of Conservative Medical Treatment in Patients with Intestinal Obstruction Due to Abdominal Cancer
Authors:   Department of General Surgery, Fourth-year Resident, General Hospital No. 3 (I.M.S.S.), Aguascalientes, Aguascalientes, Mexico., Massiel Márquez Lara, , José Luis Bizueto Monroy, ,   Department of General Surgery, General Surgeron, General Hospital No. 3 (I.M.S.S.), Aguascalientes, Aguascalientes, Mexico., Ivonne González Espinosa, ,   Department of General Surgery, General Surgeron, General Hospital No. 3 (I.M.S.S.), Aguascalientes, Aguascalientes, Mexico., Santiago Domínguez Barrios, ,   Social Service Medical Intern, Directorate of Medical Services of the State Comprehensive Family Development, Aguascalientes, Aguascalientes, Mexico., Yulian Haro Salas, ,   Department of General Surgery, Fourth-year Resident, General Hospital No. 3 (I.M.S.S.), Aguascalientes, Aguascalientes, Mexico., Estefanía Rocha Cabrera, Cecilia ,   Department of General Surgery, Fourth-year Resident, General Hospital No. 3 (I.M.S.S.), Aguascalientes, Aguascalientes, Mexico., Jafeth Palacios Godinez, Edgar ,   Department of General Surgery, Fourth-year Resident, General Hospital No. 3 (I.M.S.S.), Aguascalientes, Aguascalientes, Mexico.
Published: December 2024

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.