## 4 Discussion  
In our study, we found that patients undergoing lung anatomic robotic-assisted surgery experienced an increase in the absolute values of neutrophils and monocytes while experiencing is a decrease in the absolute values of lymphocytes and platelets. In addition, the ratios were modified accordingly, with an increase in PLR and NLR and a respective decrease in LMR. The NLR and PLR showed an increase in the postoperative period with respect to the preoperative period. This is a common response to different types of injury. The MRL decreases its value in the postoperative period with respect to the preoperative period, with this decrease being a usual response to injury. However, no relationship was found between the inflammatory hemocytometry indices for any of the variables studied, both preoperatively and postoperatively. As for the SII, there was no association between its increase and the occurrence of post-surgical events. In the current literature, there are many studies aimed at detecting and determining the prognostic potential of many biological markers that are accessible to all media and low in cost. A historical review of a group of these studies [16] highlights the importance of the immunological changes that develop during cancer. These immunological changes, including increased neutrophils and lymphopenia, allow the development of certain ratios that function as indices. In the case of solid tumors of the gastrointestinal tract, one ratio in particular, the preoperative NLR, has been shown to be a prognostic factor in survival  
Figure 2: ROC curve between complications and postoperative values as **(A)** LMR; **(B)** PLR; **(C)** NLR and **(D)** SII. The ROC curves, which relate complications to the results of both pre and postoperative indices, do not show good results. Recalling that when the ROC curve approaches the dotted straight line on the graph, which corresponds to an AUC of 0.50, it is equivalent to random guessing by flipping a coin. In all cases, it is very close to this line, and in some cases, it crosses it downwards, indicating an even worse statistical performance. and postsurgical outcomes. Some studies have found a negative prognostic relationship between PLR and 2-year survival in cohorts of 500 NSCLC patients [17]. Other authors, on the other hand, have focused on determining the relationship between SII and prognosis in neoplastic diseases. Other studies with a retrospective design have found that elevated values of SII, PLR and NLR are associated with a negative prognosis in the early stages of NSLC [18; 19; 21]. However, these are studies with heterogeneity in their samples, which does not allow their conclusions to be generalized. A meta-analysis of retrospective studies in SCLC showed a relationship between high levels of SII and a worse prognosis [27]. We can observe that NRL, SII and PLR are shown as a constant, where the higher the values, the worse the prognosis; however, in no case has a cut-off value been defined to establish this relationship. There is also no consistency between stages, since some find this relationship in early stage16 while others do so only in advanced stage20. As previously published, a retrospective study showed that high LMR values are associated with worse DFS and OS in early stages [28]. The same index has been described as a worse independent prognosis in advanced stages [29]. It is this inconsistency between the different indices, the pathological stage and the threshold or cut-off values that prevents, for the time being, these indices to be established as useful tools in clinical practice. In the case of our current study, although the design does not present advantages over pre-existing ones, the results differ from those found by other authors. Some studies support the idea that different stages imply different inflammatory states and, therefore, different outcomes [30; 31]. In our case, we did not find such a claim.