Perioperative neutrophil-to-lymphocyte ratio in patients with melanoma: a pilot study assessing surgical stress after sentinel lymph node biopsy.

Abstract

Surgical stress is gaining increasing focus in surgical oncology due to its impact on complications, prognosis, and survival. The neutrophil-to-lymphocyte ratio (NLR) is a recognized biomarker reflecting inflammation and immune response, key aspects of surgical stress. Sentinel lymph node biopsy (SLNB) and wide local excision (WLE) are considered minimally invasive procedures used in the management of melanoma. Yet, the surgical stress response of WLE and SLNB remains unexplored. This study aims to investigate perioperative changes in the NLR as a marker of surgical stress in patients with melanoma undergoing WLE and SLNB. This prospective pilot study investigated NLR as a marker of surgical stress in patients (n = 20) with melanoma undergoing WLE and SLNB. NLR was calculated from the plasma differential count and measured preoperatively and at 2 and 6 h postoperatively. Surgical stress was categorized into four groups according to the NLR values: No stress, mild, moderate, and severe stress. Paired t-tests tested differences between time points. Mean NLR increases from 1.94 (±0.86) preoperatively to 9.5 (±4.39) at 2 h (P < 0.001) and further increases to 16.04 (±11.11) at 6 h (P = 0.02) postoperatively. This increase reflects a shift from no systemic stress (NLR: 1-3) to a moderate (NLR: 8-18) response, approaching severe thresholds. Changes in NLR are driven by significant neutrophilia and lymphocytopenia. Despite minor procedures, WLE and SLNB elicit a substantial surgical stress response. NLR may serve as a valuable biomarker for monitoring surgical stress in melanoma surgery, with potential implications for surgical and oncologic outcomes.