{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T13:42:59Z","timestamp":1788961379326,"version":"build-2803163510"},"reference-count":31,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Composite immunonutritional biomarkers reflecting systemic inflammation, nutritional status, and immune competence have emerged as promising tools for perioperative risk stratification in colorectal cancer (CRC). However, their prognostic value during the perioperative period following minimally invasive CRC surgery remains unresolved. This study aimed to evaluate the association between perioperative inflammatory biomarkers, including the neutrophil-to-lymphocyte ratio (NLR), hemoglobin\u2013albumin\u2013lymphocyte\u2013platelet (HALP) score, and Host Index (H-index), and short-term postoperative outcomes after minimally invasive colorectal cancer surgery. Methods: This retrospective single-center study included 105 patients who underwent minimally invasive curative-intent surgery for CRC between 2023 and 2025. Biomarkers were assessed preoperatively and during the first four postoperative days. Severe postoperative morbidity was defined as a Comprehensive Complication Index (CCI) \u2265 20.9. Results: Among all parameters, NLR measured on postoperative day 3 demonstrated the highest apparent discriminatory ability for severe complications (AUC = 0.87, 95% CI: 0.74\u20130.95; sensitivity 91.7%; specificity 73.7%). Preoperative HALP was the most informative preoperative marker (AUC = 0.78, 95% CI: 0.66\u20130.87; sensitivity 76.5%; specificity 87.7%). Conclusions: Perioperative inflammatory and immunonutritional biomarkers are associated with postoperative morbidity following CRC surgery. Preoperative HALP and postoperative day 3 NLR demonstrated the strongest apparent discrimination for CCI \u2265 20.9; however, these findings require confirmation in larger, independent prospective cohorts.<\/jats:p>","DOI":"10.3390\/nu18152581","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T14:45:47Z","timestamp":1786027547000},"page":"2581","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Let\u2019s See Day Three: Association and Potential Discriminatory Value of Selected Inflammatory and Immunonutritional Biomarkers for Postoperative Morbidity After Minimally Invasive Colorectal Cancer Surgery"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8519-7655","authenticated-orcid":false,"given":"Magdalena","family":"Le\u015bniewska","sequence":"first","affiliation":[{"name":"Doctoral School, Medical University of Lublin, Chod\u017aki 7 St., 20-093 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zofia","family":"Chy\u0142a","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Medical University of Lublin, Staszica 16 St., 20-080 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6632-4938","authenticated-orcid":false,"given":"Zuzanna","family":"D\u0105browska","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Medical University of Lublin, Staszica 16 St., 20-080 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8187-7394","authenticated-orcid":false,"given":"Jolanta","family":"Sado","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Medical University of Lublin, Staszica 16 St., 20-080 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5620-8882","authenticated-orcid":false,"given":"Kinga","family":"Bielarska","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Medical University of Lublin, Staszica 16 St., 20-080 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8185-0746","authenticated-orcid":false,"given":"Szymon","family":"Bielecki","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Medical University of Lublin, Staszica 16 St., 20-080 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zuzanna","family":"Pelc","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Medical University of Lublin, Staszica 16 St., 20-080 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcin","family":"Kubiak","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Medical University of Lublin, Staszica 16 St., 20-080 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarzyna","family":"S\u0119d\u0142ak","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Medical University of Lublin, Staszica 16 St., 20-080 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rados\u0142aw","family":"Mlak","sequence":"additional","affiliation":[{"name":"Department of Laboratory Diagnostics, Medical University of Lublin, Chod\u017aki 1 St., 20-093 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2555-2114","authenticated-orcid":false,"given":"Karol","family":"Rawicz-Pruszy\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Medical University of Lublin, Staszica 16 St., 20-080 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1097\/SLA.0000000000000216","article-title":"Preoperative Neutrophil to Lymphocyte Ratio of 3 Predicts Disease-Free Survival After Curative Elective Colorectal Cancer","volume":"260","author":"Malietzis","year":"2014","journal-title":"Ann. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"O236","DOI":"10.1111\/codi.13373","article-title":"The neutrophil\/lymphocyte ratio predicts major perioperative complications in patients undergoing colorectal surgery","volume":"18","author":"Josse","year":"2016","journal-title":"Color. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Shevchenko, I., Serban, D., Simion, L., Motofei, I., Cristea, B.M., Dumitrescu, D., Grigorescu, C.C., Dascalu, A.M., Tribus, L., and Alius, C. (2025). Clinical Significance of Blood Cell-Derived Inflammation Markers in Assessing Potential Early and Late Postoperative Complications in Patients with Colorectal Cancer: A Systematic Review. J. Clin. Med., 14.","DOI":"10.3390\/jcm14072529"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"109496","DOI":"10.1016\/j.intimp.2022.109496","article-title":"Hemoglobin, albumin, lymphocyte, and platelet (HALP) score and cancer prognosis: A systematic review and meta-analysis of 13,110 patients","volume":"114","author":"Xu","year":"2023","journal-title":"Int. Immunopharmacol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1236","DOI":"10.1038\/sj.bjc.6604997","article-title":"Preoperative Systemic Inflammation Predicts Postoperative Infectious Complications in Patients Undergoing Curative Resection for Colorectal Cancer","volume":"100","author":"Moyes","year":"2009","journal-title":"Br. J. Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2832","DOI":"10.1245\/s10434-016-5204-5","article-title":"Postoperative Systemic Inflammatory Response, Complication Severity, and Survival Following Surgery for Colorectal Cancer","volume":"23","author":"McSorley","year":"2016","journal-title":"Ann. Surg. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"10744","DOI":"10.1038\/s41598-020-67285-y","article-title":"The Geriatric Nutritional Risk Index predicts postoperative complications and prognosis in elderly patients with colorectal cancer after curative surgery","volume":"10","author":"Sasaki","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"558639","DOI":"10.2147\/CMAR.S558639","article-title":"Preoperative Prognostic Nutritional Index Predicts Postoperative Outcomes in Colorectal Cancer: A Propensity Score-Matched Cohort Study","volume":"18","author":"Kor","year":"2026","journal-title":"Cancer Manag. Res."},{"key":"ref_9","unstructured":"GLOBOCAN (2026, May 01). GLOBOCAN\u2014Cancer Tomorrow. 2050. Available online: https:\/\/gco.iarc.who.int\/tomorrow\/en\/dataviz\/trends?multiple_populations=1&age_start=0&age_end=12."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1001\/jamasurg.2013.4930","article-title":"Colorectal cancer resections in the aging US population: A trend toward decreasing rates and improved outcomes","volume":"149","author":"Jafari","year":"2014","journal-title":"JAMA Surg."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"O\u2019Donnell, C.D.J., Hubbard, J., and Jin, Z. (2024). Updates on the Management of Colorectal Cancer in Older Adults. Cancers, 16.","DOI":"10.20944\/preprints202404.0689.v1"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1016\/S0140-6736(19)32319-0","article-title":"Title Colorectal Cancer","volume":"394","author":"Dekker","year":"2019","journal-title":"Lancet"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1093\/annonc\/mdu253","article-title":"Treatment of Colorectal Cancer in Older Patients: International Society of Geriatric Oncology (SIOG) Consensus Recommendations 2013","volume":"26","author":"Papamichael","year":"2015","journal-title":"Ann. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.jgo.2016.06.001","article-title":"The Impact of Frailty on Postoperative Outcomes in Individuals Aged 65 and Over Undergoing Elective Surgery for Colorectal Cancer: A Systematic Review","volume":"7","author":"Fagard","year":"2016","journal-title":"J. Geriatr. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1002\/jso.27736","article-title":"Impact of Comprehensive Geriatric Assessment on Treatment Strategies and Complications in Older Adults with Colorectal Cancer Considering Surgery","volume":"130","author":"Sugiyama","year":"2024","journal-title":"J. Surg. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1675","DOI":"10.1016\/j.ejso.2021.01.029","article-title":"Treatment Patterns and Primary Reasons for Adjusted Treatment in Older and Younger Patients with Stage II or III Colorectal Cancer","volume":"47","author":"Scheepers","year":"2021","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1650","DOI":"10.1016\/j.ejso.2022.02.017","article-title":"Annual Hospital Volume and Colorectal Cancer Survival in a Population-Based Nationwide Cohort Study in Finland","volume":"48","author":"Sarjanoja","year":"2022","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/SLA.0b013e318296c732","article-title":"The Comprehensive Complication Index: A Novel Continuous Scale to Measure Surgical Morbidity","volume":"258","author":"Slankamenac","year":"2013","journal-title":"Ann. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Kubiak, M., G\u00f3rski, W., and Mlak, R. (2026). Quality Without Compromise: A Propensity Score-Matched Analysis of Robotic Versus Laparoscopic Surgery for Locally Advanced Colorectal Cancer. Cancers, 18.","DOI":"10.3390\/cancers18101601"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"438","DOI":"10.4240\/wjgs.v16.i2.438","article-title":"Preoperative Neutrophil-to-Lymphocyte Ratio Predicts Symptomatic Anastomotic Leakage in Elderly Colon Cancer Patients: Multicenter Propensity Score-Matched Analysis","volume":"16","author":"Wang","year":"2024","journal-title":"World J. Gastrointest. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"41370","DOI":"10.18632\/oncotarget.5629","article-title":"Prognostic Significance of the Combination of Preoperative Hemoglobin, Albumin, Lymphocyte and Platelet in Patients with Gastric Carcinoma: A Retrospective Cohort Study","volume":"6","author":"Chen","year":"2015","journal-title":"Oncotarget"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Seyyar, M., \u015eanc\u0131, P.C., K\u00f6\u015feci, T., Karakayal\u0131, A., \u00d6zkorkmaz Akda\u011f, M., Bakkal Temi, Y., and Korkmaz, H. (2025). HALP-H Index as a Prognostic Biomarker for Predicting Pathological Complete Response in Early-Stage HER2-Positive Breast Cancer\u2014A Multicenter Retrospective Cohort Study. J. Clin. Med., 14.","DOI":"10.3390\/jcm14134431"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Haghi, S.E., Khanzadeh, M., and Sarejloo, S. (2024). Systematic Review of the Significance of Neutrophil-to-Lymphocyte Ratio in Anastomotic Leak after Gastrointestinal Surgeries. BMC Surg., 24.","DOI":"10.1186\/s12893-023-02292-0"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.ijsu.2006.05.013","article-title":"Post-operative Neutrophil-Lymphocyte Ratio Predicts Complications Following Colorectal Surgery","volume":"5","author":"Cook","year":"2007","journal-title":"Int. J. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"33","DOI":"10.5604\/01.3001.0015.8385","article-title":"Neutrophil-to-Lymphocyte Ratio in Predicting Postoperative Complications and Prognosis in Patients with Colorectal Cancer","volume":"94","author":"Fuss","year":"2022","journal-title":"Pol. J. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2331","DOI":"10.1007\/s13304-025-02286-y","article-title":"Prognostic Impact of Persistent Postoperative Neutrophil-to-Lymphocyte Ratio Elevation 1 Year after Colorectal Cancer Surgery","volume":"77","year":"2025","journal-title":"Updates Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"90","DOI":"10.59869\/24033","article-title":"The Association of the Neutrophil-to-Lymphocyte Ratio and Postoperative Complications in Colorectal Cancer Surgery: A Scoping Review","volume":"94","author":"Kalali","year":"2024","journal-title":"Hell. J. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Park, S.H., Woo, H.S., Hong, I.K., and Park, E.J. (2023). Impact of Postoperative Naples Prognostic Score to Predict Survival in Patients with Stage II-III Colorectal Cancer. Cancers, 15.","DOI":"10.3390\/cancers15205098"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1694304","DOI":"10.3389\/fsurg.2025.1694304","article-title":"Complications and Length of Stay after Enhanced Recovery after Surgery Compared to Conventional Care in Colorectal Cancer Patients in Northern Italy","volume":"12","author":"Fabozzi","year":"2025","journal-title":"Front. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2821","DOI":"10.1016\/j.ejso.2021.05.045","article-title":"Textbook Outcome after Rectal Cancer Surgery as a Composite Measure for Quality of Care: A Population-Based Study","volume":"47","author":"Warps","year":"2021","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"72076","DOI":"10.18632\/oncotarget.12271","article-title":"Preoperative Combined Hemoglobin, Albumin, Lymphocyte and Platelet Levels Predict Survival in Patients with Locally Advanced Colorectal Cancer","volume":"7","author":"Jiang","year":"2016","journal-title":"Oncotarget"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/15\/2581\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T14:50:04Z","timestamp":1786027804000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/15\/2581"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,6]]},"references-count":31,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["nu18152581"],"URL":"https:\/\/doi.org\/10.3390\/nu18152581","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,6]]}}}