BACKGROUND: The pre-operative neutrophil-to-lymphocyte ratio (NLR), when ≥5 has 
been associated with reduced survival for patients with various gastrointestinal 
tract cancers, however, it's prognostic value in patients with periampullary 
tumour has not been reported to date.
OBJECTIVES: To determine the prognostic value of pre-operative NLR in terms of 
survival and recurrence of resected periampullary carcinomas.
METHODS: This was a retrospective cohort study of consecutive patients 
undergoing pancreatoduodenectomy (PD) for periampullary carcinoma (pancreatic, 
ampullary, cholangiocarcinoma) identified from a departmental database. The 
effect of NLR upon survival and recurrence was explored.
RESULTS: Overall median survival amongst 228 patients was 24 months 
(inter-quartile range [IQR]: 12-43). The median survival for those whose NLR was 
<5 was not significantly greater than those patients whose NLR was ≥5 (24 months 
[IQR: 14-42] versus 13 months [IQR: 8-48], respectively; p = 0.234). However, 
for those that developed recurrence, survival was greater in those with an NLR 
<5 at (20 months [IQR: 12-27] versus 11 months [IQR: 7-22], respectively; 
p = 0.038). This effect was most marked in those patients with 
cholangiocarcinoma (p = 0.019) whilst a trend to worse survival was seen in 
those with pancreatic adenocarcinoma. No effect was seen in patients with 
ampullary carcinoma (p = 0.516).
CONCLUSIONS: This study provides further evidence that pre-operative NLR offers 
important prognostic information regarding disease-free survival. This effect, 
however, is dependent upon the tumour type amongst patients undergoing PD.