Perioperative Dynamics of the Hemoglobin–Albumin–Lymphocyte–Platelet (HALP) Score and Early Morbidity After Curative Esophagectomy

Background/Objectives: The hemoglobin–albumin–lymphocyte–platelet (HALP) score is an immune–nutritional biomarker associated with oncological outcomes. We evaluated perioperative HALP trajectories and their association with early postoperative complications after curative esophagectomy. Methods: In this retrospective single-center cohort study, 129 patients undergoing esophagectomy between June 2020 and March 2025 were included. HALP was calculated preoperatively and on postoperative days 1 and 7. Trajectories were analyzed using generalized estimating equations. Discriminative performance was assessed using receiver operating characteristic (ROC) analysis, and independent associations were evaluated using multivariable logistic regression. Results: HALP declined markedly after surgery (median, 28.93 preoperatively, 10.11 on postoperative day 1, and 10.53 on postoperative day 7; p < 0.001). Patients with major complications, anastomotic leakage, or intensive care unit readmission had lower postoperative day 7 HALP values. Postoperative day 7 HALP discriminated intensive care unit readmission (area under the curve [AUC] = 0.769), anastomotic leakage (AUC = 0.734), major complications (AUC = 0.733), and overall complications (AUC = 0.697). Each doubling of postoperative day 7 HALP was independently associated with lower odds of overall complications (odds ratio [OR] = 0.473), major complications (OR = 0.351), anastomotic leakage (OR = 0.383), and intensive care unit readmission (OR = 0.374; all p ≤ 0.002). Preoperative HALP showed limited discriminative performance. Bootstrap-corrected AUCs for the models including age, ASA, and POD7 HALP ranged from 0.696 to 0.737. Conclusions: HALP demonstrates a distinct perioperative trajectory after esophagectomy, with persistent impairment on postoperative day 7 associated with early postoperative morbidity. The potential clinical role of serial HALP assessment requires prospective evaluation.