Postoperative procalcitonin is a biomarker for excluding the onset of clinically relevant pancreatic fistula after pancreaticoduodenectomy

Predictive value of C-reactive protein, procalcitonin, and total bilirubin levels for pancreatic fistula after gastrectomy for gastric cancer

BACKGROUND

Gastric cancer is the most common malignancy of the digestive system and surgical resection is the primary treatment. Advances in surgical technology have reduced the risk of complications after radical gastrectomy; however, post-surgical pancreatic fistula remain a serious issue. These fistulas can lead to abdominal infections, anastomotic leakage, increased costs, and pain; thus, early diagnosis and prevention are crucial for a better prognosis. Currently, C-reactive protein (CRP), procalcitonin (PCT), and total bilirubin (TBil) levels are used to predict post-operative infections and anastomotic leakage. However, their predictive value for pancreatic fistula after radical gastrectomy for gastric cancer remains unclear. The present study was conducted to determine their predictive value.

AIM

To determine the predictive value of CRP, PCT, and TBil levels for pancreatic fistula after gastric cancer surgery.

METHODS

In total, 158 patients who underwent radical gastrectomy for gastric cancer at our hospital between January 2019 and January 2023 were included. The patients were assigned to a pancreatic fistula group or a non-pancreatic fistula group. Multivariate logistic analysis was conducted to assess the factors influencing development of a fistula. Receiver operating characteristic (ROC) curves were used to determine the predictive value of serum CRP, PCT, and TBil levels on day 1 post-surgery.

RESULTS

On day 1 post-surgery, the CRP, PCT, and TBil levels were significantly higher in the pancreatic fistula group than in the non-pancreatic fistula group (P < 0.05). A higher fistula grade was associated with higher levels of the indices. Univariate analysis revealed significant differences in the presence of diabetes, hyperlipidemia, pancreatic injury, splenectomy, and the biomarker levels (P < 0.05). Logistic multivariate analysis identified diabetes, hyperlipidemia, pancreatic injury, CRP level, and PCT level as independent risk factors. ROC curves yielded predictive values for CRP, PCT, and TBil levels, with the PCT level having the highest area under the curve (AUC) of 0.80 [95% confidence interval (CI): 0.72-0.90]. Combined indicators improved the predictive value, with an AUC of 0.86 (95%CI: 0.78-0.93).

CONCLUSION

Elevated CRP, PCT, and TBil levels predict risk of pancreatic fistula post-gastrectomy for gastric cancer.

Development and validation of a nomogram based on preoperative factors for predicting clinically relevant postoperative pancreatic fistula following pancreaticoduodenectomy

Background

Clinically relevant postoperative pancreatic fistula (CR-POPF) remains a significant complication after pancreaticoduodenectomy (PD), leading to prolonged hospital stays, increased healthcare costs, and higher mortality rates. Timely recognition of patients at high risk for CR-POPF is critical for the implementation of personalized management strategies. This study aimed to develop and validate a predictive nomogram using preoperative factors to accurately predict CR-POPF after PD.

Methods

A total of 262 consecutive patients who underwent PD between February 2021 and December 2022 at a single institution were enrolled and divided into a training cohort (n=209) and a validation cohort (n=53). Preoperative risk factors for CR-POPF were identified through least absolute shrinkage and selection operator (LASSO) regression and further evaluated using univariate and multivariate logistic regression models. A predictive nomogram was constructed based on the training cohort and validated internally using the validation cohort, with additional cross-validation. The nomogram's discriminative performance was evaluated using the area under the curve (AUC), sensitivity, specificity, calibration curves, and decision curve analysis (DCA).

Results

Overall, 36.2% (n=95) patients developed CR-POPF. The nomogram identified several preoperative factors, including triglycerides (TGs), neutrophils, the size of the main pancreatic duct (MPD), pancreatic index (PI), and thickness of the pancreas (TP), as independent risk factors for CR-POPF. Internal and cross-validation of receiver operating characteristic (ROC) curves yielded statistically significant results (AUC =0.761 and 0.812, respectively). Calibration curves demonstrated strong agreement between the nomogram's predictions and actual outcomes. DCA confirmed the nomogram's substantial clinical relevance. The sensitivity and specificity of the nomogram in the validation cohort were 60.9% and 90.0%, respectively.

Conclusions

This predictive nomogram, based on preoperative risk factors such as TG, neutrophils, the size of MPD, PI, and TP, provides a simple and accurate method for predicting CR-POPF after PD, aiding clinicians in identifying high-risk patients and optimizing preoperative management strategies to improve decision-making.