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Updated: Sep 6, 2025
DIPLOMA Approach for Standardized Pathology Assessment of Distal Pancreatectomy Specimens
Published on: February 1, 2020
C-reactive protein postoperative values to predict clinically relevant postoperative pancreatic fistula after distal
Luz Divina Juez1, Elena Payno2, Irene de Vicente2
1General Surgery, Hospital Universitario Ramón y Cajal, España.
Insights
Postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) remains a significant risk. C-reactive protein (CRP) levels on postoperative day 3 are a key predictor, enabling early identification of high-risk patients for improved management.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Clinical Medicine
Background:
- Postoperative pancreatic fistula (POPF) is a common complication after distal pancreatectomy (DP), with reported incidence ranging from 3-45%.
- Despite medical and technological advancements, predicting and managing POPF remains challenging.
- Early identification of risk factors is crucial for optimizing patient outcomes.
Purpose of the Study:
- To analyze early post-surgical risk factors for developing POPF after distal pancreatectomy (DP).
- To identify predictive markers for clinically relevant POPF (Grade B/C).
Main Methods:
- Retrospective observational study of 52 patients undergoing DP from January 2011 to December 2021.
- Analysis of sociodemographic, preoperative analytical, tumor-related, and postoperative complication variables.
- Univariate logistic regression and ROC curve analysis to identify risk factors and predictive cut-off points.
Main Results:
- 71.8% of patients showed elevated amylase in postoperative drains; 25.7% developed Grade B/C POPF.
- Significant risk factors for Grade B/C POPF included preoperative BMI, amylase levels on postoperative day 5, and C-reactive protein (CRP) on postoperative day 3.
- CRP value at postoperative day 3 demonstrated a predictive value (AUC=0.764) with an optimal cut-off of 190 mg/l.
Conclusions:
- C-reactive protein (CRP) level on postoperative day 3 is a significant predictive factor for POPF after DP.
- Early detection of patients at risk using CRP levels can impact postoperative management strategies.
- Further research into early predictive markers can improve patient care following DP.
Introduction:
despite significant medical and technological advances, the incidence of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) is reported to be between 3-45 %. The main objective of this study was to analyze the early post-surgical risk factors for developing POPF after DP.
Material And Methods:
a retrospective observational study was performed on a prospective basis of patients undergoing DP in a tertiary hospital from January 2011 to December 2021. Sociodemographic, preoperative analytical, tumor-related and postoperative complications variables were analyzed.
Results:
of the 52 patients analyzed, 71.8 % of the sample had postoperative drains amylase elevation. However, 25.7 % of the total had grade-B and/or grade-C POPF. Univariate logistic regression with the variables studied showed the following as risk factors for B-C or clinically relevant POPF: amylase values in drainage at the 5th postoperative day (POD) (p = 0.097; 1.01 [1-1.01]), preoperative BMI (p = 0.015; 1.27 [1.04-1.55]) and C-reactive protein (CRP) value at the 3rd POD (p = 0.034; 1.01 [1.01-1.02]). The ROC curve of CRP value at the 3rd POD showed an area under the curve of 0.764 (95 % CI: 0.6-0.93) and the best cut-off point was 190 mg/l (sensitivity 89 % and specificity 67 %).
Conclusions:
CRP value at the 3rd POD is a predictive factor for POPF after DP. Early detection of patients at risk of POPF based on these characteristics could have an impact on their postoperative management.
