Combination of postoperative C-reactive protein value and computed tomography imaging can predict severe pancreatic fistula after pancreatoduodenectomy

Abstract

Background: Recent management after pancreatoduodenectomy recommends either omission of prophylactic drainage or early removal. This potentially makes the diagnosis of postoperative pancreatic fistula (POPF) difficult because the diagnosis is based on the amylase value of drain effluent. The aim of this study was to determine if severe POPF could be predicted independent of drainage information.Methods: Records of consecutive patients who underwent pancreatoduodenectomy between 2012 and 2018 were included for further analysis. The presence of a peripancreatic collection (PC) on routine postoperative (day7) computed tomography (early CT) and perioperative characteristics were analyzed.Results: PC appeared in 82/211 patients (39%) and was associated with clinically relevant POPF (p < 0.001). The C-reactive protein (CRP) on postoperative day5 was a good predictor of severe POPF (needing interventional therapy or Grade C) (area under the receiver operating characteristics curve, 0.802; 95% confidence interval, 0.702-0.875). Presence of a PC and a high CRP value were independent risk factors for severe POPF following multivariate analysis. The combination of CRP<5.0 mg/dL on postoperative day 5 and the absence of a PC had 98% negative predictive value. Conclusion:The combination of CRP measurement and PC evaluation by early CT was useful in predicting severe POPF after pancreatoduodenectomy.

Postoperative serum procalcitonin versus C‐reactive protein as a marker of postoperative infectious complications in pancreatic surgery: a meta‐analysis

“…1). 10,[20][21][22][23][24][25][26][27][28][29][30][31][32][33] Six studies included analysis of postoperative day 3 procalcitonin analysis, [20][21][22][23][24][25] eight studies day 3 C-reactive protein analysis. Five studies included analysis of CRP of day 4.…”

Prophylactic drain management after pancreaticoduodenectomy without focusing on the drain fluid amylase level: A prospective validation study regarding criteria for early drain removal that do not include the drain fluid amylase level

“…Intra-abdominal infection was strongly associated with the development of CR-POPF 9,10,[11][12][13][14]22 . Recent studies demonstrated that elevated serum CRP 24 as well as drain fluid culture results 25 during the early postoperative period are strongly associated with CR-POPF. In particular, the coexistence of positive drain fluid culture and markedly elevated CRP strongly suggests intra-abdominal infection.…”

Diagnostic value of C-reactive protein and procalcitonin for postoperative pancreatic fistula following pancreatoduodenectomy: a systematic review and meta-analysis

“…After full-text screening, a further 142 articles were excluded. Thus, 20 studies met the criteria for inclusion in the present meta-analysis (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45). The process of literature retrieval is shown in Figure 1.…”