The Possum Scoring System and Complete Blood Count in the Prediction of Complications After Pancreato-Duodenal Area Resections

Abstract

The introduction of markers which help in the identification of patients prone to suffer from postoperative complications enables to recognize them more easily and thus, treat them more effectively. the aim of the study was to evaluate complete blood count indicators, as well as preoperative results obtained on the basis of the PoSSUM and P-PoSSUM scoring systems, considering the prediction of complications after surgical resections in the pancreato-duodenal area. material and methods. A prospective 30-day non-interventional clinical study was conducted on a group of 65 patients who underwent scheduled surgery, due to pancreatic head cancer or chronic pancreatitis. Total pancreatoduodenectomy was performed in 24.1% of patients, while the remaining were subject to hemi-pancreatoduodenectomy. The authors evaluated the preoperative complete blood count parameters, as well as the risk of complications and mortality using the audit PoSSUM and P-PoSSUM scoring systems. Results. Postoperative complications were observed in 32.4% of patients. The white blood cell count and platelet count in the preoperative period were statistically lower in the group of patients with postoperative complications, in comparison to patients without diagnosed complications. Higher severity scores obtained by means of the P-PoSSUM scoring system, as well as higher mortality during the perioperative period can be ascribed to patients who suffered postoperative complications. However, no correlation was found between the occurrence of complications and gender, age, type of resection, preoperative hemoglobin level, absolute lymphocyte count, or numerical value representing the patient's general condition (PoSSUM) and predicted postoperative morbidity. conclusions. The absolute white blood cell count and total platelet count during the preoperative period may be considered as an indicator of the higher risk of complications during pancreato-duodenal area resections. The usefulness of the PoSSUM and P-PoSSUM scoring systems is limited. However, the surgical severity index and calculated mortality coefficient risk can facilitate the identification of patients threatened with postoperative complications. Key words: complete blood count, surgical severity index, PoSSUM and P-PoSSUM scoring systems, pancreato-duodenal area, pancreatoduodenectomy Anatomical conditions and complex pathophysiological processes are responsible for the difficulties connected with the surgical management of patients with pancreatic disorders. Pancreatic resections are considered as difficult operations connected with increased risk of postoperative complications (1).Progress in pancreatic surgery, lead towards significant mortality reduction after resection procedures, especially in specialistic centers. Postoperative complications continue to pose a significant problem concerning 25-40% of patients subject to pancreatoduodenectomies, influencing the final treatment result,