Postoperative Serum Procalcitonin to Predict Clinically Relevant Pancreatic Fistula after Pancreatoduodenectomy

Abstract

INTRODUCTION: Early detection of postoperative pancreatic fistula (POPF) is crucial for clinical and oncologic outcomes of patients who undergo pancreaticoduodenectomy (PD). The role of inflammation on post-PD morbidity is still controversial. Here, we aimed to assess the value of postoperative serum procalcitonin (PO-PCT) in predicting the onset of POPF, with particular regard to the clinically relevant POPF (CR-POPF). METHODS: A prospectively maintained database of patients who underwent PD between January 2012 and January 2020 has been retrospectively analyzed. Receiving operator characteristic analyses have been performed to identify the optimal postoperative cutoff values of PCT in predicting POPF and CR-POPF. RESULTS: A total of 124 PDs with available PO-PCT levels have been considered. PCT levels on postoperative day (POD) 3 >0.47 ng/mL were significantly associated with POPF (odds ratio [OR] 2.078; p < 0.017). Regarding CR-POPF, patients with POD 5 PCT levels >0.5 ng/mL have been found to be significantly at higher risk of developing this complication (OR 2.251; p < 0.046; area under the ROC curve of 0.680; Fig. 1). POD 5 PCT was significantly associated with severe postoperative complication (p = 0.006) and mortality (p = 0.005).CONCLUSION: POD 3 and POD 5 PCT may represent simple and useful tools to predict POPF, CR-POPF, severe complication, and mortality in patients undergoing PD.