Postoperative Inflammatory Complications Research Articles

Патогенетические основы терапии послеоперационного транзиторного роговично-конъюнктивального ксероза

The article presents the dynamics of clinical manifestations, immunological and inflammatory parameters of tear fluid of patients suffering from postoperative transient corneal conjunctival xerosis with the combined application of derinat, emoksipin and stillavit accompanied by traditional therapy postoperative transient corneal conjunctival xerosis. Revealed that this scheme improves the function of lacrimal glands and immunological resistance of tear fluid, increasing the activity factor of the local immune protection and changed IL4, helps to prevent postoperative inflammatory complications.

The impact of preoperative dexamethasone on the postoperative systemic inflammatory response and complications following surgery for colorectal cancer.

692 Background: It is now clear that there is a significant association between the magnitude of the systemic inflammatory response and postoperative complications (Adamina et al. Br J Surg 2015;102(6):590-8). The present study examined the impact of preoperative steroids on the postoperative systemic inflammatory response and complications, following elective surgery for colorectal cancer. Methods: The administration of dexamethasone at induction of anaesthesia was prospectively audited from a cohort of patients who underwent elective, potentially curative surgery for colorectal cancer at a single centre between 2008 and 2013. Results: 286 patients were included, of which the majority were male (161, 57%), over 65 (190, 66%) with colonic (183, 64%) and node negative disease (192, 67%). 114 (40%) received dexamethasone at induction of anaesthesia. There was a significant association (Table 1) between preoperative dexamethasone administration and the proportion of patients breaching established CRP thresholds on postoperative days 2 (190mg/L, 14% vs. 50%, p<0.001), and 3 (170mg/L, 27% vs. 49%, p<0.001) but not 4 (145mg/L, 50% vs. 36%, p=0.658). There was no significant association between preoperative dexamethasone and postoperative complications. Conclusions: The present study suggests that the systemic inflammatory response following surgery for colorectal cancer may be attenuated by preoperative steroids. It remains to be determined whether this will lead to a reduction in postoperative complications. [Table: see text]

The relationship between systemic inflammation and postoperative outcomes following neoadjuvant chemoradiotherapy for rectal cancer.

682 Background: The magnitude of the systemic inflammatory response before and after surgery for rectal cancer is increasingly understood to have an impact on clinical outcomes. The aim of the present study was to examine the impact of neoadjuvant chemoradiotherapy (nCRT) on pre- and postoperative systemic inflammation and clinical outcomes in patients undergoing surgery for rectal cancer. Methods: Data was recorded prospectively for patients who underwent elective, potentially curative surgery for rectal cancer, from 2008 to 2015 at a single centre, n = 251. Patients had routine pre- and postoperative blood sampling. Results: Of the 251 patients, the majority were male (62%) and over 65 years old (57%) with node negative disease (66%). 85 patients (33%) were allocated to preoperative nCRT based on probable margin threatening disease at preoperative MRI. nCRT was significantly associated with a higher proportion of patients having neutrophil lymphocyte ratio (NLR) > 5 (39% vs. 12%, p < 0.001), and a modified Glasgow Prognostic Score (mGPS) of 2 (14% vs. 6%, p = 0.035) prior to surgery. There was no significant association between nCRT and the magnitude of the postoperative systemic inflammatory response or complications. Of the 85 patients who underwent nCRT, there was a small but significant reduction in CRP following treatment (3.25 mg/L vs. 4.1 mg/L, p = 0.007). Of the 16 patients who were systemically inflamed prior to nCRT, 9 patients achieved mGPS score 0 after treatment (p = 0.004). There was a significant association between having an mGPS score 1 or 2 both before and after nCRT and breaching established thresholds of CRP on postoperative days 2 (190mg/L, 86% vs. 33%, p = 0.002), 3 (170mg/L, 86% vs. 38%, p = 0.015) and 4 (145mg/L, 71% vs. 36%, p = 0.031). Conclusions: Allocation to nCRT was significantly associated with a systemic inflammatory response prior to surgery for rectal cancer. nCRT was significantly associated with attenuation of existing systemic inflammation. Such attenuation of the systemic inflammatory response may in part explain the efficacy of nCRT in patients with rectal cancer.

A way of inhibiting the bacterial biofilm formation produced by staphylococcus epidermidis 33 on the surface of titan dioxide having nanomodified surface

The summary The article describes a way of solving the problem of formation of a bacterial biofilm on the constructional material of titan dioxide having nanomodified surface in the form of anatase. The possibility of using low-molecular cationic peptide of a varnerin is considered. This method is characterized by significant activity of varnerin peptide against the general biomass and the living cells of bacterial biofilms which is proved by both experimental and laboratory research. The nanostructured surface of the titan dioxide doesn't interfere with the manifestation of the varnerin antibacterial action when Staphylococcus epidermidis 33 biofilms are cultivated. The way of inhibiting the formation of bacterial biofilms on the surface of the suggested constructional material can be used in clinical stomatology for prevention and treatment of inflammatory postoperative complications in patients with the acquired defects of maxillofacial area and after dental implantat surgery.

A Comparative Study of the Effectiveness of Immediate Versus Delayed Photobiomodulation Therapy in Reducing the Severity of Postoperative Inflammatory Complications.

The aim of this study was to compare the immediate versus the delayed application of photobiomodulation (PBM) therapy following odontectomy of horizontally impacted mandibular third molars, and assess which application method is more effective at reducing postoperative complications. Surgical removal of horizontally impacted mandibular third molars is a common surgical procedure, usually associated with postoperative complications such as pain, swelling, and trismus. Several attempts have been made to minimize these complications. One such method is the use of PBM therapy. Eighty patients with horizontally impacted mandibular third molars with no inferior alveolar canal approximation were recruited for this study. They were divided into two groups. The immediate group received PBM therapy immediately after surgery and on the 3rd day postoperatively. Subjects in the delayed group received PBM therapy on the 2nd and 4th days postoperatively. All subjects received 2 min of treatment using a 4 W laser beam, during which 171 J were delivered via a 2.8 cm(2) spot size. Clinical and statistical results showed a significant reduction in pain, trismus, and swelling in the immediate PBM therapy group compared with the delayed PBM therapy group. Immediate PBM therapy is more effective than delayed PBM therapy in minimizing the complications associated with mandibular third molar removal surgery.

Do Antibiotics Decrease the Risk of Inflammatory Complications After Third Molar Removal in Community Practices?

The role of antibiotic use in third molar (M3) surgery is unclear and remains controversial. A 2013 Cochrane review found evidence indicating antibiotic use reduced the risk of surgical site infection (SSI) and alveolar osteitis (AO) following extraction of M3s.[1] The purpose of this study was to estimate the frequency of antibiotic use in M3 surgery, the frequency of postoperative inflammatory complications following M3 surgery, and to measure association between antibiotic use and postoperative inflammatory complications following M3 surgery in the community, office-based ambulatory practice setting.

Efficacy of antibiotic prophylaxis on postoperative inflammatory complications in Chinese patients having impacted mandibular third molars removed: a split-mouth, double-blind, self-controlled, clinical trial

We investigated the effect of antibiotic prophylaxis on postoperative inflammatory complications after operations for impacted mandibular third molars in Chinese patients. A total of 207 patients had their bilateral third molars removed in a split-mouth, double-blind, self-controlled, clinical trial in two visits. For one side amoxicillin (or clindamycin) was given (antibiotic group) from one hour before operation until 3 days postoperatively. For the other side a placebo was given (placebo group) at the same time. The outcome, including alveolar osteitis, surgical wound infection, prebuccal infection, and infection of the anterior isthmus of fauces, was assessed 2 and 10 days postoperatively. A total of 192 patients completed the study, and there was no difference between the groups in the incidence of inflammatory complications. In the treatment group, there were 4 cases of alveolar osteitis (2%), 2 infections of the wound (1%), and 14 other reactions (gastrointestinal (n=4), bleeding (n=2), ulcer (n=2), and fever (n=6)). In the placebo group, there were 6 cases of alveolar osteitis (3%), 2 wound infections (1%), and 22 other reactions (bleeding (n=6), ulcer (n=2) and fever (n=14)). There was no significant difference in the extraction time and postoperative reactions, except the pain score on day 10 (p=0.005). Prophylactic amoxicillin (or clindamycin) is not effective for the prevention or reduction of postoperative inflammatory complications after the removal of impacted mandibular third molars in Chinese patients.

Limited utility of inflammatory markers in the early detection of postoperative inflammatory complications after pancreatic resection: Cohort study and meta-analyses

PurposeTo examine the diagnostic accuracy of systemic inflammatory markers in early prediction of inflammatory postoperative complications (IPC) and clinically-relevant pancreatic fistula (PF). MethodsPreoperative and postoperative [until postoperative day (POD) 4)] measurements of hemoglobin, white blood cell counts (WBC), neutrophil/lymphocyte ratio (NLR) and C-reactive protein (CRP) were correlated with IPC and PF. Meta-analyses of biochemical predictors were performed. ResultsNinety-two out of 378 patients developed IPC, PF occurred in 31. Preoperative WBC (OR 1.0001, 95% CI: 1.0001–1.0002, p = 0.02), NLR on POD2 (OR 1.05, 95% CI: 1.006–1.1, p = 0.02) and CRP on POD4 (OR 1.006, 95% CI: 1.002–1.01, p = 0.02) predicted IPC at multivariate analysis. The model including these three variables showed a diagnostic accuracy of 76.8% (sensitivity 20, specificity 97%.14; PPV 71.43, PPN 77.27) and, at logistic regression analysis an OR of 8.5 (95% CI: 2.5–28.6, p < 0.001). Only CRP >272 on POD3 (OR 3.32, 95% CI: 1.46–7.52, p = 0.003) was associated with PF with a diagnostic accuracy of 74% (sensitivity 54.5, specificity 78.5; PPV 16.88, NPV 94.25). Meta-analyses of available data suggested sensitivity of 75.3% (95% CI 66.7–82.6) and specificity of 75.5% (95% CI 61.3–85.7). However, these studies were significantly heterogeneous. ConclusionsReadily available, routine tests have limited utility in predicting IPC. Further research is required to develop novel biomarkers to aid management of these patients.

Monocyte hyporesponsiveness and Toll-like receptor expression profiles in coronary artery bypass grafting and its clinical implications for postoperative inflammatory response and pneumonia: An observational cohort study.

Cardiac surgery with cardiopulmonary bypass has a major impact on the congenital immune response, in which Toll-like receptors (TLRs) are the first line of defence. Decreased surface expression of TLRs and impaired monocyte responsiveness to TLR ligands occur following surgery. However, the clinical implications of this altered immune response are not clear. To study cardiac surgery induced changes in perioperative TLR expression and monocyte responsiveness, and the association with postoperative inflammatory complications. A prospective cohort study. Single university hospital, enrolment March to December 2007. Eighty-four out of 92 patients who underwent coronary artery bypass grafting (CABG) were followed up until hospital discharge. We assessed in-vivo TLR-2 and TLR-4 expression and ex-vivo monocyte responsiveness to TLR-2 and TLR-4 ligands, measured by Pam3Cys and lipopolysaccharide (LPS)-induced interleukin (IL)-6 and IL-8, and tumour necrosis factor alpha (TNF-α) secretion until 24 h after surgery. Patients were followed to identify adverse inflammatory and infectious outcomes. Monocyte TLR expression decreased during CABG but returned to baseline after 24 h [linear mixed effects (LME) over time P < 0.0001]. Monocyte responsiveness changed significantly over time, with marked postoperative hyporesponsiveness (LME P < 0.0001). Decreased monocyte responsiveness to LPS was associated with monocyte TLR-4 expression (LME for IL-6 P = 0.04, IL-8 P = 0.002, TNF-α P = 0.05). Intraoperative decrease of monocyte TLR-2 expression was associated with postoperative systemic inflammatory response syndrome (SIRS) and pneumonia [odds ratio (OR) 2.06, 95% confidence interval (95% CI) 1.14 to 3.72], but the perioperative decrease of monocyte TLR-4 expression was not (OR 1.10, 95% CI 0.80 to 1.52). CABG surgery induced a decrease in in-vivo monocyte TLR expression and also in ex-vivo monocyte responsiveness, with which monocyte TLR-4 expression and monocyte LPS responsiveness seemed to be associated. Decreased TLR-2 expression was associated with the occurrence of SIRS and pneumonia, suggesting a role in the cause of postoperative inflammatory conditions. Clinicaltrials.gov identifier: NCT00356746.

Blood count and C-reactive protein evolution in gastric cancer patients with total gastrectomy surgery

BackgroundThe complete blood count (CBC) and C-reactive protein (CRP) are useful inflammatory parameters for ruling out acute postoperative inflammatory complications.AimTo determine their changes in gastric cancer patients submitted to total gastrectomy.MethodsThis is a prospective study, with 36 patients with gastric cancer who were submitted to elective total gastrectomy. On the first, third and fifth postoperative day (POD), blood count and CRP changes were assessed. Patients with postoperative complications were excluded.ResultsTwenty-one (58%) were men and 15 (42%) women. The mean age was 65 years. The leukocytes peaked on the 1st POD with a mean of 13,826 u/mm³, and decreased to 8,266 u/mm³ by the 5th POD. The bacilliforms peaked on the 1st POD with a maximum value of 1.48%. CRP reached its maximum level on the 3rd POD with a mean of 144.64 mg/l±44.84. Preoperative hematocrit (HCT) was 35% and 33.67% by the 5th POD. Hemoglobin, showed similar values.ConclusionsLeukocytes increased during the 1st POD but reached normal values by the 5th POD. CRP peaked on the 3rd POD but did not reach normal values by the 5th POD.

Влияние миниинвазивных колостом на микробную обсемененность брюшной полости и развитие интоксикационного синдрома у больных раком прямой кишки, осложненным острой непроходимостью

The article studies the influence of proximal colostomy formed through minimal access for microbial contamination of the abdominal cavity during the radical phase of treatment and the dynamics of the inflammatory changes and intoxication syndrome in patients with rectal cancer complicated by acute obstruction. The research on microbial contamination of the abdominal cavity was made in 32 patients, including 15 patients in whom obstruction was resolved conservatively and 17 patients in whom was made a proximal colostomy through mini-invasive access to eliminate acute obstruction. In 30 patients were investigated acute phase proteins and determined the level of toxemia available by calculation leukocyte index of intoxication. Blood sampling was carried out in patients with acute intestinal obstruction directly before applying the proximal colostomy, and before the second - a radical step treatment in 7-10 days. Found that the imposition of the proximal colostomy through minimal access does not lead to an increase in microbial contamination of the abdomen; helps reduce the level of acute phase proteins, the level of general toxemia and reduces the risk of postoperative inflammatory complications before performing radical phase of treatment.

Effect of antibiotics on postoperative inflammatory complications after surgical extraction of the impacted mandibular third molar

To investigate the effect of antibiotics on postoperative inflammatory complications after surgical extraction of the impacted mandibular third molar. Ninety-Six patients had their bilateral third molars removed through a split-mouth, double-blind, controlled, clinical trial in two visits. On one side amoxicillin (or clindamycin) was used (antibiotics group) from 1 h pre-operation to 3 d post-operation. On the other side, placebo was used (placebo group) the same time. Postoperative inflammatory complications including alveolar osteitis (AO), surgical site infection (SSI), pre-buccal site infection and anterior isthmus faucium space infection were monitored and recorded 2 d and 10 d after the surgery. The pain, swelling, and trismus were also recorded. All 96 patients completed the study. Two AO (2.1%), one SSI (1.0%) and seven other infections were observed in the treatment group. Also three AO (3.1%), one SSI (1.0%) and eleven other infections were observed in the placebo group. However, no statistically significant differences were found in the incidence of various postoperative inflammatory complications and reactions between the groups (P > 0.05). There was no significant difference on the postoperative reaction, except pain on 10 d. Patients who had inflammatory infection recovered well with symptomatic anti-infection treatment. The use of amoxicillin (or clindamycin) cannot effectively prevent and reduce the postoperative inflammatory complications after surgical extraction of the impacted mandibular third molar.

Prognostic Significance of Complications after Curative Surgery for Gastric Cancer

Postoperative complications such as anastomotic leakage were reported to be a major independent prognostic factor for long-term survival in gastrointestinal malignancies. This study sought to clarify the prognostic significance of postoperative inflammatory complications specifically for patients with gastric cancer. This study included 1,395 patients who underwent curative resection for gastric cancer from 2005 to 2008. Complications were evaluated according to the Clavien-Dindo classification. Overall survival (OS) and disease-specific mortality (DSM) were compared between complication and no-complication groups. Presence of complications was modeled by the Cox proportional hazard model for OS and the Fine and Gray competing risk regression model for DSM to assess the correlation between complication and prognosis. The median follow-up time was 3.1 years. Two hundred seven patients (14.8 %) had complications of grade 2 or higher. Of 131 patients who died within this period, 87 died of gastric cancer. The 3-year OS in the complication group was 84.1 % compared to 93.1 % in the no-complication group (P < 0.0001). The cumulative incidence of DSM was also significantly worse in patients with complications (P < 0.0001). Multivariate analysis identified the same significant increasing risk of complication for both OS (hazard ratio 1.88; 95 % confidence interval 1.26-2.80) and DSM (hazard ratio 1.90; 95 % confidence interval 1.19-3.02). Postoperative complications that can cause prolonged inflammation have an obvious impact not only on the OS but also on the DSM of patients with gastric cancer even if the tumor is resected curatively.

Effect of antibiotics on postoperative inflammatory complications in lower impacted third molar surgery

下颌第三磨牙阻生发生率很高,常引起冠周炎、邻牙远中龋、牙间骨吸收,少数可引起颌骨周围软组织间隙感染、颌骨骨髓炎、颌骨囊肿等并发症[1].下颌阻生第三磨牙拔除术后如何规范应用抗菌药物具有重要临床意义,但围手术期抗菌药物的选择和剂量并无明确的应用指南,国内外文献报道不一.不合理应用抗菌药物可能导致感染病菌的高度耐药而难以控制感染;另一方面加大了患者就医和整个社会的经济负担.现对下颌阻生第三磨牙拔除术围手术期应用抗菌药物能否预防术后炎性并发症的相关文献综述,以期对临床应用提供参考。

English

With the new arrivals in open heart surgery and cardiopulmonary bypass, the present study was undertaken to monitor the extent of acute inflammatory response to cardiopulmonary bypass by using serum CRP as an indicator and correlating this with the early morbidity and mortality in patients undergoing cardiopulmonary bypass for cardiac surgery. 25 patients, aged 10- 40 years of NYHA Class I, II, III scheduled for open heart surgeries with the use of cardiopulmonary bypass were included in the study in our study. The serum CRP levels were measured at 6 hours and 24 hours after weaning from cardiopulmonary bypass. The results were analysed using the unpaired t-test to find out if the increase in serum CRP levels and patient morbidity were statistically significant. There were no significant differences regarding anesthetic premedication, induction and maintenance drugs and intraoperative hemodynamics between patients with duration of cardiopulmonary bypass ≤90 min. & those with the duration of >90 minutes. However there was a change in the level of CRP between these two groups. Increase in the levels of serum CRP at 6 hours and 24 hours after weaning from cardiopulmonary bypass was noted in patients who developed morbidly and mortality post procedure. All the above mentioned patients with complications had undergone cardiopulmonary bypass of duration >90 min. In our study, Aprotinin was used in 4 patients and these patients had reduced mean CRP as compared to the controls. Elevated serum concentration of CRP is an unequivocal evidence of an active tissue damage process. CRP levels invariably rise after major surgery but fall to normal within 7-10 days. Absence of this fall is indicative of possible septic or inflammatory postoperative complications. Further, by serial measurements important information can be obtained on the resolution or continuation of the inflammatory process. Thus, we conclude that serum CRP levels can be used to monitor the extent of inflammatory response induced by cardiopulmonary bypass. The duration of cardiopulmonary bypass directly influences the inflammation and damage caused which is suggested by patient morbidity and mortality in the postoperative period.

Correlation of antibiotic prophylaxis and difficulty of extraction with postoperative inflammatory complications in the lower third molar surgery

Our aim was to investigate the correlation among antibiotic prophylaxis, difficulty of extraction, and postoperative complications in the removal of lower 3rd molars. A total of 1222 such extractions in 890 patients between January 2010 and January 2012 were analysed retrospectively. The difficulty of extraction measured by Pederson's index, antibiotic prophylaxis with cefditoren, and postoperative complications were recorded. The difficulty of extraction was significantly associated with postoperative complications (p=0.03). There were no significant associations between antibiotic prophylaxis and postoperative complications in groups of equal difficulty (“easy” group (class I) p=1.00; “moderate” group (class II) p=1.00; and “difficult” group (class III) p=0.65). There was a small but insignificant increase in the number of dry sockets and infections in class III cases. In conclusion, this study provides further evidence that antibiotic prophylaxis for the prevention of postoperative inflammatory complications is unnecessary for extraction of 3rd molars.

Clinical research on intestinal bacteria shift and intestinal barrier of pediatric intestinal surgery

Objective To investigate the clinical correlation of intestinal bacterial translocation(BT) and in-testinal barrier of pediatric intestinal surgery,and to observe the relationship between BT and postoperative infection.Methods The plasma D-lactic acid,LPS level of 61 children with intestinal surgery in our hospital were detected before and after surgery.Polymerase chain reaction (PCR) was used to test blood bacterial DNA,in order to judge whether there is BT.Results The PCR results of preoperative children were negative,the PCR positive for 3 cases.According to the PCR results,postoperative systemic inflammatory response syndrome(SIRS) and complications of infection of PCR positive group were obviously higher than those of PCR negative group(P ＜ 0.01).And plasma D-lactic acid,LPS inspection of PCR positive group were obviously higher than PCR negative group(P ＜ 0.01).Conclusion Intestinal barrier damage has close relationship with BT in children after intestinal surgery,SIRS and infection complications also has a direct relationship with BT. Key words: Digestive system surgical procedures; Bacterial translocation; Gastrointestinal tract

Reactive C Protein (RCP) and white blood cells (WBC) as early predictors of postoperative inflammatory complications (PICs) in pancreatic surgery

Reactive C Protein (RCP) and white blood cells (WBC) as early predictors of postoperative inflammatory complications (PICs) in pancreatic surgery

Mo1700 Palliative Surgery for Malignant Bowel Obstruction: A Systematic Review

S A T A b st ra ct s recovery was significantly associated with a reduction in the development of pneumonia following elective surgery for colon cancer (p=0.028), but was not associated with a significant difference in the systemic inflammatory response following on postoperative days 1 to 5. CONCLUSION Enhanced recovery was associated with a significant reduction in length of hospital stay. In contrast, the post-operative systemic inflammatory response was similar in the conventional care and enhanced recovery groups. Overall complication rates, both infective and non-infective, were also similar. Enhanced recovery does not appear to be associated with a reduction in the postoperative systemic inflammatory response or overall infective complications.

Reactive C Protein and White Blood Cells Levels as Early Predictors of Postoperative Inflammatory Complications After Pancreatic Surgery

Context Pancreatic surgery is challenging and associated with high morbidity, even in high-volume surgical settings; this is probably the reason why, while in other surgical areas fast-track recovery programs are nowadays widely performed, pancreatic surgeons are still reluctant in applying them. The identification of clinical and diagnostic criteria to early predict postoperative inflammatory complications (PIC) development could be useful in tailoring postoperative management to patient personal risk. Objective Aim of the study is the assessment of diagnostic accuracy of reactive C protein (RCP) and white blood cells (WBC) levels as early predictors of PIC in pancreatic surgery. Methods Between January 2010 and June 2012 we performed 225 pancreatic resections for benign and malignant disease, of which: 136 pancreatico­duodenectomies (PD), 65 left pancreatectomies (LP), 11 total pancreatectomies (TP), 12 enucleations (EN). Postoperative levels of RCP (detected by our laboratory with a high-sensitivity method) and WBC from postoperative day 1 (POD 1) to POD 7, recorded in our perspective electronic database, were analyzed searching for association with PIC (anastomotic leakage, sepsis, airways, urinary tract and wound infection, abdominal collection); using the receiver operating characteristic method (ROC curve), diagnostic accuracy was evaluated by an area under the curve (AUC) analysis. Results PIC occurred in 39.6% of patients (43.4% after PD; 30.3% after LP; 45.5% after TP, 41.7% after EN). Cancer diagnosis, preoperative chemotherapy, age and ASA score did not influence PIC rates. Mean RCP levels were significantly higher in patients who developed PIC each day from POD 1 to POD 7 (P<0.001), while mean WBC levels were significantly higher in this group only from POD 4 to POD 7 (P<0.001). The highest diagnostic accuracy was observed for RCP levels on POD 4 (AUC=0.835), with a cut-off value of 14,62 mg/L, whose sensibility and specificity were 83% and 81%, respectively. In a similar way, RCP postoperative levels resulted significantly associated, from POD 1 to POD 7, with high grade PIC (grade II-V according to Clavien-Dindo classification) (P<0.001). We could not identify any valuable cut-off for WBC. Conclusion RCP postoperative level on POD 4 appears to be an useful early predictor for PIC in pancreatic surgery and could guide patient’s management (fast track recovery programs and/or further diagnostic research for septic processes); otherwise, WBC values, probably more influenced than RCP by physiological postoperative acute inflammatory response, fail in decisively distinguishing patients who are developing PIC.