Utility of preoperative systemic inflammatory biomarkers in predicting postoperative complications after pancreaticoduodenectomy: Literature review and single center experience

Abstract

BACKGROUND The role of preoperative inflammatory biomarkers (PIBs) in predicting postoperative morbidity has been assessed in colorectal and otorhinolaryngeal surgery. However, data regarding the role that preoperative inflammatory biomarkers have on morbidity after pancreaticoduodenectomiy (PD) are less consistent. AIM To assess the utility of PIBs in predicting postoperative complications after pancreaticoduodenectomy. METHODS A database of 317 consecutive pancreaticoduodenectomies performed from April 2003 to November 2018 has been retrospectively analyzed. Data regarding preoperative neutrophil-to-lymphocyte ratio (NLR), derived NLR and C-reactive protein (CRP), and postoperative complications of 238 cases have been evaluated. Exclusion criteria were: age < 18-years-old, previous neoadjuvant treatment, absence of data about PIBs, concomitant hematological disorders, and presence of active infections at the moment of the surgery. PIBs were compared using Mann-Whitney’s test and receiver operating characteristic (ROC) analysis was performed to define the cutoffs. The positive predictive value (PPV) was computed to evaluate the probability to develop complication. P -values < 0.05 were considered statistically significant. RESULTS According to the literature findings, only four papers have been published reporting the relation between the inflammatory biomarkers and PD postoperative morbidity. A combination of preoperative and postoperative inflammatory biomarkers in predicting complications after PD and the utility of preoperative NLR in the development of postoperative pancreatic fistula (POPF) have been reported. The combination of PIBs and postoperative day-1 drains amylase has been reported to predict the incidence of POPF. According to our results, CRP values were significantly different between patients who had/did not have postoperative complications and abdominal collections ( P < 0.05). Notably, patients with preoperative CRP > 8.81 mg/dL were at higher risk of both overall complications and abdominal collections (respectively P = 0.0037, PPV = 0.95, negative predictive value [NPV] = 0.27 and P = 0.016, PPV = 0.59, NPV = 0.68). Preoperative derived neutrophil-to-lymphocyte ratio (dNLR) (cut off > 1.47) was also a predictor of abdominal collection ( P = 0.021, PPV = 0.48, NPV = 0.71). Combining CRP and dNLR, PPV increased to 0.67. NLR (cut off > 1.65) was significantly associated with postoperative hemorrhage ( P = 0.016, PPV = 0.17, NPV = 0.98). CONCLUSION PIBs may predict complications after PD. During postoperative care, PIB levels could influence decisions regarding the timing of drains removal and the selection of patients who might benefit from second level diagnostic exams.

A nomogram for constructing a multidimensional postoperative pancreatic fistula for pancreatic tumors:Based on Systemic Inflammatory Biomarkers

“…In this study, we have carried out relevant verification, and to a certain extent, we can improve its clinical applicability. At the same time, according to the relevant situation of previous studies, almost no relevant researchers made relevant predictions of POPF based on SIB level, and most researchers turned to the aspect of imaging omics for research [35] [36] [37] [19] [38] .In this study, we finally screened out NLR and SII as independent risk factors for POPF [39] [35], which also provided relevant and valuable exploration for the prediction of POPF, and also provided further instructions for the optimization of some models with good fit degree. The developed nomogram offers several clinical implications.…”

Comprehensive analysis of the association between inflammation indexes and complications in patients undergoing pancreaticoduodenectomy

“…NLR has attracted significant attention in the investigation of postoperative complications following PD compared to SII. Elevated preoperative NLR has been linked to comprehensive postoperative morbidity and hemorrhage (29,30). Herein, we conducted a comprehensive analysis of specific outcomes and discovered that increased NLR was associated with clinical POPF, SSI, CD3 complications, and readmission.…”

Preoperative C-Reactive Protein-to-Albumin Ratio Predicts Postoperative Pancreatic Fistula following Pancreatoduodenectomy: A Single-Center, Retrospective Study

“…Thus, adequate prevention or treatment of POPF can contribute to reducing the mortality rate. Accumulating evidence suggests that patient characteristics and perioperative conditions are associated with POPF following pancreatic resection, including higher BMI, soft pancreatic texture, lower serum albumin levels, higher CRP levels, and preoperative nutritional status [ 19 , 20 , 21 ]. However, a definitive risk factor for POPF has not yet been established.…”