Background: Distal pancreatectomy (DP) carries high risk for postoperative pancreatic fistula
(POPF). This study evaluates WBC, CRP, and IL-6 as serum-based predictors, offering
potential alternatives to drain amylase for early POPF diagnosis.
Material and methods: This retrospective cohort study included adult patients who underwent elective DP
between 01/2014 and 12/2023. Exclusions were prior pancreatic surgery, combined DP/enucleation,
or missing data. Data collected included demographics, comorbidities, intraoperative
details, and postoperative serum markers (WBC, CRP, IL-6) from POD1 to POD5 ([Fig. 1]).
Fig. 1
Results: This study included 363 patients who underwent DP and met all inclusion criteria.
Median WBC counts were significantly higher in patients with POPF B/C), especially
on POD 2 (18.1×10⁹/L vs. 15.8×10⁹/L, p=0.002). CRP levels also peaked higher in the
POPF group on POD3 (18.9 mg/dL vs. 15.3 mg/dL, p=0.001). IL-6 levels showed no significant
difference. ROC analysis identified WBC on POD2 and CRP on POD3 (AUC=0.63 each) as
meaningful predictors. Among 210 patients with complete data, simultaneous elevation
of both marker, termed “The Critical 18”, was associated with a 59% POPF rate versus
18% when neither was elevated.
Conclusion: In light of these findings, we propose the "The Critical 18" as a simple
yet powerful tool for early risk stratification of POPF B/C following DP. By using
WBC>18 x 10x9/L on POD 2 and CRP>18 mg/dl on POD 3, clinicians can easily identify
patients at escalating risk, offering a clear framework for guiding postoperative
management and interventions.
