Postoperative C-reactive protein ≥ 15 mg/dl and its relation with clinical relevant intra-abdominal abscess and postoperative pancreatic fistula grade B-C after pancreaticoduodenectomy

Background: An early recognition of clinically relevant pancreatic fistula (PF) and clinically relevant intra-abdominal abscess (CRIA) after pancreaticoduodenectomy (PD) is essential. C-reactive protein (CRP) is widely used as a predictor for gastrointestinal leak in colorectal and esophageal surgery. Methods: Clinical data of 120 consecutive retrospectively enrolled patients who underwent PD were analyzed. Post-operative day 3 CRP was registered. Two groups were compared; CRP ≥15 mg/dl vs CRP <15 mg/dl. Outcomes measured were PF grade B and C (PF-BC), mortality, hospital stay and infected intra-abdominal collections. Results: Mean age was 64.5+/-11.6. Incidence of PF grade B/C was 25.6%. PF-BC occurrence was higher in the CRP ≥15 mg/ml group compared with CRP <15 mg/dl (group 38.8% vs. 10.3%, p = 0,001). For local complications, CRP >15 mg group was related with higher incidence of intra-abdominal collections and higher incidence of infected intra-abdominal collections compared with CRP <15 group (47.6% vs 17.6%, p = 0.044 and 66.7% vs 35.3%, p = 0.027 respectively). No difference was found in hospital stay or mortality between groups. Conclusions: CRP >15 mg/dl on PO day 3 relates to occurrence of PF-BC, and clinically relevant intra-abdominal collections. Routinely CT scan based on this simple tool could guide an early diagnostic and treatment of PD complications.