Yuan JL, Wen X, Xiong P, Pei L. Predictive value of C-reactive protein, procalcitonin, and total bilirubin levels for pancreatic fistula after gastrectomy for gastric cancer. World J Gastrointest Surg 2025; 17(2): 103266 [DOI: 10.4240/wjgs.v17.i2.103266]
Corresponding Author of This Article
Li Pei, Department of Clinical Laboratory, Western Theater Command Air Force Hospital, No. 1 Gongnongyuan Street, Jinjiang District, Chengdu 610000, Sichuan Province, China. peilipli@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Feb 27, 2025; 17(2): 103266 Published online Feb 27, 2025. doi: 10.4240/wjgs.v17.i2.103266
Predictive value of C-reactive protein, procalcitonin, and total bilirubin levels for pancreatic fistula after gastrectomy for gastric cancer
Jing-Long Yuan, Xuan Wen, Pan Xiong, Li Pei
Jing-Long Yuan, Xuan Wen, Pan Xiong, Li Pei, Department of Clinical Laboratory, Western Theater Command Air Force Hospital, Chengdu 610000, Sichuan Province, China
Author contributions: Yuan JL performed the majority of the experiments and wrote the manuscript; Pei L designed the study and corrected the manuscript and Pei L is the guarantor; Wen X was involved in analytical tools and served as a scientific advisor and participated in the collection of human material; Xiong P participated in the collection of human material.
Institutional review board statement: This study was approved by the Ethics Committee of Western Theater Command Air Force Hospital (Chengdu, Sichuan Province, China).
Informed consent statement: All patients provided informed consent.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li Pei, Department of Clinical Laboratory, Western Theater Command Air Force Hospital, No. 1 Gongnongyuan Street, Jinjiang District, Chengdu 610000, Sichuan Province, China. peilipli@163.com
Received: November 13, 2024 Revised: December 8, 2024 Accepted: December 20, 2024 Published online: February 27, 2025 Processing time: 70 Days and 1.6 Hours
Abstract
BACKGROUND
Gastric cancer is the most common malignancy of the digestive system and surgical resection is the primary treatment. Advances in surgical technology have reduced the risk of complications after radical gastrectomy; however, post-surgical pancreatic fistula remain a serious issue. These fistulas can lead to abdominal infections, anastomotic leakage, increased costs, and pain; thus, early diagnosis and prevention are crucial for a better prognosis. Currently, C-reactive protein (CRP), procalcitonin (PCT), and total bilirubin (TBil) levels are used to predict post-operative infections and anastomotic leakage. However, their predictive value for pancreatic fistula after radical gastrectomy for gastric cancer remains unclear. The present study was conducted to determine their predictive value.
AIM
To determine the predictive value of CRP, PCT, and TBil levels for pancreatic fistula after gastric cancer surgery.
METHODS
In total, 158 patients who underwent radical gastrectomy for gastric cancer at our hospital between January 2019 and January 2023 were included. The patients were assigned to a pancreatic fistula group or a non-pancreatic fistula group. Multivariate logistic analysis was conducted to assess the factors influencing development of a fistula. Receiver operating characteristic (ROC) curves were used to determine the predictive value of serum CRP, PCT, and TBil levels on day 1 post-surgery.
RESULTS
On day 1 post-surgery, the CRP, PCT, and TBil levels were significantly higher in the pancreatic fistula group than in the non-pancreatic fistula group (P < 0.05). A higher fistula grade was associated with higher levels of the indices. Univariate analysis revealed significant differences in the presence of diabetes, hyperlipidemia, pancreatic injury, splenectomy, and the biomarker levels (P < 0.05). Logistic multivariate analysis identified diabetes, hyperlipidemia, pancreatic injury, CRP level, and PCT level as independent risk factors. ROC curves yielded predictive values for CRP, PCT, and TBil levels, with the PCT level having the highest area under the curve (AUC) of 0.80 [95% confidence interval (CI): 0.72-0.90]. Combined indicators improved the predictive value, with an AUC of 0.86 (95%CI: 0.78-0.93).
CONCLUSION
Elevated CRP, PCT, and TBil levels predict risk of pancreatic fistula post-gastrectomy for gastric cancer.
Core Tip: This study found that the serum C-reactive protein (CRP), procalcitonin (PCT), and total bilirubin (TBil) levels on day 1 post-surgery had a significant predictive value for pancreatic fistula post-radical gastrectomy; therefore, elevated serum CRP, PCT, and TBil levels in the early post-operative period could be used to indicate the presence of pancreatic fistula.
