Predictive value of C-reactive protein, procalcitonin, and total bilirubin levels for pancreatic fistula after gastrectomy for gastric cancer.

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.