ArticleSurgery in practice and science2026
Postoperative day 3 biomarkers for risk stratification and prediction of clinically relevant pancreatic fistula after pancreaticoduodenectomy: A retrospective cohort study.
Article in Surgery in practice and science, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Clinically relevant postoperative pancreatic fistula (CR-POPF) significantly affects patient outcomes after pancreaticoduodenectomy, necessitating accurate risk stratification for personalized perioperative management. This study evaluated postoperative day 3 (POD3) biomarkers for CR-POPF prediction compared to established criteria. Materials and Methods: We retrospectively analyzed 439 consecutive pancreaticoduodenectomy patients (2019-2023) at a tertiary referral center. Drain fluid amylase (DFA) and serum C-reactive protein (CRP) were measured on postoperative days 1, 3, and 7. Logistic regression identified CR-POPF risk factors, and receiver operating characteristic curves assessed predictive performance. This study followed STROBE guidelines for observational research. Results: CR-POPF occurred in 55 patients (12.5%). Independent risk factors included age >56 years (OR: 2.33), absence of pancreatic duct dilation (OR: 2.33), and soft pancreatic texture (OR: 2.11). POD3 DFA >300 U/L and serum CRP >200 mg/L strongly predicted CR-POPF (OR: 6.62 and 4.42, respectively). The combination demonstrated high predictive capability (AUC: 0.83) and enabled stratification into four distinct risk groups with CR-POPF rates of 1.2%, 8.0%, 10.5%, and 31.6% ( Discussion: POD3 biomarker combination provides superior risk stratification with straightforward clinical utility compared to conventional single-parameter approaches. The 26-fold difference in CR-POPF rates between risk groups enables personalized management strategies. Conclusions: POD3 DFA ≤300 U/L combined with CRP ≤200 mg/L reliably identifies patients at low risk for CR-POPF, with 39.6% of patients meeting these criteria. This approach facilitates evidence-based perioperative decision-making and warrants prospective validation.
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