Serum level of C-reactive protein on postoperative day 3 is a predictive indicator of postoperative pancreatic fistula after laparoscopic gastrectomy for gastric cancer.

INTRODUCTION: Postoperative pancreatic fistula (POPF) is a serious complication after gastrectomy for gastric cancer. It is vitally important to detect signs of POPF in the early postoperative period and perform adequate management to avoid patient death. The aim of this study was to investigate the predictive indicators of POPF after laparoscopic gastrectomy for gastric cancer.

METHODS: The current study included 197 patients who were pathologically diagnosed with adenocarcinoma and underwent laparoscopic gastrectomy between January 2010 and December 2014 in our hospital.

RESULT: Nine patients (5.6%) developed POPF of grade III or higher according to the Clavien-Dindo classification. There was no statistical difference between POPF and various clinicopathological indicators, including age, gender, BMI, extent of lymph node dissection, and operative procedure. With respect to postoperative laboratory data, however, the serum level of C-reactive protein on postoperative day 3 was significantly related to the development of POPF. Receiver-operating characteristic analysis indicated that optimal cut-off value of the serum level of C-reactive protein on postoperative day 3 was 17.0 mg/dL, with a sensitivity of 74.0, specificity of 88.0, positive predictive value of 0.14, and negative predictive value of 0.99.

CONCLUSION: An elevated C-reactive protein level on postoperative day 3 can help physicians predict the likelihood of POPF and facilitate decision making regarding prompt clinical evaluation and therapeutic approaches for POPF.