The Role of Inflammatory Indices in Predicting Pancreatic Fistula After Distal Pancreatectomy

Background: The significance of inflammatory markers in forecasting pancreatic fistula development has not been thoroughly investigated in patients who have undergone distal pancreatectomy. This study seeks to assess the predictive value of postoperative inflammatory indices, particularly SII (systemic immune inflammation index), NLR (neutrophil-to-lymphocyte ratio) and PLR (platelet-to-lymphocyte ratio), concerning the onset of pancreatic fistula in these patients. Materials and Methods: This retrospective study analyzed patients who underwent distal pancreatec-tomy for pancreatic cancer between January 2020 and December 2023. Statistical analyses were performed by retrospectively examining the data obtained from the prospectively filled clinical notes of patients who developed pancreatic fistula (Grade B and C) using the SII, NLR and PLR calculated based on the laboratory results obtained on the third postoperative day. Results: The study included 72 patients who fulfilled the established criteria. Pancreatic fistulas were observed in 25 (34.7%) of the patients. In this study, BMI and soft pancreatic tissue were statistically significant risk factors for pancreatic fistula development (p=0.02 for both). SII and NLR from the third postoperative day were statistically significant predictors of pancreatic fistula development, while postoperative PLR did not provide statistically significant results. SII was a more significant predictor of pancreatic fistula than NLR. Conclusions: This study conveys that monitoring the increase in SII and NLR, which are inflammation-related indices, is an effective method for predicting the development of pancreatic fistula after distal pancreatectomy, whereas PLR is not effective in predicting the development of pancreatic fistula.