C-reactive Protein as an Early Marker for Postoperative Pancreatic Fistula After Pancreaticoduodenectomy

Objective: Clinically relevant postoperative pancreatic fistula (CR-POPF) remains one of the most serious complications following pancreaticoduodenectomy (PD), leading to increased morbidity and secondary adverse events. Early identification of CR-POPF risk is essential for timely intervention and optimal drain management. This study aimed to evaluate the predictive value of serum C-reactive protein (CRP) levels on postoperative day 3 (POD 3) for the development of CR-POPF. Material and Method: We retrospectively analyzed 112 patients who underwent PD between March 2020 and February 2025. Patients with distal or total pancreatectomy, neoadjuvant therapy, poorly controlled diabetes, immunosuppression, or anastomotic leaks unrelated to the pancreas were excluded. Serum CRP levels, drain amylase concentration, and drainage volume were recorded on POD 3. CR-POPF was defined according to International Study Group on Pancreatic Surgery (ISGPS) criteria. Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic performance of CRP. Multivariable logistic regression was used to identify independent risk factors for CR-POPF. Results: CR-POPF occurred in 17 patients (15.2%). These patients had significantly softer pancreatic texture and smaller duct diameters (p < 0.01). ROC analysis revealed that a POD 3 CRP level >161 mg/L predicted CR-POPF with an area under the curve (AUC) of 0.77, sensitivity of 82.4%, and specificity of 66.3%. Logistic regression identified small duct diameter and soft pancreatic texture as independent predictors of CR-POPF. Conclusion: Elevated POD 3 serum CRP levels are significantly associated with CR-POPF development after PD. Incorporating CRP into routine postoperative assessment may enhance early risk stratification, support clinical decision-making, and guide individualized drain management strategies.