Mustafa Kerem

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.

Background: Postoperative pancreatic fistula (POPF) is a common and serious complication following pancreatic surgery. While several studies have attempted to predict the development of POPF using drain amylase concentration, predictive values vary widely due to factors like abdominal irrigation and chylous drainage, which can dilute the amylase levels. This study aims to evaluate whether the “Real Amylase Value” (RAV), calculated as the product of drain amylase concentration and drainage volume, provides a more reliable prediction of POPF compared to conventional amylase concentration. Better prediction of pancreatic fistula development could lead to closer clinical monitoring of these patients, reassessment of hospital stay duration, and more careful management of drains over an extended period. Additionally, carefully managing the timing of drain removal may improve patient recovery and discharge process. Methodology: Data from 198 patients who underwent pancreaticoduodenectomy (PD) and distal pancreatectomy (DP) were retrospectively analyzed. Drain amylase concentrations and drainage volumes were measured on postoperative days (POD) 1 and 3, and the RAV (U) was calculated. Real Amylase Value (RAV) (U) was calculated using the formula: RAV (U) = Drain Amylase Concentration (U/L) × Drainage Amount (L). Predictive values for POPF were evaluated using receiver operating characteristic (ROC) curve analysis, comparing conventional amylase concentration (U/L) and RAV (U). Results: On POD1, the RAV (U) demonstrated greater predictive value for POPF compared to the conventional drain amylase concentration (U/L) with an area under the ROC curve (AUROC) of 0.85 versus 0.79, respectively. Similarly, on POD3, RAV showed superior predictive accuracy (AUROC 0.89) compared to amylase concentration (AUROC 0.79). Conclusion: The RAV (U) offers a more accurate and reliable prediction of POPF than traditional drain amylase concentration (U/L), with improved sensitivity and specificity. This method could refine clinical management, particularly in the timing of drain removal and early intervention strategies for patients at high risk of developing pancreatic fistulas.

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.

Travmaya Metabolik, Endokrin ve İmmün-İnflamatuar Yanıt Aydın YAVUZ Sıvı ve Elektrolit Metabolizması Ramazan KOZAN Asit- Baz Dengesi ve Bozuklukları Saygın ALTINER Şok Hakan SÖZEN Cerrahi Hastada Beslenme Kürşat DİKMEN Cerrahi Alan Enfeksiyonları Kürşat DİKMEN Cerrahi Hastanın Monitörizasyonu Murat AKIN Yara İyileşmesi Çağrı BÜYÜKKASAP Benign Tiroid Hastalıkları, Tiroid Nodüllerine Yaklaşım ve Tiroidektomi Komplikasyonları Hüseyin GÖBÜT Malign Tiroid Hastalıkları Hüseyin GÖBÜT Paratiroid Bezinin Cerrahi Hastalıkları Murat AKIN Meme Kanserı Rölatif Risk Faktörleri Osman KURUKAHVECİOĞLU Memenin Benign Hastalıkları Osman KURUKAHVECİOĞLU Memede Kitleye Yaklaşım Ekmel TEZEL Meme Kanseri Ekmel TEZEL Adrenal Bez Hastalıkları Murat AKIN Karın Duvarı Anatomisi Ziya ANADOL Fıtıklar Ziya ANADOL Karın Travmaları Osman YÜKSEL Akut Karın Sendromu Akif TÜRKOĞLU Akut Apandisit Hasan BOSTANCI Akut Pankreatit Çağrı BÜYÜKKASAP Bağırsak Obstrüksiyonu Hakan SÖZEN Gastrointestinal Kanamalar Aydın YAVUZ Mezenterik Vasküler Hastalıklar Abdülkadir BEDİRLİ Özofagus Tümörleri Aydın YAVUZ Mide Tümörleri Osman YÜKSEL Morbid Obezite Abdülkadir BEDİRLİ Kolorektal Anatomi ve Anorektal Muayene Sezai LEVENTOĞLU Kolorektal Polipler ve Prekanseröz Lezyonlar Sezai LEVENTOĞLU Benign Anorektal Hastalıklar Sezai LEVENTOĞLU Pelvik Taban Hastalıkları Sezai LEVENTOĞLU Kolorektal Tümörler Ahmet KARAMERCAN Karaciğer Tümörleri Mustafa ŞARE Karaciğer Apseleri Akif TÜRKOĞLU Kist Hidatik Hasan BOSTANCI Safra Kesesi ve Safra Yollarının Hastalıkları Aydın DALGIÇ Pankreatik Kistler ve Pankreasın Premalign Lezyonları Mustafa KEREM Pankreas Kanseri ve Periampuller Tümörler Mustafa KEREM Portal Hipertansiyon ve Cerrahi Tedavisi Aydın DALGIÇ Organ Transplantasyonu Aydın DALGIÇ Cerrahide Onkolojik Tedavi İlkeleri Ekmel TEZEL Klinikte Sık Kullanılan Ameliyat ve Girişim Adları Ekmel TEZEL Cerrahi Terimler Kılavuzu Ekmel TEZEL