title: Procalcitonin--a Marker for Anastomotic Insufficiency after Pancreatoduodenectomy?
abstract: BACKGROUND
  Anastomotic insufficiency after pancreatoduodenectomy (PD) represents a major complication in pancreatic surgery. Early detection and treatment of pancreatic fistulas (PF) are essential for the outcome of affected patients. Procalcitonin (PCT) is a biochemical marker which allows detection of bacterial infections. The aim of this study was to evaluate if PCT is suitable for early detection of PF after PD.
  
  
  METHODS
  In this prospective study patients undergoing PD from 08/2010 to 09/2012 were included into three groups: (1) patients without complications (n = 19), (2) patients with postoperative infections (n = 14) and (3) PF (n = 7). Using a defined study protocol, clinical (e.g., vital signs, drain fluid, etc.) and laboratory parameters (full blood count, inflammatory markers) were assessed daily for the first ten postoperative days.
  
  
  RESULTS
  76 patients were assessed. 40 (52.6%) patients underwent PD and were included. CRP and PCT demonstrated an initial peak at the 1st to 3rd postoperative day with subsequent normalization. Patients with postoperative infections and PF showed a significant increase of PCT and CRP (p < 0.05) compared to patients without complications. Leucocyte counts demonstrated a variance in all three groups and clinical use for detection of complications was not evident.
  
  
  CONCLUSIONS
  Patients with a postoperative complication revealed significantly increased levels of PCT and CRP without the expected normalization. PCT and/or CRP did not enable a distinction between patients with PF or postoperative infections. Thus, PCT does not seem to be suitable for detecting PF after PD and its use in the postoperative course after PD cannot be recommended.
authors.forename: Christina
authors.initials: C
authors.lastname: Lenschow
authors.forename: Richard
authors.initials: R
authors.lastname: Hummel
authors.forename: Kirsten
authors.initials: K
authors.lastname: Lindner
authors.forename: Wolf Arif
authors.initials: WA
authors.lastname: Mardin
authors.forename: Norbert
authors.initials: N
authors.lastname: Senninger
authors.forename: Heiner
authors.initials: H
authors.lastname: Wolters
authors.forename: Soeren Torge
authors.initials: ST
authors.lastname: Mees
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D042241:Early Diagnosis; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide