Pretreatment red blood cell distribution width as a predictive marker for postoperative complications after laparoscopic pancreatoduodenectomy

Abstract

BACKGROUND

Red blood cell distribution width (RDW) is associated with the development and progression of various diseases.

AIM

To explore the association between pretreatment RDW and short-term outcomes after laparoscopic pancreatoduodenectomy (LPD).

METHODS

A total of 804 consecutive patients who underwent LPD at our hospital between March 2017 and November 2021 were retrospectively analyzed. Correlations between pretreatment RDW and clinicopathological characteristics and short-term outcomes were investigated.

RESULTS

Patients with higher pretreatment RDW were older, had higher Eastern Cooperative Oncology Group scores and were associated with poorer short-term outcomes than those with normal RDW. High pretreatment RDW was an independent risk factor for postoperative complications (POCs) (hazard ratio = 2.973, 95% confidence interval: 2.032-4.350, P < 0.001) and severe POCs of grade IIIa or higher (hazard ratio = 3.138, 95% confidence interval: 2.042-4.824, P < 0.001) based on the Clavien-Dino classification system. Subgroup analysis showed that high pretreatment RDW was an independent risk factor for Clavien-Dino classification grade IIIb or higher POCs, a comprehensive complication index score ≥ 26.2, severe postoperative pancreatic fistula, severe bile leakage and severe hemorrhage. High pretreatment RDW was positively associated with the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and was negatively associated with albumin and the prognostic nutritional index.

CONCLUSION

Pretreatment RDW was a special parameter for patients who underwent LPD. It was associated with malnutrition, severe inflammatory status and poorer short-term outcomes. RDW could be a surrogate marker for nutritional and inflammatory status in identifying patients who were at high risk of developing POCs after LPD.

Keywords: Biomarker; Laparoscopic pancreatoduodenectomy; Postoperative complication; Red blood cell distribution width; Short-term outcomes

Core Tip: Pretreatment red blood cell distribution width was a special parameter for patients who underwent laparoscopic pancreatoduodenectomy. It was associated with malnutrition, severe inflammatory status and poorer short-term outcomes. Pretreatment red blood cell distribution width could be a surrogate marker for nutritional and inflammatory status in identifying patients who were at high risk of developing postoperative complications after laparoscopic pancreatoduodenectomy.