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

Table 1 Baseline characteristics of patients who underwent laparoscopic pancreaticoduodenectomy, n (%)

Variables	Total (n = 804)	Red blood cell distribution width		P value
		< 15.4 (n = 573)	≥ 15.4 (n = 231)
Age, years
< 65	478 (59.5)	353 (61.6)	125 (54.1)	0.050
≥ 65	326 (40.5)	220 (38.4)	106 (45.9)
Sex				0.325
Male	529 (65.8)	383 (66.8)	146 (63.2)
Female	275 (34.2)	190 (33.2)	85 (36.8)
Body mass index, kg/m2
< 25	500 (62.2)	341 (59.5)	159 (68.8)	0.014
≥ 25	304 (37.8)	232 (40.5)	72 (31.2)
Drinking				0.489
No	553 (68.8)	390 (68.1)	163 (70.6)
Yes	251 (31.2)	183 (31.9)	68 (29.4)
Smoking				0.983
No	526 (65.4)	375 (65.4)	151 (65.4)
Yes	278 (34.6)	198 (34.6)	80 (34.6)
ECOG score				0.029
0-1	734 (91.3)	531 (92.7)	203 (87.9)
2	70 (8.7)	42 (7.3)	28 (12.1)
Comorbidity
Hypertension	218 (27.1)	156 (27.2)	62 (26.8)	0.911
Pancreatitis	65 (8.1)	52 (9.1)	13 (5.6)	0.105
Diabetes mellitus	157(19.5)	119 (20.8)	38 (16.5)	0.162
Upper-abdominal operation history				0.717
No	759 (94.4)	542 (94.6)	217 (93.9)
Yes	45 (5.6)	31 (5.4)	14 (6.1)
Preoperative biliary drainage				0.009
No	682 (84.8)	498 (86.9)	184 (79.7)
Yes	122 (15.2)	75 (13.1)	47 (20.3)
Pathology				< 0.001
Malignant tumor	618 (76.9)	414 (72.3)	204 (88.3)
Benign tumor	186 (23.1)	159 (27.7)	27 (11.7)
ASA physical status				0.083
II	514 (63.9)	377 (65.8)	137 (59.3)
III	290 (36.1)	196 (34.2)	94 (40.7)
ALT, U/L, mean ± SD	134.91 ± 144.16	122.26 ± 134.32	166.31 ± 162.17	< 0.001
< 40	257 (32.0)	214 (37.3)	43 (18.6)	< 0.001
≥ 40	547 (68.0)	359 (62.7)	188 (81.4)
AST, U/L, mean ± SD	104.40 ± 134.09	92.11 ± 128.77	134.89 ± 142.22	< 0.001
< 35	549 (68.3)	349 (60.9)	31 (13.4)	< 0.001
≥ 35	255 (31.7)	224 (39.1)	200 (86.6)
ALP, U/L, mean ± SD	345.49 ± 305.36	287.75 ± 263.95	488.72 ± 351.25	< 0.001
< 140	268 (33.3)	239 (41.7)	29 (12.6)	< 0.001
≥ 140	536 (66.7)	334 (58.3)	202 (87.4)
GGT, U/L, mean ± SD	511.57 ± 559.77	115.90 ± 529.70	667.70 ± 601.57	< 0.001
< 54	217 (27.0)	195 (34.0)	22 (9.5)	< 0.001
≥ 54	587 (73.0)	378 (66.0)	209 (90.5)
TBIL, μmol/L, mean ± SD	125.95 ± 141.75	87.95 ± 109.20	220.19 ± 167.27	< 0.001
< 235.0	547 (68.0)	449 (78.4)	98 (42.4)	< 0.001
≥ 235.0	257 (32.0)	124 (21.6)	133 (57.6)
Albumin, g/L, mean ± SD	39.55 ± 5.65	40.74 ± 5.28	36.60 ± 5.47	< 0.001
< 35	152 (18.9)	60 (10.5)	92 (39.8)	< 0.001
≥ 35	652 (81.1)	513 (89.5)	139 (60.2)
CRP, mg/L, mean ± SD	12.72 ± 21.03	12.14 ± 21.65	14.14 ± 19.39	< 0.001
< 10	564 (70.1)	425 (74.2)	139 (60.2)	< 0.001
≥ 10	240 (29.9)	148 (25.8)	92 (39.8)
PT, second, mean ± SD	12.32 ± 1.39	12.26 ± 1.32	12.47 ± 1.54	0.105
< 14	730 (90.8)	523 (91.3)	207 (89.6)	0.460
≥ 14	74 (9.2)	50 (8.7)	24 (10.4)
Hemoglobin, g/L, mean ± SD	126.52 ± 18.88	131.65 ± 16.46	113.80 ± 18.49	< 0.001
< 115	192 (23.9)	79 (13.8)	113 (48.9)	< 0.001
≥ 115	612 (76.1)	494 (86.2)	118 (51.1)
Leucocytes, 109/L, mean ± SD	6.37 ± 2.64	6.13 ± 2.43	6.96 ± 3.03	< 0.001
< 9.5	722 (89.8)	521 (90.9)	201 (87.0)
≥ 9.5	82 (10.2)	52 (9.1)	30 (13.0)	0.097
Lymphocyte, 109/L, mean ± SD	1.55 ± 0.60	1.64 ± 0.59	1.33 ± 0.57	< 0.001
< 3.2	797 (99.1)	567 (99.0)	230 (99.6)	0.680 (F)
≥ 3.2	7 (0.9)	6 (1.0)	1 (0.4)
Platelet, 109/L, mean ± SD	258.893 ± 88.76	249.92 ± 75.82	281.27 ± 111.84	< 0.001
< 350	698 (86.8)	518 (90.4)	180 (77.9)	< 0.001
≥ 350	106 (13.2)	55 (9.6)	51 (22.1)
NLR, mean ± SD	3.23 ± 2.94	2.70 ± 2.46	4.54 ± 3.56	< 0.001
PLR, mean ± SD	197.51 ± 101.20	187.46 ± 95.80	222.45 ± 109.82	< 0.001
PNI, mean ± SD	46.94 ± 6.766	48.26 ± 6.35	43.69 ± 6.64	< 0.001

ECOG: Eastern Cooperative Oncology Group; ASA: American Society of Anesthesiologists; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; GGT: γ-glutamyl transferase; TBIL: Total bilirubin; CRP: C-reactive protein; PT: Prothrombin time; NLR: Neutrophil-to-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio; PNI: Prognostic nutritional index.

Table 2 Surgical details and short-term outcomes of patients who underwent laparoscopic pancreatoduodenectomy, n (%)

Variables	Total (n = 804)	Red blood cell distribution		P value
		< 15.4 (n = 573)	≥ 15.4 (n = 231)
Operative time, minute, mean ± SD	329.14 ± 91.77	325.39 ± 92.03	338.44 ± 90.65	0.068
Blood loss, mL, mean ± SD	156.20 ± 155.38	155.13 ± 160.75	158.85 ± 141.47	0.759
Blood transfusion				< 0.001
No	576 (71.6)	454 (79.2)	122 (52.8)
Yes	228 (28.4)	119 (20.8)	109 (47.2)
Postoperative morbidity				< 0.001
No	421 (52.4)	327 (57.1)	94 (40.7)
Yes	383 (47.6)	246 (42.9)	137 (59.3)
Any POPF	213 (26.5)	132 (23.0)	81 (35.1)	< 0.001
POPF, grade B/C	83 (10.3)	44 (7.7)	39 (16.9)	< 0.001
BL	119 (14.8)	70 (12.2)	49 (21.2)	0.001
BL, grade B/C	89 (11.1)	40 (7.0)	49 (21.2)	< 0.001
DGE	185 (23.0)	126 (22.0)	59 (25.5)	0.279
DGE, grade B/C	62 (7.7)	43 (7.5)	19 (8.2)	0.729
Hemorrhage	113 (14.1)	69 (12.0)	44 (19.0)	0.010
Hemorrhage, B/C	82 (10.2)	47 (8.2)	35 (15.2)	0.003
Intra-abdominal infection	140 (17.4)	90 (15.7)	50 (21.6)	0.045
Clavien-Dino classification				< 0.001
0	421 (52.4)	327 (57.1)	94 (40.7)
I	53 (6.6)	38 (6.6)	15 (6.5)
II	164 (20.4)	102 (17.8)	62 (26.8)
IIIa	117 (14.6)	80 (14.0)	37 (16.0)
IIIb	12 (1.5)	8 (1.4)	4 (1.7)
IVa	16 (2.0)	11 (1.9)	5 (2.2)
IVb	7 (0.9)	3 (0.5)	4 (1.7)
V	14 (1.7)	4 (0.7)	10 (4.3)
CCI score, mean ± SD	20.0 ± 25.5	17.2 ± 23.5	26.9 ± 28.9	< 0.001
< 26.2	519 (64.6)	396 (69.1)	123 (53.2)	< 0.001
≥ 26.2	285 (35.4)	177 (30.9)	108 (46.8)
Hospital stay, day, mean ± SD	13.65 ± 11.98	13.13 ± 10.44	14.93 ± 15.09	0.027

POPF: Postoperative pancreatic fistula; BL: Bile leakage; DGE: Delayed gastric emptying; CCI: Comprehensive complication index.

Table 3 Logistic analysis for exploration of risk factors of any postoperative complications of patients who underwent laparoscopic pancreatoduodenectomy

Variables	Univariate analysis1		Multivariate analysis1		Univariate analysis2		Multivariate analysis2
	OR (95%CI)	P value	OR (95%CI)	P value	OR (95%CI)	P value	OR (95%CI)	P value
Sex		0.766				0.095		0.528
Male	1.000				1.000		1.000
Female	0.957 (0.714-1.281)				0.729 (0.502-1.057)		0.872 (0.570-1.334)
Age		0.268				0.046		0.209
< 65	1.000				1.000		1.000
≥ 65	1.173 (0.885-1.555)				1.417 (1.006-1.998)		1.266 (0.876-1.829)
Pathology		0.203				0.117
Benign tumors	1.000				1.000
Malignant tumors	1.239 (0.891-1.723)				1.411 (0.918-2.169)
ECOG score		0.245				0.010		0.107
0-1	1.000				1.000		1.000
2	1.339 (0.819-2.190)				2.005 (1.179-3.410)		1.637 (0.898-2.982)
Preoperative biliary drainage		0.047				0.419
Yes	1.000		1.000	0.001	1.000
No	1.488 (1.005-2.205)		2.160 (1.387-3.364)		1.227 (0.747-2.017)
Hypertension		0.510				0.802
No	1.000				1.000
Yes	1.110 (0.813-1.516)				1.051 (0.714-1.545)
Diabetes mellitus		0.568				0.012		0.031
No	1.000				1.000		1.000
Yes	1.107 (0.781-1.569)				1.887 (1.150-3.096)		1.773 (1.054-2.983)
Pancreatitis		0.194				0.633
No	1.000				1.000
Yes	1.402 (0.842-2.335)				1.159 (0.633-2.119)
Abdominal surgery history		0.276				0.170
No	1.000				1.000
Yes	1.400(0.765-2.564)				1.596 (0.818-3.144)
Smoking		0.511				0.253
No	1.000				1.000
Yes	1.103 (0.824-1.476)				1.228 (0.863-1.747)
Alcohol consumption		0.258				0.272
No	1.000				1.000
Yes	1.188 (0.881-1.602)				1.224 (0.854-1.756)
BMI		0.115				0.271
< 25	1.000				1.000
≥ 25	1.259 (0.945-1.676)				1.222 (0.855-1.747)
Operation time	1.001 (0.999-1.002)	0.484			1.001 (0.999-1.003)	0.408
Blood loss	1.000 (0.999-1.001)	0.956			1.000 (0.998-1.001)	0.533
Intraoperative blood transfusion		0.004		0.890		0.096		0.660
No	1.000		1.000		1.000		1.000
Yes	1.572 (1.154-2.140)		1.025 (0.722-1.455)		1.364 (0.946-1.966)		1.102 (0.715-1.700)
ASA score		0.475				0.496
II	1.000				1.000
III	1.111 (0.833-1.481)				1.130 (0.795-1.606)
RDW		< 0.001		< 0.001		< 0.001		< 0.001
< 15.4	1.000		1.000		1.000		1.000
≥ 15.4	3.537 (2.553-4.900)		2.973 (2.032-4.350)		3.603 (2.525-5.141)		3.138 (2.042-4.824)
Hemoglobin, g/L		0.212				0.024		0.426
< 115	1.000				1.000		1.000
≥ 115	0.813 (0.588-1.125)				0.647 (0.443-0.944)		0.823 (0.509-1.331)
Leucocytes, 109/L		0.250				0.047		0.533
< 9.5	1.000				1.000		1.000
≥ 9.5	1.308 (0.827-2.068)				1.675 (1.006-2.789)		1.198 (0.679-2.113)
Platelet, 109/L		0.003		0.093		0.996
< 350	1.000		1.000		1.000
≥ 350	1.894 (1.247-2.878)		1.493 (0.935-2.383)		1.001 (0.605-1.657)
Lymphocyte, 109/L		0.225				0.612
< 3.2	1.000				1.000
≥ 3.2	2.771 (0.534-14.368)				1.532 (0.295-7.968)
AST, U/L		0.002		0.190		0.016		0.649
< 35	1.000		1.000		1.000		1.000
≥ 35	1.610 (1.191-2.177)		1.617 (0.788-3.320)		1.618 (1.094-2.393)		1.229 (0.505-2.991)
ALT, U/L		0.042		0.731		0.035		0.651
< 40	1.000		1.000		1.000		1.000
≥ 40	1.363 (1.011-1.837)		1.140 (0.541-2.403)		1.516 (1.031-2.231)		1.226 (0.508-2.959)
GGT, U/L		0.004		0.186		0.006		0.454
< 45	1.000		1.000		1.000		1.000
≥ 45	1.601 (1.166-2.199)		1.511 (0.820-2.785)		1.809 (1.182-2.770)		1.335 (0.626-2.848)
ALP, U/L		0.058		0.017		0.220
< 140	1.000		1.000		1.000
≥ 140	1.330 (0.990-1.787)		1.979 (1.130-3.464)		1.262 (0.871-1.829)
TBIL, umol/L		0.002		0.624		< 0.001		0.152
< 235	1.000		1.000		1.000		1.000
≥ 235	1.605 (1.191-2.163)		1.099 (0.754-1.601)		2.172 (1.531-3.082)		1.551 (0.850-2.829)
Albumin, g/L		< 0.001		0.012		< 0.001		0.149
≥ 35	1.000		1.000		1.000		1.000
< 35	2.598 (1.794-3.764)		1.735 (1.130-2.662)		2.628 (1.781-3.879)		1.417 (0.883-2.274)
CRP, mg/L		0.002		0.197		0.001		0.205
< 10	1.000		1.000		1.000		1.000
≥ 10	1.599 (1.180-2.168)		1.265 (0.885-1.807)		1.797 (1.260-2.564)		1.308 (0.863-1.983)
PT, second		0.760				0.277
< 14	1.000				1.000
≥ 14	0.928 (0.574-1.499)				0.736 (0.424-1.278)

¹Any morbidity, Clavien-Dino classification grade I or higher.

²Severe morbidity, Clavien-Dino classification grade IIIa or higher.

OR: Odds ratio; CI: Confidence interval; ECOG: Eastern Cooperative Oncology Group; BMI: Body mass index; ASA: American Society of Anesthesiologists; RDW: Red blood cell distribution width; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; GGT: γ-glutamyl transferase; TBIL: Total bilirubin; CRP: C-reactive protein; PT: Prothrombin time.

Table 4 Subgroup analysis of risk factors for the development of postoperative complications of grades IIIa or higher, grades IIIb or higher according to the Clavien-Dino classification, and specific types of postoperative complications, including severe bile leakage, severe postoperative pancreatic fistula, delayed gastric emptying, hemorrhage, and intra-abdominal infection in patients who underwent laparoscopic pancreatoduodenectomy

POCs	Variables	Univariate analysis		Multivariate analysis
		OR (95%CI)	P value	OR (95%CI)	P value
CDc grade IIIb or higher	ECOG score, 2 vs 0-1	3.415 (1.659-7.028)	0.001	4.169 (1.895-9.174)	< 0.001
	Preoperative biliary drainage, yes vs no	0.225 (0.054-0.940)	0.041	0.138 (0.032-0.600)	0.008
	Smoking, yes vs no	1.735 (0.970-3.101)	0.063	1.496 (0.727-3.079)	0.274
	Drinking, yes vs no	1.712 (0.952-3.078)	0.072	1.650 (0.791-3.440)	0.182
	ALP, ≥ 140 U/L vs < 140 U/L	1.783 (0.896-3.546)	0.099	1.614 (0.717-3.634)	0.247
	RDW, ≥ 15.4 vs < 15.4	2.326 (1.298-4.169)	0.005	2.127 (1.116-4.055)	0.022
	Lymphocyte, ≥ 3.2 × 109/L vs < 3.2 × 109/L	6.383 (1.206-33.775)	0.029	6.536 (1.068-39.978)	0.042
	CRP, ≥ 10 mg/L vs < 10 mg/L	1.836 (1.020-3.302)	0.043	1.400 (0.741-2.646)	0.300
Severe POPF (grade B and C)	Age, ≥ 65 years vs < 65 years	1.756 (1.113-2.772)	0.016	1.435 (0.889-2.316)	0.139
	ECOG score, 2 vs 0-1	2.671 (1.433-4.981)	0.002	2.878 (1.435-5.774)	0.003
	Operative time	0.997 (0.994-1.000)	0.026	0.996 (0.993-0.999)	0.006
	RDW, ≥ 15.4 vs < 15.4	2.442 (1.539-3.875)	< 0.001	2.246 (1.320-3.820)	0.003
	Hemoglobin, ≥ 115 g/L vs < 115 g/L	0.544 (0.335-0.882)	0.014	0.856 (0.495-1.481)	0.579
	Leucocytes, ≥ 9.5 × 109/L vs < 9.5 × 109/L	1.755 (0.924-3.334)	0.086	1.609 (0.815-3.177)	0.170
	Albumin, < 35 g/L vs ≥ 35 g/L	1.885 (1.130-3.143)	0.015	1.153 (0.641-2.074)	0.643
	PT, ≥ 14 seconds vs < 14 seconds	0.343 (0.106-1.115)	0.075	0.229 (0.067-0.783)	0.019
Severe BL	Diabetes mellitus, yes vs no	3.110 (1.408-6.870)	0.005	2.484 (1.105-5.583)	0.028
	Smoking, yes vs no	2.010 (1.289-3.133)	0.002	1.660 (0.959-2.874)	0.070
	Drinking, yes vs no	1.580 (1.005-2.484)	0.048	1.200 (0.687-2.097)	0.522
	BMI ≥ 24 kg/m2 vs < 24 kg/m2	2.442 (1.439-4.143)	0.001	1.988 (1.143-3.456)	0.015
	Intra-operative blood transfusion, yes vs no	1.660 (1.050-2.625)	0.030	1.210 (0.707-2.072)	0.487
	RDW, ≥ 15.4 vs < 15.4	3.587 (2.287-5.628)	< 0.001	3.401 (1.979-5.845)	< 0.001
	Hemoglobin, ≥ 115 g/L vs < 115 g/L	0.648 (0.401-1.048)	0.077	0.824 (0.448-1.515)	0.533
	TBIL, ≥ 235 μmol/L vs < 235 μmol/L	2.188 (1.402-3.417)	0.001	1.326 (0.776-2.264)	0.302
	Albumin, < 35 g/L vs ≥ 35 g/L	2.326 (1.434-3.774)	0.001	1.290 (0.721-2.309)	0.391
	CRP, ≥ 10 mg/L vs < 10 mg/L	1.527 (0.967-2.413)	0.069	1.138 (0.679-1.907)	0.623
Severe hemorrhage	ECOG score, 2 vs 0-1	2.715 (1.455-5.066)	0.002	2.832 (1.447-5.540)	0.002
	Smoking, yes vs no	1.937 (1.223-3.068)	0.005	1.437 (0.820-2.517)	0.206
	Drinking, yes vs no	2.064 (1.299-3.278)	0.002	1.858 (1.047-3.297)	0.034
	RDW, ≥ 15.4 vs < 15.4	1.998 (1.252-3.189)	0.004	1.794 (1.050-3.063)	0.032
	GGT, ≥ 45 U/L vs < 45 U/L	1.735 (0.969-3.108)	0.064	1.215 (0.640-2.307)	0.551
	Albumin, < 35 g/L vs ≥ 35 g/L	1.792 (1.067-3.008)	0.027	1.022 (0.559-1.869)	0.944
	CRP, ≥ 10 mg/L vs < 10 mg/L	1.582 (0.986-2.536)	0.057	1.181 (0.699-1.997)	0.534
Intra-abdominal infection	Age, ≥ 65 vs < 65	1.539 (1.067-2.220)	0.021	1.363 (0.928-2.001)	0.114
	ECOG score, 2 vs 0-1	1.887 (1.076-3.310)	0.027	1.725 (0.957-3.109)	0.070
	Hypertension, yes vs no	1.577 (1.069-2.326)	0.022	1.365 (0.909-2.052)	0.134
	Drinking, yes vs no	1.603 (1.100-2.338)	0.014	1.556 (1.052-2.301)	0.027
	RDW, ≥ 15.4 vs < 15.4	1.483 (1.008-2.180)	0.045	1.201 (0.793-1.817)	0.387
	Leucocytes, ≥ 9.5 × 109/L vs < 9.5 × 109/L	1.618 (0.942-2.779)	0.081	1.247 (0.703-1.817)	0.450
	TBIL, ≥ 235 μmol/L vs < 235 μmol/L	1.426 (0.977-2.081)	0.066	1.585 (1.027-2.446)	0.038
	CRP, ≥ 10 mg/L vs < 10 mg/L	1.675 (1.147-2.448)	0.008	1.304 (0.868-1.960)	0.202
Severe DGE	Pathology, malignant tumors vs benign tumors	1.652 (0.944-2.892)	0.079	1.058 (0.548-2.042)	0.886
	Preoperative biliary drainage, yes vs no	0.365 (0.130-1.024)	0.055	0.421 (0.144-1.236)	0.155
	Pancreatitis, yes vs no	2.748 (1.354-5.578)	0.005	2.555 (1.158-5.639)	0.020
	Intra-operative blood transfusion, yes vs no	1.931 (1.137-3.279)	0.015	1.667 (0.901-3.082)	0.103
	ASA, III vs I-II	1.683 (0.935-3.031)	0.083	1.893 (1.028-3.487)	0.041
	RDW, ≥ 15.4 vs < 15.4	1.105 (0.629-1.940)	0.729	1.130 (0.573-2.226)	0.725
	Operative time	1.003 (1.000-1.005)	0.028	1.002 (0.999-1.005)	0.212
	Lymphocyte, ≥ 3.2 × 109/L vs < 3.2 × 109/L	4.913 (0.933-25.861)	0.060	4.019 (0.696-23.193)	0.120
	ALP, ≥ 140 U/L vs < 140 U/L	2.131 (1.265-3.588)	0.004	2.913 (1.538-5.518)	0.001
	Albumin, < 35 g/L vs ≥ 35 g/L	2.201 (1.251-3.871)	0.006	3.065 (1.568-5.992)	0.001
CCI ≥ 26.2	Intra-operative blood transfusion, yes vs no	1.489(1.087-2.041)	0.013	1.150 (0.816-1.621)	0.425
	Preoperative biliary drainage, yes vs no	0.695 (0.456-1.060)	0.091	0.573 (0.368-0.891)	0.014
	RDW, ≥ 15.4 vs < 15.4	1.964 (1.436-2.687)	< 0.001	1.680 (1.185-2.382)	0.004
	Leucocytes, ≥ 9.5 × 109/L vs < 9.5 × 109/L	1.854 (1.171-2.936)	0.008	1.740 (1.076-2.815)	0.024
	Albumin, < 35 g/L vs ≥ 35 g/L	1.918 (1.341-2.743)	< 0.001	1.511 (1.017-2.244)	0.041
	Platelet, ≥ 350 × 109/L vs 350 × 109/L	1.472 (0.973-2.229)	0.067	1.241 (0.798-1.930)	0.337

POCs: Postoperative complications; OR: Odds ratio; CI: Confidence interval; CDc: Clavien-Dino classification; ECOG: Eastern Cooperative Oncology Group; BMI: Body mass index; ASA: American Society of Anesthesiologists; RDW: Red blood cell distribution width; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; GGT: γ-glutamyl transferase; TBIL: Total bilirubin; CRP: C-reactive protein; PT: Prothrombin time; POPF: Postoperative pancreatic fistula; BL: Bile leakage; DGE: Delayed gastric emptying; CCI: Comprehensive complication index.