Preoperative C-reactive protein and textbook outcome following pancreaticoduodenectomy for pancreatic head adenocarcinoma

Figure 1 Patient selection flow diagram. Of 151 patients who underwent pancreaticoduodenectomy between March 2015 and January 2022, 2 were excluded because of benign pathology, and 49 because of pathology other than pancreatic head adenocarcinoma. The final analytic cohort comprised 100 patients with pancreatic head adenocarcinoma.

Figure 2 Cumulative distribution of unmet textbook outcome criteria among the 47 patients in the non-textbook outcome group. Percentages were calculated using the non-textbook outcome group as the denominator (n = 47). Criteria are cumulative and not mutually exclusive; therefore, one patient could fail more than one criterion. Single-criterion failure occurred in 24 patients (51.1%), and multiple concurrent failures occurred in 23 patients (48.9%). The most frequent isolated failure was severe complications (Clavien-Dindo ≥ III; 11/24, 45.8%). TO: Textbook outcome.

Figure 3 Receiver operating characteristic curve. A: Receiver operating characteristic curve of preoperative C-reactive protein alone for predicting non-textbook outcome. The area under the curve was 0.815 (95% confidence interval: 0.722-0.896). The Youden-derived cut-off was C-reactive protein ≥ 13.0 mg/L, with 66.0% sensitivity and 90.6% specificity. The diagonal dashed line represents the reference line; B: Receiver operating characteristic curves of the multivariable models for textbook outcome achievement. The area under the curve was 0.819 for the primary preoperative model and 0.820 for the bilirubin-adjusted sensitivity model. The diagonal reference line is shown for comparison. AUC: Area under the curve; CI: Confidence interval; ROC: Receiver operating characteristic; TO: Textbook outcome; CRP: C-reactive protein.