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

Xian-Rang Cao; Yin-Long Xu; Jia-Wei Chai; Kai Zheng; Jun-Jie Kong; Jun Liu; Shun-Zhen Zheng

doi:10.4251/wjgo.v17.i1.98168

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

World J Gastrointest Oncol. 2025 Jan 15;17(1):98168. doi: 10.4251/wjgo.v17.i1.98168.

Authors

Xian-Rang Cao¹, Yin-Long Xu¹, Jia-Wei Chai², Kai Zheng¹, Jun-Jie Kong¹, Jun Liu¹, Shun-Zhen Zheng³

Affiliations

¹ Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China.
² Department of Breast and Thyroid Surgery, Shandong Provincial Maternal and Child Health Care Hospital, Jinan 250014, Shandong Province, China.
³ Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China. zsz5512920@hotmail.com.

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.