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Received Jul 21, 2017; Revised Dec 6, 2017; Accepted Dec 13, 2017
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1. Introduction
Pancreaticoduodenectomy (PD) is a procedure that is used to treat diseases of the periampullary area. It is a complex and invasive method that requires a high degree of technical skill. Due to the anatomical complexity of the area, the fragility of the soft pancreatic tissue, and the risk of pancreatic fluid leakage, this procedure is predominantly performed in high-volume centers. Despite recent important advances in surgical techniques, technology, and perioperative care, mortality and morbidity rates remain high (5% and 35–60%, resp.), even in experienced centers [1]. Pancreas-specific complications, particularly pancreatic fistula, bleeding, and intraabdominal collection, are the leading causes of mortality and morbidity following pancreaticoduodenectomy. As a result of these complications, intraabdominal infection and bleeding can occur, causing an increased risk of mortality and prolonged length of hospital stay and, thereby, increased costs. Among these complications, postoperative pancreatic fistula (POPF) is the most serious [2–6]. Many studies have investigated the causes of the development of POPF, including the influence of intraoperative findings, particularly amount of bleeding, properties of the pancreas, and diameter of the pancreatic duct. Additionally, many studies have examined the effects of various factors, including patient age, body mass index, and indications for the surgical treatment including malignant and benign etiologies. It has been found that poor pancreatic quality, small pancreatic duct diameter, and obesity are associated with high rates of the development of POPF. There have been efforts to predict the development of serious POPF by using clinical scoring systems in the postoperative period. It has been thought that such approaches may help physicians to minimize additional morbidity and mortality [7].
C-reactive protein (CRP) is an acute phase reactant with a half-life as short as 19 hours. Therefore, it is conveniently used for the assessment of disease status and inflammatory response during the postoperative healing process [8]. In 1976, Fischer et al. [9] were the first to show the role of CRP in the prediction of postoperative inflammatory complications. Consequently, several studies have examined the role of CRP...