Research Article| Volume 220, ISSUE 2, P354-358, August 2020

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Leukocytosis after distal pancreatectomy and splenectomy as a marker of major complication

Published:December 05, 2019DOI:


      • Retrospective evaluation of white blood cell count (WBC) to detect complications.
      • WBC ≥16 × 109/L on postoperative day (POD) 3 is associated with major morbidity.
      • WBC increase ≥9 × 109/L on POD 3 from baseline is associated with major morbidity.
      • Patients meeting these criteria should raise concern for postoperative complication.



      The aim of this study was to analyze the associations between the degree of postoperative leukocytosis and major morbidity after elective distal pancreatectomy with splenectomy (DPS).


      Retrospective review of patients undergoing DPS for pancreatic diseases (2013–2016). Receiver operating characteristic curves, Youden’s index, and area under the curve were used to identify ideal lab cut-off values and discriminatory ability of postoperative white blood cell count to detect complications.


      158 patients underwent DPS. Median age was 57 years (range, 22–90) and 53% of patients were male. POD3 absolute WBC count ≥16 × 109/L or an increase in WBC count ≥9 × 109/L from preoperative baseline was associated with major morbidity after DPS (AUC 0.7 and 0.7, respectively).


      Postoperative day three leukocytosis ≥16 × 109/L or an increase in WBC of ≥9 × 109/L from preoperative baseline should raise clinical awareness for major postoperative complication after DPS.


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        • Morris D.
        • Bullock F.
        The importance of the spleen in resistance to infection.
        Ann Surg. 1919; 70: 513-521
        • Horowitz J.
        • Leonard D.
        • Smith J.
        • Brotman S.
        Postsplenectomy leukocystosis: physiologic or an indicator of infection?.
        Am Surg. 1992; 58: 387-390
        • Rutherford E.
        • Morris J.J.
        • van Aalst J.
        • et al.
        The white blood cell response to splenectomy and bacteraemia.
        Injury. 1994; 25: 289-292
        • Ceppa E.P.
        • Pitt H.A.
        • House M.G.
        • et al.
        Reducing surgical site infections in hepatopancreatobiliary surgery.
        HPB. 2013 May; 15 (PubMed PMID: 23557410. Pubmed Central PMCID: PMC3633041. Epub 2013/04/06): 384-391
        • Wu C.
        • Yeh D.
        • Lin M.
        • et al.
        Prospective randomized trial of systemic antibiotics in patients undergoing liver resection.
        Br J Surg. 1998 April 1998; 85: 5
        • Arikawa T.
        • Kurokawa T.
        • Ohwa Y.
        • et al.
        Risk factors for surgical site infection after hepatectomy for hepatocellular carcinoma.
        Hepato-Gastroenterology. 2011; 58 (2011 Jan-Feb): 4
        • Schmidt C.
        • Powell E.
        • Yiannoutsos C.
        • et al.
        Pancreaticoduodenectomy: a 20-year experience in 516 patients.
        Arch Surg. 2004; 139 (discussion 25-7): 718-725
        • Toutouzas K.
        • Velmahos G.
        • Kaminski A.
        • et al.
        Leukocytosis after posttraumatic splenectomy: a physiologic event or sign of sepsis?.
        Arch Surg. 2002; 137 (discussion 8-9): 924-928
        • Duke B.
        • Modin G.
        • Schecter W.
        • Horn J.
        Transfusion significantly increases the risk for infection after splenic injury.
        Arch Surg. 1993; 128: 1125-1132
        • Sekikawa T.
        • Shatney C.
        Septic sequelae after splenectomy for trauma in adults.
        Am J Surg. 1983; 145: 667-673
        • Weng J.
        • Brown C.V.R.
        • Rhee P.
        • et al.
        White blood cell and platelet counts can Be used to differentiate between infection and the normal response after splenectomy for trauma: prospective validation.
        J Trauma Inj Infect Crit Care. 2005; : 1076-1080
        • Charlson M.
        • Pompei P.
        • Ales K.
        • MacKenzie C.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Marshall J.
        • Cook D.
        • Christou N.
        • et al.
        Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome.
        Crit Care Med. 1995 10/1995; 23: 1638-1652
        • Bassi C.
        • Dervenis C.
        • Butturini G.
        • et al.
        Postoperative pancreatic fistula: an international study group (ISGPF) definition.
        Surgery. 2005; 138: 8-13
        • Pratt W.
        • Maithel S.
        • Vanounou T.
        • et al.
        Clinical and economic validation of the international study group of pancreatic fistula (ISGPF) classification scheme.
        Ann Surg. 2007; 245: 443-451
      1. CDC/NHSN Surveillance Definitions for Specific Types of Infections. Centers for Disease Control and Prevention, Atlanta, GA2019: 1-29
        • Korner H.
        • Nielsen H.
        • Soreide J.
        • et al.
        Diagnostic accuracy of C-reactive protein for intraabdominal infections after colorectal resections.
        J Gastrointest Surg. 2009; 13: 1599-1606
        • Pantel H.J.
        • Jasak L.J.
        • Ricciardi R.
        • et al.
        Should they stay or should they go? The utility of C-reactive protein in predicting readmission and anastomotic leak after colorectal resection.
        Dis Colon Rectum. 2019 Feb; 62 (PubMed PMID: 30640836. Epub 2019/01/15): 241-247
        • Singh P.
        • Zeng I.
        • Srinivasa S.
        • et al.
        Systematic review and meta-analysis of use of serum C-reactive protein levels to predict anastomotic leak after colorectal surgery.
        Br J Surg. 2014; 101: 339-346
        • Ceppa E.
        • McCurdy R.
        • Becerra D.
        • et al.
        Does pancreatic stump closure method influence distal pancreatectomy outcomes?.
        J Gastrointest Surg. 2015; 19: 1449-1456