Abstract
BACKGROUND: The aim of this study was to evaluate the clinical utility of the monocyte distribution width (MDW) as an early diagnostic biomarker for detecting postoperative complications in pancreatic surgery patients. Complications from pancreatic surgery, particularly pancreatic fistulas, significantly reduce patient survival rates. Compared with conventional markers, changes in the MDW may be detected earlier, facilitating timely intervention and potentially improving patient outcomes. METHODS: The MDW, C-reactive protein (CRP) level, and white blood cell (WBC) count were measured preoperatively and on postoperative days 1, 3, and 7. Complications-including clinically relevant pancreatic fistulas (CR-POPF) and anastomotic leaks-were classified using standardized criteria. Statistical analysis involved ROC curves and multivariate modelling to assess diagnostic accuracy and independent predictors. This retrospective analysis of a prospectively collected cohort included 82 patients who underwent elective pancreaticoduodenectomy (PD) for cancer at a single centre between May 2021 and March 2024. RESULTS: In this cohort of 82 patients with prospective data collection and retrospective analysis who underwent PD, the MDW emerged as a significant early predictor of postoperative complications. On postoperative day 3, the MDW was independently associated with CR-POPF (AUC 0.781; OR 1.31, p = 0.044) and anastomotic leaks (ΔMDW days 0-3: OR 1.30, p = 0.015). Compared with conventional markers, the MDW demonstrated superior diagnostic performance, with ROC AUC values ranging from 0.770 to 0.818 across different complications. A day 3 cut-off value of > 23.1 showed high sensitivity (84%) and yielded positive likelihood ratios of up to 3.7. Furthermore, the MDW on day 3 was moderately to strongly correlated with subsequent inflammatory markers, such as the CRP level, on day 7 (r = 0.468, p < 0.001). Multivariate models confirmed the independent prognostic value of the MDW for predicting overall complications, anastomotic leaks, and CR-POPF. CONCLUSION: Compared with the CRP level and WBC count, the MDW demonstrated superior and earlier predictive ability for detecting postoperative complications. Its elevation by day 3 provided early warning, especially for CR-POPF and leaks. As a rapid, cost-effective marker available from routine blood counts, the MDW may enhance postoperative monitoring and guide timely intervention.