Ann Hepatobiliary Pancreat Surg.  2019 Nov;23(4):377-384. 10.14701/ahbps.2019.23.4.377.

Extremely high white blood cell counts on postoperative day 1 do not predict severe complications following distal pancreatectomy

  • 1Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
  • 2Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
  • 3Pancreatobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul, Korea.


Distal pancreatectomy(DP) is associated with high morbidity. In clinical practice, postoperative white blood cell(WBC) counts are useful indicators of infection complications. The aim of this study was to determine the relevance of extremely high postoperative day (POD)1 WBC counts after DP and their relationship to perioperative outcomes.
From December 2005 to December 2016, data from patients who had open or minimally invasive DP surgery (robot or laparoscopy, MIS) for benign or borderline malignant tumors were retrospectively reviewed. Patients were divided into groups based on POD1 WBC count (>20K, High and <20K, Low) for comparisons.
Twelve patients (4.6%) were categorized into the High group. There were significant differences in age (p=0.019), BMI (p=0.010), and spleen-preserving rate (p=0.002) between the High and Low groups. In binary logistic regression analysis, the risk factors for severe complication was age (p=0.032) and open DP (p=0.005), not POD1 WBC count.
Extremely high WBC count after POD1 after DP was not associated with severe complications, but was associated with splenectomy. Surgical methods and age were associated with severe complications.


WBC; Distal pancreatectomy; Minimally invasive surgery; Leukocytosis; Postoperative pancreatic fistula; Retrospective study

MeSH Terms

Leukocyte Count*
Logistic Models
Minimally Invasive Surgical Procedures
Retrospective Studies
Risk Factors


  • Fig. 1 Patient eligibility.

  • Fig. 2 Proportion of MIS for DP at Yonsei University Health System, Seoul, Korea. There was increasing trend annually (p<0.001) for MIS. MIS, minimally invasive surgery; DP, distal pancreatectomy.

  • Fig. 3 WBC count profiles preoperative, POD1-7 and at the first OPD follow-up. Data is shown as number (%) or mean±SD. WBC, white blood cell; POD, postoperative day; OPD, out-patient department. *<0.05.

  • Fig. 4 Incidence of CD-III/IV complications after DP. There was annually decreasing trend (p<0.001). CD, calvien-dindo; DP, distal pancreatectomy.


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