The value and prognostic significance of preoperative hemoglobin and albumin levels, and the lymphocyte and platelet count (HALP) scores in predicting pancreatic fistula in patients undergoing pancreaticoduodenectomy due to periampullary region tumors

Türkmen Bahadır Arıkan², Erdogan Sozuer^1,2, Ugur Topal^1,2, Azmi Lale¹, Ahmet Zeki Yılmaz¹

¹Department of Surgical Oncology, Erciyes University Medical Faculty, Melikgazi, Kayseri, Turkey - ²Department of General Surgery, Erciyes University Medical Faculty, Melikgazi, Kayseri, Turkey

Introduction: The prognostic significance of the hemoglobin, albumin, lymphocyte and platelet (HALP) score has been previously demonstrated in many types of malignant tumors. In this study, we aimed to determine the clinical value of HALP score in predicting postoperative pancreatic fistula and its relationship with survival in patients who underwent curative surgical resection due to periampullary region tumors.

Material and method: Patients who underwent pancreatoduodenectomy due to a periampullary region tumor between 2010-2019 were included in the study. Two groups, Group 1 (low HALP) and Group 2 (high HALP) were created. Demographic and clinical features of the patients, tumor characteristics, postoperative results, and mean survival were compared between the groups. The value of HALP in predicting pancreatic fistula at the cut-off value was evaluated. Factors associated with survival were determined by multivariate analysis.

Results: The patients were divided into two groups according to the cut- off value of 25. Group 1 consisted of 67, and Group 2 consisted of 62 patients. Age was higher in Group 1 (66.86 vs 62.51 years, p:0.047). The number of lymph nodes dissected was higher in Group 2 (9.63 vs 11.82, p:0.049). The postoperative complication rate was similar (28.4% vs 27.4, p: 0.531). Postoperative 30-day mortality rates were similar (13.4% vs 8.1% p:0.244). The HALP score predicted pancreatic fistula development by 73% (55.6-87.1) specificity (95%CI) and 62.11% (51.6-71.9) sensitivity (95%Cl) (AUC 0.666, p:0.002). The average survival was shorter in group 1 (18.43 months vs 44.95 months, p:0.002), but in the multivariate analysis the HALP score was not a risk factor for survival (HR = 1.518, 95% CI, 0.690-3.341, p:0.496).

Conclusion: The HALP score is related to the mean survival in patients who underwent pancreaticoduodenectomy due to periampullary region tumor and is a safe parameter that can be used to predict the development of a postoperative pancreatic fistula.