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Optimal Predictors of Postoperative Complications After Gastrectomy: Results from the Procalcitonin and C-reactive Protein for the Early Diagnosis of Anastomotic Leakage in Esophagogastric Surgery (PEDALES) Study

  • Original Article
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Journal of Gastrointestinal Surgery

Abstract

Background

The aim of this study was to define whether procalcitonin (PCT) is an earlier and more accurate predictor than C-reactive protein (CRP) for anastomotic leakage (AL) and major infective complications (MICs).

Methods

This was a prospective multicentric observational study conducted in three Italian centers, including all patients undergoing gastrectomy from May 2016 to April 2021. The endpoint was the assessment of the discrimination and accuracy achieved by the PCT and CRP values measured from POD1 to POD7 for predicting the occurrence of AL and MICs. Accuracy was assessed by calculating the area under the receiver operating curve (AUROC) values and Youden’s statistics. Two charts were created for risk stratification during the postoperative course.

Results

The rate of AL was 4.6%, with a median day of occurrence on POD5 (range 3–26). The overall rate of major infective complications was 19.9%, with a median day of occurrence on POD6 (range 2–30). PCT showed a significant association with AL on POD6 and POD7 and a significant association with MICs on POD2, while CRP values showed a significant association with AL on POD4 and a significant association with MICs on POD1. No difference in the prediction of AL was observed between PCT and CRP, while CRP was found to be a superior predictor of major infective complications on POD5 (p = 0.024) and POD7 (p = 0.035).

Conclusions

PCT was not superior to CRP as an early predictor of AL and major infective complications after gastrectomy. CRP should be used as the reference screening postoperative marker.

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Authors and Affiliations

  1. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, Pieve Emanuele, MI, Italy

    Ferdinando Carlo Maria Cananzi, Laura Ruspi & Federico Sicoli

  2. Sarcoma and Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy

    Ferdinando Carlo Maria Cananzi, Laura Ruspi, Federico Sicoli & Vittorio Quagliuolo

  3. Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli N. 8, 00168, Rome, Italy

    Alberto Biondi, Annamaria Agnes, Domenico D’Ugo & Roberto Persiani

  4. Digestive Surgery - European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milano, Italy

    Alberto Biondi, Annamaria Agnes, Domenico D’Ugo & Roberto Persiani

  5. Università Cattolica del Sacro Cuore, Largo F. Vito N.1, 00168, Rome, Italy

    Stefano De Pascale & Uberto Romario Fumagalli

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  1. Ferdinando Carlo Maria Cananzi
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on behalf of the Italian Gastric Cancer Research Group (GIRCG)

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Figure 1s

Graphs depicting the mean values of CRP, PCT and WBC on each postoperative day from 1 to 7 for patients with or without major infective complications. The aim of this figure is to depict the timing of the variations among the different biomarkers according to the postoperative day. (PNG 424 kb)

High resolution image (TIFF 28987 kb)

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Cananzi, F.C.M., Biondi, A., Agnes, A. et al. Optimal Predictors of Postoperative Complications After Gastrectomy: Results from the Procalcitonin and C-reactive Protein for the Early Diagnosis of Anastomotic Leakage in Esophagogastric Surgery (PEDALES) Study. J Gastrointest Surg 27, 478–488 (2023). https://doi.org/10.1007/s11605-022-05547-y

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