Prospective evaluation of clinical and analytical values in the early diagnosis of anastomotic leak after oncological gastric surgery (PROFUGO study).
Abstract
INTRODUCTION Resective surgery is the cornerstone of gastric cancer treatment, but it carries considerable morbidity and mortality, with anastomotic leak (AL) being the most feared complication. This study aims to describe the prevalence and diagnostic management of AL after oncological gastrectomy, analyzing clinical and laboratory parameters that may facilitate its early diagnosis.
Methods
A prospective, multicentre, national study was conducted between 2023 and 2024. 435 patients who underwent surgery for gastric cancer at 43 centres were included. Sociodemographic variables and diagnostic and therapeutic management data were described, comparing the postoperative evolution of clinical and laboratory variables in patients with and without anastomotic leak.
Results
The overall prevalence of AL was 10.5%, with patients exhibiting a significantly higher heart rate from the second postoperative day. In the group of patients with AL, C-reactive protein, procalcitonin, and interleukin-6 showed higher levels from the first postoperative day. Other markers, such as leukocytes and the neutrophil-to-lymphocyte ratio, were also significantly higher in the AL group. The diagnosis of AL was established at a median of 6 days post-surgery, with a resolution rate of 80% using endoscopic therapies, interventional radiology and surgery.
Discussion
Although the diagnosis of AL is often delayed until the sixth postoperative day, the differences in the values of variables such as C-reactive protein, procalcitonin, and interleukin-6 between patients with and without AL become noticeable earlier. These findings support the creation of predictive models based on the variables studied to diagnose this complication early.