PROCALCITONIN AS A TOOL FOR TIMELY DIAGNOSIS OF ANASTOMOTIC LEAK IN ELDERLY COLORECTAL CANCER SURGERY: A DIAGNOSTIC ACCURACY STUDY.
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Abstract
Background: The diagnostic utility of procalcitonin for detecting anastomotic leaks (AL) in older adults following colorectal cancer surgery remains unclear. Age-related immune system changes may influence baseline procalcitonin levels and its diagnostic performance in this population. This study aimed to evaluate the diagnostic accuracy of postoperative day 3 procalcitonin levels for AL detection in older adults with colorectal cancer.
Methods: A delayed cross-sectional diagnostic test study was conducted in patients aged ≥65 years undergoing colorectal cancer surgery. Postoperative day 3 procalcitonin levels were assessed against the reference standard of clinically confirmed AL. Receiver operating characteristic (ROC) curve analysis and area under the curve (AUC) were calculated.
Results: The AL incidence was 7.7%. The ROC analysis for procalcitonin on postoperative day 3 yielded an AUC of 0.68 (95% CI: 0.58-0.78) for AL prediction. The optimal cutoff point (Youden index) was 0.61 ng/mL, with a sensitivity of 0.69, specificity of 0.62, positive likelihood ratio of 1.86, and negative likelihood ratio of 0.48. Excluding ileostomies improved the AUC to 0.78, and focusing on grade C ALs resulted in an AUC of 0.81.
Conclusion: Procalcitonin on postoperative day 3 demonstrated limited diagnostic accuracy for AL detection in older adults with colorectal cancer. However, performance improved when excluding ileostomies and was notably better for detecting severe (grade C) ALs, suggesting a potential role in identifying high-risk leaks in this population.
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Dr. Satish Baburao Rajurkar
Assistant Professor, General Surgery, Mamata Medical College, Khammam.