Paradigm shift in postoperative monitoring: Integrating dynamic ultrasound and biomarkers for precision management following laparoscopic gastrectomy

Table 1 Comparison of traditional monitoring vs integrated ultrasound-biomarker surveillance

Characteristic	Traditional monitoring	Integrated surveillance
Monitoring philosophy	Reactive-triggered by clinical suspicion	Proactive-structured, scheduled assessments
Timing of assessment	As needed, based on symptoms or laboratory changes	Standardized: POD 1, 3, and 7
Primary indicators	Clinical signs (fever, abdominal pain, distension), CRP, WBC count	Ultrasound effusion type (simple vs mixed) + procalcitonin (PCT)
Intervention trigger	Clinical deterioration or laboratory confirmation of infection	Combined imaging + biomarker threshold (POD 3: Mixed effusion + PCT > 0.47 ng/mL)
Timing of intervention	Often delayed (POD 5-7)	Earlier, pre-emptive (POD 3-5)
Risk stratification capability	Limited-unable to differentiate high-risk from low-risk patients early	Yes-enables early identification of high-risk patients based on effusion characteristics and PCT levels
Alignment with ERAS principles	Partial-primarily diagnostic rather than preventive	Full-aligns with “prevention rather than treatment” core principle
Evidence base	Well-established, but with recognized limitations for early detection	Emerging-requires prospective, multicenter validation
Resource requirements	Low-relies on clinical examination and routine laboratory tests	Moderate-requires trained sonographers, ultrasound equipment, and serial PCT assays

POD: Postoperative days; ERAS: Enhanced recovery after surgery; CRP: C-reactive protein; WBC: White blood cell.