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

Figure 1 Integrated surveillance algorithm for postoperative risk stratification following laparoscopic gastrectomy. Based on the findings of Gao et al[17] and our systematic synthesis of the evidence, this algorithm centers on postoperative day 3 as the critical assessment window. Patients are stratified by ultrasound effusion type (simple vs mixed) and procalcitonin level (using the optimal cutoff of 0.47 ng/mL). Low-risk patients continue standard enhanced recovery after surgery pathways, while high-risk patients trigger enhanced surveillance and pre-emptive intervention. This algorithm represents a hypothesis-generating framework requiring prospective validation. PCT: Procalcitonin; ERAS: Enhanced recovery after surgery; CRP: C-reactive protein.