Project description:Anastomotic leakage is a major complication after gastrointestinal surgery, yet early detection remains limited by nonspecific clinical signs and narrow biomarker panels. Here, we used longitudinal data-independent acquisition proteomics to profile postoperative drain fluid from two surgical cohorts, comprising 34 pancreatic surgery patients with 222 drain-fluid samples and 34 colorectal surgery patients with 146 drain-fluid samples. We aimed to define procedure-specific leakage signatures, evaluate established biomarkers across postoperative time, and identify additional candidate markers beyond routinely measured proteins. In pancreatic surgery, established enzyme markers, particularly AMY2A and PNLIP, showed strong early discrimination between leak and non-leak patients. In colorectal surgery, the same predefined marker strategy performed inconsistently, indicating that leakage-associated biology may differ between surgical procedures. Discovery analysis revealed divergent temporal patterns. Pancreatic leakage was dominated by early enzyme enrichment followed by inflammatory, antimicrobial, oxidative stress, and matrix-remodelling-associated proteins. Colorectal leakage showed strongest divergence around POD3 and was driven largely by reduced abundance of proteins linked to uncomplicated recovery, including endothelial integrity, extracellular matrix organization, complement regulation, and coagulation balance. From these procedure-specific patterns, PRSS2 and AZU1 were selected for pancreatic surgery, and FBLN1 and CDH5 for colorectal surgery, as novel candidate markers for targeted follow-up. Targeted ELISA measurements confirmed detectability of selected candidates in drain fluid, supporting their further development as markers for novel leakage detection strategies. Overall, these data show that postoperative leakage follows procedure-specific proteomic trajectories and support drain-fluid proteomics as a framework for biologically informed biomarker discovery beyond routinely measured markers.

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Hand assisted laparoscopic surgery (HALS) versus open surgery in the treatment of sigmoid colon cancer and upper rectal cancer: a randomized control clinical trial of multiple centers

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