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Background:Postoperative pancreatic fistula (PF) are frequent major complications after pancreatic surgery. Detection of amylase in drainage-fluid and serum-CRP are well established diagnostic parameters. The importance of Procalcitonin (PCT) in the diagnosis of PF remains to be elucidated. Aim of the study was therefore, to evaluate of PCT in the diagnostic of PF and major complications following pancreatic surgery (PS).Methods:All patients with PS were prospectively collected from Jan. 2009 - Sept. 2009. Serum-PCT, -CRP as well as amylase in drainage-fluid were measured every second postoperative day. Following parameters were analyzed: diagnosis, age, operation, complications (major, minor, secondary), PF (grade A, B and C; according to the ISGPF-definition). Results:During the observation period, n = 107 pat. received PS and developed n = 15 minor, n = 12 major and n = 3 secondary complications. Among major complications, n = 9 PF (8.9%) were diagnosed in the drainage-fluid, thereof n = 3 grade A, n = 2 grade B and n = 4 grade C. CRP and PCT were significantly increased in pat. with PF and other major complications after the 10th postop. day (p ≤ 0.001; Anova). In the detection of PF, the ROC-Analysis for PCT revealed an AUC of 0.736 with a sensitivity of 83% and a specificity of 72% for the cut-off-value of 17.8ng/ml. For CRP the AUC was 0.855 with a sensitivity of 86% and a specificity of 83% for the cut-off-value of 77.1mg/l. For the detection of major complications, the ROC-Analysis of PCT resulted in an AUC of 0.977 with a sensitivity of 100% and a specificity of 93% for the cut-off-value of 20.9 ng/l. For CRP, the AUC was 0.770 with a sensitivity of 73% and a specificity of 84% for the cut-off-value of 77.1 mg/l.Conclusion:Our results demonstrate that PCT is equivalent with CRP in the early diagnosis of postoperative pancreatic fistula, however superior in the diagnosis of all major complications following PS. Therefore we advocate the routine use of PCT and CRP following PS.