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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 9/2018

01-09-2018 | Original Article

A Nomogram to Predict Anastomotic Leakage in Open Rectal Surgery—Hope or Hype?

Authors: Johannes Klose, Ignazio Tarantino, Armin von Fournier, Moritz J. Stowitzki, Yakup Kulu, Thomas Bruckner, Claudia Volz, Thomas Schmidt, Martin Schneider, Markus W. Büchler, Alexis Ulrich

Published in: Journal of Gastrointestinal Surgery | Issue 9/2018

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Abstract

Background

Anastomotic leakage is the most dreaded complication after rectal resection and total mesorectal excision, leading to increased morbidity and mortality. Formation of a diverting ileostomy is generally performed to protect anastomotic healing. Identification of variables predicting anastomotic leakage might help to select patients who are under increased risk for the development of anastomotic leakage prior to surgery. The objective of this study was to assess the applicability of a nomogram as prognostic model for the occurrence of anastomotic leakage after rectal resection in a cohort of rectal cancer patients.

Methods

Nine hundred seventy-two consecutive patients who underwent surgery for rectal cancer were retrospectively analyzed. Univariate and multivariable Cox regression analyses were used to determine independent risk factors associated with anastomotic leakage. Receiver operating characteristics (ROC) curve analysis was performed to calculate the sensitivity, specificity, and overall model correctness of a recently published nomogram and an adopted risk score based on the variables identified in this study as a predictive model.

Results

Male sex (p = 0.042), obesity (p = 0.017), smoking (p = 0.012), postoperative bleeding (p = 0.024), and total protein level ≤ 5.6 g/dl (p = 0.007) were identified as independent risk factors for anastomotic leakage. The investigated nomogram and the adopted risk score failed to reach relevant areas under the ROC curve greater than 0.700 for the prediction of anastomotic leakage.

Conclusions

The proposed nomogram and the adopted risk score failed to reliably predict the occurrence of anastomotic leakage after rectal resection. Risk scores as prognostic models for the prediction of anastomotic leakage, independently of the study population, still need to be identified.
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Metadata
Title
A Nomogram to Predict Anastomotic Leakage in Open Rectal Surgery—Hope or Hype?
Authors
Johannes Klose
Ignazio Tarantino
Armin von Fournier
Moritz J. Stowitzki
Yakup Kulu
Thomas Bruckner
Claudia Volz
Thomas Schmidt
Martin Schneider
Markus W. Büchler
Alexis Ulrich
Publication date
01-09-2018
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 9/2018
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-018-3782-1

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