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Techniques in Coloproctology
Published in: Techniques in Coloproctology 7/2019

01-07-2019 | Rectal Cancer | Original Article

The REAL (REctal Anastomotic Leak) score for prediction of anastomotic leak after rectal cancer surgery

Authors: A. Arezzo, M. Migliore, P. Chiaro, S. Arolfo, C. Filippini, D. Di Cuonzo, R. Cirocchi, M. Morino, REAL Score Collaborators

Published in: Techniques in Coloproctology | Issue 7/2019

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Abstract

Background

Anastomotic leak after rectal cancer surgery is a severe complication associated with poorer oncologic outcome and quality of life. Preoperative assessment of the risk for anastomotic leak is a key component of surgical planning, including the opportunity to create a defunctioning stoma.

Objective

The purpose of this study was to identify and quantify the risk factors for anastomotic leak to minimize risk by either not restoring bowel continuity or protecting the anastomosis with a temporary diverting stoma.

Methods

Potentially relevant studies were identified from the following databases: PubMed, Embase and Cochrane Library. This meta-analysis included studies on transabdominal resection for rectal cancer that reported data about anastomotic leak. The risk for anastomotic leak after rectal cancer surgery was investigated. Preoperative, intraoperative, and postoperative factors were extracted and used to compare anastomotic leak rates. All variables demonstrating a p value < 0.1 in the univariate analysis were entered into a multivariate logistic regression model to determine the risk factors for anastomotic leak.

Results

Twenty-six centers provided individual data on 9735 patients. Selected preoperative covariates (time before surgery, age, gender, smoking, previous abdominal surgery, BMI, diabetes, ASA, hemoglobin level, TNM classification stage, anastomotic distance) were used as independent factors in a logistic regression model with anastomotic leak as dependent variable. With a threshold value of the receiver operating characteristics (ROC) curve corresponding to 0.0791 in the training set, the area under the ROC curve (AUC) was 0.585 (p < 0.0001). Sensitivity and specificity of the model’s probability > 0.0791 to identify anastomotic leak were 79.1% and 32.9%, respectively. Accuracy of the threshold value was confirmed in the validation set with 77.8% sensitivity and 35.2% specificity.

Conclusions

We trust that, with further refinement using prospective data, this nomogram based on preoperative risk factors may assist surgeons in decision making. The score is now available online (http://​www.​real-score.​org).
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Metadata
Title
The REAL (REctal Anastomotic Leak) score for prediction of anastomotic leak after rectal cancer surgery
Authors
A. Arezzo
M. Migliore
P. Chiaro
S. Arolfo
C. Filippini
D. Di Cuonzo
R. Cirocchi
M. Morino
REAL Score Collaborators
Publication date
01-07-2019
Publisher
Springer International Publishing
Published in
Techniques in Coloproctology / Issue 7/2019
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI
https://doi.org/10.1007/s10151-019-02028-4

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