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Surgical Endoscopy
Published in: Surgical Endoscopy 10/2013

01-10-2013

Predictive score for anastomotic leakage after elective colorectal cancer surgery: a decision making tool for choice of protective measures

Authors: Fuad Pasic, Nermin N. Salkic

Published in: Surgical Endoscopy | Issue 10/2013

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Abstract

Background

Anastomotic leakage is the most severe complication after colorectal surgery and a major cause of postoperative morbidity and mortality. We aimed to identify a predictive score for postoperative leakage after colorectal cancer surgery and to evaluate its usefulness in assessing various protective measures.

Methods

A total of 159 patients were divided into test (79 patients) and validation (40 patients) groups in order to identify the risk factors and construct the predictive score. The remaining 40 patients (intervention group) were prospectively evaluated with the application of protective measures guided by risk stratification according to the predictive score.

Results

A total of 23 of 159 (14.5 %) patients had anastomotic leakage, with 7 of 23 (30.4 %) of them needing reoperation. 11 of 159 (6.9 %) patients died, with 10 (6.3 %) deaths directly associated with anastomotic leakage. The rate of leakage in the test and validation groups (nonintervention group) was 22 of 119 (18.5 %), while the rate of leakage in the intervention group was 3 of 40 (7.5 %). The odds ratio for anastomotic leakage in the intervention group was 0.23 compared to the nonintervention group, with a relative risk reduction of 73 % for unfavorable event. The number needed to treat was 8 patients. There were also 10 of 119 (8.4 %) deaths in the nonintervention group compared to 1 of 40 (2.5 %) in the intervention group (Fisher’s test; p = 0.18).

Conclusions

Our simple predictive score may be a valuable decision making tool that can help surgeons reliably identify patients at high risk for postoperative anastomotic leakage and apply guided intraoperative protective measures.
Literature
1.
Soeters PB, de Zoete JP, Dejong CH, Williams NS, Baeten CG (2002) Colorectal surgery and anastomotic leakage. Dig Surg 19(2):150–155PubMedCrossRef
2.
Karliczek A, Harlaar NJ, Zeebregts CJ, Wiggers T, Baas PC, van Dam GM (2009) Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery. Int J Colorectal Dis 24(5):569–576PubMedCrossRef
3.
Boccola MA, Lin J, Rozen WM, Ho YH (2010) Reducing anastomotic leakage in oncologic colorectal surgery: an evidence-based review. Anticancer Res 30(2):601–607PubMed
4.
Buchs NC, Gervaz P, Secic M, Bucher P, Mugnier-Konrad B, Morel P (2008) Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Int J Colorectal Dis 23(3):265–270PubMedCrossRef
5.
Alves A, Panis Y, Pocard M, Regimbeau JM, Valleur P (1999) Management of anastomotic leakage after nondiverted large bowel resection. J Am Coll Surg 189(6):554–559PubMedCrossRef
6.
Wong NY, Eu KW (2005) A defunctioning ileostomy does not prevent clinical anastomotic leak after a low anterior resection: a prospective, comparative study. Dis Colon Rectum 48(11):2076–2079PubMedCrossRef
7.
Agnifili A, Schietroma M, Carloni A, Mattucci S, Caterino G, Lygidakis NJ, Carlei F (2004) The value of omentoplasty in protecting colorectal anastomosis from leakage. A prospective randomized study in 126 patients. Hepatogastroenterology 51(60):1694–1697PubMed
8.
Beard JD, Nicholson ML, Sayers RD, Lloyd D, Everson NW (1990) Intraoperative air testing of colorectal anastomoses: a prospective, randomized trial. Br J Surg 77(10):1095–1097PubMedCrossRef
9.
Marusch F, Koch A, Schmidt U, Geibetaler S, Dralle H, Saeger HD, Wolff S, Nestler G, Pross M, Gastinger I, Lippert H (2002) Value of a protective stoma in low anterior resections for rectal cancer. Dis Colon Rectum 45(9):1164–1171PubMedCrossRef
10.
Meade B, Moran B (2004) Reducing the incidence and managing the consequences of anastomotic leakage after rectal resection. Acta Chir Iugosl 51(3):19–23PubMedCrossRef
11.
Moran BJ (2010) Predicting the risk and diminishing the consequences of anastomotic leakage after anterior resection for rectal cancer. Acta Chir Iugosl 57(3):47–50PubMedCrossRef
12.
Biondo S, Pares D, Kreisler E, Rague JM, Fraccalvieri D, Ruiz AG, Jaurrieta E (2005) Anastomotic dehiscence after resection and primary anastomosis in left-sided colonic emergencies. Dis Colon Rectum 48(12):2272–2280PubMedCrossRef
13.
Choi HK, Law WL, Ho JW (2006) Leakage after resection and intraperitoneal anastomosis for colorectal malignancy: analysis of risk factors. Dis Colon Rectum 49(11):1719–1725PubMedCrossRef
14.
Eckmann C, Kujath P, Schiedeck TH, Shekarriz H, Bruch HP (2004) Anastomotic leakage following low anterior resection: results of a standardized diagnostic and therapeutic approach. Int J Colorectal Dis 19(2):128–133PubMedCrossRef
15.
Golub R, Golub RW, Cantu R Jr, Stein HD (1997) A multivariate analysis of factors contributing to leakage of intestinal anastomoses. J Am Coll Surg 184(4):364–372PubMed
16.
Konishi T, Watanabe T, Kishimoto J, Nagawa H (2006) Risk factors for anastomotic leakage after surgery for colorectal cancer: results of prospective surveillance. J Am Coll Surg 202(3):439–444PubMedCrossRef
17.
Lipska MA, Bissett IP, Parry BR, Merrie AE (2006) Anastomotic leakage after lower gastrointestinal anastomosis: men are at a higher risk. ANZ J Surg 76(7):579–585PubMedCrossRef
18.
Lohsiriwat V, Lohsiriwat D, Boonnuch W, Chinswangwatanakul V, Akaraviputh T, Lert-Akayamanee N (2008) Pre-operative hypoalbuminemia is a major risk factor for postoperative complications following rectal cancer surgery. World J Gastroenterol 14(8):1248–1251PubMedCrossRef
19.
Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M (1998) Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 85(3):355–358PubMedCrossRef
Metadata
Title
Predictive score for anastomotic leakage after elective colorectal cancer surgery: a decision making tool for choice of protective measures
Authors
Fuad Pasic
Nermin N. Salkic
Publication date
01-10-2013
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 10/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-013-2997-1

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