TORNA ALL’ELENCO

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

2019
AOU Città della Salute di Torino

Tipo pubblicazione

Article

Autori/Collaboratori (53)Vedi tutti...

Arezzo A

Migliore M

Chiaro P


et alii...

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 refineme

PMID : 31240416

DOI : 10.1007/s10151-019-02028-4

Keywords

risk factor; rectum cancer; scoring system; Rectal Anastomotic Leak score; prevalence; preoperative period; prediction; postoperative period; meta analysis; intraoperative period; human; gender; digestive system disease assessment; diabetes mellitus; cancer surgery; cancer staging; body mass; article; age; anastomosis leakage; hemoglobin; sensitivity and specificity; smoking; stoma; surgical risk; systematic review;