A preoperative prediction model for anastomotic leakage after rectal cancer resection based on 13.175 patients

Hoek, Vincent T.; Buettner, Stefan; Sparreboom, Cloë L; Detering, Robin; Menon, Anand; Kleinrensink, Gert-Jan; Wouters, Michel W. J. M.; Lange, Johan F.; Wiggers, Jimme K.

doi:10.1016/j.ejso.2022.06.016

Cited by 12 publications

(7 citation statements)

References 44 publications

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“…Reported anastomotic leak rates after low anterior resection vary widely from 3% to up to 36% [34–40]. Among other factors, delivery of preoperative pelvic radiotherapy substantially influences leak rates [41–44]. In the present study, there was no significant difference in the frequency of nonrestorative anterior resection between the two groups.…”

Section: Discussioncontrasting

confidence: 48%

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Influence of neoadjuvant treatment strategy on perioperative outcomes in locally advanced rectal cancer

McFeetors,

O'Connell,

Choy

et al. 2024

Colorectal Disease

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AimNeoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer facilitates tumour downstaging and complete pathological response (pCR). The goal of neoadjuvant systemic chemotherapy (total neoadjuvant chemotherapy, TNT) is to further improve local and systemic control. While some patients forgo surgery, total mesorectal excision (TME) remains the standard of care. While TNT appears to be noninferior to nCRT with respect to short‐term oncological outcomes few data exist on perioperative outcomes. Perioperative morbidity including anastomotic leaks is associated with a negative effect on oncological outcomes, probably due to a delay in proceeding to adjuvant therapy. Thus, we aimed to compare conversion rates, rates of sphincter‐preserving surgery and anastomosis formation rates in patients undergoing rectal resection after either TNT or standard nCRT.MethodsAn institutional colorectal oncology database was searched from January 2018 to July 2023. Inclusion criteria comprised patients with histologically confirmed rectal cancer who had undergone neoadjuvant therapy and TME. Exclusion criteria comprised patients with a noncolorectal primary, those operated on emergently or who had local excision only. Outcomes evaluated included rates of conversion to open, sphincter‐preserving surgery, anastomosis formation and anastomotic leak.ResultsA total of 119 patients were eligible for inclusion (60 with standard nCRT, 59 with TNT). There were no differences in rates of sphincter preservation or primary anastomosis formation between the groups. However, a significant increase in conversion to open (p = 0.03) and anastomotic leak (p = 0.03) was observed in the TNT cohort.ConclusionIn this series TNT appears to be associated with higher rates of conversion to open surgery and higher anastomotic leak rates. While larger studies will be required to confirm these findings, these factors should be considered alongside oncological benefits when selecting treatment strategies.

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Section: Discussioncontrasting

confidence: 48%

“…Reported anastomotic leak rates after low anterior resection vary widely from 3% to up to 36% [34][35][36][37][38][39][40]. Among other factors, delivery of preoperative pelvic radiotherapy substantially influences leak rates [41][42][43][44].…”

Section: Discussionmentioning

confidence: 99%

Influence of neoadjuvant treatment strategy on perioperative outcomes in locally advanced rectal cancer

McFeetors,

O'Connell,

Choy

et al. 2024

Colorectal Disease

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“…The LASSO-logistics model, including hypertension, operating time, cT4, tumor location, and intraoperative blood loss, has good performance in predicting anastomotic leakage with an AUC of 0.790 [39]. Hoek et al [40] identi ed and developed a prediction model for anastomotic leakage with a concordance index of 0.664: gender, age, BMI, American Society of Anesthesiologists, nCRT, cT stage, tumor location, and ileostomy. Li et al [41] found that independent risk factors associated with anastomotic leakage included male, diabetes, neoadjuvant therapy, tumor location, tumor size ≥ 5 cm, and blood loss > 50 ml, with an AUC of 0.83.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Histological Calculator for Anastomotic Margins to Predict Anastomotic Failure Among Rectal Cancer Patients Treated with Neoadjuvant Chemoradiotherapy

Liu,

Huang,

et al. 2024

Preprint

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Purpose To identify histological features of anastomotic margins and develop a prediction model for anastomotic failure (AF) in rectal cancer (RC) patients with neoadjuvant chemoradiotherapy (nCRT). Methods A total of 350 pairs anastomotic “doughnuts” from RC with nCRT were randomly divided into the primary and validation cohorts at a ratio of 7:3. The histological features were identified and constructed using LASSO (Least absolute shrinkage and selection operator) regression to develop the radiation-induced colorectal injury (RCI) score. An AF prediction mode based on the RCI score was built and evaluated using the area under the receiver operating characteristic curve (AUC) and decision curve, decision curve analysis (DCA), and the DeLong test. Results The primary cohort consisted of 245 patients, among whom AF occurred in 26.9% of cases, while the validation cohort comprised 105 patients, with an AF rate of 24.8%. The RCI score of anastomotic margins showed a significant correlation with AF (odds ratio: 2.963; 95% confidence interval [CI]: 2.298–3.822; P < 0.001). Multivariable analysis identified body mass index (BMI) < 18.5, tumor location, long-course radiotherapy, and the RCI score as independent predictors for AF. The nomogram based on the RCI score exhibited good discrimination in both the primary cohort (AUC: 0.886; 95% CI: 0.840–0.931), with a sensitivity of 86.36% (95% CI, 75.7–93.6%) and specificity of 76.54% (95% CI, 69.6–82.5%). Calibration curves revealed satisfactory agreement between the predicted and the observed probabilities. Conclusions The comprehensive nomogram incorporating the RCI score could assist physicians in predicting AF and formulating personalized treatment strategies for RC patients with neoadjuvant radiotherapy.

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“…We expect that further research will be conducted to determine which patients are at a high risk and are eligible for diverting stoma augmentation. The time from preoperative radiation therapy to surgery varies among patients[ 10 ], and other risk factors for AL, such as sex, age, tumor size, and tumor location have been reported[ 26 , 27 ]. The role of TDT may be to steadily reduce AL in patients for whom a stoma may be avoided, rather than to place a stoma in such high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of transanal drainage tube in preventing anastomotic leakage after surgery for rectal cancer: A meta-analysis

Fujino¹,

Yasui²,

Ohue³

et al. 2023

World J Gastrointest Surg

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BACKGROUND Anastomotic leakage (AL) following rectal cancer surgery is an important cause of mortality and recurrence. Although transanal drainage tubes (TDTs) are expected to reduce the rate of AL, their preventive effects are controversial. AIM To reveal the effect of TDT in patients with symptomatic AL after rectal cancer surgery. METHODS A systematic literature search was performed using the PubMed, Embase, and Cochrane Library databases. We included randomized controlled trials (RCTs) and prospective cohort studies (PCSs) in which patients were assigned to two groups depending on the use or non-use of TDT and in which AL was evaluated. The results of the studies were synthesized using the Mantel-Haenszel random-effects model, and a two-tailed P value > 0.05 was considered statistically significant. RESULTS Three RCTs and two PCSs were included in this study. Symptomatic AL was examined in all 1417 patients (712 with TDT), and TDTs did not reduce the symptomatic AL rate. In a subgroup analysis of 955 patients without a diverting stoma, TDT reduced the symptomatic AL rate (odds ratio = 0.50, 95% confidence interval: 0.29–0.86, P = 0.012). CONCLUSION TDT may not reduce AL overall among patients undergoing rectal cancer surgery. However, patients without a diverting stoma may benefit from TDT placement.

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A preoperative prediction model for anastomotic leakage after rectal cancer resection based on 13.175 patients

Cited by 12 publications

References 44 publications

Influence of neoadjuvant treatment strategy on perioperative outcomes in locally advanced rectal cancer

Influence of neoadjuvant treatment strategy on perioperative outcomes in locally advanced rectal cancer

Development and Validation of a Histological Calculator for Anastomotic Margins to Predict Anastomotic Failure Among Rectal Cancer Patients Treated with Neoadjuvant Chemoradiotherapy

Efficacy of transanal drainage tube in preventing anastomotic leakage after surgery for rectal cancer: A meta-analysis

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