Nomogram for predicting anastomotic leakage after low anterior resection for rectal cancer

Hoshino, Nobuaki; Hida, Koya; Sakai, Yoshiharu; Osada, Shinji; Ichikawa, Hitoshi; Satô, Toshihiko; Takii, Yasumasa; Bando, Hiroyuki; Shiomi, Akio; Saitô, Norio

doi:10.1007/s00384-018-2970-5

Cited by 92 publications

(82 citation statements)

References 25 publications

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“…Therefore, patients with type 2 DM should be ensured that blood glucose is well controlled before surgery to reduce the risk of AL. However, several studies found that diabetes was not a risk factor for AL [27, 34]. …”

Section: Discussionmentioning

confidence: 99%

Laparoscopic surgery may decrease the risk of clinical anastomotic leakage and a nomogram to predict anastomotic leakage after anterior resection for rectal cancer

Zheng

et al. 2018

Int J Colorectal Dis

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IntroductionAnastomotic leakage is still one of the most dreaded complications after anterior resection for rectal cancer. This study aimed to identify risk factors for anastomotic leakage and to create a nomogram for precise prediction of anastomotic leakage after anterior resection for rectal cancer.MethodsTwo thousand six hundred eighteen consecutive patients who underwent anterior resection for rectal cancer with primary anastomosis, with or without diverting stoma, were retrospectively analyzed as a training dataset. Univariate and multivariable Cox regression analyses were used to determine independent risk factors associated with anastomotic leakage. A nomogram was constructed to predict anastomotic leakage. Data containing 611 patients were prospectively collected as a test dataset. The performance of the nomogram was evaluated by using a bootstrapped-concordance index and calibration plots.ResultsThe rate of clinical anastomotic leakage was 9.3% in the training dataset. Multivariate analysis identifies the following variables as independent risk factors for anastomotic leakage: gender (male) (odds ratio (OR) = 2.286), distance of tumor to anal verge (OR = 0.791), tumor size (OR = 1.175), operating time (OR = 1.009), diabetes mellitus (OR = 1.704), laparoscopic surgery (OR = 0.445), anastomotic bleeding (OR = 13.46), and diverting stoma (OR = 0.386). We created a nomogram with high discriminative ability (concordance index, 0.722). The area under the curve value, which evaluated the predictive performance of external validation, was 0.723.ConclusionsA protective diverting stoma and laparoscopic surgery significantly decrease the risk of anastomotic leakage. Our nomogram was a useful tool for precise prediction of anastomotic leakage after anterior resection for rectal cancer.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic surgery may decrease the risk of clinical anastomotic leakage and a nomogram to predict anastomotic leakage after anterior resection for rectal cancer

Zheng

et al. 2018

Int J Colorectal Dis

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“…Based on the results of the multivariate regression analysis, a prediction model was established and presented as a nomogram by using the “rms” package in R software (version 3.4.5; http://www.Rproject.org). Briefly, the nomogram was built as follows: according to the regression coefficients of all independent parameters, scoring criteria were set, and each independent parameter was given a score; then a total score could be calculated for each patient . Finally, the probability of AL in each patient can be calculated with the conversion function between the total score and the probability of AL.…”

Section: Methodsmentioning

confidence: 99%

“…Briefly, the nomogram was built as follows: according to the regression coefficients of all independent parameters, scoring criteria were set, and each independent parameter was given a score; then a total score could be calculated for each patient. 11,16,17 Finally, the probability of AL in each patient can be calculated with the conversion function between the total score and the probability of AL. Moreover, receiver operating characteristic (ROC) curves and calibration curves were used to assess the discrimination and calibration abilities of the nomogram by using the "rms" and "pROC" packages.…”

Section: Development Of the Prediction Modelmentioning

confidence: 99%

“…Many studies have shown that AL‐leading increase the mortality, hospitalization time, and cost of treatment, moreover, it could lead to increased risk of local recurrence and metastasis . Many risk factors for AL have been reported, such as age, sex, body mass index (BMI), location of the tumor, and more, however, it still a challenge to predict AL accurately for surgeon.…”

Section: Introductionmentioning

confidence: 99%

“…mass index (BMI), location of the tumor, and more, [8][9][10][11] however, it still a challenge to predict AL accurately for surgeon. Sufficient blood supply is an important factor for the smooth anastomosis healing process after intestinal reconstruction, and left colon artery preservation in laparoscopic low anterior resection (LAR) is associated with a reduced risk of AL.…”

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confidence: 99%

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Novel nomogram with microvascular density in the surgical margins can accurately predict the risk for anastomotic leakage after anterior resection for rectal cancer

Xiao

Zhou

Yang

et al. 2019

Journal of Surgical Oncology

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Abstracts Background Anastomotic leakage (AL) is a serious complication after anterior resection. The purpose of this study was to determine the role of microvascular density (MVD) in AL and to develop a nomogram to accurately predict AL. Methods This study retrospectively enrolled 477 consecutive patients who underwent anterior resection for rectal cancer from January 2011 to January 2019. Tissue samples of the resection margins were assessed for MVD. Univariate and multivariate regression analyses were used to identify the risk factors for AL. Results The incidence of clinical AL was 6.7%. MVD in the distal margin was associated with AL (P < .001). Univariate and multivariate regression analysis identified the following variables as independent risk factors for AL: preoperative albumin ≤35 g/L (odds ratio [OR] = 2.511), neoadjuvant treatment (OR = 3.560), location of tumor ≤7 cm (OR = 3.381), blood loss ≥100 mL (OR = 2.717), and MVD in the distal margin ≤20 (OR = 4.265). Then, a nomogram including these predictors was developed. The nomogram showed good discrimination (AUC = 0.816) and calibration (concordance index = 0.816). The decision curve analysis demonstrated that the nomogram was clinically useful. Conclusions MVD in the distal margin is closely associated with AL. The nomogram can be used for individualized prediction of AL after anterior resection for patients with rectal cancer.

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A nomogram for predicting food allergy in infants with feeding problems and malnutrition

Yang,

Zhou,

et al. 2024

J. pediatr. gastroenterol. nutr.

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Background and ObjectiveAs oral food challenge (OFC) cannot be performed routinely in the general outpatient, this study aimed to construct a nomogram to predict the odds of food allergy in infants with idiopathic feeding problems and malnutrition.MethodsFrom August 2018 to December 2021, 289 infants (median age, 6 months; P25–P75, 4–8) with idiopathic feeding problems and malnutrition were enrolled from seven hospitals in Shanghai, China. Food allergy was defined as a positive response to a skin prick test or OFC, with gastrointestinal, dermatologic, or respiratory symptom improvement after 4 weeks of avoidance of the suspected food. Demographic characteristics, Cow's Milk‐related Symptom Scores (CoMiSS), and blood eosinophil amounts were evaluated for their associations with food allergy. Multivariable logistic regression analysis was used to identify variables to develop a nomogram model with the bootstrapped‐concordance index as an assessment metric.ResultsTotally 249 of 289 infants had food allergy (86.2%). After logistic regression analysis, the feeding pattern (odds ratio [OR] = 5.28, 95% confidence interval [CI]: 2.13–13.09), a family history of allergy (OR = 1.79, 95% CI: 0.71–4.51), CoMiSS (OR = 1.45, 95% CI: 1.19–1.77), and eosinophil percentage (OR = 1.33, 95% CI: 1.11–1.60) were used to develop the model, which had a good performance with an area under the curve of 0.868 (95% CI: 0.792–0.944) and a bootstrapped‐concordance index of 0.868.ConclusionFood allergy is common in infants with idiopathic feeding problems and malnutrition. The developed nomogram may help identify infants with food allergy for further diagnosis.

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Nomogram for predicting anastomotic leakage after low anterior resection for rectal cancer

Abstract: Our nomogram was a useful tool for precise prediction of anastomotic leakage after low anterior resection for rectal cancer.

Cited by 92 publications

References 25 publications

Laparoscopic surgery may decrease the risk of clinical anastomotic leakage and a nomogram to predict anastomotic leakage after anterior resection for rectal cancer

Laparoscopic surgery may decrease the risk of clinical anastomotic leakage and a nomogram to predict anastomotic leakage after anterior resection for rectal cancer

Novel nomogram with microvascular density in the surgical margins can accurately predict the risk for anastomotic leakage after anterior resection for rectal cancer

A nomogram for predicting food allergy in infants with feeding problems and malnutrition

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