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

Abstract

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.

Machine learning-based random forest predicts anastomotic leakage after anterior resection for rectal cancer

“…Consistently, our study showed that male patients and those with lower distance of tumor from the anal verge were more likely to have AL. Similarly, preoperative bowel stenosis or obstruction, preoperative anemia (<90 g/L) or massive blood loss during operation, diabetes, and nCRT that were also considered as predictors in our study, have also been reported in several other studies (19,29). A proximal bowel stenosis or even obstruction may induce the proximal and distal bowel tissue edema, and thus increase the incidence of AL after AR.…”

“…Thus, the results in our study are likely to be more reliable and convincing. Moreover, compared to other studies, our model also showed a better predicting performance (11,12,19,20,(25)(26)(27) (Table 6).…”

“…was widely used in the previous studies (5,6,11,12,19). However, the principle of the nomogram to predict AL is based on logistic regression that has limitations in the fitting of model creation (20).…”