Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery

Zarnescu, Eugenia Claudia; Zarnescu, Narcis; Costea, Radu

doi:10.3390/diagnostics11122382

Cited by 65 publications

(64 citation statements)

References 152 publications

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“…Therefore, adequate nutritional support before surgery is necessary to prevent the occurrence of AL. In addition, male is also an independent risk factor for postoperative AL, which is similar to previous studies ( 27 – 29 ). The content of androgens in intestinal microcirculation may be related to anastomotic healing ( 30 ).…”

Section: Discussionsupporting

confidence: 90%

Development and validation of a nomogram to predict anastomotic leakage in colorectal cancer based on CT body composition

et al. 2022

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BackgroundAnastomotic leakage (AL) is one of the most serious postoperative complications. This study aimed to investigate the predictive value of preoperative body composition for AL in patients with colorectal cancer (CRC).MethodsWe first reviewed data from 3,681 patients who underwent radical CRC resection 2013–2021 in our hospital, and 60 patients were diagnosed with AL after surgery. We designed a nested case-control study and two controls were randomly selected for each case according to the time and position of surgery. Body composition was measured at the level of the third lumbar vertebra based on computed tomography (CT) images. The risk factors of AL were analyzed by univariate and multivariate analysis. Nomogram was built using binary regression analysis and assessed for clinical usefulness, calibration, and discrimination.ResultsIn the multivariate analysis, gender, blood glucose, nutrition risk screening (NRS), skeletal muscle area (SMA) and visceral fat area (VFA) were independent risk factors for developing anastomotic leakage after surgery. The prognostic model had an area under the receiver operating characteristic curve of 0.848 (95% CI, 0.781–0.914). The calibration curve showed good consistency between the predicted and observed outcomes. Decision curve analysis indicated that patients with colorectal cancer can benefit from the prediction model.ConclusionsThe nomogram that combined with gender, blood glucose, NRS, SMA, and VFA had good predictive accuracy and reliability to AL. It may be conveniently for clinicians to predict AL preoperatively and be useful for guiding treatment decisions.

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Section: Discussionsupporting

confidence: 90%

Development and validation of a nomogram to predict anastomotic leakage in colorectal cancer based on CT body composition

et al. 2022

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“…Patient related factors: In our study, male, PCT, and HbA1c (> 6.3%) all were risk factors for postoperative AL. Male was a risk factor for AL, possibly due to the narrower and more complex anatomy of the male pelvis, which increased the di culty of operation and transection of the rectal bowel [8] [13]. For patients with locally advanced rectal cancer, neoadjuvant therapy has been recognized as an important treatment modality to improve clinical outcomes.…”

Section: Diagnostic Effect Of Rareal Model Analyzed By Roc Curve and ...mentioning

confidence: 99%

Risk assessment of rectal anastomotic leakage (RAREAL) after DIXON in non-emergency patients with rectal cancer: a retrospective study

Zheng

2022

Preprint

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Background The routine establishment of a diverting stoma (DS) remains controversial in every patient undergoing Dixon operation. We aimed to establish a model for the risk assessment of rectal anastomotic leak (RAREAL) after Dixon in non-emergency patients with rectal cancer, using routinely available variables, by which surgeons could individualize their approach to DS. Methods 413 patients who underwent Dixon operation for rectal cancer from January 2015 to December 2018 were taken as the model group for retrospective study. Univariate and multivariate logistic regression analysis was used to determine the independent risk factors associated with anastomotic leakage(AL). The area under the curve (AUC) of the receiver operating characteristic (ROC) and the Youden index were used to evaluate the RAREAL score. We constructed the RAREAL model. 191 patients who underwent Dixon operation due to rectal cancer from January 2019 to December 2020 were collected according to the uniform criteria as a validation group to validate the RAREAL model. The RAREAL score was performed on the patients in the modeling group, the ROC curve was used for analysis, and the Z test was used to evaluate the consistency of the ROC curve between the modeling group and the validation group. Results In the model group, multivariate analysis identified the following variables as independent risk factors for AL: HbA1c (odds ratio (OR) = 7.831; P = 0.004), Left colic artery (LCA) non preservation (OR = 7.035; P = 0.003), Tumor distance from the anal margin (TD) (OR = 14.246; P = 0.000). In the model group, the AUC of the ROC for evaluating AL with RAREAL was 0.764, and when RAREAL score = 4.5, its sensitivity, specificity and Youden index were 0.419, 0.995, 0.415, respectively. The AUC was 0.757 in the validation group and its sensitivity and specificity were 0.471 and 0.989, respectively, when RAREAL score = 4.5. Conclusion The RAREAL score can be used to assess the risk of AL after Dixon operation for rectal cancer, and prophylactic DS should be proactively done when the score is greater than 4.5.

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“…Smoking was found to be a cause of vascular ischemia and carbon monoxide cellular hypoxia, which would impair anastomotic circulation [ 28 ]. Many patient-related factors can affect anastomotic healing, such as male sex, increased BMI, and preoperative nutritional status.…”

Section: Reviewmentioning

confidence: 99%

Predictors That Identify Complications Such As Anastomotic Leak in Colorectal Surgery: A Systematic Review

Selvamani¹,

Shoukrie²,

Malla³

et al. 2022

Cureus

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Leakage of the anastomotic site is considered to be one of the most serious complications after colon and rectal surgery. It is associated with increased mortality, morbidity, and longer hospital stays. This systematic review examines the need for blood markers such as C-reactive protein (CRP), procalcitonin (PCT), albumin, and various other molecular markers that assist in their propensity to diagnose anastomotic leakage (AL) early after surgery. Utilizing PubMed and Google Scholar as resources and including the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for the articles, and studies over the last five years were included. A total of 12 studies have been discussed, and most articles suggest CRP as an excellent indicator. CRP compared to Dutch leakage scores (DLS) and PCT studies suggest that the three combinations improve the predictable outcome of AL. In addition, CRP and PCT have been shown to diagnose AL early in the postoperative period. Other studies include the role of markers of oxidative stress markers, Interleukin-6, Interleukin-10, and other molecular markers in the peritoneal drain which are predictive for identifying AL after three days postoperatively (POD-3). Overall, CRP has proven to be a reliable standard indicator of diagnosis. This is because the postoperative elevation of this protein indicates a problem of leakage with clinical symptoms. Other blood parameters are useful for diagnosis as well, but the limitations are the lack of appropriate studies and the number of randomized controlled trials in this area of study.

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Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery

Cited by 65 publications

References 152 publications

Development and validation of a nomogram to predict anastomotic leakage in colorectal cancer based on CT body composition

Development and validation of a nomogram to predict anastomotic leakage in colorectal cancer based on CT body composition

Risk assessment of rectal anastomotic leakage (RAREAL) after DIXON in non-emergency patients with rectal cancer: a retrospective study

Predictors That Identify Complications Such As Anastomotic Leak in Colorectal Surgery: A Systematic Review

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