title: A Clinical Parameters-Based Model Predicts Anastomotic Leakage After a Laparoscopic Total Mesorectal Excision: A Large Study With Data From China.
abstract: Anastomotic leakage after colorectal surgery is a major and life-threatening complication that occurs more frequently than expected. Intraoperative judgment in predicting potential leakage has shown extremely low sensitivity and specificity. The lack of a model for predicting anastomotic leakage might explain this insufficient judgment. We aimed to propose a clinical parameters-based model to predict anastomotic leakage after laparoscopic total mesorectal excision (TME).This study was a retrospective analysis of a prospectively designed colorectal cancer dataset. In total, 1968 patients with a laparoscopic TME were enrolled from November 1, 2010, to March 20, 2014. The independent risk factors for anastomotic leakage were identified, from which the parameters-based model for leakage was developed.Anastomotic leakage was noted in 63 patients (3.2%). Male sex, a low level of anastomosis, intraoperative blood loss, diabetes, the duration time of the surgery, and low temperature were significantly associated by the bivariate analysis and the Cochran-Mantel-Haenszel test with an increased risk. From these factors, the logistic regression model identified the following 4 independent predictors: male sex (risk ratio [RR] = 1.85, 95% confidence interval [CI]: 1.13-4.87), diabetes (RR = 2.08, 95% CI: 1.19-5.8), a lower anastomosis level (RR = 3.41, 95% CI: 1.17-6.71), and a high volume of blood loss (RR = 1.03, 95% CI: 1.01-1.05). The locally weighted scatterplot smoothing regression showed an anastomosis within 5 cm from the anus and intraoperative blood loss of >100 mL as the cutoff values for a significantly increased risk of leakage. Based on these independent factors, a parameters-based model was established by the regression coefficients. The high and low-risk groups were classified according to scores of 3-5 and 0-2, with leakage rates of 8.57% and 1.66%, respectively (P < 0.001).This parameters-based model could predict the risk of anastomotic leakage following laparoscopic rectal cancer. After further validation, this model might facilitate the intraoperative recognition of high-risk patients to perform defunctional stomas.
authors.affiliation: From the Department of General Surgery (Gastrointestinal Surgery), The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Hu
authors.forename: Yong
authors.initials: Y
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak; D002277:Carcinoma / Q000601:surgery; D002681:China; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012004:Rectal Neoplasms / Q000601:surgery; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies