Prediction of anastomotic leak in colorectal cancer surgery based on a new prognostic index PROCOLE (prognostic colorectal leakage) developed from the meta-analysis of observational studies of risk factors.
OBJECTIVE
To obtain a prognostic index, which has been named PROCOLE (prognostic colorectal leakage), it can predict the risk that a certain individual may suffer anastomotic leakage.


METHODS
The methodology consists of a systematic review to identify potential risk factors for anastomotic leakage and a meta-analysis of studies of each of these factors. In the meta-analysis, the prognostic index integrates factors that are statistically significant, which are weighted according to the estimated value of the effect size. The prognostic index was validated using retrospectively collected data from patients who underwent colorectal cancer surgery anastomosis at our institution.


RESULTS
The mean and standard deviation of the PROCOLE prognostic index in patients with anastomotic leakage is 1.9 ± 6.13, whereas in controls, it is 3.63 ± 2.1. The predictive ability of the PROCOLE, assessed by calculating the area under the curve (AUC) of the receiver operating characteristic (ROC), results in an AUC of 0.82 with a 95% confidence interval (CI) (0.75, 0.89) of the AUC, and it can be considered a good prognostic indicator.


CONCLUSIONS
The PROCOLE prognostic index predicts the risk of a certain individual developing anastomotic leakage after colorectal cancer surgery. Specifically, the PROCOLE prognostic index establishes a discrimination value threshold of 4.83 for recommending the implementation of a protective stoma. We have developed free software with a simple interface that only requires the selection of risk factors to obtain the PROCOLE value.
Coloproctology Unit, Department of Surgery, University Hospital of Alicante, Alicante, Spain.|Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain.
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Rojas-Machado
Coloproctology Unit, Department of Surgery, University Hospital of Alicante, Alicante, Spain.|Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain.
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Romero-Simó
Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain. arroyocir@hotmail.com.|Coloproctology Unit, Department of Surgery, University Hospital of Elche, C/ Camí de l'Almazara no. 11, 03203, Elche, Spain. arroyocir@hotmail.com.
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Arroyo
Coloproctology Unit, Department of Surgery, University Hospital of Alicante, Alicante, Spain.|Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain.
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Rojas-Machado
Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain.
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López
Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain.|Coloproctology Unit, Department of Surgery, University Hospital of Elche, C/ Camí de l'Almazara no. 11, 03203, Elche, Spain.
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Calpena
D057868:Anastomotic Leak / Q000209:etiology*; D003106:Colon / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000601:surgery*; D006801:Humans; D064887:Observational Studies as Topic; D011379:Prognosis; D012007:Rectum / Q000601:surgery*; D012307:Risk Factors
Anastomotic leakage; Meta-analysis; Prognosis; Risk factors