title: Anastomic leak in colorectal cancer surgery. Development of a diagnostic index (DIACOLE).
abstract: BACKGROUND
  We have obtained a diagnostic score (DIACOLE) in order to detect anastomotic leakage in the postoperative period of colorectal cancer surgery.
  
  
  METHODS
  Systematic review to identify any symptoms and clinical or analytical signs associated with anastomotic leakage after colorectal cancer surgery and a meta-analysis of each of these factors. The DIACOLE score encompasses all factors that reached statistical significance in their respective meta-analyses. The value of each factor in the score was determined depending the Napierian logarithm of the odds ratios. The index was validated using collected data at our institution.
  
  
  RESULTS
  We identified 13 potential signs and symptoms of anastomotic leakage to elaborate the DIACOLE score. The predictive power of the DIACOLE was validated in a case-control study, resulting in an Area Under Curve (AUC) of 0.911 and a 95% confidence interval. These values were considered indicative of a very good diagnostic score.
  
  
  CONCLUSIONS
  If DIACOLE score is > 3.065, a blood count and re-evaluating the score daily are recommended. If the DIACOLE>5.436, a radiological test is advised. We have developed free software to obtain DIACOLE value.
authors.affiliation: Coloproctology Unit, Department of Surgery, University Hospital of Alicante, Spain.
authors.forename: Silvia-Angélica
authors.initials: SA
authors.lastname: Rojas-Machado
authors.affiliation: Coloproctology Unit, Department of Surgery, University Hospital of Alicante, Spain; Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Romero
authors.affiliation: Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain. Electronic address: arroyocir@hotmail.com.
authors.forename: Antonio
authors.initials: A
authors.lastname: Arroyo
authors.affiliation: Coloproctology Unit, Department of Surgery, University Hospital of Alicante, Spain.
authors.forename: Adaly
authors.initials: A
authors.lastname: Rojas-Machado
authors.affiliation: Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain.
authors.forename: Jerónimo
authors.initials: J
authors.lastname: López
authors.affiliation: Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Calpena
mesh_terms: D057868:Anastomotic Leak / Q000097:blood / Q000175:diagnosis*; D019540:Area Under Curve; D016022:Case-Control Studies; D003082:Colectomy / Q000009:adverse effects*; D015179:Colorectal Neoplasms / Q000097:blood / Q000601:surgery*; D006305:Health Status Indicators; D006801:Humans; D016017:Odds Ratio; D011184:Postoperative Period; D011237:Predictive Value of Tests; D012189:Retrospective Studies
keywords: Anastomotic leakage; Colorectal cancer; Diagnostic score; Meta-analysis