|Table of Contents|

Prediction and clinical decision-making of anastomotic leakage after anterior resection of rectal cancer

Journal Of Modern Oncology[ISSN:1672-4992/CN:61-1415/R]

Issue:
2022 06
Page:
1036-1041
Research Field:
Publishing date:

Info

Title:
Prediction and clinical decision-making of anastomotic leakage after anterior resection of rectal cancer
Author(s):
WU Xiaoyu; ZHOU Bo; CAO Xiandong
Department of General Surgery,the First Affiliated Hospital of Anhui Medical University,Anhui Hefei 230022,China.
Keywords:
rectal cancer; anastomotic leakage; nomogram; defunctioning stoma; decision curve analysis
PACS:
R735.3+7
DOI:
10.3969/j.issn.1672-4992.2022.06.017
Abstract:
Objective:To explore the independent risk factors for anastomotic leakage after anterior resection of rectal cancer and establish an anastomotic leakage risk prediction model.Then,using decision curve analysis to compare it with traditional empirical models,find the optimal model to guide the intraoperative decision on defunctioning stoma,minimize unnecessary defunctioning stoma.Methods:The clinical data of 404 patients undergoing anterior resection of rectal cancer in our hospital from October 2017 to December 2019 were retrospectively collected.Firstly,we screened the effective variables by χ2 test and Lasso analysis,picked independent influence factors by Logistic regression analysis,then used R (4.0.5) to establish a predictive model and draw a nomogram.After that,we established decision models based respectively on diabetes,preoperative radiotherapy and chemotherapy,hemoglobin,albumin,the distance between the tumor and the anal margin,and the prediction model of this study.Finally,a decision curve was drawn through R (4.0.5).Those models on the level of net benefit in different threshold ranges were compared.Results:Male (OR=4.490,95%CI:1.491~13.518),blood transfusion (OR=5.822,95%CI:1.939~17.475) and the distance between the tumor and the anal margin ≤7 cm (OR=2.385,95%CI:1.086~5.237) were independent risk factors for anastomotic leakage,and preoperative mechanical bowel preparation was an independent protective factor (OR=0.360,95%CI:0.165~0.785).The concordance index of the prediction model was 0.735.The area under the receiver operating characteristic curve was 0.755 (95%CI：0.669~0.841).Our model was optimal within the threshold range of 0.05~1.00,and the net benefit rate was 1%~6%.Conclusion:Male,blood transfusion,the distance between the tumor and the anal margin ≤7 cm,and mechanical bowel preparation are independent risk factors for anastomotic leakage after anterior resection of rectal cancer.Our prediction model is well discriminated and accurate,and is superior to other traditional empirical models in terms of guiding the intraoperative decision on defunctioning stoma within the threshold range of 0.1~0.2,can also achieve the highest clinical benefit.That is to say,using our predictive model to guide intraoperative stoma decision-making is reasonable.

References:

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Memo

Memo:
National Natural Science Foundation of China(No.81801952）；国家自然科学基金资助项目（编号：81801952）
Last Update: 1900-01-01