The REAL (REctal Anastomotic Leak) score for prediction of anastomotic leak after rectal cancer surgery

被引：62

作者：

Arezzo, A. ^{[1
]}

Migliore, M. ^{[1
]}

Chiaro, P. ^{[1
]}

Arolfo, S. ^{[1
]}

Filippini, C. ^{[1
]}

Di Cuonzo, D. ^{[2
]}

Cirocchi, R. ^{[3
]}

Morino, M. ^{[1
]}

Akiyoshi, Takashi ^{[4
]}

Alonso Araujo, Sergio Eduardo ^{[5
]}

Baiocchi, Gian Luca ^{[6
]}

Bergamaschi, Roberto ^{[7
]}

Bertelsen, Claus Anders ^{[8
]}

Biffi, Roberto ^{[9
,10
]}

Bonino, Marco Augusto ^{[11
]}

Contul, Riccardo Brachet ^{[12
]}

Bujko, Krzysztof ^{[13
]}

But-Hadzic, Jasna ^{[14
]}

Cats, Annemieke ^{[15
]}

Cuesta, Miguel A. ^{[16
]}

Desiderio, Jacopo ^{[17
]}

Eriksen, Morten Tandberg ^{[18
]}

Evrard, Serge ^{[19
]}

Foo, Dominic C. C. ^{[20
]}

Fukuoka, Hironori ^{[4
]}

Harling, Henrik ^{[21
]}

Hidaka, Eiji ^{[22
]}

Jani, Kalpesh ^{[23
]}

Jarry, Julien ^{[19
]}

Kim, Jin Cheon ^{[24
,25
]}

Lange, Marilyn M. ^{[26
]}

Lakkis, Zaher ^{[27
,28
]}

Law, Wai Lun ^{[20
]}

Lim, Seok-Byung ^{[24
,25
]}

Martz, Joseph E. ^{[29
]}

Kranenbarg, Elma Meershoek-Klein ^{[30
]}

Motson, Roger ^{[31
]}

Navarro Graciela, Valero ^{[32
]}

Palanivelu, Chinnasamy ^{[33
]}

Panis, Yves ^{[27
,28
]}

Parisi, Amilcare ^{[17
]}

Passera, Roberto ^{[34
]}

Peeters, Koen C. M. J. ^{[30
]}

Penninckx, Freddy ^{[35
]}

Sartori, Carlo Augusto ^{[36
]}

Shmaissany, Kassem ^{[9
,10
]}

Skrovina, Matej ^{[37
]}

van de Velde, Cornelis J. H. ^{[30
]}

van der Noort, Vincent ^{[38
]}

Veenhof, Alexander A. F. A. ^{[16
]}

机构：

[1] Univ Turin, Dept Surg Sci, Corso Dogliotti 14, I-10126 Turin, Italy

[2] Univ Turin, San Giovanni Battista Hosp, Canc Epidemiol Unit, CPO Piemonte, Turin, Italy

[3] Univ Perugia, Terni Hosp, Dept Gen Surg, Terni, Italy

[4] Japanese Fdn Canc Res, Canc Inst Hosp, Dept Gastroenterol Surg, Tokyo, Japan

[5] Santa Catarina Teaching Hosp SBIB Albert Einstein, Div Surg Oncol 5, Sao Paulo, Brazil

[6] Univ Brescia, Dept Clin & Expt Sci, Surg Clin, Brescia, Italy

[7] SUNY Stony Brook, Div Colon & Rectal Surg, Stony Brook, NY 11794 USA

[8] Hillerod Univ Hosp, Dept Surg, Copenhagen, Denmark

[9] European Inst Oncol, Dept Gen Surg, Milan, Italy

[10] Univ Milan, Milan, Italy

[11] Univ Torino, Dept Surg Sci, Turin, Italy

[12] Dept Surg, Aosta, Italy

[13] Maria Sklodowska Curie Mem Canc Ctr, Dept Radiotherapy, Warsaw, Poland

[14] Inst Oncol, Radiotherapy Dept, Ljubljana, Slovenia

[15] Antoni van Leeu Wenhoek Hosp, Netherlands Canc Inst, Dept Gastroenterol & Hepatol, Amsterdam, Netherlands

[16] Vrije Univ Amsterdam Med Ctr, Dept Surg, Amsterdam, Netherlands

[17] St Maria Hosp, Dept Digest Surg & Liver Unit, Terni, Italy

[18] Buskerud Hosp, Dept Surg, Drammen, Norway

[19] Univ Bordeaux, Inst Bergonie, Bordeaux, France

[20] Univ Hong Kong, Queen Mary Hosp, Dept Surg, Hong Kong, Peoples R China

[21] Bispebjerg Hosp, Dept Surg, Copenhagen, Denmark

[22] Showa Univ, Northern Yokohama Hosp, Digest Dis Ctr, Yokohama, Kanagawa, Japan

[23] SIGMA Surg, Ahmadabad, Gujarat, India

[24] Univ Ulsan, Coll Med, Dept Surg, Seoul, South Korea

[25] Asan Med Ctr, Seoul, South Korea

[26] Leiden Univ, Dept Surgn, Med Ctr, Leiden, Netherlands

[27] Beaujon Hosp, Dept Colorectal Surg, Clichy, France

[28] Univ Paris VII, Paris, France

[29] Beth Israel Deaconess Med Ctr, Dept Surg, New York, NY 10003 USA

[30] Leiden Univ, Med Ctr, Leiden, Netherlands

[31] Colchester Gen Hosp, ICENI Ctr, Colchester, Essex, England

[32] Univ Murcia, Virgen Arrixaca Univ Hosp, Dept Gen Surg, Murcia, Spain

[33] GEM Hosp, Coimbatore, Tamil Nadu, India

[34] Univ Torino, Div Nucl Med, BioStat & PharmD, Turin, Italy

[35] Dept Abdominal Surg, Leuven, Belgium

[36] Castelfranco Veneto Hosp, Gen Surg Dept, Castelfranco Veneto, Italy

[37] Oncol Ctr Novy Jicin, Novy Jicin, Czech Republic

[38] Netherlands Canc Inst, Biometr Dept, Amsterdam, Netherlands

[39] Trondhe Univ Hosp, Inst Canc Res & Mol Med, Trondheim, Norway

来源：

TECHNIQUES IN COLOPROCTOLOGY | 2019年 / 23卷 / 07期

关键词：

Rectal cancer; Anastomotic leak; Score; TOTAL MESORECTAL EXCISION; LOW ANTERIOR RESECTION; INCREASES DISTANT RECURRENCE; LONG-TERM MORTALITY; RISK-FACTORS; PREOPERATIVE RADIOTHERAPY; NEOADJUVANT RADIOCHEMOTHERAPY; CURATIVE RESECTION; SINGLE-CENTER; CHEMORADIOTHERAPY;

D O I：

10.1007/s10151-019-02028-4

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background Anastomotic leak after rectal cancer surgery is a severe complication associated with poorer oncologic outcome and quality of life. Preoperative assessment of the risk for anastomotic leak is a key component of surgical planning, including the opportunity to create a defunctioning stoma. Objective The purpose of this study was to identify and quantify the risk factors for anastomotic leak to minimize risk by either not restoring bowel continuity or protecting the anastomosis with a temporary diverting stoma. Methods Potentially relevant studies were identified from the following databases: PubMed, Embase and Cochrane Library. This meta-analysis included studies on transabdominal resection for rectal cancer that reported data about anastomotic leak. The risk for anastomotic leak after rectal cancer surgery was investigated. Preoperative, intraoperative, and postoperative factors were extracted and used to compare anastomotic leak rates. All variables demonstrating a p value < 0.1 in the univariate analysis were entered into a multivariate logistic regression model to determine the risk factors for anastomotic leak. Results Twenty-six centers provided individual data on 9735 patients. Selected preoperative covariates (time before surgery, age, gender, smoking, previous abdominal surgery, BMI, diabetes, ASA, hemoglobin level, TNM classification stage, anastomotic distance) were used as independent factors in a logistic regression model with anastomotic leak as dependent variable. With a threshold value of the receiver operating characteristics (ROC) curve corresponding to 0.0791 in the training set, the area under the ROC curve (AUC) was 0.585 (p < 0.0001). Sensitivity and specificity of the model's probability > 0.0791 to identify anastomotic leak were 79.1% and 32.9%, respectively. Accuracy of the threshold value was confirmed in the validation set with 77.8% sensitivity and 35.2% specificity. Conclusions We trust that, with further refinement using prospective data, this nomogram based on preoperative risk factors may assist surgeons in decision making. The score is now available online ().

引用

页码：649 / 663

页数：15

共 56 条

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