Bülent Cavit YÜKSEL, Sadettin ER, Barış Doğu YILDIZ, Faruk KOCA, Mesut TEZ, Sabri ÖZDEN

External validation of anastomotic leakage risk analysis system in patients who underwent colorectal resection

Background/aim: One of the most feared complications after colon resection for carcinoma is anastomotic leakage. Prediction of anastomoticleakage can alter pre- and perioperative management of patients. This study validates an anastomotic leakage prediction system.Materials and methods: Ninety-five patients who underwent colonic resection between 1 January 2016 and 30 January 2017 were includedin the study. Patient records and electronic charting system data were used to calculate anastomotic leakage risk on the http://www.anastomoticleak.com/ website.Results: Fifty-six (58.9%) patients were male and thirty-nine (41.1%) were female. The mean age was 61.7 (min: 33, max: 90). Six (6.3%)patients had anastomotic leakage. According to the ROC analysis, the area under curve for the prediction system was 0.767.Conclusion: The prediction system for anastomotic leakage produced significant results for our patient population. It can be effectivelyutilized in preoperative and perioperative measures to prevent anastomotic leakage.

PDF

___

1. Golub R, Golub RW, Cantu R, Jr., Stein HD. A multivariate analysis of factors contributing to leakage of intestinal anastomoses. J Am Coll Surg 1997; 184: 364-372.
2. Matthiessen P, Hallbook O, Andersson M, Rutegard J, Sjodahl R. Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis 2004; 6: 462-469.
3. Nachiappan S, Faiz O. Anastomotic leak increases distant recurrence and long-term mortality after curative resection for colonic cancer. Ann Surg 2015; 262: e111.
4. Karliczek A, Harlaar NJ, Zeebregts CJ, Wiggers T, Baas PC, van Dam GM. Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery. Int J Colorectal Dis 2009; 24: 569-576.
5. Soeters PB, de Zoete JP, Dejong CH, Williams NS, Baeten CG. Colorectal surgery and anastomotic leakage. Dig Surg 2002; 19: 150-155.
6. Frasson M, Flor-Lorente B, Rodriguez JL, Granero-Castro P, Hervas D, Alvarez Rico MA, Brao MJ, Sanchez Gonzalez JM, Garcia-Granero E; ANACO Study Group. Risk factors for anastomotic leak after colon resection for cancer: multivariate analysis and nomogram from a multicentric, prospective, national study with 3193 patients. Ann Surg 2015; 262: 321-330.
7. Rose J, Schneider C, Yildirim C, Geers P, Scheidbach H, Kockerling F. Complications in laparoscopic colorectal surgery: results of a multicentre trial. Tech Coloproctol 2004; 8 (Suppl. 1): s25-28.
8. Sevim Y, Celik SU, Yavarifar H, Akyol C. Minimally invasive management of anastomotic leaks in colorectal surgery. World J Gastrointest Surg 2016; 8: 621-626.
9. Fouda E, El Nakeeb A, Magdy A, Hammad EA, Othman G, Farid M. Early detection of anastomotic leakage after elective low anterior resection. J Gastrointest Surg 2011; 15: 137-144.
10. Bokey EL, Chapuis PH, Fung C, Hughes WJ, Koorey SG, Brewer D, Newland RC. Postoperative morbidity and mortality following resection of the colon and rectum for cancer. Dis Colon Rectum 1995; 38: 480-487.
11. Alves A, Panis Y, Trancart D, Regimbeau JM, Pocard M, Valleur P. Factors associated with clinically significant anastomotic leakage after large bowel resection: multivariate analysis of 707 patients. World J Surg 2002; 26: 499-502.
12. Hyman N, Manchester TL, Osler T, Burns B, Cataldo PA. Anastomotic leaks after intestinal anastomosis: it’s later than you think. Annals of Surgery 2007; 245: 254.
13. Khan AA, Wheeler JM, Cunningham C, George B, Kettlewell M, Mortensen NJ. The management and outcome of anastomotic leaks in colorectal surgery. Colorectal Dis 2008; 10: 587-592.
14. Alves A, Panis Y, Pocard M, Regimbeau JM, Valleur P. Management of anastomotic leakage after nondiverted large bowel resection. J Am Coll Surg 1999; 189: 554-559.
15. Makela JT, Kiviniemi H, Laitinen S. Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis. Dis Colon Rectum 2003; 46: 653-660.
16. Lipska MA, Bissett IP, Parry BR, Merrie AE. Anastomotic leakage after lower gastrointestinal anastomosis: men are at a higher risk. ANZ Journal of Surgery 2006; 76: 579-585.
17. Volk A, Kersting S, Held HC, Saeger HD. Risk factors for morbidity and mortality after single-layer continuous suture for ileocolonic anastomosis. Int J Colorectal Dis 2011; 26: 321-327.
18. Senagore AJ, Delaney CP, Madboulay K, Brady KM, Fazio VW. Laparoscopic colectomy in obese and nonobese patients. J Gastrointest Surg 2003; 7: 558-561.
19. Watanabe J, Tatsumi K, Ota M, Suwa Y, Suzuki S, Watanabe A, Ishibe A, Watanabe K, Akiyama H, Ichikawa Y et al. The impact of visceral obesity on surgical outcomes of laparoscopic surgery for colon cancer. Int J Colorectal Dis 2014; 29: 343-351.
20. Dekker JWT, Liefers GJ, van Otterloo JCdM, Putter H, Tollenaar RA. Predicting the risk of anastomotic leakage in leftsided colorectal surgery using a colon leakage score. Journal of Surgical Research 2011; 166: e27-e34.
21. den Dulk M, Noter SL, Hendriks ER, Brouwers MA, van der Vlies CH, Oostenbroek RJ, Menon AG, Steup WH, van de Velde CJ. Improved diagnosis and treatment of anastomotic leakage after colorectal surgery. Eur J Surg Oncol 2009; 35: 420-426.
22. den Dulk M, Witvliet MJ, Kortram K, Neijenhuis PA, de Hingh IH, Engel AF, van de Velde CJ, de Brauw LM, Putter H, Brouwers MA et al. The DULK (Dutch leakage) and modified DULK score compared: actively seek the leak. Colorectal Dis 2013; 15: e528-533.