Hoek V T, Buettner S, Sparreboom C L, Detering R, Menon A G, Kleinrensink G J, Wouters M W J M, Lange J F, Wiggers J K
Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands.
Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands.
Eur J Surg Oncol. 2022 Dec;48(12):2495-2501. doi: 10.1016/j.ejso.2022.06.016. Epub 2022 Jun 22.
This study aims to develop a robust preoperative prediction model for anastomotic leakage (AL) after surgical resection for rectal cancer, based on established risk factors and with the power of a large prospective nation-wide population-based study cohort.
A development cohort was formed by using the DCRA (Dutch ColoRectal Audit), a mandatory population-based repository of all patients who undergo colorectal cancer resection in the Netherlands. Patients aged 18 years or older were included who underwent surgical resection for rectal cancer with primary anastomosis (with or without deviating ileostomy) between 2011 and 2019. Anastomotic leakage was defined as clinically relevant leakage requiring reintervention. Multivariable logistic regression was used to build a prediction model and cross-validation was used to validate the model.
A total of 13.175 patients were included for analysis. AL was diagnosed in 1319 patients (10%). A deviating stoma was constructed in 6853 patients (52%). The following variables were identified as significant risk factors and included in the prediction model: gender, age, BMI, ASA classification, neo-adjuvant (chemo)radiotherapy, cT stage, distance of the tumor from anal verge, and deviating ileostomy. The model had a concordance-index of 0.664, which remained 0.658 after cross-validation. In addition, a nomogram was developed.
The present study generated a discriminative prediction model based on preoperatively available variables. The proposed score can be used for patient counselling and risk-stratification before undergoing rectal resection for cancer.
本研究旨在基于既定的风险因素，并借助一项大规模前瞻性全国性人群队列研究的力量，开发一种用于直肠癌手术切除术后吻合口漏（AL）的可靠术前预测模型。
利用荷兰结直肠癌审计（DCRA）组建了一个开发队列，DCRA是荷兰所有接受结直肠癌切除患者的强制性基于人群的资料库。纳入年龄在18岁及以上、在2011年至2019年间接受直肠癌手术切除并进行一期吻合（有或无临时性回肠造口术）的患者。吻合口漏被定义为需要再次干预的具有临床意义的漏。采用多变量逻辑回归构建预测模型，并使用交叉验证对模型进行验证。
共纳入13175例患者进行分析。1319例患者（10%）被诊断为吻合口漏。6853例患者（52%）进行了临时性造口。以下变量被确定为显著风险因素并纳入预测模型：性别、年龄、体重指数、美国麻醉医师协会（ASA）分级、新辅助（化疗）放疗、cT分期、肿瘤距肛缘距离以及临时性回肠造口术。该模型的一致性指数为0.664，交叉验证后仍为0.658。此外，还制定了一个列线图。
本研究基于术前可用变量生成了一个具有鉴别力的预测模型。所提出的评分可用于患者咨询以及在接受直肠癌切除术前进行风险分层。
