Ozata Ibrahim H, Bozkurt Emre, Sucu Serkan, Karahan Salih N, Camci Furkan, Cetin Feyza, Ozoran Emre, Agcaoglu Orhan, Balik Emre, Bugra Dursun
Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey.
Koc University School of Medicine, Istanbul, Turkey.
Front Surg. 2023 Jul 28;10:1204785. doi: 10.3389/fsurg.2023.1204785. eCollection 2023.
Anastomotic leakage is a major complication in colorectal surgery, resulting in significant morbidity and mortality rates. Despite substantial progress in surgical technique, anastomotic leakage rates remain stable. An early diagnosis of anastomotic leaks was proven to reduce adverse outcomes and improve survival.
This study aims to find a novel scoring system for detecting anastomotic leaks using inflammatory and nutritional indicators after colorectal surgery. Our purpose was to analyze the diagnostic accuracy of leak scores in predicting postoperative complications.
The study included colorectal cancer patients who underwent curative surgery at Koc University Hospital between 2014 and 2018. Patients were categorized into two groups depending on the presence of anastomotic leaks and compared in terms of preoperative albumin levels, CRP levels in postoperative days 1 and 3, anastomotic leakage rates, length of hospital stay, and CRP quotient, which was calculated by dividing POD 3 CRP level to POD 1 CRP level. The bedside leak score is calculated by dividing the CRP quotient by the preoperative albumin level. The predictive value of bedside leak score, CRP quotient, and preoperative albumin levels in estimating anastomotic leakage was analyzed, and a cutoff value for the leak score was calculated.
A total of 184 patients were included in the study. The leak score, CRP POD 3-1 ratio, and preoperative albumin levels were found to successfully detect anastomotic leakage. The area under the curve for the leak score was calculated as 0.78. The optimal cutoff value was found to be 50.3 for the bedside leak score, which shows 90.9% sensitivity and 59.3% specificity.
The leak score may represent a valuable diagnostic tool for detecting patients at risk for anastomotic leakage after colorectal surgery and planning a better strategy to reduce morbidity and mortality rates and associated costs. However, further multicenter studies with large cohorts are necessary to confirm these results.
吻合口漏是结直肠手术中的一种主要并发症，会导致较高的发病率和死亡率。尽管手术技术取得了显著进展，但吻合口漏的发生率仍保持稳定。事实证明，早期诊断吻合口漏可减少不良后果并提高生存率。
本研究旨在找到一种使用结直肠手术后炎症和营养指标检测吻合口漏的新型评分系统。我们的目的是分析漏诊评分预测术后并发症的诊断准确性。
该研究纳入了2014年至2018年在科克大学医院接受根治性手术的结直肠癌患者。根据是否存在吻合口漏将患者分为两组，并比较术前白蛋白水平、术后第1天和第3天的CRP水平、吻合口漏发生率、住院时间以及CRP商（通过将术后第3天的CRP水平除以术后第1天的CRP水平计算得出）。床边漏诊评分通过将CRP商除以术前白蛋白水平来计算。分析了床边漏诊评分、CRP商和术前白蛋白水平在估计吻合口漏方面的预测价值，并计算了漏诊评分的临界值。
共有184例患者纳入该研究。发现漏诊评分、CRP术后第3天与第1天的比值以及术前白蛋白水平能够成功检测出吻合口漏。漏诊评分的曲线下面积计算为0.78。床边漏诊评分的最佳临界值为50.3，其灵敏度为90.9%，特异度为59.3%。
漏诊评分可能是一种有价值的诊断工具，用于检测结直肠手术后有吻合口漏风险的患者，并制定更好的策略以降低发病率、死亡率和相关成本。然而，需要进一步开展多中心大样本队列研究来证实这些结果。
