Mamlin Meiram, Khamzina Saule, Zhanmukanbetova Gulden, Mukazhanov Nurlan, Amangeldiyeva Aidana, Kozhakhmetov Arman
Department of Multidisciplinary Surgery, National Research Oncology Center, Astana, Kazakhstan.
Mathematics in Data Science, Technical University of Munich, Munich, Bavaria, Germany.
Front Surg. 2025 Jun 4;12:1538023. doi: 10.3389/fsurg.2025.1538023. eCollection 2025.
Colorectal cancer is the third most common malignancy globally and in Kazakhstan, with anastomotic leakage (AL) being a severe complication of colorectal surgeries. Early detection of AL is critical for improving patient outcomes and reducing mortality, as the condition is also characterized by a deterioration in quality of life. The "Colorectal Leakage App," based on the Dutch Leakage Score (DLS), offers a standardized approach for postoperative monitoring and early AL detection.
In this single-center pilot study conducted at the National Research Oncology Center in Kazakhstan, sixty-three patients who underwent colorectal surgery were monitored daily during the postoperative period using the "Colorectal Leakage App" mobile application. Patients with anastomosis were included. The app integrates clinical signs and laboratory data to recommend further diagnostic steps, such as CT with rectal contrast. The primary endpoint was to determine the feasibility of using the "Colorectal Leakage App" in standardized postoperative care. The frequency of AL was also measured as an additional outcome.
Of 63 patients enrolled, AL was observed in 3.2% (2/63) of cases. In one case, the app flagged a score of 9 on postoperative day (POD) 7, prompting timely CT and intervention. Another case was identified via drainage findings on POD 5. A third flagged case (score 10, POD 10) revealed a gallbladder abscess rather than AL, highlighting the app's potential for broader complication monitoring.
The "Colorectal Leakage App," based on the Dutch Leakage Score, was integrated as a standardized postoperative care protocol. Given the small sample size and insufficient number of AL cases, statistical analysis is currently not feasible. However, initial results suggest that the application may have a role in enhancing postoperative surveillance.
The implementation of the "Colorectal Leakage App" may facilitate the early detection of AL. In this single-center pilot study, the AL rate was 3.2% (2 out of 63 patients). We plan to continue our study and conduct a multicenter study to further evaluate the app's effectiveness across different healthcare settings in Kazakhstan, aiming to standardize postoperative care.
结直肠癌是全球及哈萨克斯坦第三大常见恶性肿瘤，吻合口漏（AL）是结直肠手术的严重并发症。早期发现AL对于改善患者预后和降低死亡率至关重要，因为该病症还会导致生活质量下降。基于荷兰漏诊评分（DLS）的“结直肠漏诊应用程序”为术后监测和早期AL检测提供了标准化方法。
在哈萨克斯坦国家肿瘤研究中心进行的这项单中心试点研究中，使用“结直肠漏诊应用程序”移动应用程序在术后期间对63例行结直肠手术的患者进行每日监测。纳入了有吻合口的患者。该应用程序整合了临床体征和实验室数据，以推荐进一步的诊断步骤，如直肠造影CT。主要终点是确定在标准化术后护理中使用“结直肠漏诊应用程序”的可行性。AL的发生率也作为一项额外结果进行了测量。
在63名入组患者中，3.2%（2/63）的病例观察到AL。其中1例在术后第7天应用程序标记评分为9，促使及时进行CT检查和干预。另一例通过术后第5天的引流结果得以确诊。第三例标记病例（评分10，术后第10天）显示为胆囊脓肿而非AL，突出了该应用程序在更广泛并发症监测方面的潜力。
基于荷兰漏诊评分的“结直肠漏诊应用程序”被整合为标准化术后护理方案。鉴于样本量小且AL病例数量不足，目前无法进行统计分析。然而，初步结果表明该应用程序可能在加强术后监测方面发挥作用。
“结直肠漏诊应用程序”的实施可能有助于早期发现AL。在这项单中心试点研究中，AL发生率为3.2%（63例患者中有2例）。我们计划继续开展研究并进行多中心研究，以进一步评估该应用程序在哈萨克斯坦不同医疗环境中的有效性，旨在使术后护理标准化。
