Risk of anastomotic leak after colon resection for cancer
Anastomotic leak is still the most dreaded complication in colorectal surgery. This prediction tool calculates the risk of anastomotic leak after colon resection for cancer based on data derived from multicentric prospective studies.
Research authors: Frasson M, Flor-Lorente B, Rodríguez JL, Granero-Castro P, Hervás D, Alvarez Rico MA, Brao MJ, Sánchez González JM, Garcia-Granero E.
Details Formula Study characteristics Files & References
Model author
Model ID
129
Version
1.10
Revision date
2017-11-21
MeSH terms
  • Anastomosis, Surgical
  • Risk Factors
  • Colorectal Cancer
  • Nomograms
  • Anastomotic Leakage
  • Model type
    Logistic regression (Calculation)
    Status
    public
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    Formula
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    Condition Formula

    Additional information

    The study included patients with colon cancer (with its distal edge located at more than 15 cm from the anal verge, measured by rigid proctoscopy) treated with elective or emergent surgery, with local curative intention, in whom primary anastomosis with no protective stoma was performed. Patients were included consecutively over 1 year (September 2011- September 2012). The exclusion criteria were as follows: patients younger than 18 years, R2 cancer resection, and inclusion in other randomized clinical trials. Patients with missing information were also excluded from the data analysis.

    Study Population

    Total population size: 3193
    Males: {{ model.numberOfMales }}
    Females: {{ model.numberOfFemales }}

    Continuous characteristics

    Name LL Q1 Median Q3 UL Unit
    Age 63 (IQR) 72 79 (IQR) years
    Number of lymph nodes excised 11 (IQR) 15 22 (IQR) lymph nodes

    Categorical characteristics

    Name Subset / Group Nr. of patients
    ASA score ASA I 179
    ASA II 1608
    ASA III 1246
    ASA IV 160
    Previous abdominal surgery Yes 841
    No 2352
    Obesity (Body mass index > 30 kg/m2) Yes 128
    No 3065
    Tumor localization Right colon 1053
    Hepatic flexure 287
    Transverse colon 234
    Splenic flexure 178
    Left colon 262
    Sigma 1179
    Type of surgery Urgent 225
    Elective 2968
    Type of surgeon Colorectal surgeon 1750
    General surgeon 941
    Resident tutorized by colorectal surgeon 341
    Resident tutorized by general surgeon 161
    Type of resection Right colectomy 1200
    Extended right colectomy 290
    Segmental resection of transverse colon 39
    Left colectomy 370
    Simoidectomy 1141
    Subtotal colectomy 57
    Total colectomy 96
    Surgical approach Open approach 1872
    Laparoscopy 1138
    Laparoscopy converted 183
    Anastomosis technique Manual 689
    Mechanic 2504
    Abdominal drain Yes 2079
    No 1114
    Perioperative transfusion Yes 539
    No 2654
    TNM stage 0 172
    I 654
    II 1033
    III 995
    IV 339
    Pathological oncological radicality R0 3130
    R1 63

    Calculated risk of anastomotic leak is:
    ...

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    Result
    Note
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    Calculated risk of anastomotic leak is:

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    Outcome stratification

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    Conditional information

    Result interpretation

    In the underlying multicenter study, the anastomotic leak rate was 8.7%, and widely varied between hospitals. Anastomotic leak significantly increased mortality (15.2% vs 1.9% in patients without anastomotic leak, P <0.0001) and length of hospitalization (median 23 vs 7 days in uncomplicated patients, P < 0.0001).

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    Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.

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