Abstract
Purpose
Anastomotic leakage after low anterior resection for rectal cancer is a critical problem. Many risk factors have been suggested and surgical techniques have improved, but anastomotic leakage remains a major postoperative challenge. This study sought to create a nomogram for precise prediction of anastomotic leakage after low anterior resection for rectal cancer.
Methods
We used data of 936 patients that had been prospectively collected by the Japanese Society for Colon and Rectal Cancer between June 2010 and February 2013. Risk factors for anastomotic leakage were identified by multivariate logistic regression analysis and used to create a nomogram. The performance of the nomogram was evaluated by using a bootstrapped-concordance index and calibration plots.
Results
Sex, preoperative serum albumin, tumor location and diameter, and simultaneous resection of other organs were identified as significantly associated factors that could be combined for accurate prediction of anastomotic leakage. We created a nomogram for anastomotic leakage by using these risk factors. The area under the curve was 0.72 (95% confidence interval 0.67–0.76). The nomogram had a bootstrapped-concordance index of 0.72 and was well calibrated.
Conclusions
Our nomogram was a useful tool for precise prediction of anastomotic leakage after low anterior resection for rectal cancer.
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Acknowledgements
The following is a list of participating surgeons and centers: K. Komori (Aichi Cancer Center Hospital, Aichi), J. Okuda (Osaka Medical College Hospital, Osaka), K. Otsuka (Iwate Medical University School of Medicine, Iwate), A. Kanazawa (Japanese Red Cross Osaka Hospital, Osaka), M. Ueno (Cancer Institute Hospital, Tokyo), T. Masaki (Kyorin University Hospital, Tokyo), E. Otsuji (Kyoto Prefectural University of Medicine, Kyoto), T. Kusumi (Keiyukai Sapporo Hospital, Hokkaido), K. Minami (National Hospital Organization Kyusyu Cancer Center, Fukuoka), T. Kobatake (National Hospital Organization Shikoku Cancer Center, Ehime), Y. Nishimura (Saitama Cancer Center, Saitama), K. Sakamoto (Juntendo University Hospital, Tokyo), K. Sugihara (Tokyo Medical and Dental University, Tokyo), S. Kameoka (Tokyo Women’s Medical University Hospital, Tokyo), Y. Saida (Toho University Ohashi Medical Center, Tokyo), N. Tomita (Hyogo College of Medicine, Hyogo), M. Yoshimitsu (Hiroshima City Asa Hospital, Hiroshima), K. Hase (National Defence Medical College Hospital, Saitama), M. Hamada (Kochi Health Sciences Center, Kochi), M. Ito (National Cancer Center Hospital East, Chiba), K. Maeda (Fujita Health University School of Medicine, Aichi), Y. Kinugasa (Shizuoka Cancer Center Hospital, Shizuoka), M. Ota (Yokohama City University Medical Center, Kanagawa), M. Shiozawa (Kanagawa Cancer Center, Kanagawa), H. Horie (School of Medicine, Jichi Medical University, Tochigi), H. Yamaue (Wakayama Medical University, School of Medicine, Wakayama), H. Ike (Saiseikai Yokohamashi Nanbu Hospital, Kanagawa), N. Takiguchi (Chiba Cancer Center, Chiba), H. Yamagami (Sapporo-Kosei General Hospital, Hokkaido), S. Nishikawa (Aomori Prefectural Central Hospital, Aomori), Y. Akagi (Kurume University School of Medicine, Fukuoka), M. Ohue (Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka), and M. Watanabe (Kitasato University School of Medicine, Kanagawa).
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This study was approved by the Ethics Committee of JSCCR and by the institutional review board of each participating hospital. Informed consent was obtained from all patients.
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Table S1
(DOCX 40 kb)
Fig. S1
Nomogram for grades B and C anastomotic leakage after low anterior resection for rectal cancer. To estimate the probability of grades B and C anastomotic leakage, mark patient values on each axis, draw a straight line perpendicular to the point axis, and sum the points of all variables. Next, mark the sum on the total point axis and draw a straight line perpendicular to the probability axis. NR, no residual tumor (GIF 58 kb)
Fig. S2
Receiver operating characteristic curve for the prediction model of grades B and C anastomotic leakage. Area under the curve was 0.71 (95% confidence interval 0.67–0.76) (GIF 21 kb)
Fig. S3
Calibration of the nomogram for grades B and C anastomotic leakage. The x-axis shows the predicted probability of grades B and C anastomotic leakage, and the y-axis shows the observed probability of grades B and C anastomotic leakage. (GIF 35 kb)
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Hoshino, N., Hida, K., Sakai, Y. et al. Nomogram for predicting anastomotic leakage after low anterior resection for rectal cancer. Int J Colorectal Dis 33, 411–418 (2018). https://doi.org/10.1007/s00384-018-2970-5
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DOI: https://doi.org/10.1007/s00384-018-2970-5