Clinical Value of Colon Leakage Score System in Predicting Anastomotic Leakage after Left-Sided Colorectal Cancer Surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LILiang , YANGRen-bao , JIANGMing , ZHANGJun

Department of General Surgery, Hefei Second People's Hospital, Hefei 230001, Anhui Province, China;

Corresponding author：

LILiang, Email: 574884399@qq.com

Keywords：

Colorectal cancer surgery; Anastomotic leakage; Colon leakage score system; Prediction value

DOI：

10.7507/1007-9424.20160350

Video：

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Objective To evaluate clinical value of colon leakage score (CLS), a preoperative predictive scoring system, for risk of anastomotic leakage after left-sided colorectal cancer surgery. Methods The clinical data of 310 patients who underwent left-sided colorectal cancer surgery from January 2010 to December 2014 were studied retrospectively. Risk factors for postoperative anastomotic leakage were analyzed by univariate analysis. The sensitivity and specificity of CLS system were determined by receiver operating characteristic (ROC) curve analysis. Results a total of 14 patients were diagnosed as anastomotic leakage. The point of CLS for the patients with anastomotic leakage was significantly higher than that for the patients without anastomotic leakage (14.21±5.76 versus 4.43±3.36, t=9.474, P=0.000). The results of ROC curve analysis showed that the sensitivity and specificity of the CLS system were 92.9% and 88.6%, respectively. The area under the curve was 0.957 (95% CI 0.924-0.991). The best cut off value of CLS was 10 (The Youden index was 0.867). The results of univariate analysis showed that the age, preoperative hemoglobin level, status of intestinal obstruction, and blood loss were associated with postoperative anastomotic leakage (P<0.05). Conclusion The preoperative predictive score system CLS could accurately predict occurrence of anastomotic leakage. While large, multicenter prospective randomized controlled trial is still needed to further confirm it.

Citation： LILiang, YANGRen-bao, JIANGMing, ZHANGJun. Clinical Value of Colon Leakage Score System in Predicting Anastomotic Leakage after Left-Sided Colorectal Cancer Surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(11): 1370-1374. doi: 10.7507/1007-9424.20160350 Copy

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2.	刘宝善, 徐琳, 燕锦, 等. 直肠癌超低位前切除术508例临床分析. 中华外科杂志, 2008, 46(22):1712-1715.
3.	Kingham TP, Pachter HL. Colonic anastomotic leak:risk factors, diagnosis, and treatment. J Am Coll Surg, 2009, 208(2):269-278.
4.	孔杰, 甘从存, 徐士杰, 等. 中低位直肠癌全直肠系膜切除术后吻合口瘘的危险因素分析. 中国普外基础与临床杂志, 2016, 23(2):210-213.
5.	Dekker JW, Liefers GJ, de Mol van Otterloo JC, et al. Predicting the risk of anastomotic leakage in left-sided colorectal surgery using a colon leakage score. J Surg Res, 2011, 166(1):e27-e34.
6.	Daams F, Wu Z, Lahaye MJ, et al. Prediction and diagnosis of colorec-tal anastomotic leakage:A systematic review of literature. World J Gastrointest Surg, 2014, 6(2):14-26.
7.	Girard E, Messager M, Sauvanet A, et al. Anastomotic leakage after gastrointestinal surgery:diagnosis and management. J Visc Surg, 2014, 151(6):441-450.
8.	Liu Y, Wan X, Wang G, et al. A scoring system to predict the risk of anastomotic leakage after anterior resection for rectal cancer. J Surg Oncol, 2014, 109(2):122-125.
9.	Pommergaard HC, Gessler B, Burcharth J, et al. Preoperative risk factors for anastomotic leakage after resection for colorectal cancer:a systematic review and meta-analysis. Colorectal Dis, 2014, 16(9):662-671.
10.	王新, 周建平, 张丹华, 等. 直肠癌术后发生吻合口瘘危险因素分析(附506 例报告). 中国实用外科杂志, 2014, 34(9):876-879.
11.	Boccola MA, Buettner PG, Rozen WM. Risk factors and outcomes for anastomotic leakage in colorectal surgery:a single-institution analysis of 1 576 patients. World J Surg, 2011, 35(1):186-195.
12.	李思源, 赵鹏, 李洪波, 等. 结直肠癌术后吻合口瘘的危险因素分析. 中国现代普通外科进展, 2015, 18(2):163-164.
13.	Rutegård M, Rutegård J. Anastomotic leakage in rectal cancer surgery:The role of blood perfusion. World J Gastrointest Surg, 2015, 7(11):289-292.
14.	Konishi T, Watanabe T, Kishimoto J, et al. Risk factors for anasto-motic leakage after surgery for colorectal cancer:results of prospec-tive surveillance. J Am Coll Surg, 2006, 202(3):439-444.
15.	Lyall A, Mc Adam TK, Townend J, et al. Factors affecting anastomotic complications following anterior resection in rectal cancer. Colorectal Dis, 2007, 9(9):801-807.
16.	Yang L, Huang XE, Zhou JN, et al. Risk assessment on anastomotic leakage after rectal cancer surgery:an analysis of 753 patients. Asian Pac J Cancer Prev, 2013, 14(7):4447-4453.
17.	Gong JP, Yang L, Huang XE, et al. Outcomes based on risk assess-ment of anastomotic leakage after rectal cancer surgery. Asian Pac J Cancer Prev, 2014, 15(2):707-712.
18.	Kawada K, Hasegawa S, Hida K, et al. Risk factors for anastomotic leakage after laparoscopic low anterior resection with DST anastomosis. Surg Endosc, 2014, 28(10):2988-2995.
19.	Katsuno H, Shiomi A, Ito M, et al. Comparison of symptomatic anastomotic leakage following laparoscopic and open low anterior resection for rectal cancer:a propensity score matching analysis of 1 014 consecutive patients. Surg Endosc, 2016, 30(7):2848-2856.
20.	徐建, 李钊, 李浩, 等. 腹腔镜直肠癌前切除术吻合口瘘危险因素分析. 临床外科杂志, 2015, 23(4):266-268.
21.	赵文韬, 胡丰良, 李玉英, 等. 直肠癌前切除术后吻合口瘘的危险因素分析. 中国普通外科杂志, 2012, 21(6):746-748.
22.	Rullier E, Laurent C, Garrelon JL, et al. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg, 1998, 85(3):355-358.
23.	Yamano T, Yoshimura M, Kobayashi M, et al. Malnutrition in rectal cancer patients receiving preoperative chemoradiotherapy is common and associated with treatment tolerability and anastomotic leakage. Int J Colorectal Dis, 2016, 31(4):877-884.
24.	Wang L, Li ZY, Li ZW, et al. Efficacy and safety of neoadjuvant intensity-modulated radiotherapy with concurrent capecitabine for locally advanced rectal cancer. Dis Colon Rectum, 2015, 58(2):186-192.
25.	Hu MH, Huang RK, Zhao RS, et al. Does neoadjuvant therapy increase the incidence of anastomotic leakage after anterior resec-tion for mid and low rectal cancer? A systematic review and meta-analysis. Colorectal Dis, 2016 Jun 20[Epub ahead of print].

1. Bertelsen CA, Andreasen AH, Jørgensen T, et al. Anastomotic leakage after curative anterior resection for rectal cancer:short and long-term outcome. Colorectal Dis, 2010, 12(7 Online):e76-e81.
2. 刘宝善, 徐琳, 燕锦, 等. 直肠癌超低位前切除术508例临床分析. 中华外科杂志, 2008, 46(22):1712-1715.
3. Kingham TP, Pachter HL. Colonic anastomotic leak:risk factors, diagnosis, and treatment. J Am Coll Surg, 2009, 208(2):269-278.
4. 孔杰, 甘从存, 徐士杰, 等. 中低位直肠癌全直肠系膜切除术后吻合口瘘的危险因素分析. 中国普外基础与临床杂志, 2016, 23(2):210-213.
5. Dekker JW, Liefers GJ, de Mol van Otterloo JC, et al. Predicting the risk of anastomotic leakage in left-sided colorectal surgery using a colon leakage score. J Surg Res, 2011, 166(1):e27-e34.
6. Daams F, Wu Z, Lahaye MJ, et al. Prediction and diagnosis of colorec-tal anastomotic leakage:A systematic review of literature. World J Gastrointest Surg, 2014, 6(2):14-26.
7. Girard E, Messager M, Sauvanet A, et al. Anastomotic leakage after gastrointestinal surgery:diagnosis and management. J Visc Surg, 2014, 151(6):441-450.
8. Liu Y, Wan X, Wang G, et al. A scoring system to predict the risk of anastomotic leakage after anterior resection for rectal cancer. J Surg Oncol, 2014, 109(2):122-125.
9. Pommergaard HC, Gessler B, Burcharth J, et al. Preoperative risk factors for anastomotic leakage after resection for colorectal cancer:a systematic review and meta-analysis. Colorectal Dis, 2014, 16(9):662-671.
10. 王新, 周建平, 张丹华, 等. 直肠癌术后发生吻合口瘘危险因素分析(附506 例报告). 中国实用外科杂志, 2014, 34(9):876-879.
11. Boccola MA, Buettner PG, Rozen WM. Risk factors and outcomes for anastomotic leakage in colorectal surgery:a single-institution analysis of 1 576 patients. World J Surg, 2011, 35(1):186-195.
12. 李思源, 赵鹏, 李洪波, 等. 结直肠癌术后吻合口瘘的危险因素分析. 中国现代普通外科进展, 2015, 18(2):163-164.
13. Rutegård M, Rutegård J. Anastomotic leakage in rectal cancer surgery:The role of blood perfusion. World J Gastrointest Surg, 2015, 7(11):289-292.
14. Konishi T, Watanabe T, Kishimoto J, et al. Risk factors for anasto-motic leakage after surgery for colorectal cancer:results of prospec-tive surveillance. J Am Coll Surg, 2006, 202(3):439-444.
15. Lyall A, Mc Adam TK, Townend J, et al. Factors affecting anastomotic complications following anterior resection in rectal cancer. Colorectal Dis, 2007, 9(9):801-807.
16. Yang L, Huang XE, Zhou JN, et al. Risk assessment on anastomotic leakage after rectal cancer surgery:an analysis of 753 patients. Asian Pac J Cancer Prev, 2013, 14(7):4447-4453.
17. Gong JP, Yang L, Huang XE, et al. Outcomes based on risk assess-ment of anastomotic leakage after rectal cancer surgery. Asian Pac J Cancer Prev, 2014, 15(2):707-712.
18. Kawada K, Hasegawa S, Hida K, et al. Risk factors for anastomotic leakage after laparoscopic low anterior resection with DST anastomosis. Surg Endosc, 2014, 28(10):2988-2995.
19. Katsuno H, Shiomi A, Ito M, et al. Comparison of symptomatic anastomotic leakage following laparoscopic and open low anterior resection for rectal cancer:a propensity score matching analysis of 1 014 consecutive patients. Surg Endosc, 2016, 30(7):2848-2856.
20. 徐建, 李钊, 李浩, 等. 腹腔镜直肠癌前切除术吻合口瘘危险因素分析. 临床外科杂志, 2015, 23(4):266-268.
21. 赵文韬, 胡丰良, 李玉英, 等. 直肠癌前切除术后吻合口瘘的危险因素分析. 中国普通外科杂志, 2012, 21(6):746-748.
22. Rullier E, Laurent C, Garrelon JL, et al. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg, 1998, 85(3):355-358.
23. Yamano T, Yoshimura M, Kobayashi M, et al. Malnutrition in rectal cancer patients receiving preoperative chemoradiotherapy is common and associated with treatment tolerability and anastomotic leakage. Int J Colorectal Dis, 2016, 31(4):877-884.
24. Wang L, Li ZY, Li ZW, et al. Efficacy and safety of neoadjuvant intensity-modulated radiotherapy with concurrent capecitabine for locally advanced rectal cancer. Dis Colon Rectum, 2015, 58(2):186-192.
25. Hu MH, Huang RK, Zhao RS, et al. Does neoadjuvant therapy increase the incidence of anastomotic leakage after anterior resec-tion for mid and low rectal cancer? A systematic review and meta-analysis. Colorectal Dis, 2016 Jun 20[Epub ahead of print].

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Value of Colon Leakage Score System in Predicting Anastomotic Leakage after Left-Sided Colorectal Cancer Surgery

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