Analysis of risk factors and construction of a nomogram predictive model for anastomotic leakage after elective colectomy in elderly patients with colon cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Chaoyang ¹ , LI Xiaolong ² , LIN Hao ¹ , ZHANG Haibao ¹ , JU Jiahua ¹ ,  YU Yongjiang ^1,2

1. The First Clinical Medical College, Lanzhou University, Lanzhou 730000, P. R. China;
2. Depatment of Gastrointestinal Surgery / Hernia and Abdominal Wall Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, P. R. China;

Corresponding?author：

YU Yongjiang, Email: ylongy@163.com

Keywords：

aged; colonic neoplasm; anastomotic leak; nomogram; prediction model

DOI：

10.7507/1007-9424.202303059

Video：

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Objective To determine the risk factors of anastomotic leakage after elective colectomy in elderly patients with colon cancer, and to establish a model for predicting the risk of postoperative anastomotic leakage based on these factors. Methods The clinical data of 122 over 65 years old elderly patients who underwent colon cancer surgery in the First Hospital of Lanzhou University from January 2018 to December 2021 were analyzed retrospectively. Single factor analysis and multivariate logistic regression were used to analyze the potential risk factors for anastomotic leakage. A nomogram predictive model was established based on the determined independent risk factors, and the predictive performance of the model was evaluated by the receiver operating characteristic curve. Results Among the 122 patients included in this study, 10 had postoperative anastomotic leakage and 112 had no anastomotic leakage. Single factor analysis results showed that the occurrence of anastomotic leakage was associated with body mass index, smoking, combined diabetes, age-adjusted Charlson comorbidity index, intraoperative and postoperative blood transfusion within 2 days, preoperative hemoglobin, preoperative albumin, and preoperative prognostic nutritional index (P＜0.05). The results of multivariate logistic regression analysis showed that smoking [OR=15.529, 95%CI (1.529, 157.690), P=0.020], age-adjusted Charlson comorbidity index [OR=1.742, 95%CI (1.024, 2.966), P=0.041], and intraoperative and postoperative blood transfusion within 2 days [OR=82.223, 95%CI (1.265, 5 343.025), P=0.038] were independent risk factors for anastomotic leakage. A nomogram predictive model was established based on three independent risk factors. The area under the receiver operating characteristic curve of the model was 0.897 [95%CI (0.804, 0.990)], and its corrected C-index value was 0.881, indicating that the model had good predictive ability for the risk of anastomotic leakage. Conclusions Smoking, higher age-adjusted Charlson comorbidity index, and intraoperative and postoperative blood transfusion within 2 days are important risk factors for anastomotic leak in elderly patients undergoing elective colon cancer resection. This nomogram predictive model based on the combination of the three factors is helpful for surgeons to optimize treatment decisions and postoperative monitoring.

Citation： WANG Chaoyang, LI Xiaolong, LIN Hao, ZHANG Haibao, JU Jiahua, YU Yongjiang. Analysis of risk factors and construction of a nomogram predictive model for anastomotic leakage after elective colectomy in elderly patients with colon cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(7): 820-826. doi: 10.7507/1007-9424.202303059 Copy

1.	Spence RT, Hirpara DH, Doshi S, et al. Will my patient survive an anastomotic leak? predicting failure to rescue using the modified frailty index. Ann Surg Oncol, 2021, 28(5): 2779-2787.
2.	中國醫師協會結直腸腫瘤專業委員會. 中國老年結直腸腫瘤患者圍手術期管理專家共識(2020版). 中華結直腸疾病電子雜志, 2020, 9(4): 325-334.
3.	康志勇, 姜昌鎬. 結直腸癌術后吻合口漏的相關因素及預防研究進展. 中國普外基礎與臨床雜志, 2020, 27(11): 1450-1456.
4.	Spinelli A, Anania G, Arezzo A, et al. Italian multi-society modified Delphi consensus on the definition and management of anastomotic leakage in colorectal surgery. Updates Surg, 2020, 72(3): 781-792.
5.	Charlson ME, Carrozzino D, Guidi J, et al. Charlson comorbidity index: a critical review of clinimetric properties. Psychother Psychosom, 2022, 91(1): 8-35.
6.	李方洪, 李志霞, 安大立, 等. 老年人結直腸癌的圍手術期治療. 中華老年醫學雜志, 2010, 29(3): 226-228.
7.	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. doi: 10.1016/j.jss.2010.11.004.
8.	Yang SU, Park EJ, Baik SH, et al. Modified colon leakage score to predict anastomotic leakage in patients who underwent left-sided colorectal surgery. J Clin Med, 2019, 8(9): 1450. doi: 10.3390/jcm8091450.
9.	Frasson M, Flor-Lorente B, Rodríguez JL, et al. Risk factors for anastomotic leak after colon resection for cancer: multivariate analysis and nomogram from a multicentric, prospective, national study with 3 193 patients. Ann Surg, 2015, 262(2): 321-330.
10.	李良, 楊仁保, 江鳴, 等. 結直腸漏評分系統在左半結直腸癌切除術后吻合口漏預測中的應用價值. 中國普外基礎與臨床雜志, 2016, 23(11): 1370-1374.
11.	Kwak HD, Kim SH, Kang DW, et al. Risk factors and oncologic outcomes of anastomosis leakage after laparoscopic right colectomy. Surg Laparosc Endosc Percutan Tech, 2017, 27(6): 440-444.
12.	Tsai KY, Huang SH, You JF, et al. Smoking cessation for less than 10 years remains a risk factor of anastomotic leakage in mid-to-low rectal cancer patients undergoing sphincter-preserving surgery. Langenbecks Arch Surg, 2022, 407(3): 1131-1138.
13.	Wada H, Tominaga T, Nonaka T, et al. Charlson comorbidity index predicts anastomotic leakage in patients with resected right-sided colon cancer. Surg Today, 2022, 52(5): 804-811.
14.	Tominaga T, Nonaka T, Takeshita H, et al. The Charlson comorbidity index as an independent prognostic factor in older colorectal cancer patients. Indian J Surg, 2018, 80(1): 54-60.
15.	Tian Y, Xu B, Yu G, et al. Comorbidity and the risk of anastomotic leak in Chinese patients with colorectal cancer undergoing colorectal surgery. Int J Colorectal Dis, 2017, 32(7): 947-953.
16.	Trencheva K, Morrissey KP, Wells M, et al. Identifying important predictors for anastomotic leak after colon and rectal resection: prospective study on 616 patients. Ann Surg, 2013, 257(1): 108-113.
17.	Thompson SK, Chang EY, Jobe BA. Clinical review: healing in gastrointestinal anastomoses, partⅠ. Microsurgery, 2006, 26(3): 131-136.
18.	Zarnescu EC, Zarnescu NO, Costea R. Updates of risk factors for anastomotic leakage after colorectal surgery. Diagnostics (Basel), 2021, 11(12): 2382. doi: 10.3390/diagnostics11122382.
19.	Kang J, Kim H, Park H, et al. Risk factors and economic burden of postoperative anastomotic leakage related events in patients who underwent surgeries for colorectal cancer. PLoS One, 2022, 17(5): e0267950. doi: 10.1371/journal.pone.0267950.
20.	Zarnescu EC, Zarnescu NO, Sanda N, et al. Risk factors for severe postoperative complications after oncologic right colectomy: unicenter analysis. Medicina (Kaunas), 2022, 58(11): 1598. doi: 10.3390/medicina58111598.
21.	Nagababu E, Scott AV, Johnson DJ, et al. Oxidative stress and rheologic properties of stored red blood cells before and after transfusion to surgical patients. Transfusion, 2016, 56(5): 1101-1111.
22.	Lai R, Lu Y, Li Q, et al. Risk factors for anastomotic leakage following anterior resection for colorectal cancer: the effect of epidural analgesia on occurrence. Int J Colorectal Dis, 2013, 28(4): 485-492.

1. Spence RT, Hirpara DH, Doshi S, et al. Will my patient survive an anastomotic leak? predicting failure to rescue using the modified frailty index. Ann Surg Oncol, 2021, 28(5): 2779-2787.
2. 中國醫師協會結直腸腫瘤專業委員會. 中國老年結直腸腫瘤患者圍手術期管理專家共識(2020版). 中華結直腸疾病電子雜志, 2020, 9(4): 325-334.
3. 康志勇, 姜昌鎬. 結直腸癌術后吻合口漏的相關因素及預防研究進展. 中國普外基礎與臨床雜志, 2020, 27(11): 1450-1456.
4. Spinelli A, Anania G, Arezzo A, et al. Italian multi-society modified Delphi consensus on the definition and management of anastomotic leakage in colorectal surgery. Updates Surg, 2020, 72(3): 781-792.
5. Charlson ME, Carrozzino D, Guidi J, et al. Charlson comorbidity index: a critical review of clinimetric properties. Psychother Psychosom, 2022, 91(1): 8-35.
6. 李方洪, 李志霞, 安大立, 等. 老年人結直腸癌的圍手術期治療. 中華老年醫學雜志, 2010, 29(3): 226-228.
7. 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. doi: 10.1016/j.jss.2010.11.004.
8. Yang SU, Park EJ, Baik SH, et al. Modified colon leakage score to predict anastomotic leakage in patients who underwent left-sided colorectal surgery. J Clin Med, 2019, 8(9): 1450. doi: 10.3390/jcm8091450.
9. Frasson M, Flor-Lorente B, Rodríguez JL, et al. Risk factors for anastomotic leak after colon resection for cancer: multivariate analysis and nomogram from a multicentric, prospective, national study with 3 193 patients. Ann Surg, 2015, 262(2): 321-330.
10. 李良, 楊仁保, 江鳴, 等. 結直腸漏評分系統在左半結直腸癌切除術后吻合口漏預測中的應用價值. 中國普外基礎與臨床雜志, 2016, 23(11): 1370-1374.
11. Kwak HD, Kim SH, Kang DW, et al. Risk factors and oncologic outcomes of anastomosis leakage after laparoscopic right colectomy. Surg Laparosc Endosc Percutan Tech, 2017, 27(6): 440-444.
12. Tsai KY, Huang SH, You JF, et al. Smoking cessation for less than 10 years remains a risk factor of anastomotic leakage in mid-to-low rectal cancer patients undergoing sphincter-preserving surgery. Langenbecks Arch Surg, 2022, 407(3): 1131-1138.
13. Wada H, Tominaga T, Nonaka T, et al. Charlson comorbidity index predicts anastomotic leakage in patients with resected right-sided colon cancer. Surg Today, 2022, 52(5): 804-811.
14. Tominaga T, Nonaka T, Takeshita H, et al. The Charlson comorbidity index as an independent prognostic factor in older colorectal cancer patients. Indian J Surg, 2018, 80(1): 54-60.
15. Tian Y, Xu B, Yu G, et al. Comorbidity and the risk of anastomotic leak in Chinese patients with colorectal cancer undergoing colorectal surgery. Int J Colorectal Dis, 2017, 32(7): 947-953.
16. Trencheva K, Morrissey KP, Wells M, et al. Identifying important predictors for anastomotic leak after colon and rectal resection: prospective study on 616 patients. Ann Surg, 2013, 257(1): 108-113.
17. Thompson SK, Chang EY, Jobe BA. Clinical review: healing in gastrointestinal anastomoses, partⅠ. Microsurgery, 2006, 26(3): 131-136.
18. Zarnescu EC, Zarnescu NO, Costea R. Updates of risk factors for anastomotic leakage after colorectal surgery. Diagnostics (Basel), 2021, 11(12): 2382. doi: 10.3390/diagnostics11122382.
19. Kang J, Kim H, Park H, et al. Risk factors and economic burden of postoperative anastomotic leakage related events in patients who underwent surgeries for colorectal cancer. PLoS One, 2022, 17(5): e0267950. doi: 10.1371/journal.pone.0267950.
20. Zarnescu EC, Zarnescu NO, Sanda N, et al. Risk factors for severe postoperative complications after oncologic right colectomy: unicenter analysis. Medicina (Kaunas), 2022, 58(11): 1598. doi: 10.3390/medicina58111598.
21. Nagababu E, Scott AV, Johnson DJ, et al. Oxidative stress and rheologic properties of stored red blood cells before and after transfusion to surgical patients. Transfusion, 2016, 56(5): 1101-1111.
22. Lai R, Lu Y, Li Q, et al. Risk factors for anastomotic leakage following anterior resection for colorectal cancer: the effect of epidural analgesia on occurrence. Int J Colorectal Dis, 2013, 28(4): 485-492.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of risk factors and construction of a nomogram predictive model for anastomotic leakage after elective colectomy in elderly patients with colon cancer

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