Predictive score for anastomotic leakage after elective colorectal cancer surgery: a decision making tool for choice of protective measures

Abstract

Anastomotic leakage is the most severe complication after colorectal surgery and a major cause of postoperative morbidity and mortality. We aimed to identify a predictive score for postoperative leakage after colorectal cancer surgery and to evaluate its usefulness in assessing various protective measures. A total of 159 patients were divided into test (79 patients) and validation (40 patients) groups in order to identify the risk factors and construct the predictive score. The remaining 40 patients (intervention group) were prospectively evaluated with the application of protective measures guided by risk stratification according to the predictive score. A total of 23 of 159 (14.5%) patients had anastomotic leakage, with 7 of 23 (30.4%) of them needing reoperation. 11 of 159 (6.9%) patients died, with 10 (6.3%) deaths directly associated with anastomotic leakage. The rate of leakage in the test and validation groups (nonintervention group) was 22 of 119 (18.5%), while the rate of leakage in the intervention group was 3 of 40 (7.5%). The odds ratio for anastomotic leakage in the intervention group was 0.23 compared to the nonintervention group, with a relative risk reduction of 73% for unfavorable event. The number needed to treat was 8 patients. There were also 10 of 119 (8.4%) deaths in the nonintervention group compared to 1 of 40 (2.5%) in the intervention group (Fisher's test; p=0.18). Our simple predictive score may be a valuable decision making tool that can help surgeons reliably identify patients at high risk for postoperative anastomotic leakage and apply guided intraoperative protective measures.