Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage

Author:

Greijdanus Nynke G.1,Wienholts Kiedo234,Ubels Sander1,Talboom Kevin234,Hannink Gerjon5,Wolthuis Albert6,de Lacy Francisco B.7,Lefevre Jérémie H.8,Solomon Michael9,Frasson Matteo10,Rotholtz Nicolas11,Denost Quentin12,Perez Rodrigo O.13,Konishi Tsuyoshi14,Panis Yves15,Rutegård Martin1617,Hompes Roel234,Rosman Camiel1,van Workum Frans18,Tanis Pieter J.23419,de Wilt Johannes H.W.1,

Affiliation:

1. Department of Surgery, Radboud university medical centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands

2. Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands

3. Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands

4. Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands

5. Department of Medical Imaging, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands

6. Department of Surgery, UZ Leuven, Leuven, Belgium

7. Department of Gastrointestinal Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain

8. Department of Digestive Surgery, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France

9. Department of Surgery, University of Sydney Central Clinical School, Camperdown, New South Wales, Australia

10. Department of Surgery, Valencia University Hospital La Fe, Valencia, Spain

11. Department of Surgery, Hospital Alemán, Buenos Aires, Argentina

12. Bordeaux Colorectal Institute, Clinique Tivoli, Bordeaux, France

13. Department of Colorectal Surgery, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil

14. Department of Colon and Rectal Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX

15. Department of Colorectal Surgery, Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly Seine, France

16. Department of Surgery, Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden

17. Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden

18. Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands

19. Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands

Abstract

Objective: To develop and validate a prediction model (STOMA score) for 1-year stoma-free survival in patients with rectal cancer (RC) with anastomotic leakage (AL). Background: AL after RC resection often results in a permanent stoma. Methods: This international retrospective cohort study (TENTACLE-Rectum) encompassed 216 participating centres and included patients who developed AL after RC surgery between 2014 and 2018. Clinically relevant predictors for 1-year stoma-free survival were included in uni and multivariable logistic regression models. The STOMA score was developed and internally validated in a cohort of patients operated between 2014 and 2017, with subsequent temporal validation in a 2018 cohort. The discriminative power and calibration of the models’ performance were evaluated. Results: This study included 2499 patients with AL, 1954 in the development cohort and 545 in the validation cohort. Baseline characteristics were comparable. One-year stoma-free survival was 45.0% in the development cohort and 43.7% in the validation cohort. The following predictors were included in the STOMA score: sex, age, American Society of Anestesiologist classification, body mass index, clinical M-disease, neoadjuvant therapy, abdominal and transanal approach, primary defunctioning stoma, multivisceral resection, clinical setting in which AL was diagnosed, postoperative day of AL diagnosis, abdominal contamination, anastomotic defect circumference, bowel wall ischemia, anastomotic fistula, retraction, and reactivation leakage. The STOMA score showed good discrimination and calibration (c-index: 0.71, 95% CI: 0.66–0.76). Conclusions: The STOMA score consists of 18 clinically relevant factors and estimates the individual risk for 1-year stoma-free survival in patients with AL after RC surgery, which may improve patient counseling and give guidance when analyzing the efficacy of different treatment strategies in future studies.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Surgery

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