Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage
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Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage : Development and Validation of a Prediction Model in a Large International Cohort. / Greijdanus, Nynke G; Wienholts, Kiedo; Ubels, Sander; Talboom, Kevin; Hannink, Gerjon; Wolthuis, Albert; de Lacy, Francisco B; Lefevre, Jérémie H; Solomon, Michael; Frasson, Matteo; Rotholtz, Nicolas; Denost, Quentin; Perez, Rodrigo O; Konishi, Tsuyoshi; Panis, Yves; Rutegård, Martin; Hompes, Roel; Rosman, Camiel; van Workum, Frans; Tanis, Pieter J; de Wilt, Johannes H W; TENTACLE-Rectum Collaborative Group.
In: ANN SURG, Vol. 278, No. 5, 01.11.2023, p. 772-780.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage
T2 - Development and Validation of a Prediction Model in a Large International Cohort
AU - Greijdanus, Nynke G
AU - Wienholts, Kiedo
AU - Ubels, Sander
AU - Talboom, Kevin
AU - Hannink, Gerjon
AU - Wolthuis, Albert
AU - de Lacy, Francisco B
AU - Lefevre, Jérémie H
AU - Solomon, Michael
AU - Frasson, Matteo
AU - Rotholtz, Nicolas
AU - Denost, Quentin
AU - Perez, Rodrigo O
AU - Konishi, Tsuyoshi
AU - Panis, Yves
AU - Rutegård, Martin
AU - Hompes, Roel
AU - Rosman, Camiel
AU - van Workum, Frans
AU - Tanis, Pieter J
AU - de Wilt, Johannes H W
AU - TENTACLE-Rectum Collaborative Group
AU - Graß, Julia-Kristin
N1 - Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
PY - 2023/11/1
Y1 - 2023/11/1
N2 - 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.
AB - 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.
KW - Humans
KW - Anastomotic Leak/etiology
KW - Rectum/surgery
KW - Retrospective Studies
KW - Rectal Neoplasms/surgery
KW - Anastomosis, Surgical/methods
KW - Risk Factors
U2 - 10.1097/SLA.0000000000006043
DO - 10.1097/SLA.0000000000006043
M3 - SCORING: Journal article
C2 - 37498208
VL - 278
SP - 772
EP - 780
JO - ANN SURG
JF - ANN SURG
SN - 0003-4932
IS - 5
ER -
