Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage: Development and Validation of a Prediction Model in a Large International Cohort.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 11 2023
01 11 2023
Historique:
medline:
6
11
2023
pubmed:
27
7
2023
entrez:
27
7
2023
Statut:
ppublish
Résumé
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). AL after RC resection often results in a permanent stoma. 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. 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). 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.
Sections du résumé
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.
Identifiants
pubmed: 37498208
doi: 10.1097/SLA.0000000000006043
pii: 00000658-202311000-00019
pmc: PMC10549897
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
772-780Investigateurs
Andreas J A Bremers
(AJA)
Floris T Ferenschild
(FT)
Stefanie de Vriendt
(S)
André D'Hoore
(A)
Gabriele Bislenghi
(G)
Jordi Farguell
(J)
Antonio M Lacy
(AM)
Paula González Atienza
(PG)
Charlotte S van Kessel
(CS)
Yann Parc
(Y)
Thibault Voron
(T)
Maxime K Collard
(MK)
Jorge Sancho Muriel
(JS)
Hannia Cholewa
(H)
Laura A Mattioni
(LA)
Alice Frontali
(A)
Sebastiaan W Polle
(SW)
Fatih Polat
(F)
Ndidi J Obihara
(NJ)
Bruna B Vailati
(BB)
Miranda Kusters
(M)
Jurriaan B Tuynmann
(JB)
Sanne J A Hazen
(SJA)
Alexander A J Grüter
(AAJ)
Takahiro Amano
(T)
Hajime Fujiwara
(H)
Mario Salomon
(M)
Hernán Ruiz
(H)
Ricardo Gonzalez
(R)
Diego Estefanía
(D)
Nicolas Avellaneda
(N)
Augusto Carrie
(A)
Mateo Santillan
(M)
Diana A Pantoja Pachajoa
(DA)
Matias Parodi
(M)
Manuel Gielis
(M)
Alf-Dorian Binder
(AD)
Thomas Gürtler
(T)
Peter Riedl
(P)
Sarit Badiani
(S)
Christophe Berney
(C)
Matthew Morgan
(M)
Paul Hollington
(P)
Nigel da Silva
(N)
Gavin Nair
(G)
Yiu M Ho
(YM)
Michael Lamparelli
(M)
Raj Kapadia
(R)
Hidde M Kroon
(HM)
Nagendra N Dudi-Venkata
(NN)
Jianliang Liu
(J)
Tarik Sammour
(T)
Nicolas Flamey
(N)
Paul Pattyn
(P)
Ahmed Chaoui
(A)
Louis Vansteenbrugge
(L)
Nathalie E J van den Broek
(NEJ)
Patrick Vanclooster
(P)
Charles de Gheldere
(C)
Pieter Pletinckx
(P)
Barbara Defoort
(B)
Maxime Dewulf
(M)
Mihail Slavchev
(M)
Nikolay Belev
(N)
Boyko Atanasov
(B)
Panche Krastev
(P)
Manol Sokolov
(M)
Svilen Maslyankov
(S)
Petar Gribnev
(P)
Vasil Pavlov
(V)
Tsvetomir Ivanov
(T)
Martin Karamanliev
(M)
Emil Filipov
(E)
Pencho Tonchev
(P)
Felix Aigner
(F)
Martin Mitteregger
(M)
Caterina Allmer
(C)
Gerald Seitinger
(G)
Nicola Colucci
(N)
Nicolas Buchs
(N)
Frédéric Ris
(F)
Christian Toso
(C)
Eleftherios Gialamas
(E)
Aurélie Vuagniaux
(A)
Roland Chautems
(R)
Marc-Olivier Sauvain
(MO)
Silvio Daester
(S)
Markus von Flüe
(M)
Marc-Olivier Guenin
(MO)
Stephanie Taha-Mehlitz
(S)
Gabriel F Hess
(GF)
Lubomír Martínek
(L)
Matej Skrovina
(M)
Maria Machackova
(M)
Vladimir Benčurik
(V)
Deniz Uluk
(D)
Johann Pratschke
(J)
Luca S Dittrich
(LS)
Safak Guel-Klein
(S)
Daniel Perez
(D)
Julia-Kristin Grass
(JK)
Nathaniel Melling
(N)
Simone Mueller
(S)
Lene H Iversen
(LH)
Jacob D Eriksen
(JD)
Gunnar Baatrup
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Issam Al-Najami
(I)
Thomas Bjørsum-Meyer
(T)
Jüri Teras
(J)
Roland M Teras
(RM)
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Nagm Eldin Abu Elnga Ahmed
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(AK)
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Lisa Massey
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George E Fowler
(GE)
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Informations de copyright
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
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