Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct 3;23(1):343.
doi: 10.1186/s12876-023-02982-2.

Risk assessment of rectal anastomotic leakage (RAREAL) after DIXON in non-emergency patients with rectal cancer

Xue-Cong Zheng  1 , Jin-Bo Su  2 , Jin-Jie Zheng  3
Affiliations

Risk assessment of rectal anastomotic leakage (RAREAL) after DIXON in non-emergency patients with rectal cancer

Xue-Cong Zheng et al. BMC Gastroenterol. .

Abstract

Background: The routine establishment of a diverting stoma (DS) remains controversial in every patient undergoing Dixon operation. We aimed to establish a model for the risk assessment of rectal anastomotic leak (RAREAL) after Dixon in non-emergency patients with rectal cancer, using routinely available variables, by which surgeons could individualize their approach to DS.

Methods: 323 patients who underwent Dixon operation for rectal cancer from January 2015 to December 2018 were taken as the model group for retrospective study. Univariable and multivariable logistic regression analysis was used to determine the independent risk factors associated with anastomotic leakage. We constructed the RAREAL model. 150 patients who underwent Dixon operation due to rectal cancer from January 2019 to December 2020 were collected according to the uniform criteria as a validation group to validate the RAREAL model.

Results: In the model group, multivariable analysis identified the following variables as independent risk factors for AL: HbA1c (odds ratio (OR) = 4.107; P = 0.044), Left colic artery (LCA) non preservation (OR = 4.360; P = 0.026), Tumor distance from the anal margin (TD) (OR = 6.373; P = 0.002). In the model group, the area under the curve (AUC) of the receiver operating characteristic (ROC) for evaluating AL with RAREAL was 0.733, and when RAREAL score = 2.5, its sensitivity, specificity and Youden index were 0.385, 0.973, 0.358, respectively. The AUC was 0.722 in the validation group and its sensitivity and specificity were 0.333 and 0.985, respectively, when RAREAL score = 2.5.

Conclusion: The RAREAL score can be used to assess the risk of AL after Dixon operation for rectal cancer, and prophylactic DS should be proactively done when the score is greater than 2.5.

Keywords: Anastomotic leakage (AL); DIXON; Rectal cancer; Risk assessment of rectal anastomotic leak (RAREAL).

PubMed Disclaimer

Conflict of interest statement

All authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart of experimental design in our study
Fig. 2
Fig. 2
Image of AL. (a) Computed tomography scan of the pelvis: air bubbles and fluid around the rectal anastomosis; (b) Colonoscopy: rectal anastomotic defect
Fig. 3
Fig. 3
(a) The ROC (AUC 0.733) for the diagnosis of AL with the RAREAL score in the modeling group; (b) The ROC (AUC 0.722) for the diagnosis of AL with the RAREAL score in the validation group
See this image and copyright information in PMC

References

    1. Olsen BC, Sakkestad ST, Pfeffer F, Karliczek A. Rate of Anastomotic Leakage after rectal anastomosis depends on the definition: pelvic abscesses are significant. Scand J Surg. 2019;108(3):241–9. doi: 10.1177/1457496918812223. - DOI - PubMed
    1. Wang ZJ, Liu Q. A Retrospective Study of Risk Factors for Symptomatic Anastomotic Leakage after Laparoscopic Anterior Resection of the Rectal Cancer without a Diverting Stoma. Gastroenterol Res Pract 2020, 2020:4863542. - PMC - PubMed
    1. Anderin K, Gustafsson UO, Thorell A, Nygren J. The effect of diverting stoma on postoperative morbidity after low anterior resection for rectal cancer in patients treated within an ERAS program. Eur J Surg Oncol. 2015;41(6):724–30. doi: 10.1016/j.ejso.2015.03.234. - DOI - PubMed
    1. Ihnat P, Gunkova P, Peteja M, Vavra P, Pelikan A, Zonca P. Diverting ileostomy in laparoscopic rectal cancer surgery: high price of protection. Surg Endosc. 2016;30(11):4809–16. doi: 10.1007/s00464-016-4811-3. - DOI - PubMed
    1. Ito M, Sugito M, Fau - Kobayashi A, Kobayashi A, Fau - Nishizawa Y, Nishizawa Y, Fau - Tsunoda Y, Tsunoda Y, Fau - Saito N, Saito N. Influence of learning curve on short-term results after laparoscopic resection for rectal cancer. (1432–2218 (Electronic)). - PubMed