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.
Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage / Nynke G., Greijdanus; Kiedo, Wienholts; Sander, Ubels; Kevin, Talboom; Gerjon, Hannink; Albert, Wolthuis; Francisco B., De Lacy; Jérémie H., Lefevre; Michael, Solomon; Matteo, Frasson; Nicolas, Rotholtz; Quentin, Denost; Rodrigo O., Perez; Tsuyoshi, Konishi; Yves, Panis; Martin, Rutegård; Roel, Hompes; Camiel, Rosman; Frans, Van Workum; Pieter J., Tanis; Johannes H. W., De Wilt; Bremers, Andreas J. A.; Ferenschild (Radboud University Medical Centre, Floris T.; Institute For Health Sciences, Radboud; Nijmegen, ; Netherlands) Stefanie de Vriendt, The; D’Hoore, André; Bislenghi (University Hospitals Leuven, Gabriele; Belgium), Leuven; Farguell, Jordi; Lacy, Antonio M.; González Atienza (Hospital Clínic de Barcelona, Paula; Spain), Barcelona; van Kessel (Royal Prince Albert Hospital, Charlotte S.; Australia), Sydney; Parc, Yann; Voron, Thibault; Collard (Sorbonne Université, Maxime K.; AP-HP, ; Saint Antoine, Hôpital; France), Paris; Sancho Muriel, Jorge; Cholewa (Valencia University Hospital La Fe, Hannia; Spain), Valencia; Mattioni (Hospital Alemán, Laura A.; Aires, Buenos; Argentina), ; Frontali (Beaujon Hospital, Alice; Clichy, ; University Of Paris, And; France), Clichy; Polle, Sebastiaan W.; Polat, Fatih; Obihara (Canisius Wilhelmina Hospital, Ndidi J.; Nijmegen, ; Netherlands), The; Vailati (Hospital Alemão Oswaldo Cruz, Bruna B.; Paulo, São; Brazil), ; Kusters, Miranda; Tuynmann, Jurriaan B.; Hazen, Sanne J. A.; Grüter (Amsterdam University Medical Centers, Alexander A. J.; Vumc, Location; Amsterdam, ; Netherlands, The; Center Amsterdam, Cancer; And Quality Of Life, Treatment; Amsterdam, ; Netherlands, The; Center Amsterdam, Cancer; And Biomarkers, Imaging; Amsterdam, ; Netherlands), The; Amano, Takahiro; Fujiwara (Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Hajime; Japan), Tokyo; Salomon, Mario; Ruiz, Hernán; Gonzalez, Ricardo; Estefanía (Buenos Aires British Hospital, Diego; Aires, Buenos; Argentina), ; Avellaneda, Nicolas; Carrie, Augusto; Santillan (CEMIC University Hospital, Mateo; Aires, Buenos; Argentina), ; Pantoja Pachajoa, Diana A.; Parodi, Matias; Gielis (Clínica Universitaria Reina Fabiola, Manuel; Argentina), Córdoba; Binder, Alf-Dorian; Gürtler, Thomas; Riedl (Universitätsklinikum Tulln, Peter; An Der Donau, Tulln; Austria), ; Badiani, Sarit; Berney, Christophe; Morgan (Bankstown-Lidcombe Hospital, Matthew; Sydney, ; South Wales, New; Australia), ; Hollington, Paul; Da Silva, Nigel; Nair (Flinders Medical Centre, Gavin; Adelaide, ; Australia, South; Australia), ; Ho, Yiu M.; Lamparelli, Michael; Kapadia (Rockhampton Hospital, Raj; Australia), Queensland; Kroon, 19 Hidde M.; Dudi-Venkata, Nagendra N.; Liu, Jianliang; Sammour (Royal Adelaide Hospital, Tarik; Adelaide, ; Australia, South; Australia), ; Flamey, Nicolas; Pattyn, Paul; Chaoui, Ahmed; Vansteenbrugge (AZ Delta, Louis; Belgium), Roeselare; Van Den Broek, Nathalie E. J.; Vanclooster, Patrick; de Gheldere (Heilig-Hartziekenhuis, Charles; Belgium), Lier; Pletinckx, Pieter; Defoort, Barbara; Dewulf (Maria Middelares Ghent, Maxime; Belgium), ; Slavchev, Mihail; Belev, Nikolay; Atanasov, Boyko; - Medical University Plovdiv, Panche Krastev (University Hospital Eurohospital; Bulgaria), Plovdiv; Sokolov, Manol; Maslyankov, Svilen; Gribnev, Petar; Pavlov (Aleksandrovska University Hospital, Vasil; Bulgaria), Sofia; Ivanov, Tsvetomir; Karamanliev, Martin; Filipov, Emil; Tonchev (Medical University Pleven, Pencho; Bulgaria), Pleven; Aigner, Felix; Mitteregger, Martin; Allmer, Caterina; John Of God Hospital Graz, Gerald Seitinger (St.; Austria), Graz; Colucci, Nicola; Buchs, Nicolas; Ris, Frédéric; Toso (Geneva University Hospitals and Faculty of Medicine, Christian; Switzerland), Geneva; Gialamas, Eleftherios; Vuagniaux, Aurélie; Chautems, Roland; Sauvain (Neuchâtel Hospital, Marc-Olivier; Switzerlandl), Neuchâtel; Daester, Silvio; Von Flüe, Markus; Guenin, Marc-Olivier; Taha-Mehlitz, Stephanie; Clara Hospital And University Hospital Basel, Gabriel F. Hess (St.; Switzerland), Basel; Martínek, Lubomír; Skrovina, Matej; Machackova, Maria; Benčurik (Hospital Nový Jičín, Vladimir; Jičín, Nový; Republic), Czech; Uluk, Deniz; Pratschke, Johann; Dittrich, Luca S.; Guel-Klein (Charité-Universitätsmedizin Berlin, Safak; Member of Freie Universität Berlin and Humboldt-Universität zu Berlin and Berlin Institut of Health, Corporate; Germany), Berlin; Perez (Asclepios Clinic Altona, Daniel; Germany), Hamburg; Grass, Julia-Kristin; Melling, Nathaniel; Mueller (University Medical Centre of Hamburg-Eppendorf, Simone; Germany), Hamburg; Iversen, Lene H.; Eriksen (Aarhus University Hospital, Jacob D.; Denmark), Aarhus; Baatrup, Gunnar; Al-Najami, Issam; Bjørsum-Meyer (Odense University Hospital, Thomas; Sygehus, Svendborg; Denmark), ; Teras, Jüri; Teras (North Estonia Medical Centre Foundation, Roland M.; Estonia), Tallinn; Monib, Fatma A.; Eldin Abu Elnga Ahmed, Nagm; Alkady, Eithar; Ali (Assiut University Hospital, Ahmed K.; Egypt), Assiut; Abd Elatti Khedr, Gehan; Samir Abdelaal, Ahmed; Bassyouni Ashoush, Fouad M.; Ewedah (Alexandria Main University Hospital, Moataz; Governorate, Alexandria; Egypt), ; Elshennawy, Eslam M.; Hussein (Kafr Elshikh University Hospital, Mohamed; el-Sheikh, Kafr; Egypt), ; Fernández-Martínez, Daniel; García-Flórez, Luis J.; Fernández-Hevia, María; Suárez-Sánchez (Central University Hospital of Asturias, Aida; Spain), Asturias; Del Hoyo Aretxabala, Izaskun; Losada Docampo, Iria; Gómez Zabala (Basurto University Hospital, Jesús; Spain), Bilbao; Tejedor, Patricia; Morales Bernaldo De Quirós, Javier T.; Bodega Quiroga (Hospital Universitario Gómez Ulla, Ignacio; Spain), ; Navarro-Sánchez, Antonio; Soto Darias, Iván; López Fernández, Cristina; de La Cruz Cuadrado (Hospital Materno Infantil de Gran Canaria, Cristina; Palmas, Las; Spain), ; Sánchez-Guillén, Luis; López-Rodríguez-Arias, Francisco; Soler-Silva, Álvaro; Arroyo (University Hospital of Elche, Antonio; Spain), Elche; Bernal-Sprekelsen, Juan C.; Gómez-Abril, Segundo Á.; Gonzálvez, Paula; Peset, María T. Torres (Hospital Universitario Dr.; Spain), Valencia; Rubio Sánchez, Teresa; Blanco Antona, Francisco; Sánchez Lara, Juan E.; Alcázar Montero (University Hospital of Salamanca, José A.; Spain), Salamanca; Fernández-Martínez, Daniel; García-Flórez, Luis J.; Fernández-Hevia, María; Suárez-Sánchez (Central University Hospital of Asturias, Aida; Spain), Asturias; Colás-Ruiz, Enrique; Tasende-Presedo, Marta M.; Fernández-Hurtado, Ignacio; Cifuentes-Ródenas, José A.; Castro Suárez (Son Llàtzer Hospital, Marta; Balears, Illes; Spain), ; Losada, Manuel; Hernández, Miguel; Alonso, Alfredo; Diéguez (Hospital Universitario del Sureste, Beatriz; Spain), Madrid; Serralta, Daniel; Medina Quintana, Rita E.; Gil Lopez, Jose M.; Lima Pinto, Francisca; Nieto-Moreno (Hospital Infanta Leonor, Elena; Sebastián De Los Reyes, San; Spain), Madrid; Correa Bonito, Alba; Cerdán Santacruz, Carlos; Bermejo Marcos, Elena; García Septiem (University Hospital de La Princesa, Javier; Spain), Madrid; Calero-Lillo, Aránzazu; Alanez-Saavedra, Javier; Muñoz-Collado, Salvador; López-Lara (Fundación Hospital del Espíritu Santo, Manuel; Coloma De Gramenet, Santa; Spain), Barcelona; Labalde Martínez, María; Ferrero Herrero, Eduardo; Javier García Borda, Francisco; García Villar (12 de Octubre University Hospital, Óscar; Spain), Madrid; Escartín, Jorge; Blas, Juan L.; Ferrer, Rocío; García Egea (Hospital Royo Villanova, Jorge; Spain), Zaragoza; Rodríguez-Infante, Antonio; Mínguez-Ruiz, Germán; Carreño-Villarreal, Guillermo; Pire-Abaitua (Hospital Universitario San Agustín, Gerardo; Spain), Avilés; Dziakova, Jana; Sáez-Cazallas Rodríguez, Carlos; Pizarro Aranda, María J.; Muguerza Huguet (Hospital Universitario Clínico San Carlos, José M.; Spain), Madrid; Borda-Arrizabalaga, Nerea; Enriquez-Navascués, José M.; Elorza Echaniz, Garazi; Saralegui Ansorena (Donostia University Hospital, Yolanda; Spain), Donostia; Estaire-Gómez, Mercedes; Martínez-Pinedo, Carlos; Barbero-Valenzuela, Alejandro; Ruíz-García (Hospital General Universitario de Ciudad Real, Pablo; Real, Ciudad; Spain), ; Kraft, Miquel; Gómez-Jurado, María J.; Pellino, Gianluca; Espín-Basany (Vall d'Hebron University Hospital, Eloy; Autonoma De Barcelona, Universitat; Spain), Barcelona; Cotte, Eddy; Panel, Nathalie; Goutard (Hospices Civils de Lyon, Claire-Angéline; Sud University Hospital, Lyon; Bénite, Pierre; France), ; Deángelis, Nicola; Lauka (Henri Mondor Hospital, Lelde; Créteil, AP-HP; France), ; Shaikh, Shafaque; Osborne, Laura; Ramsay (Aberdeen Royal Infirmary, George; Grampian, Nhs; Aberdeen, ; Kingdom), United; Nichita, Vladimir-Ion; Bhandari, Santosh; Sarmah (Cambridgeshire in Peterborough City Hospital, Panchali; Peterborough, ; Kingdom), United; Bethune, Rob M.; Pringle, Heather C. M.; Massey, Lisa; Fowler (Royal Devon and Exeter Hospital, George E.; Exeter, ; Kingdom), United; Hamid, Hytham K. S.; de Simone (East Kent Hospitals University NHS Foundation Trust, Belinda D.; Ashford, ; Kingdom), United; Kynaston, James; Bradley, Nicholas; Stienstra (Forth Valley Royal Hospital, Roxane M.; Scotland), Larbert; Gurjar, Shashank; Mukherjee, Tanmoy; Chandio, Ashfaq; Ahmed (Bedfordshire Hospitals NHS Foundation Trust, Safia; Luton, ; Kingdom), United; Singh, Baljit; Runau, Francois; Chaudhri, Sanjay; Siaw (Leicester General Hospital, Oliver; Leicester, ; Kingdom), United; Sarveswaran, Janahan; Miu, Victor; Ashmore, Daniel; Darwich (Pinderfields Hospital, Haitham; Wakefield, ; Kingdom), United; Singh-Ranger, Deepak; Singh (The Royal Wolverhampton NHS Trust, Nirbhaibir; Wolverhampton, ; Midlands, West; Kingdom), United; Shaban (Newcastle upon Tyne NHS Foundation Trust, Mohamed; Upon Tyne, Newcastle; Kingdom), United; Gareb (Queen Elizabeth The Queen Mother Hospital, Fahed; Margate, ; Kingdom), United; Petropolou, Thalia; Polydorou (Euroclinic Athens, Adreas; Greece), Athens; Dattani, Mit; Afzal (University Hospitals Birmingham NHS Foundation Trust, Asma; Birmingham, ; Kingdom), United; Bavikatte, Akshay; Sebastian, Boby; Ward, Nicholas; Mishra (West Suffolk Hospital, Amitabh; Suffolk, ; Kingdom), United; Manatakis, Dimitrios; Agalianos, Christos; Tasis, Nikolaos; Antonopoulou (Athens Naval and Veterans Hospital, Maria-Ioanna; Greece), Athens; Karavokyros, Ioannis; Charalabopoulos, Alexandros; Schizas, Dimitrios; Baili, Efstratia; Syllaios, Athanasios; Karydakis, Lysandros; Vailas (Laikon General Hospital- National and Kapodistrian University of Athens, Michail; Greece), ; Balalis, Dimitrios; Korkolis, Dimitrios; Plastiras, Aris; Rompou (Saint Savvas Anti-Cancer Hospital, Aliki; Greece), Athens; Xenaki, Sofia; Xynos, Evangelos; Chrysos, Emmanuel; Venianaki (University Hospital of Heraklion Crete, Maria; Greece), ; Christodoulidis, Grigorios; Perivoliotis, Konstantinos; Tzovaras, George; Baloyiannis (University Hospital of Larissa, Ioannis; Greece), Larissa; Ho, Man-Fung; Siu-man Ng, Simon; Wing-chung Mak, Tony; Futaba (Prince of Wales Hospital, Kaori; Chinese University Of Hong Kong, The; Shatin, ; Kong), Hong; Šantak, Goran; Šimleša, Damir; Ćosić, Jurica; Zukanović (General County Hospital Požega, Goran; Croatia), Požega; Kelly, Michael E.; Larkin, John O.; Mccormick, Paul H.; James’S Cancer Institute, Brian J. Mehigan (The Trinity St.; + School of Medicine, Dublin; College Dublin, Trinity; Ireland), ; Connelly, Tara M.; Neary, Peter; Ryan, Jessica; McCullough (University Hospital Waterford, Peter; Ireland), Waterford; Al-Juaifari, Maytham A.; Hammoodi, Hayder; Hashim Abbood (Al-Sadder Teaching Hospital, Ali; Iraq), Najaf; Calabrò, Marcello; Muratore, Andrea; La Terra, Antonio; Farnesi (Edoardo Agnelli Hospital, Francesca; Italy), Pinerolo; Feo, Carlo V.; Fabbri, Nicolò; Pesce, Antonio; Fazzin (Azienda Unità Sanitaria Locale di Ferrara, Marta; Di Ferrara, Università; Italy), Ferrara; Roscio, Francesco; Clerici (ASST Valle Olona Busto Arsizio Italy, Federico; Arsizio Va, Busto; Italy), ; Lucchi, Andrea; Vittori, Laura; Agostinelli, Laura; Cristina Ripoli (AUSL Romagna Ceccarini Hospital, Maria; Italy), Riccione; Sambucci, Daniele; Porta (Fatebenefratelli Hospital, Andrea; Italy), Erba; Sinibaldi, Giovanni; Crescentini, Giacomo; Larcinese, Antonella; Picone (Fatebbenefratelli Hospital, Emanuele; Tiberina, Isola; Italy), Rome; Persiani, Roberto; Biondi, Alberto; Pezzuto, Roberto; Lorenzon, Laura; Rizzo, Gianluca; Coco, Claudio; (, Luca D’Agostino; University Of Rome, Catholic; Italy), Rome; Spinelli, Antonino; Sacchi, Matteo M.; Carvello, Michele; Foppa (Humanitas University, Caterina; Italy), Milan; Spinelli, Antonino; Sacchi, Matteo M.; Carvello, Michele; Foppa, Caterina; Maroli (IRCCS Humanitas Research Hospital, Annalisa; Italy), Milan; Palini, Gian M.; Garulli, Gianluca; Zanini (Infermi Hospital of Rimini, Nicola; Della Romagna, Ausl; Italy), Rimini; Delrio, Paolo; Rega, Daniela; Carbone, Fabio; - IRCCS, Alessia Aversano (Fondazione Giovanni Pascale; Italy), Naples; Pirozzolo, Giovanni; Recordare, Alfonso; D'Alimonte, Lucrezia; Vignotto (Dell'Angelo Hospital, Chiara; Italy), Venice; Corbellini, Carlo; Sampietro, Gianluca M.; Lorusso, Leonardo; Manzo (ASST Rhodense, Carlo A.; Memorial Hospital, Rho; Italy), Milano; Ghignone, Federico; Ugolini, Giampaolo; Montroni, Isacco; Pasini (Ospedale Santa Maria delle Croci, Franceso; Italy), Ravenna; Pasini (Ospedale per gli Infermi, Francesco; Italy), Faenza; Ballabio, Michele; Bisagni, Pietro; Armao, Francesca T.; Longhi (Maggiore Hospital in Lodi, Marco; Italy), Lodi; Ghazouani, Omar; Galleano (Santa Corona Hospital, Raffaele; Ligure, Pietra; Italy), ; Tamini, Nicolò; Oldani, Massimo; Nespoli (San Gerardo Hospital, Luca; Italy), Monza; Picciariello, Arcangelo; Altomare, Donato F.; Tomasicchio, Giovanni; Lantone (University of Bari Aldo Moro, Giuliano; Italy), Bari; Catena, Fausto; Giuffrida, Mario; Annicchiarico, Alfredo; Perrone (Parma University Hospital, Gennaro; Italy), Parma; Grossi, Ugo; Santoro, Giulio A.; Zanus, Giacomo; Iacomino, Alessandro; Novello, Simone; Passuello, Nicola; Zucchella (Regional Hospital Treviso, Martino; Italy), Treviso; Puca, Lucia; Degiuli, Maurizio; Reddavid (San Luigi University Hospital, Rossella; Torino, Orbassano; Italy), ; Scabini, Stefano; Aprile, Alessandra; Soriero, Domenico; Fioravanti (AOU San Martino Hospital, Emanuela; Italy), Genoa; Rottoli, Matteo; Romano, Angela; Tanzanu, Marta; Belvedere (IRCCS Azienda Ospedaliero Universitaria di Bologna, Angela; Italy), Bologna; Mariani, Nicolò M.; Ceretti, Andrea P.; E Carlo, Enrico Opocher (ASST Santi Paolo; Italy), Milan; Gallo, Gaetano; Sammarco (University of Catanzaro, Giuseppe; Italy), Catanzaro; de Paola (University of Milano, Gilda; Italy), Milano; Pucciarelli, Salvatore; Marchegiani, Francesco; Spolverato, Gaya; Buzzi (Azienda Ospedale-Università di Padova, Gianluca; Italy), Padova; Di Saverio, Salomone; Meroni, Paola; Parise, Cristiano; Bottazzoli (University of Insubria, Elisa I.; Hospital Of Varese, University; Sette Laghi, Asst; Lombardia, Regione; Italy), Varese; Lapolla, Pierfrancesco; Brachini, Gioia; Cirillo, Bruno; (, Andrea Mingoli; I University Hospital, Policlinico Umberto; University Of Rome, Sapienza; Italy), Rome; Sica, Giuseppe; Siragusa, Leandro; Bellato, Vittoria; Cerbo (University of Rome, Daniele; Italy), Rome; De Pasqual, Carlo A.; De Manzoni, Giovanni; di Cosmo (University of Verona, Maria A.; Italy), Verona; Alrayes, Bourhan M. H.; Qandeel (Islamic Hospital Amman, Mahmoud W. M.; Jordan), Amman; Bani Hani (King Abdullah University Hospital, Mohammad; Jordan), Ar-Ramtha; Rabadi, Alexander; El Muhtaseb, Mohammad S.; Abdeen, Basel; Karmi (The University of Jordan, Fahed; Jordan), Amman; Žilinskas, Justas; Latkauskas, Tadas; Tamelis, Algimantas; Pikūnienė, Ingrida; Šlenfuktas (Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Vygintas; Lithuania), Kaunas; Poskus, Tomas; Kryzauskas, Marius; Jakubauskas, Matas; Mikalauskas, Saulius; Jakubauskiene (Vilnius University, Lina; Lithuania), Vilnius; Hassan, Soha Y.; Altrabulsi (Benghazi Medical Center, Amani; Libya), Benghazi; Abdulwahed, Eman; Ghmagh, Reem; Deeknah, Abdulqudus; Alshareea (Tripoli Central Hospital, Entisar; Libya), Tripoli; Elhadi, Muhammed; Abujamra, Saleh; Msherghi, Ahmed A.; Tababa (Tripoli University Hospital, Osama W. E.; Libya), Tripoli; Majbar, Mohammed A.; Souadka, Amine; Benkabbou, Amine; Mohsine, Raouf; Echiguer (National Institute of Oncology, Sabrillah; V In Rabat, University Mohammed; Morocco), Rabat; Moctezuma-Velázquez, Paulina; Salgado-Nesme, Noel; Vergara-Fernández, Omar; Sainz-Hernández, Juan C.; Alvarez-Bautista (Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Francisco E.; City, Mexico; Mexico), ; Zakaria, Andee D.; Zakaria, Zaidi; Wong, Michael P. K.; Ismail (Universiti Sains Malaysia, Razif; Kerian, Kubang; Malaysia), Kelantan; Ibrahim, Aini F.; Abdullah, Nik A. N.; Julaihi (Universiti Malaysia Sarawak, Rokayah; Samarahan, Kota; Sarawak), ; Bhat, Sameer; O'Grady, Greg; Bissett (University of Auckland, Ian; Auckland, ; Zealand), New; Lamme, Bas; Musters, Gijsbert D.; Dinaux (Albert Schweitzer Hospital, Anne M.; Dordrecht, ; Netherlands), The; Grotenhuis, Brechtje A.; Aalbers, Ernst J. Steller Arend G. J.; Leeuwenburgh (Netherlands Cancer Institute-Antoni van Leeuwenhoek, Marjolein M.; Amsterdam, ; Netherlands), The; Rutten, Harm J. T.; Burger, Jacobus W. A.; Bloemen, Johanne G.; Ketelaers (Catharina Hospital, Stijn H. J.; Eindhoven, ; Netherlands), The; Waqar, Usama; Chawla, Tabish; Rauf, Hareem; Rani (Aga Khan University, Pallavi; City, Karachi; Pakistan), ; Talsma, Aaldert K.; Scheurink, Lieke; van Praagh (Deventer Hospital, Jasper B.; Deventer, ; Netherlands), The; Segelman, Josefin; Nygren, Jonas; Anderin, Kajsa; Tiefenthal (Ersta Hospital, Marit; Sweden), Stockholm; De Andrés, Beatriz; Beltrán De Heredia, Juan P.; Vázquez, Andrea; Gómez (University Clinical Hospital of Valladolid, Tania; Spain), Valladolid; Golshani, Parisa; Kader, Rawaz; Mohamed (Gävle Hospital, Abudi; Sweden), Gävle; Westerterp, Marinke; Marinelli, Andreas; Niemer (Medical Center Haaglanden, Quirine; Westeinde, ; Haag, Den; Netherlands), ; Doornebosch, Pascal G.; Shapiro, Joël; Vermaas, Maarten; de Graaf (Jsselland Hospital, Eelco J. R.; Aan Den Ijssel, Capelle; Netherlands), The; Van Westreenen, Hendrik L.; Zwakman, Marije; van Dalsen (Isala Hospital, Annette D.; Zwolle, ; Netherlands), The; Vles, Wouter J.; Nonner, Joost; Toorenvliet, Boudewijn R.; Janssen (Ikazia Hospital, Paul T. J.; Rotterdam, ; Netherlands), The; Verdaasdonk, Emiel G. G.; Amelung (Jeroen Bosch Hospital, Femke J.; 's-Hertogenbosch, ; Netherlands), The; Bahadoer, Koen C. M. J. Peeters Renu R.; Holman (Leiden University Medical Center, Fabian A.; Netherlands), Leiden; Heemskerk, Jeroen; Vosbeek, Noortje; Leijtens, Jeroen W. A.; Taverne (Laurentius Hospital, Sophie B. M.; Roermond, ; Netherlands), The; Heijnen, Bob H. M.; El-Massoudi, Youssef; de Groot-van Veen (LangeLand Hospital, Irene; Zoetermeer, ; Netherlands), The; Hoff, Christiaan; Jou-Valencia (Medical Centre Leeuwarden, Daniela; Leeuwarden, ; Netherlands), The; Burghgraef, Esther C. J. Consten Thijs A.; Geitenbeek, Ritch; Hulshof (Meander Medical Centre, Lorenzo G. W. L.; Netherlands), Amersfoort; Slooter, Gerrit D.; Reudink (Máxima Medical Centre, Muriël; Netherlands), Veldhoven; Bouvy, Nicole D.; Wildeboer, Aurelia C. L.; Verstappen, Sonja; Pennings (Maastricht University Medical Centre, Alexander J.; Maastricht, ; Netherlands), The; Van Den Hengel, Berber; Wijma, Allard G.; de Haan (Martini Hospital, Jael; Groningen, ; Netherlands), The; De Nes, Lindsey C. F.; Heesink (Maasziekenhuis Pantein, Vera; Boxmeer, ; Netherlands), The; Karsten, Tom; Heidsma, Charlotte M.; Koemans (Onze Lieve Vrouwe Gasthuis, Willem J.; Amsterdam, ; Netherlands), The; Dekker, Jan-Willem T.; Van Der Zijden, Charlène J.; Roos (Reinier de Graaf Gasthuis, Daphne; Delft, ; Netherlands), The; Demirkiran, Ahmet; van der Burg (Red Cross Hospital, Sjirk; Beverwijk, ; Netherlands), The; Oosterling, Steven J.; Hoogteijling (Spaarne Gasthuis, Tijs J.; Haarlem, ; Netherlands), The; Wiering, Bastiaan; Smeeing (Slingeland Ziekenhuis, Diederik P. J.; Netherlands), Doetinchem; Havenga, Klaas; Lutfi, Hamid; Consten (University Medical Centre Groningen, Esther C. J.; Groningen, ; Netherlands), The; Tsimogiannis, Konstantinos; Sköldberg, Filip; Folkesson (Uppsala University, Joakim; Sweden), Uppsala; Den Boer, Frank; Van Schaik, Ted G.; van Gerven (Zaans Medical Center, Pieter; Zaandam, ; Netherlands), The; Sietses, Colin; Hol (Gelderse Vallei Hospital Ede, Jeroen C.; Ede, ; Netherlands), The; Boerma, Evert-Jan G.; Creemers (Zuyderland Medical Center, Davy M. J.; Sittard/heerlen, ; Netherlands), The; Schultz, Johannes K.; Frivold, Tone; Riis (Akershus University Hospital, Rolf; Norway), Lørenskog; Gregussen, Hilde; Busund (Hospital innland Hamar, Sondre; Norway), Hamar; Sjo, Ole H.; Gaard, Maria; Krohn, Nina; Ersryd (Ullevål Oslo University Hospital, Amanda L.; Norway), Oslo; Leung (Hereford County Hospital, Edmund; Hereford, ; Kingdom), United; Waqar, Usama; Chawla, Tabish; Rauf, Hareem; Rani (Aga Khan University, Pallavi; City, Karachi; Pakistan), ; Sultan, Hytham; Nabil Hajjaj, Baraa; Jehad Alhisi, Ahmed; Khader (Al-Shifa Hospital, Ahmed A. E.; City, Gaza; Palestine), ; Filipa Dias Mendes, Ana; Semião, Miguel; Queiroz Faria, Luis; Azevedo (Centro Hospitalar Universitário Cova da Beira, Constança; Portugal), Covilha; Da Costa Devesa, Helena M.; Fortuna Martins, Sónia; Rodrigues Jarimba, Aldo M.; Ribeiro Marques (Hospital Distrital de Santarém, Sónia M.; Portugal), Santarém; Marques Ferreira, Rita; Oliveira, António; Ferreira, Cátia; E Alto Douro Epe, Ricardo Pereira (Centro Hospitalar de Trás-os-Montes; Real, Vila; Portugal), ; Surlin, Valeriu M.; Graure, Giorgiana M.; Ramboiu (Clinical County Emergency Hospital of Craiova, Stefan Patrascu Sandu D.; Of Medicine And Pharmacy Of Craiova, University; Romania), ; Negoi, Ionut; Ciubotaru, Cezar; Stoica, Bogdan; Tanase (Carol Davila University of Medicine and Pharmacy Bucharest, Ioan; Romania), Bucharest; Stoica, Bogdan; Ciubotaru, Cezar; Negoita (Clinical Emergency Hospital Bucharest, Valentina M.; Romania), Bucharest; Florea, Sabrina; Macau, Florin; Vasile, Mihai; Carol Davila, Victor Stefanescu (Central Military Emergency Hospital Dr.; Romania), Bucharest; Dimofte, Gabriel-Mihail; Luncă, Sorinel; Roată, Cristian-Ene; Mușină (Regional Oncology Institute, Ana-Maria; Romania), Iasi; Garmanova, Tatiana; Agapov, Mikhail N.; Markaryan, Daniil G.; Eduard (Lomonosov Moscow State University, Galliamov; Russia), Moscow; Yanishev, Alexey; Abelevich, Alexander; Bazaev (Privolzhsky Research Medical University, Andrey; Novgorod, Nizhny; Russia), ; Rodimov, Sergey V.; Filimonov, Victor B.; Melnikov, Andrey A.; Suchkov (Ryazan State Medical University, Igor A.; Russia), Ryazan; Drozdov, Evgeniys.; Kostromitskiy (Siberian State Medical University, Dmitriy N.; Russia), Tomsk; Sjöström (Östersund Hospital, Olle; Sweden), Östersund; Matthiessen, Peter; Baban, Bayar; Gadan, Soran; Dehlaghi Jadid (chool of Medical Sciences, Kaveh; University, Örebro; Sweden), Örebro; Staffan (Region Dalarna Hospital, Maria; University, Dalarna; Sweden), Falun; Park, Jennifer M.; Rydbeck (Scandinavian Surgical Outcomes Research Group, Daniel; Of Clinical Sciences, Institute; Academy, Sahlgrenska; Of Gothenburg, University; Sweden, Gothenburg; Västra Götaland, Region; University Hospital/östra, Sahlgrenska; Sweden), Gothenburg; Lydrup, Marie-Louise; Buchwald, Pamela; Jutesten, Henrik; Darlin, Lotten; Lindqvist (Skåne Univeristy Hospital, Ebba; Sweden), Malmö; Nilsson, Karl; Larsson (Skaraborgs Hospital, Per-Anders; Sweden), Skövde; Staffan Jangmalm (Växjö Hospital, 186; Sweden), Växjö; Košir, Jurij A.; Tomažič, Aleš; Grosek, Jan; Košir Božič (Ljubljana University Medical Center, Tajda; Slovenia), Ljubljana; Zazo, Aya; Zazo, Rama; Fares, Hala; Ayoub (University of Aleppo, Kusay; Syria), Aleppo; Niazi, Ammar; Mansour, Ali; Abbas, Ayman; Tantoura (The Arabic Medicine Hospital, Mohammad; Syria), Aleppo; Hamdan, Alaa; Hassan, Naya; Hasan, Bassam; Saad (Tishreen University, Ahmad; Syria), Latakia; Sebai, Amine; Haddad, Anis; Maghrebi, Houcine; Kacem (La Rabta Hospital, Montasser; Tunisia), Tunis; Yalkın, Ömer; Veysi Samsa, Mehmet; Atak (Ali Osman Sönmez Oncology Hospital, İbrahim; Turkiye), Bursa; Balci, Bengi; Haberal, Elifcan; Dogan (Ankara Oncology Training and Research Hospital, Lütfi; Turkiye), Ankara; Gecim, Ibrahim E.; Akyol, Cihangir; Koc (Ankara University Medical School, Mehmet A.; Turkiye), Ankara; Sivrikoz, Emre; Piyadeoğlu (Bahçeşehir University, Deniz; Turkiye), Istanbul; Larkin, John O.; James’S, Dara O. avanagh (St.; Dublin, Hospital; Ireland), ; Sökmen, Selman; Bişgin, Tayfun; Günenç, Erşan; Güzel (Dokuz Eylul University, Melek; Izmir, Balcova; Turkiye), ; Leventoğlu, Sezai; Yüksel, Osman; Kozan, Ramazan; Göbüt (Gazi University Medical School, Hüseyin; Turkiye), Ankara; Cengiz, Fevzi; Erdinc, Kemal; Coşgun Acar, Nihan; Kamer (Izmir Katip Celebi University, Erdinc; Turkiye), İzmir; Özgür, İlker; Aydın, Oguzhan; Keskin, Metin; Türker Bulut, Mehmet; Kulle (Istanbul University, Cemil B.; Faculty Of Medicine, Istanbul; Turkiye), Istanbul; Kara, Yasin; Sıbıç (University of Health Sciences, Osman; Sultan Suleyman Training And Research Hospital, Kanuni; Turkiye), Istanbul; Özata, İbrahim H.; Buğra, Dursun; Balık, Emre; Kulle (Koç University Hospital, Cemil B.; Turkiye), Istanbul; Çakır, Murat; Alhardan (Meram Tip Faculty Hospital, Anas; Turkiye), Meram/konya; Colak, Elif; Ciftciengin Aybar, Ahmet B.; Can Sari (University of Samsun, Ahmet; Training And Research Hospital, Samsun; Turkiye), Samsun; Demirli Atici, Semra; Kaya, Tayfun; Dursun, Ayberk; Calik (University of Health Sciences, Bulent; Training And Research Hospital, Tepecik; Turkiye), Izmir; Faruk Özkan, Ömer; Şeyda Ülgür, Hanife; Düzgün (University of Health Sciences Turkiye, Özgül; Training And Research Hospital, Ümraniye; Turkiye), Istanbul; Monson, John; George, Sarah; Woods (AdventHealth Orlando, Kayla; Florida, Orlando; States of America), United; Al-Eryani, Fatima; Albakry (Al-Kuwait Hospital, Rudaina; Yemen), Sana’A; George’S Hospital, Emile Coetzee (Life St.; Elizabeth, Port; Cape, Eastern; Africa), South; Boutall, Adam; Herman, Ayesiga; Warden, Claire; Mugla (Groote Schuur Hospital and University of Cape Town, Naser; Town, Cape; Africa), South; Forgan, Tim; Mia, Imraan; Lambrechts (Tygerberg Academic Hospital, Anton; Parow, ; Town, Cape; Africa, South. - In: ANNALS OF SURGERY. - ISSN 0003-4932. - 278:5(2023), pp. 772-780. [10.1097/sla.0000000000006043]
Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage
Alfredo AnnicchiaricoMembro del Collaboration Group
;
2023-01-01
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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
