Non-specific risk factors for predicting intestinal anastomotic leakage following right/left hemicolectomy and sigmoidectomy: development and internal validation of a model
https://doi.org/10.21294/1814-4861-2025-24-6-19-30
Abstract
Objective. Тhis study aimed to identify early predictors of intestinal anastomotic leakage following hemicolectomies.
Material and Methods. We conducted a retrospective analysis of 583 patients who underwent elective hemicolectomies and sigmoid resections at the Ulyanovsk Regional Oncology Center from 2019 to 2024. Patients with fatal outcomes from comorbid conditions or emergency surgeries were excluded. Complications were assessed using the Clavien-Dindo classification, while tumors were evaluated using the ТNM classification. Statistical analysis involved methods for comparing quantitative and categorical data, assessing odds ratios, and developing a predictive model using logistic regression and ROC analysis.
Results. Statistically significant risk factors for intestinal anastomotic leakage were: colostomy before surgery (p<0.001); multiorgan resections (p<0.001); albumin levels before surgery (p=0.001) albumin levels on day 1 after surgery (p<0.001); albumin levels on day 5 after surgery (p=0.032), neutrophil counts on day 5 after surgery (p=0.012), and operation time (p=0.048).
Conclusion. In our study, the incidence of intestinal anastomotic leakage was 48 (8.24%). Multivariate analysis identified the following statistically significant factors for developing anastomotic leakage: cancer stage, Т-spread of the primary tumor, presence of metastases, operation time, length of hospital stay, preoperative colostomy, multiorgan resection, Clavien–Dindo complications, blood loss volume, type of surgery, albumin levels before surgery, albumin levels on day 1 and day 5 after surgery, neutrophil counts on day 1 and day 5 after surgery, lymphocyte counts on day 1 after surgery, and the neutrophil-to-lymphocyte ratio on day 1 and day 5 after surgery.
Supporting agencies: This study required no funding
About the Authors
E. A. Toneev
Regional Clinical Oncology Center; Ulyanovsk State University
Russian Federation
Russian Federation
Evgeny A. Toneev - MD, PhD, Thoracic Surgeon, Department of Thoracic Oncology, Regional Clinical Oncology Center; Associate Professor, Department of Faculty Surgery, T.Z. Biktimirov Faculty of Medicine, Institute of Medicine, Ecology and Physical Culture.
90, 12 Sentyabrya St., Ulyanovsk, 432017; 2/1, Arkhitektora Livchaka St., Ulyanovsk, 432017
D. D. Prokhorov
Ulyanovsk State University
Russian Federation
Russian Federation
Daniil D. Prokhorov - MD, Resident, Department of Hospital Surgery, Anesthesiology, Resuscitation, Urology, Traumatology, and Orthopedics, Faculty of Dentistry, Pharmacy, and Postgraduate Medical Education, Institute of Medicine, Ecology and Physical Education.
2/1, Arkhitektora Livchaka St., Ulyanovsk, 432017
M. O. Pavlov
Ulyanovsk State University
Russian Federation
Russian Federation
Maxim O. Pavlov - 5th-year student, T.Z. Biktimirov Faculty of Medicine, Institute of Medicine, Ecology and Physical Culture.
2/1, Arkhitektora Livchaka St., Ulyanovsk, 432017
E. A. Rodionova
Samara State Medical University
Russian Federation
Russian Federation
Evgeniya A. Rodionova - 5th-year student.
89, Chapaevskaya St., Samara, 443099
Z. F. Gasanov
Samara State Medical University
Russian Federation
Russian Federation
Zaur F. Gasanov - 6th-year student.
89, Chapaevskaya St., Samara, 443099
References
1. Cherkasov M.F., Dmitriev A.V., Pereskokov S.V., Kozyrevskiy M.A., Afunts L.S. Risk factors and their impact on the viability of a colorectal anastomosis. Modern Problems of Science and Education. 2018; 4: 141. (in Russian). EDN: MGDMWT.
2. Ivanov Y.V., Smirnov A.V., Davidovich D.L., Keshvedinova A.A., Razbirin D.V., Stankevich V.R., Danilina E.S. Predictors of anastomotic leak after anterior rectal resections for localized malignant neoplasms. Journal of Clinical Practice. 2024; 15(1): 7–16. (in Russian). doi: 10.17816/clinpract623690. EDN: TZYWHN.
3. Kolesnik O.P., Kolesnyk I.P., Kechedzhyiev V.V. The anastomotic failure impact on the surgical treatment results for colorectal cancer (Literature review). Surgery of Ukraine 2019; 2: 92–99. (in Russian). doi: 10.30978/SU2019-2-92. EDN: VRINJZ.
4. Akhmetzyanov F.Sh., Egorov V.I. Colorecral anastomosis failure (Literature review). Siberian Journal of Oncology. 2016; 15(2): 107–12. (in Russian). doi: 10.21294/1814-48612016-15-2-107-112. EDN: WAIJXH.
5. Darbishgadjiev SH.O., Vihrev D.V., Baulin A.A., Kaganov O.I., Gudoshnikov V.YU., Nikishin S.A. Prediction of the failure of colonic anastomoses during resection of the left parts of the colon and rectum. Medical news of the North Caucasus. 2021; 16(4): 382–86. (in Russian). doi: 10.14300/mnnc.2021.16091. EDN: FAFMZO.
6. Kulikov V.D., Danilova L.A., Prokhorov D.D., Midlenko O.V., Zhinov A.V., Toneev E.A., Shagdaleev R.F., Mukhutdinova A.N., Martynova E.V., Murtazin A.R., Pavlov M.O., Nuretdinov D.I., Choshchiev A. Database of hemicolectomies performed in the regional oncological dispensary over a three-year period. Certificate of state registration of the database. No. 2024622330 Russian Federation: No. 2024622107: application. 16.05.2024: publ. 29.05.2024. (in Russian). EDN: LECDWF.
7. Clavien P.A., Barkun J., de Oliveira M.L., Vauthey J.N., Dindo D., Schulick R.D., de Santibañes E., Pekolj J., Slankamenac K., Bassi C., Graf R., Vonlanthen R., Padbury R., Cameron J.L., Makuuchi M. The Clavien-Dindo classification of surgical complications: fiveyear experience. Ann Surg. 2009; 250(2): 187–96. doi: 10.1097/SLA.0b013e3181b13ca2.
8. Amin M.B., Edge S.B., Greene F.L. et al., editors. AJCC Cancer Staging Manual. 8th ed. New York: Springer, 2017.
9. Wang Y., Huang X., Cheryala M., Aloysius M., Zheng B., Yang K., Chen B., Fang Q., Chowdary S.B., Abougergi M.S., Chen S. Global increase of colorectal cancer in young adults over the last 30 years: an analysis of the Global Burden of Disease Study 2019. J Gastroenterol Hepatol. 2023; 38(9): 1552–58. doi: 10.1111/jgh.16220.
10. Ang Z.H., Wong S.W. Prevention of Anastomotic Leak in Colorectal Surgery: Current Knowledge and Next Steps. Open Access Surgery. 2024; 17: 11–20. doi: 10.2147/OAS.S429415.
11. Parthasarathy M., Greensmith M., Bowers D., Groot-Wassink T. Risk factors for anastomotic leakage after colorectal resection: a retrospective analysis of 17 518 patients. Colorectal Dis. 2017; 19(3): 288–98. doi: 10.1111/codi.13476.
12. Liu F., Wang L.L., Liu X.R., Li Z.W., Peng D. Risk Factors for Radical Rectal Cancer Surgery with a Temporary Stoma Becoming a Permanent Stoma: A Pooling Up Analysis. J Laparoendosc Adv Surg Tech A. 2023; 33(8): 743–49. doi: 10.1089/lap.2023.0119.19.
13. Khasanov A.G., Sufiyarov I.F., Bakirov E.R., Yamalova G.R. Colonic anastomoses leakage. Bashkortostan Medical Journal. 2020; 15(1): 75–79. (in Russian). EDN: WHOIZL.
14. Shelygin Yu.A., Tarasov M.A., Zarodnyuk I.V., Nagudov M.A., Alekseev M.V., Rybakov E.G. The role of neutrophil-to-lymphocyte ratio in the diagnosis of low colorectal anastomosis leakage. Coloproctology. 2017; (4): 74–81. (in Russian). doi: 10.33878/2073-7556-2017-0-4-74-81. EDN: ZUCPEX.
15. Haghi S.E., Khanzadeh M., Sarejloo S., Mirakhori F., Hernandez J., Dioso E., Goutnik M., Lucke-Wold B., Ghaedi A., Khanzadeh S. Systematic review of the significance of neutrophil to lymphocyte ratio in anastomotic leak after gastrointestinal surgeries. BMC Surg. 2024; 24(1): 15. doi: 10.1186/s12893-023-02292-0.
16. Rojas-Machado S.A., Romero-Simó M., Arroyo A., Rojas-Machado A., López J., Calpena R. Prediction of anastomotic leak in colorectal cancer surgery based on a new prognostic index PROCOLE (prognostic colorectal leakage) developed from the meta-analysis of observational studies of risk factors. Int J Colorectal Dis. 2016; 31(2): 197–210. doi: 10.1007/s00384-015-2422-4.
17. McKenna N.P., Bews K.A., Cima R.R., Crowson C.S., Habermann E.B. Development of a Risk Score to Predict Anastomotic Leak After Left-Sided Colectomy: Which Patients Warrant Diversion? J Gastrointest Surg. 2020; 24(1): 132–43. doi: 10.1007/s11605-019-04293-y.
Review
For citations:
Toneev E.A., Prokhorov D.D., Pavlov M.O., Rodionova E.A., Gasanov Z.F. Non-specific risk factors for predicting intestinal anastomotic leakage following right/left hemicolectomy and sigmoidectomy: development and internal validation of a model. Siberian journal of oncology. 2025;24(6):19-30. (In Russ.) https://doi.org/10.21294/1814-4861-2025-24-6-19-30
Views:
33
JATS XML
Email this article 
