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Anastomic leak in colorectal cancer surgery. Development of a diagnostic index (DIACOLE)
Silvia-Angélica Rojas-Machado1, Manuel Romero2, Antonio Arroyo3
1Coloproctology Unit, Department of Surgery, University Hospital of Alicante, Spain.
Background:
We have obtained a diagnostic score (DIACOLE) in order to detect anastomotic leakage in the postoperative period of colorectal cancer surgery.
Methods:
Systematic review to identify any symptoms and clinical or analytical signs associated with anastomotic leakage after colorectal cancer surgery and a meta-analysis of each of these factors. The DIACOLE score encompasses all factors that reached statistical significance in their respective meta-analyses. The value of each factor in the score was determined depending the Napierian logarithm of the odds ratios. The index was validated using collected data at our institution.
Results:
We identified 13 potential signs and symptoms of anastomotic leakage to elaborate the DIACOLE score. The predictive power of the DIACOLE was validated in a case-control study, resulting in an Area Under Curve (AUC) of 0.911 and a 95% confidence interval. These values were considered indicative of a very good diagnostic score.
Conclusions:
If DIACOLE score is > 3.065, a blood count and re-evaluating the score daily are recommended. If the DIACOLE>5.436, a radiological test is advised. We have developed free software to obtain DIACOLE value.
