Nomogram for Predicting Anastomotic Leakage after Rectal Cancer Surgery in Elderly Patients with Dysfunctional Stomata

Figures & data

Table 1 Patient characteristics

	AL, n (%)	No AL, n (%)	P
Patients, n	63 (19.33%)	263 (80.67%)	—
Age (years)			0.667
<75	39 (61.90%)	155 (58.94%)
≥75	24 (38.10%)	108 (41.06%)
Sex			0.003
Male	53 (84.13%)	177 (67.30%)
Female	10 (15.87%)	86 (32.70%)
BMI (kg/m^2)	22.40±3.11	22.20±3.17	0.661
Comorbidity	31 (49.21%)	90 (34.22%)	0.035
ASA score			0.010
1 or 2	49 (77.78%)	243 (92.40%)
≥3	14 (22.22%)	20 (7.60%)
Preoperative Hb (g/dL)	118.70±17.39	120.93±16.84	0.323
Preoperative albumin (g/L)	39.73±4.26	39.29±4.06	0.319
Neoadjuvant chemotherapy	21 (33.33%)	68 (25.86%)	0.258
Neoadjuvant radiotherapy	10 (15.87%)	23 (8.75%)	0.154
Surgical approach			0.198
Laparoscopy	55 (87.30%)	245 (93.16%)
Open	8 (12.70%)	18 (6.84%)
Surgical method			0.539
Dixon	40 (63.49%)	179 (68.06%)
Parks and Nose	23 (36.51%)	84 (31.94)
Operation time	291.92±90.22	268.15±88.59	0.083
Pathological T stage			0.034
T1–T2	15 (23.81%)	99 (37.64%)
T3–T4	48 (76.19%)	164 (62.36%)
Pathological N stage			0.018
N0	34 (53.97%)	190 (72.24%)
N1	20 (31.75%)	56 (21.29%)
N2	9 (14.28%)	17 (6.46%)
Metastasis			0.147
Yes	7 (11.11%)	13 (4.94%)
No	56 (88.89%)	250 (95.06%)
Distance from anal verge (cm)			0.327
>5	32 (50.79%)	151 (57.41%)
≤5	31 (49.21%)	112 (42.59%)
Anastomosis method			0.480
Stapled	51 (80.95%)	202 (76.81%)
Hand-sewn	12 (19.05%)	61 (23.19%)

Table 2 Univariate and multivariate logistic regression model for risk factors of AL

		Univariate	Multivariate
		P	HR (95% CI)	P
Sex	Male vs female	0.010	0.339 (0.144–0.802)	0.014
Age (years)	≥75 vs <75	0.666
BMI (kg/m^2)		0.660
Comorbidity	Absent vs present	0.028	1.806 (0.886–3.670)	0.102
ASA score	1 or 2 vs ≥3	0.001	3.250 (1.310–8.064)	0.011
Preoperative Hb (g/dL)		0.347
Preoperative albumin(g/L)		0.448
Neoadjuvant chemotherapy	Absent vs present	0.233
Neoadjuvant radiotherapy	Absent vs present	0.097	2.876 (1.030–8.032)	0.044
Surgical approach	Laparoscopy vs open	0.129
Surgical method	Dixon vs Parks or Nose	0.319
Anastomosis method	Stapled vs hand-sewn	0.479
Operation time		0.016	4.314 (0.972–19.157)	0.055
Pathological T stage	T1 and T2 vs T3 and T4	0.048	1.063 (0.722–1.567)	0.755
Pathological N stage	N0 vs N1 vs N2	0.009	1.420 (0.876–2.300)	0.155
Metastasis	Absent vs present	0.074	1.552 (0.460–5.231)	0.479
Distance from anal verge (cm)	>5 vs ≤5	0.327

Figure 1 Forest plot.

Figure 2 Nomogram for predicting anastomotic leakage (C index 0.645) after rectal cancer surgery. Incidence of anastomotic leakage was estimated by summing scores of sex, ASA score, and neoadjuvant radiotherapy.

Figure 3 (A) ROC curve for the nomogram. AUC was 0.645 (95% CI 0.762–0.903). (B) Nomogram calibration curve. The y‐axis represents the actual probability of anastomotic leakage. The x‐axis represents predicted anastomotic leakage probability. The ideal line represents a perfect prediction model. The apparent line represents the performance of the nomogram, and a close fit to the ideal line represents a good prediction.