OVA-LEAK: Prognostic score for colo-rectal anastomotic leakage in patients undergoing ovarian cancer surgery

Autores de IIS La Fe

• Víctor Lago Leal

  Autor

• Blanca Segarra Vidal

  Autor

• Pablo Padilla Iserte

  Autor

• Luis Javier Matute Tobias

  Autor

• Marta Gurrea Soteras

  Autor

• Lourdes Sala Climent

  Autor

• Manel Montesinos Albert

  Autor

• David Hervás Marín

  Autor

• Santiago Domingo Del Pozo

  Autor

Participantes ajenos a IIS La Fe

• Cappucio S.
• Angeles M.A.
• Fotopoulou C.
• Muallem M.Z.
• Manzanedo I.
• Iglesias J.L.S.
• Chacón E.
• Fagotti A.
• Ferron G.
• Kluge L.
• Vargiu V.
• Del M.
• Scambia G.
• Minig L.
• Tejerizo Á.
• Segovia M.G.
• Cascales-Campos P.A.
• Gil-Moreno A.
• Chiva L.
• Rinne N.
• Martinez A.

Grupos

• Medicina Fetal y Reproductiva

Abstract

Objective: The objective of the present study was to define and validate an anastomotic leak prognostic score based on previously described and reported anastomotic leak risk factors (OVA-LEAK: https://n9.cl/ova-leakscore) and to establish if the use of OVA-LEAK score is better than clinical criteria (surgeon's choice) selecting anastomosis to be protected with a diverting ileostomy. Material & methods: This is a retrospective, multicentre cohort study that included patients who underwent cytoreductive surgery for primary advanced or relapsed ovarian cancer with colorectal resection and anastomosis between January 2011 and June 2021. Data from patients already included in the previous predictive model were not considered in the present analysis. To validate the performance of our logistic regression model, we used the OVA-LEAK formula (Annex I: https://n9.cl/ova-leakscore) for estimating leakage probabilities in a new independent cohort. Then, receiver operating characteristic (ROC) analysis was performed and area under the curve (AUC) was used to measure the performance of the model. Additionally, the Brier score was also estimated. 95% confidence intervals (CI) for each of the estimated performance measures were also calculated. Results: 848 out of 1159 recruited patients were finally included in the multivariable logistic regression model validation. The AUC of the new cohort was 0.63 for predicting anastomotic leak. Considering a cut-off point of 22.1% to be ‘positive’ (to get a leak) this would provide a sensitivity of 0.45, specificity of 0.80, positive predictive value of 0.09 and negative predictive value of 0.97 for anastomotic leak. If we consider this cut-off point to select patients at risk of leak for bowel diversion, up to 22.5% of the sampled patients would undergo a diverting ileostomy and 47% (18/40) of the anastomotic leaks would be ‘protected’ with the stoma. Nevertheless, if we consider only the ‘clinical criteria’ for performing or not a diverting ileostomy, only 12.5% (5/40) of the leaks would be ‘protected’ with a stoma, with a rate of diverting ileostomy of up to 24.3%. Conclusions: Compared with subjective clinical criteria, the use of a predictive model for anastomotic leak improves the selection of patients who would benefit from a diverting ileostomy without increasing the rate of stoma use. © 2022 Elsevier Inc.

Keywords

• Anastomosis, Surgical; Anastomotic Leak; Cohort Studies; Female; Humans; Ileostomy; Neoplasm Recurrence, Local; Ovarian Neoplasms; Prognosis; Retrospective Studies; bevacizumab; corticosteroid; serum albumin; adult; advanced cancer; age; albumin blood level; American Society of Anaesthesiologists score; anastomosis leakage; appendectomy; Article; bladder injury; blood vessel injury; body mass; cancer patient; cancer prognosis; cancer recurrence; cholecystectomy; cohort analysis; colon stoma; colorectal anastomosis; colorectal surgery; cystectomy; cytoreductive surgery; diabetes mellitus; erythrocyte transfusion; female; hepatectomy; human; hyperthermic intraperitoneal chemotherapy; ileostomy; International Federation of Gynecology and Obstetrics; intestine injury; large intestine resection; long term care; lymph node dissection; major clinical study; middle aged; multicenter study (topic); neoadjuvant chemotherapy; omentectomy; operation duration; operative blood loss; OVA-LEAK score;