Hoek et al reported a nomogram for predicting anastomotic leak in a patient undergoing a colorectal cancer resection. This can help to identify a patient who may benefit from more aggressive management. The authors are from multiple institutions in The Netherlands.
Patient selection: colorectal cancer resection
Parameters:
(1) sex
(2) age in years, from 10 to 100
(3) body mass index (BMI) in kg per square meter
(4) ASA status from 1 to 4
(5) clinical T stage
(6) tumor distance from anal verge in cm, from 0 to 160
(7) chemoradiation
(8) deviating stoma
points for body mass index =
= (1.1067 * (BMI)) - 16.6
points for distance from anal verge =
= 100 - (0.625 * (distance))
|
Age of the Patient
|
Points
|
|
10 to 60
|
50.55 - (0.1007 * (age))
|
|
60 to 100
|
(-0.01575 * ((age)^2)) + (1.291 * (age)) + 24.03
|
|
Parameter
|
Finding
|
Points
|
|
sex
|
male
|
25.6
|
|
|
female
|
0
|
|
ASA status
|
1 or 2
|
0
|
|
|
3 or 4
|
15.5
|
|
clinical T stage
|
T1
|
0
|
|
|
T2
|
6.1
|
|
|
T3
|
15.9
|
|
|
T4
|
7.6
|
|
chemoradiation
|
no
|
0
|
|
|
chemoradiation
|
5.2
|
|
|
short-course radiotherapy
|
15.9
|
|
deviating stoma
|
no
|
42.8
|
|
|
yes
|
0
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 315
|
Score
|
Risk Group
|
Anastomotic Leak
|
|
0 to 137.9
|
low
|
5%
|
|
138 to 164.9
|
intermediate
|
8.5%
|
|
>= 165
|
high
|
16.4%
|
Performance:
• The area under the ROC curve is 0.68.
