Prediction and diagnosis of colorectal anastomotic leakage: A systematic review of literature

Table 1 Clinical methods

Author	Type ofstudy	Loe	n (CAL/non-CAL)	Colorectal/rectum	Stapled/handsewn anastomosis	Study subject/tool		Se	Sp	PPV	NPV	ROC	Main outcome
Dekker et al[22]	Pro	3b	10/121	Colorectal	?	Leakage score		-	-	-	-	0.95	OR = 1.74 for leakage score predictive of CAL
den Dulk et al[23]	Pro	2b	21/223	Colorectal	Both	Leakage score		-	-	-	-	-	Delay of treatment reduced from 4 d to 1.5 d
Sutton et al[18]	Pro	3b	22/398	Colorectal	?	Clinical symptoms		0.33	0.97	0.59	0.93		Over 40% of patients with cardiac event has CAL
Haase et al[19]	Pro	4	3/40	Colorectal	?	Clinical symptoms		-	-	-	-	-	No difference in heart rate variability between CAL and non-CAL
Ghariani et al[17]	Retro	3b	23/314	Colon	?	Clinical symptoms		-	-	-	-	-	Respiratory, neurological disorders and bloating precipitate CAL
Bellows et al[16]	Retro	3b	25/311	Colorectal	?	Clinical symptoms	Respiratory symptoms	0.52	0.84	0.22	0.95	-	Respiratory, neurological disorders and abdominal pain and distension precipitate CAL
							Neurology symptoms	0.24	0.97	0.4	0.94	-
							Abdominal pain and distension	0.52	0.83	0.21	0.95	-
Nesbakken et al[20]	Pro	3b	5/56	Rectum	?	Clinical symptoms	Daily assessment by surgeon	0.50	0.89	0.5	0.89	-	50% of CAL is silent
Tang et al[21]	Pro	3b	10/195	Rectum	Both	Digital rectal examination		0.98	-	-	-	-	As valuable as WSCE before stoma closure
Pettigrew et al[13]	Pro	3b	28/113	Colorectal and general	?	Risk prediction by surgeon		0.38	0.91	0.56	0.82		Highest predictive value for postop surg assessment
Makela et al[14]	Retro	3b	44/88	Rectum	Both	Risk prediction by surgeon		-	-	-	-	-	In 86% of pts with > 3 risk factors CAL occurs
Karliczek et al[15]	Pro	3b	26/191	Colorectal	?	Risk prediction by surgeon	High anastomosis	0.38	0.46	-	-	-	Low predictive value for prediction of CAL by surgeon
							Low anastomosis	0.62	0.52	-	-	-

Pro: Prospective; Retro: Retrospective; Loe: Level of evidence; CAL: Colorectal anastomotic leakage; Se: Sensitivity; Sp: Specificity; PPV: Positive predictive value; NPV: Negative predictive value; ROC: Receiver-operating characteristic curve; WSCE: Water soluble contrast enema.