Anastomic leak in colorectal cancer surgery. Development of a diagnostic index (DIACOLE)

• We have obtained a diagnostic score (DIACOLE) to detect anastomotic leakage.
• We identified 13 potential signs and symptoms of anastomotic leakage.
• If the DIACOLE is > 3.065, a blood count and re-evaluating.
• If the DIACOLE > 5.436, a radiological test is advised.

BackgroundWe have obtained a diagnostic score (DIACOLE) in order to detect anastomotic leakage in the postoperative period of colorectal cancer surgery.MethodsSystematic 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.ResultsWe 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.ConclusionsIf 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.