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

Table 5 Radiology

Author	Type of study	Loe	n (CAL/non-CAL)	Colorectal/rectum	Stapled/handsewn anastomosis	Study tool	Se	Sp	PPV	NPV	Main outcome
Eckmann et al[77]	Retro	3b	30/306	Rectum	Stapled	CT	-	-	-	-	29 of 30 CAL detected by CT
Power et al[78]	Retro	3b	17/50	Colorectal	?	CT	0.30	0.90	0.58	0.74	Peri-anastomotic located fluid containing air found in CAL
Gouya et al[75]	Retro	3b	10/195	Rectum	?	CT	-	-	1.00	1.00	CT has role in predicting CAL
DuBrow et al[68]	Retro	3b	35/75	Rectum	?	CT	-	-	-	-	30% of pts with CAL have presacral abnormalities
Nicksa et al[73]	Retro	4	36 CAL	Rectum	?	CT	0.12	-	-	-	Low percentage true positives
Doeksen et al[67]	Retro	3b	68/429	Colorectal	?	CT	0.54	0.78	0.68	0.66	Interobserver variability 10%
Nesbakken et al[20]	Pro	3b	5/56	Rectum	?	CT	0.57	1.00	-	-	94% accuracy of CT for detection of CAL
Severini et al[74]	Retro	3b	12/175	Rectum	?	WSCE	-	-	-	-	2 CAL out of 78 positive WSCE, low predictive value
Hoffmann et al[70]	Retro	3b	5/51	Colorectal	Both	WSCE	0.20	0.85	0.13	0.91	WSCE not recommended for routine use
Markham et al[72]	Retro	3b	1/136	Rectum	Handsewn	WSCE	1.00	0.57	0.02	1.00	WSCE no contribution to surgical management
Kalady et al[71]	Retro	3b	8/211	Rectum	?	WSCE	0.88	1.00	1.00	0.99	WSCE does not provide additional information
Akyol et al[66]	Pro	3b	12/233	Colorectal	Both	WSCE	0.52	0.87	0.30	0.94	WSCE provides little useful clinical information
Haynes et al[69]	Retro	3b	14/117	Colorectal	Both	WSCE	0.71	0.86	0.42	0.96	WSCE not recommended for routine use
Gouya et al[75]	Retro	3b	10/195	Rectum	?	WSCE	-	-	1.00	0,98	WSCE is recommended for routine use
Nicksa et al[73]	Retro	4	36 CAL	Rectum	?	WSCE	0.88	-	-	-	WSCE superior to CT
Doeksen et al[67]	Retro	3b	68/429	Colorectal	?	WSCE	0.68	0.94	0.91	0.76	Interobserver variability 13%
Nesbakken et al[20]	Pro	3b	5/56	Rectum	?	WSCE	0.60	1.00	-	-	93% accuracy of WSCE for detection of CAL
Williams et al[76]	Retro	4	10/31	Rectum	Stapled	X-ray	0.90	1.00	1.00	0.95	Staple line dehiscence in 9/10 patients with CAL
Tang et al[79]	Pro	4	2/64	Colorectal	?	X-ray	-	-	-	-	Increase free air after POD 5 higher chance CAL

Pro: Prospective; Retro: Retrospective; Meta: Meta-analysis; Leo: Level of evidence; CAL: Colorectal anastomotic leakage; CT: Computer tomography; WSCE: Water-soluble contrast enema; Se: Sensitivity; Sp: Specificity; PPV: Positive predictive value; NPV: Negative predictive value; POD: Postoperative day.