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Artificial intelligence assists surgeons’ decision-making of temporary ileostomy in patients with rectal cancer who have received anterior resection

  • Author Footnotes
    1 These authors contributed equally to this work.
    Shengli Shao
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China

    Molecular Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Yufeng Zhao
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Vascular Surgery, First Hospital of Lanzhou University, 730030, Lanzhou, China
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  • Qiyi Lu
    Affiliations
    Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China

    Molecular Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
    Search for articles by this author
  • Lu Liu
    Affiliations
    Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China

    Molecular Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
    Search for articles by this author
  • Lei Mu
    Affiliations
    Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China

    Molecular Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
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  • Jichao Qin
    Correspondence
    Corresponding author. Department of Surgery and Molecular Medicine Center, Tongji Hospital, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, China.
    Affiliations
    Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China

    Molecular Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.
Published:October 02, 2022DOI:https://doi.org/10.1016/j.ejso.2022.09.020

      Abstract

      Background

      Due to the difficult evaluation of the risk of anastomotic leakage (AL) after rectal cancer resection, the decision to perform a temporary ileostomy is not easily distinguishable. The aim of the present study was to develop an artificial intelligence (AI) model for identifying the risk of AL to assist surgeons in the selective implementation of a temporary ileostomy.

      Materials and methods

      The data from 2240 patients with rectal cancer who received anterior resection were collected, and these patients were divided into one training and two test cohorts. Five AI algorithms, such as support vector machine (SVM), logistic regression (LR), Naive Bayes (NB), stochastic gradient descent (SGD) and random forest (RF) were employed to develop predictive models using clinical variables and were assessed using the two test cohorts.

      Results

      The SVM model indicated good discernment of AL, and might have increased the implementation of temporary ileostomy in patients with AL in the training cohort (p < 0.001). Following the assessment of the two test cohorts, the SVM model could identify AL in a favorable manner, which performed with positive predictive values of 0.150 (0.091–0.234) and 0.151 (0.091–0.237), and negative predictive values of 0.977 (0.958–0.988) and 0.986 (0.969–0.994), respectively. It is important to note that the implementation of temporary ileostomy in patients without AL would have been significantly reduced (p < 0.001) and which would have been significantly increased in patients with AL (p < 0.05).

      Conclusion

      The model (https://alrisk.21cloudbox.com/) indicated good discernment of AL, which may be used to assist the surgeon's decision-making of performing temporary ileostomy.

      Keywords

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      References

        • Carlsen E.
        • Schlichting E.
        • Guldvog I.
        • Johnson E.
        • Heald R.J.
        Effect of the introduction of total mesorectal excision for the treatment of rectal cancer.
        Br J Surg. 1998; 85: 526-529
        • Law W.L.
        • Chu K.W.
        Anterior resection for rectal cancer with mesorectal excision: a prospective evaluation of 622 patients.
        Ann Surg. 2004; 240: 260-268
        • Boström P.
        • Haapamäki M.M.
        • Rutegård J.
        • Matthiessen P.
        • Rutegård M.
        Population-based cohort study of the impact on postoperative mortality of anastomotic leakage after anterior resection for rectal cancer.
        BJS open. 2019; 3: 106-111
        • Matthiessen P.
        • Hallböök O.
        • Rutegård J.
        • Simert G.
        • Sjödahl R.
        Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial.
        Ann Surg. 2007; 246: 207-214
        • Hüser N.
        • Michalski C.W.
        • Erkan M.
        • Schuster T.
        • Rosenberg R.
        • Kleeff J.
        • et al.
        Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery.
        Ann Surg. 2008; 248: 52-60
        • Wu S.W.
        • Ma C.C.
        • Yang Y.
        Role of protective stoma in low anterior resection for rectal cancer: a meta-analysis.
        World J Gastroenterol. 2014; 20: 18031-18037
        • Garg P.K.
        • Goel A.
        • Sharma S.
        • Chishi N.
        • Gaur M.K.
        Protective diversion stoma in low anterior resection for rectal cancer: a meta-analysis of randomized controlled trials.
        Visceral Med. 2019; 35: 156-160
        • Danielsen A.K.
        • Park J.
        • Jansen J.E.
        • Bock D.
        • Skullman S.
        • Wedin A.
        • et al.
        Early closure of a temporary ileostomy in patients with rectal cancer: a multicenter randomized controlled trial.
        Ann Surg. 2017; 265: 284-290
        • Vallance A.
        • Wexner S.
        • Berho M.
        • Cahill R.
        • Coleman M.
        • Haboubi N.
        • et al.
        A collaborative review of the current concepts and challenges of anastomotic leaks in colorectal surgery.
        Colorectal Dis : Off J Assoc Coloproctol Great Britain Ireland. 2017; 19: 1-12
        • Arezzo A.
        • Migliore M.
        • Chiaro P.
        • Arolfo S.
        • Filippini C.
        • Di Cuonzo D.
        • et al.
        The REAL (REctal Anastomotic Leak) score for prediction of anastomotic leak after rectal cancer surgery.
        Tech Coloproctol. 2019; 23: 649-663
        • Hu X.
        • Cheng Y.
        A clinical parameters-based model predicts anastomotic leakage after a laparoscopic total mesorectal excision: a large study with data from China.
        Medicine. 2015; 94e1003
        • Klose J.
        • Tarantino I.
        • von Fournier A.
        • Stowitzki M.J.
        • Kulu Y.
        • Bruckner T.
        • et al.
        A nomogram to predict anastomotic leakage in open rectal surgery-hope or hype?.
        J Gastrointest Surg : Off J Soc Surg Aliment Tract. 2018; 22: 1619-1630
        • D’Ascenzo F.
        • De Filippo O.
        • Gallone G.
        • Mittone G.
        • Deriu M.A.
        • Lannaccone A.
        • et al.
        Machine learning-based prediction of adverse events following an acute coronary syndrome (PRAISE): a modelling study of pooled datasets.
        Lancet (London, England). 2021; 397: 199-207
        • Komorowski M.
        • Celi L.A.
        • Badawi O.
        • Gordon A.C.
        • Faisal A.A.
        The Artificial Intelligence Clinician learns optimal treatment strategies for sepsis in intensive care.
        Nat Med. 2018; 24: 1716-1720
        • Kudo S.E.
        • Ichimasa K.
        • Villard B.
        • Mori Y.
        • Misawa M.
        • Saito S.
        • et al.
        Artificial intelligence system to determine risk of T1 colorectal cancer metastasis to lymph node.
        Gastroenterology. 2021; 160 (84.e2): 1075
        • Ichimasa K.
        • Kudo S.E.
        • Mori Y.
        • Misawa M.
        • Matsudaira S.
        • Kouyama Y.
        • et al.
        Artificial intelligence may help in predicting the need for additional surgery after endoscopic resection of T1 colorectal cancer.
        Endoscopy. 2018; 50: 230-240
        • Catto J.W.
        • Abbod M.F.
        • Wild P.J.
        • Linkens D.A.
        • Pilarsky C.
        • Rehman I.
        • et al.
        The application of artificial intelligence to microarray data: identification of a novel gene signature to identify bladder cancer progression.
        Eur Urol. 2010; 57: 398-406
        • Shao S.
        • Liu L.
        • Zhao Y.
        • Mu L.
        • Lu Q.
        • Qin J.
        Application of machine learning for predicting anastomotic leakage in patients with gastric adenocarcinoma who received total or proximal gastrectomy.
        J Personalized Med. 2021; 11
        • Collins G.S.
        • Reitsma J.B.
        • Altman D.G.
        • Moons K.G.M.
        Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement.
        Eur Urol. 2015; 67: 1142-1151
        • Rahbari N.N.
        • Weitz J.
        • Hohenberger W.
        • Heald R.J.
        • Moran B.
        • Ulrich A.
        • et al.
        Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer.
        Surgery. 2010; 147: 339-351
        • Ihnát P.
        • Guňková P.
        • Peteja M.
        • Vávra P.
        • Pelikán A.
        • Zonča P.
        • et al.
        Diverting ileostomy in laparoscopic rectal cancer surgery: high price of protection.
        Surg Endosc. 2016; 30: 4809-4816
        • Yang K.
        • Zhao J.
        • Chu L.
        • Hu M.
        • Zhou W.
        • Li Y.
        • et al.
        Temporary impairment of renal function in patients with rectal cancer treated with diverting ileostomy.
        J Gastrointest Oncol. 2021; 12: 620-629
        • Du R.
        • Zhou J.
        • Tong G.
        • Chang Y.
        • Li D.
        • Wang F.
        • et al.
        Postoperative morbidity and mortality after anterior resection with preventive diverting loop ileostomy versus loop colostomy for rectal cancer: a updated systematic review and meta-analysis.
        Eur J Surg Oncol : J Eur Soc Surg Oncol British Assoc Surg Oncol. 2021; 47: 1514-1525
        • Hanna M.H.
        • Vinci A.
        • Pigazzi A.
        Diverting ileostomy in colorectal surgery: when is it necessary?.
        Langenbeck's Arch Surg. 2015; 400: 145-152
        • Shimizu H.
        • Yamaguchi S.
        • Ishii T.
        • Kondo H.
        • Hara K.
        • Takemoto K.
        • et al.
        Who needs diverting ileostomy following laparoscopic low anterior resection in rectal cancer patients? Analysis of 417 patients in a single institute.
        Surg Endosc. 2020; 34: 839-846
        • Park J.S.
        • Choi G.S.
        • Kim S.H.
        • Kim H.R.
        • Kim N.K.
        • Lee K.Y.
        • et al.
        Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group.
        Ann Surg. 2013; 257: 665-671
        • Kang C.Y.
        • Halabi W.J.
        • Chaudhry O.O.
        • Nguyen V.
        • Pigazzi A.
        • Carmichael J.C.
        • et al.
        Risk factors for anastomotic leakage after anterior resection for rectal cancer.
        JAMA Surg. 2013; 148: 65-71
        • Kim C.W.
        • Baek S.J.
        • Hur H.
        • Min B.S.
        • Baik S.H.
        • Kim N.K.
        • et al.
        Anastomotic leakage after low anterior resection for rectal cancer is different between minimally invasive surgery and open surgery.
        Ann Surg. 2016; 263: 130-137
        • Shiwakoti E.
        • Song J.
        • Li J.
        • Wu S.
        • Zhang Z.
        Prediction model for anastomotic leakage after laparoscopic rectal cancer resection.
        J Int Med Res. 2020; 48300060520957547
        • Wen R.
        • Zheng K.
        • Zhang Q.
        • Zhou L.
        • Liu Q.
        • Yu G.
        • et al.
        Machine learning-based random forest predicts anastomotic leakage after anterior resection for rectal cancer.
        J Gastrointest Oncol. 2021; 12: 921-932