Background
Anastomotic leakage represents a major complication after anterior resection of the
rectum. The incidence of anastomotic leakage varies considerably among clinical studies
in part owing to the lack of a standardized definition of this complication. The aim
of the present article was to propose a definition and severity grading of anastomotic
leakage after anterior rectal resection.
Methods
After a literature review a consensus definition and severity grading of anastomotic
leakage was developed within the International Study Group of Rectal Cancer.
Results
Anastomotic leakage should be defined as a defect of the intestinal wall at the anastomotic
site (including suture and staple lines of neorectal reservoirs) leading to a communication
between the intra- and extraluminal compartments. Severity of anastomotic leakage
should be graded according to the impact on clinical management. Grade A anastomotic
leakage results in no change in patients’ management, whereas grade B leakage requires
active therapeutic intervention but is manageable without re-laparotomy. Grade C anastomotic
leakage requires re-laparotomy.
Conclusion
The proposed definition and clinical grading is applicable easily in the setting of
clinical studies. It should be applied in future reports to facilitate valid comparison
of the results of different studies.
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Article info
Publication history
Published online: December 11, 2009
Accepted:
October 5,
2009
Footnotes
Members of the International Study Group of Rectal Cancer (ISREC): Markus W. Büchler (Heidelberg, Germany), Marcel den Dulk (Leiden, The Netherlands), Richard J. Heald (Basingstoke, United Kingdom), Werner Hohenberger (Erlangen, Germany), Torbjörn Holm (Stockholm, Sweden), Søren Laurberg (Aarhus, Denmark), Yoshihiro Moriya (Tokyo, Japan), Emmanuel Tiret (Paris, France), Nuh N. Rahbari (Heidelberg, Germany), Cornelis van de Velde (Leiden, The Netherlands), Jürgen Weitz (Heidelberg, Germany), and W. Douglas Wong (New York, NY).
N.N.R. and J.W. contributed equally to this work.
Identification
Copyright
© 2010 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
