Original CommunicationDefinition and grading of anastomotic leakage following anterior resection of the rectum: A proposal by the International Study Group of Rectal Cancer
Section snippets
Methods
An extensive literature search of the Medline database was conducted to identify available definitions of anastomotic leakage after anterior resection of the rectum. Furthermore, we sought whether a definition of anastomotic leakage had already been generally accepted and adopted within scientific reports on anterior resection. Using the following search terms we searched the Medline database for the period of the past 5 years: (Resection AND [rectum OR rectal] OR proctectomy). Clinical studies
Review of the literature
The literature search to detect available definitions yielded 1,995 references. Of these, a total of 59 articles providing a definition of anastomotic leakage after anterior resection were evaluated critically. Most definitions consisted of a clinical suspicion based on the patient's symptoms, which was subsequently confirmed by further diagnostic tests or direct evidence of anastomotic leakage during operative exploration (Table I). Routine postoperative radiologic tests were only performed in
Discussion
Randomized, controlled trials and meta-analyses are considered the reference tools to generate and summarize evidence on the benefits and harms of certain treatments,45, 46 Uniform, procedure-specific definitions of outcome variables are, however, the prerequisite for comparing the results of different studies. After anterior rectal resection with primary anastomosis, anastomotic leakage represents the major cause of postoperative morbidity and has a substantive impact on the patients’
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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.