Systematic Review of Anastomotic Leakage Rate According to an International Grading System Following Anterior Resection for Rectal Cancer

Abstract

BackgroundA generally acceptable definition and a severity grading system for anastomotic leakages (ALs) following rectal resection were not available until 2010, when the International Study Group of Rectal Cancer (ISGRC) proposed a definition and a grading system for AL.MethodsA search for published data was performed using the MEDLINE database (2000 to December 5, 2012) to perform a systematic review of the studies that described AL, grade AL according to the grading system, pool data, and determine the average rate of AL for each grade after anterior resection (AR) for rectal cancer.ResultsA total of 930 abstracts were retrieved; 40 articles on AR, 25 articles on low AR (LAR), and 5 articles on ultralow AR (ULAR) were included in the review and analysis. The pooled overall AL rate of AR was 8.58% (2,085/24,288); the rate of the asymptomatic leakage (Grade A) was 2.57%, that of AL that required active intervention without relaparotomy (Grade B) was 2.37%, and that of AL that required relaparotomy (Grade C) was 5.40%. The pooled rate of AL that required relaparotomy was higher in AR (5.40%) than in LAR (4.70%) and in ULAR (1.81%), which could be attributed to the higher rate of protective defunctioning stoma in LAR (40.72%) and ULAR (63.44%) compared with that in AR (30.11%).ConclusionsThe new grading system is simple that the ALs of each grade can be easily extracted from past publications, therefore likely to be accepted and applied in future studies.

Circular anastomotic experimental fibrin sealant protection in deep colorectal anastomosis in pigs in a randomized 9-day survival study

“…This rate is within the range of literature-reported clinical situations in patients [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] and could be reduced significantly by a circumferential extraluminal experimental fibrin sealant to the site of the circular anastomosis.…”

“…The rate of a clinically apparent leakage of a circular double-stapled anastomosis (CDSA) after LAR without defunctioning stoma ranges from 8 to 37.% [1][2][3][4][5][6][7][8][9][10][11]. There are additional 30 % leaks following a stapled end-to-end colorectal anastomosis that are asymptomatic or non-clinically apparent [8].…”

Diagnostic Value of Serial Measurement of C-Reactive Protein in the Detection of a Surgical Complication after Laparoscopic Bowel Resection for Endometriosis

“…We have shown that a decrease in inflam- We are aware that the anastomotic leakage rate is relatively high compared with other series [23,31,32] . However, our results represent consecutive patients including our first experience.…”

Laparoscopic Inferior Mesenteric Artery Peeling: An Alternative to High or Low Vascular Ligation for Sigmoid Colon Cancer Resection

“…The unique anastomotic failure recorded in our casuistic occurred in an elderly patient who received an end-toend recanalization, in which the underlying diabetes could have compromised local blood flow [6] despite IMA preservation. However, it is clear that arteries preservation Lymph node harvested, n mean (range) 16.7 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) World J Surg does not eliminate the incidence of anastomotic leakage in every colorectal recanalization and positive effects of artery peeling should be more investigated. When comparing anastomotic leak rate of our casuistic to the literature [17,18], our good results could be also attributable to the attitude in constructing, whenever possible, a complete intracorporeal side-to-side anastomosis.…”

“…However, it is clear that arteries preservation Lymph node harvested, n mean (range) 16.7 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) World J Surg does not eliminate the incidence of anastomotic leakage in every colorectal recanalization and positive effects of artery peeling should be more investigated. When comparing anastomotic leak rate of our casuistic to the literature [17,18], our good results could be also attributable to the attitude in constructing, whenever possible, a complete intracorporeal side-to-side anastomosis. Intracorporeal anastomoses can be safely constructed even in case of short colonic stumps, resulting in a better predisposition for primary recanalization, thus avoiding the greater limb mobilization needed for the extracorporeal setting of an end-to-end or end-to-side anastomosis.…”