Affiliation:
1. Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
2. Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
3. Department of Colorectal Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
Abstract
Introduction
Anastomotic leakage (AL) is generally accepted as a major complication of rectal resection surgery. However, there is still debate about the definition and evaluation of AL. The International Study Group of Rectal Cancer (ISREC) raised a definition of and grading system for AL in 2010.
Aim
In our study, we aimed to validate AL's present definition and grading system, which were proposed by ISREC in 2010.
Methods
Patients who underwent rectal anterior resection in 2 colorectal surgery centers from January 2012 to December 2014 were included and categorized into different groups according to the ISREC criteria; further, the rate, severity and clinical outcomes of their ALs were analyzed and compared.
Results
During a median follow-up period of 38.9 months, 984 patients were included in total. The overall AL rate was 5.0% (49/984), including 7 grade A patients (14%), 21 grade B patients (43%), and 21 grade C patients (43%). The rate of grade C AL in the protective diverting stoma group was significantly lower than that in the nonstoma group (0.6% versus 2.8%, P = 0.029). Patients with grade B or grade C AL had much longer hospital stays than grade A AL patients (P = 0.016). The overall 3-year survival rates of grades A, B, and C groups were 83.3%, 66.7% and 55.6% respectively, without statistical significance.
Conclusions
Patients who were divided into different groups according to the grading system proposed by the ISREC criteria had significantly different symptoms, clinical outcomes, management, and duration of hospitalization. Our study supported that the ISREC criteria are a simple but valid classification to evaluate the surgical performance of the rectal cancer resection.
Publisher
International College of Surgeons