Article
Validation of the International Study Group of Rectal Cancer (ISREC) Definition and Severity Grading of Anastomotic Leakage
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Published: | April 26, 2013 |
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Introduction: The ISREC has proposed a generally applicable definition and severity grading of anastomotic leakage after sphincter-preserving resection of the rectum. This work has been carried out to test for validity.
Material and methods: A total of 746 patients who were identified from a prospective rectal cancer database underwent sphincter-preserving anterior resection of the rectum between October 2001 and January 2011. The incidence and severity of anastomotic leakage was determined using the criteria established by the ISREC. Fifty-six Patients with anastomotic leakage were categorized according to the ISREC scheme. The clinical outcomes were analyzed and compared between the groups.
Results: The overall anastomotic leakage rate was 7.5% (56/746). The 56 patients with anastomotic leakage were distributed among the different groups as follows: grade A – 16%, grade B – 23%, and grade C – 61%. Compared to the grade A patients, grade B and C patients had statistically significant elevated serum CRP levels (p<0.01). None of the grade A patients were transferred to the ICU. Their further hospital stay was uneventful. The length of stay in the ICU was significantly longer in grade C patients compared to grade B patients (p<0.001). The median hospital stay of grade C patients was significantly longer than that of grade A and B patients (p<0.001).
Conclusion: The definition and severity grading of anastomotic leakage after anterior resection of the rectum proposed by the ISREC provides a simple, easily applicable and valid classification. Using this classification system may facilitate comparison of results from different studies on AL following sphincter-preserving rectal surgery.