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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Definition of colorectal anastomotic leakage: A consensus survey among Dutch and Chinese colorectal surgeons
Stefanus J van Rooijen, Audrey CHM Jongen, Zhou-Qiao Wu, Jia-Fu Ji, Gerrit D Slooter, Rudi MH Roumen, Nicole D Bouvy
Stefanus J van Rooijen, Gerrit D Slooter, Rudi MH Roumen, Department of Surgery, Máxima Medical Center, 5500 MB Veldhoven, The Netherlands
Stefanus J van Rooijen, Audrey CHM Jongen, Nicole D Bouvy, NUTRIM School of Nutrition and Translational Research in Metabolism, 6200 MD Maastricht, The Netherlands
Audrey CHM Jongen, Nicole D Bouvy, Department of Surgery, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
Zhou-Qiao Wu, Jia-Fu Ji, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Ward I of Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, Beijing 100142, China
Author contributions: van Rooijen SJ, Jongen ACHM and Wu ZQ contributed equally to this work; van Rooijen SJ and Ji JF should be regarded as co-corresponding authors; all authors participated sufficiently in the work to take public responsibility for appropriate portions of the content; van Rooijen SJ, Jongen ACHM and Wu ZQ contributed to drafting of the article and acquisition, analysis, and interpretation of data; Ji JF, Slooter GD, Roumen RMH and Bouvy ND contributed to study concept and design, data interpretation and critical revision of all versions of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Boards of Maastricht University Medical Center and Peking University Cancer Hospital.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
Data sharing statement: The technical appendix and dataset are available from the corresponding author at stefan.van.rooijen@mmc.nl.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Stefanus J van Rooijen, Department of Surgery, Máxima Medical Center, De Run 4600, 5500 MB Veldhoven, the Netherlands. crc.resurge@mmc.nl
Telephone: +31-40-8886231 Fax: +31-40-8886219
Received: February 3, 2017
Peer-review started: February 8, 2017
First decision: February 23, 2017
Revised: March 28, 2017
Accepted: July 22, 2017
Article in press: July 24, 2017
Published online: September 7, 2017
AIM
To determine the level of consensus on the definition of colorectal anastomotic leakage (CAL) among Dutch and Chinese colorectal surgeons.
METHODS
Dutch and Chinese colorectal surgeons were asked to partake in an online questionnaire. Consensus in the online questionnaire was defined as > 80% agreement between respondents on various statements regarding a general definition of CAL, and regarding clinical and radiological diagnosis of the complication.
RESULTS
Fifty-nine Dutch and 202 Chinese dedicated colorectal surgeons participated in the online survey. Consensus was found on only one of the proposed elements of a general definition of CAL in both countries: ‘extravasation of contrast medium after rectal enema on a CT scan’. Another two were found relevant according to Dutch surgeons: ‘necrosis of the anastomosis found during reoperation’, and ‘a radiological collection treated with percutaneous drainage’. No consensus was found for all other proposed elements that may be included in a general definition.
CONCLUSION
There is no universally accepted definition of CAL in the Netherlands and China. Diagnosis of CAL based on clinical manifestations remains a point of discussion in both countries. Dutch surgeons are more likely to report ‘subclinical’ leaks as CAL, which partly explains the higher reported Dutch CAL rates.
Core tip: The present international online survey proves the inconsistent views as to what is considered colorectal anastomotic leakage among surgeons in the Netherlands and China, and shows large differences between the countries. This is in line with the current literature, since there is no uniformly accepted definition worldwide. We therefore propose to perform a systematic literature review to identify the available definitions. The final stage would be to perform a Delphi analysis within a representative panel of colorectal surgeons to develop a widely accepted definition of colorectal anastomotic leakage.
