Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2020; 26(23): 3293-3303
Published online Jun 21, 2020. doi: 10.3748/wjg.v26.i23.3293
Consensus on the definition of colorectal anastomotic leakage: A modified Delphi study
Claire PM van Helsdingen, Audrey CHM Jongen, Wouter J de Jonge, Nicole D Bouvy, Joep PM Derikx
Claire PM van Helsdingen, Joep PM Derikx, Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam 1105 AZ, Netherlands
Claire PM van Helsdingen, Wouter J de Jonge, Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 BK, Netherlands
Audrey CHM Jongen, Nicole D Bouvy, Department of Surgery, Maastricht University Medical Center, Maastricht 6202 AZ, Netherlands
Wouter J de Jonge, Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn 53127, Germany
Author contributions: van Helsdingen CPM, Jongen ACHM and Derikx JPM designed the study; van Helsdingen CPM performed the research; van Helsdingen CPM and Derikx JPM analysed the data; van Helsdingen CPM, Jongen ACHM, de Jonge WJ, Bouvy ND and Derikx JPM wrote and revised the manuscript.
Supported by the Dutch Research Council (NWO) research programme Vidi project, No. 91719343.
Institutional review board statement: The study was reviewed and approved by the Medical Ethics Review Committee of the Academic Medical Center (Amsterdam).
Informed consent statement: All panel members provided informed consent prior to study participation.
Conflict-of-interest statement: All authors have no conflict of interest to disclose.
Data sharing statement: The dataset is available from the corresponding author at c.p.vanhelsdingen@amsterdamumc.nl.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement —checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Claire PM van Helsdingen, MD, Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, Netherlands. c.p.vanhelsdingen@amsterdamumc.nl
Received: March 6, 2020
Peer-review started: March 6, 2020
First decision: April 25, 2020
Revised: May 14, 2020
Accepted: May 27, 2020
Article in press: May 27, 2020
Published online: June 21, 2020
Abstract
BACKGROUND

Despite the emerging knowledge about colorectal anastomotic leakage (CAL) through the increasing number of clinical and experimental studies, there is no generally accepted definition of CAL. Because of the wide variety of definitions used in literature, comparison of study outcomes and quality of care is complicated.

AIM

To reach consensus on the definition of CAL using a modified Delphi method.

METHODS

The RAND/UCLA appropriateness method was used. The expert panel consisted of international colorectal surgeons and researchers who had published three or more articles about CAL. The consensus process consisted of two online distributed questionnaires and a third round with a recommendation. In the questionnaires participants were asked to rate the appropriateness of statements using a 1-9 Likert scale. Consensus was defined as a panel median between 1-3 or 7-9 without disagreement. In the final round a recommendation was formed regarding the definition of CAL and the expert panel was asked if they agreed or disagreed.

RESULTS

Twenty-three authors participated in the first round and twenty-one finished the second round. After two rounds consensus was reached on 37 items (80%) in nine different categories. The International Study Group of Rectal Cancer definition is the most frequently advised general definition by our panel. Consensus was reached regarding the clinical symptoms of CAL, which serum markers contributes to the suspicion of CAL, which radiological and perioperative findings should be considered as CAL, which grading system is appropriate and if there should be a range of postoperative days in the definition. Eventually, 19 experts completed all three rounds of which 16 (84%) agreed with our final recommendations for the definition of CAL.

CONCLUSION

A consensus-based recommendation for the definition of CAL was formed using our modified Delphi method that can be widely incorporated in the field.

Keywords: Anastomotic leak, Consensus, Colorectal surgery, Postoperative complication, Morbidity, Colorectal anastomosis, Definition

Core tip: Colorectal anastomotic leakage (CAL) remains one of the most feared complications after colorectal surgery. Despite the increasing number of studies on CAL, there is still no widely accepted definition of CAL. In this study an international expert panel achieved consensus on the definition of CAL using a modified Delphi method. The consensus based definition will increase the comparability of research outcomes and quality of care.