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




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Background

A 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.

Methods

A 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.

Results

A 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%.

Conclusions

The 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.



Author: Zhi-Jie Cong , Liang-Hao Hu , Zheng-Qian Bian , Guang-Yao Ye, Min-Hao Yu, Yun-He Gao, Zhao-Shen Li, En-Da Yu , Ming Zhong

Source: http://plos.srce.hr/



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