Published online Sep 7, 2017. doi: 10.3748/wjg.v23.i33.6172
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
Processing time: 215 Days and 17.5 Hours
To determine the level of consensus on the definition of colorectal anastomotic leakage (CAL) among Dutch and Chinese colorectal surgeons.
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.
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.
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.