title: Validation of the International Study Group of Rectal Cancer definition and severity grading of anastomotic leakage.
abstract: BACKGROUND
  The International Study Group of Rectal Cancer (ISREC) has proposed a generally applicable definition and severity grading of (AL) after sphincter-preserving resection of the rectum. This work has been carried out to test for validity.
  
  
  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 AL was determined using the criteria established by the ISREC. Patients with AL were categorized according to the ISREC scheme. The clinical outcomes were analyzed and compared between the groups.
  
  
  RESULTS
  The overall AL rate was 7.5% (56/746). The 56 patients with AL were distributed among the different groups as follows: Grade A, 16%; grade B, 23%; and grade C, 61%. Compared with the grade A patients, grades B and C patients had significantly elevated serum C-reactive protein levels (P < .01). None of the grade A patients were transferred to the intensive care unit (ICU). Their further hospital stay was uneventful. The length of stay in the ICU was significantly longer for grade C patients compared with grade B patients (P < .001). The median hospital stay of grade C patients was significantly longer than that of grades A and B patients (P < .001).
  
  
  CONCLUSIONS
  The definition and severity grading of AL 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 after sphincter-preserving rectal surgery.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
authors.forename: Yakup
authors.initials: Y
authors.lastname: Kulu
authors.forename: Alexis
authors.initials: A
authors.lastname: Ulrich
authors.forename: Thomas
authors.initials: T
authors.lastname: Bruckner
authors.forename: Pietro
authors.initials: P
authors.lastname: Contin
authors.forename: Thilo
authors.initials: T
authors.lastname: Welsch
authors.forename: Nuh N
authors.initials: NN
authors.lastname: Rahbari
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: Jürgen
authors.initials: J
authors.lastname: Weitz
mesh_terms: D000328:Adult; D026683:Advisory Committees; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000097:blood / Q000145:classification* / Q000209:etiology*; D002097:C-Reactive Protein / Q000378:metabolism; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011183:Postoperative Complications / Q000097:blood / Q000145:classification* / Q000209:etiology*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000097:blood / Q000601:surgery* / Q000628:therapy; D012720:Severity of Illness Index
chemical_list: D002097:C-Reactive Protein