title: Clinical characteristics of anastomotic leakage after an anterior resection for rectal cancer by assessing of the international classification on anastomotic leakage.
abstract: OBJECTIVE
  The International Study Group of Rectal Cancer (ISREC) has proposed a new definition of anastomotic leakage (AL) which was simply classified into three grades; however, these criteria have not been assessed well. The aims of this study are to assess the new definition and to show the clinical features of AL after an anterior resection for rectal cancer.
  
  
  METHODS
  Fifty consecutive patients developed AL after an anterior resection for rectal cancer was retrospectively assessed. AL was defined by the ISREC criteria.
  
  
  RESULTS
  Twenty-seven (54 %) patients with AL were diagnosed by drain contents. The postoperative day of diagnosis for AL was later in grade A versus grades B and C (p = 0.038 vs p = 0.006, respectively). Permanent stoma (PS) was significantly more frequent in patients with grade C but not grade B compared to the patients with no AL (p < 0.001 and p = 0.171, respectively). In patients without diverting stoma, there was more serious grade of AL (p < 0.001).
  
  
  CONCLUSIONS
  Differences were observed in the postoperative day of diagnosis, the creation rate of PS, and impact on diverting stoma after AL between each grade of leakage. The new classification was easy and reasonable to evaluate AL. As a result, it should be widely used in future studies.
authors.affiliation: Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8510, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Matsuda
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Hotta
authors.forename: Katsunari
authors.initials: K
authors.lastname: Takifuji
authors.forename: Shozo
authors.initials: S
authors.lastname: Yokoyama
authors.forename: Takashi
authors.initials: T
authors.lastname: Watanabe
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Mitani
authors.forename: Junji
authors.initials: J
authors.lastname: Ieda
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Iwamoto
authors.forename: Yuki
authors.initials: Y
authors.lastname: Mizumoto
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaue
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D057868:Anastomotic Leak / Q000145:classification* / Q000453:epidemiology; D015331:Cohort Studies; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D054047:Surgical Stomas / Q000009:adverse effects; D015996:Survival Rate; D016896:Treatment Outcome