Consensus on the definition of colorectal anastomotic leakage: A modified Delphi study

Table 2 Summary of the consensus on the definition of colorectal anastomotic leakage after two rounds

Category	Consensus
Clinical parameters	Tachycardia, clinical deterioration, abdominal pain, discharge from abdominal drain, discharge from rectum, rectovaginal fistula and anastomotic defect found by digital examination contribute to the suspicion of CAL
Laboratory tests	CRP and the combination of CRP and leukocytosis contribute to the suspicion of CAL; Albumin, urea and creatinine do not contribute to the suspicion of CAL
Radiological findings	Extravasation of endoluminal administrated contrast, collection around the anastomosis, presacral abscess near anastomosis, perianastomotic air and free intra-abdominal air are defined as CAL on CT-scan
Findings during reoperation	Necrosis of anastomosis, necrosis of blind loop, signs of peritonitis and dehiscence of anastomosis are defined as CAL during reoperation
Grading systems	Grading or classifying CAL is important; Both the ISREC-classification and Clavien-Dindo classification are suitable
Timing	Distinction between early and late anastomosis should be made; There should not be a fixed range of days in which CAL can occur to define it as CAL
Colon/rectum	Colon and rectum should be seen as separate entities

CAL: Colorectal anastomotic leakage; CRP: C-reactive protein; CD: Clavien-Dindo; CT: Computed tomography.