Definition of colorectal anastomotic leakage: A consensus survey among Dutch and Chinese colorectal surgeons

Table 1 English questionnaire on definition of colorectal anastomotic leakage

General definition
Do we have to consider the following findings as anastomotic leakage?			Yes	No
1	Extravasation of contrast after rectal enema on a CT scan
2	Radiological collection around the anastomosis and no treatment
3	Radiological collection around the anastomosis treated with antibiotics
4	Radiological collection around the anastomosis treated with percutaneous drainage
5	Abdominal sepsis and reoperation needed
6	Necrosis of the anastomosis seen at reoperation
7	Necrosis of the blind loop seen at reoperation
8	Signs of peritonitis during reoperation
9	Air bubbles around the anastomosis seen on a CT scan
10	Free intra-abdominal air seen on a CT scan
Clinical diagnosis
In what extent do the following clinical parameters contribute to the suspicion of colorectal anastomotic leakage? Please note the relevance on a numeric scale of 0-10:
1	Increased C-reactive protein
2	Increased leukocytes
3	Tachycardia
4	Increased respiratory rate
5	(Sub-) febrile temperature
6	Postoperative ileus (> 4 d)
7	Deterioration in clinical condition
8	Abdominal pain, other than wound pain
Radiological diagnosis
Answer the following questions using percentages (0% = never, 100% = always)
1	In how many percent of patients with clinical suspicion of anastomotic leakage do you perform radiodiagnostics?
2	In how many percent of patients with clinical suspicion of anastomotic leakage do radiodiagnostics change your treatment policy?
3	In how many cases did the CT scan report no anastomotic leakage while there finally was an anastomotic leakage.
4	In how many percent of cases do you consider a reoperation without previous radiodiagnostics?
Early anastomotic leakage
In your opinion, is ‘very early (< 3 d) anastomotic leakage the result of technical failure?
1	Yes
2	No

Table 2 Sensitivity scores of clinical parameters for the suspicion of anastomotic leakage in the direct postoperative period in China and The Netherlands

Clinical parameter	China	The Netherlands	P-value
	Score ± SD	Score ± SD
Increased CRP	4.35 ± 2.466	7.45 ± 1.871	< 0.001
Leukocytosis	5.96 ± 2.596	6.53 ± 1.824	0.095
Tachycardia	4.55 ± 2.411	7.13 ± 1.937	< 0.001
Tachypnea	4.46 ± 2.244	7.13 ± 1.937	< 0.001
Febrile temperature	6.23 ± 2.281	5.86 ± 1.963	0.207
Postoperative ileus	4.47 ± 2.363	5.76 ± 1.679	< 0.001
Clinical deterioration	6.67 ± 2.033	7.83 ± 1.205	< 0.001
Abdominal pain	6.61 ± 2.247	6.74 ± 1.835	0.659

CRP: C-reactive protein.

Table 3 Surgeons’ opinion regarding the value of radiodiagnostics in the diagnosis of colorectal anastomotic leakage

Responders, n (%)	China (%)	The Netherlands (%)	P-value
In how many percent of patients with clinical suspicion of anastomotic leakage do you perform radiodiagnostics?
	202 (100)	55 (93)
0%-20%	3.0	0
21%-40%	6.4	0
41%-60%	6.9	1.8
61%-80%	24.3	16.4
81%-100%	59.4	81.8
Average	83.3	91.5	0.285
In how many percent of patients with clinical suspicion of anastomotic leakage do radiodiagnostics change your treatment policy?
	202 (100)	54 (91.5)
0%-20%	10.9	13.0
21%-40%	9.9	5.6
41%-60%	27.7	44.4
61%-80%	30.2	25.9
81%-100%	26.7	11.1
Average	63.6	55.9	0.028
In how many cases did the CT scan report no anastomotic leakage while there finally was an anastomotic leakage?
	202 (100)	52 (88.1)
0%-20%	40.6	51.9
21%-40%	29.2	28.8
41%-60%	25.2	15.4
61%-80%	4.0	1.9
81%-100%	1.0	1.9
Average	31.8	28.7	0.221
In how many percent of cases do you consider a reoperation without previous radiodiagnostics?
	202 (100)	53 (89.8)
0%-20%	58.4	84.9
21%-40%	18.8	13.2
41%-60%	17.3	0
61%-80%	4.5	0
81%-100%	1.0	1.9
Average	25.4	13.6	< 0.001