Key result
In a systematic review of 471 articles reporting anastomotic leakage in colorectal cancer trials, only 18% (95 studies) provided a specific definition, highlighting inconsistent reporting.
Why the study?
Although past attempts have been made to establish consensus on definitions and severity grading of colorectal anastomotic leakage, widespread adoption has remained limited.
Systematic Review (n=346,140)
There is incomplete and inconsistent reporting of anastomotic leakage across published colorectal cancer literature, highlighting the need for a consensus framework for defining, grading, and reporting.
Inconsistent anastomotic leakage definitions limit outcome comparability; supports urgent consensus on standardized definitions, grading, and reporting.
BACKGROUND: Although attempts have been made in the past to establish consensus regarding the definitions and grading of the severity of colorectal anastomotic leakage, widespread adoption has remained limited. OBJECTIVE: A systematic review of the literature was conducted to examine the various elements used to report and define anastomotic leakage in colorectal cancer resections. DATA SOURCES: A systematic review was conducted using the PubMed, Embase, and Cochrane Library Database. STUDY SELECTION: All published randomized controlled trials, systematic reviews, and meta-analyses containing data related to adult patients undergoing colorectal cancer surgery and reporting anastomotic leakage as a primary or secondary outcome, with a definition of anastomotic leakage were included. MAIN OUTCOME MEASURES: Definitions of anastomotic leakage, clinical symptoms, radiological modalities and findings, findings at reoperation, and grading terminology or classifications for anastomotic leakage. RESULTS: Of the 471 articles reporting anastomotic leakage as a primary or secondary outcome, a definition was reported in 95 studies (45 randomized controlled trials, 13 systematic reviews, and 37 meta-analyses) involving a total of 346,140 patients. Of these 95 articles, 68% reported clinical signs and symptoms of anastomotic leakage, 26% biochemical criteria, 63% radiological modalities, 62% radiological findings, and 13% findings at reintervention. Only 45% (n = 43) of included studies reported grading of anastomotic leakage severity or leak classification, and 41% (n = 39) included a time frame for reporting. LIMITATIONS: There was a high level of heterogeneity between the included studies. CONCLUSIONS: This evidence synthesis confirmed incomplete and inconsistent reporting of anastomotic leakage across the published colorectal cancer literature. There is a great need to develop and implement a consensus framework for defining, grading, and reporting anastomotic leakage. REGISTRATION: Prospectively registered at PROSPERO (ID 454660).
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Heuvelings et al. (2024) conducted a systematic review in Colorectal cancer (n=346,140). Reporting of anastomotic leakage definitions and grading was evaluated on Definitions of anastomotic leakage, clinical symptoms, radiological modalities and findings, findings at reoperation, and grading terminology or classifications. In a systematic review of 471 articles reporting anastomotic leakage in colorectal cancer trials, only 18% (95 studies) provided a specific definition, highlighting inconsistent reporting.
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