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Updated: Jun 17, 2025
The C-seal: A Biofragmentable Drain Protecting the Stapled Colorectal Anastomosis from Leakage
Published on: November 4, 2010
Quality of Reporting on Anastomotic Leaks in Colorectal Cancer Trials: A Systematic Review
Danique J I Heuvelings1,2, Omar Mollema2, Sander M J van Kuijk3
1NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
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).
