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

C.P.M. van Helsdingen*, A.C.H.M. Jongen, W.J. de Jonge, N.D. Bouvy, J.P.M. Derikx

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


BACKGROUNDDespite the emerging knowledge about colorectal anastomotic leakage (CAL) through the increasing number of clinical and experimental studies, there is no generally accepted definition of CAL. Because of the wide variety of definitions used in literature, comparison of study outcomes and quality of care is complicated.AIMTo reach consensus on the definition of CAL using a modified Delphi method. METHODSThe RAND/UCLA appropriateness method was used. The expert panel consisted of international colorectal surgeons and researchers who had published three or more articles about CAL. The consensus process consisted of two online distributed questionnaires and a third round with a recommendation. In the questionnaires participants were asked to rate the appropriateness of statements using a 1-9 Likert scale. Consensus was defined as a panel median between 1-3 or 7-9 without disagreement. In the final round a recommendation was formed regarding the definition of CAL and the expert panel was asked if they agreed or disagreed.RESULTSTwenty-three authors participated in the first round and twenty-one finished the second round. After two rounds consensus was reached on 37 items (80%) in nine different categories. The International Study Group of Rectal Cancer definition is the most frequently advised general definition by our panel. Consensus was reached regarding the clinical symptoms of CAL, which serum markers contributes to the suspicion of CAL, which radiological and perioperative findings should be considered as CAL, which grading system is appropriate and if there should be a range of postoperative days in the definition. Eventually, 19 experts completed all three rounds of which 16 (84%) agreed with our final recommendations for the definition of CAL. CONCLUSIONA consensus-based recommendation for the definition of CAL was formed using our modified Delphi method that can be widely incorporated in the field.
Original languageEnglish
Pages (from-to)3293-3303
Number of pages12
JournalWorld Journal of Gastroenterology
Issue number23
Publication statusPublished - 21 Jun 2020


  • anastomotic leak
  • biomarkers
  • c-reactive protein
  • cancer patients
  • colorectal anastomosis
  • colorectal surgery
  • consensus
  • curative resection
  • definition
  • diagnosis
  • low anterior resection
  • morbidity
  • postoperative complication
  • risk-factors
  • surgery
  • survival
  • Colorectal anastomosis
  • Colorectal surgery
  • Definition
  • Consensus
  • Morbidity
  • Postoperative complication
  • Anastomotic leak


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