International Consensus on Reporting Anastomotic Leaks After Colorectal Cancer Surgery: The CoReAL Reporting Framework

Abstract

BACKGROUND: Anastomotic leak frequently complicates colorectal anastomoses with high morbidity and mortality. The substantial variability in published leak rates reflects the lack of consistency in reporting variables that may impact the occurrence, management, and short- and long-term outcomes of patients. OBJECTIVE: The Consensus for Reporting of Colorectal Anastomotic Leaks is an international collaborative that developed a standardized evidence-based framework for reporting key variables related to the entire episode of colorectal anastomotic leak in patients with cancer. DESIGN: Along the preoperative, intraoperative, and short- and long-term postoperative phases of a left-sided colorectal anastomotic leak, key questions regarding all potentially relevant variables were formulated. A literature review was conducted to generate evidence-based statements in response to these questions. Statements that reached consensus, together with input from patients’ experience and experts’ opinion, were incorporated into the framework as reporting elements. SETTING: Modified Delphi methodology, including online voting and an in-person consensus meeting, was used to generate consensus statements based on the literature review and to develop the reporting framework. PARTICIPANTS: An international panel of 32 colorectal surgeons with expertise in the field of colorectal anastomotic leaks, representing 6 surgical societies, along with radiologists, research collaborators, patients, health care economists, and surgical trial methodologists. MAIN OUTCOME MEASURES: Evidence-based statements and reporting elements with more than 70% agreement were included. RESULTS: Consensus among experts was achieved on 33 evidence-based statements and 43 reporting elements for the Consensus on Reporting colorectal Anastomotic Leaks framework. The reporting elements encompassed evidence-based statements (27), patient perspectives (7), and expert opinion (9). LIMITATIONS: Sampling did not represent all regions in the world. Because of the paucity of evidence for some topics, evidence-based statements were primarily based on a moderate-to-low level of evidence. CONCLUSIONS: This international consensus provides an evidence-based standardized framework for reporting of key variables related to a colorectal anastomotic leak after oncologic resection.