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Anastomotic leakage (AL) is generally accepted as a major complication of rectal resection surgery. However, there is still debate about the definition and evaluation of AL. The International Study Group of Rectal Cancer (ISREC) raised a definition of and grading system for AL in 2010. Aim In our study, we aimed to validate AL's present definition and grading system, which were proposed by ISREC in 2010. Methods Patients who underwent rectal anterior resection in 2 colorectal surgery centers from January 2012 to December 2014 were included and categorized into different groups according to the ISREC criteria; further, the rate, severity and clinical outcomes of their ALs were analyzed and compared. Results During a median follow-up period of 38.9 months, 984 patients were included in total. The overall AL rate was 5.0% (49/984), including 7 grade A patients (14%), 21 grade B patients (43%), and 21 grade C patients (43%). The rate of grade C AL in the protective diverting stoma group was significantly lower than that in the nonstoma group (0.6% versus 2.8%, P = 0.029). Patients with grade B or grade C AL had much longer hospital stays than grade A AL patients (P = 0.016). The overall 3-year survival rates of grades A, B, and C groups were 83.3%, 66.7% and 55.6% respectively, without statistical significance. Conclusions Patients who were divided into different groups according to the grading system proposed by the ISREC criteria had significantly different symptoms, clinical outcomes, management, and duration of hospitalization. Our study supported that the ISREC criteria are a simple but valid classification to evaluate the surgical performance of the rectal cancer resection.

Evaluation of Anastomotic Leakages Grading System Following Anterior Resection for Rectal Cancer