Șandra-Petrescu Flavius, Rahbari Nuh N, Birgin Emrullah, Kouladouros Konstantinos, Kienle Peter, Reissfelder Christoph, Tzatzarakis Emmanouil, Herrle Florian
Surgical Department, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
Interdisciplinary Endoscopy, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
J Clin Med. 2023 Jul 27;12(15):4933. doi: 10.3390/jcm12154933.
(1) Background: A widely accepted algorithm for the management of colorectal anastomotic leakage (CAL) is difficult to establish. The present study aimed to evaluate the current clinical practice on the management of CAL among the German CHIR-Net centers. (2) Methods: An online survey of 38 questions was prepared using the International Study Group of Rectal Cancer (ISREC) grading score of CAL combined with both patient- and surgery-related factors. All CHIR-Net centers received a link to the online questionary in February 2020. (3) Results: Most of the answering centers (55%) were academic hospitals (41%). Only half of them use the ISREC definition and grading for the management of CAL. A preference towards grade B management (no surgical intervention) of CAL was observed in both young and fit as well as elderly and/or frail patients with deviating ostomy and non-ischemic anastomosis. Elderly and/or frail patients without fecal diversion are generally treated as grade C leakage (surgical intervention). A grade C management of CAL is preferred in case of ischemic bowel, irrespective of the presence of an ostomy. Within grade C management, the intestinal continuity is preserved in a subgroup of patients with non-ischemic bowel, with or without ostomy, or young and fit patients with ischemic bowel under ostomy protection. (4) Conclusions: There is no generally accepted therapy algorithm for CAL management within CHIR-Net Centers in Germany. Further effort should be made to increase the application of the ISREC definition and grading of CAL in clinical practice.
(1) 背景：难以建立一种广泛接受的结直肠吻合口漏（CAL）管理算法。本研究旨在评估德国CHIR-Net中心目前对CAL的临床管理实践。(2) 方法：使用国际直肠癌研究组（ISREC）的CAL分级评分，结合患者和手术相关因素，编制了一份包含38个问题的在线调查问卷。所有CHIR-Net中心于2020年2月收到了在线问卷的链接。(3) 结果：大多数回复中心（55%）是学术医院（41%）。其中只有一半使用ISREC定义和分级来管理CAL。对于年轻健康以及老年和/或体弱且造口异常和非缺血性吻合的患者，观察到倾向于对CAL进行B级管理（不进行手术干预）。没有粪便转流的老年和/或体弱患者通常被视为C级漏（手术干预）。无论是否存在造口，对于缺血性肠病患者，CAL的C级管理是首选。在C级管理中，对于非缺血性肠病患者（无论有无造口）或在造口保护下患有缺血性肠病的年轻健康患者的一个亚组中保留肠道连续性。(4) 结论：在德国的CHIR-Net中心内，没有普遍接受的CAL管理治疗算法。应进一步努力在临床实践中增加ISREC对CAL定义和分级的应用。
