Antonino Spinelli1,2, Gabriele Anania3, Alberto Arezzo4, Stefano Berti5, Francesco Bianco6, Paolo Pietro Bianchi7, Maurizio De Giuli8, Paola De Nardi9, Paolo de Paolis10, Caterina Foppa11, Mario Guerrieri12, Pierluigi Marini13, Roberto Persiani14, Diego Piazza15, Gilberto Poggioli16, Salvatore Pucciarelli17, Domenico D'Ugo18, Adolfo Renzi19, Francesco Selvaggi20, Gianfranco Silecchia21, Marco Montorsi22,23. 1. Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy. antonino.spinelli@hunimed.eu. 2. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy. antonino.spinelli@hunimed.eu. 3. Dipartimento di Scienze Mediche-Università di Ferrara, Azienda Ospedaliero Universitaria S. Anna, Ferrara, Italy. 4. Department of Surgical Sciences, University of Torino, Torino, Italy. 5. S.C. Chirurgia Generale, Dipartimento Chirurgico, ASL 5 Spezzino-POLL-Regione Liguria, La Spezia, Italy. 6. General and Colo-Rectal Surgery Unit, S. Leonardo-ASL Naples 3 Hospital, C.mare di Stabia, Naples, Italy. 7. UOC di Chirurgia Generale e Mini-Invasiva, Dipartimento di Chirurgia Generale e Specialistiche, ASL Toscana Sud-Est. Ospedale Misericordia, Grosseto, Italy. 8. Department of Oncology, Head, Digestive and Surgical Oncology, University of Torino, and San Luigi University Hospital, Orbassano, Italy. 9. Gastrointestinal Surgery, Scientific Institute San Raffaele Hospital, Milan, Italy. 10. Città della Salute-Ospedale Molinette, Torino, Italy. 11. Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy. 12. Clinica Chirurgica Generale e d'urgenza, Università Politecnica delle Marche, Ancona, Italy. 13. Surgery Unit, San Camillo Forlanini Hospital, Rome, Italy. 14. Minimally-Invasive Surgical Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy. 15. U.O.C. Chirurgia Oncologica, ARNAS Garibaldi, Catania, Italy. 16. Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy. 17. Dipartimento di Scienze Chirurgiche Oncologiche e Gastroenterologiche-DISCOG, Università di Padova, Padova, Italy. 18. General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy. 19. Department of General Surgery, Fatebenefratelli Hospital, Naples, Italy. 20. Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy. 21. Deparment of Medico-Surgical Science and Biotechnologies, Sapienza University of Rome, Rome, Italy. 22. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy. 23. Department of Surgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy.
Abstract
INTRODUCTION: The incidence of anastomotic leak (AL) has not decreased over the past decades and some important grey areas remain in its definition, prevention, and management. The aim of this study was to reach a national consensus on the definition of AL and to identify key points to be applied in clinical practice. METHODS: A 3-step modified Delphi method was used to establish consensus. Ten representative members of the major Italian surgical scientific societies with proven colorectal expertise were selected after a call to action. After a comprehensive literature search, each expert drew a list of evidence-based statements which were voted in round one by the scientific board. Panel members were asked to mark "totally disagree", "partially agree" or "totally agree" for each statement and provide comments. The same voting method was used for round 2. Round 3 consisted of a final face-to-face meeting. RESULTS: Thirty-three statements (clustered into 14 topics) were included in round 1. Following the third voting round, a final list of 16 items was formulated, which encompass the following 9 topics: AL definition, patient- and operative-related risk factors, prevention measures, bowel preparation, surgical technique, intraoperative assessment, early diagnosis, radiological diagnosis and management of specific patterns of AL. The overall response rate was 100% for all items in all the three rounds. CONCLUSIONS: This Delphi survey identified items that expert colorectal surgeons agreed were important to be applied in the prevention, diagnosis, and management of AL. This represents the first consensus involving all relevant national scientific societies, defining important and shared concepts in the diagnosis and management of AL.
INTRODUCTION: The incidence of anastomotic leak (AL) has not decreased over the past decades and some important grey areas remain in its definition, prevention, and management. The aim of this study was to reach a national consensus on the definition of AL and to identify key points to be applied in clinical practice. METHODS: A 3-step modified Delphi method was used to establish consensus. Ten representative members of the major Italian surgical scientific societies with proven colorectal expertise were selected after a call to action. After a comprehensive literature search, each expert drew a list of evidence-based statements which were voted in round one by the scientific board. Panel members were asked to mark "totally disagree", "partially agree" or "totally agree" for each statement and provide comments. The same voting method was used for round 2. Round 3 consisted of a final face-to-face meeting. RESULTS: Thirty-three statements (clustered into 14 topics) were included in round 1. Following the third voting round, a final list of 16 items was formulated, which encompass the following 9 topics: AL definition, patient- and operative-related risk factors, prevention measures, bowel preparation, surgical technique, intraoperative assessment, early diagnosis, radiological diagnosis and management of specific patterns of AL. The overall response rate was 100% for all items in all the three rounds. CONCLUSIONS: This Delphi survey identified items that expert colorectal surgeons agreed were important to be applied in the prevention, diagnosis, and management of AL. This represents the first consensus involving all relevant national scientific societies, defining important and shared concepts in the diagnosis and management of AL.
Authors: Elena Belloni; Edoardo Maria Muttillo; Salomone Di Saverio; Marcello Gasparrini; Antonio Brescia; Giuseppe Nigri Journal: Cancers (Basel) Date: 2022-05-13 Impact factor: 6.575
Authors: L Siragusa; B Sensi; D Vinci; M Franceschilli; C Pathirannehalage Don; G Bagaglini; V Bellato; M Campanelli; G S Sica Journal: Discov Oncol Date: 2021-04-12
Authors: Kevin Talboom; Nynke G Greijdanus; Frans van Workum; Sander Ubels; Camiel Rosman; Roel Hompes; Johannes H W de Wilt; Pieter J Tanis Journal: Int J Colorectal Dis Date: 2022-08-24 Impact factor: 2.796