Table 1.

Main classification systems of anastomotic leakage

System	Leak classification	Grade	Signs and symptoms (or definition)	Management
Bruce et al., 2001*	Radiological	−	• Detected only on routine imaging; no clinical signs	• No change
	Clinical minor	−	• Luminal contents through the drain or wound site (local inflammation) • Fever (>38°C) or leukocytosis (>10,000/L) • Leak may also be detected on imaging studies	• Prolonged hospital stay and/or delay in resuming oral intake
	Clinical major	−	• As clinical minor with severe disruption to anastomosis • Leak may also be detected on imaging studies	• Intervention required
Lerut et al., 2002†	Radiological	−	• No clinical signs	• No change
	Clinical minor	−	• Local inflammation cervical wound • X-ray contained leak (thoracic anastomosis) • Fever, > WBC, > CRP	• Drain wound • Delay oral intake • Antibiotics
	Clinical major	−	• Severe disruption on endoscopy • Sepsis	• CT-guided drainage or reintervention
	Conduit necrosis	−	• Endoscopic confirmation	• Reintervention
Price et al., 2013‡	Radiological	I	• No clinical signs or symptoms • Purely radiological diagnosis	• No change in management
	Clinical minor	II	• Minor clinical signs (e.g. cervical wound inflammation or drainage) • Radiographically contained intrathoracic leak • Fever, leukocytosis	• Delay oral intake • Antibiotics • Wound drainage • CT-guided drain placement
	Clinical major	III	• Significant anastomotic disruption requiring surgical—revision • Minor anastomotic disruption with systematic sepsis	• Esophageal stent placement • Surgical debridement • Anastomotic revision
	Conduit necrosis	IV	• Conduit necrosis necessitating esophageal diversion	• Conduit resection with esophageal diversion
Low et al., 2015§	Anastomotic leakage	I	• Local defect	• No change in therapy or medical treatment or dietary modification
		II	• Local defect	• Interventional radiology drain • Stenting or bedside opening • Packing of incision
		III	• Local defect	• Surgical therapy
	Conduit necrosis	I	• Focal (identified endoscopically)	• Additional monitoring or nonsurgical therapy
		II	• Focal (identified endoscopically, not associated with free anastomotic or conduit leakage)	• Surgical therapy without esophageal diversion
		III	• Extensive	• Surgical therapy: conduit resection with diversion

^*Bruce, J., Krukowski, Z. H., Al-Khairy, G., Russell, E. M. & Park, K. G. M. Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. British Journal of Surgery (2001) doi:10.1046/j.0007-1323.2001.01829.x.

^†Lerut, T. et al. Anastomotic complications after esophagectomy. in Digestive Surgery (2002). doi:10.1159/000052018.

^‡T.N., P. et al. A comprehensive review of anastomotic technique in 432 esophagectomies. Ann. Thorac. Surg. (2013).

^§Low, D. E. et al. International consensus on standardization of data collection for complications associated with esophagectomy: Esophagectomy Complications Consensus Group (ECCG). Ann. Surg. (2015) doi:10.1097/SLA.0000000000001098.