15 General introduction AIMS AND OUTLINE OF THIS THESIS By examining innovative approaches and intercontinental expert opinions, this thesis aims to shed light on promising avenues that contribute to improved patient outcome after CRC surgery. While this thesis may not offer unequivocal solutions to the aforementioned discussion points, it does present novel perspectives within four distinct areas; evidence overview and reporting of colorectal AL, improvement of bowel perfusion assessment, impact of colorectal AL on patients, and prevention of metachronous PM. PART I: Increasing international consensus on current evidence and reporting of anastomotic leaks after colorectal cancer surgery Aims - To increase insight in how AL is currently reported in high level evidence literature; - T o provide an overview of evidence-based statements regarding AL and a subsequent reporting framework that can be used to standardize AL reporting in the future; - To create a radiological scoring system that can be used to standardize the assessment of AL on computerized tomography (CT) scans in the future. The first part of this thesis focuses on the reporting of AL after CRC surgery. Chapter 2 is a systematic review that focuses on the use of different AL definitions in high-level evidence literature (randomized controlled trials, systematic reviews, and meta-analyses) and additional reported elements that are related to AL. In this chapter, we also highlight the importance of standardized reporting of AL. Subsequently, Chapter 3 reflects an international consensus project, in which the overview of current evidence regarding colorectal AL is presented, followed by a reporting framework to standardize reporting of colorectal AL after oncological surgery. As radiological assessment of AL plays a key role in the diagnostic phase, Chapter 4 displays a study protocol for the development of a radiological scoring system that can be used to assess AL on CT-scans and to radiologically report its assessment in a standardized way. Part II: Improving bowel perfusion assessment to reduce the risk of anastomotic leaks Aims - To study the feasibility and quantification of intestinal perfusion and ureter visualization with indocyanine green (ICG) and methylene blue (MB) using a new near-infrared fluorescence imaging system; - T o study the feasibility and quantification of intestinal perfusion during surgery with laser speckle contrast imaging (LSCI). 1
RkJQdWJsaXNoZXIy MTk4NDMw