16 Chapter 1 Part II of this thesis provides insights into bowel perfusion assessment to reduce the risk of AL. Chapter 5 is a feasibility study in a porcine model which evaluates a new imaging system that is able to visualize both MB and ICG. This study illustrates the use of MB for both ureter visualization and bowel perfusion assessment. Subsequently, Chapter 6 is a quantification analysis in which MB and ICG are compared in a porcine model using ischemic bowel loops. Chapter 7 highlights the clinical implications of LSCI by performing a porcine experiment on anastomotic site selection. In this study, we demonstrate how LSCI can provide valuable real-time feedback on intestinal tissue perfusion during surgery. Chapter 8 is a preclinical validation of LSCI for bowel perfusion assessment in a porcine model. In this quantification study, we perform a correlation analysis between laser speckle units and local lactate levels in ischemic bowel loops and assess inter-observer variability. PART III: Patients’ perspectives on colorectal anastomotic leaks Aims - T o create an overview of the current knowledge of the impact on Quality of Life (QoL) of patients after colorectal AL; - T o obtain a more in-depth understanding of patients’ experiences after AL. The third part of this thesis gives insights into the patients’ perspective on AL after CRC surgery. Chapter 9 is a systematic review that provides an overview of current literature on the impact on the QoL of patients after AL. In this chapter, we also give additional recommendations on how to improve future AL research in relation to QoL. In Chapter 10, a qualitative interview study provides an insight into patients’ experiences after developing an AL. In addition to summarizing the identified interview themes, we emphasize the key factors highlighted by patients that can directly enhance clinical practice and improve patient outcomes. PART IV: Prevention of metachronous peritoneal metastases after colorectal cancer surgery Aims - T o create an overview of the current knowledge on predictive biomarkers in primary colorectal tumors for PM; - T o identify predictive biomarkers in primary colorectal tumors for metachronous PM; - To evaluate the safety of intraperitoneal cytostatic-loaded supramolecular hydrogel administration after the creation of a colon anastomosis. Part IV of this thesis describes potentials to reduce the risk of developing PM by considering prophylactic interventions in patients who are at risk. Chapter 11 provides an overview of current knowledge on specific biomarkers in the primary colorectal tumor that could
RkJQdWJsaXNoZXIy MTk4NDMw