177 Impact of anastomotic leakage after colorectal cancer surgery on quality of life: A systematic review INTRODUCTION Oncological colorectal resection with or without primary anastomosis remains the cornerstone in the treatment of colorectal cancer (CRC). In patients undergoing restorative procedures, anastomotic leakage (AL) remains one of the most frequent and dreaded postoperative complications with reported incidence varying from 1.5-20% 1-4. This wide ranging incidence in the literature may be due to differences in surgical risk among different study populations and variability in surgical techniques, but also reflects significant differences in reporting standards for AL. Albeit several classifications and definitions of AL have been described in the literature, there is no consensus on definitive diagnostic or clinical criteria for AL 5-8. Several important risk factors for AL have been identified over the past decades, such as active smoking, malnutrition, male gender, obesity, emergency surgery, operative time, postoperative use of non-steroidal anti-inflammatory drugs and neoadjuvant chemotherapy 9-11. Despite innovations in surgical techniques, preoperative optimization and intraoperative interventions to further minimize the risk of AL, rates of anastomotic complications have not decreased. AL range in clinical severity from minor, subclinical, and contained leaks to fulminant sepsis, organ failure with increased short-term mortality rates 12. A standardized consensus framework for defining, reporting and, grading colorectal AL is currently being developed by the Consensus on Reporting and Defining Colorectal Anastomotic Leaks (CoReAL). This expert group noticed gaps in knowledge about the short and long-term impact AL on functional outcomes and overall quality of life (QoL). As patients should be fully informed not only regarding the immediate surgical risks, but also on the impact surgical complications may have on long-term function and QoL, this systematic review was undertaken to address this important question about short and long-term impact of AL in CRC patients. The aim of this systematic review was to identify, appraise and synthesize the available evidence regarding short- and long-term QoL in patients undergoing oncological colorectal resections complicated by AL. METHODS Study protocol and Registration This systematic review was conducted according to the latest edition of the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines 13. The study protocol was developed a priori and registered at PROSPERO (ID 411065). Outcomes and Definitions The primary outcomes were QoL and Health-related Quality of Life (HRQoL). QoL was defined according to the World Health Organization (WHO) as “an individuals’ perception of their 9
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