178 Chapter 9 position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns” 14. HRQoL in cancer is often used interchangeably with QoL, since there is no consensus on a standardized definition. We have applied the definition of Testa et al. on HRQoL as the “physical, psychological and social domains of health, seen as distinct areas that are influenced by a person’s experiences, beliefs, expectations and perceptions” 15. AL was defined as a combination of clinical signs and symptoms (e.g., abdominal pain or tenderness, peritonitis, fever, tachycardia, purulent or faecal discharge from an abdominal drain or vagina, purulent discharge per anus), biochemical elements (elevated white cell count and/or C-reactive protein (CRP)), and radiological confirmation of an interruption of the anastomosis and/or a peri-anastomotic collection on computed tomography (CT) scan 6, 16. Search and information sources The literature search was performed on the 13th of March 2023 and repeated on the 14th of August 2023. PubMed, Cochrane library and Embase were searched with the use of MeSH-, Emtree- and free terms including ‘colorectal neoplasms’, ‘(adeno)carcinoma’, ‘colorectal surgery’, ‘anastomotic leak’, ‘complications’, Quality of life (QoL)’ and ‘Health-Related Quality of Life (HRQoL)’ (Supplementary S1). Reference lists of relevant publications were crosschecked to identify additional studies. This hand-search method was continued until no further relevant studies were identified. Selection process Eligibility criteria and selection process All English or Dutch articles published in peer reviewed index journals reporting on QoL in patients over the age of 18 with AL after oncological colorectal resections were considered eligible for inclusion. Analysis of QoL after AL had to be identified as a predetermined aim in the ‘methods’ section of the study in order to be eligible for inclusion. Trials were included irrespective of blinding. Systematic reviews and secondary sources such as letters to the editor, technical descriptions, conference proceedings or commentaries were excluded. Articles reporting on fewer than ten patients, or solely reporting on outcomes after colorectal resections for benign indications were excluded. Since the first systematic review on the definition of AL has been published in the year 2001, all articles published before the 1st of January 2000 were excluded 8. Furthermore, articles were excluded when no validated (HR)QoL instrument had been applied. All search results were imported into an online tool designed for systematic reviews (Rayyan) 17. After removal of duplicates, articles were screened for eligibility by two independent researchers (AG and DH) according to the predefined criteria. First, articles were screened based on title and abstracts. Definitive article inclusion followed if the eligibility criteria were met after full-text screening by both reviewers. Disagreements were resolved through discussion. All references were stored in the Endnote Reference Management Tool (version 20.4, Clarivate, Chandler, United States).
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