322 Chapter 14 to collect pertinent outcome data in a standardized and reproducible manner, enabling both comparisons among various centers, strategies/therapies, and within a center over time. The latter served as the background for the creation of the Clavien-Dindo classification in 2004 2, which serves as a general way to report surgical complications and was also used to report AL in chapter 2. Later on, the International Study Group of Rectal Cancer (ISCREC) made an effort to define and grade AL in a more specific way 3. This expert group stated that AL should be defined as an intestinal wall defect at the anastomotic site, encompassing suture and staple lines of neorectal reservoirs, resulting in communication between the intra- and extraluminal compartments. Additionally, they stratified severity based on its impact on clinical management, with grade A indicating no change, grade B requiring active therapeutic intervention but manageable without re-laparotomy, and grade C necessitating re-laparotomy. In our systematic review it became clear that worldwide adoption of this definition and reporting of this grading system has not been accomplished yet. Besides, this classification only focused on anterior resections for cancer and did not take all colorectal resections into account. Despite of debating on how we all should call a leak; we think it is more important to increase awareness and consensus on reporting of leaks in general. So, since the Clavien-Dindo classification is not specifically designed to document AL but rather complications in general, and there is no global standardization for reporting based on the ISREC definition and grading, we need to change this in order to enhance outcomes. Moreover, as numerous factors influence the occurrence of leaks and their subsequent reporting, reporting of leaks requires a broader framework, as outlined in Chapter 3. We believe this is necessary for several reasons. Standardizing reporting leaks across different institutions and countries will enhance the reliability of research findings and facilitating accurate comparisons between studies and improve care for colorectal surgical patients 4, 5. We noticed in both chapter 2 and 3 that it was very difficult to compare outcomes due to heterogeneity in the way leaks were reported. Therefore, standardized reporting is also essential for conducting high-quality research in the future and generating reliable evidence to guide clinical practice and to assess the effectiveness of different interventions and identify factors associated with leaks 5. Additionally, a standardized reporting protocol will help healthcare providers to benchmark their performance against international norms, identify areas for improvement, and implement targeted quality improvement initiatives to reduce the incidence of leaks and improve patient outcomes. We hope that in the end consistency will provide clinicians with more valuable information for optimal risk assessment, guiding clinical decision-making, enabling them to identify leaks early, initiate appropriate interventions promptly, and optimize patient management strategies. The evidence- and expert-based reporting framework as presented in Chapter 3 may also help promote transparency and enhances patient safety by providing patients with the information they need to make informed decisions about their treatment options and participate actively in their care, which will be also highlighted later in Chapter 10. By involving surgeons from the most important colorectal surgical societies throughout the world and aiming to publish this in their journals we expect that the impact of our framework will be more significant. The consensus group
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