325 Summary, general discussion and future perspectives disease and CO-RADS (chest CT) to assess coronavirus disease 19, 20. Yet, this has not been developed to assess specific complications such as AL. However, it has not been designed to evaluate particular complications like AL. Our team has taken the initiative to develop such a scoring system to enhance diagnostic communication in cases where AL is suspected, aiming to facilitate clear communication, earlier recognition, and appropriate management. Chapter 4 provides the protocol of the pre-clinical validation of a standardized score to assess potential leaks after colorectal surgery on CT scanning. The research team proposed a standardized CT assessment scheme for AL based on findings from 30 patients who developed an AL after colorectal surgery. Building on the standardization efforts seen in previous systems, the research team opted for the term Colorectal Anastomotic Leakage Reporting and Data System (CAL-RADS). The proposed score ranges from 0 to 5 and addresses the likelihood of AL. The aim of this study is to optimize the CAL-RADS classification, calculate interobserver variability, investigate the feasibility and clinical translation, and correlate its diagnostic value. A total of 150 CT scans of patients who had undergone colorectal surgery were recently scored with the proposed CAL-RADS score by 6 radiologists. Preliminary results suggest that the score is easy and feasible to assess the likelihood AL. Inter-observer variability is currently analyzed. Additional correlation analysis between the given scores and final interventions will be performed soon. Also, the influence of rectal or oral contrast in certain cases will be addressed. PART II: IMPROVING BOWEL PERFUSION ASSESSMENT TO REDUCE THE RISK OF ANASTOMOTIC LEAKS Typically, AL is attributed to factors such as technical errors in suturing by the surgeon or increased tension on the anastomosis. Nevertheless, it is increasingly evident that AL may occur regardless of surgical technique 21, as also demonstrated in the evidence summarized in the CoReAL project (Chapter 3). Insufficient blood supply to the transected intestinal edges has always been a known risk factor for the development of a leak, which can be assessed using near-infrared fluorescence (NIRF) imaging 22. NIRF stands out as one of the most notable technical advancements in surgery over the past decade to improve patients’ outcomes. Consequently, its clinical applications have proliferated significantly, encompassing various procedures such as fluorescence cholangiography, lymph node identification, ureteral delineation, and assessment of bowel anastomotic perfusion 23. Improving imaging systems to optimize bowel perfusion assessment and simultaneous visualization of other structures is therefore essential to reduce the occurrence of AL and other possible complications. Chapter 5 investigated the feasibility of simultaneous imaging of intestinal perfusion and the ureter using a commercially available near-infrared fluorescence (NIRF) imaging system. Six Landrace pigs underwent laparotomy under general anesthesia. Bowel perfusion was 14
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