338 Chapter 14 WRAP-UP AND FUTURE PERSPECTIVES Numerous generations of clinical and experimental researchers have dedicated their efforts to address the challenge of improving patients’ outcomes after colorectal surgery. Despite significant insights gained over the decades, AL continues to pose a substantial postoperative concern for a considerable number of patients. Furthermore, identifying patients at risk of metachronous PM and subsequently tailoring personalized treatment has posed challenges. While this thesis may not offer a conclusive solution to eliminate AL or metachronous PM, it signifies progress in confronting these issues. We believe that enhanced reporting of AL will also reduce its incidence and impact. The proposed CoReAL framework for standardizing reporting of leaks after colorectal surgery is crucial to improve patients’ outcomes. Not only will this framework help to enhance the reliability of research findings, but it will also promote early recognition and guide clinical decision making. Therefore, future steps will be taken to achieve worldwide adoption, including submitting our consensus statements and the reporting framework to surgical societies for evaluation of agreement and potential adoption into clinical practice, followed by surveys among physicians to monitor adherence. Additionally, factors contributing to potential lack of agreement will be systematically explored and discussed, with the expectation that evidence-based reporting elements will be effectively integrated into local practices and accepted by stakeholders. With the help of artificial intelligence to support clinicians, the reporting system will probably be self-generated in the future. The development and additional validation of our proposed CAL-RADS score will extra support the standardization of assessing and reporting leaks in the diagnostic phase. The current thesis highlighted the use of NIRF or LSCI to assess bowel perfusion. To our expectation, bowel perfusion assessment will increase over the next decade, and eventually it will become standard of care in colorectal surgery under a few conditions. In the widespread search for reliable quantification of perfusion with both NIRF imaging and LSCI, standardization of quantification methods and surgical procedures and data acquisition is essential. Subsequent, clinical trials in which direct patient benefit is explored are necessary to improve worldwide adoption. Stronger evidence derived from larger human cohorts (ideally RCTs) is required to substantiate the effectiveness in reducing AL rates and improving patients’ outcomes. Also, this will enhance comparison of both imaging techniques. Additionally, the role of MB in the landscape of NIRF should be investigated parallel to this. Larger datasets both for NIRF and LSCI should be used to develop prediction models providing risk rated of AL per tissue location in real time to alter surgical strategies. MB can probably also play an important role to reduce the number of iatrogenic ureter damage. Camera systems should therefore be adapted to visualize more wave lengths.
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