Danique Heuvelings

348 Chapter 15 Over the recent decades, the incidence of colorectal cancer (CRC) has exhibited dynamic trends 1. This phenomenon has initiated research into potential etiological factors and environmental exposures. The escalating burden of CRC poses significant challenges to global healthcare systems. Consequently, research efforts on CRC are dedicated to investigating this burden and optimizing the allocation of medical resources and outcomes in a more equitable manner 2. In essence, this thesis centered on enhancing patient outcomes following colorectal surgery, with the overarching goal of directly influencing patient well-being. This chapter delves into the societal and economic implications of the knowledge gathered from the various projects outlined in this thesis, while also analyzing their impact on the prevailing scientific priorities within the anastomotic leakage (AL) and peritoneal metastases (PM) field after CRC surgery. SOCIETAL RELEVANCE Firstly, reflecting on the work related to AL in this thesis, we believe better reporting of colorectal AL using the proposed reporting framework in this thesis (part I) can lead to a reduction for societal impacts in several ways. A worldwide issue of colorectal AL is that the lack of reporting them results in delayed recognition and treatment. Better reporting will ensure that leaks are identified promptly, allowing for early intervention and treatment. This can prevent acute complications such as sepsis and abscess formation, but also chronic sequelae like sinuses and fistulae, reducing the overall need for more extensive surgical procedures and hospitalizations over the long term 3. Also, by accurately documenting the occurrence and severity of leaks, healthcare facilities can allocate resources more efficiently. Detailed reporting of leaks additionally provides valuable feedback to surgeons and healthcare teams, facilitating continuous improvement in perioperative care protocols, including adequate pre-operative assessment, intraoperative measurements, and postoperative diagnostic tools. This can ultimately reduce the incidence of leaks and improve patient outcomes over time, but also enhance more efficient care when a leak occurs. Furthermore, it is anticipated that the reporting framework will encourage closer collaboration between healthcare professionals and software developers in the coming years. This could involve facilitating electronic data collection as suggested by our reporting framework, including input from patients as presented in our qualitative study. These initiatives align with the current priorities of e-health outlined by the Dutch Ministry of Health, Welfare, and Sport 4. By leveraging information technology, perioperative care stands to undergo further transformation. Not only by improving reporting of leaks, but also by optimizing bowel perfusion assessment (part II), we hope to reduce the risk of developing AL. Additionally, this thesis sheds light on the challenges faced by patients who developed AL post-surgery (part III), highlighting the importance of dialogue and additional support for patients dealing with AL. Also, it emphasizes the importance of psychological support and coping mechanisms for patients facing challenges such as pain, rehabilitation difficulties, and emotional distress.

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