349 Impact Secondly, reflecting on the work related to PM in this thesis (part IV), we underscored the importance of accurate prediction tools for estimating the risk of peritoneal spread in CRC patients using genetic alterations. As PM is associated with a dismal prognosis and research into the prevention of PM, it is therefore crucial to improve outcomes. Our study investigating the safety of a preventive strategy in the form of an injectable hydrogel needs to be addressed here. Although the impact on patients may be primarily indirect, as it involves preclinical research conducted on rats rather than direct human subjects, the findings have important societal implications. As previous studies showed enhanced survival among animals subjected to this treatment, our study team strongly believed this hydrogel could influence patients’ outcomes positively. Yet, the observed safety concerns, particularly the significant intestinal blood loss observed in animals receiving the hydrogel, highlight the importance of rigorous preclinical testing to ensure the safety and efficacy of new interventions before their translation into clinical practice. By identifying potential risks associated with the use of hydrogel, this study underscores the need for further optimization and refinement of the intervention to ensure patient safety in future clinical trials. ECONOMIC RELEVANCE Complications following colon or rectum surgery have a significant economic impact. For patients without complications, the average cost is €9,226 in the Netherlands (2015). However, for those with minor complications, the cost increases by €2,403, and for those with severe complications, it rises to €17,906 5. The occurrence of AL leads to a significant rise in healthcare resource utilization, primarily driven by longer hospital stays 6, 7. The more complex the AL, the greater the associated treatment costs 6. Subsequently, preventing or minimizing the occurrence of colorectal AL by enhancing uniform reporting of leaks (part I) can lead to significant cost savings within the healthcare system. Fewer complications mean shorter hospital stays, fewer readmissions, and reduced reliance on costly interventions such as reoperations, prolonged antibiotic therapy, and admission in the intensive care unit. Timely identification and management of leaks may help mitigate long-term complications, improving patients’ quality of life (QoL) and reducing the burden on healthcare resources associated with ongoing care needs. It is also important to address the potential benefits against the cost when using bowel perfusion assessment (part II) as a potential preventive strategy for AL. A recent article investigated the cost-effectiveness of utilizing indocyanine green fluorescence angiography (ICG-FA) as a preventive measure against AL in colorectal surgery 8. It assessed the potential economic benefits and analyzed various factors, including the cost of ICG-FA equipment, procedure costs, and potential savings associated with reduced postoperative complications. According to this cost analysis based on recent studies on leak rates and the expenses of colorectal resections, incorporating fluorescence imaging for perfusion assessment as a 15
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