68 Chapter 3 Table 2. Overview of evidence-based statement with corresponding Level of Evidence (LoE) and percentage of agreement. LoE Statement No. of Delphi round: % of agreement Preoperative topics M 1. Modifiable preoperative risk factors that probably do increase AL rates after CRC surgery include obesity, alcohol, smoking, and low preoperative serum albumin level. 1: 100% M 2. Not-modifiable preoperative risk factors that probably do increase AL rates after CRC surgery include male gender, high ASA (>2), diabetes, cardiovascular disease, renal disease, chronic steroid use, advanced TMN stage (T3-4), tumor size > 5cm, tumor location < 12cm from the anal verge, complicated tumor (perforation or obstruction), and neoadjuvant therapy (preoperative chemotherapy, radiotherapy, long course chemoradiotherapy, short course radiotherapy). 1: 96.67% M 3. Adding pre- and postoperative probiotics to standard nutrition probably does not reduce AL rates after CRC surgery. 1: 80% M 4. The use of preoperative oral mechanical bowel preparation alone probably does not influence AL rates after CRC surgery. 1: 80% L 5. The addition of mechanical bowel preparation to single phosphate enema may not influence the AL rates after CRC surgery. 1: 83.33% M 6. The addition of preoperative oral antibiotics (to mechanical bowel preparation and perioperative IV antibiotics) probably reduces AL rates after CRC surgery. 1: 96.67% L 7. Sarcopenia, diagnosed with L3 skeletal muscle index, may not influence AL rates after CRC surgery but the evidence is very uncertain. 2: 83.87% Intraoperative topics L 8. High IMA ligation may be associated with higher AL rates compared to low IMA. 2: 73.03% M 9. Routine splenic flexure mobilization when performing anterior rectal resections probably does not affect AL rates. 1: 76,67% M 10. Choice of either performing a laparoscopic or open CRC resection probably does not affect AL rates. 1: 86,67% M 11. Conversion (from laparoscopic to open surgery) for patients undergoing rectal cancer resection may increase AL rates. 1: 76,67% L 12. The choice of either performing open TME, robotic TME, laparoscopic TME or transanal TME may not affect AL. 1: 86,67% L 13. Firing more than one stapler during laparoscopic rectal resection may be associated with higher AL rates. 1: 90% M 14. The use of ICG (fluorescence angiography) for bowel perfusion assessment during CRC surgery is probably associated with a decrease in AL rates. 2: 76,92% L 15. Prophylactic fecal diversion may reduce the severity of AL after rectal cancer surgery. 2: 88,46% L 16. Intraoperative anastomotic integrity assessments (air leak test and/or endoscopy) may be associated with lower AL rates. 1: 100% L 17. The choice of either performing intraoperative endoscopy or air leak test alone, may not influence AL rates after CRC surgery. 1: 80% L 18. Staple line reinforcement may not affect AL rates after CRC surgery. 1: 83,33%
RkJQdWJsaXNoZXIy MTk4NDMw