69 International Consensus on Reporting colorectal Anastomotic Leaks (CoReAL) Table 2. Continued LoE Statement No. of Delphi round: % of agreement L 19. Anastomotic reinforcement with omentoplasty may not affect AL rates after CRC surgery. 1: 90% M 20. Using a prophylactic pelvic drain for rectal surgery probably does not affect overall AL rates after CRC surgery. 2: 96,15% Postoperative short-term topics M 21. In addition to the confirmed overall benefits of ERAS, the use of an ERAS protocol probably does not impact AL rates after CRC surgery. 2: 73.08% L 22. Within the context of ERAS protocols, short-term use of NSAIDs in the postoperative phase may not influence the prevalence of AL after CRC surgery. 2: 84.62% M 23. Serial CRP in the early postoperative phase probably has strong negative predictive value for AL after CRC surgery. 2: 100% M 24. While serial CRP on itself is not diagnostic for AL, increased values in the early postoperative phase probably are a predictor of an adverse postoperative event after CRC surgery. 2: 84.62% M 25. Endoscopy or CT scan (with at least IV-contrast) may be more accurate than water-soluble contrast enema for the diagnosis of AL after CRC surgery. 2: 96.61% L 26. Following a minimally invasive CRC operation, a laparoscopic approach as re-intervention may be safe and feasible for the management of AL. 2: 96.15% L 27. In a hemodynamically stable patient with AL after CRC surgery, transanal or endoscopic management, either alone or in combination with other modalities, may be safe. 2: 96.15% L 28. The development of AL after CRC surgery may result in higher mortality rates compared to patients without AL. 2: 92.30% Postoperative long-term topics L 29. The development of AL after CRC surgery may result in higher overall complications compared to patients without AL. 1: 100% L 30. The development of AL may be associated with increased healthcare costs due to increased hospital stay after rectal cancer surgery. 1: 100% L 31. The development of AL after CRC surgery may be a risk factor for permanent stoma compared to patients without AL. 2: 96.15% M 32. The development of AL is probably associated with decreased overall survival and disease-free survival after CRC surgery. 1: 96.67% M 33. The development of AL is probably associated with an increased local recurrence after rectal cancer surgery. 1: 90% AL, anastomotic leak; IV, intravenous; CRC, colorectal cancer; CRP, C-reactive protein; ERAS, Enhanced Recovery After Surgery; IMA, inferior mesenteric artery; NSAID, nonsteroidal anti-inflammatory drugs; TME, total mesorectal excision. LoE; Level of Evidence, green = moderate (M), orange = low (L). 3
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