70 Chapter 3 Table 3. Overview of topics that require further investigation Topic Reason to not formulate a statement Preoperative • Preoperative selective decontamination compared to broad-spectrum antibiotics Too low level of evidence • Anemia correction Too low level of evidence • Oral nutritional supplement/ support Too much heterogeneity in the duration of administration, different types of oral nutritional support and no clear consensus on what the definition is of immunonutrition. Intraoperative • Human factors* Too low level of evidence • Anastomotic configuration** The reported data in the analysis is very scarce and heterogeneous, overall evidence was too low. • Anesthesia factors or intraoperative risk scoring systems Too low level of evidence and lack of worldwide validation. Postoperative short-term • Clinical predictions scores Not described in high level evidence literature. • Peritoneal fluid markers Not described in high level evidence literature. • Low fiber diet Not described in high level evidence literature. • Laxatives Not described in high level evidence literature. Postoperative long-term • Impact on QoL Too low level of evidence • Financial impact Too low level of evidence. The expert team felt like additional intervention, imaging modalities and paramedical care were contributors within the statement. • Chronic sequalae of AL Evidence too low, not well described in high level evidence literature. *hospital volume, surgeon volume, surgeon specialization; **side-to-side versus side-to-end versus end-to-end versus J-pouch, anti-peristaltic versus isoperistaltic, intracorporeal versus extracorporeal, handsewn versus stapled, immediate versus delayed (Turnbull-Cutait), compression versus handsewn versus stapled, and single vs double layered anastomosis. AL; anastomotic leak, QoL; Quality of Life. CoReAL reporting framework By the end of day 2 of the in-person consensus meeting, 46 reporting elements were included in the reporting framework including 7 preoperative, 14 intraoperative, 7 postoperative -index admission, 8 postoperative -30 to 90 day period, and 10 postoperative -long-term elements. Following the 2nd online Delphi round, three elements did not reach consensus. Of the 43 reporting elements that reached consensus, 27 reporting elements were derived from evidence-based consensus statements, 7 were based on patient perspectives and 9 from expert opinion (Table 4). Patient-centered elements were informed by the results of our qualitative analysis and included preoperative discussion regarding the potential need for a stoma after surgery, preparation and planning for possible stoma creation, postoperative assessment and management of potential sequelae of AL, and the impact of AL on QoL
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