71 International Consensus on Reporting colorectal Anastomotic Leaks (CoReAL) and functional outcomes 22. Consensus was reached to report these outcomes for at least one year after surgery, with the aspirational goal of reporting on oncologic, survival, and functional status at 2 and 5 years postoperatively. Although the evidence suggested that mechanical bowel preparation alone and routine splenic flexure mobilization did not significantly impact AL rates, both were included as elements based on expert opinion that they reflected standard practice during left-sided restorative proctectomy for cancer. In addition, 6 intraoperative elements reflecting the intraoperative difficulty (3) and surgical pitfalls (3) were based on expert opinion. Although these elements are not based on evidence, they were felt to serve as surrogates for the technical and human factors that likely contribute to AL. Lastly, given the importance of documenting resolution (or lack thereof) of AL and its potential sequelae, status of the anastomosis was included as a postoperative element to be captured beyond 90 days and up to 1 year postoperatively. Table 4. Reporting elements included in the CoReAL reporting framework Reporting elements Agreement (%) Background Preoperative elements 1. Modifiable risk factors 92.31 Evidence based 2. Preoperative oral antibiotics 92.31 Evidence based 3. Mechanical bowel preparation 88.45 Expert opinion 4. Other risk factors 84.62 Evidence based 5. Was the potential need of a postoperative/permanent stoma discussed? 84.62 Patient centered 6. Was the patient referred to a stoma therapist preoperatively? 76.92 Patient centered Intraoperative elements 7. Diverting stoma creation 100 Evidence based 8. Intraoperative difficulty: Distance of the anastomosis (cm) from AV 100 Expert opinion 9. Anastomotic integrity testing 96.15 Evidence based 10. Number of stapler loads for rectal transection 92.31 Evidence based 11. Intraoperative difficulty: Redo pelvic surgery 92.31 Expert opinion 12. Conversion MIS to open 88.46 Evidence based 13. Pitfalls: pelvic stapler failures 88.46 Expert opinion 14. Pitfalls: Unplanned multivisceral resection or repair (of organ injury) 84.62 Expert opinion 15. Splenic flexure mobilization 84.62 Expert opinion 16. Intraoperative difficulty: acute blood loss requiring blood transfusion 80.77 Expert opinion 17. Location of inferior mesenteric artery ligation 76.92 Evidence based 18. Pitfalls: other device failures 76.92 Expert opinion 19. Perfusion assessment of conduit with fluorescence angiography 73.08 Evidence based 3
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