73 International Consensus on Reporting colorectal Anastomotic Leaks (CoReAL) The CoReAL project aimed to bridge this gap by developing a standardized reporting framework for patients undergoing left-sided colorectal cancer resections. Drawing upon the most robust evidence available, along with insights from patients and experts, the CoReAL framework encompasses key variables related to the development, severity and postoperative outcomes of AL to create a comprehensive, data-driven and patient-centered approach for the clinical reporting of AL. We believe that integration of this framework into the clinical workflow will promote risk stratification for AL, adoption of evidence-based preventive and mitigation strategies, and demonstrate that time to diagnosis and corrective intervention correlates with persistence of long-term sequelae and patient reported outcomes. The strength of the manuscript derives from the rigorous methodology for consensus development among a large group of international experts with a wide range of practices. Representation of several surgical societies was critical for endorsement, dissemination, and subsequent adoption by members. The core of the project’s achievement lies in its evidence synthesis, which is encapsulated in 33 evidence-based statements derived from the highest level of evidence. The framework differs from prior consensus efforts in that it is largely built on these evidence-based statements and enriched by patients’ experiences and experts’ opinions to ensure it achieved its objectives whilst remaining relevant and meaningful to all relevant stakeholders 8-10. The CoReAL reporting framework consists of 43 elements, organized along the four phases of the AL episode. This structured approach was intended to standardize reporting practices rather than replace existing AL classification systems. We envisage the framework to become integrated into the clinical workflow, ensuring that implementation does not disrupt but complements current documentation. Preoperative elements can be included in standard assessments or informed consent discussions. Intraoperative elements can be added to operative report templates for CRC resections, while discharge summaries should incorporate short-term postoperative elements from the index admission and any readmissions, with follow-up reports including data up to 30, 90 days, and beyond. To date, institutions have only been required to report 30-day leak, re-intervention, reoperation, and readmission rates, which have been used as colectomy-specific quality benchmarking. This has reinforced the stigma associated with the reporting of AL and deterred clinical teams from interrogating anastomoses early, particularly when subclinical leaks are suspected. Another shortcoming of traditional quality reporting is that it does not consider whether steps were taken to mitigate the risk of leaks, identify and manage them early, effectively shortening the time to resolution. Extending the reporting period beyond 90 days is also critical to document resolution of AL, assess the true impact on healthcare resource utilization, and capture oncologic and functional sequelae, which are often omitted in shorter follow-up periods 29,30. The proposed extended reporting timeframe for AL, which 3
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