91 Proposal of a Reporting and Data System for Colorectal Anastomotic Leakage: CAL-RADS INTRODUCTION Surgery remains the primary curative option for individuals with colorectal cancer (CRC), yet it can result in significant post-operative complications, with anastomotic leakage (AL) being particularly concerning. AL arises in 8-15% of colorectal surgery cases and is linked to elevated morbidity rates and short-term mortality rates reaching up to 39% 1. The manifestation of AL can range from abdominal discomfort and mild fever to peritonitis and severe sepsis. This ambiguous progression often hampers prompt radiological assessment, and even when conducted, diagnoses frequently remain uncertain. Prior studies have reported false-negative rates ranging from 17-52% for both contrast enemas and computerized tomography (CT) scans, resulting in significant delays in re-intervention 2, 3. Given that delayed detection of AL is linked to unfavorable outcomes and premature reintervention may result in numerous negative re-explorations, it’s crucial to critically look at radiological examinations and additionally weight the risks of delayed intervention against the morbidity of re-intervention. Physicians have a limited set of parameters to assess the likelihood of AL development on CT scans, which may help improve earlier recognition and re-interventions of AL after colorectal surgery. As the sensitivity of abdominal CT scanning after colonic surgery is considered low, we must make efforts to recognize, interpret, and communicate the imaging findings pertaining to the abdomen. In early 2022, the American Society for Colorectal Surgery (ASCRS) initiated the Consensus on Reporting and Defining Colorectal Anastomotic Leaks (CoReAL) project to facilitate development and nationwide dissemination of AL information and tools together with the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), the European Association for Endoscopic Surgery (EAES), the European Society of Coloproctology (ESCP), the Endoscopic and Laparoscopic Surgeons of Asia (ELSA) and the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). Within this network, a standardized reporting framework for AL after colorectal surgery was developed. Besides, the research team proposed a standardized CT assessment scheme for AL. Developing this classification system would make it possible to compare data across institutions and populations and, thus, provide a basis for gathering scientific evidence and improved communication with referring physicians when assessing CT scans for the suspicion of a leak. Building on the standardization efforts seen in systems like Breast Imaging Reporting and Data System (BI-RADS), the Lung Imaging Reporting and Data System (Lung-RADS), and Prostate Imaging Reporting and Data System (PI-RADS), the authors opted for the term Colorectal Anastomotic Leakage Reporting and Data System (CAL-RADS) 4. 4
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