Imperial College London

Mr Christos Kontovounisios

Faculty of MedicineDepartment of Surgery & Cancer

Clinical Senior Lecturer in Colorectal Surgery
 
 
 
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Contact

 

+44 (0)20 3315 8529c.kontovounisios

 
 
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Location

 

Chelsea and Westminster HospitalChelsea and Westminster Campus

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Summary

 

Publications

Publication Type
Year
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187 results found

Kontovounisios C, 2022, 3D Printing in the National Health Service. Facilitating the adoption and evolution of digital technologies through re-conceptualization, Frontiers in Surgery, ISSN: 2296-875X

Journal article

Celentano V, Tekkis P, Nordenvall C, Mills S, Spinelli A, Smart N, Selvaggi F, Warren O, Espin-Basany E, Kontovounisios C, Pellino G, Warusavitarne J, Hancock L, Myelid P, Remzi Fet al., 2021, Standardization of ileoanal J-pouch surgery technique: Quality assessment of minimally invasive ileoanal J-pouch surgery videos., Surgery

BACKGROUND: Ileal pouch anal anastomosis is a complex procedure associated with significant morbidity, with several complications after ileal pouch anal anastomosis surgery leading to pouch failure. The aim of the study is to evaluate the heterogeneity surrounding the technique of ileoanal J-pouch surgery by assessing the safety and quality of published online peer-reviewed surgical videos. METHODS: Ileal pouch anal anastomosis videos published on peer-reviewed surgical journals and video channels were edited and anonymized to demonstrate specific steps of the surgical procedure: mobilization and division of the rectum, formation of the ileoanal J-pouch reservoir, anastomosis, and lengthening techniques. The anonymized videos were presented to a group of reviewers with expertise in ileal pouch anal anastomosis blinded to the names and affiliations of the surgeons performing the procedure. Primary outcome was the rate of interobserver variability in the assessment of specific technical steps of the ileal pouch anal anastomosis surgery procedure. Secondary outcome was the appropriateness of the use of surgical videos review as an assessment tool for ileal pouch anal anastomosis surgery, measured as rate of reviewers being unable to answer for poor video quality. RESULTS: In total, 29 video fragments were distributed, and 13 assessors completed a 60-item survey, organized in 7 major domains. The survey completion rate was 93.4%. Out of a total 729 answers, in 23 (3.2%) the reviewers indicated they were unable to comment due to poor video image, and in 48 (6.5%) were unable to comment due to the particular step not being shown in the procedure. The proportion of assessors rating rectal mobilization technically appropriate ranged from 30.7% to 92.3% and from 7.7% to 69.2% for safety. The level of rectal division was considered appropriate in 0 to 53.8% of the videos, whereas the stapling technique used for rectal division was appropriate in 0 to 70% of the videos. CONCLU

Journal article

Kontovounisios C, 2021, Demographics and incidence of Anal Squamous Cell Carcinoma in people living in high HIV prevalence geographical areas, Sexually Transmitted Infections, ISSN: 1368-4973

ObjectivesAnal Squamous Cell Carcinoma (ASCC) is an uncommon cancer that is rapidly increasing in incidence. HIV is a risk factor in the development of ASCC and it is thought that the rapidly increasing incidence in men is related to increasing numbers of people living with HIV (PLWH). We undertook a population-based study comparing the demographics and incidence of ASCC in patients residing high HIV prevalence areas in England to patients living in average HIV prevalence areas in England MethodsThis is a cross-sectional study following the “strengthening the reporting of observational studies in epidemiology” STROBE statement. Demographic data and incidence rates of ASCC within Clinical Commissioning Groups (CCGs) between 2013 and 2018 were extracted from the Cancer Outcomes and Services Dataset (COSD). CCGs were then stratified by HIV prevalence from data given by Public Health England and high HIV prevalence geographical areas were compared with average HIV geographical areas. ResultsPatients in high HIV areas were more likely to be young and male with higher levels of social deprivation. Incidence rates in men between 2013 and 2017 were higher in high HIV areas than average HIV areas with a rapidly increasing incidence rates in early-stage disease and a 79.1% reduction in incidence of metastatic Stage 4 disease. Whereas women in high HIV areas had lower ASCC incidence than the national average and a low incidence of early-stage disease, however metastatic disease in women had quintupled in incidence in high HIV areas since 2013.ConclusionsPatients presenting with ASCC in high HIV geographical areas have different demographics to patients presenting in average HIV geographical areas. This may be related to screening programmes for PLWH in high HIV areas.

Journal article

McLean KA, Kamarajah SK, Chaudhry D, Gujjuri RR, Raubenheimer K, Trout I, AlAmeer E, Creagh-Brown B, Harrison EM, Nepogodiev D, Roslani AC, Li E, Pata F, Ramos-De La Medina A, van Ramshorst GH, Sayyed R, Simoes J, Valente DCA, Smart N, Bhangu A, Glasbey JC, Khaw RA, Ahmed W, Akhbari M, Baker D, Borakati A, Mills E, Murray V, Thavayogan R, Yasin I, Glasbey J, Ridley W, Sarrami M, Zhang G, Egoroff N, Pockney P, Richards T, Edwards M, Lee M, Pinkney T, Pearse R, Vohra R, Sohrabi C, Jamieson A, Nguyen M, Rahman A, English C, Tincknell L, Kakodkar P, Kwek I, Punjabi N, Burns J, Varghese S, Erotocritou M, McGuckin S, Vayalapra S, Dominguez E, Moneim J, Bhatia S, Kouli O, Salehi M, Tan HL, Yoong A, Zhu L, Seale B, Nowinka Z, Patel N, Chrisp B, Harris J, Maleyko I, Muneeb F, Gough M, James CE, Skan O, Chowdhury A, Rebuffa N, Khan H, Down B, Fatimah HQ, Siaw-Acheampong K, Benson RA, Bywater E, Dawson BE, Evans JP, Heritage E, Jones CS, Khatri C, Keatley JM, Knight A, Lawday S, Mann HS, Marson EJ, Mckay SC, Mills EC, Pellino G, Picciochi M, Taylor EH, Tiwari A, Simoes JF, Trout IM, Venn ML, Wilkin RJW, Smart NJ, Minaya-Bravo A, Gallo G, Moug S, Di Saverio S, Vallance A, Vimalchandran D, Griffiths EA, Evans RPT, Townend P, Roberts K, McKay S, Isaac J, Satoi S, Edwards J, Coonar AS, Marchbank A, Caruana EJ, Layton GR, Patel A, Brunelli A, Ford S, Desai A, Gronchi A, Fiore M, Almond M, Tirotta F, Dumitra S, Kolias A, Price SJ, Fountain DM, Jenkinson MD, Hutchinson P, Marcus HJ, Piper RJ, Lippa L, Servadei F, Esene I, Freyschlag C, Neville I, Rosseau G, Schaller K, Demetriades AK, Robertson F, Alamri A, Shaw R, Schache AG, Winter SC, Ho M, Nankivell P, Biel JR, Batstone M, Ganly I, Vidya R, Wilkins A, Singh JK, Thekinkattil D, Sundar S, Fotopoulou C, Leung E, Khan T, Chiva L, Sehouli J, Fagotti A, Cohen P, Gutelkin M, Ghebre R, Konney T, Pareja R, Bristow R, Dowdy S, Rajkumar STS, Ng J, Fujiwara K, Stewart GD, Lamb B, Narahari K, McNeill A, Colquhoun A, McGrath J, Bromage S, Baroet al., 2021, Death following pulmonary complications of surgery before and during the SARS-CoV-2 pandemic, BRITISH JOURNAL OF SURGERY, Vol: 108, Pages: 1448-1464, ISSN: 0007-1323

Journal article

Rogers AC, Jenkins JT, Rasheed S, Malietzis G, Burns EM, Kontovounisios C, Tekkis PPet al., 2021, Towards Standardisation of Technique for En Bloc Sacrectomy for Locally Advanced and Recurrent Rectal Cancer., Journal of clinical medicine, Vol: 10, ISSN: 2077-0383

Treatment strategies for advanced or recurrent rectal cancer have evolved such that the ultimate surgical goal to achieve a cure is complete pathological clearance. To achieve this where the sacrum is involved, en bloc sacrectomy is the current standard of care. Sacral resection is technically challenging and has been described; however, the technique has yet to be streamlined across units. This comprehensive review aims to outline the surgical approach to en bloc sacrectomy for locally advanced or recurrent rectal cancer, with standardisation of the operative steps of the procedure and to discuss options that enhance the technique.

Journal article

Kontovounisios C, 2021, Towards standardisation of technique for en bloc sacrectomy for locally advanced and recurrent rectal cancer, Journal of Clinical Medicine, Vol: 10, Pages: 1-12, ISSN: 2077-0383

Treatment strategies for advanced or recurrent rectal cancer have evolved such that the ultimate surgical goal to achieve a cure is complete pathological clearance. To achieve this where the sacrum is involved, en bloc sacrectomy is the current standard of care. Sacral resection is technically challenging and has been described; however, the technique has yet to be streamlined across units. This comprehensive review aims to outline the surgical approach to en bloc sacrectomy for locally advanced or recurrent rectal cancer, with standardisation of the operative steps of the procedure and to discuss options that enhance the technique.

Journal article

Kontovounisios C, 2021, The current and possible future role of 3D modelling within oesophagogastric surgery: a scoping review protocol, BMJ Open, Vol: 11, Pages: 1-4, ISSN: 2044-6055

IntroductionThree-dimensional (3D) reconstruction describes the generation of either virtual or physically printed anatomically accurate 3D models from two-dimensional (2D) medical images. Their implementation has revolutionised medical practice. Within surgery, key applications include growing roles in operative planning and procedures, surgical education and training as well as patient engagement and education. In comparison to other surgical specialties, oesophagogastric surgery has been slow in their adoption of this technology. Herein the authors outline a scoping review protocol that aims to analyse the current role of 3D modelling in oesophagogastric surgery and highlight any unexplored avenues for future research. Methods and AnalysisThe protocol was generated using internationally accepted methodological frameworks. A succinct primary question was devised, and a comprehensive search strategy developed for key databases (MEDLINE, Embase, Elsevier Scopus and ISI Web of Science). These were searched from their inception to 1/6/2020. Reference lists will be reviewed by hand and grey literature identified using OpenGrey and Grey Literature Report. The protocol was registered to the Open Science Framework (osf.io/ta789). Two independent reviewers will screen titles, abstracts and perform full text reviews for study selection. There will be no methodological quality assessment to ensure a full thematic analysis is possible. A data charting tool will be created by the investigatory team. Results will be analysed to generate descriptive numerical tabular results and a thematic analysis performed. Ethics and Dissemination Ethical approval was not required for the collection and analysis of the published data. The scoping review report will be disseminated through a peer-reviewed publication and international conferences.Registration detailsThe scoping review protocol has been registered on the Open Science Framework (osf.io/ta789)

Journal article

Glasbey J, Ademuyiwa A, Adisa A, AlAmeer E, Arnaud AP, Ayasra F, Azevedo J, Minaya-Bravo A, Costas-Chavarri A, Edwards J, Elhadi M, Fiore M, Fotopoulou C, Gallo G, Ghosh D, Griffiths EA, Harrison E, Hutchinson P, Lawani I, Lawday S, Lederhuber H, Leventoglu S, Li E, Gomes GMA, Mann H, Marson EJ, Martin J, Mazingi D, McLean K, Modolo M, Moore R, Morton D, Ntirenganya F, Pata F, Picciochi M, Pockney P, Ramos-De la Medina A, Roberts K, Roslani AC, Kottayasamy Seenivasagam R, Shaw R, Simões JFF, Smart N, Stewart GD, Sullivan R, Sundar S, Tabiri S, Taylor EH, Vidya R, Nepogodiev D, Bhangu A, Glasbey JC, McLean K, Nepogodiev D, Harrison E, Bhangu AA, Nepogodiev D, Siaw-Acheampong K, Benson RA, Bywater E, Chaudhry D, Dawson BE, Evans JP, Glasbey JC, Gujjuri RR, Heritage E, Jones CS, Kamarajah SK, Khatri C, Khaw RA, Keatley JM, Knight A, Lawday S, Li E, Mann HS, Marson EJ, McLean KA, Mckay SC, Mills EC, Pellino G, Picciochi M, Taylor EH, Tiwari A, Simoes JFF, Trout IM, Venn ML, Wilkin RJW, Bhangu A, Glasbey JC, Smart NJ, Minaya-Bravo A, Evans JP, Gallo G, Moug S, Pata F, Pockney P, Di Saverio S, Vallance A, Vimalchandran D, Griffiths EA, Kamarajah SK, Evans RPT, Townend P, Roberts K, McKay S, Isaac J, Satoi S, Edwards J, Coonar AS, Marchbank A, Caruana EJ, Layton GR, Patel A, Brunelli A, Ford S, Desai A, Gronchi A, Fiore M, Almond M, Tirotta F, Dumitra S, Kolias A, Price SJ, Fountain DM, Jenkinson MD, Hutchinson P, Marcus HJ, Piper RJ, Lippa L, Servadei F, Esene I, Freyschlag C, Neville I, Rosseau G, Schaller K, Demetriades AK, Robertson F, Alamri A, Shaw R, Schache AG, Winter SC, Ho M, Nankivell P, Rey Biel J, Batstone M, Ganly I, Vidya R, Wilkins A, Singh JK, Thekinkattil D, Sundar S, Fotopoulou C, Leung EYL, Khan T, Chiva L, Sehouli J, Fagotti A, Cohen P, Gutelkin M, Ghebre R, Konney T, Pareja R, Bristow R, Dowdy S, Shylasree TS, Kottayasamy Seenivasagam R, Ng J, Fujiwara K, Stewart GD, Lamb B, Narahari K, McNeill A, Colquhoun A, McGrath JS, Bromage S, Barod R, Kasivisvaet al., 2021, Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study, The Lancet Oncology, ISSN: 1470-2045

BackgroundSurgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction.MethodsThis international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20–60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926.FindingsOf eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notif

Journal article

Kontovounisios C, 2021, Perioperative optimization in complex abdominal wall hernias: Delphi consensus statement, BJS Open, Vol: 5, Pages: 1-7, ISSN: 2474-9842

Background The incidence of incisional hernia after major abdominal surgery via a midline laparotomy is 20–41 percent with short-term follow-up, and over 50 per cent in those surviving an abdominal catastrophe.Abdominal wall reconstruction (AWR) requires complex operations, often involving mesh resection,management of scarred skin, fistula takedown, component separation or flap reconstruction. Patientstend to have more complex conditions, with multiple co-morbidities predisposing them to a viciouscycle of complications and, subsequently, hernia recurrence. Currently there appears to be variance inperioperative practice and minimal guidance globally. The aim of this Delphi consensus was to providea clear benchmark of care for the preoperative assessment and perioperative optimization of patientsundergoing AWR.MethodsThe Delphi method was used to achieve consensus from invited experts in the field of AWR. Thirtytwo hernia surgeons from recognized hernia societies globally took part. The process included tworounds of anonymous web-based voting with response analysis and formal feedback, concluding witha live round of voting followed by discussion at an international conference. Consensus for a strongrecommendation was achieved with 80 per cent agreement, and a weak recommendation with 75 percent agreement. ResultsConsensus was obtained on 52 statements including surgical assessment, preoperative assessment,perioperative optimization, multidisciplinary team and decision-making, and quality-of-life assessment.Forty-six achieved over 80 per cent agreement; 14 statements achieved over 95 per cent agreement.ConclusionClear consensus recommendations from a global group of experts in the AWR field are presented inthis study. These should be used as a baseline for surgeons and centres managing abdominal wallhernias and performing complex AWR.TOC summary: The Delphi method was used to provide consensus statements for preoperativeassessment and perioperative optimization

Journal article

Rottoli M, Pellino G, Tanzanu M, Baldi C, Frontali A, Carvello M, Foppa C, Kontovounisios C, Tekkis P, Colombo F, Sancho-Muriel J, Frasson M, Danelli P, Celentano V, Spinelli A, Panis Y, Sampietro GM, Poggioli Get al., 2021, Inflammatory bowel disease patients requiring surgery can be treated in referral centres regardless of the COVID-19 status of the hospital: results of a multicentric European study during the first COVID-19 outbreak (COVIBD-Surg) (Jun, 10.1007/s13304-021-01119-y, 2021), UPDATES IN SURGERY, ISSN: 2038-131X

Journal article

Brogden DRL, Lupi MEE, Warren OJ, Kontovounisios C, Mills SCet al., 2021, Comparing and contrasting clinical consensus and guidelines for anal intraepithelial neoplasia in different geographical regions, UPDATES IN SURGERY, Vol: 73, Pages: 2047-2058, ISSN: 2038-131X

Journal article

Fadel MG, Iskandarani M, Cuddihy J, Jones I, Collins D, Kontovounisios Cet al., 2021, Colonic perforation following major burns: Experience from a burns center and a systematic review, BURNS, Vol: 47, Pages: 1241-1251, ISSN: 0305-4179

Journal article

Zaborowski AM, Abdile A, Adamina M, Aigner F, d'Allens L, Allmer C, Alvarez A, Anula R, Andric M, Atallah S, Bach S, Bala M, Barussaud M, Bausys A, Bebington B, Beggs A, Bellolio F, Bennett M-R, Berdinskikh A, Bevan V, Biondo S, Bislenghi G, Bludau M, Boutall A, Brouwer N, Brown C, Bruns C, Buchanan DD, Buchwald P, Burger JWA, Burlov N, Campanelli M, Capdepont M, Carvello M, Chew H-H, Christoforidis D, Clark D, Climent M, Cologne KG, Contreras T, Croner R, Daniels IR, Dapri G, Davies J, Delrio P, Denost Q, Deutsch M, Dias A, D'Hoore A, Drozdov E, Duek D, Dunlop M, Dziki A, Edmundson A, Efetov S, El-Hussuna A, Elliot B, Emile S, Espin E, Evans M, Faes S, Faiz O, Fleming F, Foppa C, Fowler G, Frasson M, Figueiredo N, Forgan T, Frizelle F, Gadaev S, Gellona J, Glyn T, Gong J, Goran B, Greenwood E, Guren MG, Guillon S, Gutlic I, Hahnloser D, Hampel H, Hanly A, Hasegawa H, Iversen LH, Hill A, Hill J, Hoch J, Hoffmeister M, Hompes R, Hurtado L, Iaquinandi F, Imbrasaite U, Islam R, Jafari MD, Kanemitsu Y, Karachun A, Karimuddin AA, Keller DS, Kelly J, Kennelly R, Khrykov G, Kocian P, Koh C, Kok N, Knight KA, Knol J, Kontovounisios C, Korner H, Krivokapic Z, Kronberger I, Kroon HM, Kryzauskas M, Kural S, Kusters M, Lakkis Z, Lankov T, Larson D, Lazar G, Lee K-Y, Lee SH, Lefevre JH, Lepisto A, Lieu C, Loi L, Lynch C, Maillou-Martinaud H, Maroli A, Martin S, Martling A, Matzel KE, Mayol J, McDermott F, Meurette G, Millan M, Mitteregger M, Moiseenko A, Monson JRT, Morarasu S, Moritani K, Moslein G, Munini M, Nahas C, Nahas S, Negoi I, Novikova A, Ocares M, Okabayashi K, Olkina A, Onate-Ocana L, Otero J, Ozen C, Pace U, Juliao GPS, Panaiotti L, Panis Y, Papamichael D, Park J, Patel S, Uriburu JCP, Pera M, Perez RO, Petrov A, Pfeffer F, Phang PT, Poskus T, Pringle H, Proud D, Raguz I, Rama N, Rasheed S, Raval MJ, Rega D, Reissfelder C, Meneses JCR, Ris F, Riss S, Rodriguez-Zentner H, Roxburgh CS, Saklani A, Salido AJ, Sammour T, Saraste D, Schneider M, Seishima R, Sekulic A, Sepet al., 2021, Characteristics of Early-Onset vs Late-Onset Colorectal Cancer A Review, JAMA SURGERY, Vol: 156, Pages: 865-874, ISSN: 2168-6254

Journal article

Tekkis NP, Rafi D, Brown S, Courtney A, Kawka M, Howell A-M, McLean K, Gardiner M, Mavroveli S, Hutchinson P, Tekkis P, Wilkinson P, Sam AH, Savva N, Kontovounisios Cet al., 2021, The impact of the COVID-19 pandemic on UK medical education. A nationwide student survey, MEDICAL TEACHER, ISSN: 0142-159X

Journal article

Kontovounisios C, 2021, The role of demographics, social deprivation and ethnicity on anal squamous cell carcinoma incidence in England, Journal of Clinical Medicine, Vol: 10, Pages: 1-11, ISSN: 2077-0383

Anal Squamous Cell Carcinoma (ASCC) is an HPV-related malignancy with increasingincidence in high-income economies. Although ethnicity and social deprivation are known to berisk factors in other malignancies, little is known about socioeconomic status and risk of ASCC.This is a cross-sectional study following the STROBE Statement. Demographic data from the English Clinical Outcomes and Services Dataset (COSD) were extracted for all patients diagnosed withASCC in England between 2013 and 2018. Outcomes included ethnicity, social deprivation, staging and treatment. This study included 5457 patients. Incidence increased by 23.4% in 5 years,with female incidence increasing more rapidly than male incidence (28.6% vs. 13.5%). Men weremore likely to present with early staging (p < 0.001) and have surgery as their only treatment (p <0.001). The rate of incidence of Stage 1 tumours in men was 106.9%; however, women had thegreatest increase in metastatic tumours (76.1%). Black Caribbean and Black African patients weremore likely to present at an earlier age with later staging (p < 0.001) and social deprivation wasassociated with younger age (p < 0.001). ASCC incidence is rapidly increasing in patterns consistent with two separate populations: one male with early staging, the other female and related tosocial deprivation and ethnicity factors.

Journal article

Makris GC, Thulasidasan N, Malietzis G, Kontovounisios C, Saibudeen A, Uberoi R, Diamantopoulos A, Sapoval M, Vidal Vet al., 2021, Catheter-Directed Hemorrhoidal Dearterialization Technique for the Management of Hemorrhoids: A Meta-Analysis of the Clinical Evidence, JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY, Vol: 32, Pages: 1119-1127, ISSN: 1051-0443

Journal article

Cardiothoracic Interdisciplinary Research Network and COVIDSurg Collaborative, 2021, Early outcomes and complications following cardiac surgery in patients testing positive for coronavirus disease 2019: An international cohort study., Journal of Thoracic and Cardiovascular Surgery, Vol: 162, Pages: e355-e372, ISSN: 0022-5223

Journal article

COVIDSurg Collaborative Co-authors, 2021, Machine learning risk prediction of mortality for patients undergoing surgery with perioperative SARS-CoV-2: the COVIDSurg mortality score, British Journal of Surgery, Vol: 108, Pages: 1274-1292, ISSN: 0007-1323

Since the beginning of the COVID-19 pandemic tens of millions of operations have been cancelled1 as a result of excessive postoperative pulmonary complications (51.2 per cent) and mortality rates (23.8 per cent) in patients with perioperative SARS-CoV-2 infection2. There is an urgent need to restart surgery safely in order to minimize the impact of untreated non-communicable disease.As rates of SARS-CoV-2 infection in elective surgery patients range from 1–9 per cent3–8, vaccination is expected to take years to implement globally9 and preoperative screening is likely to lead to increasing numbers of SARS-CoV-2-positive patients, perioperative SARS-CoV-2 infection will remain a challenge for the foreseeable future.To inform consent and shared decision-making, a robust, globally applicable score is needed to predict individualized mortality risk for patients with perioperative SARS-CoV-2 infection. The authors aimed to develop and validate a machine learning-based risk score to predict postoperative mortality risk in patients with perioperative SARS-CoV-2 infection.

Journal article

Brogden DRL, Kontovounisios C, Chong I, Tait D, Warren OJ, Bower M, Tekkis P, Mills SCet al., 2021, Local excision and treatment of early node-negative anal squamous cell carcinomas in a highly HIV prevalent population, Techniques in Coloproctology, Vol: 25, Pages: 1027-1036, ISSN: 1123-6337

BackgroundAnal squamous cell carcinoma (ASCC) is an uncommon cancer associated with human immunodeficiency virus (HIV) infection. There has been increasing interest in providing organ-sparing treatment in small node-negative ASCC’s, however, there is a paucity of evidence about the use of local excision alone in people living with HIV (PLWH). The aim of this study was to evaluate the efficacy of local excision alone in this patient population.MethodsWe present a case series of stage 1 and stage 2 ASCC in PLWH and HIV negative patients. Data were extracted from a 20-year retrospective cohort study analysing the treatment and outcomes of patients with primary ASCC in a cohort with a high prevalence of HIV.ResultsNinety-four patients were included in the analysis. Fifty-seven (61%) were PLWH. Thirty-five (37%) patients received local excision alone as treatment for ASCC, they were more likely to be younger (p = 0.037, ANOVA) and have either foci of malignancy or well-differentiated tumours on histology (p = 0.002, Fisher’s exact test).There was no statistically significant difference in 5-year disease-free survival and recurrence between treatment groups, however, patients who had local excision alone and PLWH were both more likely to recur later compared to patients who received other treatments for ASCC. (72.3 months vs 27.3 months, p = 0.06, ANOVA, and 72.3 months vs 31.8 months, p = 0.035, ANOVA, respectively).ConclusionsWe recommend that local excision be considered the sole treatment for stage 1 node-negative tumours that have clear margins and advantageous histology regardless of HIV status. However, PLWH who have local excision alone must have access to an expert long-term surveillance programme after treatment to identify late recurrences.

Journal article

Rottoli M, Pellino G, Tanzanu M, Baldi C, Frontali A, Carvello M, Foppa C, Kontovounisios C, Tekkis P, Colombo F, Sancho-Muriel J, Matteo F, Danelli P, Celentano V, Spinelli A, Panis Y, Sampietro G, Poggioli Get al., 2021, P145 Inflammatory Bowel Disease patients requiring surgery can be treated in referral centres regardless of the COVID-19 status of the hospital: results of a multicentric European study during the first COVID-19 outbreak (COVIBD-Surg), Journal of Crohn's and Colitis, Vol: 15, Pages: S228-S229, ISSN: 1873-9946

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Little is known regarding the outcomes of inflammatory bowel disease (IBD) patients who required surgery during the outbreak of Coronavirus disease 19 (COVID-19). This study aimed to compare outcomes of IBD patients undergoing surgery in COVID-19-treatment and COVID-19-free hospitals.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Retrospective study involving patients undergoing IBD surgery in seven centres (six COVID-19-treatment hubs and one COVID-free hospital) across 5 European countries during the period of highest reduction of elective activity due to the first peak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Predictive variables of the risk of moderate-to-severe postoperative complications were analysed using logistic regression analysis. Considering the large number of regressors and the risk of over-fitting due to the small number of events, the least absolute shrinkage and selection operator (LASSO) method was used.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Of the 91 patients (59 males, 64.8%) with Crohn’s disease (54, 59.3%) or ulcerative colitis (37, 40.7%), 66 (72.5%) had surgery in a COVID-19-treatment hospital, while 25 (27.5%) were treated in the COVID-19-free centre. A higher proportion of COVID-19-treatment patients required urgent surgery (48.4% vs 24%, p=0.035), did not discontinue the biologic therapy (15.1% vs. 0%, p=0.039), underwent surgery without a SARS-CoV-2 test (19.7% vs. 0%, p=0.0033), and were admitted to intensive care postoperatively (10.6% vs. 0%, p=0.032). Three patients (4.6

Journal article

Fehervari M, Hamrang-Yousefi S, Mills SC, Warren OJ, Tekkis PP, Kontovounisios Cet al., 2021, A systematic review of colorectal multidisciplinary team meetings: an international comparison, BJS Open, Vol: 5, ISSN: 2474-9842

Background:Colorectal multidisciplinary teams (CR MDTs) were introduced to enhance the cancer care pathway and allow for early investigation and treatment of cancer. However, there are no ‘gold standards’ set for this process. The aim of this study was to review the literature systematically and provide a qualitative analysis on the principles, organization, structure and output of CR MDTs internationally.Methods:Literature on the role of CR MDTs published between January 1999 and March 2020 in the UK, USA and continental Europe was evaluated. Historical background, structure, core members, education, frequency, patient-selection criteria, quality assurance, clinical output and outcomes were extracted from data from the UK, USA and continental Europe.Results:Forty-eight studies were identified that specifically met the inclusion criteria. The majority of hospitals held CR MDTs at least fortnightly in the UK and Europe by 2002 and 2005 respectively. In the USA, monthly MDTs became a mandatory element of cancer programmes by 2013. In the UK, USA and in several European countries, the lead of the MDT meeting is a surgeon and core members include the oncologist, specialist nurse, histopathologist, radiologist and gastroenterologist. There were differences observed in patient-selection criteria, in the use of information technology, MDT databases and quality assurance internationally.Conclusion:CR MDTs are essential in improving the patient care pathway and should express clear recommendations for each patient. However, a form of quality assurance should be implemented across all MDTs.

Journal article

Rottoli M, Pellino G, Tanzanu M, Baldi C, Frontali A, Carvello M, Foppa C, Kontovounisios C, Tekkis P, Colombo F, Sancho-Muriel J, Matteo F, Danelli P, Celentano V, Spinelli A, Panis Y, Sampietro G, Poggioli Get al., 2021, Inflammatory Bowel Disease patients requiring surgery can be treated in referral centres regardless of the COVID-19 status of the hospital: results of a multicentric European study during the first COVID-19 outbreak (COVIBD-Surg), JOURNAL OF CROHNS & COLITIS, Vol: 15, Pages: S228-S229, ISSN: 1873-9946

Journal article

Voogt ELK, Nordkamp S, Aalbers AGJ, Buffart T, Creemers GJ, Marijnen CAM, Verhoef C, Havenga K, Holman FA, Kusters M, Marinelli AWKS, Melenhorst J, Aziz NA, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alberda W, Albert M, Andric M, Angenete E, Antoniou A, Auer R, Austin KK, Aziz O, Baker RP, Bali M, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Beets-Tan RGH, Berbee M, Berg J, Berg PL, Beynon J, Biondo S, Bloemen JG, Boyle K, Bordeianou L, Bremers AB, Brunner M, Buchwald P, Bui A, Burgess A, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceha HM, Chan KKL, Chang GJ, Chang M, Chew MH, Chok AK, Chong P, Christensen HK, Clouston H, Codd M, Collins D, Colquhoun AJ, Corr A, Coscia M, Cosimelli M, Coyne PE, Crobach ASLP, Crolla RMPH, Croner RS, Damjanovic L, Daniels IR, Davies M, Davies RJ, Delaney CP, de Roos MAJ, de Wilt JHW, den Hartogh MD, Denost Q, Deseyne P, Deutsch C, Cappel RDVTN, de Vries M, Dieters M, Dietz D, Domingo S, Doukas M, Dozois EJ, Duff M, Eglinton T, Enrique-Navascues JM, Espin-Basany E, Evans MD, Eyjolfsdottir B, Fahy M, Fearnhead NS, Feshtali S, Flatmark K, Fleming F, Folkesson J, Frizelle FA, Frodin JE, Gallego MA, Garcia-Granero E, Garcia-Sabrido JL, Geboes K, Gentilini L, George ML, George V, Ghouti L, Giner F, Ginther N, Glyn T, Glynn R, Golda T, Grabsch H, Griffiths B, Harris DA, Hagemans JA, Hanchanale V, Harji DP, Helewa RM, Helgason H, Hellawell G, Heriot AG, Heyman S, Hochman D, Hoff C, Hohenberger W, Holm T, Hompes R, Horsthuis K, Hospers G, Houwers J, Iversen H, Jenkins JT, Kaffenberger S, Kandaswamy G, Kapur S, Kanemitsu Y, Kats-Ugurlu G, Kelley SR, Keller DS, Kelly ME, Keymeulen K, Khan MS, Kim H, Kim HJ, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kristensen HO, Kroon HM, Kumar S, Lago V, Lakkis Z, Lamberg T, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Leseman-Hoogenboom MM, Limbert M, Lydrup ML, Lyons A, Lynch AC, Mantyh C, Mathis KL, Margues CFS, Martling A, Meijer OWM, Meijerink WJHet al., 2021, Induction chemotherapy followed by chemoradiotherapy versus chemoradiotherapy alone as neoadjuvant treatment for locally recurrent rectal cancer: study protocol of a multicentre, open-label, parallel-arms, randomized controlled study (PelvEx II), BJS OPEN, Vol: 5, ISSN: 2474-9842

Journal article

Kontovounisios C, 2021, Systematic review of classification systems for locally recurrent rectal cancer, BJS Open, Vol: 5, Pages: 1-14, ISSN: 2474-9842

BACKGROUNDClassification of pelvic local recurrence (LR) after surgery for primary rectal cancer is not currently standardised and optimal imaging is required to categorise anatomical site and plan treatment in patients with LR. The aim of this review was to evaluate the systems used to classify locally recurrent rectal cancer (LRRC) and the relevant published outcomes.METHODSA systematic review of the literature prior to April 2020 was performed through electronic searches of the Science Citation Index Expanded, EMBASE, MEDLINE and CENTRAL databases. The primary outcome was to review the classifications currently in use; the secondary outcome was the extraction of relevant information provided by these classification systems including prognosis, anatomy and prediction of R0 after surgery. RESULTSA total 21 out of 58 eligible studies, classifying LR in 2,086 patients were reviewed. Studies used at least one of the following eight classification systems proposed by Institutions or Institutional Groups (Mayo Clinic, Memorial Sloan-Kettering -original and modified-, Royal Marsden and Leeds) or authors (Yamada, Hruby and Kusters). Negative survival outcomes were associated with increased pelvic fixity, associated symptoms of LR, lateral compared with central LR and three or more pelvic compartment involvement. A total of seven studies used MRI with specifically defined anatomical compartments to classify LR.CONCLUSION This review highlights the various imaging systems in use to classify LRRC and some of the prognostic indicators for survival and oncological clearance based on these systems. Implementation of an agreed classification system to consistently document pelvic LR should provide more detailed information on anatomical site of recurrence, burden of disease and standards for comparative outcome assessment. This would optimise treatment planning, operative procedures and research into LR. An MRI classification system with its inherent anatomic precision is id

Journal article

Rottoli M, Pellino G, Tanzanu M, Baldi C, Frontali A, Carvello M, Foppa C, Kontovounisios C, Tekkis P, Colombo F, Sancho-Muriel J, Matteo F, Danelli P, Celentano V, Spinelli A, Panis Y, Sampietro G, Poggioli Get al., 2021, P145 Inflammatory Bowel Disease patients requiring surgery can be treated in referral centres regardless of the COVID-19 status of the hospital: results of a multicentric European study during the first COVID-19 outbreak (COVIBD-Surg), Journal of Crohn's & colitis, Vol: 15, Pages: S228-S229, ISSN: 1873-9946

Abstract <h4>Background</h4> Little is known regarding the outcomes of inflammatory bowel disease (IBD) patients who required surgery during the outbreak of Coronavirus disease 19 (COVID-19). This study aimed to compare outcomes of IBD patients undergoing surgery in COVID-19-treatment and COVID-19-free hospitals. <h4>Methods</h4> Retrospective study involving patients undergoing IBD surgery in seven centres (six COVID-19-treatment hubs and one COVID-free hospital) across 5 European countries during the period of highest reduction of elective activity due to the first peak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Predictive variables of the risk of moderate-to-severe postoperative complications were analysed using logistic regression analysis. Considering the large number of regressors and the risk of over-fitting due to the small number of events, the least absolute shrinkage and selection operator (LASSO) method was used. <h4>Results</h4> Of the 91 patients (59 males, 64.8%) with Crohn’s disease (54, 59.3%) or ulcerative colitis (37, 40.7%), 66 (72.5%) had surgery in a COVID-19-treatment hospital, while 25 (27.5%) were treated in the COVID-19-free centre. A higher proportion of COVID-19-treatment patients required urgent surgery (48.4% vs 24%, p=0.035), did not discontinue the biologic therapy (15.1% vs. 0%, p=0.039), underwent surgery without a SARS-CoV-2 test (19.7% vs. 0%, p=0.0033), and were admitted to intensive care postoperatively (10.6% vs. 0%, p=0.032). Three patients (4.6%) of the COVID-19-treatment group had a SARS-CoV-2 infection during the hospital course. Use of steroids at surgery (Odds ratio [OR]=4.10, 95% CI 1.14–15.3, p=0.03), presence of comorbidities (OR=3.33, 95% CI 1.08–11, p=0.035), and Crohn’s disease (vs. ulcerative colitis, OR=3.82, 95% CI 1.14–15.4, p=0.028) were associated with risk of moderate-to-severe postoperative complications. The a

Journal article

Kontovounisios C, 2021, The effect of perioperative administration of probiotics on col- 2 colorectal cancer surgery outcomes, Nutrients, Vol: 13, Pages: 1-12, ISSN: 2072-6643

The perioperative care of colorectal cancer (CRC) patients includes antibiotics. Although antibiotics do provide a certain protection against infections, they do not eliminate them completely, and they do carry risks of microbial resistance and disruption of the microbiome. Probiotics can maintain the microbiome’s balance postoperatively by maintaining intestinal mucosal integrity and reducing bacterial translocation (BT). This review aims to assess the role of probiotics in the perioperative management of CRC patients. The outcomes were categorised into: postoperative infectious and non-infectious complications, BT rate analysis, and intestinal permeability assessment. Fifteen randomised controlled trials (RCTs) were included. There was a trend towards lower rates of postoperative infectious and non-infectious complications with probiotics versus placebo. Probiotics reduced BT, maintained intestinal mucosal permeability, and provided a better balance of beneficial to pathogenic microorganisms. Heterogeneity among RCTs was high. Factors that influence the effect of probiotics include the species used, using a combination vs. single species, the duration of administration, and the location of the bowel resection. Although this review provided evidence for how probiotics possibly operate and reported notable evidence that probiotics can lower rates of infections, heterogeneity was observed. In order to corroborate the findings, future RCTs should keep the aforementioned factors constant.

Journal article

Chang TP, Chok AY, Tan D, Rogers A, Rasheed S, Tekkis P, Kontovounisios Cet al., 2021, The emerging role of robotics in pelvic exenteration surgery for locally advanced rectal cancer: a narrative review, Journal of Clinical Medicine, Vol: 10, ISSN: 2077-0383

Pelvic exenteration surgery for locally advanced rectal cancers is a complex and extensive multivisceral operation, which is associated with high perioperative morbidity and mortality rates. Significant technical challenges may arise due to inadequate access, visualisation, and characterisation of tissue planes and critical structures in the spatially constrained pelvis. Over the last two decades, robotic-assisted technologies have facilitated substantial advancements in the minimally invasive approach to total mesorectal excision (TME) for rectal cancers. Here, we review the emerging experience and evidence of robotic assistance in beyond TME multivisceral pelvic exenteration for locally advanced rectal cancers where heightened operative challenges and cumbersome ergonomics are likely to be encountered.

Journal article

Selvaggi L, Menegon Tasselli F, Sciaudone G, Kontovounisios C, Cosenza A, Sica GS, Selvaggi F, Pellino Get al., 2021, Shifting paradigms in two common abdominal surgical emergencies during the pandemic, British Journal of Surgery, Vol: 108, Pages: e127-e128, ISSN: 0007-1323

During the pandemic there was a reduction in access to the hospital and surgical treatment of appendicitis and cholecystitis at a global level. Some strategies adopted during this challenging time could be applied even after the emergency has been controlled.

Journal article

Fadel MG, Malietzis G, Constantinides V, Pellino G, Tekkis P, Kontovounisios Cet al., 2021, Clinicopathological factors and survival outcomes of signet-ring cell and mucinous carcinoma versus adenocarcinoma of the colon and rectum: a systematic review and meta-analysis, Discover Oncology, Vol: 12, ISSN: 2730-6011

Background:Histological subtypes of colorectal cancer may be associated with varied prognostic features. This systematic review and meta-analysis aimed to compare clinicopathological characteristics, recurrence and overall survival between colorectal signet-ring cell (SC) and mucinous carcinoma (MC) to conventional adenocarcinoma (AC).Methods:A literature search of MEDLINE, EMBASE, Ovid and Cochrane Library was performed for studies that reported data on clinicopathological and survival outcomes on SC and/or MC versus AC from January 1985 to May 2020. Meta-analysis was performed using random-effect models and between-study heterogeneity was assessed.Results:Thirty studies of 1,087,055 patients were included: 11,510 (1.06%) with SC, 110,179 (10.13%) with MC and 965,366 (88.81%) with AC. Patients with SC were younger than patients with AC (WMD − 0.47; 95% CI − 0.84 to –0.10; I2 88.6%; p = 0.014) and more likely to have right-sided disease (OR 2.12; 95% CI 1.72–2.60; I2 82.9%; p < 0.001). Locoregional recurrence at 5 years was more frequent in patients with SC (OR 2.81; 95% CI 1.40–5.65; I2 0.0%; p = 0.004) and MC (OR 1.92; 95% CI 1.18–3.15; I2 74.0%; p = 0.009). 5-year overall survival was significantly reduced when comparing SC and MC to AC (HR 2.54; 95% CI 1.98–3.27; I2 99.1%; p < 0.001 and HR 1.38; 95% CI 1.19–1.61; I2 98.6%; p < 0.001, respectively).Conclusion:SC and MC are associated with right-sided lesions, advanced stage at presentation, higher rates of recurrence and poorer overall survival. This has strong implications towards surgical and oncological management and surveillance of colorectal cancer.

Journal article

Brogden D, Khoo C, Kontovounisios C, Pellino G, Chong I, Tait D, Warren O, Bower M, Tekkis P, Mills Set al., 2021, The treatment of anal squamous cell carcinoma in a high HIV prevalence population, Discover Oncology, Vol: 12, ISSN: 2730-6011

Anal Squamous Cell Carcinoma (ASCC) is a rare cancer that has a rapidly increasing incidence in areas with highly developed economies. ASCC is strongly associated with HIV and there appears to be increasing numbers of younger male persons living with HIV (PLWH) diagnosed with ASCC in Greater London. This is a retrospective cohort study of HIV positive and HIV negative patients diagnosed with primary ASCC between January 2000 and January 2020 in a demographic group with high prevalence rates of HIV. 176 patients were included, and clinical data was retrieved from multiple, prospective databases. A clinical subgroup was identified in this cohort of younger HIV positive males who were more likely to have had a prior diagnosis of Anal Intraepithelial Neoplasia (AIN). Gender and HIV status had no effect on staging or disease-free survival. PLWH were more likely to develop a recurrence (p < 0.000) but had a longer time to recurrence than HIV negative patients, however this was not statistically significant (46.1 months vs. 17.5 months; p = 0.077). Patients known to have a previous diagnosis of AIN were more likely to have earlier staging and local tumour excision but there was no identifiable survival benefit in this cohort. Five-year Disease-Free Survival was associated with tumour size and the absence of nodal or metastatic disease (p < 0.000).

Journal article

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