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
to

174 results found

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 Surg

Anal Squamous Cell Carcinoma (ASCC) is an uncommon cancer with a recognised precursor Anal Intraepithelial Neoplasia (AIN). Although there are consistent evidence-based guidelines for the management of ASCC, historically this has not been the case for AIN and as a result there have been geographical variations in the recommendations for the treatment of AIN. More recently there have been updates in the literature to the recommendations for the management of AIN. To assess whether we are now closer to achieving an international consensus, we have completed a systematic scoping review of available guidelines for the screening, treatment and follow-up of AIN as a precursor to ASCC. MEDLINE and EMBASE were systematically searched for available clinical guidelines endorsed by a recognised clinical society that included recommendations on either the screening, treatment or follow-up of AIN. Nine clinical guidelines from three geographical areas were included. The most recent guidelines agreed that screening for AIN in high-risk patients and follow-up after treatment was necessary but there was less consensus on the modality of screening. Six Guidelines recommended the treatment of high-grade AIN and four guidelines describe a follow-up protocol of patients diagnosed with AIN. There appears to be increasing consensus on the treatment and follow-up of patients despite a poor evidence base. There is still significant discrepancy in guidance on the method to identify patients at risk of ASCC and AIN despite consensus between geographical regions on which patient subgroups are at the highest risk.

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

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, 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

Kontovounisios C, 2021, Perioperative optimization in complex abdominal wall hernias: Delphi consensus statement, BJS Open, 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

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

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, Sao Juliao GP, Panaiotti L, Panis Y, Papamichael D, Park J, Patel S, Patron Uriburu JC, 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, Reyes Meneses JC, Ris F, Riss S, Rodriguez-Zentner H, Roxburgh CS, Saklani A, Salido AJ, Sammour T, Saraste D, Schneider M, Seishima Ret al., 2021, Characteristics of Early-Onset vs Late-Onset Colorectal Cancer A Review, JAMA SURGERY, ISSN: 2168-6254

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 (COVID-Surg), UPDATES IN SURGERY, ISSN: 2038-131X

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

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

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

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 S, Brogden DRL, Khoo CC, Kontovounisios C, Pellino G, Chong I, Tait D, Warren OJ, Bower M, Tekkis P, Mills SCet 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

Editorial Office, 2021, Acknowledgment to Reviewers of Journal of Clinical Medicine in 2020, Journal of clinical medicine, Vol: 10, ISSN: 2077-0383

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, Correction to: 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) (Updates in Surgery, (2021), 10.1007/s13304-021-01119-y), Updates in Surgery, ISSN: 2038-131X

While typesetting the article the copyeditor changed the title incorrectly. The correct title has been copied below: “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)” The original article has been updated.

Journal article

Brogden DRL, Khoo CC, Kontovounisios C, Pellino G, Chong I, Tait D, Warren OJ, Bower M, Tekkis P, Mills SCet al., 2021, 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. 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. One Hundred and seventy six 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. Five-year Disease-Free Survival was associated with tumour size and the absence of nodal or metastatic disease (p < 0.000).

Journal article

Kontovounisios C, 2021, Perioperative management and anaesthetic considerations in pelvic exenterations using Delphi methodology: results from the PelvEx Collaborative, BJS Open, Vol: 5, Pages: 1-10, ISSN: 2474-9842

Background: The multidisciplinary perioperative and anaesthetic management of patients undergoing pelvic exenteration (PE) is essential for good surgical outcomes. No clear guidelines have been established, and there is wide variation in clinical practice internationally. This consensus statement consolidates clinical experience and best practice collectively, and systematically addresses key domains in the perioperative and anaesthetic management. Methods: The modified Delphi methodology was used to achieve consensus from the PelvEx Collaborative. The process included one round of online questionnaire involving controlled feedback and structured participant response, two rounds of editing, and one round of web-based voting. It was held from December 2019 to February 2020. Consensus was defined as more than 80 per cent agreement; whereas less than 80 per cent agreement indicated low consensus. Results: The final consensus document contained 47 voted statements, across six key domains of perioperative and anaesthetic management in PEs comprising preoperative assessment and preparation, anaesthetic considerations, perioperative management, anticipating possible massive haemorrhage, stress response and postoperative critical care, and pain management. Consensus recommendations were developed based on consensus agreement achieved on 34 statements. Conclusion: The perioperative and anaesthetic management of PE patients is best accomplished by a dedicated multidisciplinary team with relevant domain expertise in the setting of a specialized tertiary unit. This consensus statement has addressed key domains within the framework of current perioperative and anaesthetic management among PE patients, with an international perspective, to guide clinical practice, and has outlined areas for future clinical research.

Journal article

Bhangu A, 2020, Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic, COLORECTAL DISEASE, Vol: 23, Pages: 732-749, ISSN: 1462-8910

Journal article

Arezzo A, Francis N, Mintz Y, Adamina M, Antoniou SA, Bouvy N, Copaescu C, de Manzini N, Di Lorenzo N, Morales-Conde S, Mueller-Stich BP, Nickel F, Popa D, Tait D, Thomas C, Nimmo S, Paraskevis D, Pietrabissa Aet al., 2020, EAES recommendations for recovery plan in minimally invasive surgery amid COVID-19 pandemic, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 35, Pages: 1-17, ISSN: 0930-2794

BackgroundCOVID-19 pandemic presented an unexpected challenge for the surgical community in general and Minimally Invasive Surgery (MIS) specialists in particular. This document aims to summarize recent evidence and experts’ opinion and formulate recommendations to guide the surgical community on how to best organize the recovery plan for surgical activity across different sub-specialities after the COVID-19 pandemic.MethodsRecommendations were developed through a Delphi process for establishment of expert consensus. Domain topics were formulated and subsequently subdivided into questions pertinent to different surgical specialities following the COVID-19 crisis. Sixty-five experts from 24 countries, representing the entire EAES board, were invited. Fifty clinicians and six engineers accepted the invitation and drafted statements based on specific key questions. Anonymous voting on the statements was performed until consensus was achieved, defined by at least 70% agreement.ResultsA total of 92 consensus statements were formulated with regard to safe resumption of surgery across eight domains, addressing general surgery, upper GI, lower GI, bariatrics, endocrine, HPB, abdominal wall and technology/research. The statements addressed elective and emergency services across all subspecialties with specific attention to the role of MIS during the recovery plan. Eighty-four of the statements were approved during the first round of Delphi voting (91.3%) and another 8 during the following round after substantial modification, resulting in a 100% consensus.ConclusionThe recommendations formulated by the EAES board establish a framework for resumption of surgery following COVID-19 pandemic with particular focus on the role of MIS across surgical specialities. The statements have the potential for wide application in the clinical setting, education activities and research work across different healthcare systems.

Journal article

Glasbey JC, Bhangu A, 2020, Elective cancer surgery in COVID-19–free surgical pathways during the SARS-CoV-2 pandemic: an international, multicenter, comparative cohort study, Journal of Clinical Oncology, Vol: 39, Pages: 66-78, ISSN: 0732-183X

PURPOSEAs cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway.PATIENTS AND METHODSThis international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation).RESULTSOf 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76).CONCLUSIONWithin available resources, dedicated COVID-19–free

Journal article

Przedlacka A, Cox S, Tekkis P, Bello F, Kontovounisios Cet al., 2020, Rectal 3D MRI modelling for benign and malignant disease, British Journal of Surgery, Vol: 107, Pages: e561-e562, ISSN: 0007-1323

Journal article

Brogden DRL, Walsh U, Pellino G, Kontovounisios C, Tekkis P, Mills SCet al., 2020, Evaluating the efficacy of treatment options for anal intraepithelial neoplasia: a systematic review, International Journal of Colorectal Disease: clinical and molecular gastroenterology and surgery, Vol: 36, Pages: 213-226, ISSN: 0179-1958

PurposeAnal intraepithelial neoplasia (AIN) is the accepted precursor of anal squamous cell carcinoma (ASCC). There has long been a hypothesis that treating AIN may prevent ASCC. Many different treatment modalities have been suggested and studied. We conducted this systematic review to evaluate their efficacy and the evidence as to whether we can prevent ASCC by treating AIN.MethodsMEDLINE and EMBASE were electronically searched using relevant search terms. All studies investigating the use of a single treatment for AIN that reported at least one end outcome such as partial or complete response to treatment, recurrence after treatment and/or ASCC diagnosis after treatment were included.ResultsThirty studies were included in the systematic review investigating 10 treatment modalities: 5% imiquimod, 5-fluorouracil, cidofovir, trichloroacetic acid, electrocautery, surgical excision, infrared coagulation, radiofrequency ablation, photodynamic therapy and HPV vaccination. All treatment modalities demonstrated some initial regression of AIN after treatment; however, recurrence rates were high especially in HIV-positive patients. Many of the studies suffered from significant bias which prevented direct comparison.ConclusionsAlthough the theory persists that by inducing the regression of AIN, we may be able to reduce the risk of ASCC, there was no clinical evidence within the literature advocating that treating AIN does prevent ASCC.

Journal article

COVIDSurg Collaborative, 2020, Delaying surgery for patients with a previous SARS-CoV-2 infection, British Journal of Surgery, ISSN: 0007-1323

Journal article

Fadel MG, Boshier PR, Howell A-M, Iskandarani M, Tekkis P, Kontovounisios Cet al., 2020, The management of acute lower gastrointestinal bleeding using a Sengstaken-Blakemore tube, International Journal of Surgery Case Reports, Vol: 75, Pages: 394-397, ISSN: 2210-2612

IntroductionAcute lower gastrointestinal haemorrhage can potentially be life-threatening. We present a case of a massive rectal bleed which was managed successfully with a balloon tamponade device designed for upper gastrointestinal haemorrhage.Presentation of caseA 75-year-old gentleman, with a history of human immunodeficiency virus and cirrhosis with portal hypertension, presented with bright red rectal bleeding. Investigations showed a low haemoglobin level (74 g/L) and deranged clotting. Oesophago-gastro-duodenoscopy demonstrated no fresh or altered blood. Flexible sigmoidoscopy revealed active bleeding from a varix within the anterior rectal wall 4 cm from the anal verge. Efforts to stop the bleeding, including endoscopic clips, adrenaline injection and rectal packing, were unsuccessful and the patient became haemodynamically unstable. A Sengstaken-Blakemore tube was inserted per rectum and the gastric balloon was inflated to tamponade the lower rectum. The oesophageal balloon was then inflated to hold the gastric balloon firmly in place. A computed tomography angiogram demonstrated no evidence of haemorrhage with balloon tamponade. After 36 h, the balloon was removed with no further episodes of bleeding.DiscussionThe application of a balloon tamponade device should be considered in the management algorithm for acute lower gastrointestinal bleed. Advantages include its rapid insertion, immediate results and ability to measure further bleeding after the catheter has been placed.ConclusionSengstaken-Blakemore tube per rectum may effectively control massive low rectal bleeding when alternative methods have been unsuccessful.

Journal article

Kontovounisios C, 2020, Timing of nasogastric tube insertion and the risk of postoperative pneumonia: an international, prospective cohort study, COLORECTAL DISEASE, Vol: 22, Pages: 2288-2297, ISSN: 1462-8910

Journal article

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