Publications
230 results found
Pellino G, Vaizey CJ, Maeda Y, 2020, The COVID-19 pandemic: considerations for resuming normal colorectal services, Colorectal Disease, Vol: 22, Pages: 1006-1014, ISSN: 1462-8910
This European Society of Coloproctology guidance focuses on a proposed conceptual framework to resume standard service in colorectal surgery. The proposed conceptual framework is a schematic and stepwise approach including: in-depth assessment of damage to non-COVID-19-related colorectal service; the return of service (integration with the COVID-19-specific service and the existing operational continuity planning); safety arrangements in parallel with minimizing downtime; the required support for staff and patients; the aftermath of the pandemic and continued strategic planning. This will be dynamic guidance with ongoing updates using critical appraisal of emerging evidence. We will welcome input from all stakeholders (statutory organizations, healthcare professionals, public and patients). Any new questions, new data and discussion are welcome via https://www.escp.eu.com/guidelines.
Muangpoon T, Haghighi Osgouei R, Escobar-Castillejos D, et al., 2020, Augmented reality system for digital rectal examination training and assessment: system validation, Journal of Medical Internet Research, Vol: 22, Pages: 1-13, ISSN: 1438-8871
Background: Digital rectal examination is a difficult examination to learn and teach because of limited opportunities for practice; however, the main challenge is that students and tutors cannot see the finger when it is palpating the anal canal and prostate gland inside the patients.Objective: This paper presents an augmented reality system to be used with benchtop models commonly available in medical schools with the aim of addressing the problem of lack of visualization. The system enables visualization of the examining finger, as well as of the internal organs when performing digital rectal examinations. Magnetic tracking sensors are used to track the movement of the finger, and a pressure sensor is used to monitor the applied pressure. By overlaying a virtual finger on the real finger and a virtual model on the benchtop model, students can see through the examination and finger maneuvers.Methods: The system was implemented in the Unity game engine (Unity Technologies) and uses a first-generation HoloLens (Microsoft Inc) as an augmented reality device. To evaluate the system, 19 participants (9 clinicians who routinely performed digital rectal examinations and 10 medical students) were asked to use the system and answer 12 questions regarding the usefulness of the system.Results: The system showed the movement of an examining finger in real time with a frame rate of 60 fps on the HoloLens and accurately aligned the virtual and real models with a mean error of 3.9 mm. Users found the movement of the finger was realistic (mean 3.9, SD 1.2); moreover, they found the visualization of the finger and internal organs were useful for teaching, learning, and assessment of digital rectal examinations (finger: mean 4.1, SD 1.1; organs: mean 4.6, SD 0.8), mainly targeting a novice group.Conclusions: The proposed augmented reality system was designed to improve teaching and learning of digital rectal examination skills by providing visualization of the finger and internal or
Kontovounisios C, 2020, CRC COVID: Colorectal cancer services during COVID-19 pandemic. studyprotocol for service evaluation, International Journal of Surgery Protocols, Vol: 23, Pages: 15-19, ISSN: 2468-3574
IntroductionCOVID-19 has had an impact on the provision of colorectal cancer care. The aim of the CRC COVID study is to describe the changes in colorectal cancer services in the UK and USA in response to the pandemic and to understand the long-term impact.Methods and analysisThis study comprises 4 phases. Phase 1 is a survey of colorectal units that aims to evaluate adherences and deviations from the best practice guidelines during the COVID-19 pandemic. Phase 2 is a monthly prospective data collection of service provision that aims to determine the impact of the service modifications on the long-term cancer specific outcomes compared to the national standards. Phase 3 aims to predict costs attributable to the modifications of the CRC services and additional resources required to treat patients whose treatment has been affected by the pandemic. Phase 4 aims to compare the impact of COVID-19 on the NHS and USA model of healthcare in terms of service provision and cost, and to propose a standardised model of delivering colorectal cancer services for future outbreaks.
Kontovounisios C, 2020, The impact of the COVID-19 pandemic on the Management of Locally Advanced Primary/Recurrent Rectal Cancer, BRITISH JOURNAL OF SURGERY, Vol: 107, Pages: E547-E548, ISSN: 0007-1323
Qiu S, Nikolaou S, Zhu J, et al., 2020, Characterisation of the expression of neurotensin and its receptors in human colorectal cancer and its clinical implications, Biomolecules, Vol: 10, Pages: 1-15, ISSN: 2218-273X
Introduction: Colorectal Cancer (CRC) accounts for 9% of cancer deaths globally. Hormonal pathways play important roles in some cancers. This study investigated the association of CRC expression of neurotensin (NTS), NTS receptors 1 and 3 (NTSR1 and NTSR3) and clinical outcomes. Methods: A prospective cohort study which quantifies the protein expression of NTS, NTSR1 and NTSR3 in human CRCs using immunohistochemistry. Expression levels were then compared with clinico-pathological outcome including histological grade, overall survival (OS) and disease-free survival (DFS). Results: Sixty-four patients were enrolled with median follow-up of 44.0 months. There was significantly higher expression of NTS in cancer tissue in CRC with higher T stages (p < 0.01), N stages (p = 0.03), and AJCC clinical stages (p = 0.04). There was significantly higher expression of NTS, NTSR1 and NTSR3 in cancer tissue compared to surrounding normal epithelium (median H-score 163.5 vs 97.3, p < 0.01). There was significantly shorter DFS in individuals with CRC with high levels of NTS compared to lower levels of NTS (35.8 months 95% CI 28.7–42.8 months vs 46.4 months 95% CI 42.2–50.5 months, respectively, p = 0.02). Above median NTS expression in cancer tissue was a significant risk factor for disease recurrence (HR 4.10, 95% CI 1.14–14.7, p = 0.03). Discussion: The expression of NTS and its receptors has the potential to be utilised as a predictive and prognostic marker in colorectal cancer for postoperative selection for adjuvant therapy and identify individuals for novel therapies targeting the neurotensinergic pathways. Conclusions: High NTS expression appears to be associated with more advanced CRC and worse DFS.
Christodoulides N, Lami M, Malietzis G, et al., 2020, Sporadic colorectal cancer in adolescents and young adults: a scoping review of a growing healthcare concern, International Journal of Colorectal Disease: clinical and molecular gastroenterology and surgery, Vol: 35, Pages: 1413-1421, ISSN: 0179-1958
PurposeSporadic colorectal cancer (CRC) amongst adolescents and young adults (AYA) is increasing in incidence. The reasons for this trend are not well understood. Current guidelines do not specifically address this patient cohort. A scoping review was performed to summarise the range of available evidence and identify key areas that need to be addressed in current guidelines.MethodsA systematic literature search was conducted adhering to the PRISMA statement. All potentially eligible studies were screened, and data extraction was performed by two reviewers independently. The studies were then divided into 5 broad subgroups: (1) risk factors, (2) screening, (3) clinicopathological and molecular features, (4) presentation and (5) management. Descriptive statistics were used for data analysis.ResultsA total of 17 studies were included from 2010 to 2019. Overall, young adults with CRC tend to present with non-specific symptoms. The majority of these patients have a delayed diagnosis and more advanced disease at presentation, with a rise in prevalence of distal colon and rectal cancers. AYAs tend to have poorly differentiated tumours and are managed more aggressively. Overall 5-year survival varies between studies.ConclusionThis is, to our knowledge, the first scoping review presenting the range of available evidence on CRC in AYAs. Although the rise in incidence is recognised by specialist bodies, recommendations are limited by the sparsity of available data. We seek to highlight the need for further research, define the role of earlier screening and raise awareness to promote thorough assessment of young patients.
Dudurych I, Kelly ME, Aalbers AGJ, et al., 2020, Predicting outcomes of pelvic exenteration using machine learning, Colorectal Disease, Pages: 1-8, ISSN: 1462-8910
AimWe aim to compare machine learning with neural network performance in predicting R0 resection (R0), length of stay > 14 days (LOS), major complication rates at 30 days postoperatively (COMP) and survival greater than 1 year (SURV) for patients having pelvic exenteration for locally advanced and recurrent rectal cancer.MethodA deep learning computer was built and the programming environment was established. The PelvEx Collaborative database was used which contains anonymized data on patients who underwent pelvic exenteration for locally advanced or locally recurrent colorectal cancer between 2004 and 2014. Logistic regression, a support vector machine and an artificial neural network (ANN) were trained. Twenty per cent of the data were used as a test set for calculating prediction accuracy for R0, LOS, COMP and SURV. Model performance was measured by plotting receiver operating characteristic (ROC) curves and calculating the area under the ROC curve (AUROC).ResultsMachine learning models and ANNs were trained on 1147 cases. The AUROC for all outcome predictions ranged from 0.608 to 0.793 indicating modest to moderate predictive ability. The models performed best at predicting LOS > 14 days with an AUROC of 0.793 using preoperative and operative data. Visualized logistic regression model weights indicate a varying impact of variables on the outcome in question.ConclusionThis paper highlights the potential for predictive modelling of large international databases. Current data allow moderate predictive ability of both complex ANNs and more classic methods.
COVIDSurg Collaborative, Jiao LR, 2020, Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study, The Lancet, Vol: 396, Pages: 27-38, ISSN: 0140-6736
BackgroundThe impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection.MethodsThis international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation.FindingsThis analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p<0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p<0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p<0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1&mi
Marechal L, Balland P, Lindenroth L, et al., 2020, Toward a common framework and database of materials for soft robotics, Soft Robotics, Vol: 8, Pages: 1-14, ISSN: 2169-5172
To advance the field of soft robotics, a unified database of material constitutive models and experimental characterizations is of paramount importance. This will facilitate the use of finite element analysis to simulate their behavior and optimize the design of soft-bodied robots. Samples from seventeen elastomers, namely Body Double™ SILK, Dragon Skin™ 10 MEDIUM, Dragon Skin 20, Dragon Skin 30, Dragon Skin FX-Pro, Dragon Skin FX-Pro + Slacker, Ecoflex™ 00–10, Ecoflex 00–30, Ecoflex 00–50, Rebound™ 25, Mold Star™ 16 FAST, Mold Star 20T, SORTA-Clear™ 40, RTV615, PlatSil® Gel-10, Psycho Paint®, and SOLOPLAST 150318, were subjected to uniaxial tensile tests according to the ASTM D412 standard. Sample preparation and tensile test parameters are described in detail. The tensile test data are used to derive parameters for hyperelastic material models using nonlinear least-squares methods, which are provided to the reader. This article presents the mechanical characterization and the resulting material properties for a wide set of commercially available hyperelastic materials, many of which are recognized and commonly applied in the field of soft robotics, together with some that have never been characterized. The experimental raw data and the algorithms used to determine material parameters are shared on the Soft Robotics Materials Database GitHub repository to enable accessibility, as well as future contributions from the soft robotics community. The presented database is aimed at aiding soft roboticists in designing and modeling soft robots while providing a starting point for future material characterizations related to soft robotics research.
Sachdeva A, Gouge J, Kontovounisios C, et al., 2020, Klotho and the treatment of human malignancies, Cancers, Vol: 12, Pages: 1-22, ISSN: 2072-6694
Klotho was first discovered as an anti-ageing protein linked to a number of age-related disease processes, including cardiovascular, renal, musculoskeletal, and neurodegenerative conditions. Emerging research has also demonstrated a potential therapeutic role for Klotho in cancer biology, which is perhaps unsurprising given that cancer and ageing share similar molecular hallmarks. In addition to functioning as a tumour suppressor in numerous solid tumours and haematological malignancies, Klotho represents a candidate therapeutic target for patients with these diseases, the majority of whom have limited treatment options. Here, we examine contemporary evidence evaluating the anti-neoplastic effects of Klotho and describe the modulation of downstream oncogenic signalling pathways, including Wnt/β-catenin, FGF, IGF1, PIK3K/AKT, TGFβ, and the Unfolded Protein Response. We also discuss possible approaches to developing therapeutic Klotho and consider technological advances that may facilitate the delivery of Klotho through gene therapy.
Carbone F, Kaur M, Chok AY, et al., 2020, Endometrial Stromal Sarcoma arising from Polypoid Endometriosis: case report and literature review, International Journal of Surgery Case Reports, Vol: 72, Pages: 537-540, ISSN: 2210-2612
BackgroundPolypoid endometriosis (PE) is a rare and uncommon variant of endometriosis that may present as a polypoid mass that simulates a malignant neoplasm. Typically, PE develops locally as a large benign pelvic mass. However, it may sometimes conceal a malignant disease in its context.Case presentationA 53 years old, nulliparous lady, had been treated over a 10-year period for recurrent and symptomatic polypoid endometriosis of the pelvis. During this time, she underwent four surgical resections, the final one being a total pelvic exenteration, with histology demonstrating the presence of a rare myxoid low grade Endometrial Stromal Sarcoma (ESS) that had arisen in PE.ConclusionPE is a rare variant growth pattern of endometriosis which may involve different pelvic organs and can mimic a malignant mass in the pelvis. It mostly affects women in their peri- or post-menopausal age and it is not always related to hormonal therapy. Malignances, such as Endometrial Stromal Sarcoma in this case, can arise in the context of PE and their diagnosis can be challenging. Surgical excision may constitute radical multi-organ resection, particularly for recurrent and symptomatic cases. However, the recurrence rates after surgery can be significant.
The CRC COVID research collaborative, 2020, Colorectal cancer services during the COVID-19 pandemic, British Journal of Surgery, Vol: 107, Pages: e255-e256, ISSN: 0007-1323
Grove TN, Muirhead LJ, Parker SG, et al., 2020, Measuring quality of life in patients with abdominal wall hernias: a systematic review of available tools, Hernia, Vol: 25, Pages: 491-500, ISSN: 1248-9204
IntroductionAbdominal wall herniation (AWH) is an increasing problem for patients, surgeons, and healthcare providers. Surgical-site specific outcomes, such as infection, recurrence, and mesh explantation, are improving; however, successful repair still exposes the patient to what is often a complex major operation aimed at improving quality of life. Quality-of-life (QOL) outcomes, such as aesthetics, pain, and physical and emotional functioning, are less often and less well reported. We reviewed QOL tools currently available to evaluate their suitability.MethodsA systematic review of the literature in compliance with PRISMA guidelines was performed between 1st January 1990 and 1st May 2019. English language studies using validated quality-of-life assessment tool, whereby outcomes using this tool could be assessed were included.ResultsHeterogeneity in the QOL tool used for reporting outcome was evident throughout the articles reviewed. AWH disease-specific tools, hernia-specific tools, and generic tools were used throughout the literature with no obviously preferred or dominant method identified.ConclusionDespite increasing acknowledgement of the need to evaluate QOL in patients with AWH, no tool has become dominant in this field. Assessment, therefore, of the impact of certain interventions or techniques on quality of life remains difficult and will continue to do so until an adequate standardised outcome measurement tool is available.
Nikolaou S, Qiu S, Fiorentino F, et al., 2020, The role of Neurotensin and its receptors in non-gastrointestinal cancers: a review, Cell Communication and Signaling, Vol: 18, ISSN: 1478-811X
BackgroundNeurotensin, originally isolated in 1973 has both endocrine and neuromodulator activity and acts through its three main receptors. Their role in promoting tumour cell proliferation, migration, DNA synthesis has been studied in a wide range of cancers. Expression of Neurotensin and its receptors has also been correlated to prognosis and prediction to treatment.Main bodyThe effects of NT are mediated through mitogen-activated protein kinases, epidermal growth factor receptors and phosphatidylinositol-3 kinases amongst others. This review is a comprehensive summary of the molecular pathways by which Neurotensin and its receptors act in cancer cells.ConclusionIdentifying the role of Neurotensin in the underlying molecular mechanisms in various cancers can give way to developing new agnostic drugs and personalizing treatment according to the genomic structure of various cancers.
Clark ST, Malietzis G, Grove TN, et al., 2020, The emerging role of sarcopenia as a prognostic indicator in patients undergoing abdominal wall hernia repairs: a systematic review of the literature, Hernia, Vol: 24, Pages: 1361-1370, ISSN: 1248-9204
BackgroundThere is strong evidence suggesting that excessive fat distribution, for example, in the bowel mesentery or a reduction in lean body mass (sarcopenia) can influence short-, mid-, and long-term outcomes from patients undergoing various types of surgery. Body composition (BC) analysis aims to measure and quantify this into a parameter that can be used to assess patients being treated for abdominal wall hernia (AWH). This study aims to review the evidence linking quantification of BC with short- and long-term abdominal wall hernia repair outcomes.MethodsA systematic review was performed according to the PRISMA guidelines. The literature search was performed on all studies that included BC analysis in patients undergoing treatment for AWH using Medline, Google Scholar and Cochrane databases by two independent reviewers. Outcomes of interest included short-term recovery, recurrence outcomes, and long-term data.Results201 studies were identified, of which 4 met the inclusion criteria. None of the studies were randomized controlled trials and all were cohort studies. There was considerable variability in the landmark axial levels and skeletal muscle(s) chosen for analysis, alongside the methods of measuring the cross-sectional area and the parameters used to define sarcopenia. Only two studies identified an increased risk of postoperative complications associated with the presence of sarcopenia. This included an increased risk of hernia recurrence, postoperative ileus and prolonged hospitalisation.ConclusionThere is some evidence to suggest that BC techniques could be used to help predict surgical outcomes and allow early optimisation in AWH patients. However, the lack of consistency in chosen methodology, combined with the outdated definitions of sarcopenia, makes drawing any conclusions difficult. Whether body composition modification can be used to improve outcomes remains to be determined.
, 2020, Safety of hospital discharge before return of bowel function after elective colorectal surgery, BRITISH JOURNAL OF SURGERY, Vol: 107, Pages: 552-559, ISSN: 0007-1323
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Baird DLH, Pellino G, Rasheed S, et al., 2020, A Comparison of the Short-term Outcomes of Three Flap Reconstruction Techniques Used After Beyond Total Mesorectal Excision Surgery for Anorectal Cancer, DISEASES OF THE COLON & RECTUM, Vol: 63, Pages: 461-468, ISSN: 0012-3706
Pellino G, Vinci D, Signoriello G, et al., 2020, Long-Term Bowel Function and Fate of the Ileal Pouch After Restorative Proctocolectomy in Patients With Crohn's Disease: A Systematic Review With Meta-Analysis and Metaregression, JOURNAL OF CROHNS & COLITIS, Vol: 14, Pages: 418-427, ISSN: 1873-9946
Chapman SJ, Blanco-Colino R, Clerc D, et al., 2020, Author response to: Comment on: Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery, BRITISH JOURNAL OF SURGERY, Vol: 107, Pages: 317-317, ISSN: 0007-1323
Chapman SJ, Blanco-Colino R, Clerc D, et al., 2020, Author response to: Comment on: Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery., Br J Surg, Vol: 107
Haghighi Osgouei R, Marechal L, Kontovounisios C, et al., 2020, Soft pneumatic actuator for rendering anal sphincter tone, IEEE Transactions on Haptics, Vol: 13, Pages: 183-190, ISSN: 1939-1412
Sphincter tone examination, as part of digital rectal examination (DRE), can provide essential information to support the early detection of colorectal cancer. Mastering DRE skills for junior doctors is always challenging due to the lack of real training cases. In this article, we developed a soft pneumatic active actuator,made of a compound of silicone rubber materials, to mimic human sphincter muscles and simulate various anal sphincter tones for the purpose of training. Different pumping actuation (syringe and bellows) and driving mechanisms (linear, stepper, and servo motor) were implemented and compared for their effect on the rendered tones. A further comparison was made with a previous prototype based on a cable-driven mechanism. Both quantitative and qualitative assessments were conducted to evaluate the performance of each mechanism. A differential pressure sensor was used to measure applied pressure on a catheter balloon placed inside the sphincter, comparing the readings with anorectal manometry data obtained from real patients. Qualitative feedback was gathered through a user study with ten colorectal expert practitioners. Four questions were asked targeting reaction/response time, pressure level, pressure quality, and similarity to a real case. The results show the capacity and limitation of each mechanism, with the one based on a servo motor and a bellows being the most favourably rated.
Anandakumar A, Pellino G, Tekkis P, et al., 2019, Fungal microbiome in colorectal cancer: a systematic review, UPDATES IN SURGERY, Vol: 71, Pages: 625-630, ISSN: 2038-131X
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Brogden DRL, Kontovounisios C, Pellino G, et al., 2019, Improving outcomes for the treatment of Anal Squamous Cell Carcinoma and Anal Intraepithelial Neoplasia, TECHNIQUES IN COLOPROCTOLOGY, Vol: 23, Pages: 1109-1111, ISSN: 1123-6337
Ramage L, Qiu S, Yeap Z, et al., 2019, Anorectal manometry versus patient-reported outcome measures as a predictor of maximal treatment for fecal incontinence, Annals of coloproctology, Vol: 35, Pages: 319-326, ISSN: 2287-9714
PurposeThis study aims to establish the ability of patient-reported outcome measures (PROMs) and anorectal manometry (ARM) in predicting the need for surgery in patients with fecal incontinence (FI).MethodsBetween 2008 and 2015, PROMs data, including the Birmingham Bowel and Urinary Symptoms Questionnaire (BBUSQ), Short Form 36 (SF-36), Wexner Incontinence Score and ARM results, were prospectively collected from 276 patients presenting with FI. Spearman rank was used to assess correlations between specific PROMs questions and ARM assessments of sphincter motor function. Binomial regression analyses were performed to identify factors predictive of the need for surgery. Finally, receiver operating characteristic (ROC) curve analyses were performed to establish the utility of individual ARM and PROMs variables in predicting the need for surgical intervention in patients with FI.ResultsTwo hundred twenty-eight patients (82.60%) were treated conservatively while 48 (17.39%) underwent surgery. On univariate analyses, all 4 domains of the BBUSQ, all 8 domains of the SF-36, and the Wexner Incontinence Score were significant predictors of surgery. Additionally, maximum resting pressure, 5-second squeeze endurance, threshold volume, and urge volume were significant. On ROC curve analyses, the only significant ARM measurement was the 5-second squeeze endurance. PROMs, such as the incontinence domain of the BBUSQ and five of the SF-36 domains, were identified as fair discriminators of the need for surgery.ConclusionPROMs are reliable predictors of maximal treatment in patients with FI and can be readily used in primary care to aid surgical referrals and can be applied in hospital settings as an aid to guide surgical treatment decisions.
Kelly ME, Ryan EJ, Aalbers AGJ, et al., 2019, Pelvic Exenteration for Advanced Nonrectal Pelvic Malignancy PelvExCollaborative, ANNALS OF SURGERY, Vol: 270, Pages: 899-905, ISSN: 0003-4932
, 2019, 27th International Congress of the European Association for Endoscopic Surgery (EAES) Sevilla, Spain, 12-15 June 2019 Abstracts, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 33, Pages: S485-S781, ISSN: 0930-2794
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Kroon HM, Dudi-Venkata NN, Bedrikovetski S, et al., 2019, Palliative pelvic exenteration: A systematic review of patient-centered outcomes, EJSO, Vol: 45, Pages: 1787-1795, ISSN: 0748-7983
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Carbone F, Alsaleh A, Rasheed S, et al., 2019, The impact of D2 lymphadenectomy on pathology understaging of right colon cancer, ANNALS OF LAPAROSCOPIC AND ENDOSCOPIC SURGERY, Vol: 4, Pages: 1-8, ISSN: 2518-6973
The question of how extensive lymphadenectomy should be in right colon cancer (RCC) surgery remains widely debated in the literature. A correct evaluation of the lymph node status of the surgical specimen is essential for staging and need for adjuvant therapy. Surgery and lymph node assessment are both important factors that influence the lymph node staging. Currently the European and American guidelines recommend the removal of a minimum number of 12 lymph nodes while the Japanese guidelines suggest modulating lymphadenectomy according to the stage of the disease. D2 lymphadenectomy can lead to downstaging of the disease due to several physiopathological mechanisms. The aim of this manuscript is to show the different factors that play a role in a better pathological evaluation of the lymph node status for RCC.
Liccardo F, Baird DLH, Pellino G, et al., 2019, Predictors of short-term readmission after beyond total mesorectal excision for primary locally advanced and recurrent rectal cancer, Updates in Surgery, Vol: 71, Pages: 477-484, ISSN: 2038-131X
Unplanned readmissions heavily affect the cost of health care and are used as an indicator of performance. No clear data are available regarding beyond-total mesorectal excision (bTME) procedure. Aim of the study is to identify patient-related and surgery-related factors influencing the 30-day readmissions after bTME. Retrospective data were collected from 220 patients who underwent bTME procedures at single centre between 2006 and 2016. Patient-related and operative factors were assessed, including body mass index (BMI), age, gender, American Society of Anaesthesiologists’ (ASA) score, preoperative stage, neo-adjuvant therapy, primary tumour vs recurrence, the extent of surgery. The readmission rate was 8.18%. No statistically significant association was found with BMI, ASA score, length of stay and stay in the intensive care unit, primary vs recurrent tumour or blood transfusions. Not quite statistically significant was the association with pelvic side wall dissection (OR 3.32, p = 0.054). Statistically significant factors included preoperative stage > IIIb (OR: 4.77, p = 0.002), neo-adjuvant therapy (OR: 0.13, p = 0.0006), age over 65 years (OR: 5.96, p = 0.0005), any re-intervention during the first admission (OR: 7.4, p = 0.0001), and any post-operative complication (OR: 9.01, p = 0.004). The readmission rate after beyond-TME procedure is influenced by patient-related factors as well as post-operative morbidity.
El-Bahnasawi M, Tekkis P, Kontovounisios C, 2019, Is it the surgeon or the technology performing the operation?, TECHNIQUES IN COLOPROCTOLOGY, Vol: 23, Pages: 933-934, ISSN: 1123-6337
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