Publications
231 results found
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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- Citations: 2
Simillis C, Lal N, Thoukididou SN, et al., 2019, Meta-analysis of randomized controlled trials of surgery for rectal cancer, European Colorectal Congress, Publisher: E M H SWISS MEDICAL PUBLISHERS LTD, Pages: 8S-8S, ISSN: 1424-7860
Kelly ME, Aalbers AGJ, Aziz NA, et al., 2019, Changing outcomes following pelvic exenteration for locally advanced and recurrent rectal cancer, BJS Open, Vol: 3, Pages: 516-520, ISSN: 2474-9842
BackgroundPelvic exenteration for locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LRRC) is technically challenging but increasingly performed in specialist centres. The aim of this study was to compare outcomes of exenteration over time.MethodsThis was a multicentre retrospective study of patients who underwent exenteration for LARC and LRRC between 2004 and 2015. Surgical outcomes, including rate of bone resection, flap reconstruction, margin status and transfusion rates, were examined. Outcomes between higher‐ and lower‐volume centres were also evaluated.ResultsSome 2472 patients underwent pelvic exenteration for LARC and LRRC across 26 institutions. For LARC, rates of bone resection or flap reconstruction increased from 2004 to 2015, from 3·5 to 12·8 per cent, and from 12·0 to 29·4 per cent respectively. Fewer units of intraoperative blood were transfused over this interval (median 4 to 2 units; P = 0·040). Subgroup analysis showed that bone resection and flap reconstruction rates increased in lower‐ and higher‐volume centres. R0 resection rates significantly increased in low‐volume centres but not in high‐volume centres over time (low‐volume: from 62·5 to 80·0 per cent, P = 0·001; high‐volume: from 83·5 to 88·4 per cent, P = 0·660). For LRRC, no significant trends over time were observed for bone resection or flap reconstruction rates. The median number of units of intraoperative blood transfused decreased from 5 to 2·5 units (P < 0·001). R0 resection rates did not increase in either low‐volume (from 51·7 to 60·4 per cent; P = 0·610) or higher‐volume (from 48·6 to 65·5 per cent; P = 0·100) centres. No significant differences in length of hospital stay, 30‐day complication, reintervention or mortality
Alyaqout K, Lairy A, Efthymiou E, et al., 2019, Minimally invasive colorectal cancer procedures in patients with obesity: an interdisciplinary approach., Techniques in Coloproctology, Vol: 23, Pages: 583-587, ISSN: 1123-6337
Fehervari M, Prossor T, Kontovounisios C, 2019, An Unusual Cause of Rectal Ischemia and Prolapse, GASTROENTEROLOGY, Vol: 157, Pages: 25-26, ISSN: 0016-5085
Gor R, Prossor T, Kontovounisios C, 2019, Perforated Gastric Ulcer in a Traveler Post-Nissen Fundoplication., The American surgeon, Vol: 85, Pages: e292-e294, ISSN: 0003-1348
Qiu S, Nikolaou S, Fiorentino F, et al., 2019, Exploratory analysis of plasma neurotensin as a novel biomarker for early detection of colorectal polyp and cancer, Hormones and Cancer, Vol: 10, Pages: 128-135, ISSN: 1868-8500
Earlier detection of colorectal cancer (CRC) results in improved survival. Existing non-invasive biomarkers have suboptimal accuracy. Neurotensin (NTS) is involved in CRC carcinogenesis. This study evaluated the diagnostic potential of plasma NTS for colorectal polyps and cancers. Participants were selected based on national CRC referral guidelines. All subjects underwent colonoscopy. Average plasma concentrations were compared across different diagnostic groups. Predictors for detecting colorectal neoplasia were identified. Receiver operator characteristic (ROC) curve analysis assessed the diagnostic accuracy of NTS. An independent biobank was used as validation group. Of 165 participants, 46 had polyps or CRC. Significantly higher plasma NTS was found in the colonic neoplasia group (603.6 pg/ml vs. 407.2 pg/ml, p < 0.01). Risk factors for colonic polyps or cancers included Loge (plasma NTS concentration) (OR, 2.73; 95% CI, 1.33–5.59, p < 0.01), loge (Age) (OR, 15.49; 95% CI, 2.67–89.66, p < 0.01) and cigarette smoking (OR, 3.49; 95% CI, 1.31–9.26, p = 0.01). Plasma NTS had an optimal sensitivity of 60.4% and specificity of 71.6% for the diagnosis of colorectal polyps and cancers. Similar diagnostic accuracy was obtained in the validation group. Plasma NTS has the potential to be a non-invasive biomarker for colorectal neoplasia. It appears to be more accurate than existing blood markers and is unique in being able to detect precancerous polyps.
Simillis C, Lal N, Pellino G, et al., 2019, A systematic review and network meta-analysis comparing treatments for faecal incontinence, INTERNATIONAL JOURNAL OF SURGERY, Vol: 66, Pages: 37-47, ISSN: 1743-9191
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- Citations: 14
Baird D, Simillis C, Pellino G, et al., 2019, The obesity paradox in beyond total mesorectal excision surgery for locally advanced and recurrent rectal cancer, Updates in Surgery, Vol: 71, Pages: 313-321, ISSN: 2038-131X
The objective is to investigate preoperative body mass index (BMI) in patients receiving beyond total mesorectal excision (bTME) surgery. The primary end point is length of postoperative stay. Secondary end points are length of intensive care stay, postoperative morbidity and overall survival. BMI is the most commonly used anthropometric measurement of nutrition and studies have shown that overweight and obese patients can have improved surgical outcomes. Patients who underwent a bTME operation for locally advanced or recurrent rectal cancer were put into three BMI (kg/m2) groups of normal weight (18.5–24.9), overweight (25–29.9) and obese (≥ 30) for analysis. Included are 220 consecutive patients from a single centre. The overall length of stay, in days ± standard deviation (range), for normal weight, overweight and obese patients was 21.14 ± 16.4 (6–99), 15.24 ± 4.3 (7–32) and 19.10 ± 9.8 (8–62) respectively (p = 0.002). The mean ICU length of stay was 5.40 ± 9.1 (1–69), 3.37 ± 2.4 (0–19) and 3.60 ± 2.4 (1–14), respectively (p = 0.030). There was no significant difference between the three groups in terms of postoperative morbidity or overall survival. Patients with a normal weight BMI in this cohort have a significantly longer length of stay in ICU and in hospital than overweight or obese patients. This is seen with no significant difference in morbidity or overall survival.
Nikolaou S, Taylor J, Stem M, et al., 2019, COLORECTAL CANCER REGISTRIES: COMPARING THE UNITED KINGDOM AND UNITED STATES OF AMERICA AND THE CALL FOR INTERNATIONAL STANDARDIZATION., Annual Scientific Meeting of the American-Society-of-Colon-and-Rectal-Surgeons (ASCRS), Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: E141-E141, ISSN: 0012-3706
Pellino G, Baird D, Rasheed S, et al., 2019, RECONSTRUCTION OF THE PERINEAL DEFECT AFTER PELVIC EXENTERATION: COMPARISON OF THREE FLAP PROCEDURES., Annual Scientific Meeting of the American-Society-of-Colon-and-Rectal-Surgeons (ASCRS), Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: E310-E310, ISSN: 0012-3706
Gor R, Prossor T, Kontovounisios C, 2019, Perforated Gastric Ulcer in a Traveler Post-Nissen Fundoplication, The American Surgeon, Vol: 85, Pages: 292-294, ISSN: 0003-1348
Anastasiadou S, Tekkis P, Kontovounisios C, 2019, An unusual rectal duplication cyst, Surgical Case Reports, Vol: 5, ISSN: 2198-7793
BackgroundRectal duplication cysts are rare gastrointestinal congenital duplicate cysts with various clinical presentations that require different management.Case presentationWe present a case of a lady with a double rectal duplicate cyst which was found incidentally on a follow-up CT abdomen and pelvis scan. The patient initially had a mucocele excision, and following that, she had a non-contrast CT abdomen and pelvis to investigate post-operative pain. The CT scan revealed a single rectal duplicate cyst. She had a posterior approach excision to have it removed, and only intra-operatively, she was found to have a double rectal duplicate cyst. She had them both removed via a midline incision running from the perineal pigmentation and extending until the coccyx. She had another follow-up CT which showed complete excision of the cysts.ConclusionsAfter a thorough review of the literature regarding rectal cysts, there was no mention of a double rectal duplicate cyst. The purpose of this paper is to point out the various potential presentations of a rectal cyst as well as the idea that a double cyst is managed effectively in a similar way as the single one.
Muirhead LJ, Shaw AV, Kontovounisios C, et al., 2019, Establishing a robust multidisciplinary team process in complex abdominal wall reconstruction within a colorectal surgical unit, Techniques in Coloproctology, Vol: 23, Pages: 379-383, ISSN: 1123-6337
D'Souza N, Lord A, Shaw A, et al., 2019, Meta-analysis of oncological outcomes of sigmoid cancers: A hidden epidemic of R1 "palliative" resections, EJSO, Vol: 45, Pages: 489-497, ISSN: 0748-7983
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- Citations: 3
Marano L, Pellino G, Kontovounisios C, et al., 2019, Translational research in colorectal Cancer: Current status and future perspectives of multimodal treatment approach, Gastroenterology Research and Practice, Vol: 2019, ISSN: 1687-6121
Simillis C, Kalakouti E, Afxentiou T, et al., 2019, Primary tumor resection in patients with incurable localized or metastatic colorectal cancer: A systematic review and meta-analysis, World Journal of Surgery, Vol: 43, Pages: 1829-1840, ISSN: 1432-2323
BackgroundTo assess the impact of primary tumor resection (PTR) on survival and morbidity in incurable colorectal cancer.MethodsSystematic literature review and meta-analysis to compare PTR versus primary tumor intact (PTI).ResultsSeventy-seven studies were included, reporting on 159,991 participants (94,745 PTR; 65,246 PTI). PTR improved overall survival (hazard ratio [HR] 0.59, P < 0.0001; mean difference [MD] 7.27 months, P < 0.0001), cancer-specific survival (HR 0.47, MD 10.80), and progression-free survival (HR 0.76, MD 1.67). Overall survival remained significantly improved during subgroup analysis of asymptomatic patients (HR 0.69, MD 3.86), elderly patients (HR 0.46, MD 7.71), patients diagnosed after 2000 (HR 0.62, MD 7.29), patients with colon (HR 0.58, MD 6.31) or rectal (HR 0.54, MD 6.88) primary tumor, patients undergoing resection of primary tumor versus non-resectional surgery (NRS) to treat primary tumor complications (HR 0.56, MD 8.72), and of studies with propensity score analysis (HR 0.65, MD 5.68). Overall survival per treatment strategy was: [PTI/chemotherapy] 14.30 months, [PTI/bevacizumab] 17.27 months, [PTR/chemotherapy] 21.52 months, [PTR/bevacizumab] 27.52 months. PTR resulted in 4.5% perioperative mortality and 22.4% morbidity (major adverse events 10.2%, minor 18.5%, reoperation 2.5%, intraabdominal collection/sepsis 2.2%). PTI had 21.7% morbidity (obstruction 14.4%, anemia 11.0%, hemorrhage 1.5%, perforation 0.6%, adverse events requiring surgery 15.8%). NRS resulted in 10.6% perioperative mortality and 21.7% morbidity (major 7.9%, minor 21.7%, reoperation 0.1%).ConclusionsPTR in patients with incurable colorectal cancer results in a limited improvement of survival without a significant increase in morbidity. PTR should be considered by the multidisciplinary team on an individual patient basis.
Alsaleh A, Pellino G, Christodoulides N, et al., 2019, Hyponatremia could identify patients with intrabdominal sepsis and anastomotic leak after colorectal surgery: a systematic review of the literature, UPDATES IN SURGERY, Vol: 71, Pages: 17-20, ISSN: 2038-131X
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- Citations: 7
Nikolaou S, Qiu S, Fiorentino F, et al., 2019, The prognostic and therapeutic role of hormones in colorectal cancer: a review, Molecular Biology Reports, Vol: 46, Pages: 1477-1486, ISSN: 0301-4851
Colorectal cancer (CRC) is one of the commonest cancers in Western society with a poor prognosis in patients with advanced disease. Targeted therapy is of increasing interest and already, targeted hormone treatment for breast and prostate cancer has improved survival. The aim of this literature review is to summarise the role of hormones in CRC prognosis and treatment. A literature review of all human and animal in vivo and in vitro studies in the last 20 years, which assessed the role of hormones in CRC treatment or prognosis, was carried out. The hormones described in this review have been subdivided according to their secretion origin. Most of the studies are based on in vitro or animal models. The main findings point to adipokines, insulin and the insulin growth factor axis as key players in the link between obesity, type 2 diabetes mellitus and a subset of CRC. Gut-derived hormones, especially uroguanylin and guanylin are being increasingly investigated as therapeutic targets, with promising results. Using hormones as prognostic and therapeutic markers in CRC is still in the preliminary stages for only a fraction of the hormones affecting the GIT. In light of the increasing interest in tailoring treatment strategies, hormones are an important area of focus in the future of CRC management.
Kontovounisios C, Tekkis P, Bello F, 2019, 3D imaging and printing in pelvic colorectal cancer: 'The New Kid on the Block', Techniques in Coloproctology, Vol: 23, Pages: 171-173, ISSN: 1123-6337
Kelly ME, Alberda W, Antoniou A, et al., 2019, Surgical and survival outcomes following pelvic exenteration for locally advanced and recurrent rectal cancer: results from an international collaboration, Annual Meeting of the Society-of-Academic-and-Research-Surgery (SARS), Publisher: WILEY, Pages: 16-16, ISSN: 0007-1323
Simillis C, 2019, Open vs laparoscopic vs robotic vs transanal mesorectal excision for rectal cancer: a systematic review and network meta-analysis, Annals of Surgery, ISSN: 0003-4932
Lal N, Simillis C, Slesser A, et al., 2019, A systematic review of the literature reporting on randomised controlled trials comparing treatments for faecal incontinence in adults., Acta Chir Belg, Pages: 1-15, ISSN: 0001-5458
AIM: To perform a review of the literature reporting on randomised controlled trials (RCTs) comparing treatments for faecal incontinence (FI) in adults. METHODS: A literature search of MEDLINE, Embase, Science Citation Index Expanded and Cochrane was performed in order to identify RCTs reporting on treatments for FI. RESULTS: The review included 60 RCTs reporting on 4838 patients with a mean age ranging from 36.8 to 88 years. From the included RCTs, 32 did not identify a significant difference between the treatments compared. Contradictory results were identified in RCTs comparing percutaneous posterior tibial nerve stimulation and transcutaneous tibial nerve stimulation versus sham stimulation, biofeedback-pelvic floor muscle training (BF-PFMT) versus PFMT, and between bulking agents such as PTQTM versus Durasphere®. In two separate RCTs, combination treatment of amplitude-modulated medium frequency stimulation and electromyography-biofeedback (EMG-BF), was noted to be superior to EMG-BF and low-frequency electrical stimulation alone. Combination of non-surgical treatments such as BF with sphincteroplasty significantly improved continence scores compared to sphincteroplasty alone. Surgical treatments were associated with higher rates of serious adverse events compared to non-surgical interventions. CONCLUSIONS: The current evidence has not identified significant differences between treatments for FI, and where differences were identified, the results were contradictory between RCTs.
Ramage L, Georgiou P, Qiu S, et al., 2018, Can we correlate pelvic floor dysfunction severity on MR defecography with patient-reported symptom severity?, Updates in Surgery, Vol: 70, Pages: 467-476, ISSN: 2038-131X
MR defecography (MRD) is an alternative to conventional defecography (CD) which allows for dynamic visualisation of the pelvic floor. The aim of this study was to assess whether MRI features indicative of pelvic floor dysfunction correlated with patient-reported symptom severity. MR proctograms were matched to a prospectively-maintained functional database. Univariate and multivariate analyses were performed using pre-treatment questionnaire responses to the Birmingham Bowel, Bladder and Urinary Symptom Questionnaire (BBUSQ), Wexner Incontinence Score (WIS), and modified Obstructed Defecation Symptom (ODS) Score. 302 MRI proctograms were performed between January 2012 and April 2015. 170 patients were included. Patients with a rectocele > 2 cm (p = 0.003; OR 5.756) or MRD features suggestive of puborectalis syndrome (p = 0.025; OR 8.602) were more likely to report a higher ODS score on multivariate analysis. Lack of rectal evacuation was negatively associated with an abnormal WIS (p = 0.007; OR 0.228). Age > 50 (p = 0.027, OR 2.204) and a history of pelvic floor surgery (p = 0.042, OR 0.359) were correlated with an abnormal BBUSQ incontinence score. Lack of rectal evacuation (p = 0.027, OR 3.602) was associated with an abnormal BBUSQ constipation score. Age > 50 (p = 0.07, OR 0.156) and the presence of rectoanal intussusception (p = 0.010, OR 0.138) were associated with an abnormal BBUSQ evacuation score. Whilst MRD is a useful tool in aiding multidisciplinary decision making, overall, it is poorly correlated with patient-reported symptom severity, and treatment decisions should not rest solely on results.
Luzietti E, Pellino G, Nikolaou S, et al., 2018, Comparison of guidelines for the management of rectal cancer, BJS Open, Vol: 2, Pages: 433-451, ISSN: 2474-9842
BackgroundOverall survival from rectal cancer has almost doubled over the last 20 years. Following recommendations in management guidelines plays some part in this, but the extent of discrepancies between them has not been evaluated.MethodsNational Comprehensive Cancer Network (NCCN, USA), European Society for Medical Oncology (ESMO, Europe) and Japanese Society for Cancer of the Colon and Rectum (JSCCR, Japan) guidelines were examined and compared. These were chosen as representative of the countries with the highest incidences of rectal cancer and because no previous collaborations among societies were found.ResultsOverall agreement among societies was found regarding the definition of total mesorectal excision as the surgical standard, the administration of adjuvant therapy for stage III disease, indications for surgical resection for metastases and/or recurrent disease, and the treatment of peritoneal disease. Discrepancies emerged, in particular between Western and Japanese guidelines. The most significant differences involved the endoscopic approach to early cancer, extended lymph node dissection, adjuvant treatment for patients with stage I and II disease, neoadjuvant chemotherapy, the specific management of metachronous disease, and restaging strategies.ConclusionThere are major discrepancies among guidelines. These differences should constitute topics for further research.
Srinivasaiah N, Shekleton F, Kelly ME, et al., 2018, Minimally invasive surgery techniques in pelvic exenteration: a systematic and meta-analysis review, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 32, Pages: 4707-4715, ISSN: 0930-2794
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- Citations: 38
Pellino G, Frasson M, Garcia-Granero A, et al., 2018, Predictors of complications and mortality following left colectomy with primary stapled anastomosis for cancer: results of a multicentric study with 1111 patients, COLORECTAL DISEASE, Vol: 20, Pages: 986-995, ISSN: 1462-8910
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- Citations: 9
Zucker B, Simillis C, Tekkis P, et al., 2018, Suture choice to reduce occurrence of surgical site infection (SSI), hernia, wound dehiscence, and sinus/fistula. A network meta-analysis, European Society of Coloproctology ESCP 2018
Nicolaou S, Qiu S, Fiorentino F, et al., 2018, Systematic review on blood/tissue diagnostic markers in colorectal cancer, European Society of Coloproctology ESCP 2018
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