Publications
231 results found
Zaborowski AM, Abdile A, Adamina M, et al., 2022, Impact of microsatellite status in early-onset colonic cancer, BRITISH JOURNAL OF SURGERY, Vol: 109, Pages: 632-636, ISSN: 0007-1323
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- Citations: 4
REACCT C, 2022, Post-operative functional outcomes in early age onset rectal cancer, Frontiers in Oncology, Vol: 12, Pages: 1-7, ISSN: 2234-943X
BackgroundImpairment of bowel, urogenital and fertility-related function in patients treated for rectal cancer is common. While the rate of rectal cancer in the young (<50 years) is rising, there is little data on functional outcomes in this group.MethodsThe REACCT international collaborative database was reviewed and data on eligible patients analysed. Inclusion criteria comprised patients with a histologically confirmed rectal cancer, <50 years of age at time of diagnosis and with documented follow-up including functional outcomes.ResultsA total of 1428 (n=1428) patients met the eligibility criteria and were included in the final analysis. Metastatic disease was present at diagnosis in 13%. Of these, 40% received neoadjuvant therapy and 50% adjuvant chemotherapy. The incidence of post-operative major morbidity was 10%. A defunctioning stoma was placed for 621 patients (43%); 534 of these proceeded to elective restoration of bowel continuity. The median follow-up time was 42 months. Of this cohort, a total of 415 (29%) reported persistent impairment of functional outcomes, the most frequent of which was bowel dysfunction (16%), followed by bladder dysfunction (7%), sexual dysfunction (4.5%) and infertility (1%).ConclusionA substantial proportion of patients with early-onset rectal cancer who undergo surgery report persistent impairment of functional status. Patients should be involved in the discussion regarding their treatment options and potential impact on quality of life. Functional outcomes should be routinely recorded as part of follow up alongside oncological parameters.
Tekkis NP, Rafi D, Brown S, et al., 2022, The impact of the COVID-19 pandemic on UK medical education. A nationwide student survey, MEDICAL TEACHER, Vol: 44, Pages: 574-575, ISSN: 0142-159X
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- Citations: 4
Adamina M, Ademuyiwa A, Adisa A, et al., 2022, The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study, Colorectal Disease, Vol: 24, Pages: 708-726, ISSN: 1462-8910
AimThe SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery.MethodsThis was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January–April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin.ResultsOverall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90–1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69–1.27, P = 0.672). Longer delays were not associated with poorer outcomes.ConclusionOne in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease.
Carbone F, Chee Y, Rasheed S, et al., 2022, Which surgical strategy for colorectal cancer with synchronous hepatic metastases provides the best outcome? A comparison between primary first, liver first and simultaneous approach, UPDATES IN SURGERY, Vol: 74, Pages: 451-465, ISSN: 2038-131X
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- Citations: 3
Robb H, Scrimgeour G, Boshier P, et al., 2022, The current and possible future role of 3D modelling within oesophagogastric surgery: a scoping review, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 36, Pages: 5907-5920, ISSN: 0930-2794
Background3D reconstruction technology could revolutionise medicine. Within surgery, 3D reconstruction has a growing role in operative planning and procedures, surgical education and training as well as patient engagement. Whilst virtual and 3D printed models are already used in many surgical specialities, oesophagogastric surgery has been slow in their adoption. Therefore, the authors undertook a scoping review to clarify the current and future roles of 3D modelling in oesophagogastric surgery, highlighting gaps in the literature and implications for future research.MethodsA scoping review protocol was developed using a comprehensive search strategy based on internationally accepted guidelines and tailored for key databases (MEDLINE, Embase, Elsevier Scopus and ISI Web of Science). This is available through the Open Science Framework (osf.io/ta789) and was published in a peer-reviewed journal. Included studies underwent screening and full text review before inclusion. A thematic analysis was performed using pre-determined overarching themes: (i) surgical training and education, (ii) patient education and engagement, and (iii) operative planning and surgical practice. Where applicable, subthemes were generated.ResultsA total of 56 papers were included. Most research was low-grade with 88% (n = 49) of publications at or below level III evidence. No randomised control trials or systematic reviews were found. Most literature (86%, n = 48) explored 3D reconstruction within operative planning. These were divided into subthemes of pre-operative (77%, n = 43) and intra-operative guidance (9%, n = 5). Few papers reported on surgical training and education (14%, n = 8), and were evenly subcategorised into virtual reality simulation (7%, n = 4) and anatomical teaching (7%, n = 4). No studies utilising 3D modelling for patient engagement and education were found.ConclusionThe use
Pellino G, Fuschillo G, Simillis C, et al., 2022, Abdominal versus perineal approach for external rectal prolapse: systematic review with meta-analysis, BJS Open, Vol: 6, ISSN: 2474-9842
BackgroundExternal rectal prolapse (ERP) is a debilitating condition in which surgery plays an important role. The aim of this study was to evaluate the outcomes of abdominal approaches (AA) and perineal approaches (PA) to ERP.MethodsThis was a PRISMA-compliant systematic review with meta-analysis. Studies published between 1990 and 2021 were retrieved. The primary endpoint was recurrence at the last available follow-up. Secondary endpoints included factors associated with recurrence and function. All studies were assessed for bias using the Newcastle–Ottawa Scale and Cochrane tool.ResultsFifteen studies involving 1611 patients (AA = 817; PA = 794) treated for ERP were included, three of which were randomized controlled trials (RCTs; 114 patients (AA = 54; PA = 60)). Duration of follow-up ranged from 12 to 82 months. Recurrence in non-randomized studies was 7.7 per cent in AA versus 20.1 per cent in PA (odds ratio (OR) 0.29, 95 per cent confidence interval (c.i.) 0.17 to 0.50; P < 0.001, I2 = 45 per cent). In RCTs, there was no significant difference (9.8 per cent versus 16.3 per cent, AA versus PA (OR 0.82, 95 per cent c.i. 0.29 to 2.37; P = 0.72, I2 = 0.0 per cent)). Age at surgery and duration of follow-up were risk factors for recurrence. Following AA, the recurrence rates were 10.1 per cent and 6.2 per cent in patients aged 65 years and older and less than 65 years of age, respectively (effect size [e.s.] 7.7, 95 per cent c.i. 4.5 to 11.5). Following PA, rates were 27 per cent and 16.3 per cent (e.s. 20.1, 95 per cent c.i. 13 to 28.2). Extending follow-up to at least 40 months increased the likelihood of recurrence. The median duration of hospital stay was 4.9 days after PA versus 7.2 days after AA. Overall, incontinence was less likely after AA (OR 0.32), but constipation occurred more frequently (OR 1.68). Most studies were retrospective, a
Carvalho F, Rogers AC, Chang T-P, et al., 2022, Feasibility and usability of a regional hub model for colorectal cancer services during the COVID-19 pandemic, Updates in Surgery, Vol: 74, Pages: 619-628, ISSN: 2038-131X
The outbreak of the COVID-19 pandemic produced unprecedented challenges, at a global level, in the provision of cancer care. With the ongoing need in the delivery of life-saving cancer treatment, the surgical management of patients with colorectal cancer required prompt significant transformation. The aim of this retrospective study is to report the outcome of a bespoke regional Cancer Hub model in the delivery of elective and essential colorectal cancer surgery, at the height of the first wave of the COVID-19 pandemic. 168 patients underwent colorectal cancer surgery from April 1st to June 30th of 2020. Approximately 75% of patients operated upon underwent colonic resection, of which 47% were left-sided, 34% right-sided and 12% beyond total mesorectal excision surgeries. Around 79% of all resectional surgeries were performed via laparotomy, and the remainder 21%, robotically or laparoscopically. Thirty-day complication rate, for Clavien-Dindo IIIA and above, was 4.2%, and 30-day mortality rate was 0.6%. Re-admission rate, within 30 days post-discharge, was 1.8%, however, no patient developed COVID-19 specific complications post-operatively and up to 28 days post-discharge. The established Cancer Hub offered elective surgical care for patients with colorectal cancer in a centralised, timely and efficient manner, with acceptable post-operative outcomes and no increased risk of contracting COVID-19 during their inpatient stay. We offer a practical model of care that can be used when elective surgery "hubs" for streamlined delivery of elective care needs to be established in an expeditious fashion, either due to the COVID-19 pandemic or any other future pandemics.
Kelly ME, 2022, Contemporary management of locally advanced and recurrent rectal cancer: views from the PelvEx collaborative, Cancers, Vol: 14, ISSN: 2072-6694
Pelvic exenteration is a complex operation performed for locally advanced and recurrent pelvic cancers. The goal of surgery is to achieve clear margins, therefore identifying adjacent or involved organs, bone, muscle, nerves and/or vascular structures that may need resection. While these extensive resections are potentially curative, they can be associated with substantial morbidity. Recently, there has been a move to centralize care to specialized units, as this facilitates better multidisciplinary care input. Advancements in pelvic oncology and surgical innovation have redefined the boundaries of pelvic exenterative surgery. Combined with improved neoadjuvant therapies, advances in diagnostics, and better reconstructive techniques have provided quicker recovery and better quality of life outcomes, with improved survival This article provides highlights of the current management of advanced pelvic cancers in terms of surgical strategy and potential future developments
Zaborowski AM, Abdile A, Adamina M, et al., 2022, Microsatellite instability in young patients with rectal cancer: molecular findings and treatment response, BRITISH JOURNAL OF SURGERY, Vol: 109, Pages: 251-255, ISSN: 0007-1323
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- Citations: 8
Tekkis NP, Richmond-Smith R, Pellino G, et al., 2022, Facilitating the adoption and evolution of digital technologies through re-conceptualization, Frontiers in Surgery, Vol: 9, ISSN: 2296-875X
Background: The NHS has been making steps toward greater efficiency and cutting costs to maintain quality of care despite constraints, but without innovation the NHS will not be able to meet its increasing financial demands. The purpose of this article is to analyse a single potentially transformative technology's path of adoption in the NHS [3D printing (3DP)].Methods: Analysis of 3DP and its current value propositions. Re-conceptualization of the technology to gain insights into these value propositions and identify the capabilities it may provide. Analysis of previous business models to identify where this value is not fully captured and development of a new business model, followed by exploration of benefits and potential limitations of this new model.Results: 3D printing applications can be broadly categorized into anatomical modeling, implants, and tools. Conceptualizing 3D imaging using the layered architecture model suggests the potential of 3DP to evolve the current imaging and modeling infrastructure of the NHS, and as such should be adopted to facilitate this potential.Conclusion: 3D printing is an innovation with large potential for generativity, and it is important that it is integrated at a level that could both stimulate and communicate its benefits. Re-conceptualization identified a backbone within the NHS that could facilitate it as a point of entry, and the most successful installations have been through this channel. However, progress on the frontier is currently limited by both physical and organizational boundaries, the resolution of which is paramount for the current and future success of this technology.
Tabiri S, Kamarajah SK, Nepogodiev D, et al., 2022, Impact of Bacillus Calmette-Guerin (BCG) vaccination on postoperative mortality in patients with perioperative SARS-CoV-2 infection, BJS Open, Vol: 5, ISSN: 2474-9842
Przedlacka A, Pellino G, Fletcher J, et al., 2021, Current and future role of three-dimensional modelling technology in rectal cancer surgery: a systematic review, World Journal of Gastrointestinal Surgery, Vol: 13, Pages: 1754-1769, ISSN: 1948-9366
BACKGROUND: Three-dimensional (3D) modelling technology translates the patient-specific anatomical information derived from two-dimensional radiological images into virtual or physical 3D models, which more closely resemble the complex environment encountered during surgery. It has been successfully applied to surgical planning and navigation, as well as surgical training and patient education in several surgical specialties, but its uptake lags behind in colorectal surgery. Rectal cancer surgery poses specific challenges due to the complex anatomy of the pelvis, which is difficult to comprehend and visualise. AIM: To review the current and emerging applications of the 3D models, both virtual and physical, in rectal cancer surgery. METHODS: Medline/PubMed, Embase and Scopus databases were searched using the keywords "rectal surgery", "colorectal surgery", "three-dimensional", "3D", "modelling", "3D printing", "surgical planning", "surgical navigation", "surgical education", "patient education" to identify the eligible full-text studies published in English between 2001 and 2020. Reference list from each article was manually reviewed to identify additional relevant papers. The conference abstracts, animal and cadaveric studies and studies describing 3D pelvimetry or radiotherapy planning were excluded. Data were extracted from the retrieved manuscripts and summarised in a descriptive way. The manuscript was prepared and revised in accordance with PRISMA 2009 checklist. RESULTS: Sixteen studies, including 9 feasibility studies, were included in the systematic review. The studies were classified into four categories: feasibility of the use of 3D modelling technology in rectal cancer surgery, preoperative planning and intraoperative navigation, surgical education and surgical device design. Thirteen studies used virtual models, one 3D printed model and 2 both types of mod
McLean KA, Kamarajah SK, Chaudhry D, et 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
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- Citations: 7
Glasbey J, Ademuyiwa A, Adisa A, et 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, Vol: 22, Pages: 1507-1517, 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
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.
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)
Rottoli M, Pellino G, Tanzanu M, et 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, Vol: 73, Pages: 1811-1818, ISSN: 2038-131X
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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
Rottoli M, Pellino G, Tanzanu M, et 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, Pages: 1-1, ISSN: 2038-131X
Brogden DRL, Lupi MEE, Warren OJ, et 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
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.
Zaborowski AM, Abdile A, Adamina M, et al., 2021, Characteristics of Early-Onset vs Late-Onset Colorectal Cancer A Review, JAMA SURGERY, Vol: 156, Pages: 865-874, ISSN: 2168-6254
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Iskandarani M, Fadel M, Boshier P, et al., 2021, The management of acute lower gastrointestinal bleeding using a Sengstaken-Blakemore tube, Publisher: OXFORD UNIV PRESS, Pages: 98-98, ISSN: 0007-1323
Fadel M, Hamrang-Yousefi S, Mills S, et al., 2021, A Systematic Review of International Colorectal Multidisciplinary Team Meetings: The Development of Best Practice Through Inter-Regional Learning, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323
Fadel MG, Iskandarani M, Cuddihy J, et 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
BackgroundMajor burns complicated by stress ulceration and perforation of the stomach or duodenum is a recognized clinical phenomenon. Colonic perforation in burns patients is not common, and the overall incidence, diagnosis, intervention undertaken and mortality is incompletely described in the literature.MethodWe performed a systematic review of the literature on severe burns resulting in colonic perforation during the initial admission period. Relevant studies from January 1975 to June 2020 were retrieved from MEDLINE and EMBASE databases. Patient demographics, co-morbidities, total body surface area (TBSA) and anatomical region of burn, site of colonic perforation and management, nutrition, sepsis and microbiology, length of stay and overall outcome were extracted. We present a case series of five burns patients who had colonic perforations in our Specialist Burns Center.ResultsWe identified 54 studies, of which nine (two case series and seven case reports) met the inclusion criteria. Colonic perforation following burns was most common in middle-aged male patients with a proportion of patients having a history of mental health issues. In most cases, the TBSA associated with a colonic perforation was ≥30% (11/16 patients, 69%). Perforations mainly affected the right side of the colon (12/16 patients, 75%), usually occurring after the second week of admission (13/16 patients, 81%). Right-sided colonic perforations were associated with an increased mortality rate compared to left-sided perforations (42% vs 25%).ConclusionsThe current literature is mainly limited to case series and case reports and confirms that colonic perforations in burns patients are rare. Colonic perforations are related to the systemic effect of burn injuries including sepsis and gastrointestinal stasis. We have identified patients who are at higher risk of developing colonic perforations and have described the common findings in these patients. Through greater awareness early diagnosis and
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.
Kachapila M, Ademuyiwa AO, Biccard BM, et al., 2021, Preliminary model assessing the cost-effectiveness of preoperative chlorhexidine mouthwash at reducing postoperative pneumonia among abdominal surgery patients in South Africa, PLoS One, Vol: 16, Pages: 1-19, ISSN: 1932-6203
BackgroundPneumonia is a common and severe complication of abdominal surgery, it is associated with increased length of hospital stay, healthcare costs, and mortality. Further, pulmonary complication rates have risen during the SARS-CoV-2 pandemic. This study explored the potential cost-effectiveness of administering preoperative chlorhexidine mouthwash versus no-mouthwash at reducing postoperative pneumonia among abdominal surgery patients.MethodsA decision analytic model taking the South African healthcare provider perspective was constructed to compare costs and benefits of mouthwash versus no-mouthwash-surgery at 30 days after abdominal surgery. We assumed two scenarios: (i) the absence of COVID-19; (ii) the presence of COVID-19. Input parameters were collected from published literature including prospective cohort studies and expert opinion. Effectiveness was measured as proportion of pneumonia patients. Deterministic and probabilistic sensitivity analyses were performed to assess the impact of parameter uncertainties. The results of the probabilistic sensitivity analysis were presented using cost-effectiveness planes and cost-effectiveness acceptability curves.ResultsIn the absence of COVID-19, mouthwash had lower average costs compared to no-mouthwash-surgery, $3,675 (R 63,770) versus $3,958 (R 68,683), and lower proportion of pneumonia patients, 0.029 versus 0.042 (dominance of mouthwash intervention). In the presence of COVID-19, the increase in pneumonia rate due to COVID-19, made mouthwash more dominant as it was more beneficial to reduce pneumonia patients through administering mouthwash. The cost-effectiveness acceptability curves shown that mouthwash surgery is likely to be cost-effective between $0 (R0) and $15,000 (R 260,220) willingness to pay thresholds.ConclusionsBoth the absence and presence of SARS-CoV-2, mouthwash is likely to be cost saving intervention for reducing pneumonia after abdominal surgery. However, the available evidence for the eff
Makris GC, Thulasidasan N, Malietzis G, et 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
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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
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.
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