Imperial College London

Chris Rao

Faculty of MedicineDepartment of Surgery & Cancer

Honorary Clinical Research Fellow
 
 
 
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Publications

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136 results found

Wong R, Hussain MI, Toh S, Rao C, St John ERet al., 2023, Digital and paper consent errors, BRITISH JOURNAL OF SURGERY, ISSN: 0007-1323

Journal article

SunMyint A, Rao C, Barbet N, Thamphya B, PaceLoscos T, Schiappa R, Magné N, MartelLafay I, Mineur L, Deberne M, Zilli T, Dhadda A, Gerard JPet al., 2023, The safety and efficacy of total mesorectal excision (TME) surgery following dose‐escalation: Surgical outcomes from the organ preservation in early rectal adenocarcinoma (OPERA) trial, a European multicentre phase 3 randomised trial (NCT02505750), Colorectal Disease, ISSN: 1462-8910

<jats:title>Abstract</jats:title><jats:sec><jats:title>Aim</jats:title><jats:p>Nonsurgical treatment with chemoradiotherapy for rectal cancer is gaining interest as it avoids total mesorectal excision (TME) surgery and stoma. The OPERA trial aims to evaluate whether dose escalation with contact X‐ray brachytherapy (CXB) boost improves organ preservation compared to external beam radiotherapy (EBRT) boost. It has been suggested that dose escalation adversely affects surgical outcomes and therefore we report outcomes following TME in OPERA at 36 months.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>OPERA is a European multicentre phase 3 trial (NCT02505750) which randomises patients with cT2‐3a‐b, cN0‐1, M0 to EBCRT (45 Gy in 25 fractions over 5 weeks with oral capecitabine 825 mg/m<jats:sup>2</jats:sup>) followed by EBRT boost (9 Gy in 5 fractions over 5 days) versus EBCRT followed by CXB boost (90 Gy in 3 fractions over 4 weeks). Patients were assessed at 14, 20 and 24 weeks from the start of treatment. Watch and wait management was adopted for patients who achieved a clinical complete response (cCR) at 24 weeks following treatment. Either local excision (LE) or TME surgery was offered for residual disease or local regrowth, according to patient and surgeon preference. Surgical morbidity and mortality were recorded prospectively.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Between July 2015 and June 2020, 148 patients were randomised of which 141 were evaluable in March 2022. At median follow‐up of 38.2 months (range: 34.2–42.5), surgery was performed for 66 (47%) patients. A total of 27 (20%) patients had local excision and 39 (29%) had TME surgery, 22/39 (56%) underwent anterior resection and 17/39 (44%) underwent abd

Journal article

West CT, West MA, Mirnezami AH, Drami I, Denys A, Glyn T, Sutton PA, Tiernan J, Behrenbruch C, Guerra G, Waters PS, Woodward N, Applin S, Charles SJ, Rose SA, Pape E, van Ramshorst GH, Aalbers AGJ, Abdul AN, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alahmadi R, Alberda W, Albert M, Andric M, Angeles M, Angenete E, Antoniou A, Armitage J, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brown K, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelen W, Chan KKL, Chang GJ, Chew MH, Chok AK, Chong P, Christensen HK, Clouston H, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovic L, Daniels IR, Davies M, Davies RJ, Delaney CP, de Wilt JHW, Denost QD, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Egger E, Eglinton T, Enrique-Navascues JM, Espin-Basany E, Evans MD, Eyjolfsdottir B, Fahy M, Fearnhead NS, Fichtner-Feigl S, Flatmark K, Fleming F, Flor B, Folkesson J, Foskett K, Frizelle FA, Funder J, Gallego MA, Garcia-Granero E, Garcia-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Ginther N, Glover T, Goffredo P, Golda T, Gomez CM, Griffiths B, Gwenael F, Harris C, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helbren C, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Holmstroem A, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy G, Kapur S, Kanemitsu Y, Kaufman M, Kazi M, Kelley SR, Keller DS, Kelly ME, Kersting S, Ketelaers SHJ, Khan MS, Khaw J, Kim H, Kim HJ, Kiran R, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kraft M, Kristensen HO, Kumar S, Kusters M, Lago V, Lakkis Zet al., 2023, Empty pelvis syndrome: PelvEx Collaborative guideline proposal, BRITISH JOURNAL OF SURGERY, ISSN: 0007-1323

Journal article

Rao C, 2023, Appeal Panel Decision: Molnupiravir, remdesivir and tixagevimab plus cilgavimab for treating COVID-19 [ID6261], Appeal Panel Decision: Molnupiravir, remdesivir and tixagevimab plus cilgavimab for treating COVID-19, London, Publisher: National Institute of Health and Care Excellence (NICE), ID6261

Report

Rahman F, Trivedy M, Rao C, Akinlade F, Mansuri A, Aggarwal A, Laskaratos F-M, Rajendran N, Banerjee Set al., 2023, Faecal immunochemical testing to detect colorectal cancer in symptomatic patients: a diagnostic accuracy study, Diagnostics, Vol: 13, ISSN: 2075-4418

(1) Background: NHS England recommended faecal immunochemical testing (FIT) for symptomatic patients in June 2020 to rationalise limited diagnostic services during COVID-19. (2) Aim: to investigate the diagnostic performance of FIT, analysing the proportion of FIT-negative colorectal cancers (CRC) missed in symptomatic patients and how this risk could be mitigated. (3) Design and Setting: a retrospective study of biochemistry and cancer databases involving patients referred from primary healthcare with suspected CRC to a single secondary care trust in North East London. (4) Methods: a retrospective cohort diagnostic accuracy study was undertaken to determine the performance of FIT for detecting CRC at 10 µgHb/g. (5) Results: between January and December 2020, 7653 patients provided a stool sample for FIT analysis; 1679 (22%) samples were excluded due to inadequate or incorrect specimens; 48% of suspected CRC referrals completed FIT before evaluation; 86 FIT tested patients were diagnosed with histologically proven CRC. At 10 µgHb/g, FIT performance was comparable with the existing literature with a sensitivity of 0.8140 (95% CI 0.7189–0.8821), a specificity of 0.7704 (95% CI 0.7595–0.7809), a positive predictive value (PPV) of 0.04923 (95% CI 0.03915–0.06174), a negative predictive value (NPV) of 0.9965 (95% CI 0.9943–0.9978), and a likelihood ratio (LR) of 3.545; 16 patients with CRC had an FIT of ≤10 µgHb/g (18.6% 95% CI 11.0–28.4%). (6) Conclusions: this study raises concerns about compliance with FIT testing and the incidence of FIT-negative CRC at the NICE recommended threshold and how this risk can be mitigated without colonic imaging. Whilst FIT may have facilitated prioritisation during COVID-19, we must be cautious about using FIT alone to determine which patients are referred to secondary care or receive further investigation.

Journal article

Umeojiako W, Hurndall KH, Mansuri A, Rao Cet al., 2023, The Role of Patient Reported Outcomes Measures (PROMS) and Health-Related Quality-of-Life (HRQoL) in Economic Analysis, Patient Reported Outcomes and Quality of Life in Surgery, Editors: Patel, Athanasiou, Darzi, Publisher: Springer, ISBN: 9783031275968

In this chapter the importance of quality-of-life estimates in the prevailing paradigm for economic evaluation is discussed. Empirical methods for measuring quality-of-life are described. Finally, the generic and disease-specific PROMS used to derive estimates of quality-of-life in economic evaluation are discussed.

Book chapter

Shamsiddinova A, Deputy M, Worley G, Rao C, Thomas-Gibson S, Faiz Oet al., 2023, Systematic review: oncological outcomes of patients with inflammatory bowel disease undergoing segmental colonic resections for colorectal cancer and dysplasia, Publisher: BMJ PUBLISHING GROUP, Pages: A108-A108, ISSN: 0017-5749

Conference paper

Ainsworth N, Hussain MI, Houten R, Martin AP, Toh S, Rao C, St John ERet al., 2023, Informed consent failures: National Health Service Resolution data, BRITISH JOURNAL OF SURGERY, ISSN: 0007-1323

Journal article

Shamsiddinova A, Deputy M, Worley G, Rao C, Dean H, Thomas-Gibson S, Faiz Oet al., 2023, Systematic review: Oncological outcomes of patients with Inflammatory Bowel Disease undergoing segmental colonic resections for colorectal cancer and dysplasia, Publisher: OXFORD UNIV PRESS, Pages: 494-495, ISSN: 1873-9946

Conference paper

Bibi S, Edilbe MW, Rao C, 2023, The Cost-effectiveness of Watch and Wait for Rectal Cancer, CLINICAL ONCOLOGY, Vol: 35, Pages: 132-137, ISSN: 0936-6555

Journal article

Myint AS, Dhadda A, Stewart A, Mills J, Sripadam R, Rao C, Hunter A, Hershman M, Franklin A, Chadwick E, Banerjee A, Rockall T, Pritchard DM, Gerard JPet al., 2023, The Role of Contact X-Ray Brachytherapy in Early Rectal Cancer- Who, when and How?, CLINICAL ONCOLOGY, Vol: 35, Pages: 87-96, ISSN: 0936-6555

Journal article

Shamsiddinova A, Deputy M, Worley G, Rao C, Dean H, Thomas-Gibson S, Faiz Oet al., 2023, P362 Systematic review: Oncological outcomes of patients with Inflammatory Bowel Disease undergoing segmental colonic resections for colorectal cancer and dysplasia, Publisher: Oxford University Press (OUP), Pages: i494-i495, ISSN: 1873-9946

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Current international guidelines recommend that patients with inflammatory bowel disease (IBD) diagnosed with high grade dysplasia (HGD), or colorectal cancer undergo a proctocolectomy, and that proctocolectomy is considered within a shared decision-making framework with the patient in cases of low grade (LGD) or indeterminate (IND) dysplasia. However, segmental colectomy (surgical resection leaving remaining colon or rectum) is considered by some as a valid alternative, with less physiological stress, stoma avoidance and thus acceptability to patients. This systematic review aims to assess oncological and post-operative outcomes in studies reporting on segmental colectomy or proctocolectomy for patients with IBD and colonic or rectal dysplasia and cancer.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>This systematic review was prospectively registered with PROSPERO (CRD42021292891) and carried out in line with the PRISMA guidelines. Studies published between 1990 and 2022 reporting on oncological and surgical outcomes of adult patients undergoing segmental resection and/or proctocolectomy that included at least three cases of neoplasia were included. Descriptive statistics were used in the context of significant heterogeneity. A meta-analysis was performed for outcomes with at least three results.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The search returned 2178 results, and after screening 12 studies were included in the final analysis. A total 12,701 patients were included reporting on outcomes of 10,386 segmental resections and 2,315 proctoco

Conference paper

Rao C, 2023, Appeal Panel Decision: Tafasitamab with lenalidomide for treating relapsed or refractory diffuse large B-cell lymphoma [ID3795], Appeal Panel Decision: Tafasitamab with lenalidomide for treating relapsed or refractory diffuse large B-cell lymphoma, London, Publisher: National Institute of Health and Care Excellence, TA883

Report

Ghanem K, Momotaz S, Banerjee S, Ball SK, Khan W, Burling D, Corr A, Kaul S, Rao C, Rajendran Net al., 2022, “Extensive Anal Cancer Resection Requiring Bilateral Subtotal Buttockectomy” - A case report, Annals of Oncology Case Reports, Vol: 1, Pages: 1-2

We report an aggressive case of anal cancer recurrences.This 38-year-old male presented with extensive verrucousanal carcinoma extending laterally across both buttocks. Hewas diagnosed in May 2019 with a T3N1cM0 anal SCC. Hisinitial treatment entailed four cycles of neoadjuvant chemotherapywith carboplatin and paclitaxel, completed inOctober 2019, preceded by a laparoscopic defunctioningloop colostomy. Subsequent radical chemo radiotherapy using53.2 Gy in 28 fractions with concurrent mitomycin C andcapecitabine was complete in January 2020. MRI pelvis andPET CT scan 5 months later demonstrated total resolution,supported by an equally promising clinical response. However,further follow-up imaging at ten months post completionof treatment, suggested local disease recurrence withprominent FDG avid internal iliac lymph node, correlatingwith clinical findings. He underwent an extended ELAPE followedby VRAM myo-cutaneous flap with unilateral V-Y advancementflap on right side and fascio-cutaneous rotationadvancement flap on left side. Recovery was complicatedby wound dehiscence, successfully managed by a negativepressure dressing. He remains well and disease free.

Journal article

Fahy MR, Kelly ME, Aalbers AGJ, Aziz AN, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alberda W, Albert M, Andric M, Angeles MA, Angenete E, Antoniou A, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Beynon J, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelan W, Chan KKL, Chang GJ, Chang M, Chew MH, Chok AY, Chong P, Clouston H, Codd M, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovich L, Daniels IR, Davies M, Delaney CP, de Wilt JH, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Eglinton T, Enriquez-Navascues JM, Espin-Basany E, Evans MD, Eyjolfsdottir B, Fearnhead NS, Ferron G, Flatmark K, Fleming FJ, Flor B, Folkesson J, Frizelle FA, Funder J, Gallego MA, Gargiulo M, Garcia-Granero E, Garcia-Sabrido JL, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Dn G, Glyn T, Glynn R, Golda T, Griffiths B, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Hompes R, Hornung B, Hurton S, HyunE, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy G, Kapur S, Kanemitsu Y, Kazi M, Kelley SR, Keller DS, Ketelaers SHJ, Khan MS, Kiran RP, Kim H, Kim HJ, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kristensen HO, Kroon HM, Kumar S, Kusters M, Lago V, Lampe B, Lakkis Z, Larach JT, Larkin JO, Larsen SG, Larson DW, Law WL, Lee PJ, Limbert M, Loria A, Lydrup ML, Lyons A, Lynch AC, Maciel J, Manfredelli S, Mann C, Mantyh C, Mathis KL, Marques CFS, Martinez A, Martling A, Mehigan BJ, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, Mikalauskas S, McArthur DR, McCormick JJ, McCormick P, McDermott FDet al., 2022, Minimum standards of pelvic exenterative practice: PelvEx Collaborative guideline, BRITISH JOURNAL OF SURGERY, Vol: 109, Pages: 1251-1263, ISSN: 0007-1323

Journal article

Myint AS, Dhadda AS, Stewart A, Mills J, Sripadam R, Rao C, Hershman MJ, Pritchard DM, Gerard JPet al., 2022, New hope from OPERA trial for surgically fit rectal cancer patients who wish to have organ preservation, Colorectal Disease, ISSN: 1462-8910

Journal article

Logan R, Rao C, Hunt N, Banerjee S, Myers Met al., 2022, DUPLICATE FIT TESTING AS A SAFETY NETTING STRATEGY FOR PATIENTS AT RISK OF COLORECTAL CANCER, Publisher: BMJ PUBLISHING GROUP, Pages: A5-A5, ISSN: 0017-5749

Conference paper

Hunt N, Rao C, Logan R, Chandrabalan V, Oakey J, Ainsworth C, Smith N, Banerjee S, Myers Met al., 2022, A cohort study of duplicate faecal immunochemical testing in patients at risk of colorectal cancer from North-West England, BMJ Open, Vol: 12, Pages: 1-7, ISSN: 2044-6055

Objectives We sought to investigate if duplicate faecal immunochemical testing (FIT) sampling improves the negative and positive predictive value of patients thought to be at risk of colorectal cancer (CRC). Specifically, we aimed to investigate whether the proportion of FIT-negative CRC missed by a single FIT test in symptomatic patients could be reduced by duplicate FIT testing.Design A retrospective service evaluation cohort study of the diagnostic accuracy of duplicate FIT testing.Setting Patients referred from primary care with suspected CRC to four secondary care trusts in North-West England.Participants 28 622 patients over 18-years-old with lower gastrointestinal symptoms suggestive of CRC who completed two FIT samples.Primary and secondary outcome measures The performance of duplicate FIT for detecting CRC at a threshold of 10 µgHb/g.Results The sensitivity if either test was >10 µgHb/g was 0.978 (0.955–0.989), specificity was 0.662 (0.657–0.668), positive predictive value 0.031 (0.028–0.035) and negative predictive value 1.00 (0.999–1.00). Despite two-thirds of patients (18952) being negative following two tests, at this threshold only seven CRC were missed over a 26-month period. All seven patients had other high-risk features which should have prompted investigation.Conclusions This study suggests that in routine NHS practice, a duplicate FIT sample strategy together with clinical evaluation for evidence of anaemia and weight loss is superior to a single FIT sample alone and would allow sym

Journal article

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

Journal article

Myint AS, Rao C, Dhadda AS, Wong H, Hershman M, Sripadam R, Pritchard Met al., 2022, Improved organ preservation with dose escalation using contact X-ray brachytherapy for good responders following external beam chemoradiotherapy: Long-term outcomes from a single institution, ASCO Gastrointestinal Cancers Symposium, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0732-183X

Conference paper

Mansuri A, Tan KL, Kaul S, Rao C, Mane R, Khan A, Hussain S, Banerjee S, Boulton R, Bhargava A, Huang J, Matthew H, Raouf S, Ball S, Rajendran Net al., 2022, Is management of rectal cancer using watch-and-wait approach feasible, safe, and effective in a publicly funded general hospital?, Publisher: Elsevier BV, Pages: e102-e103, ISSN: 0748-7983

Conference paper

Mansuri A, Dimitrios Z, Strano G, Kaul S, Mehmood W, Christopher R, Veeranna Set al., 2022, IMPROVING PATIENT FLOW VIA SURGICAL HOT CLINIC, Publisher: Elsevier BV, Pages: e143-e143, ISSN: 0748-7983

Conference paper

Kaul S, Rao C, Mane R, Tan KL, Khan AHA, Hussain MS, Shafi MA, Buettner F, Banerjee S, Boulton R, Bhargava A, Huang J, Hanson M, Raouf S, Ball S, Rajendran Net al., 2022, Is the Management of Rectal Cancer Using a Watch and Wait Approach Feasible, Safe and Effective in a Publicly Funded General Hospital?, CLINICAL ONCOLOGY, Vol: 34, Pages: E25-E34, ISSN: 0936-6555

Journal article

Rao C, 2021, Appeal Panel Decision: Avelumab for maintenance treatment of locally advanced or metastatic urothelial cancer after platinum-based chemotherapy [TA788], Appeal Panel Decision: Avelumab for maintenance treatment of locally advanced or metastatic urothelial cancer after platinum-based chemotherapy, London, Publisher: National Institute of Health and Care Excellence, TA788

Report

Deputy M, Rao C, Worley G, Balinskaite V, Bottle A, Aylin P, Burns EM, Faiz Oet al., 2021, Effect of the SARS-CoV-2 pandemic on mortality related to high-risk emergency and major elective surgery, British Journal of Surgery, Vol: 108, Pages: 754-759, ISSN: 0007-1323

The coronavirus pandemic has had a significant impact on the provision of surgery globally. This research looked at how the pandemic has affected rates of surgery in England using administrative data. Specifically, it examined the characteristics of patients who were admitted and mortality when patients contracted coronavirus. It found that the overall risk of death did not change in 2020 compared with the same time period in 2019. It did find that the risk of death increased with coronavirus infection. The authors recommend preventive measures to ensure patient safety when restarting elective surgery during the pandemic.

Journal article

Rao C, 2021, Appeal Panel Decision: Tafamidis for treating transthyretin amyloidosis with cardiomyopathy [TA696], Appeal Panel Decision: Tafamidis for treating transthyretin amyloidosis with cardiomyopathy, London, Publisher: National Institute of Health and Care Excellence, TA696

Report

Gash K, Vaughan-Shaw PG, Brown J, Adams K, Valiance AE, Torkington J, Morris K, Cornish JA, Chambers A, Stearns A, Walsh A, Rankin A, Khan A, Morton A, Engledow A, Newman A, Shaw A, Wilkins A, Curtis A, Jones A, Makhort A, Groves A, Bilkhu A, Alabi A, Miller A, Kosti A, Lyons A, Sayers A, Homer A, Soares AS, Williams A, Oglesby A, Abdelmabod A, Silva ANS, Pannu A, Khan A, Stubbs B, Vadhwana B, Cruz C, El-Sayed C, Currow C, Bowman C, Liao C, Rao C, Halkias C, Glancy D, Anderson D, Bowden D, Zosimas D, Waugh D, Speake D, Scrimgeour D, Monaghan E, Crossley E, Alkizwini E, Barron E, Blower E, Kastanias E, Mosley F, Ugwu F, Faulkner G, Gossedge G, Ramsay G, Lloyd G, Williams G, Preziosi G, McAdam G, Taylor G, Boyd-Carson H, Copley H, Naheswaran H, Black H, Ferguson H, Koh H, Jones H, Lord I, Reece I, Foster J, Pitt J, Shabbir J, Sarveswaran J, Sagar J, Foot J, Allison J, Hilton J, Deery J, Fallon J, Lund J, Easterbrook J, Fletcher J, Bailey J, Huang J, John J, Roy J, Leong K, Sahnan K, Hodson K, Cross K, Hobson K, Siggens K, Keogh K, Hureibi K, Hashmi K, Muirhead L, Kennedy L, Sheahlin L, Reza L, Pippard L, Dickerson L, Stevenson L, Chand M, Chan M, Yiasemidou M, Wiggans M, Boal M, Feretis M, Saunders M, Shinkwin M, Thornton M, Williamson M, Elshaer M, Rabie M, Fakhrul-Aldeen M, Harilingam M, Francis N, Curtis N, Smart N, Fearnhead N, Symons N, Reay-Jones N, Marks N, Eardley N, Nanjappa N, Pawa N, Husnoo N, Warren O, James O, Mackey P, Sutton P, Herrod P, Orchard P, Tozer P, Persson P, Lokanathan P, Falconer R, Thomas R, Harshen R, Kushwaha R, Maahi R, Bhardwaj R, Radwan R, Oliphant R, Bourdon-Pierre R, Fallaize R, Iddles R, Kelleher R, Rai S, Mehmood S, Arman S, Granger S, Lawday S, Bhandari S, Duff S, Rehman SFU, Rehman S, Mitra S, Lockwood S, Doran S, Pilkington S, Shepherd S, Dilke S, Lindley S, Chandler S, Moug S, Ross T, Hussain T, Roe T, Hettiarachchi T, Mcbride T, Walsh U, Kulikova V, Hariharan V, Datta V, Kenworthy W, Ibrahim Y, Thackray Y, Karar S, Baker Ket al., 2021, Factors impacting time to ileostomy closure after anterior resection: the UK closure of ileostomy timing cohort study (CLOSE-IT), Colorectal Disease, Pages: 1-11, ISSN: 1462-8910

AimDelay to closure of ileostomy following anterior resection for rectal cancer may impair postoperative bowel function and quality of life. We analysed time to ileostomy closure across the UK and investigated factors delaying closure.MethodsFor the retrospective cohort we assessed time to closure and incidence of non‐closure for patients who underwent anterior resection with defunctioning ileostomy during 2015. Multivariate linear/Cox regression analyses were performed. For the prospective cohort we captured patients undergoing ileostomy closure during a 3‐month period in 2018 to validate retrospective findings.ResultsThe retrospective cohort involved 788 patients of whom 669 (84.9%) had bowel continuity restored, median time to closure 259 days. Recognized factors associated with delay and risk of non‐closure included anastomotic leak (hazard ratio [HR] 3.65, 2.61–5.08), chemotherapy (HR 2.62, 2.17–3.15) and cancer progression (HR 2.05, 1.62–2.58). Crucially, specific aspects of the surgical pathway were associated with time to closure; for example, waiting list entry prior to outpatient clinic review/imaging was associated with an estimated 133‐day shorter interval to closure (P < 0.001). In the prospective cohort 288 patients underwent closure, at a median of 271 days. Chemotherapy use and cancer progression were associated with delay to closure while listing for surgery prior to clinic and imaging was associated with an estimated shorter interval to closure of 168 days (P = 0.008).ConclusionsDelays to closure of ileostomy are common in the UK. Listing patients for surgery only after follow‐up outpatient appointment, imaging or chemotherapy delays closure. Findings will inform consensus guidelines towards an optimum treatment pathway to reduce delay and improve post‐closure quality of life.

Journal article

Sun Myint A, Dhadda A, Rao C, Sripadam R, Gerard JPet al., 2020, Will GRECCAR 2 be a game changer for the management of rectal cancer?, COLORECTAL DISEASE, Vol: 22, Pages: 2330-2330, ISSN: 1462-8910

Journal article

Rao C, 2020, Appeal Panel Decision: Erenumab for preventing migraine [TA682], Appeal Panel Decision: Erenumab for preventing migraine, London, Publisher: National Institute of Health and Care Excellence, TA682

Report

O'Donohoe N, Chandak P, Likos-Corbett M, Yee J, Hurndall K, Rao C, Engledow AHet al., 2019, Follow up colonoscopy may be omissible in uncomplicated left-ided acute diverticulitis diagnosed with CT- a retrospective cohort study, Scientific Reports, Vol: 9, Pages: 1-4, ISSN: 2045-2322

International guidelines recommend colonoscopy following hospitalisation for acute diverticulitis. There is a paucity of evidence supporting the efficacy of colonoscopy in this context, particularly for patients with CT-diagnosed uncomplicated left-sided diverticulitis. This study aims to investigate the frequency that colorectal cancer (CRC) and advanced adenomas (AA) are identified during follow-up colonoscopy after hospitalisation with CT-proven left-sided diverticulitis for the first time in a UK population. In this single-centre retrospective-cohort study all patients presenting with CT-diagnosed uncomplicated left-sided diverticulitis between 2014 and 2017 were identified. The incidence of histologically confirmed CRC and AA identified at follow-up colonoscopy 4–6 weeks following discharge was assessed. 204 patients with CT proven uncomplicated left-sided diverticulitis underwent follow-up colonoscopy. 72% were female and the median age was 63 years. There were no major complications. 22% of patients were found to have incidental hyperplastic polyps or adenomas with low-grade dysplasia. No CRC or AA were found. Routine colonoscopy following acute diverticulitis in this cohort did not identify a single CRC or AA and could arguably have been omitted. This would significantly reduce cost and pressure on endoscopy departments, in addition to the pain and discomfort that is commonly associated with colonoscopy.

Journal article

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