115 results found
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
Pring ET, Malietzis G, Kendall SWH, et al., 2021, Crisis management for surgical teams and their leaders, lessons from the COVID-19 pandemic; A structured approach to developing resilience or natural organisational responses, INTERNATIONAL JOURNAL OF SURGERY, Vol: 91, ISSN: 1743-9191
Drami I, Pring ET, Gould L, et al., 2021, Body Composition and Dose-limiting Toxicity in Colorectal Cancer Chemotherapy Treatment; a Systematic Review of the Literature. Could Muscle Mass be the New Body Surface Area in Chemotherapy Dosing?, Clin Oncol (R Coll Radiol)
Chemotherapy dosing is traditionally based on body surface area calculations; however, these calculations ignore separate tissue compartments, such as the lean body mass (LBM), which is considered a big pool of drug distribution. In our era, colorectal cancer patients undergo a plethora of computed tomography scans as part of their diagnosis, staging and monitoring, which could easily be used for body composition analysis and LBM calculation, allowing for personalised chemotherapy dosing. This systematic review aims to evaluate the effect of muscle mass on dose-limiting toxicity (DLT), among different chemotherapy regimens used in colorectal cancer patients. This review was carried out according to the PRISMA guidelines. MEDLINE and EMBASE databases were searched from 1946 to August 2019. The primary search terms were 'sarcopenia', 'myopenia', 'chemotherapy toxicity', 'chemotherapy dosing', 'dose limiting toxicity', 'colorectal cancer', 'primary colorectal cancer' and 'metastatic colorectal cancer'. Outcomes of interest were - DLT and chemotoxicity related to body composition, and chemotherapy dosing on LBM. In total, 363 studies were identified, with 10 studies fulfilling the selection criteria. Seven studies were retrospective and three were prospective. Most studies used the same body composition analysis software but the chemotherapy regimens used varied. Due to marked study heterogeneity, quantitative data synthesis was not possible. Two studies described a toxicity cut-off value for 5-fluorouracil and one for oxaliplatin based on LBM. The rest of the studies showed an association between different body composition metrics and DLTs. Prospective studies are required with a larger colorectal cancer cohort, longitudinal monitoring of body composition changes during treatment, similar body composition analysis techniques, agreed cut-off values and standardised chemotherapy regimens. Incorporation of body composition analysis in the clinical setting will allow early
Fadel MG, Malietzis G, Constantinides V, et al., 2021, Clinicopathological factors and survival outcomes of signet-ring cell and mucinous carcinoma versus adenocarcinoma of the colon and rectum: a systematic review and meta-analysis, Discover Oncology, Vol: 12, ISSN: 2730-6011
Background:Histological subtypes of colorectal cancer may be associated with varied prognostic features. This systematic review and meta-analysis aimed to compare clinicopathological characteristics, recurrence and overall survival between colorectal signet-ring cell (SC) and mucinous carcinoma (MC) to conventional adenocarcinoma (AC).Methods:A literature search of MEDLINE, EMBASE, Ovid and Cochrane Library was performed for studies that reported data on clinicopathological and survival outcomes on SC and/or MC versus AC from January 1985 to May 2020. Meta-analysis was performed using random-effect models and between-study heterogeneity was assessed.Results:Thirty studies of 1,087,055 patients were included: 11,510 (1.06%) with SC, 110,179 (10.13%) with MC and 965,366 (88.81%) with AC. Patients with SC were younger than patients with AC (WMD − 0.47; 95% CI − 0.84 to –0.10; I2 88.6%; p = 0.014) and more likely to have right-sided disease (OR 2.12; 95% CI 1.72–2.60; I2 82.9%; p < 0.001). Locoregional recurrence at 5 years was more frequent in patients with SC (OR 2.81; 95% CI 1.40–5.65; I2 0.0%; p = 0.004) and MC (OR 1.92; 95% CI 1.18–3.15; I2 74.0%; p = 0.009). 5-year overall survival was significantly reduced when comparing SC and MC to AC (HR 2.54; 95% CI 1.98–3.27; I2 99.1%; p < 0.001 and HR 1.38; 95% CI 1.19–1.61; I2 98.6%; p < 0.001, respectively).Conclusion:SC and MC are associated with right-sided lesions, advanced stage at presentation, higher rates of recurrence and poorer overall survival. This has strong implications towards surgical and oncological management and surveillance of colorectal cancer.
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.
Makris GC, Malietzis G, Uberoi R, 2020, Commentary on "Society of Interventional Radiology Quality Improvement Standards for Image-Guided Percutaneous Drainage and Aspiration of Abscesses and Fluid Collections", CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, Vol: 43, Pages: 1108-1109, ISSN: 0174-1551
Sivarajah V, Walsh U, Malietzis G, et al., 2020, The importance of discussing mortality risk prior to emergency laparotomy, UPDATES IN SURGERY, Vol: 72, Pages: 859-865, ISSN: 2038-131X
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.
Oke SM, Rye B, Malietzis G, et al., 2020, Survival and CT defined sarcopenia in patients with intestinal failure on home parenteral support, CLINICAL NUTRITION, Vol: 39, Pages: 829-836, ISSN: 0261-5614
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
Gottlieb-Vedi E, Kauppila JH, Malietzis G, et al., 2019, Long-term Survival in Esophageal Cancer After Minimally Invasive Compared to Open Esophagectomy: A Systematic Review and Meta-analysis., Ann Surg
OBJECTIVE: Evaluate the existing literature comparing long-term survival after minimally invasive esophagectomy (MIE) and open esophagectomy (OE), and conduct a meta-analysis based on relevant studies. BACKGROUND: It is unknown whether the choice between MIE and OE influences the long-term survival in esophageal cancer. METHODS: A systematic electronic search for articles was performed in Medline, Embase, Web of Science, and Cochrane Library for studies comparing long-term survival after MIE and OE. Additionally, an extensive hand-search was conducted. The I test and χ test were used to test for statistical heterogeneity. Publication bias and small-study effects were assessed using Egger test. A random-effects meta-analysis was performed for all-cause 5-year (main outcome) and 3-year mortality, and disease-specific 5-year and 3-year mortality. Meta-regression was performed for the 5-year mortality outcomes with adjustment for the covariates age, physical status, tumor stage, and neoadjuvant or adjuvant therapy. The results were presented as hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS: The review identified 55 relevant studies. Among all 14,592 patients, 7358 (50.4%) underwent MIE and 7234 (49.6%) underwent OE. The statistical heterogeneity was limited [I = 12%, 95% confidence interval (CI) 0%-41%, and χ = 0.26] and the funnel plot was symmetrical both according to visual and statistical testing (Egger test = 0.32). Pooled analysis revealed 18% lower 5-year all-cause mortality after MIE compared with OE (HR 0.82, 95% CI 0.76-0.88). The meta-regression indicated no confounding. CONCLUSIONS: The long-term survival after MIE compares well with OE and may even be better. Thus, MIE can be recommended as a standard surgical approach for esophageal cancer.
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
Bagnall NM, Pring ET, Malietzis G, et al., 2018, Perioperative risk prediction in the era of enhanced recovery: a comparison of POSSUM, ACPGBI, and E-PASS scoring systems in major surgical procedures of the colorectal surgeon, INTERNATIONAL JOURNAL OF COLORECTAL DISEASE, Vol: 33, Pages: 1627-1634, ISSN: 0179-1958
Pring ET, Malietzis G, Kennedy RH, et al., 2018, Cancer cachexia and myopenia - Update on management strategies and the direction of future research for optimizing body composition in cancer - A narrative review, CANCER TREATMENT REVIEWS, Vol: 70, Pages: 245-254, ISSN: 0305-7372
Walton SJ, Malietzis G, Clark SK, et al., 2018, Urological sequelae of desmoids associated with familial adenomatous polyposis, FAMILIAL CANCER, Vol: 17, Pages: 525-530, ISSN: 1389-9600
Martin L, Hopkins J, Malietzis G, et al., 2018, Assessment of Computed Tomography (CT)-Defined Muscle and Adipose Tissue Features in Relation to Short-Term Outcomes After Elective Surgery for Colorectal Cancer: A Multicenter Approach, ANNALS OF SURGICAL ONCOLOGY, Vol: 25, Pages: 2669-2680, ISSN: 1068-9265
Kedrzycki M, Liasis L, Watfah J, et al., 2018, Management of Caecal diverticulitis: A Systematic Review, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY, Pages: 170-170, ISSN: 0007-1323
Pring E, Malietzis G, Athanasiou T, et al., 2018, Revolutions in tackling sarcopenia in cancer - why surgeons should be driving a multidisciplinary team approach, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY, Pages: 224-224, ISSN: 0007-1323
Oke SM, Rye B, Malietzis G, et al., 2018, SURVIVAL AND CT DEFINED SARCOPENIA IN PATIENTS WITH INTESTINAL FAILURE ON HPN, Annual General Meeting of the British-Society-of-Gastroenterology, Publisher: BMJ PUBLISHING GROUP, Pages: A159-A160, ISSN: 0017-5749
Doherty DJ, Pottle A, Malietzis G, et al., 2018, Vascular access in lipoprotein apheresis: a retrospective analysis from the UK's largest lipoprotein apheresis centre, JOURNAL OF VASCULAR ACCESS, Vol: 19, Pages: 52-57, ISSN: 1129-7298
Ding NS, Malietzis G, Hart AL, 2018, Editorial: anti-TNF therapy and myopenia in Crohn's diseaseanother step towards personalised medicine. Authors' reply, ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Vol: 47, Pages: 142-143, ISSN: 0269-2813
Garas G, Markar SR, Malietzis G, et al., 2017, Induced Bias Due to Crossover Within Randomized Controlled Trials in Surgical Oncology: A Meta-regression Analysis of Minimally Invasive versus Open Surgery for the Treatment of Gastrointestinal Cancer., Annals of Surgical Oncology, Vol: 25, Pages: 221-230, ISSN: 1068-9265
BACKGROUND: Randomized controlled trials (RCTs) inform clinical practice and have provided the evidence base for introducing minimally invasive surgery (MIS) in surgical oncology. Crossover (unplanned intraoperative conversion of MIS to open surgery) may affect clinical outcomes and the effect size generated from RCTs with homogenization of randomized groups. OBJECTIVES: Our aims were to identify modifiable factors associated with crossover and assess the impact of crossover on clinical endpoints. METHODS: A systematic review was performed to identify all RCTs comparing MIS with open surgery for gastrointestinal cancer (1990-2017). Meta-regression analysis was performed to analyze factors associated with crossover and the influence of crossover on endpoints, including 30-day mortality, anastomotic leak rate, and early complications. RESULTS: Forty RCTs were included, reporting on 11,625 patients from 320 centers. Crossover was shown to affect one in eight patients (mean 12.6%, range 0-45%) and increased with American Society of Anesthesiologists score (β = + 0.895; p = 0.050). Pretrial surgeon volume (β = - 2.344; p = 0.037), composite RCT quality score (β = - 7.594; p = 0.014), and site of tumor (β = - 12.031; p = 0.021, favoring lower over upper gastrointestinal tumors) showed an inverse relationship with crossover. Importantly, multivariate weighted linear regression revealed a statistically significant positive correlation between crossover and 30-day mortality (β = + 0.125; p = 0.033), anastomotic leak rate (β = + 0.550; p = 0.004), and early complications (β = + 1.255; p = 0.001), based on intention-to-treat analysis. CONCLUSIONS: Crossover in trials was associated with an increase in 30-day mortality, anastomotic leak rate, and early complications within the MIS group based on intention-
Ding NS, Malietzis G, Lung PFC, et al., 2017, The body composition profile is associated with response to anti-TNF therapy in Crohn's disease and may offer an alternative dosing paradigm, ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Vol: 46, Pages: 883-891, ISSN: 0269-2813
Makris MC, Alexandrou A, Papatsoutsos EG, et al., 2017, Ghrelin and Obesity: Identifying Gaps and Dispelling Myths. A Reappraisal, IN VIVO, Vol: 31, Pages: 1047-1050, ISSN: 0258-851X
Shetty K, Poo SXW, Sriskandarajah K, et al., 2017, "The longest way round is the shortest way home": an overhaul of surgical ward rounds, World Journal of Surgery, Vol: 42, Pages: 937-949, ISSN: 1432-2323
BACKGROUND: Ward rounds, a keystone of hospital surgical practice, have recently been under the spotlight. Poor-quality ward rounds can lead to a greater number of adverse events, thereby cascading to an increased financial strain on our already burdened healthcare systems. Faced with mounting pressures from both outside and inside health organizations, concerted efforts are required to restore it back into prominence where it can no longer take a backseat to the other duties of a surgeon. METHODS: The nucleus of this narrative review is derived from an extensive literature search on surgical ward rounds. RESULTS: In this review, we focus on the need for reforms, current characteristics of surgical ward rounds, obstacles encountered by competing interests and proposed solutions in delivery of effective ward rounds that can meet with newly laid guidelines. CONCLUSION: Ward rounds should be standardized and prioritized to improve patient care.
Markar SR, Naik R, Malietzis G, et al., 2017, Component analysis of enhanced recovery pathways for esophagectomy, Diseases of the Esophagus, Vol: 30, ISSN: 1120-8694
The objective of this systematic review is to identify key components of enhanced recovery protocols (ERP) that lead to improved length of hospital stay (LOS) following esophagectomy. Relevant electronic databases were searched for studies comparing clinical outcome from esophagectomy followed by a conventional pathway versus ERP. Relevant outcome measures were compared and metaregression was performed to identify the key ERP components associated with reduced in LOS. Thirteen publications were included, ERP was associated with no changes in in-hospital mortality, total complications, anastomotic leak, or pulmonary complications compared with a conventional pathway, however LOS was reduced in the ERP group. Metaregression identified that immediate extubation was associated with reduced LOS (OR = −0.51, 95%CI −0.77 to −0.25; P < 0.01). Several postoperative factors were associated with a significant reduction in length of hospital stay, and in order of most important were (i) gastrograffin swallow ≤5 days (OR = −4.27, 95%CI −4.50 to −4.03); (ii) mobilization on postoperative day ≤1 (OR = −2.49, 95%CI −2.63 to −2.34); (iii) removal of urinary catheter ≤2 days (OR = −0.99, 95%CI −1.15 to −0.84); (iv) oral intake with at least sips of fluid ≤1 day (OR = −0.96, 95%CI −1.24 to −0.68); (v) enteral diet with feeding jejunostomy or gastrostomy ≤ 1 day (OR = −0.57, 95%CI −0.80 to −0.35) and (vi) epidural removal ≤ 4 days (OR = −0.17, 95%CI −0.27 to −0.07). Several core ERP components and principles appear to be associated with LOS reduction. These elements should form a part of the core ERP for the specialty, while surgical teams incorporate other elements through an iterative process.
Zucker B, Malietzis G, Kontovounisios C, 2017, An Unexpected Cause of Acute Abdomen, GASTROENTEROLOGY, Vol: 153, Pages: E4-E5, ISSN: 0016-5085
Erridge S, Pucher PH, Markar SR, et al., 2017, Meta-analysis of determinants of survival following treatment of recurrent hepatocellular carcinoma, British Journal of Surgery, Vol: 104, Pages: 1433-1442, ISSN: 1365-2168
BackgroundIntrahepatic recurrence of hepatocellular carcinoma (HCC) following resection is common. However, no current consensus guidelines exist to inform management decisions in these patients. Systematic review and meta-analysis of survival following different treatment modalities may allow improved treatment selection. This review aimed to identify the optimum treatment strategies for HCC recurrence.MethodsA systematic review, up to September 2016, was conducted in accordance with MOOSE guidelines. The primary outcome was the hazard ratio for overall survival of different treatment modalities. Meta-analysis of different treatment modalities was carried out using a random-effects model, with further assessment of additional prognostic factors for survival.ResultsNineteen cohort studies (2764 patients) were included in final data analysis. The median 5-year survival rates after repeat hepatectomy (525 patients), ablation (658) and transarterial chemoembolization (TACE) (855) were 35·2, 48·3 and 15·5 per cent respectively. Pooled analysis of ten studies demonstrated no significant difference between overall survival after ablation versus repeat hepatectomy (hazard ratio 1·03, 95 per cent c.i. 0·68 to 1·55; P = 0·897). Pooled analysis of seven studies comparing TACE with repeat hepatectomy showed no statistically significant difference in survival (hazard ratio 1·61, 0·99 to 2·63; P = 0·056).ConclusionBased on these limited data, there does not appear to be a significant difference in survival between patients undergoing repeat hepatectomy or ablation for recurrent HCC. The results also identify important negative prognostic factors (short disease-free interval, multiple hepatic metastases and large hepatic metastases), which may influence choice of treatment.
Moscarelli M, Athanasiou T, Speziale G, et al., 2017, The value of adding sub-valvular procedures for chronic ischemic mitral regurgitation surgery: a meta-analysis, PERFUSION-UK, Vol: 32, Pages: 436-445, ISSN: 0267-6591
Jamel S, Markar SR, Malietzis G, et al., 2017, Prognostic significance of peritoneal lavage cytology in staging gastric cancer: systematic review and meta-analysis, Gastric Cancer, Vol: 21, Pages: 10-18, ISSN: 1436-3291
BackgroundPeritoneal cytology has been used as a part of the cancer staging of gastric cancer patients. The primary aim of this systematic review was to evaluate the value of peritoneal cytology as part of the staging of gastric cancer and survival prediction. The second aim was to establish if positive cytology may be modified by neoadjuvant therapy, to improve prognosis.MethodsAn electronic literature search was performed using Embase, Medline, Web of Science, and Cochrane library databases up to January 2016. The logarithm of the hazard ratio (HR) with 95% confidence intervals (CI) was used as the primary summary statistic. Comparative studies were used, and the outcome measure was survival in three groups: (1) positive versus negative cytology at staging laparoscopy immediately preceding surgery; (2) effect of neoadjuvant therapy on cytology and survival; and (3) positive cytology in the absence of macroscopic peritoneal disease was compared with obvious macroscopic peritoneal disease.ResultsPooled analysis demonstrated that positive cytology was associated with significantly reduced overall survival (HR, 3.46; 95% CI, 2.77–4.31; P < 0.0001). Interestingly, negative cytology following neoadjuvant chemotherapy was associated with significantly improved overall survival (HR, 0.42; 95% CI, 0.31–0.57; P < 0.0001). The absence of macroscopic peritoneal disease with positive cytology was associated with significantly improved overall survival (HR, 0.64; 95% CI, 0.56–0.73; P < 0.0001).ConclusionThis study suggests that patients with initial positive cytology may have a good prognosis following neoadjuvant treatment if the cytology results change to negative after treatment.
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.