Publications
91 results found
Orlando A, Thomas G, Murphy J, et al., 2024, A systematic review and a meta-analysis on the incidence of obstetric anal sphincter injuries during vaginal delivery., Colorectal Dis, Vol: 26, Pages: 227-242
AIM: The incidence of obstetric anal sphincter injuries (OASIS) has increased in the past two decades despite improved awareness of the risk factors. This study aimed to define the incidence of OASIS in women with different features (instrumental delivery or other variables). METHODS: A systematic review was conducted on articles reporting the incidence of OASIS. This review aims to examine the association of instrumentation and OASIS by performing a formal systematic review of the published literature. Databases used for the research were MEDLINE, Embase, CINAHL and 'Maternity and infant care' databases. RESULTS: Two independent reviewers screened the selected articles. 2326 duplicates were removed from the total of 4907 articles. The remaining 2581 articles were screened for title and abstract. 1913 articles were excluded due to irrelevance. The remaining 300 were screened as full text. Primiparity associated with the use of forceps were the features associated with the highest incidence of OASIS in the selected articles (19.4%). OASIS in all women had an overall incidence of 3.8%. The incidence of OASIS in all women by geographical region was the highest (6.5%) in North America. CONCLUSIONS: There are various factors that impact on the incidence of OASIS and the combination of some of these, such as the use of forceps in primiparas, resulted in the highest incidence of OASIS. The lack of international consensus is limiting the improvements that can be done to reduce OASIS rates and improve best clinical practice.
Challoner BR, Woolston A, Lau D, et al., 2024, Genetic and immune landscape evolution in MMR-deficient colorectal cancer., J Pathol, Vol: 262, Pages: 226-239
Mismatch repair-deficient (MMRd) colorectal cancers (CRCs) have high mutation burdens, which make these tumours immunogenic and many respond to immune checkpoint inhibitors. The MMRd hypermutator phenotype may also promote intratumour heterogeneity (ITH) and cancer evolution. We applied multiregion sequencing and CD8 and programmed death ligand 1 (PD-L1) immunostaining to systematically investigate ITH and how genetic and immune landscapes coevolve. All cases had high truncal mutation burdens. Despite pervasive ITH, driver aberrations showed a clear hierarchy. Those in WNT/β-catenin, mitogen-activated protein kinase, and TGF-β receptor family genes were almost always truncal. Immune evasion (IE) drivers, such as inactivation of genes involved in antigen presentation or IFN-γ signalling, were predominantly subclonal and showed parallel evolution. These IE drivers have been implicated in immune checkpoint inhibitor resistance or sensitivity. Clonality assessments are therefore important for the development of predictive immunotherapy biomarkers in MMRd CRCs. Phylogenetic analysis identified three distinct patterns of IE driver evolution: pan-tumour evolution, subclonal evolution, and evolutionary stasis. These, but neither mutation burdens nor heterogeneity metrics, significantly correlated with T-cell densities, which were used as a surrogate marker of tumour immunogenicity. Furthermore, this revealed that genetic and T-cell infiltrates coevolve in MMRd CRCs. Low T-cell densities in the subgroup without any known IE drivers may indicate an, as yet unknown, IE mechanism. PD-L1 was expressed in the tumour microenvironment in most samples and correlated with T-cell densities. However, PD-L1 expression in cancer cells was independent of T-cell densities but strongly associated with loss of the intestinal homeobox transcription factor CDX2. This explains infrequent PD-L1 expression by cancer cells and may contribute to a higher recurrence risk of MMRd CRCs
Nazarian S, Gkouzionis I, Murphy J, et al., 2024, Real-time classification of tumour and non-tumour tissue in colorectal cancer using diffuse reflectance spectroscopy and neural networks to aid margin assessment, International Journal of Surgery, ISSN: 1743-9159
Background: Colorectal cancer is the third most commonly diagnosed malignancy and the second leading cause of mortality worldwide. A positive resection margin following surgery for colorectal cancer is linked with higher rates of local recurrence and poorer survival. We investigated diffuse reflectance spectroscopy (DRS) to distinguish tumour and non-tumour tissue in ex vivo colorectal specimens, to aid margin assessment and provide augmented visual maps to the surgeon in real-time.Methods: Patients undergoing elective colorectal cancer resection surgery at a London-based hospital were prospectively recruited. A hand-held DRS probe was used on the surface of freshly resected ex vivo colorectal tissue. Spectral data was acquired for tumour and non-tumour tissue. Binary classification was achieved using conventional machine learning classifiers and a convolutional neural network (CNN), which were evaluated in terms of sensitivity, specificity, accuracy and the area under the curve.Results: A total of 7692 mean spectra were obtained for tumour and non-tumour colorectal tissue. The CNN-based classifier was the best performing machine learning algorithm, when compared to contrastive approaches, for differentiating tumour and non-tumour colorectal tissue, with an overall diagnostic accuracy of 90.8% and area under the curve of 96.8%. Live on-screen classification of tissue type was achieved using a graduated colourmap.Conclusion: A high diagnostic accuracy for a DRS probe and tracking system to differentiate ex vivo tumour and non-tumour colorectal tissue in real-time with on-screen visual feedback was highlighted by this study. Further in vivo studies are needed to ensure integration into a surgical workflow.
Kyle P, Perry K, Moutadjer A, et al., 2023, UK trial of pressurised intraperitoneal aerosolised chemotherapy (PIPAC) with oxaliplatin for colorectal cancer peritoneal metastases (NCT03868228), PLEURA AND PERITONEUM, ISSN: 2364-7671
Murphy J, Donato-Brown D, Efeotor O, et al., 2023, A prospective case series assessing the Imperial College London intraoperative radiotherapy protocol for advanced rectal cancer: an IDEAL phase 2a study, COLORECTAL DISEASE, ISSN: 1462-8910
West R, Soo CP, Murphy J, et al., 2023, A protocol for a pilot study to assess the feasibility of a randomised clinical trial of perioperative intravenous lidocaine on colorectal cancer outcome after surgery (FLICOR trial)., BJA Open, Vol: 6
BACKGROUND: Cancer recurrence after curative cancer surgery significantly impacts patients and healthcare services. Before surgery, a small number of clinically undetectable circulating tumour cells are often present. The surgical stress response promotes the distribution and proliferation of circulating tumour cells leading to cancer recurrence and metastasis. Preclinical evidence suggests that lidocaine may exert 'anti-cancer' effects and alleviate pro-metastatic environments. The Feasibility Study of Lidocaine Infusion During Bowel Cancer Surgery for Cancer Outcome (FLICOR) will assess the feasibility of conducting a clinical trial on perioperative intravenous lidocaine infusion for postoperative colorectal cancer outcomes. METHODS: The study is a double-blinded, randomised, controlled pilot study for a full trial comparing intravenous lidocaine administration at 1.5 mg kg-1 bolus followed by 1.5 mg kg-1 h-1 infusion for 24 h with placebo in patients undergoing minimally invasive (laparoscopy or robotic) colorectal cancer surgery. The feasibility of data collection instruments will be measured, including those for future economic evaluation and clinical and patient-reported outcomes. For the exploratory outcomes, blood samples will be collected before and after surgery on days 0, 1, and 3. Recruitment is planned for two NHS Trusts over 6 months with a 12-month follow-up. Patients and clinicians will be asked for their feedback on the study process. DISSEMINATION PLAN: Study data will be disseminated to trial participants, the public, and academic communities. The work will be presented at national and international conferences to stimulate interest and enthusiasm for centres to participate in the future definitive trial. This research will also be published in peer-reviewed open-access journals. CLINICAL TRIAL REGISTRATION: ISRCTN29594895 (ISRCTN), NCT05250791 (ClinicalTrials.gov). PROTOCOL VERSION NUMBER AND DATE: 3.0, February 8, 2023.
Menon K, Vijayashanker A, Murphy J, et al., 2023, Liver transplantation for isolated unresectable colorectal liver metastases- Protocol for a service evaluation in the United Kingdom- UKCoMET study, HPB, Vol: 25, Pages: 684-692, ISSN: 1365-182X
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Murphy J, Prasad R, Menon K, 2023, United Kingdom criteria for liver transplantation in the setting of isolated unresectable colorectal liver metastases, COLORECTAL DISEASE, Vol: 25, Pages: 489-494, ISSN: 1462-8910
Baggaley AE, Lafaurie GBRC, Tate SJ, et al., 2023, Pressurized intraperitoneal aerosol chemotherapy (PIPAC): updated systematic review using the IDEAL framework, British Journal of Surgery, Vol: 110, Pages: 10-18, ISSN: 0007-1323
Sahid S, Daurka J, Gibbs R, et al., 2022, O094 Novel technique and cohort study: Stoppa approach to sciatic notch clearance in locally advanced/recurrent pelvic cancer pelvic cancer, Annual Scientific Meeting of the Surgical-Research-Society, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323
Sgarbura O, Eveno C, Alyami M, et al., 2022, Consensus statement for treatment protocols in pressurized intraperitoneal aerosol chemotherapy (PIPAC), PLEURA AND PERITONEUM, Vol: 7, Pages: 1-7, ISSN: 2364-7671
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- Citations: 5
Gujjuri R, Kawka M, Murphy J, 2022, 31Quality or Quantity? An Analysis of the Colorectal Cancer Resection Volume-Outcome Relationship From the 2019 National Bowel Cancer Audit Data, ASiT Surgical Innovation Summit - Future Surgery Show, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323
Leo CA, Thomas GP, Hodgkinson JD, et al., 2021, Randomized Pilot Study: Anal Inserts Versus Percutaneous Tibial Nerve Stimulation in Patients With Fecal Incontinence, DISEASES OF THE COLON & RECTUM, Vol: 64, Pages: 466-474, ISSN: 0012-3706
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- Citations: 3
Leo CA, Leeuwenburgh M, Orlando A, et al., 2020, Initial experience with SphinKeeper™ intersphincteric implants for faecal incontinence in the UK: a two-centre retrospective clinical audit, COLORECTAL DISEASE, Vol: 22, Pages: 2161-2169, ISSN: 1462-8910
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- Citations: 8
Leo CA, Thomas GP, Bradshaw E, et al., 2020, Long-term outcome of sacral nerve stimulation for faecal incontinence, COLORECTAL DISEASE, Vol: 22, Pages: 2191-2198, ISSN: 1462-8910
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- Citations: 4
Leo CA, Cavazzoni E, Leeuwenburgh MMN, et al., 2020, Comparison between high-resolution water-perfused anorectal manometry and THD(R)Anopress anal manometry: a prospective observational study, Colorectal Disease, Vol: 22, Pages: 923-930, ISSN: 1462-8910
AimAnorectal physiology tests provide a functional assessment of the anal canal. The aim of this study was to compare the results generated by standard high‐resolution water‐perfused manometry (WPM) with the newer THD® Anopress manometry system.MethodThis was a prospective observational study. Conventional manometry was carried out using a water‐perfused catheter with high‐resolution manometry and compared with the Anopress system with air‐filled catheters. All patients underwent the two procedures successively in a randomized order. Time to arrive at the resting pressure plateau, resting, squeeze, straining pressure and visual analogue scale (VAS) scores for pain were recorded. A qualitative analysis of the two devices was performed.ResultsBetween 2016 and 2017, 60 patients were recruited. The time from insertion of the catheter to arriving at the resting pressure plateau was significantly lower with the Anopress compared with WPM: 12 s [interquartile range (IQR) 10–17 s] versus 100 s (IQR 67–121 s) (P < 0.001). A strong correlation between the manometric values of WPM and the Anopress was observed. Both procedures were well tolerated, although the VAS score for insertion of the WPM catheter was significantly higher. The Anopress was easier to use and more time‐efficient than the WPM.ConclusionThe pressure values obtained with Anopress correlated well with those of conventional manometry. The Anopress has the advantage of being less time‐consuming, user‐friendly and better tolerated by patients.
Palaniappan V, Noble E, Qi J, et al., 2020, Optical Polarization-resolved Imaging of Human Colon Cancer Tissue, London Surgery Symposium
Vallance AE, Harji D, Fearnhead NS, et al., 2019, Making an IMPACT: A priority setting consultation exercise to improve outcomes in patients with locally advanced, recurrent and metastatic colorectal cancer, European Journal of Surgical Oncology, ISSN: 0748-7983
Leo CA, Thomas GP, Hogkinson JD, et al., 2019, The Renew® Anal Insert for Passive Faecal Incontinence: a retrospective audit of our use of a novel device., Colorectal Dis
INTRODUCTION: The Renew® Anal Insert is a recent treatment for patients who suffer from passive faecal incontinence (FI). The aim was to assess the effectiveness of the insert and patient satisfaction. METHOD: A retrospective audit of patients who were treated with the Renew® Anal Insert was undertaken. The St Mark's Incontinence Score was used to evaluate clinical outcome. Renew® size, the number of inserts used per day and per week had also been recorded. Subjective assessment of symptoms, how beneficial Renew® was and how satisfied patients were with the device were all recorded. Major events and side effects were also noted. RESULTS: Thirty patients received Renew® as a treatment for passive incontinence in 2016. The median St Mark's FI score was 15 (range 7-18) at baseline and 10 (range 2-18) at first follow-up (p=<0.0001) at a median of 11 (range 8-14) weeks. Eleven (37%) patients used the regular size and 19 (63%) used the large size. Patients used an average of 1.67 inserts/day (range 1 - 3), on an average of 3.58 days/week (1 - 7). Three patients reported a deterioration in symptoms, seven (23%) no change and twenty (67%) a significant improvement. Six patients (20%) did not like this device while 24 (80%) liked them. Seventeen patients (57%) wanted to continue this treatment in long-term. CONCLUSION: The Renew device seems to be an acceptable and effective therapeutic option for passive FI. Further work is needed to compare it to other treatments and establish its position in the treatment pathway. This article is protected by copyright. All rights reserved.
Thomas HS, Weiser TG, Drake TM, et al., 2019, Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy, British Journal of Surgery, Vol: 106, Pages: E103-E112, ISSN: 1365-2168
Background: The World Health Organization (WHO) Surgical Safety Checklist has fostered safepractice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aimof this study was to evaluate reported checklist use in emergency settings and examine the relationshipwith perioperative mortality in patients who had emergency laparotomy.Methods: In two multinational cohort studies, adults undergoing emergency laparotomy were comparedwith those having elective gastrointestinal surgery. Relationships between reported checklist use andmortality were determined using multivariable logistic regression and bootstrapped simulation.Results: Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. Afteradjusting for patient and disease factors, checklist use before emergency laparotomy was more commonin countries with a high Human Development Index (HDI) (2455 of 2741, 89⋅6 per cent) comparedwith that in countries with a middle (753 of 1242, 60⋅6 per cent; odds ratio (OR) 0⋅17, 95 per cent c.i. 0⋅14to 0⋅21, P < 0⋅001) or low (363 of 860, 42⋅2 per cent; OR 0⋅08, 0⋅07 to 0⋅10, P < 0⋅001) HDI. Checklistuse was less common in elective surgery than for emergency laparotomy in high-HDI countries (riskdifference −9⋅4 (95 per cent c.i. −11⋅9 to −6⋅9) per cent; P < 0⋅001), but the relationship was reversed inlow-HDI countries (+12⋅1 (+7⋅0 to +17⋅3) per cent; P < 0⋅001). In multivariable models, checklist use wasassociated with a lower 30-day perioperative mortality (OR 0⋅60, 0⋅50 to 0⋅73; P < 0⋅001). The greatestabsolute benefit was seen for emergency surgery in low- and middle-HDI countries.Conclusion: Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.
Waldock WJ, Avila-Rencoret FB, Tincknell LG, et al., 2018, Augmented intraoperative surgical vision for the assessment of gastrointestinal cancer resection margins, 21st Annual Meeting of the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS), Publisher: Wiley, Pages: 15-16, ISSN: 1365-2168
Leo CA, Cavazzoni E, Thomas GP, et al., 2018, Evaluation of 153 Asymptomatic Subjects Using the Anopress Portable Anal Manometry Device, JOURNAL OF NEUROGASTROENTEROLOGY AND MOTILITY, Vol: 24, Pages: 431-436, ISSN: 2093-0879
Background/Aims The Anopress device is a new portable manometry system. The aim of this study is to formulate normative data using this new device by recording the anorectal function of asymptomatic subjects. Patient comfort was also assessed. Methods Anorectal function was assessed in asymptomatic volunteers using the Anopress. All volunteers were examined in a standardized way in accordance with the study protocol. Normative values for the Anopress were obtained from the recorded data and patient comfort was assessed using a visual analogue scale. Results We recruited 153 healthy volunteers. Eighty were female (23 parous; median age 39.5 [interquartile range {IQR}, 28.75–53.00]) and 73 were male (median age 40.5 [IQR, 29.00–52.25]). For the female cohort, the following normal range (2.5–97.5 percentile) values were recorded across the whole anal canal: resting pressure 40.0–103.0 mmHg; squeeze increment 35.0–140.6 mmHg; endurance 1.3–9.0 seconds; involuntary squeeze 41.1–120.8 mmHg; and strain pressure 22.1–77.9 mmHg. Similarly, the following male normal range (2.5–97.5 percentile) values were recorded across the whole anal canal: resting pressure 38.3–99.6 mmHg; squeeze increment 42.5–154.8 mmHg; involuntary squeeze 40.0–123.6 mmHg; endurance 2.0–10.0 seconds; and strain pressure 11.0–72.1 mmHg. The median visual analogue scale scores for discomfort during the measurement was 0.0 (IQR, 0.00–0.00). Conclusions Normative values for the Anopress device have been calculated by this study. The Anopress appears to be a safe and well tolerated way of measuring pressures from the entire anal canal. Further comparisons with other standard and commonly used manometry tests are, however, required to verify its reliability.
Iqbal F, van der Ploeg V, Adaba F, et al., 2018, Patient-Reported Outcome After Ostomy Surgery for Chronic Constipation, JOURNAL OF WOUND OSTOMY AND CONTINENCE NURSING, Vol: 45, Pages: 319-325, ISSN: 1071-5754
Renshaw S, Silva IL, Hotouras A, et al., 2018, Perioperative outcomes and adverse events of robotic colorectal resections for inflammatory bowel disease: a systematic literature review, TECHNIQUES IN COLOPROCTOLOGY, Vol: 22, Pages: 161-177, ISSN: 1123-6337
The purpose of this study was to assess outcome measures and cost-effectiveness of robotic colorectal resections in adult patients with inflammatory bowel disease. The Cochrane Library, PubMed/Medline and Embase databases were reviewed, using the text “robotic(s)” AND (“inflammatory bowel disease” OR “Crohn’s” OR “Ulcerative Colitis”). Two investigators screened abstracts for eligibility. All English language full-text articles were reviewed for specified outcomes. Data were pre-sented in a summarised and aggregate form, since the lack of higher-level evidence studies precluded meta-analysis. Primary outcomes included mortality and postoperative complications. Secondary outcomes included readmission rate, length of stay, conversion rate, procedure time, estimated blood loss and functional outcome. The tertiary outcome was cost-effectiveness. Eight studies (3 case-matched observational studies, 4 case series and 1 case report) met the inclusion criteria. There was no reported mortality. Overall, complications occurred in 81 patients (54%) including 30 (20%) Clavien-Dindo III–IV complica-tions. Mean length of stay was 8.6 days. Eleven cases (7.3%) were converted to open. The mean robotic operating time was 99 min out of a mean total operating time of 298.6 min. Thirty-two patients (24.7%) were readmitted. Functional outcomes were comparable among robotic, laparoscopic and open approaches. Case-matched observational studies comparing robotic to laparoscopic surgery revealed a significantly longer procedure time; however, conversion, complication, length of stay and readmission rates were similar. The case-matched observational study comparing robotic to open surgery also revealed a longer procedure time and a higher readmission rate; postoperative complication rates and length of stay were similar. No studies compared cost-effectiveness between robotic and traditional approaches. Although robotic resections fo
Elson D, Tincknell L, Avila Rencoret F, et al., 2018, Intraoperative hyperspectral circumferential resection margin assessment for gastrointestinal cancer surgery (second prize), Career in Surgery
Waldock W, Avila Rencoret F, Tincknell L, et al., 2018, Augmented intraoperative surgical vision for the assessment of gastrointestinal cancer resection margins, London Surgery Symposium
de Bruijn H, Maeda Y, Murphy J, et al., 2018, Combined Laparoscopic and Perineal Approach to Omental Interposition Repair of Complex Rectovaginal Fistula, Diseases of the Colon and Rectum, Vol: 61, Pages: 140-143, ISSN: 0012-3706
INTRODUCTION:Surgical repair of rectovaginal fistula remains a challenge. Complex and recurrent rectovaginal fistula repairs often fail because of scarring and devascularization of the surrounding tissue. Omental interposition may promote healing by introducing bulky vascularized tissue into the rectovaginal septum.TECHNIQUE:With the patient in the lithotomy position, the rectovaginal septum was dissected transperineally up to the fistula tract and the openings on both vaginal and rectal sides were closed using interrupted, absorbable sutures. The dissection was continued cranially to meet the laparoscopic dissection from above. The laparoscopic surgeon detached the omentum from the colon, then the anastomotic arterial branches between the Barlow’s arcade and the gastroepiploic arcade were divided and the greater omentum was mobilized, retaining blood supply from the left gastroepiploic artery. The rectum was then mobilized commencing on the right lateral side of the mesorectum and then proceeding anteriorly. The peritoneum between the rectum and the vagina was incised and the anterior mobilization was continued to connect with the perineal dissection. The mobilized omentum was pulled down between the rectum and the vagina.TECHNIQUE:The perineal operator secured the omentum around the rectal closure and at skin level with absorbable sutures. All of the patients had a defunctioning ileostomy or colostomy before omental repair.RESULTS:Patients underwent repair for complex or recurrent rectovaginal fistulas with this novel approach. Fistula healing was evaluated during examination under anaesthesia. All of the patients had completely healed at the latest follow-up (median = 15 mo; range, 8–41 mo). Postoperative complications included 1 superficial wound infection that was treated conservatively and 1 rectovaginal hematoma, which required CT-guided aspiration.CONCLUSIONS:Combined laparoscopic omental interposition with perineal rectovaginal fistula repair is
Murphy J, 2018, Clinical Features of Colorectal Cancer, Surgery of Anus Rectum and Colon, Editors: Post, Keighley
Leo CA, Murphy J, Hodgkinson JD, et al., 2018, Does the Internet provide patients or clinicians with useful information regarding faecal incontinence? An observational study., G Chir, Vol: 39, Pages: 71-76, ISSN: 0391-9005
BACKGROUND: The Internet has become an important platform for information communication. This study aim to investigate the utility of social media and search engines to disseminate faecal incontinence information. METHODS: We looked into Social media platforms and search engines. There was not a direct patient recruitment and any available information from patients was already on public domain at the time of search. A quantitative analysis of types and volumes of information regarding faecal incontinence was made. RESULTS: Twelve valid pages were identified on Facebook: 5 (41%) pages were advertising commercial incontinence products, 4 (33%) pages were dedicated to patients support groups and 3 (25%) pages provided healthcare information. Also we found 192 Facebook posts. On Twitter, 2890 tweets were found of which 51% tweets provided healthcare information; 675 (45%) were sent by healthcare professionals to patients, 530 tweets (35.3%) were between healthcare professionals, 201 tweets (13.4%) were from medical journals or scientific books and 103 tweets (7%) were from hospitals or clinics with information about events and meetings. The second commonest type of tweets was advertising commercial incontinence products 27%. Patients tweeted to exchange information and advice between themselves (20.5%). In contrast, search engines as Google/Yahoo/Bing had a higher proportion of healthcare information (over 70%). CONCLUSION: Internet appears to have potential to be a useful platform for patients to learn about faecal incontinence and share information; however, given one lack of focus of available data, patients may struggle to identify valid and useful information.
Silva IL, Iskandarani M, Hotouras A, et al., 2017, A systematic review to assess the management of patients with cerebral metastases secondary to colorectal cancer, TECHNIQUES IN COLOPROCTOLOGY, Vol: 21, Pages: 847-852, ISSN: 1123-6337
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- Citations: 12
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