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Spolverato G, Bao QR, Delrio P, Guerrieri M, Ortenzi M, Cillara N, Restivo A, Deidda S, Spinelli A, Romano C, Bianco F, Sarzo G, Morpurgo E, Belluco C, Palazzari E, Chiloiro G, Meldolesi E, Coco C, Pafundi DP, Feleppa C, Aschele C, Bonomo M, Muratore A, Mellano A, Chiaulon G, Crimì F, Maretto I, Perin A, Urso EDL, Scarpa M, Bigon M, Scognamiglio F, Bergamo F, Del Bianco P, Gambacorta MA, Rega D, Pucciarelli S. Rectal Sparing Approach after preoperative Radio- and/or Chemo-therapy (ReSARCh): a prospective, multicenter, observational study. Int J Surg 2024; 110:4736-4745. [PMID: 38518084 PMCID: PMC11326028 DOI: 10.1097/js9.0000000000001322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/03/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Rectal-sparing approaches for patients with rectal cancer who achieved a complete or major response following neoadjuvant therapy constitute a paradigm of a potential shift in the management of patients with rectal cancer; however, their role remains controversial. The aim of this study was to investigate the feasibility of rectal-sparing approaches to preserve the rectum without impairing the outcomes. METHODS This prospective, multicenter, observational study investigated the outcomes of patients with clinical stage II-III mid-low rectal adenocarcinoma treated with any neoadjuvant therapy, and either transanal local excision or watch-and-wait approach, based on tumor response (major or complete) and patient/surgeon choice. The primary endpoint of the study was rectum preservation at a minimum follow-up of 2 years. Secondary endpoints were overall, disease-free, local and distant recurrence-free, and stoma-free survival at 3 years. RESULTS Of the 178 patients enrolled in 16 centers, 112 (62.9%) were managed with local excision and 66 (37.1%) with watch-and-wait. At a median (interquartile range) follow-up of 36.1 (30.6-45.6) months, the rectum was preserved in 144 (80.9%) patients. The 3-year rectum-sparing, overall survival, disease-free survival, local recurrence-free survival, and distant recurrence-free survival was 80.6% (95% CI 73.9-85.8), 97.6% (95% CI 93.6-99.1), 90.0% (95% CI 84.3-93.7), 94.7% (95% CI 90.1-97.2), and 94.6% (95% CI 89.9-97.2), respectively. The 3-year stoma-free survival was 95.0% (95% CI 89.5-97.6). The 3-year regrowth-free survival in the watch-and-wait group was 71.8% (95% CI 59.9-81.2). CONCLUSIONS In rectal cancer patients with major or complete clinical response after neoadjuvant therapy, the rectum can be preserved in about 80% of cases, without compromising the outcomes.
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Bao QR, Ferrari S, Capelli G, Chiloiro G, Rega D, Pucciarelli S, Spolverato G. Oncological outcomes of patients not undergoing Total Mesorectal Excision after local excision: rethinking surgical indications. Br J Surg 2024; 111:znae144. [PMID: 38884201 DOI: 10.1093/bjs/znae144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 06/18/2024]
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Filotico M, Ambrosio L, Rega D, Maniscalco M, Pace U, Delrio P. Incidental diagnosis and intra-operative treatment of left paraduodenal hernia in a patient undergoing ultra-low rectal anterior resection-a video vignette. Colorectal Dis 2024; 26:1318-1319. [PMID: 38581084 DOI: 10.1111/codi.16974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/08/2024] [Indexed: 04/08/2024]
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Coco C, Delrio P, Rega D, Amodio LE, Pucciarelli S, Spolverato G, Belluco C, Lauretta A, Poggioli G, Rocco G, Bianco F, Marsanic P, Sica G, Tondolo V, Rizzo G. Completion total mesorectal excision after neoadjuvant radiochemotherapy and local excision for rectal cancer. Colorectal Dis 2024; 26:281-289. [PMID: 38131642 DOI: 10.1111/codi.16834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/10/2023] [Accepted: 11/18/2023] [Indexed: 12/23/2023]
Abstract
AIM Local excision (LE) in selected cases after neoadjuvant radiochemotherapy (RCT) for locally advanced rectal cancer in clinically complete or major responders has been recently reported as an alternative to standard radical resection. Completion total mesorectal excision (cTME) is generally performed when high-risk pathological features are found in LE surgical specimens. The aim of this study was to evaluate the incidence of residual tumour and lymph node metastases after cTME in patients previously treated by RCT + LE. The secondary aims were to quantify the rate of postoperative morbidity and mortality and to evaluate the long-term oncological outcome of this group of patients. METHODS All patients treated from 2007 to 2020 by LE for locally advanced rectal cancer with a clinically complete or major response to RCT who had a subsequent cTME for high-risk pathological factors (ypT >1 and/or TRG >2 and/or positive margins) were included in this multicentre retrospective study. Pathological data, postoperative short-term morbidity (classified according to Clavien-Dindo) and mortality and oncological long-term outcome after cTME were recorded in a database. Statistical analysis was performed using Wizard for iOS version 1.9.31. RESULTS A total of 47 patients were included in the study. The rate of R0 resection was 95.7%, and a sphincter-saving procedure was performed in 37 patients (78.7%), with a protective stoma rate of 78.4%. In 28 cases (59.6%), it was possible to perform a minimally invasive approach. A residual tumour (pT and/or pN) on cTME specimens was found in 21 cases (44.7%). The rate of lymph node metastases was 12.8%. The overall short-term (within 30 days) postoperative morbidity was 34%, but grade >2 postoperative complications occurred in only nine patients (19.1%), with a reoperation rate of 6.4%. No short-term postoperative deaths occurred. At a median follow-up of 57 months (range: 21-174), the long-term stoma-free rate was 70.2%, and the actuarial 5-year overall survival (OS), disease-free survival (DFS) and local control (LC) were 86.7%, 88.9% and 95.7%, respectively. CONCLUSION When patients exhibit high-risk pathological factors after RCT + LE, cTME should be suggested due to the high risk of residual tumour or lymph node involvement (44.7%). The results after cTME in terms of the rate of R0 resection, sphincter-saving procedure, postoperative morbidity and mortality and long-term oncological outcome seem to be acceptable and do not represent a contraindication to use LE as a first-step treatment in patients with major or complete clinical response after RCT.
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Avellaneda N, Al Masri M, Baimakhanov A, Balasubramaniam D, Bhangu A, Bouchagier K, Bozbiyik O, Carpelan A, Chwat C, Cunha M, Dawson BE, Mallen MVD, Ellebæk MB, Gonzalez TE, Elshami M, Fakhradiyev I, Ozkan OF, Fleres F, Futaba K, Gallo G, Ghosh D, Glasbey JC, Harrison E, Hooper RL, Jain R, Kamarajah S, Veetil SK, Kamer E, Keatley J, Knowles CH, Kulimbet M, Lal P, Li E, Polamreddy BM, Minaya-Bravo A, Mittal R, Morton DG, Nadal LRM, Negoi I, Nepogodiev D, Omar O, Pata F, Pinkney T, Potter MA, Rottoli M, Santos G, Smith I, Spinelli A, Venn M, Hooper R, Morton D, Bywater E, Evans J, Magill L, McKay S, Bordom DO, Simões J, Venn ML, Adeyeye A, Avellaneda N, Buchs N, Cato L, Finch D, Umar GI, Bravo AM, Junior HM, Neary P, Poskus T, Roslani A, Samadov E, Sbaih M, Shalaby M, Singh B, Sinha A, Vardanyan A, Chaudhry S, Frasson M, Millward J, Sánchez-Guillén L, Schmitz ND, Stijns J, Zimmerman DDE, Beard D, Campbell M, Moug S, Aytac E, Blackwell S, Buchwald P, Chowdhury SM, Dardanov D, Dulskas A, Elhadi M, El-Hussuna A, Garoufalia Z, Aslam MI, Kelly M, Knowles C, Mendes B, Ng S, Pellino G, Sebastian S, Sivrikoz E, Tejedor P, Vaizey C, Bianchi R, Christensen P, Lee SH, Lohsiriwat V, Mantoo SK, Mazlan L, Um JW, Wang JY, Watanabe J, Yao H, Bengueddach A, Tidjane A, Tabeti B, Behilil C, Boudjenan-Serradj N, Bensafir S, Meharzi SEI, Aissat A, Ghouali AK, Larabi K, Riffi O, Kacimi SEO, Mesli SN, Rezoug W, Mitidieri A, José A, Pablo C, Rodriguez CA, Panettiere MF, Barbalace N, Juan T, Lucena J, Houdin A, Fernandez E, Lococo J, Pedro L, Loban M, Vecchio P, Grinblat A, Carrie A, Veracierto F, Santillan M, Napolitano M, Rosa SL, Gonzalez CM, Ferro E, Muñoz JP, Ventorutti T, Cabrera C, Carrizo C, Mospane C, Leiro F, Espino J, Trama M, Potolicchio A, Dindri F, Buey L, Lucas N, Catalano P, Astilleta R, Quiroga Y, Valli D, Alexandre F, Martres G, Rosato G, Lemme G, Romero V, Doniquian AM, Pachajoa DAP, Llahi F, Fiorenza JM, Parodi M, Ocaña N, Gallardo A, Valenzuela A, Perriello J, Nador R, Fermani C, Garay L, Blanco P, Villalobos S, Posner F, Vieyra N, Fiorito P, Ciabattari P, de Kort C, Daryanani D, Smit J, Gosselink MP, Janssen N, Feiss A, Lee CHA, Taylor D, Edington J, Chen N, Ong WM, Aigner F, Moitzi G, Gemes G, Braumille M, Mitteregger M, Gerald S, Uranitsch S, Belarmino A, Waha J, Kahn J, Treiber M, Schemmer P, Mikalauskas S, Ibrahimli A, Orujova E, Namazov I, Alikhanli J, Asgarov M, Kutkut A, Almahmeed E, Aljawder H, Juma I, Johnston K, Saeed MF, Khairi S, Matovic E, Omerasevic M, Delibegovic S, Hodzic S, Rudell AG, Fuzari J, Farah JF, Dos Santos MBA, Lupinacci RA, Pereira TS, da Silveira Sete A, Filho AL, de Souza Pires BL, de Queiroz FL, Amaral HAT, Dos Santos MAM, de Miranda Silvestre SC, Hanan B, Reis C, Cassia G, da Luz M, Delgado M, Campanati R, Silva R, Bomfa-Barbosa A, Alves BC, Costa BXM, Cortes BGW, Lemos FHT, Arreguy-Borges K, Silva TB, Assis A, Freitas AH, Rezende D, Silva H, Alvarenga I, Cascais R, Silva T, Pinto H, Silva I, Leite L, Massahud M, Meyer M, Tibúrcio R, Martinez CAR, Espinha DR, Marson FAL, de Oliveira Góes IA, de Souza Artioli LM, Boschiero MN, Takahashi CY, de Oliveira FG, Junior HFL, de Oliveira JCC, Dos Santos JM, Gerber MT, Erdmann TR, Barbosa A, Fernandes A, Júnior AN, Júnior HM, Moreira J, Ribeiro M, Moreira P, Carvalho A, Santos B, Fidelis F, Cruz I, Codes L, Aibe R, Boudoux S, Favacho BC, Pinto F, Gava G, Pivati IR, Vilain LF, Kim N, Nunes RL, Dimitrov D, Peneva K, Karamanliev M, Dimitrova S, Ivanov T, Atanasov B, Dzharov G, Shtereva M, Slavchev M, Belev N, Krastev P, Arabadzhiev A, Tonova D, Tzoneva D, Sokolov M, Gribnev P, Maslyankov S, Pavlov V, Bakmaz B, Dijan E, Ćoza I, Mihanovic J, Kučić J, Sulen N, Katušić Z, Hudáček K, Farkašová M, Marková M, Grolich T, Kala Z, Pazdírek F, Hoch J, Filipová L, Kocián P, Přikryl P, Høgn A, Møller B, Slot DK, Bælum JK, Cour KL, Eriksen ND, Mahmoud A, Abdellatif A, Nafea A, Ewedah M, Soliman M, Yakout N, Argawy O, Sallam I, Kamel I, Sherif M, Ashmawy S, Ali A, Saad M, Ahmed M, Mohamed M, Mohamed N, Mahmoud S, Mahmoud S, Rashed AM, Abd-Errazik MA, Ammar MA, Mohammed R, Ebrahem A, Abd El Aal A, Abdou K, Wagdy M, Qassem M, Taha M, El-Wafa YA, Shehta A, El Metwally A, Hamed H, Ali MA, Elrefai M, El Sorogy M, Abdelkhalek M, Ragab A, Refky B, Metwally IH, Abdelkhalek M, Kamal M, Zuhdy M, Shetiwy M, Sakr A, Elfallal A, Elfeki H, Eldakroury I, Elbahrawy K, Mostafa M, Emile S, Tessema A, Tasew A, Gezahegn H, Bekele K, Belay M, Gudisa Z, Teferu Z, Väyrynen A, Kechagias A, Turunen A, Katunin J, Parhiala M, Pengerma P, Lahti P, Vihervaara H, Huhtinen H, Pasonen J, Heino R, Pakarinen S, Falenius V, Pinard B, Nobile C, Duchalais E, Drissi F, Meurette G, Podevin J, Lepenndu M, Hoetzel A, Jud A, Jauch D, Stefan FF, Neeff H, Holzner P, Nguyen P, Ryl A, Kehl F, Pullig F, Baral J, Münch S, Fütterer C, Reißfelder C, Sandra-Petrescu F, Herrle F, Hardt J, Lamm L, Seyfried S, Gharbi A, Aydin F, Stavrou G, Sperber J, de Deken J, Schwarzkopf K, Widyaningsih R, Polidorou A, Mpakas A, Tokidis E, Loun L, Petropoulou T, Balalis D, Korkolis D, Manatakis D, Assimakopoulou E, Bourazani M, Gklavas A, Kalamara E, Papaconstantinou I, Theodoraki K, Chardalias L, Konstadoulakis M, Theodosopoulos T, Soulioti E, Kavezou F, Filippou J, Papadoliopoulou M, Michalopoulos N, Vassiliu P, Sidiropoulos T, Charakopoulou A, Panagiotou A, Kokkinakis K, Lambridi E, Psarologos M, Maria S, Giannaraki S, Kapiris S, Triantafyllou A, Theodoropoulos C, Matthaiou G, Westzaan N, Etelka S, Triantafyllou T, Theodoropoulos G, Schizas D, Mpaili E, Karydakis L, Mpoura M, Danassi D, Karavokyros I, Dimitriou N, Livanou X, Kikira A, Tsourouflis G, Tomara NK, Nikiteas N, Dorovinis P, Tsiotos G, Stamou K, Kocka N, Ballian N, Kalakonas S, Athanasakis E, Chrysos E, Xynos E, Tsiaoussis J, Papadaki K, Xenaki S, Nyktari V, Sarakatsianou C, Bompou E, Arnaoutoglou E, Tzovaras G, Baloyiannis I, Mamaloudis I, Perivoliotis K, Apostolidi E, Mulita F, Karpetas G, Maroulis I, Vailas M, Petra A, Kontis E, Kaouras E, Katsaros I, Katsiaras L, Manikis P, Papadopoulou T, Papadopoulos A, Manioti E, Zeringa G, Katsinelis I, Mouzakis O, Kouki P, Nikolaou V, Marinis A, Alexopoulou K, Papadaki M, Vederaki SA, Samara A, Giakoustidis D, Christodoulidis G, Bareka M, Chatzikomnitsa P, Tsigara S, Papadopoulos V, Zarzava E, Anestiadou E, Lydia L, Apostolakidou M, Ioannidis O, Simeonidis S, Mpitsianis S, Tam PTH, Ng SSM, Lau VNM, Tse WK, Bánky B, Dolhai E, Horváth É, Golub J, Marton J, Lakatos L, Suszták N, Maurya AP, Kumawat H, Saxena P, Lather R, Waindeskar V, Khanduri A, Goyal L, Gupta R, Singh S, Saksena AR, Rayani BK, Kasula J, Raju K, Shah MM, Thammineedi SR, Patnaik SC, Rathod D, Poonia DR, Vishnoi JR, Sharma N, Byshetty R, Yadav RK, Misra S, Dhali A, Dhali GK, Biswas J, Ray S, Ghose T, Pipara A, Singh HM, Roy MK, Desai N, Thambudorai R, Ishwarappagol V, Chaturvedi A, Verma D, Akhtar N, Gupta S, Rajan S, Tiwari T, Kumar V, Mahajan A, Jain D, Liddle D, Jyoti J, Haque PD, Prem W, Lakshminarayana B, S BV, Poojary PH, Bhat RRK, Mathew S, Gupta L, Bains L, Kumar M, Singh N, Sharma A, Kumar A, Garg L, Aggarwal M, Jakhar R, Kumar A, Bose B, Huda F, Thakur N, Dhar P, Seenivasagam RK, Prakash S, Chaudhari A, Shukla A, Mahakalkar C, Saxena G, Mahuli K, Kaple M, Kshirsagar S, Mehraj A, Parray F, Aziz G, Chowdri N, Wani R, Gurcoo S, Shah Z, Madhavan S, Subbarayan S, Vino S, Aravindan U, George G, Ck H, Yadev IP, Chisthi M, Ps R, Sreekumar RC, Vijayan V, Theodore B, Victor C, Jesudason MR, Arulappan N, Philip R, Durai S, Creavin B, Cullinane C, Davis C, Flynn C, Liam D, Cooke F, Earley H, Peter M, Hamilton V, Trani AD, Conversano I, Cianci P, Petta R, Picciariello A, Altomare DF, Martines G, Grasso S, Moffa S, Papagni V, Zanoni A, Belvedere A, Gori A, Romano A, Cuicchi D, Croce GD, Tanzanu M, Cardelli S, Lauro A, Sartarelli L, Binetti M, Cervellera M, Tonini V, Sanna B, Pusceddu E, Runfola M, Manunza R, Pisanu A, Cois A, Frongia F, Esposito G, Podda M, Mura P, Marzella A, Scotto B, Cuneo D, Ascari F, Giulino G, Varoli M, Laquatra N, Fortunato C, Marino F, Perrone F, Pace M, Convertini O, Cutellè C, Ammerata G, Sena G, Pignataro M, Scozzafava M, Mazza M, Bruni A, Curro G, Hila J, Ammendola M, Curcio S, Signorelli V, Marano A, Sasia D, Borghi F, Giuffrida MC, Bonardello M, Palmisano S, Testa V, Porta A, Scaltrini F, Iacob G, Gaspa I, Guatteri L, Coladonato M, Zapparoli A, Pesce A, Feo CV, Pindozzi F, Bigoni I, Torchiaro M, Fabbri N, Cianchi F, Staderini F, Elena F, Coratti F, Barbato G, Fortuna L, Romagnoli S, Bergamini C, Villa G, Cecchini I, Martellucci J, Izzo M, Trafeli M, Scheiterle M, Manoocheehri F, Cagnazzo F, Spampinato MG, Adam N, Depalma N, D'Ugo S, Garritano S, Mazzeo C, Cucinotta E, Melita F, Viscosi F, Biondo SA, Tripodi VF, Foppa C, Greco M, Sacchi M, Carvello M, Deac V, Laurenti V, Frontali A, Zappone A, Cammarata F, Colombo F, Ferrario L, Currà MC, Danelli P, Vignali A, Umberto C, Mastriale F, Riccardo R, Turi S, Elmore U, Galimberti A, Ceretti AP, Vespo D, Opocher E, Longhi M, Mariani NM, Flandoli C, Ciulli C, Vaira G, Ripamonti L, Cigagna L, Oldani M, Tamini N, Palumbo A, Castaldi A, Antropoli C, Rupealta N, Palmiero N, Donatiello V, Novi A, Cappiello A, Bianco F, de Luca M, Incollingo P, Esposito R, Gili S, Aprea G, de Simone G, Palomba G, Capuano M, Basile R, D'Angelo S, Tropeano FP, Luglio G, Pagano G, de Palma GD, Cricrì M, Milone M, Manigrasso M, Anoldo P, Boccia G, Raiano G, Nuzzo MMD, Calabria M, Peltrini R, Castiglioni S, Bracale U, Cervone C, Rega D, Caliendo D, Benetti E, Delrio P, Guarino R, de Franciscis S, Coppolino F, Romano FM, Selvaggi F, Sciaudone G, Selvaggi L, de Stefano M, Resendiz A, Carosso F, Degiuli M, Salusso P, Reddavid R, Benetti S, Callari C, Miceli DD, Pardo D, Sabatino G, Licari L, Lirosi MC, Sorce V, Peri A, Mori A, Pugliese L, Filardo M, Nuccio P, Dominioni T, Massimo C, Giuseppina F, Angelo F, Raffaele G, Michele M, Roberto P, Mondini A, Muratore A, Valentino C, Calabro' M, Danna R, Cremonini C, Sbarbaro C, Tartaglia D, Coccolini F, Chiarugi M, Musetti S, Pagani S, Neri CM, Leoni C, Rossi E, Randisi E, Puccini M, Buccianti P, Balestri R, Vasale A, Crescentini G, Ranieri G, Sinibaldi G, Biondi A, Sanesi AP, Vacca C, Lorenzon L, Sollazzi L, Persiani R, Pezzuto R, Ferroni AF, Stipa F, Volturo L, Moretti M, Tierno SM, Marina S, Mingoli A, Fiori E, Pugliese F, Brachini G, Carta G, Sapienza P, Lapolla P, Mazzotta E, Carannante F, Capolupo GT, Masciana G, Sica I, Caricato M, Antonelli S, Fiume D, Spoletini D, Lisi G, Carlini M, Menduni V, Arturi A, Proietto B, de Lucia C, Baldi C, Passantino DG, Romeo G, Paola MD, Sensi B, Sica G, Siragusa L, Dauri M, Franceschill M, Campanelli M, Bellato V, Porcu A, Garau AGG, Masala ML, Oggianu S, Tedde T, Perra T, Pazzola V, Venezia DF, Roviello F, Giacomini G, Carbone L, Marano L, Verre L, Marano M, Ciccarese AA, Bagnardi F, Shahu J, Siciliano W, Iacomino A, Armellin C, Marson F, Zanus G, Santoro GA, de Paoli M, Grossi U, Sekimoto M, Kobayashi T, Horiguchi A, Koike D, Yonekura H, Kato H, Yoshino K, Arakawa S, Asano Y, Alawneh F, Rajab I, Ramadan M, Masri MA, Qaisi MA, Alsamneh M, Mubaidin O, Al-Jarrah A, Ababneh H, Khdair K, Tawarh T, Sabri W, Arida ZA, Dzhumabekov B, Klyshbayeva D, Ispbayeva K, Nadyrov M, Tanabayeva S, Saliev T, Jumanov A, Aitbaeva A, Arynov A, Nadyrov M, Maulenov N, Dushimova Z, Park EJ, Kim H, Kang J, Baik SH, Song Y, Kwak HD, Kim J, Son JH, Chung JS, Lee H, Baek JH, Nam KH, Lee KC, Lee WS, Jeon Y, Kim CW, Park SE, Son GM, Ahn HM, Lee IY, Kim TK, Pcolkins A, Sivins A, Lobovs D, Ancans G, Kreice I, Budnikova I, Jelovskis I, Emhareb A, Abaidalla A, Hammed A, Khairallah M, Jibreel SS, Mohmmad WAS, Hasan W, Venskutonis D, Daugėla E, Dainius E, Juočas J, Kutkevičius J, Vaitkutė K, Bradulskis S, Macas A, Pauzas H, Jokubauskas M, Lizdenis P, Budrikienė R, Svagzdys S, Saladzinskas Z, Volkoviene G, Makauskiene J, Kuliavas J, Bernotaite V, Danys D, Kontrimaviciute E, Poskus E, Kryzauskas M, Jakubauskas M, Jotautas V, Zakaria AD, Kai MWP, Zainy RHM, Tan SS, Zain WZW, Zakaria Z, Yusoff ZM, Raduan F, Sagap I, Razali NYF, Rahman NA, Kanthan SBC, Nie YC, Azman ZAM, Ang CW, Tang CY, Poh KS, Ng K, Hashim NM, Xavier R, Khong TL, Amir AS, Ali CSC, Yew CK, Henry F, Muniandy J, Baharom S, Eng SCR, Hu FSM, Amin-Tai H, Jabar MF, Satar MHSA, Fathi NQ, Rao PS, Podesta AMC, Cini C, Psaila J, Debono M, Sammut M, Spiteri N, Andrejevic P, Muro AG, Leon BP, Perez JAV, Quiñonez JRA, Vera MTR, Gutierrez VMM, Bobadilla BJ, Martinez CM, de León Rendón JL, Hererro JAV, Cuichan MVY, Baez NF, Prevost PG, Hoyos-Torres A, Ruiz-Muñoz EA, Alvarez-Bautista FE, Ortíz-Méndez G, Zamudio-Bautista JL, Salgado-Nesme N, Vergara-Fernández O, Sanchez-Valdivieso E, Martinez G, Navarrete-Aleman J, Perez-Arellano J, Maldonado-Barron R, Hernandez-Krauss R, Ousadden A, Benjelloun EB, Bzikha I, Ibnmajdoub K, Mazaz K, Marghich O, Touzani S, Benkabbou A, Souadka A, El Ahmadi B, Zaari F, Laamri I, Majbar MA, Mohsine R, Van CB, Seuren D, Gillissen F, Aarts F, Konsten J, Van MH, Schlooz S, Naiqiso A, Merrie A, Varghese C, Pugh F, Bissett I, Wilson K, Mitchell S, Dawson C, Hill C, Wright D, Hubley S, Lin A, Jones D, Siggins L, Fagan P, Wu S, Ekwesianya A, Nwoye C, Agara D, Ejiofor G, Sundaynweke N, Kwentoh N, Ewah R, Aremu A, Ballah A, Ningi A, Ohia E, Mienda I, Aliyu M, Oloko N, Okunlola A, Abiyere H, Bolanle OE, Babatunde O, Fatudimu S, Orewole T, Mba EL, Felix MS, Abdulfatah M, Ibrahim N, Masoro U, Fakoya A, Irabor D, Anyadike F, Ulasi I, Orji M, Afuwape O, Ayandipo O, Aremu I, Adegboye K, Gbadegesin P, Aminu B, Aghadi IK, Makama JG, Joshua S, Kache SA, Sheshe AA, Bala AM, Garzali IU, Abdullahi MMM, Muhammad N, Umar NA, Muhammad S, Okoye A, Emegoakor C, Nwosu C, Egwuonwu OA, Ekwunife O, Amadigwe R, Ojiakor S, Akere A, Okereke C, Olaleye O, Ige O, Olubayo O, Olatiilu T, Idris M, Shehu A, Oluyori D, Nwabuoku E, Ukwubile L, Bashir M, Daniyan M, Rauf H, Ali M, Zakaria M, Hameed M, Amanullah N, Chawla T, Waqar U, Jamal A, Butt A, Kerawala A, Samson S, Dodhy AA, Gill AJ, Malik A, Ali D, Mohsin H, Afzal MF, Batool S, Suleman A, Khalid J, Zafar M, Dilawar M, Janjua MH, Sarwar MZ, Naqi SA, Akbar A, Afzal A, Anwar J, Gondal KM, Shaukat M, Waheed M, Sohail M, Mukhtiar N, Ammar AS, Hussain A, Khan AN, Sarwar A, Khan I, Khattak S, Oqaili B, Saada B, Zatari D, Jubran F, Hamdan F, Emar M, Alawi R, Jacome G, Insturain I, Arauz J, Hurtado M, Beron RI, Castaño R, Cao VHB, Kwiatkowski A, Dobkowski G, Bartosiak K, Walędziak M, Możański M, Zadrożna M, Kowalewski P, Fiedziuk A, Wątroba A, Los A, Sitarska M, Rząca M, Zawadzki M, Czarnecki R, Tavares C, Santos F, Borges F, Real JC, Lima MJ, Carlos S, Pereira V, Pacheco A, Gomes G, Pimenta J, Elisiario L, Jervis M, Gonçalves V, Pedro V, Jordão D, Neves FR, Conceição L, Ângelo MD, Marques P, Saraiva RP, Caroço TV, Windels A, Machado A, Ribeiro C, Velez C, Oliveira J, Melo MR, Lima R, Pires A, Lareiro C, Martins R, Revez T, Martins A, Cardoso D, Alegre I, Estevão P, Andrade D, Gomes DC, Duarte MJ, Custódio P, Nemésio RA, Rodrigues S, Correia A, Domingos H, Herrando I, Azevedo J, Fernandez L, Azevedo P, Vieira P, Torre A, Amado A, Paiva M, Saraiva R, Costa S, Mendes T, Queirós T, Silva A, Faustino A, Freitas A, Mendes J, Amaral L, Quintanilha R, Silva R, Coelho AM, Ribeiro A, Pinto C, Ribeiro N, Reis R, Costa S, Fernandes V, Sanches A, Amorim E, Miguel I, Rachadell J, Sanches M, Oliveira S, Baptista V, Roxo A, Devesa H, Teslyak O, Barradas R, Marques S, Martins S, Pepino S, Silva A, Deus AC, Ferreira A, Marinho D, Sousa D, Martins MJ, Matias N, Pinto A, Correia D, Amado F, Cordeiro L, Morales M, Lamas M, Marçal S, Rodrigues AI, Santos A, Marçal A, Oliveira A, Gomes C, Ferreira C, Marques R, Chitul A, Alexandrescu C, Bezede C, Cristian D, Mandi D, Grama F, Ungureanu R, Stoica B, Diaconescu C, Ciubotaru C, Tanase I, Grintescu I, Negoita VM, Calin C, Simeanu C, Ciotarla DC, Caltea M, Mirica RM, Luca A, Pasca A, Vlad C, Bonci EA, Stefanescu I, Achimas-Cadariu PA, Gata VA, Capusan A, Petrisor C, Dindelegan G, Seicean R, Scurtu R, Bintintan V, Fagarasan V, Ionescu C, Crisan D, Zanc L, Ene-Cocis MV, Muresan MS, Mihalcea SM, Dudric V, Musina AM, Ristescu AI, Roata CE, Moglan M, Dimofte MG, Lunca S, Iacob S, Dychko A, Litvin A, Kapustina A, Provozina A, Anokhin E, Zabiyaka M, Shin A, Djumabayev K, Kuznetsova M, Gordeyev S, Kochkina S, Mamedli Z, Markaryan D, Galliamov E, Semina E, Agapov M, Malahov P, Garmanova T, Kakotkin V, Zaycev A, Sumbaev A, Bedzhanyan A, Orman E, Petrenko K, Bredikhin M, Frolova Y, Tulina I, Bashilkina O, Tsarkov P, Rodimov S, Stamov V, Balaban V, Alexnder A, Yanishev A, Rogozhev D, Yakunina N, Chubukova N, Nugmanov R, Karachun A, Petrov A, Domanskiy A, Panaiotti L, Smolina M, Sapronova T, Pelipas Y, Zagaynov E, Khrykov G, Davidovskaja L, Burlov N, Mankevich N, Tverdohlebova T, Bogatikov A, Lodygin AV, Krasnoselsky C, Vasiukova ES, Kopteyev NR, Ovchinnikov T, Kashchenko VA, Novikova A, Terentyeva E, Kuleshov O, Pavlov R, Koshel A, Kostromitsky D, Drozdov E, Klokov S, Camacho A, Khan FN, Bandar MA, Shamim R, Chowdhury S, Kovacevic B, Krdzic I, Zdravkovic M, Kenic M, Milentijevic M, Petkovic N, Radulovic R, Ngu J, Teo NZ, Singh PA, Ong SY, Li S, en Siew B, Chee C, Koh JJM, Lee KY, Tan KK, Wong SC, Loh W, Pujol AF, Rubio JC, Farrés LP, Vendrell LL, Del Olmo MIU, Pedregosa AB, Galmes C, Luckute D, Casanova D, Artigot M, Guedes X, Olivella Y, Sarda MS, Toscano MJ, Damieta MP, Pera M, Gonçalvez SA, Galvez ST, Ruiz SS, Espin-Basany E, Marinello F, Villarino-Villa L, Heras MVL, Martin-Sanchez R, Mata RM, Blanco-Colino R, Otero A, de Lacy AM, Sanahuja JM, Bravo R, Ferraz T, Gonzabay V, Gonzalez F, Menendez P, Del Castillo VCG, Lopez-Pelaez VM, Silva ÁS, Lillo-García C, Tauler EM, Manresa MCE, Pérez SL, Llopis SQ, Rubio AV, Castillo ER, Miramón FJJ, Rodriguez JLR, Rizo-Lamberti LA, Garrido PG, Carneros VJ, Alfonso BA, Sierra BG, Amador CG, Gomendio MDP, Palomino MVR, de La Plaza Llamas R, Cafranga EG, Ramos JLE, Estudillo MC, Pérez RE, Pernas RM, de Lebrusant Fernández S, Bautista WMS, Llamazares AL, Valbuena AL, Moran LA, Alvarez LJ, Raposo LG, Ceron SF, Calvo AC, Valcárcel CR, Peña JP, Gómez LMJ, Díez MC, Lindenbaum PD, Mata SK, Ruiz-De-La-Hermosa A, Abad-Motos A, Toribio-Combarro B, Ripollés-Melchor J, Fuenmayor-Valera ML, Ortega-Domene P, Loscos A, Del Pueblo CS, Dziakova J, Mugüerza JM, Carlin PS, Anula R, Mouvet Y, Forero-Torres A, Andrés BDS, Marcos CM, Rubio I, Pascual I, Yague J, Alcolea NG, Alonso A, Diéguez B, Ibañez I, Pérez JL, Losada M, García-Conde M, Hernández M, Blazquez-Martin A, Vera-Mansilla C, Mendoza-Moreno F, Hernandez-Salvan J, Diez-Alonso M, Hernandez-Juara P, Barrena-Blazquez S, Minaya-Bravo AM, Galván-Pérez A, Miguel-Méndez CS, Gonzalez-Gonzalez E, Alvarez-Díez M, García-Ureña MÁ, Llorente-Moreno M, Ruiz-Lozano C, Colás-Ruiz E, Pérez-Calvo J, Gomila-Sanso JA, Álvarez-Llano L, Serrano-Fuentes SC, Soto-Montesinos C, Dedeu-Bastardas I, Perez-Reche I, Labró-Ciurans M, Pardo-López S, Pérez EG, Fernández IO, Canals LO, Espino PC, Ruano PG, Ricardo V, Ros EP, Manuel EM, Buleje JAB, Prats MMC, Baños PAP, González PM, Celdrán RG, Pellicer-Franco EM, Valero-Navarro G, Vicente-Villena JP, Martinez-Mercader MM, Baeza-Murcia M, Mengual-Ballester M, Soria-Aledo V, Fernández-Martínez D, Varela-Rodríguez L, Garcia-Flórez LJ, Fernández-Hevia M, Gonzalez-Diaz MJ, Fernández-Arias S, Puertas CP, de San Pío Carvajal E, Cebolla ES, Brainsa E, Bayo JMM, Castro MC, Blanco RR, Gutierrez E, Pinto FL, Alegre JM, Flores N, ÓSullivan SN, Fernández BF, Alonso JE, Conde JGA, Ropero NM, Bayón RÁ, Dominguez SH, Ramirez S, Martin de Pablos A, Perez-Sanchez A, Cano-Matias A, Del-Rio-Lafuente FJ, Caballero-Delgado J, Valdes-Hernandez J, Gomez-Rosado JC, Martinez C, Cholewa H, Sancho-Muriel J, Alberola MJ, Navasquillo M, Primo V, Moreno V, Espí-Macías A, Moro-Valdezate D, Carrascosa-Morales I, Martín-Arévalo J, Soro-Domingo M, García-Botello S, Pla-Marti V, Abellán AM, Pérez CM, Cortés GFV, Blasco LF, Chornet MR, Martín RS, Diego ARD, Vázquez-Fernández A, Pascual A, de Andrés-Asenjo B, Beltrán de Heredia J, Ruiz-Soriano M, Rodríguez-Jiménez R, Iribarren EM, Rodríguez EVF, Del Carmen Casas García M, García-Señoráns MP, Valderrama ÓC, Rodríguez PF, Santos RS, Currás RP, Vigorita V, Roche CG, Delgado E, Lafuente F, Gascon I, Saudi S, Fraj V, Gómez ME, Santos EG, Mena EA, Mantecón JV, García SS, Fernández-Camuñas A, Wickramasinghe D, de Zoysa I, Samarasekera N, Wickramarathne R, Dassanayake V, Balathayalan Y, de Silva D, Perera M, Pulleperuma S, Jayasekara S, Wijenayake W, Gunetilleke B, Abeysinghe N, Chandrasinghe P, Kumarage S, Abdalradiy AG, Widatalla ABH, Ahmed AY, Mohamed HA, Hamid HKS, Ali MH, Eldin SJ, Agger E, Jutesten H, Lindgren J, Lepsenyi M, Azhar N, Hansdotter P, Ekepil A, Lindén Å, Brandström G, Smedberg J, Schiffer E, Ris F, Longchamp G, Meyer J, Dupret L, Galetti K, Regusci L, Grischott M, Malugani M, Mouhandes AEF, Danial AK, Khayat M, Sbahi MHE, Marawy MK, Abdullah MA, Douba Z, Mansour A, Niazi A, Hamza A, Mohamad AH, Awead M, Mohammad S, Salloum S, Jabar AA, Zazo A, Shebli B, Ayoub K, Younes L, Bannoud MH, Zazo R, Saad A, Hamdan A, Wakkaf H, Adra L, Souliman M, Anton M, Hannouf S, Li KL, Cheng KI, Ji SJ, Hsieh YC, Parlak EA, Demir M, Kara U, Peker YS, Yiğit D, Unal N, Iflazoğlu N, Yalkin Ö, Topal S, Gulcu B, Ozturk E, Gümbelek G, Terkanlıoğlu S, Koklucan A, Ince G, Sen M, Isik O, Kural S, Akesen S, Yilmazlar T, Sungurtekin H, Sungurtekin U, Vural U, Ozgen U, Isik A, Onk D, Kurnaz E, Ozker TS, Ipek A, Ferlengez A, Erturk C, Tatar C, Sevik H, Akay O, Sensoy O, Hayirlioglu MB, Aktas S, Ozben V, Aliyeva Z, Mutlu AU, Gökay BV, Saraçoğlu C, Aytaç E, Gülmez M, Işık MÜ, Hacim A, Akbas A, Soyhan F, Turgut MA, Demirgan S, Meric S, Altinel Y, Baris B, Akova E, Kahraman E, Kucuk HF, Saracoglu KT, Kaya S, Lel S, Gurbulak EK, Caz E, Kostek M, Mihmanli M, Yazici P, Oba S, Kırkan EF, Ulgur HS, Kalın M, Dinkci MD, Duzgun O, Ozturk S, Zengin AK, Aşkar A, Şanlı AN, Erginöz E, Özçelik MF, Ergün S, Uludağ SS, Kara D, Yılmaz G, Sarıcı IŞ, Kara Y, Incesu A, Arican C, Atici SD, Kaya T, Gezer T, Kirmizi Y, Aydin G, Namdaroglu O, Adakaya S, Canda AE, Ozzeybek D, Coskun N, Sokmen S, Ozkardesler S, Bisgin T, Miftari A, Caliskan C, Akgun E, Avseren G, Deniz N, Yoldas T, Güreşin A, Zayakov G, Pösteki G, Utkan NZ, Tatar OC, Akçay Ö, Güler SA, Mantoğlu B, Demirel E, Akın E, Gonullu E, Altintoprak F, Palabıyık O, Bayhan Z, Ciftci AB, Colak E, Aybar E, Celik HK, Eraslan H, Yemez K, Ozbilgin SS, Senol S, Gultekin FA, Piskin O, Guler O, Karadere Y, Kakeeto A, Oguttu B, Sikakulya FK, Lule H, Rybachuk A, Shudrak A, Beznosenko A, Lisnyy I, Rozhkova V, Zvirych V, Alawlaqi D, El Jamali F, Balooshi IA, Ahmed M, Albers M, Ali NA, Church R, Dudas G, Wells J, Pavlova M, Sebastiani S, Paterson C, Kaushal M, Patel P, Panchal S, Handa S, Tezas S, Zaidi SN, Raj G, Wright J, Hallam S, Karandikar S, Gates Z, Marshall A, Thompson A, Tennakoon A, Rao M, Callan R, Tufail S, Rajendran G, Polisetty K, Husain N, Clarke N, Naranayanasamy S, Hallett A, Lorejo E, Ward N, Antakia R, Xanthis A, Simillis C, Tweedle E, Panagiotopoulou I, Grimes L, Mounstephen L, Bocancia R, Carden C, Lynch J, Noveros MS, Shaalan R, Khalil T, Marshall W, Hodge K, Balfour J, Mcintosh K, Buijs L, Yule M, Vaughan-Shaw PG, Smith S, Anderson T, Mcdermott FD, Daniels IR, Tapp J, Smart N, Rajaretnam N, Bethune R, Clark T, Delimpalta C, Liao C, Banham G, Induruwage L, Velchuru V, Lawrence A, Rahman A, Bennett J, Badawi M, Harshen R, Bhargava A, Gorrela K, Jumah M, Hanson M, Arya S, Atendido T, Shrestha A, Cook E, Rakhimov I, Collins J, Alamin N, Vigneswaran N, Basnyat P, Shamardal A, Chacko A, Wanshantha D, Bisheet G, Ebdewi H, Abdellatif M, Adu-Poku P, Tore A, Adams F, Allen K, Ahmed K, Kulkarni N, Chitnis A, Patel H, Magsino J, Sarodaya V, Minicozzi A, Dempsy C, Ahmed H, Jayasinghe JD, Okail MH, Thaha M, Hallworth S, Parmar C, Chua L, Pizanias M, Samin R, Young T, Sagar J, Yorkmui L, Cirocchi N, Ahmed S, Barreda SC, Kudchadkar S, Baker A, Jayasankar B, Jackson J, Abdelsaid K, Hassan M, Shetty S, Coldwell C, Davies E, Nader H, Raistrick M, Ryska O, Hawkin P, Raymond T, Witjes C, Van de Steen K, Crabtree N, Boyce S, Somera W, Woodward A, Ryan K, Kassai M, Aleem M, Keogh-Bootland S, Ghosh A, Rixson D, Lewis E, Lynch N, Shovelton C, Zywicka E, Guest F, Barton J, Purnell R, Bamford R, Teare T, Adams B, Chmielewski G, Smith L, Connolly L, Niblett R, Singh A, Halliwell G, Paraoan M, Doree N, Asaad P, Kilbride C, Carpenter H, Wilson J, Fletcher J, Vijayagopal KA, Abbakar M, Zaimis T, Walsh A, Kubisz-Pudelko A, Nono J, Pippard L, Chowdhary M, Dalton R, Moussa T, Dominguez F, Solla G, Curbelo J, Laurini M, Viola M, Brito N, Al-Alnsi A, Al-Naggar H, Saryah L, Al-Shehari M, Alsayadi R, Al-Hutheifi R, Shream S, Saeed S, Spurring EM. Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries. Br J Surg 2024; 111:znad370. [PMID: 38029386 PMCID: PMC10771257 DOI: 10.1093/bjs/znad370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. METHODS The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. RESULTS A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). CONCLUSION Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov).
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Rega D, Granata V, Romano C, Fusco R, Aversano A, Ravo V, Petrillo A, Pecori B, Di Girolamo E, Tatangelo F, Avallone A, Delrio P. Total mesorectal excision after rectal-sparing approach in locally advanced rectal cancer patients after neoadjuvant treatment: a high volume center experience. Ther Adv Gastrointest Endosc 2024; 17:26317745241231098. [PMID: 39044726 PMCID: PMC11265235 DOI: 10.1177/26317745241231098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/19/2024] [Indexed: 07/25/2024] Open
Abstract
Background In patient with a complete or near-complete clinical response after neoadjuvant treatment for locally advanced rectal cancer, the organ-sparing approach [watch & wait (W&W) or local excision (LE)] is a possible alternative to major rectal resection. Although, in case of local recurrence or regrowth, after these treatments, a total mesorectal excision (TME) can be operated. Method In this retrospective study, we selected 120 patients with locally advanced rectal cancer (LARC) who had a complete or near-complete clinical response after neoadjuvant treatment, from June 2011 to June 2021. Among them, 41 patients were managed by W&W approach, whereas 79 patients were managed by LE. Twenty-three patients underwent salvage TME for an unfavorable histology after LE (11 patients) or a local recurrence/regrowth (seven patients in LE group - five patients in W&W group), with a median follow-up of 42 months. Results Following salvage TME, no patients died within 30 days; serious adverse events occurred in four patients; 8 (34.8%) patients had a definitive stoma; 8 (34.8%) patients undergone to major surgery for unfavorable histology after LE - a complete response was confirmed. Conclusion Notably active surveillance after rectal sparing allows prompt identifying signs of regrowth or relapse leading to a radical TME. Rectal sparing is a possible strategy for LARC patients although an active surveillance is necessary.
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Rega D, Delrio P. How do you manage the peritoneal opening during TAMIS procedure? Tech Coloproctol 2023; 27:1135-1136. [PMID: 37555893 DOI: 10.1007/s10151-023-02851-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 07/31/2023] [Indexed: 08/10/2023]
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Ottaiano A, De Luca A, Santorsola M, Scognamiglio G, Di Mauro A, Chiodini P, Lambiase M, Sacco A, Petrillo A, Granata V, Fusco R, Mercadante E, Martucci N, De Luca G, Rocca AL, Celentano E, Crispo A, Di Gennaro P, Tatangelo F, Ferrara G, Izzo F, Belli A, Patrone R, Delrio P, Rega D, De Franciscis S, Muto P, Ravo V, Di Franco R, Borzillo V, Santagata S, Rea G, Castaldo D, Pace U, De Feo G, Scala S, Nasti G, Normanno N. Oligo-metastatic neoPlasms from the gastro-intestinal tract: iDentIfiCaTIon of cliNical and molecular drivers: the PREDICTION study. BMC Cancer 2023; 23:1010. [PMID: 37858132 PMCID: PMC10588113 DOI: 10.1186/s12885-023-11479-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Metastatic disease in tumors originating from the gastrointestinal tract can exhibit varying degrees of tumor burden at presentation. Some patients follow a less aggressive disease course, characterized by a limited number of metastatic sites, referred to as "oligo-metastatic disease" (OMD). The precise biological characteristics that define the oligometastatic behavior remain uncertain. In this study, we present a protocol designed to prospectively identify OMD, with the aim of proposing novel therapeutic approaches and monitoring strategies. METHODS The PREDICTION study is a monocentric, prospective, observational investigation. Enrolled patients will receive standard treatment, while translational activities will involve analysis of the tumor microenvironment and genomic profiling using immunohistochemistry and next-generation sequencing, respectively. The first primary objective (descriptive) is to determine the prevalence of biological characteristics in OMD derived from gastrointestinal tract neoplasms, including high genetic concordance between primary tumors and metastases, a significant infiltration of T lymphocytes, and the absence of clonal evolution favoring specific driver genes (KRAS and PIK3CA). The second co-primary objective (analytic) is to identify a prognostic score for true OMD, with a primary focus on metastatic colorectal cancer. The score will comprise genetic concordance (> 80%), high T-lymphocyte infiltration, and the absence of clonal evolution favoring driver genes. It is hypothesized that patients with true OMD (score 3+) will have a lower rate of progression/recurrence within one year (20%) compared to those with false OMD (80%). The endpoint of the co-primary objective is the rate of recurrence/progression at one year. Considering a reasonable probability (60%) of the three factors occurring simultaneously in true OMD (score 3+), using a significance level of α = 0.05 and a test power of 90%, the study requires a minimum enrollment of 32 patients. DISCUSSION Few studies have explored the precise genetic and biological features of OMD thus far. In clinical settings, the diagnosis of OMD is typically made retrospectively, as some patients who undergo intensive treatment for oligometastases develop polymetastatic diseases within a year, while others do not experience disease progression (true OMD). In the coming years, the identification of true OMD will allow us to employ more personalized and comprehensive strategies in cancer treatment. TRIAL REGISTRATION ClinicalTrials.gov ID NCT05806151.
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Grants
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
- L4/8 Italian Government, Ministry of Health, Ricerca Corrente 2022
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D’Angelo V, Rega D, Marone P, Di Girolamo E, Civiletti C, Tatangelo F, Duraturo F, De Rosa M, de Bellis M, Delrio P. The Role of Colonoscopy in the Management of Individuals with Lynch Syndrome: A Narrative Review. Cancers (Basel) 2023; 15:3780. [PMID: 37568596 PMCID: PMC10417258 DOI: 10.3390/cancers15153780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/07/2023] [Accepted: 03/24/2023] [Indexed: 08/13/2023] Open
Abstract
The history of Lynch syndrome changed definitively in 2000, when a study published in Gastroenterology demonstrated a significant reduction in mortality among individuals with Lynch syndrome who undergo regular endoscopic surveillance. As a consequence of this clinical evidence, all scientific societies developed guidelines, which highlighted the role of colonoscopy in the management of Lynch syndrome, especially for individuals at high risk of colorectal cancer. Over the years, these guidelines were modified and updated. Specialized networks were developed in order to standardize endoscopic surveillance programs and evaluate all the clinical data retrieved by the results of colonoscopies performed for both the screening and the surveillance of individuals with Lynch syndrome. Recent data show that the impact of colonoscopy (with polypectomy) on the prevention of colorectal cancer in individuals with Lynch syndrome is less significant than previously thought. This narrative review summarizes the current discussion, the hypotheses elaborated and the algorithms depicted for the management of individuals with Lynch Syndrome on the basis of the recent data published in the literature.
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Adisa A, Bahrami-Hessari M, Bhangu A, George C, Ghosh D, Glasbey J, Haque P, Ingabire JCA, Kamarajah SK, Kudrna L, Ledda V, Li E, Lillywhite R, Mittal R, Nepogodiev D, Ntirenganya F, Picciochi M, Simões JFF, Booth L, Elliot R, Kennerton AS, Pettigrove KL, Pinney L, Richard H, Tottman R, Wheatstone P, Wolfenden JWD, Smith A, Sayed AE, Goswami AG, Malik A, Mclean AL, Hassan A, Nazimi AJ, Aladna A, Abdelgawad A, Saed A, Abdelmageed A, Ghannam A, Mahmoud A, Alvi A, Ismail A, Adesunkanmi A, Ebrahim A, Al-Mallah A, Alqallaf A, Durrani A, Gabr A, Kirfi AM, Altaf A, Almutairi A, Sabbagh AJ, Ajiya A, Haddud A, Alnsour AAM, Singh A, Mittal A, Semple A, Adeniran A, Negussie A, Oladimeji A, Muhammad AB, Yassin A, Gungor A, Tarsitano A, Soibiharry A, Dyas A, Frankel A, Peckham-Cooper A, Truss A, Issaka A, Ads AM, Aderogba AA, Adeyeye A, Ademuyiwa A, Sleem A, Papa A, Cordova A, Appiah-Kubi A, Meead A, Nacion AJD, Michael A, Forneris AA, Duro A, Gonzalez AR, Altouny A, Ghazal A, Khalifa A, Ozair A, Quzli A, Haddad A, Othman AF, Yahaya AS, Elsherbiny A, Nazer A, Tarek A, Abu-Zaid A, Al-Nusairi A, Azab A, Elagili A, Elkazaz A, Kedwany A, Nuhu AM, Sakr A, Shehta A, Shirazi A, Mohamed AMI, Sherif AE, Awad AK, Abbas AM, Abdelrahman AS, Ammar AS, Azzam AY, Ciftci AB, Dural AC, Sanli AN, Rahy-Martín AC, Tantri AR, Khan A, Al-Touny A, Tariq A, Gmati A, Costas-Chavarri A, Auerkari A, Landaluce-Olavarria A, Puri A, Radhakrishnan A, Ubom AE, Pradhan A, Turna A, Adepiti A, Kuriyama A, Kassam AF, Hassouneh A, El-Hussuna A, Habeebullah A, Ads AM, Mousli A, Biloslavo A, Hoang A, Kirk A, Santini A, Melero AV, Calvache AJN, Baduell A, Chan A, Abrate A, Balduzzi A, Sánchez AC, Navarrete-Peón A, Porcu A, Brolese A, Barranquero AG, Saibene AM, Adam AA, Vagge A, Maquilón AJ, Leon-Andrino A, Sekulić A, Trifunovski A, Mako A, Bedada AG, Broglia A, Coppola A, Giani A, Grandi A, Iacomino A, Moro A, D’amico A, Malagnino A, Tang A, Doyle A, Alfieri A, Haynes A, Wilkins A, Baldwin A, Heriot A, Laird A, Lazarides A, O'connor A, Trulson A, Rokohl AC, Caziuc A, Triantafyllou A, Anesi A, Nikova A, Andrianakis A, Charalabopoulos A, Tsolakidis A, Chirca A, Arnaud AP, Narvaez-Rojas AR, Kavalakat A, Spina A, Recordare A, Annicchiarico A, Conti A, Mohammed AD, Kocataş A, Almhimid A, Arnaout A, Fahmy A, Mangi A, Modabber A, Ulas AB, Mohamedahmed AYY, Frontali A, Moynihan A, Yunus A, Ahmad A, Kent AJ, Khamees A, Ugwu AO, Turan A, Mohammed AAK, Navarro-Barrios A, Yebes A, De Sousa ÁFL, Moreno A, Sethi A, Dawson AC, Othman AAA, Kaur A, Wolde A, Antonelli A, Scifo A, Alhamad A, Davis A, Alderazi A, Harky A, Mohammed-Durosinlorun A, Seguya A, Okhakhu A, Chamakhi A, Sebai A, Souadka A, Asla A, Agrawal A, Persad A, Gupta A, Elgazar A, Kulkarni A, Coates A, Bellés AC, Hadzibegovic AD, Jotic A, Kowark A, Martins A, Pineda AM, Peral A, Gollarte AS, Senent-Boza A, Camarena AIA, Castaño-Leon AM, Bravo AMM, Moro AMG, Musina AM, Tapia-Herrero AM, Kothari A, Gupta A, Raja A, Aljaiuossi A, Taha A, Majbar AM, Prodromidou A, Kanatas A, Gupte A, Zakaria AD, Balla A, Barberis A, Bondurri A, Bottari A, Costantino A, Figus A, Lauretta A, Mingoli A, Romanzi A, Sagnotta A, Scacchi A, Picchetto A, Valadez AEC, Luzzi AP, Älgå A, Fontalis A, Hecker A, Demetriades AK, Serban AM, Văcărașu AB, Cokan A, Isaza-Restrepo A, Beamish A, Schache A, Stevenson A, Yiu A, Cockbain AJ, Litvin A, Abad-Motos A, Becerra A, Ramos ÁC, Chiaradia A, Dell A, Romano A, Pascale A, Marra AA, Dimas A, Kolias A, Cerovac A, Koneru A, Tidjane A, Agbeko AE, Bajaj A, Gosain A, Allan A, Carreras-Castañer A, D'amore A, Dare A, Maffioli A, Palepa A, Paspala A, Konney A, Gatta AND, Ezanno AC, Yiallourou A, Kinnair A, Rayner A, Scafa AK, Bowan AB, Veglia A, Russo A, Maniaci A, Castaldi A, Gil-Moreno A, Maffuz-Aziz A, Meola A, Nenna A, Ferrer AP, Bonilla AR, Ramos-De La Medina A, Infante AR, Santoro A, Laganà AS, Bateman A, Michael ALR, Abozid A, Seidu AS, Lowery A, Tantraworasin A, Rasheed A, Picciariello A, Isik A, Saif A, Anjum A, Ioannidis A, Abeldaño A, Hussain A, Nathan A, Bedzhanyan A, Perfecto A, De Virgilio A, Galvan A, Sablotzki A, Böttcher A, Pellacani A, Gatti A, Ibrahimli A, Menon A, Sahni A, Mwenda AS, Choudhry A, Jayawardane A, Gupta A, Ramasamy A, Mitul AR, Bawa A, Nugur A, Rammohan A, Sachdeva A, Mehraj A, Yildirim A, Alqaseer A, Radwan A, Sallam A, Syllaios A, Tampakis A, Alwael A, Samara A, Eroglu A, Rahman A, Ulkucu A, Zaránd A, Dulskas A, Tawiah A, Zani A, Vas A, Lukosiute-Urboniene A, Adamu A, Aujayeb A, Malik AA, İplikçi A, Mahmud A, Cil AP, Makanjuola A, Akwaisah A, Galandarova A, Saracoglu A, Regan A, Barlas AM, Alhassan BAB, Mostafa B, Hamida BB, Torun BC, Abdullah B, Balagobi B, Banky B, Singh B, Alegbeleye B, Yigit B, Hajjaj BN, Burgos-Blasco B, Seeliger B, Alayande B, Alhazmi B, Enodien B, Torre B, Pérez BG, Tamayo BV, De Andrés-Asenjo B, Quintana-Villamandos B, Girgin B, Barmayehvar B, Beisenov B, Creavin B, Dunne B, Marson B, Waterson B, Martin B, Zucker B, Wong BNX, Ozmen BB, Hammond B, Mbwele B, Núñez B, Dhondt B, Gafsi B, Mcleish B, Lieske B, Tailor B, La Pira B, Picardi B, Zampogna B, Casagranda B, Festa BM, Panda B, Kirmani B, Sulaiman B, Gurung B, Zacharia B, Bette B, Ayana B, Nikolovska B, Vilaró BC, De Vega Sánchez B, Hameed BZ, Diaconescu B, Kovacevic B, Bumber B, Sakakushev B, Tadic B, Malek B, Alrayes B, Thomas B, Gális B, Gallagher B, Knowles B, Cunningham B, Daley B, Mishra B, Ashford B, Pirozzi BM, Berselli B, Martinez-Leo B, Sensi B, Nardo B, Celik B, Giray B, Abud B, Almiqlash B, Pramesh CS, Taskiran C, De Campos Prado CA, Cipolla C, Kumar C, English C, Riccetti C, Vanni C, Brasset C, Downey C, Duffy C, Chwat C, Cutmore C, Sars C, Ratto C, Pacilio CA, De La Infiesta García C, Moreno CG, Magalhães C, Prada C, Zapata CS, Senni C, Flumignan CDQ, Martinez-Perez C, Duarte CL, Garcia CSR, Anderson C, Hing C, Cullinane C, Cina C, Zabkiewicz C, Sohrabi C, Guldogan CE, Ciubotaru C, Desai C, Raut C, Demetriou C, Handford C, Okpani C, Paranjape C, Koh C, Khatri C, Parmar C, Mok CW, Caricato C, Marafante C, Echieh CP, Tan CY, Ong CS, Conso C, Jardinez C, Konrads C, Warner C, Makwe CC, Henein C, Fleming C, Roland CL, Maurus C, Nitschke C, Mittermair C, Mallmann C, Andro C, Harmston C, Kuppler C, Lotz C, Nahm C, Rowe C, Ryalino C, Wallis C, Millward CP, Anthoulakis C, Apostolou C, Chouliaras C, Kalfountzos C, Kaselas C, Vosinakis C, Okereke C, Chean CS, Barlow C, Tatar C, Clancy C, Forde C, Sharpin C, Mccarthy C, Nestor C, Warden C, Ávila CC, Massaguer C, Fang CEH, Martins CP, Guerci C, Mauriello C, Holzmeister C, Miller C, Weber C, Wiesinger CG, Kenington C, Noel C, Sue-Chue-Lam C, Adumah C, Neary C, Sen C, Fitzgerald C, Ezeme C, Nastos C, Mesina C, Bombardini C, Torregrosa C, Valdespino CP, Don CP, Wickramasinghe D, Milanesi D, Armijos D, Asiimwe D, Beswick D, Clerc D, Cox D, Doherty D, Martínez DF, Lechuga DG, Gero D, Gil-Sala D, Lindegger D, Reim D, Shaerf D, Shmukler D, Branzan D, Filipescu D, Rega D, Bernardi D, Bissacco D, Fusario D, Morezzi D, Sabella D, Zimak DM, Vinci D, Sale D, Khan DZ, Thereska D, Andreotti D, Tartaglia D, Abdulai DR, Mukherjee D, Verdi D, Idowu D, John D, Johnson D, Moro-Valdezate D, Naumann D, Omar D, Proud D, Roberts D, Guzmán DS, Watson D, Bergkvist DJ, Lumenta DB, Ferrari D, Rizzo D, Degarege D, Castillo DFC, Douglas D, Wright D, Nanjiani D, Bratus D, Altun D, Sievers D, Vaysburg D, Katechia D, Ghosh D, Azize DA, Rodrigues D, Pachajoa DAP, Hayne D, Mutter D, Raimondo D, Eskinazi D, Sasia D, Corallino D, Muduly D, Grewal D, Hadzhiev D, Peristeri D, Pournaras D, Raptis DA, Angelou D, Haidopoulos D, Magouliotis D, Moris D, Schizas D, Symeonidis D, Tsironis D, Korkolis D, Tatsis D, Thekkinkattil D, Bulian DR, Pandey D, Vatansever D, Parker D, Wiedemann D, Borselle D, Pedini D, Schweitzer D, Venskutonis D, Otokwala J, Adamu KM, Pk P, Garod M, Ellafi AAD, Zivkovic D, Jelovac D, Wijeysundera D, Mcpherson D, Ryan É, Ugwu E, Baidoo EI, Shaddad E, Memişoğlu E, Naranjo EPL, Brodkin E, Segalini E, Viglietta E, Hendriks E, Bonci EA, Sá-Marta E, Ortega EN, Gomez EGL, Joviliano EE, Clune E, Horwell E, Mains E, Vasarhelyi E, Caruana EJ, Nevins EJ, Yenli EMTA, Baili E, Lostoridis E, Morgan E, Shiban E, Latif E, Tampaki EC, Ezenwa E, Irune E, Borg E, Eisa E, Gialamas E, Parvez E, Theophilidou E, Toma EA, Arnaoutoglou E, Samadov E, Kantor E, Ulman EA, Colak E, Cassinotti E, Bannone E, Sarjanoja E, Yates E, Vincent E, Lun EWY, Cerovac E, Dif ES, Alkhalifa E, Daketsey E, Fayad EA, Sheikh E, Pontecorvi E, Cammarata E, La Corte E, Rausa E, Odai ED, Guasch E, Cano-Trigueros E, Uldry E, Ros EP, Matthews E, Donmez EE, Giorgakis E, Kapetanakis E, Stamatakis E, Bua E, Schneck E, Nachelleh EA, Ofori EO, Akin E, Gönüllü E, Kirkan EF, Çelik E, Wong E, Capozzi E, Pinotti E, Colás-Ruiz E, González E, Fekaj E, Ohazurike E, Kebede E, Erginöz E, Duran EES, Scott E, Aytac E, Albanese E, Castro EJ, Albayadi E, Kriem E, Siddig E, Otify E, El Tayeb EEABH, Hong EH, Saguil E, Belzile E, Tuyishime E, Panieri E, Martínez EG, Myriokefalitaki E, Wong EG, Samara E, Agbeno EK, Drozdov E, Tokidis E, Shah FA, Barra F, Carbone F, Ferreli F, Marino F, Martinelli F, D'acapito F, Masciello F, Bàmbina F, Issa F, Salameh FT, Kethy F, Mahmood F, Gareb F, Idrees F, Karimian F, Ashraf F, Haji F, Inayat F, Begum F, Nabil F, Rosa F, Haider F, Parray F, Calculli F, Ferracci F, Saraceno F, Coppola F, Coccolini F, Fusini F, Migliorelli F, Pecoraro F, Alconchel F, Coimbra FJF, Trivik-Barrientos F, Naegele F, Almarshad F, Agresta F, Fleming F, Mendoza-Moreno F, Brzeszczyński F, Carannante F, Wu F, Aljanadi F, Hayati F, Campo F, Sorbi F, Milana F, Takeda FR, Shekleton F, Gessler F, Recker F, Grama F, Cherbanyk F, Faponle F, Angelis F, Calabretto F, Gaino F, Toia F, Bianco F, Bussu F, Cammarata F, Castagnini F, Colombo F, Ferrara F, Fleres F, Guerrera F, Litta F, Mongelli F, Pata F, Roscio F, Mulita F, Ardura F, Tejero-Pintor FJ, Calvo FJR, Escobedo FJB, Camacho FJB, Odicino F, Schmitt F, Bloemers F, Hölzle F, Gyamfi FE, Messner F, Koh F, Cáceres F, Smolle-Juettner FM, Herman F, Ayeni F, Djedovic G, De Oliveira GP, Rodrigues G, Wagner G, Bellio G, Giarratano G, Capolupo GT, Budd G, Marom G, Poillucci G, Thiruchandran G, Nicholson G, Groot G, Hoey G, Bass GA, Sachdev G, Agarwal G, Aggarwal G, Cormio G, Mazzarella G, Perrone G, Osterhoff G, Singer G, Dejeu G, Fowler G, Garas G, Gradinariu G, Theodoropoulos G, Tzimas G, Babis G, Wong GKC, Cross GWV, Micha G, Chrysovitsiotis G, Koukoulis G, Peros G, Tsoulfas G, Kapetanios G, Karagiannidis G, Verras GI, Ekwen G, Perrotta G, Petruzzi G, Bertelli G, Calini G, Fiacchini G, Pirola GM, Dolci G, Mendiola G, Baiocchi GL, Palini GM, Prucher GM, D'andrea G, Maggiore G, Cassese G, Franceschini G, Pellino G, Saponaro G, Pattacini GC, Pantuso G, Iannella G, Bonsaana GB, Lever G, Brachini G, Giraudo G, Lisi G, Russo GI, Aprea G, Pascale G, Tomasicchio G, Sandri GBL, Armatura G, Turri G, Zaccaria G, Barugola G, Lantone G, Gasparini G, Iacob G, Sozzi G, Zancana G, Mercante G, Bianco G, Brisinda G, Consorti G, Currò G, Giannaccare G, Palomba G, Pascarella G, Rotunno G, Spriano G, Vizzielli G, Cucinella G, Sica G, Campisi G, Baiocchi G, Guerra GR, Pacheco GMF, Atis G, Augustin G, Šantak G, Chauhan GS, Branagan G, Harris G, Stewart GD, Padmore G, Kocher GJ, Di Franco G, De Jesus Labrador Hernandez G, Christodoulidis G, Neal-Smith G, Yim G, Piozzi GN, Claret G, Yanowsky-Reyes G, Dhaity GD, Cakmak GK, Mohamed G, Kucuk GO, Ancans G, Banipal GS, De Bacco Marangon G, Laporte G, Martinez-Mier G, Recinos G, V GMM, Benshetrit G, Vijgen G, Pickett G, Rodriguez HA, Shiwani H, Derilo H, Awad H, El Assaad H, Raji HO, Hardgrave H, Karakullukcu HK, Abdussalam HO, Mustafa H, Parwaiz H, Khan H, Arbab H, Naga H, Salem H, Ulgur HS, Perez-Chrzanowska H, Greenlee H, Javanmard-Emamghissi H, Lederhuber H, Osman H, Adamou H, Majid HJ, Van Goor H, Spiers HVM, Manesh HF, Mushtaq H, Aljaaly H, Hasan HB, Ahmed HTA, Martinez-Said H, Aguado HJ, Consani H, Chaplin H, Mohan H, Van Vliet H, Lohse HAS, Shah H, Claireaux H, Lule H, Juara H, Abozied H, Bayo HL, Alibrahim H, Kroon HM, Ulman H, Khan H, Yonekura H, Abou-Taleb H, Wong HYF, Carpenter H, Majd HS, Zenha H, Mayer HF, Elghadban H, Abdou H, Elfeki H, Yusefi H, Gomez-Fernandez H, Horsfall HL, Meleiro H, Sungurtekin H, Junior HFL, Moloo H, Bayhan H, Şevi̇k H, Embarek H, Hamid HKS, Pradeep IHDS, Donkin I, Ateca IV, Jafarov I, Salisu I, Abdalaal I, Garzali IU, Sall I, Adebara I, Aghadi I, Ugwu I, Zapardiel I, Reis I, Nwafor I, Fakhradiyev I, Surya IU, Robo I, Njokanma I, Iannone I, Khan I, Correia I, Königsrainer I, Seiwerth I, Linero IB, Kadiri I, Florian IA, Tzima I, Akrida I, Baloyiannis I, Gerogiannis I, Katsaros I, Tsakiridis I, Valioulis I, Negoi I, Yadev I, De Haro Jorge I, Vázquez IO, Dajti I, Russo IS, Afzal I, Wasserman I, Chukwu I, Gracia I, Oliver IM, Hughes I, Mondi I, Ncogoza I, Bsisu I, Rashid I, Balasubramanian I, Omar I, Dominguez-Rosado I, Smati I, Vokshi I, Al-Badawi IA, Saleh IA, Pilkington I, Kirac I, Trostchansky I, Gawron IM, Trebol J, Martellucci J, Andreuccetti J, Abou-Khalil J, Shah J, Manickavasagam J, De Alarcón JR, Mihanovic J, O'riordan J, Archer J, Ashcroft J, Blair J, Hamill J, Munthali J, Park J, Parry J, Ryan J, Tomlinson J, Wheeler J, Wilkins J, Balogun JA, Hodgetts JM, Vatish J, Žatecký J, Dziakova J, Martin J, Beatty JW, Stijns J, Faiz J, Ripollés-Melchor J, Mata J, Vásquez JAG, Mitra JK, Tuech JJ, Mvukiyehe JP, Fallah JM, Díaz JT, Vishnoi JR, Van Den Eynde J, Rickard J, Rolinger J, Kaplowitz J, Meyer J, Reid J, Rossaak J, Smelt J, Thomas JJ, Reyes JAS, Davies J, Luc J, Alonso JAM, Hajiioannou J, Querney J, Van Acker J, Pu JJ, Cama J, Simoes J, Cozens J, Barbosa-Breda J, Ribeiro J, De Haro J, Nigh J, Bowen J, Pollok JM, Strotmann JJ, Doerner J, Edwards J, Green J, Massoud J, Mcgrath J, Squiers J, Street J, Windsor J, Santoshi JA, Meara JG, Abebrese JT, Reilly JJ, Zabaleta J, Phillips J, Herron J, Horsnell J, Dawson J, Sheen J, Kauppila JH, Konsten J, Raurich-Leandro J, Romera JS, Nuñez J, Gass JM, Blanco J, Calvache JA, Iturralde JLF, D’addino JL, Hermosa JMG, Guillen JRO, Beristain-Hernandez JL, Sole-Sedeno JM, Vives JMM, Attwood J, Furey J, Hadaya J, Mckay J, Meilak J, Natale J, Shalhoub J, Jung J, Arthur J, Kealey J, Wright J, Moreau J, Miskovic J, Juloski J, Bauset JCC, Segura-Sampedro JJ, Cisneros JRT, Gomez-Rosado JC, Arneja J, Heider J, Fernández JD, Plata-Bello J, Villanueva J, Olaogun J, Hing JX, Košir JA, Daruwalla J, Yeung J, Wormald J, Seyi-Olajide J, Rani J, Wong KY, Hristova K, Kajal K, Algarni K, Theivendran K, Futaba K, Elsayem K, Kapur K, Bailey K, El-Boghdadly K, Ataya K, Lacorbiniere K, Shah K, Tellez KSM, Szyluk K, Rangasamy K, Iyengar K, Szabómihályová K, Atkinson K, Camargo-Parra K, Galliard K, Dickson K, Singh K, Qader K, Hasan K, Spellar K, Feeney K, Ajenifuja K, Oh KE, Okunade K, Adanu K, Bateman K, Saracoglu K, Ho KW, Enwerem K, Mishra K, Verhoeff K, Bensoltane K, Larabi K, Hamdan KH, Nadi K, Fozo K, Abdelwahab K, Al-Sayaghi K, Dajani K, Algahtany K, Abdel-Galil K, Ahmed K, Bajunaid K, Bhatti K, Sofi K, Abdulsalam K, Tamoos K, Dzhumabaev K, Samo KA, Purich K, Madhvani K, Qin KR, Underwood K, Senanayake KJ, Augestad KM, Sigamoney K, Apostolou K, Bouchagier K, Bouliaris K, Bramis K, Gousias K, Lasithiotakis K, Paraskevopoulos K, Perivoliotis K, Roditis K, Stamatis K, Stroumpoulis K, Paraskevas KI, Govindarajan KK, Šimko K, Olson KA, Khobragade K, Seah KM, Kishore K, Ayad K, Papavasiliou K, Angelou K, Paniagua LC, Czako L, Ching LVK, Rai L, Gupta L, Ismail L, Mbodi L, Dasanayake L, Schröder L, Baiyewu LA, Fortuna L, Fernandez LG, Vivancos LG, Jack L, Keçi L, Lavalle L, Leonard L, Shelmerdine L, Vaassen L, Hasan L, Lazarou L, Tzelves L, Matos L, Siragusa L, Licari L, Lima LS, Solaini L, Lichman L, Moral LT, Cabeza L, Kaplan L, Valeanu L, Kaman L, Karout L, Pieteris L, Chan L, Grüßer L, Zamora L, Catarzi L, Rampersad L, Anyanwu LJ, Cheung LK, Rodríguez LV, Andreani L, Cobianchi L, Petagna L, Howse L, Gonzalez LE, Bains L, Vohra L, Ansaloni L, Bertolaccini L, Ferrario L, Orecchia L, Tirloni L, Zanin L, Morelli L, Scaravilli L, Locatello LG, García LD, Vida L, Carbone L, Heindl LM, Bonavina L, Conti L, Marano L, Verre L, Conte LE, Boccalatte L, Tellez LGS, Loureiro L, Sánchez-Guillén L, Tallon-Aguilar L, Nakano L, Alvarez-Lozada LA, Gonzalez LAS, Flórez LJG, Capitan-Morales LC, Kowalski LP, Widmer LW, Harper L, Render L, Wheldon L, Abdur-Rahman L, Doğan L, Prusty L, Katsiaras L, Gourbault L, Siddiqui MT, Saleh M, Karthigeyan M, Rodriguez M, Chowdhury M, Nagappa M, Sultania M, Bashir M, Alam M, Elshahawy MAM, Elfiky M, Loubani M, Marei M, Mewafy M, Alali M, Nassar MA, Alobied M, Bilfaqirah M, Ahmad M, Rius M, Manangi M, Dornseifer MD, Tripathi M, S M, Sokolov M, Pigeolet M, Alonso MD, Losada M, Carretero MM, Tousidonis M, Cotovio MD, Wijeyaratne M, Boira MA, Franza M, Albdour M, Alkhatieb M, Déserts MDD, Niewiera M, Vallve-Bernal M, Kavanagh MM, Migliore M, 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Kalın M, Kurawa M, Dincer MB, Tolani MA, Soytas M, Yakubu M, Usman MI, Aremu M, Paranyak M, Talat N, Kausar N, Dudi-Venkata N, Bazzi N, Hasan NB, Van Wyk NN, Shaban N, Almgla N, Kandevani NY, Alzerwi N, Alvarez N, Motas N, Rincón NAR, Blencowe N, Simon N, Aghtarafi N, Ghuman NK, Sharma N, Wijekoon N, Kumar N, Hassan N, Onyemaechi N, Prijović N, Özçay N, Goel N, Segaren N, Sharma N, Kalyva N, Palacios NM, Alonso NFP, Onyeagwara N, Petrucciani N, Daddi N, Lightfoot N, Power N, Segaren N, Starr N, Dreger NM, Cillara N, Colucci N, Eardley N, Tartaglia N, Zanini N, Bacalbasa N, Campuzano N, Mouawad N, Federico NSP, Tamini N, Mariani NM, Beasley N, Adu-Aryee NA, Burlov N, Dimitrokallis N, Gouvas N, Machairas N, Memos N, Thomakos N, Tsakiridis N, Schizas N, Börner N, Theochari N, Al-Saadi N, Glass N, Horesh N, R NE, Gahlot N, Ismail N, Aljirdabi N, Maria NUH, Trabulsi N, Akeel N, Borges N, Moda N, Redondo NV, Nyarko OO, Ginghina O, Enciu O, Okere O, Ekwunife OH, Quadri O, Ogundoyin O, Tucker O, Mateo-Sierra O, Azzis O, Ojewuyi O, Habeeb O, Idowu O, Elebute O, Agboola O, Ladipo-Ajayi O, Oyinloye O, Adebola O, Ekor O, Ogundoyin O, Salamanca O, Vergara-Fernandez O, Wafi O, Aladawi O, Bahassan OM, Tammo Ö, Ozkan OF, Williams OM, Salami O, Akinajo O, Sakhov O, Gallo O, Sole OM, Milella O, Alser O, Bettar OA, Alomar O, Osman OS, Aisuodionoe-Shadrach O, Basnayake O, Bozbiyik O, Hodges O, Ojo O, Yanık Ö, Mutlu ÖPZ, Kazan O, Calavia P, García PR, Urriza PV, Lopez PR, Christidis P, Dorovinis P, Kokoropoulos P, Mourmouris P, Papatheodorou P, Garg PK, Patel P, Vassiliu P, Campennì P, De Nardi P, Bernante P, Ubiali P, Baroffio P, Pizzini P, Sapienza P, Myrelid P, Chatzikomnitsa P, Tsiantoula P, Gada P, Avella P, Cianci P, Romero P, Méndez PS, Pazmiño PAF, Coughlin P, Kirchweger P, Pessaux P, Maguire PJ, Petrone P, Cullis P, Köglberger P, Marriott P, Nankivell P, Santos-Costa P, Martins PN, Panahi P, Botelho P, Teixeira P, Escobar P, Vázquez PJG, Gribnev P, Nolte P, Agbonrofo P, Bobak P, Choong P, Elbe P, Hutchinson P, Labib P, Paal P, Pockney P, Reemst P, Szatmary P, Vaughan-Shaw PG, Alexander P, Pucher P, Stather P, Foessleitner P, Winnand P, Zehnder P, Kruse P, Matos PAW, Lapolla P, Cicerchia PM, Solli P, Di Lascio P, Zarif P, Champagne PO, Anoldo P, Bertoglio P, Fransvea P, Familiari P, Lombardi PM, Stogowski PT, Bruzzaniti P, Tripathi P, D'sa P, Salunke P, Shah PA, Punjabi PPP, Christodoulou P, Hamdan Q, Tawalbeh R, Gadelkareem R, Awad R, Callcut R, Clegg R, Choron R, Payne R, Gefen R, Costea R, Drasovean R, Mirica RM, Ravindra R, Fajardo RT, Nunes RL, Aspide R, Lombardi R, Vidya R, Elboraei R, Saaid R, Ghodke R, Gupta R, Sharma RD, Lunevicius R, Kalayarasan R, Mohan R, Singh R, Sivaprakasam R, Seenivasagam RK, Rajendram R, Radulescu RB, Goicea R, Seshadri RA, Sarı R, Nataraja R, Aslam R, Abdelemam R, Shrestha R, Bharathan R, Pellini R, Guevara R, Agarwal R, Vissapragada R, Alharmi RA, Sayyed R, Browning R, Critchley R, Mallick R, Alarabi R, Beron RI, Függer R, Othman R, Saad R, Amores RR, Colombari RC, Radivojević RC, Patrone R, Novysedlák R, Palacios Huatuco RM, Baertschiger R, Liang R, Luckwell R, Escrevente R, Rezende RF, Cruz RP, Lenzi R, Rosati R, Donovan R, Egan R, Morris R, Page R, Seglenieks R, Unsworth R, Wilkin R, Skipworth RJ, Davies RJ, Bezirci R, Talwar R, Azami R, Bohmer R, Crichton R, Fruscio R, Hooker R, Jach R, Parker R, Pillerstorff R, Sinnerton R, Stabler R, O'connell RM, Ragozzino R, Tutino R, Angelico R, Cammarata R, Colasanti R, Macchiavello R, Peltrini R, Pirrello R, Vaschetti R, Pires RE, Papalia R, Arrangoiz R, Hompes R, Mittal R, Salah R, Pinto R, Flumignan R, Callan R, Cuthbert R, Dennis R, Scaramuzzo R, Macías RM, Sánchez R, Ogu R, Ramely R, Sgarzani R, Ramli R, Hillier R, Thumbadoo R, Ooi R, Abdus-Salam R, Masri R, Hodgson R, Mathew R, Wade R, D'archi S, Khan S, Ngaserin S, Kale S, Hassan S, Merghani S, Benamar S, Muhammad S, Badran S, Elsahli S, Heta S, Hammouche S, Baeesa S, Paiella S, Eldeen STEHT, Arkani S, Mittal S, Hirji S, Tebha S, Emile S, Dbouk S, Bandyopadhyay SK, Muhammad S, Olori S, Asirifi SA, Hailu S, Ling S, Newman S, Ross S, Wanjara S, Kumar S, Seneviratne S, Tamburello S, Suarez SB, Ingallinella S, Irshaidat S, Konswa S, Mambrilla S, Nasser S, Parini S, Pitoni S, Ornaghi S, Rodrigues SC, Abdelmohsen S, Aitken S, Tian S, Badiani S, Ahmad S, Swed S, Muthu S, Lakpriya S, Alzahrani S, Mikalauskas S, Lasrado S, Satoskar S, Bawa S, Altiner S, Garcia S, Stevens S, Demir S, Ken-Amoah S, Tranca S, Ziemann S, Awad S, Atici SD, Subramaniam S, Erel S, Jiang S, Efetov S, Efremov S, Katorkin S, Valladares SC, Contreras SM, Meriç S, Zenger S, Safi S, Leventoğlu S, Elsalhawy S, Shaikh S, Sheik S, Islam S, Shamim S, Waqar SH, Ahmad S, Farid S, Seraj SS, Sundarraju S, Karandikar S, Sambhwani S, Chopra S, Chowdhury S, Laura S, Ahmed S, Wason S, Tan SJH, Fraser S, Williams S, Ghozy S, Abdelmawgoud S, Shehata S, Sharma S, Ahmed S, Al-Touny SA, Ramzanali S, Nah SA, Jansen S, Rajan S, Dindyal S, Amin S, Ahmad S, Shoukrie SIM, Karar S, Patkar S, Abdulsalam S, Lin S, Hegde S, Fiorelli S, Quaresima S, Redondo SV, Palmisano S, Ruggiero S, Balogun S, Cais S, Cole S, Federer S, Le Roux S, Ippoliti S, Meneghini S, Viola S, Manfredelli S, Novello S, Gananadha S, Mesli SN, Kale S, Tani SI, Malik S, Anastasiadou S, Boligo S, Esposito S, Valanci S, Xenaki S, Pejkova S, Bandyopadhyay S, Trungu S, Basu S, Alkhatib S, Pérez-Bertólez S, Flores SL, Donoghue S, Lunca S, Orsoo S, Potamianos S, Devarakonda S, Suresh S, Croghan SM, Turi S, Capella S, Lucchini S, Magnone S, Salizzoni S, Scabini S, Scaringi S, Cioffi SPB, Seyfried S, Degener S, Potten S, Taha-Mehlitz S, Ali S, Angamuthu S, Mcaleer S, Knight SR, White S, Mantziari S, Kykalos S, Goh SK, Chowdhury SP, Ibrahim S, Elzwai S, Bansal S, Tripathy S, Amrayev S, Anwar SL, Banerjee S, Thakar S, Saeed S, Venkatappa SK, Das S, Techapongsatorn S, Dube SK, Lee S, González-Suárez S, Henriques S, Konjevoda S, Gisbertz S, Bravo SL, Mannan S, Bukhari SI, Zafar SN, Batista S, Chin SL, Arif T, Lawal TA, Aktokmakyan TV, Osborn T, Szakmany T, Sztipits T, Triantafyllou T, Valadez TAC, Singh T, Khaliq T, Patel T, Fadalla T, Jichi T, Sammour T, Al-Shaiji T, Naggs T, Barišić T, Nikolouzakis T, Bisgin T, Perra T, Uprak TK, Dagklis T, Liakakos T, Sidiropoulos T, Adjeso TJK, Dölker T, Oung T, Aherne T, Diehl T, Pinkney T, Raymond T, Rhomberg T, Schmitz-Rixen T, Madhuri TK, Lohmann TK, Yeoh T, Zaimis T, Bright T, Vilz TO, Glowka TR, Board T, Hardcastle T, Cohnert T, Mahečić TT, William TG, Klatte T, Abbott T, Watcyn-Jones T, Mendes T, Kulis T, Sečan T, Campagnaro T, Frisoni T, Simoncini T, Violante T, Safranovs TJ, Risteski T, Pang T, Akinyemi T, Yotsov T, Laeke T, Kochiyama T, Sholadoye TT, Alekberli T, Ezomike U, Giustizieri U, Grossi U, Köksoy ÜC, Bork U, Kisser U, Ronellenfitsch U, Saeed U, Bracale U, Jayarajah U, Rauf UHA, Bumbasirevic U, Ferrer UMJ, Ahmed U, Bello UM, Jogiat U, Sadia U, Galandarov V, Narayanan V, Calu V, Bianchi V, Ciniero V, Tonini V, Silvestri V, Vijay V, Dewan V, Lohsiriwat V, Thuduvage V, Mousafeiris V, Dragisic V, Sasireka V, Santric V, Kusuma VRM, Kolli VS, Alonso V, De Simone V, Picotti V, Martínez VM, Panduro-Correa V, Kakotkin V, Angulo VP, Turrado-Rodriguez V, Krishnamoorthy V, Ban VS, Shah V, Maiola V, Giordano V, La Vaccara V, Lizzi V, Papagni V, Schiavone V, Satchithanantham V, Garcia-Virto V, Jimenez V, Kumar V, Shelat V, Bhat V, Sodhai V, Graziadei V, Kutuzov V, Stoyanov V, Oktseloglou V, Flis V, Elhassan WAF, Yang W, Soon WC, Tashkandi W, Al-Khyatt W, Mabood W, Bijou W, Wijenayake W, D W, Krawczyk W, Atkins W, Bolton W, White W, Ceelen W, Vagena X, Gozal Y, Baba YI, Subramani Y, Jansen Y, Mittal Y, Kara Y, Zwain Y, Noureldin Y, Alawneh Y, Aydin Y, Lam YH, Tang Y, Lim Y, Dean Y, Tanas Y, Su YX, Fujimoto Y, Altinel Y, Frolova Y, Oshodi Y, Fadel ZT, Zahid Z, Elahi Z, Djama Z, Zaheen Z, Jawad Z, Demetrashvili Z, Gebremeskel Z, Gudisa Z, Alyami Z, Garoufalia Z, Li Z, Zimak Z, Radin Z, Balogh ZJ. Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries. Br J Surg 2023; 110:804-817. [PMID: 37079880 PMCID: PMC10364528 DOI: 10.1093/bjs/znad092] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. METHODS This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low-middle-income countries. RESULTS In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of 'single-use' consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low-middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. CONCLUSION This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high- and low-middle-income countries.
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Granata V, Fusco R, Setola SV, Cozzi D, Rega D, Petrillo A. Diffusion and Perfusion Imaging in Rectal Cancer Restaging. Semin Ultrasound CT MR 2023; 44:117-125. [PMID: 37245878 DOI: 10.1053/j.sult.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
The assessment of tumor response, after neoadjuvant radiochemotherapy (n-CRT), permits the stratification of patients for the proper therapeutical management. Although histopathology analysis of the surgical speciemen is considered the gold standard for assessing tumor response, magnetic resonance imaging (MRI), with its significant developments in technical imaging, have allowed an increase in accuracy for the evaluation of response. MRI provides a radiological tumor regression grade (mrTRG) that is correlated with the pathologic tumor regression grade (pTRG). Functional MRI parameters have additional impending in early prediction of the efficacy of therapy. Some of functional methodologies are already part of clinical practice: diffusion-weighted MRI (DW-MRI) and perfusion imaging (dynamic contrast enhanced MRI [DCE-MRI]).
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Degiuli M, Ortenzi M, Tomatis M, Puca L, Cianflocca D, Rega D, Maroli A, Elmore U, Pecchini F, Milone M, La Mendola R, Soligo E, Deidda S, Spoletini D, Cassini D, Aprile A, Mineccia M, Nikaj H, Marchegiani F, Maiello F, Bombardini C, Zuolo M, Carlucci M, Ferraro L, Falato A, Biondi A, Persiani R, Marsanich P, Fusario D, Solaini L, Pollesel S, Rizzo G, Coco C, Di Leo A, Cavaliere D, Roviello F, Muratore A, D'Ugo D, Bianco F, Bianchi PP, De Nardi P, Rigamonti M, Anania G, Belluco C, Polastri R, Pucciarelli S, Gentilli S, Ferrero A, Scabini S, Baldazzi G, Carlini M, Restivo A, Testa S, Parini D, De Palma GD, Piccoli M, Rosati R, Spinelli A, Delrio P, Borghi F, Guerrieri M, Reddavid R. Correction: Minimally invasive vs. open segmental resection of the splenic flexure for cancer: a nationwide study of the Italian Society of Surgical Oncology-Colorectal Cancer Network (SICO-CNN). Surg Endosc 2023:10.1007/s00464-023-10102-0. [PMID: 37160809 DOI: 10.1007/s00464-023-10102-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Giuliani G, Coletta D, Guerra F, Esposito S, Esposito A, De Pastena M, Rega D, Delrio P, La Raja C, Spinelli A, Massaron S, De Nardi P, Kauffmann EF, Boggi U, Deidda S, Zorcolo L, Marano A, Borghi F, Piccoli M, Depalma N, D'Ugo S, Spampinato M, Cozzani F, Del Rio P, Marcellinaro R, Carlini M, De Rosa R, Scabini S, Maiello F, Polastri R, Turri G, Pedrazzani C, Zese M, Parini D, Coratti A. The MIS-COVID-AGICT Study: Trend of Minimally Invasive Surgery for Gastrointestinal Cancer Treatment During the First Waves of the COVID-19 Pandemic in Italy. Subgroup Analysis from the COVID-AGICT Study: COVID-19 and Advanced Gastrointestinal Cancer Surgical Treatment. J Laparoendosc Adv Surg Tech A 2023. [PMID: 37130329 DOI: 10.1089/lap.2023.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
Background: A preliminary analysis from the COVID-Advanced Gastrointestinal Cancer Surgical Treatment (AGICT) study showed that the rate of minimally invasive surgery (MIS) for elective and urgent procedures did not decrease during the pandemic year. In this article, we aimed to perform a subgroup analysis using data from the COVID-AGICT study to evaluate the trend of MIS during the COVID-19 pandemic period in Italy. Methods: This study was conducted collecting data of MIS patients from the COVID-AGICT database. The primary endpoint was to demonstrate whether the SARS-CoV-2 pandemic scenario reduced MIS for elective treatment of gastrointestinal cancer (GIC) in Italy in 2020. The secondary endpoint was to evaluate the impact of the pandemic period on perioperative outcomes in the MIS group. Results: In the pandemic year, 62% of patients underwent surgery with a minimally invasive approach, compared to 63% in 2019 (P = .23). In 2020, the proportion of patients undergoing elective MIS decreased compared to the previous year (80% versus 82%, P = .04), and the rate of urgent MIS did not differ between the 2 years (31% and 33% in 2019 and 2020 - P = .66). Colorectal cancer was less likely to be treated with MIS approach during 2020 (78% versus 75%, P < .001). Conversely, the rate of MIS pancreatic resection was higher in 2020 (28% versus 22%, P < .002). Conversion to an open approach was lower in 2020 (7.2% versus 9.2% - P = .01). Major postoperative complications were similar in both years (11% versus 11%, P = .9). Conclusion: In conclusion, although MIS for elective treatment of GIC in Italy was reduced during the COVID-19 pandemic period, our study revealed that the overall proportion of MIS (elective and urgent) and postoperative outcomes were comparable to the prepandemic period. ClinicalTrial.gov (NCT04686747).
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Giuliani G, Guerra F, Messinese S, Santelli F, Salvischiani L, Esposito S, Ferraro L, Esposito A, De Pastena M, Rega D, Delrio P, La Raja C, Spinelli A, Massaron S, De Nardi P, Kauffmann EF, Boggi U, Deidda S, Restivo A, Marano A, Borghi F, Piccoli M, Depalma N, D'Ugo S, Spampinato M, Cozzani F, Del Rio P, Marcellinaro R, Carlini M, De Rosa R, Scabini S, Maiello F, Polastri R, Turri G, Pedrazzani C, Zese M, Parini D, Casaril A, Moretto G, De Leo A, Catarci M, Trapani R, Zonta S, Marsanic P, Muratore A, Di Franco G, Morelli L, Coppola A, Caputo D, Andreuccetti J, Pignata G, Mastrangelo L, Jovine E, Mazzola M, Ferrari G, Mariani L, Ceccarelli G, Giuseppe R, Bolzon S, Grasso M, Testa S, Germani P, de Manzini N, Langella S, Ferrero A, Coletta D, Bianchi PP, Bengala C, Coratti A. The COVID - AGICT study: COVID-19 and advanced gastro-intestinal cancer surgical treatment. A multicentric Italian study on the SARS-CoV-2 pandemic impact on gastro-intestinal cancers surgical treatment during the 2020. Analysis of perioperative and short-term oncological outcomes. Surg Oncol 2023; 47:101907. [PMID: 36924550 PMCID: PMC9892255 DOI: 10.1016/j.suronc.2023.101907] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/31/2022] [Accepted: 01/22/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND This Italian multicentric retrospective study aimed to investigate the possible changes in outcomes of patients undergoing surgery for gastrointestinal cancers during the COVID-19 pandemic. METHOD Our primary endpoint was to determine whether the pandemic scenario increased the rate of patients with colorectal, gastroesophageal, and pancreatic cancers resected at an advanced stage in 2020 compared to 2019. Considering different cancer staging systems, we divided tumors into early stages and advanced stages, using pathological outcomes. Furthermore, to assess the impact of the COVID-19 pandemic on surgical outcomes, perioperative data of both 2020 and 2019 were also examined. RESULTS Overall, a total of 8250 patients, 4370 (53%) and 3880 (47%) were surgically treated during 2019 and 2020 respectively, in 62 Italian surgical Units. In 2020, the rate of patients treated with an advanced pathological stage was not different compared to 2019 (P = 0.25). Nevertheless, the analysis of quarters revealed that in the second half of 2020 the rate of advanced cancer resected, tented to be higher compared with the same months of 2019 (P = 0.05). During the pandemic year 'Charlson Comorbidity Index score of cancer patients (5.38 ± 2.08 vs 5.28 ± 2.22, P = 0.036), neoadjuvant treatments (23.9% vs. 19.5%, P < 0.001), rate of urgent diagnosis (24.2% vs 20.3%, P < 0.001), colorectal cancer urgent resection (9.4% vs. 7.37, P < 0.001), and the rate of positive nodes on the total nodes resected per surgery increased significantly (7 vs 9% - 2.02 ± 4.21 vs 2.39 ± 5.23, P < 0.001). CONCLUSIONS Although the SARS-CoV-2 pandemic did not influence the pathological stage of colorectal, gastroesophageal, and pancreatic cancers at the time of surgery, our study revealed that the pandemic scenario negatively impacted on several perioperative and post-operative outcomes.
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Degiuli M, Ortenzi M, Tomatis M, Puca L, Cianflocca D, Rega D, Maroli A, Elmore U, Pecchini F, Milone M, La Mendola R, Soligo E, Deidda S, Spoletini D, Cassini D, Aprile A, Mineccia M, Nikaj H, Marchegiani F, Maiello F, Bombardini C, Zuolo M, Carlucci M, Ferraro L, Falato A, Biondi A, Persiani R, Marsanich P, Fusario D, Solaini L, Pollesel S, Rizzo G, Coco C, Di Leo A, Cavaliere D, Roviello F, Muratore A, D’Ugo D, Bianco F, Bianchi PP, De Nardi P, Rigamonti M, Anania G, Belluco C, Polastri R, Pucciarelli S, Gentilli S, Ferrero A, Scabini S, Baldazzi G, Carlini M, Restivo A, Testa S, Parini D, De Palma GD, Piccoli M, Rosati R, Spinelli A, Delrio P, Borghi F, Guerrieri M, Reddavid R. Minimally invasive vs. open segmental resection of the splenic flexure for cancer: a nationwide study of the Italian Society of Surgical Oncology-Colorectal Cancer Network (SICO-CNN). Surg Endosc 2023; 37:977-988. [PMID: 36085382 PMCID: PMC9944710 DOI: 10.1007/s00464-022-09547-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Evidence on the efficacy of minimally invasive (MI) segmental resection of splenic flexure cancer (SFC) is not available, mostly due to the rarity of this tumor. This study aimed to determine the survival outcomes of MI and open treatment, and to investigate whether MI is noninferior to open procedure regarding short-term outcomes. METHODS This nationwide retrospective cohort study included all consecutive SFC segmental resections performed in 30 referral centers between 2006 and 2016. The primary endpoint assessing efficacy was the overall survival (OS). The secondary endpoints included cancer-specific mortality (CSM), recurrence rate (RR), short-term clinical outcomes (a composite of Clavien-Dindo > 2 complications and 30-day mortality), and pathological outcomes (a composite of lymph nodes removed ≧12, and proximal and distal free resection margins length ≧ 5 cm). For these composites, a 6% noninferiority margin was chosen based on clinical relevance estimate. RESULTS A total of 606 patients underwent either an open (208, 34.3%) or a MI (398, 65.7%) SFC segmental resection. At univariable analysis, OS and CSM were improved in the MI group (log-rank test p = 0.004 and Gray's tests p = 0.004, respectively), while recurrences were comparable (Gray's tests p = 0.434). Cox multivariable analysis did not support that OS and CSM were better in the MI group (p = 0.109 and p = 0.163, respectively). Successful pathological outcome, observed in 53.2% of open and 58.3% of MI resections, supported noninferiority (difference 5.1%; 1-sided 95%CI - 4.7% to ∞). Successful short-term clinical outcome was documented in 93.3% of Open and 93.0% of MI procedures, and supported noninferiority as well (difference - 0.3%; 1-sided 95%CI - 5.0% to ∞). CONCLUSIONS Among patients with SFC, the minimally invasive approach met the criterion for noninferiority for postoperative complications and pathological outcomes, and was found to provide results of OS, CSM, and RR comparable to those of open resection.
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Nenert G, Pustovarenko A, Canossa S, Rega D, Van Der Veen M. Water cluster structure in the MOF CAU-10-H: a powder diffraction perspective. ACTA CRYSTALLOGRAPHICA SECTION A FOUNDATIONS AND ADVANCES 2022. [DOI: 10.1107/s2053273322090763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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Lorenzon L, De Luca R, Santoro G, Parini D, Rega D, Mellano A, Vigorita V, Jiménez-Rosellón R, Sandin M, Andriola V, Gallo G, Marino G, Turati L, Marsanic P, Marano L, Lucarini A, Aprile A, Sagnotta A, Biondi A, D'Ugo D, Delrio P, Balducci G, Montesi G, Muratore A, Ruano Poblador A, Persiani R, Frasson M, Roviello F, Vincenti L, Trompetto M, Torre GL, Scala D, Sgroi G, Patriti A, Simone M, Scabini S, Mancini S. Pathologic stage of ypT0N+ rectal cancers following neo-adjuvant treatment: clinical interpretation of an orphan status. Pathol Res Pract 2022; 237:154002. [PMID: 35849868 DOI: 10.1016/j.prp.2022.154002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/24/2022] [Accepted: 06/29/2022] [Indexed: 11/26/2022]
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Zaborowski AM, Adamina AAM, Aigner F, d'Allens L, Allmer C, Álvarez A, Anula R, Andric M, Bach SAS, Bala M, Barussaud M, Bausys A, Beggs A, Bellolio F, Bennett MR, Berdinskikh A, Bevan V, Biondo S, Bislenghi G, Bludau M, Brouwer N, Brown C, Bruns C, Buchanan DD, Buchwald P, Burger JW, Burlov N, Campanelli M, Capdepont M, Carvello M, Chew HH, Christoforidis D, Clark D, Climent M, Collinson R, Cologne KG, Contreras T, Croner R, Daniels IR, Dapri G, Davies J, Delrio P, Denost Q, Deutsch M, Dias A, D’Hoore A, Drozdov E, Duek D, Dunlop M, Dziki A, Edmundson A, Efetov S, El-Hussuna A, Elliot B, Emile S, Espin E, Evans M, Faes S, Faiz O, Figueiredo N, Fleming F, Foppa C, Fowler G, Frasson M, Forgan T, Frizelle F, Gadaev S, Gellona J, Glyn T, Goran B, Greenwood E, Guren MG, Guillon S, Gutlic I, Hahnloser D, Hampel H, Hanly A, Hasegawa H, Iversen LH, Hill A, Hill J, Hoch J, Hompes R, Hurtado L, Iaquinandi F, Imbrasaite U, Islam R, Jafari MD, Salido AJ, Jiménez-Toscano M, Kanemitsu Y, Karachun A, Karimuddin AA, Keller DS, Kelly J, Kennelly R, Khrykov G, Kocian P, Koh C, Kok N, Knight KA, Knol J, Kontovounisios C, Korner H, Krivokapic Z, Kronberger I, Kroon HM, Kryzauskas M, Kural S, Kusters M, Lakkis Z, Lankov T, Larson D, Lázár G, Lee KY, Lee SH, Lefèvre JH, Lepisto A, Lieu C, Loi L, Lynch C, Maillou-Martinaud H, Maroli A, Martin S, Martling A, Matzel KE, Mayol J, McDermott F, Meurette G, Millan M, Mitteregger M, Moiseenko A, Monson JRT, Morarasu S, Moritani K, Möslein G, Munini M, Nahas C, Nahas S, Negoi I, Novikova A, Ocares M, Okabayashi K, Olkina A, Oñate-Ocaña L, Otero J, Ozen C, Pace U, Julião GPS, Panaiotti L, Panis Y, Papamichael D, Patel S, Uriburu JCP, Peng SL, Pera M, Perez RO, Petrov A, Pfeffer F, Phang TP, Poskus T, Pringle H, Proud D, Raguz I, Rama N, Rasheed S, Raval MJ, Rega D, Reissfelder C, Meneses JCR, Ris F, Riss S, Rodriguez-Zentner H, Roxburgh CS, Saklani A, Sammour T, Saraste D, Schneider M, Seishima R, Sekulic A, Seppala T, Sheahan K, Shlomina A, Sigismondo G, Singnomklao T, Siragusa L, Smart N, Solis-Peña A, Spinelli A, Staiger RD, Stamos MJ, Steele S, Tan KK, Tanis PJ, Tekkis P, Teklay B, Tengku S, Tsarkov P, Turina M, Ulrich A, Vailati BB, van Harten M, Verhoef C, Warrier S, Wexner S, de Wilt H, Weinberg BA, Wells C, Wolthuis A, Xynos E, You N, Zakharenko A, Zeballos J, Zhou J, Winter DC. Impact of microsatellite status in early-onset colonic cancer. Br J Surg 2022; 109:632-636. [PMID: 35522613 DOI: 10.1093/bjs/znac108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 03/04/2022] [Accepted: 03/11/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND The molecular profile of early-onset colonic cancer is undefined. This study evaluated clinicopathological features and oncological outcomes of young patients with colonic cancer according to microsatellite status. METHODS Anonymized data from an international collaboration were analysed. Criteria for inclusion were patients younger than 50 years diagnosed with stage I-III colonic cancer that was surgically resected. Clinicopathological features, microsatellite status, and disease-specific outcomes were evaluated. RESULTS A total of 650 patients fulfilled the criteria for inclusion. Microsatellite instability (MSI) was identified in 170 (26.2 per cent), whereas 480 had microsatellite-stable (MSS) tumours (relative risk of MSI 2.5 compared with older patients). MSI was associated with a family history of colorectal cancer and lesions in the proximal colon. The proportions with pathological node-positive disease (45.9 versus 45.6 per cent; P = 1.000) and tumour budding (20.3 versus 20.5 per cent; P = 1.000) were similar in the two groups. Patients with MSI tumours were more likely to have BRAF (22.5 versus 6.9 per cent; P < 0.001) and KRAS (40.0 versus 24.2 per cent; P = 0.006) mutations, and a hereditary cancer syndrome (30.0 versus 5.0 per cent; P < 0.001; relative risk 6). Five-year disease-free survival rates in the MSI group were 95.0, 92.0, and 80.0 per cent for patients with stage I, II, and III tumours, compared with 88.0, 88.0, and 65.0 per cent in the MSS group (P = 0.753, P = 0.487, and P = 0.105 respectively). CONCLUSION Patients with early-onset colonic cancer have a high risk of MSI and defined genetic conditions. Those with MSI tumours have more adverse pathology (budding, KRAS/BRAF mutations, and nodal metastases) than older patients with MSI cancers.
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Degiuli M, Elmore U, De Luca R, De Nardi P, Tomatis M, Biondi A, Persiani R, Solaini L, Rizzo G, Soriero D, Cianflocca D, Milone M, Turri G, Rega D, Delrio P, Pedrazzani C, De Palma GD, Borghi F, Scabini S, Coco C, Cavaliere D, Simone M, Rosati R, Reddavid R. Risk factors for anastomotic leakage after anterior resection for rectal cancer (RALAR study): A nationwide retrospective study of the Italian Society of Surgical Oncology Colorectal Cancer Network Collaborative Group. Colorectal Dis 2022; 24:264-276. [PMID: 34816571 PMCID: PMC9300066 DOI: 10.1111/codi.15997] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/07/2021] [Accepted: 11/13/2021] [Indexed: 12/18/2022]
Abstract
AIM Anastomotic leakage after restorative surgery for rectal cancer shows high morbidity and related mortality. Identification of risk factors could change operative planning, with indications for stoma construction. This retrospective multicentre study aims to assess the anastomotic leak rate, identify the independent risk factors and develop a clinical prediction model to calculate the probability of leakage. METHODS The study used data from 24 Italian referral centres of the Colorectal Cancer Network of the Italian Society of Surgical Oncology. Patients were classified into two groups, AL (anastomotic leak) or NoAL (no anastomotic leak). The effect of patient-, disease-, treatment- and postoperative outcome-related factors on anastomotic leak after univariable and multivariable analysis was measured. RESULTS A total of 5398 patients were included, 552 in group AL and 4846 in group NoAL. The overall incidence of leaks was 10.2%, with a mean time interval of 6.8 days. The 30-day leak-related mortality was 2.6%. Sex, body mass index, tumour location, type of approach, number of cartridges employed, weight loss, clinical T stage and combined multiorgan resection were identified as independent risk factors. The stoma did not reduce the leak rate but significantly decreased leak severity and reoperation rate. A nomogram with a risk score (RALAR score) was developed to predict anastomotic leak risk at the end of resection. CONCLUSIONS While a defunctioning stoma did not affect the leak risk, it significantly reduced its severity. Surgeons should recognize independent risk factors for leaks at the end of rectal resection and could calculate a risk score to select high-risk patients eligible for protective stoma construction.
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Zaborowski AM, Abdile A, Adamina M, Aigner F, d'Allens L, Allmer C, Álvarez A, Anula R, Andric M, Atallah S, Bach S, Bala M, Barussaud M, Bausys A, Beggs A, Bellolio F, Bennett MR, Berdinskikh A, Bevan V, Biondo S, Bislenghi G, Bludau M, Brouwer N, Brown C, Bruns C, Buchanan DD, Buchwald P, Burger JWA, Burlov N, Campanelli M, Capdepont M, Carvello M, Chew HH, Christoforidis D, Clark D, Climent M, Collinson R, Cologne KG, Contreras T, Croner R, Daniels IR, Dapri G, Davies J, Delrio P, Denost Q, Deutsch M, Dias A, D'Hoore A, Drozdov E, Duek D, Dunlop M, Dziki A, Edmundson A, Efetov S, El-Hussuna A, Elliot B, Emile S, Espin E, Evans M, Faes S, Faiz O, Figueiredo N, Fleming F, Foppa C, Fowler G, Frasson M, Forgan T, Frizelle F, Gadaev S, Gellona J, Glyn T, Goran B, Greenwood E, Guren MG, Guillon S, Gutlic I, Hahnloser D, Hampel H, Hanly A, Hasegawa H, Iversen LH, Hill A, Hill J, Hoch J, Hompes R, Hurtado L, Iaquinandi F, Imbrasaite U, Islam R, Jafari MD, Salido AJ, Jiménez Toscano M, Kanemitsu Y, Karachun A, Karimuddin AA, Keller DS, Kelly J, Kennelly R, Khrykov G, Kocian P, Koh C, Kok N, Knight KA, Knol J, Kontovounisios C, Korner H, Krivokapic Z, Kronberger I, Kroon HM, Kryzauskas M, Kural S, Kusters M, Lakkis Z, Lankov T, Larson D, Lázár G, Lee KY, Lee SH, Lefèvre JH, Lepisto A, Lieu C, Loi L, Lynch C, Maillou-Martinaud H, Maroli A, Martin S, Martling A, Matzel KE, Mayol J, McDermott F, Meurette G, Millan M, Mitteregger M, Moiseenko A, Monson JRT, Morarasu S, Moritani K, Möslein G, Munini M, Nahas C, Nahas S, Negoi I, Novikova A, Ocares M, Okabayashi K, Olkina A, Oñate-Ocaña L, Otero J, Ozen C, Pace U, Julião GPS, Panaiotti L, Panis Y, Papamichael D, Patel S, Uriburu JCP, Peng SL, Pera M, Perez RO, Petrov A, Pfeffer F, Phang TP, Poskus T, Pringle H, Proud D, Raguz I, Rama N, Rasheed S, Raval MJ, Rega D, Reissfelder C, Meneses JCR, Ris F, Riss S, Rodriguez-Zentner H, Roxburgh CS, Saklani A, Sammour T, Saraste D, Schneider M, Seishima R, Sekulic A, Seppala T, Sheahan K, Shlomina A, Sigismondo G, Singnomklao T, Siragusa L, Smart N, Solis-Peña A, Spinelli A, Staiger RD, Stamos MJ, Steele S, Tan KK, Tanis PJ, Tekkis P, Teklay B, Tengku S, Tsarkov P, Turina M, Ulrich A, Vailati BB, van Harten M, Verhoef C, Warrier S, Wexner S, de Wilt H, Weinberg BA, Wells C, Wolthuis A, Xynos E, You N, Zakharenko A, Zeballos J, Zhou J, Winter DC. Microsatellite instability in young patients with rectal cancer: molecular findings and treatment response. Br J Surg 2022; 109:251-255. [PMID: 35030243 DOI: 10.1093/bjs/znab437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 11/22/2021] [Indexed: 12/27/2022]
Abstract
In this study of 400 patients with early-onset rectal cancer, 12.5 per cent demonstrated microsatellite instability (MSI). MSI was associated with a reduced likelihood of nodal positivity, an increased rate of pathological complete response, and improved disease-specific survival.
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Marchegiani F, Palatucci V, Capelli G, Guerrieri M, Belluco C, Rega D, Morpurgo E, Coco C, Restivo A, De Franciscis S, Aschele C, Perin A, Bonomo M, Muratore A, Spinelli A, Ramuscello S, Bergamo F, Montesi G, Spolverato G, Del Bianco P, Gambacorta MA, Delrio P, Pucciarelli S. ASO Visual Abstract: Rectal Sparing Approach After Neoadjuvant Therapy in Patients with Rectal Cancer: The Preliminary Results of the ReSARCh Trial. Ann Surg Oncol 2022. [PMID: 35041095 DOI: 10.1245/s10434-021-11171-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Granata V, Faggioni L, Grassi R, Fusco R, Reginelli A, Rega D, Maggialetti N, Buccicardi D, Frittoli B, Rengo M, Bortolotto C, Prost R, Lacasella GV, Montella M, Ciaghi E, Bellifemine F, De Muzio F, Grazzini G, De Filippo M, Cappabianca S, Laghi A, Grassi R, Brunese L, Neri E, Miele V, Coppola F. Structured reporting of computed tomography in the staging of colon cancer: a Delphi consensus proposal. LA RADIOLOGIA MEDICA 2022; 127:21-29. [PMID: 34741722 PMCID: PMC8795004 DOI: 10.1007/s11547-021-01418-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/28/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Structured reporting (SR) in radiology is becoming increasingly necessary and has been recognized recently by major scientific societies. This study aims to build structured CT-based reports in colon cancer during the staging phase in order to improve communication between the radiologist, members of multidisciplinary teams and patients. MATERIALS AND METHODS A panel of expert radiologists, members of the Italian Society of Medical and Interventional Radiology, was established. A modified Delphi process was used to develop the SR and to assess a level of agreement for all report sections. Cronbach's alpha (Cα) correlation coefficient was used to assess internal consistency for each section and to measure quality analysis according to the average inter-item correlation. RESULTS The final SR version was built by including n = 18 items in the "Patient Clinical Data" section, n = 7 items in the "Clinical Evaluation" section, n = 9 items in the "Imaging Protocol" section and n = 29 items in the "Report" section. Overall, 63 items were included in the final version of the SR. Both in the first and second round, all sections received a higher than good rating: a mean value of 4.6 and range 3.6-4.9 in the first round; a mean value of 5.0 and range 4.9-5 in the second round. In the first round, Cronbach's alpha (Cα) correlation coefficient was a questionable 0.61. In the first round, the overall mean score of the experts and the sum of scores for the structured report were 4.6 (range 1-5) and 1111 (mean value 74.07, STD 4.85), respectively. In the second round, Cronbach's alpha (Cα) correlation coefficient was an acceptable 0.70. In the second round, the overall mean score of the experts and the sum of score for structured report were 4.9 (range 4-5) and 1108 (mean value 79.14, STD 1.83), respectively. The overall mean score obtained by the experts in the second round was higher than the overall mean score of the first round, with a lower standard deviation value to underline greater agreement among the experts for the structured report reached in this round. CONCLUSIONS A wide implementation of SR is of critical importance in order to offer referring physicians and patients optimum quality of service and to provide researchers with the best quality data in the context of big data exploitation of available clinical data. Implementation is a complex procedure, requiring mature technology to successfully address the multiple challenges of user-friendliness, organization and interoperability.
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Marchegiani F, Palatucci V, Capelli G, Guerrieri M, Belluco C, Rega D, Morpurgo E, Coco C, Restivo A, De Franciscis S, Aschele C, Perin A, Bonomo M, Muratore A, Spinelli A, Ramuscello S, Bergamo F, Montesi G, Spolverato G, Del Bianco P, Gambacorta MA, Delrio P, Pucciarelli S. Rectal Sparing Approach After Neoadjuvant Therapy in Patients with Rectal Cancer: The Preliminary Results of the ReSARCh Trial. Ann Surg Oncol 2021; 29:1880-1889. [PMID: 34855063 DOI: 10.1245/s10434-021-11121-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/12/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Rectum-preservation for locally advanced rectal cancer has been proposed as an alternative to total mesorectal excision (TME) in patients with major (mCR) or complete clinical response (cCR) after neoadjuvant therapy. The purpose of this study was to report on the short-term outcomes of ReSARCh (Rectal Sparing Approach after preoperative Radio- and/or Chemotherapy) trial, which is a prospective, multicenter, observational trial that investigated the role of transanal local excision (LE) and watch-and-wait (WW) as integrated approaches after neoadjuvant therapy for rectal cancer. METHODS Patients with mid-low rectal cancer who achieved mCR or cCR after neoadjuvant therapy and were fit for major surgery were enrolled. Clinical response was evaluated at 8 and 12 weeks after completion of chemoradiotherapy. Treatment approach, incidence, and reasons for subsequent TME were recorded. RESULTS From 2016 to 2019, 160 patients were enrolled; mCR or cCR at 12 weeks was achieved in 64 and 96 of patients, respectively. Overall, 98 patients were managed with LE and 62 with WW. In the LE group, Clavien-Dindo 3+ complications occurred in three patients. The rate of cCR increased from 8- to 12-week restaging. Thirty-three (94.3%) of 35 patients with cCR had ypT0-1 tumor. At a median 24 months follow-up, a tumor regrowth was found in 15 (24.2%) patients undergoing WW. CONCLUSIONS LE for patients achieving cCR or mCR is safe. A 12-week interval from chemoradiotherapy completion to LE is correlated with an increased cCR rate. The risk of ypT > is reduced when LE is performed after cCR.
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Deidda S, Elmore U, Rosati R, De Nardi P, Vignali A, Puccetti F, Spolverato G, Capelli G, Zuin M, Muratore A, Danna R, Calabrò M, Guerrieri M, Ortenzi M, Ghiselli R, Scabini S, Aprile A, Pertile D, Sammarco G, Gallo G, Sena G, Coco C, Rizzo G, Pafundi DP, Belluco C, Innocente R, Degiuli M, Reddavid R, Puca L, Delrio P, Rega D, Conti P, Pastorino A, Zorcolo L, Pucciarelli S, Aschele C, Restivo A. Association of Delayed Surgery With Oncologic Long-term Outcomes in Patients With Locally Advanced Rectal Cancer Not Responding to Preoperative Chemoradiation. JAMA Surg 2021; 156:1141-1149. [PMID: 34586340 DOI: 10.1001/jamasurg.2021.4566] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Extending the interval between the end of neoadjuvant chemoradiotherapy (CRT) and surgery may enhance tumor response in patients with locally advanced rectal cancer. However, data on the association of delaying surgery with long-term outcome in patients who had a minor or poor response are lacking. Objective To assess a large series of patients who had minor or no tumor response to CRT and the association of shorter or longer waiting times between CRT and surgery with short- and long-term outcomes. Design, Setting, and Participants This is a multicenter retrospective cohort study. Data from 1701 consecutive patients with rectal cancer treated in 12 Italian referral centers were analyzed for colorectal surgery between January 2000 and December 2014. Patients with a minor or null tumor response (ypT stage of 2 to 3 or ypN positive) stage greater than 0 to neoadjuvant CRT were selected for the study. The data were analyzed between March and July 2020. Exposures Patients who had a minor or null tumor response were divided into 2 groups according to the wait time between neoadjuvant therapy end and surgery. Differences in surgical and oncological outcomes between these 2 groups were explored. Main Outcomes and Measures The primary outcomes were overall and disease-free survival between the 2 groups. Results Of a total of 1064 patients, 654 (61.5%) were male, and the median (IQR) age was 64 (55-71) years. A total of 579 patients (54.4%) had a shorter wait time (8 weeks or less) 485 patients (45.6%) had a longer wait time (greater than 8 weeks). A longer waiting time before surgery was associated with worse 5- and 10-year overall survival rates (67.6% [95% CI, 63.1%-71.7%] vs 80.3% [95% CI, 76.5%-83.6%] at 5 years; 40.1% [95% CI, 33.5%-46.5%] vs 57.8% [95% CI, 52.1%-63.0%] at 10 years; P < .001). Also, delayed surgery was associated with worse 5- and 10-year disease-free survival (59.6% [95% CI, 54.9%-63.9%] vs 72.0% [95% CI, 67.9%-75.7%] at 5 years; 36.2% [95% CI, 29.9%-42.4%] vs 53.9% [95% CI, 48.5%-59.1%] at 10 years; P < .001). At multivariate analysis, a longer waiting time was associated with an augmented risk of death (hazard ratio, 1.84; 95% CI, 1.50-2.26; P < .001) and death/recurrence (hazard ratio, 1.69; 95% CI, 1.39-2.04; P < .001). Conclusions and Relevance In this cohort study, a longer interval before surgery after completing neoadjuvant CRT was associated with worse overall and disease-free survival in tumors with a poor pathological response to preoperative CRT. Based on these findings, patients who do not respond well to CRT should be identified early after the end of CRT and undergo surgery without delay.
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Zaborowski AM, Abdile A, Adamina M, Aigner F, d'Allens L, Allmer C, Álvarez A, Anula R, Andric M, Atallah S, Bach S, Bala M, Barussaud M, Bausys A, Bebington B, Beggs A, Bellolio F, Bennett MR, Berdinskikh A, Bevan V, Biondo S, Bislenghi G, Bludau M, Boutall A, Brouwer N, Brown C, Bruns C, Buchanan DD, Buchwald P, Burger JWA, Burlov N, Campanelli M, Capdepont M, Carvello M, Chew HH, Christoforidis D, Clark D, Climent M, Cologne KG, Contreras T, Croner R, Daniels IR, Dapri G, Davies J, Delrio P, Denost Q, Deutsch M, Dias A, D'Hoore A, Drozdov E, Duek D, Dunlop M, Dziki A, Edmundson A, Efetov S, El-Hussuna A, Elliot B, Emile S, Espin E, Evans M, Faes S, Faiz O, Fleming F, Foppa C, Fowler G, Frasson M, Figueiredo N, Forgan T, Frizelle F, Gadaev S, Gellona J, Glyn T, Gong J, Goran B, Greenwood E, Guren MG, Guillon S, Gutlic I, Hahnloser D, Hampel H, Hanly A, Hasegawa H, Iversen LH, Hill A, Hill J, Hoch J, Hoffmeister M, Hompes R, Hurtado L, Iaquinandi F, Imbrasaite U, Islam R, Jafari MD, Kanemitsu Y, Karachun A, Karimuddin AA, Keller DS, Kelly J, Kennelly R, Khrykov G, Kocian P, Koh C, Kok N, Knight KA, Knol J, Kontovounisios C, Korner H, Krivokapic Z, Kronberger I, Kroon HM, Kryzauskas M, Kural S, Kusters M, Lakkis Z, Lankov T, Larson D, Lázár G, Lee KY, Lee SH, Lefèvre JH, Lepisto A, Lieu C, Loi L, Lynch C, Maillou-Martinaud H, Maroli A, Martin S, Martling A, Matzel KE, Mayol J, McDermott F, Meurette G, Millan M, Mitteregger M, Moiseenko A, Monson JRT, Morarasu S, Moritani K, Möslein G, Munini M, Nahas C, Nahas S, Negoi I, Novikova A, Ocares M, Okabayashi K, Olkina A, Oñate-Ocaña L, Otero J, Ozen C, Pace U, São Julião GP, Panaiotti L, Panis Y, Papamichael D, Park J, Patel S, Patrón Uriburu JC, Pera M, Perez RO, Petrov A, Pfeffer F, Phang PT, Poskus T, Pringle H, Proud D, Raguz I, Rama N, Rasheed S, Raval MJ, Rega D, Reissfelder C, Reyes Meneses JC, Ris F, Riss S, Rodriguez-Zentner H, Roxburgh CS, Saklani A, Salido AJ, Sammour T, Saraste D, Schneider M, Seishima R, Sekulic A, Seppala T, Sheahan K, Shine R, Shlomina A, Sica GS, Singnomklao T, Siragusa L, Smart N, Solis A, Spinelli A, Staiger RD, Stamos MJ, Steele S, Sunderland M, Tan KK, Tanis PJ, Tekkis P, Teklay B, Tengku S, Jiménez-Toscano M, Tsarkov P, Turina M, Ulrich A, Vailati BB, van Harten M, Verhoef C, Warrier S, Wexner S, de Wilt H, Weinberg BA, Wells C, Wolthuis A, Xynos E, You N, Zakharenko A, Zeballos J, Winter DC. Characteristics of Early-Onset vs Late-Onset Colorectal Cancer: A Review. JAMA Surg 2021; 156:865-874. [PMID: 34190968 DOI: 10.1001/jamasurg.2021.2380] [Citation(s) in RCA: 110] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance The incidence of early-onset colorectal cancer (younger than 50 years) is rising globally, the reasons for which are unclear. It appears to represent a unique disease process with different clinical, pathological, and molecular characteristics compared with late-onset colorectal cancer. Data on oncological outcomes are limited, and sensitivity to conventional neoadjuvant and adjuvant therapy regimens appear to be unknown. The purpose of this review is to summarize the available literature on early-onset colorectal cancer. Observations Within the next decade, it is estimated that 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in adults younger than 50 years. Potential risk factors include a Westernized diet, obesity, antibiotic usage, and alterations in the gut microbiome. Although genetic predisposition plays a role, most cases are sporadic. The full spectrum of germline and somatic sequence variations implicated remains unknown. Younger patients typically present with descending colonic or rectal cancer, advanced disease stage, and unfavorable histopathological features. Despite being more likely to receive neoadjuvant and adjuvant therapy, patients with early-onset disease demonstrate comparable oncological outcomes with their older counterparts. Conclusions and Relevance The clinicopathological features, underlying molecular profiles, and drivers of early-onset colorectal cancer differ from those of late-onset disease. Standardized, age-specific preventive, screening, diagnostic, and therapeutic strategies are required to optimize outcomes.
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