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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: 116] [Impact Index Per Article: 38.7] [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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Rega D, Granata V, Petrillo A, Pace U, Sassaroli C, Di Marzo M, Cervone C, Fusco R, D’Alessio V, Nasti G, Romano C, Avallone A, Pecori B, Botti G, Tatangelo F, Maiolino P, Delrio P. Organ Sparing for Locally Advanced Rectal Cancer after Neoadjuvant Treatment Followed by Electrochemotherapy. Cancers (Basel) 2021; 13:cancers13133199. [PMID: 34206858 PMCID: PMC8267997 DOI: 10.3390/cancers13133199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 12/21/2022] Open
Abstract
Simple Summary This is a Phase II randomized controlled trial conducted with the aim of investigating whether the use of Electrochemotherapy after neoadjuvant therapy (ECT) and before surgery in patients with major clinical response allows for a more conservative surgical approach in patients with Locally Advanced Rectal Cancer (LARC) in comparison with the control group that will not receive ECT. The treatment response, in both the control arm and in the treatment arm, will be assessed using the histopathological tumor regression grade on tissue specimens after local excision. Abstract Background: Currently, 45–55% of rectal cancer patients receive preoperative chemo- radio-therapy for Locally Advanced Rectal Cancer (LARC). The idea of our study is to use Electrochemotherapy (ECT) before surgery, in patients with major clinical response after neoadjuvant therapy, to allow for a more conservative surgical approach. Objective: To evaluate the increase of the complete response rate after neoadjuvant treatment in LARC and to spare organ function due to total mesorectal excision (TME). Patients and Methods: This is a Phase II randomized controlled trial enrolling 70 patients that will be developed in two stages. In the first step, 28 patients will be enrolled: 14 of these will receive ECT for four weeks after neo-adjuvant treatment and then local excision (treatment group) and 14 patients will receive neo-adjuvant treatment and then local excision (control group). If an increase of response rate is observed in the first stage, and/or feasibility/safety is demonstrated, the second stage of the trial will be performed, enrolling an additional 42 patients. The treatment response. in both the control arm and the treatment arm, will be assessed using the histopathological tumor regression grade on tissue specimens after local excision.
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Ottaiano A, Scala S, Santorsola M, Trotta AM, D'Alterio C, Portella L, Clemente O, Nappi A, Zanaletti N, De Stefano A, Avallone A, Granata V, Notariello C, Luce A, Lombardi A, Picone C, Petrillo A, Perri F, Tatangelo F, Di Mauro A, Albino V, Izzo F, Rega D, Pace U, Di Marzo M, Chiodini P, De Feo G, Del Prete P, Botti G, Delrio P, Caraglia M, Nasti G. Aflibercept or bevacizumab in combination with FOLFIRI as second-line treatment of mRAS metastatic colorectal cancer patients: the ARBITRATION study protocol. Ther Adv Med Oncol 2021; 13:1758835921989223. [PMID: 33854566 PMCID: PMC8010802 DOI: 10.1177/1758835921989223] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/31/2020] [Indexed: 11/16/2022] Open
Abstract
Background: The intensive study of predictive factors has strongly ameliorated the therapeutic flow-chart of metastatic colorectal cancer (mCRC) by allowing the selection of patients who benefit from specific therapies. For instance, in mRAS (mutated RAS) mCRC patients, anti-EGFR drugs (cetuximab and panitumumab) are not recommended; in this group of patients, the use of anti-angiogenic drugs (bevacizumab and aflibercept) is predominant. However, at progression to standard bevacizumab-based first-line chemotherapy, still to date, there are no studies to guide oncologists in the choice of the best second-line anti-angiogenic drug (bevacizumab beyond progression versus aflibercept). Methods: ARBITRATION is a prospective, observational study assessing efficacy differences between second-line fluorouracil/irinotecan (FOLFIRI)/bevacizumab versus FOLFIRI/aflibercept at progression to fluoropyrimidines, oxaliplatin and bevacizumab in mRAS mCRC patients. A test power of 80%, a median survival of 9 months from second-line treatment start and a hazard ratio of 0.67 between the two schedules were the basis for statistical design. The final sample will be 220 patients (110 per treatment). The significance will be verified with a two-tailed log-rank test with an alpha value of the I-type error of 5%. Time-to-outcome will be described by Kaplan–Meier curves and prognostic factors studied through multivariable analyses based on the Cox model. Secondary objectives include safety, responses’ duration and progression-free survival. A translational research will be conducted to measure several angiogenic proteins in patients’ serum before starting the therapy in order to evidence any angiogenic factor patterns related to outcome. Discussion: We present a large, prospective, observational study aiming to answer two scientific questions: (1) outcome differences between second-line treatments with FOLFIRI/bevacizumab beyond progression versus FOLFIRI/aflibercept in mRAS mCRC patients, (2) angiogenic factors’ patterns that could associate with efficacy and help oncologists to apply best the therapeutic anti-angiogenic strategies. Trial registration: The ARBITRATION trial (version 0.0, 13 April 2020) has been registered into the clinicaltrials.gov registry on 20 May 2020 with identifier NCT04397601.
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Knight SR, Shaw CA, Pius R, Drake TM, Norman L, Ademuyiwa AO, Adisa AO, Aguilera ML, Al-Saqqa SW, Al-Slaibi I, Bhangu A, Biccard BM, Brocklehurst P, Costas-Chavarri A, Chu K, Dare A, Elhadi M, Fairfield CJ, Fitzgerald JE, Ghosh D, Glasbey J, van Berge Henegouwen MI, Ingabire JA, Kingham TP, Lapitan MC, Lawani I, Lieske B, Lilford R, Martin J, McLean KA, Moore R, Morton D, Nepogodiev D, Ntirenganya F, Pata F, Pinkney T, Qureshi AU, Ramos-De la Medina A, Riad A, Salem HK, Simões J, Spence R, Smart N, Tabiri S, Thomas H, Weiser TG, West M, Whitaker J, Harrison EM, Gjata A, Modolo MM, King S, Chan E, Nahar SN, Waterman A, Vervoort D, Lawani I, Bedada AG, De Azevedo B, Figueiredo AG, Sokolov M, Barendegere V, Ekwen G, Agarwal A, Dare A, Liu Q, Camilo Correa J, Malemo KL, Bake J, Mihanovic J, Kuncarová K, Orhalmi J, Salem H, Teras J, Kechagias A, Arnaud AP, Lindert J, Tabiri S, Kalles V, Aguilera-Arevalo ML, Recinos G, Baranyai Z, Kumar B, Neelamraju Lakshmi H, Zachariah SK, Alexander P, Kumar Venkatappa S, Pramesh C, Amandito R, Fleming C, Ansaloni L, Pata F, Pellino G, Altibi AM, Nour I, Hamdun I, Elhadi M, Ghellai AM, Venskutonis D, Poskus T, Zilinskas J, Whitaker J, Malemia P, Tew YY, Borg E, Ellul S, Ramos-De la Medina A, Wafqui FZ, Borowski DW, van Dalen AS, Wells C, Adamou H, Ademuyiwa A, Adisa A, Søreide K, Qureshi AU, Al-Slaibi I, Al Saqqa S, Alser O, Tahboub H, Segovia Lohse HA, Shu Yip S, Lapitan MC, Major P, Simões J, Sampaio Soares A, Bratu MR, Litvin A, Vardanyan A, Allen Ingabire JC, Costas-Chavarri A, Gudal A, Albati N, Juloski J, Lieske B, Rems M, Rayne S, Van Straten S, Moodley Y, Chu K, Moore R, Ortega Vázquez I, Ruiz-Tovar J, Senanayake KJ, Thalgaspitiya SPB, Omer OA, Homeida A, Cengiz Y, Clerc D, Alshaar M, Bouaziz H, Altinel Y, Doe M, Freigofer M, Teasdale E, Kabariti R, Clements JM, Knight SR, Ashfaq A, Azodo I, Wagner G, Trostchansky I, Maimbo M, Linyama D, Nina H, Zeko A, Fermani CG, Modolo MM, Villalobos S, Carballo F, Farina P, Guckenheimer S, Dickfos M, Ajmera A, Chong C, Gourlay R, Hussaini S, Lee YJ, Majid A, Martin P, Miles R, Morris OJ, Phua J, Ridley W, Saluja T, Tan RR, Teh J, Wells A, Arora B, Dollie Q, Ho D, Ma Y, Perera OM, Truong A, Dawson AC, Lim B, Pahalawatta U, Phan J, Woon-Shoo-Tong XMS, Yeoh A, Charman L, Drane A, Laura S, Lo CCW, Mozes A, Poon R, Tan HH, Wall E, Chopra P, De Giovanni J, Dhital B, Draganic B, Duller A, Gani J, Goh YK, Jeong JY, McManus B, Nagappan P, Pockney P, Rugendyke A, Sarrami M, Smith S, Wills V, Wong HV, Ye G, Zhang G, Brooker E, Feng D, Lau B, Ngai C, Birks S, Gyorki D, Otero de Pablos J, Abbosh A, Gillespie C, Mahmoud A, Kwan B, Lawson J, Warwick A, Bingham J, Cockbain AJ, Dudi-Venkata NN, Ellaby-Hall J, Finlay B, Humphries E, Pisaniello J, Pisaniello M, Salih S, Sammour T, Abd Wahab HH, De Silva A, Hayward N, Iyer K, Maddern G, Prevost GA, Annapureddy N, Settipalli KP, Yeo J, Hempenstall L, Pham L, Purcell S, Talavera C, Vaska AI, Chaggar G, Chrapko P, Cocco A, Coulter-Nile SMCJ, Ctercteko G, French J, Gong H, Gosselink M, Jegathees T, Jin I, Kalachov M, Kiefhaber K, Lee K, Luong J, Phan S, Pleass H, Veale K, Zeng Z, Au A, DeBiasio A, Deng I, Myooran J, Nair A, Stewart P, Stift A, Unger LW, Wimmer K, Ahmed N, Hasan S, Rahman S, O'Shea M, Padmore G, Peters A, Perduca P, Pulcina G, Tinton N, Buxant F, Dabin E, Garofalo G, Dossou F, Lawani I, Gnangnon FHR, Imorou Souaibou Y, Bedada AG, Motlaleselelo P, Tlhomelang O, Lima Buarque I, Mendonça Ataíde Gomes G, Vieira Barros A, Batashki I, Damianov N, Stoyanov V, Dardanov D, Maslyankov S, Petkov P, Sokolov M, Todorov G, Zhivkov E, Akisheva A, Castilla Moreno MA, Genov G, Ilieva I, Ivanov T, Karamanliev M, Khan A, Mitkov E, Yotsov T, Atanasov B, Belev N, Slavchev M, Nsengiyumva C, Jones E, Stock S, Ekwen G, Kyota S, Brown J, Mabanza K. T, Nigo Samuel L, Otuneme C, Prosper N, Umenze F, Boutros M, Caminsky N, Dumitra S, Garfinkle R, Morency D, Salama E, Banks A, Ferri L, He H, Katz A, Liberman AS, Meterissian S, Pang A, Parvez E, Agarwal A, Dare A, Hameed U, Osman F, Sequeira S, Coburn N, Dare A, Jaffer A, Karanicolas P, Mosseler M, Musselman R, Liu X, Yip CW, Garces-Otero JS, Guzman C, Sierra S, Uribe Valencia A, Cabrera Rivera PA, Camelo S, Gonzalez A, González-Orozco A, Mosquera Paz MS, Perez Rivera CJ, Gonzalez F, Isaza-Restrepo A, Nino- Torres L, Arias Madrid N, Mendoza Arango MC, Sierra S, Bake J, Tsandiraki J, Jemendžic D, Kocman B, Šuman O, Canic R, Jurišic D, Karakas I, Krizanovic Rupcic A, Pitlovic V, Samardžic J, Kopljar M, Bacic I, Domini E, Karlo R, Mihanovic J, Miljanic D, Simic A, Ahmed M, Al Nassrallah M, Altaf R, Amjad T, Eltoum R, Haidar H, Hassan A, Khalil O, Qasem M, Ramesh R, Sajith G, Wisal M, Žatecký J, Bujda M, Jirankova K, Paclik A, Abdallah A, Abdulgawad Almogy M, Ayman El-sawy E, ElFayoumy AM, Elghareeb N, Esmat NA, Fadel A, Habater A, Hamdy H, Hefni A, Kamal M, Mohamed Abobakr N, Sayed A, Shaker N, Taha E, Tharwat H, Zakaria O, Abdelmotaleb I, Al-Dhufri A, Al-Himyari HS, El sheikh E, Eldmaty A, Elkhalawy A, M.Elkhashen A, Magdy K, Mostafa S, Sadia HD, Saleh MM, Samir D, Yahia Mohamed Ali M, A. Nassar M, Abdelhady S, Abdelrazek A, Abdelsalam I, El-Sawy A, Essam E, Gadelkarim M, Ghaly K, Hassabalnaby M, Masarani R, Mohamed Shaaban N, Sabry A, Salem M, Soliman NA, Zahran D, Abou El.soud MR, Badr ET, Borham H, Elmeslemany N, Elsayed M, Elsherif F, Eslam S, Gaber G, Ibrahim S, Kamh Y, Mahmoud A, Mohamed SG, Morshedy E, Omar C, Salem Soliman F, Abdelkawy S, Abdelmohsen N, Abdelshakour M, Dahy A, Gamal N, Gamal M, Hasan A, Hetta H, Mousa N, Omar M, Rabie S, Saad M, Saleh B, Sayed Mohamed M, Shawqi M, Abdelhady Mousa H, Alnoury M, Elbealawy M, Elshafey A, Essam Ibrahim El Desouki Muhammad Ahmed M, Ghonaim M, Hgag F, Ibrahim M, Morsy M, Reda Loaloa M, Refaat A, Samir H, Shahien F, Sobhy M, Sroor F, Abdellatif E, Adel M, Afifi AA, Afifi E, Antaky M, Dawoud A, El Zoghby N, El-remaily A, Elzanfaly AA, Gadallah A, Gamal FA, Hashem O, Medhat Youssef S, Muhammad Attyah A, Munir M, Shazly O, Taha E, Wilson K, Adel S, Ali A, Eid E, Elhelow E, Elmahdy M, Elshatby B, Hossam el-din Zakaria A, Hossny A, Ibrahim E, M.Yonis A, Metwalli M, Yousry B, Zid E, A Yacoub M, Abdelhakim A, Abouelsoad N, Alkhatib M, Ashraf A, Ashraf A, Elazab Y, Elfanty M, Elkabir O, Elsayed M, Elshimy A, Elsobky H, Eskander J, Gad A, Hamsho W, Khaled Abdelwahed N, Magdy M, Moharam D, Osama A, Ramadan S, Roum R, Sayed T, Shehada T, Zidan AM, Abbas K, Ali A, Attia M, Balata M, El Nakeeb A, Elewaily MIE, Elfallal A, Elfeki H, Elkhadragy A, Emile S, Ezzat H, Hosni H, Mansour I, Omar W, Othman G, Sadek K, Shalaby M, Shehab-Eldeen N, Anas khalifa R, Badr H, Eldeep M, Eldeep A, Eldoseuky mohammed A, Khallaf S, Magdy Hegazy E, Mahmoud R, Mikhail P, Morsi M, Mowafy S, Raafat D, Safy A, Sera M, Sera AS, AbdAllah MSM, Abdelkader M, Abdou AO, Ahmed A, Gaafar S, Ibrahim negm F, Lapic M, Maher A, Mahmoud H, Mostafa A, Samir M, Samy F, Semeda N, Shalaby HI, El-taweel A, Galal Elnagar A, Hemidan AG, Hussein M, Kandil A, Moawad M, Nasser Hamamah AA, Soliman M, Abdelkhalek M, Abdelmaksoud Tawakel N, Abdelwahed AM, Abdou A, Atallah K, Elsherbeny MY, Emara E, Hamdy M, Hamdy O, Haron A, Ismail S, Metwally IH, Mohamed Hamed Elgaml N, Nassar A, Refky B, Sadek M, Saleh M, Yunes A, Zakaria M, Zuhdy M, Fayed N, Mohammed MMH, Kütner S, Melnik P, Seire I, Teras J, Ümarik T, Ainoa E, Eerola V, Koppatz H, Koskenvuo L, Sallinen V, Takala S, Katunin J, Kechagias A, Turunen A, Christou N, Mathonnet M, Lavoue V, Nyangoh Timoh K, Soulabaille L, Lesourd R, Merdrignac A, Sulpice L, André B, Chantalat E, Vaysse C, Dousset B, Gaujoux S, Martin G, Clonda O, Juodis D, Kienle K, Mravik A, Palmer S, Szabadhegyi G, Agbeko AE, Gyabaah S, Gyamfi FE, Naabo N, Owusu senior A, Yorke J, Owusu F, Abantanga F, Anyomih TTK, Muntaka AJM, Owusu Abem E, Sheriff M, Tabiri S, Wondoh PM, Balalis D, Korkolis D, Gkiokas G, Pantiora E, Theodosopoulos T, Ioannidis A, Konstantinidis K, Konstantinidou S, Machairas N, Paspala A, Prodromidou A, Chouliaras C, Papadopoulos K, Baloyiannis I, Mamaloudis I, Tzovaras G, Akrida I, Argentou MI, Germanos S, Iliopoulos E, Maroulis I, Skroubis G, Theofanis G, Chatzakis C, Ioannidis O, Loutzidou L, Kalles V, Karathanasis P, Michalopoulos N, Theodoropoulos C, Theodorou D, Triantafyllou T, Garoufalia Z, Hasemaki N, Kontos M, Kouraklis G, Kykalos S, Liakakos T, Mpaili E, Papalampros A, Schizas D, Syllaios A, Tampaki EC, Tsimpoukelis A, Antonopoulou MI, Deskou E, Manatakis DK, Papageorgiou D, Zoulamoglou M, Anthoulakis C, Margaritis M, Nikoloudis N, Campo V, Ceballos A, Flores MA, Giron W, Ko D, Martinez G, Recinos G, Rivera Lara V, Rueda N, Sanchez A, Tejeda Garrido JCG, Aguilera-Arevalo ML, Alvarez Rivera AE, Bamaca Ixcajoc EB, Barreda Zelaya LE, Chacòn-Herrera P, Corea Ruiz LM, Echeverria-Davila G, Garcia M, García D, Gutiérrez Mayen EF, José N, Mazariegos N, Méndez D, Paniagua Espinoza M, Baranyai Z, Bardos D, Benke M, Illes K, Kokas BA, Szabó R, Appukuttan A, Asok A, D.k V, Malik K, Ravishankaran P, Tapkire R, Moorthy G, Abraham J, Muthuvel R, Alapatt J, Kattepur A, Pareekutty N, Garod M, Harris C, Wanniang C, Gupta A, Nehra D, Parshad S, Acharya R, Badwe R, Bhandare M, Jain U, Kirti K, Nair N, Shrikhande S, Thakkar P, Anandan P, C S A, Holenarasipur Narasannaiah A, Jagarlamudi T, Kumar Venkatappa S, M R R, Manangi M, Raghavendra A, Rao KS, S V, Sajjan V, Shenoy A, Shivashankar Chikkanayakanahalli S, Tharanath K, V S, Adidharma P, Agarwal R, Amandito R, Anggita Gultom P, Arifin GR, Billy M, Elfizri Z, Fahira A, Felicia D, Gunardi TH, Johanna N, Nugrahadi NR, Panigoro SS, Rahmayanti S, Sihotang RC, Brata SY, Winoto H, Barati N, Karami M, Khorshidi H, Naderifar H, Abdulla MA, Coleman M, Doherty RJ, Hannon R, Murphy B, Stakelum A, Winter D, Aljohmani L, Farnan R, Seldon Y, Tan T, Varghese S, Alherz M, Ather M, Bajilan M, Graziadei V, Pilkington I, Quidwai O, Ridgway P, Shiwani H, Tahir AAR, Blunnie E, Burke D, Kennedy N, Macdonagh K, O'Neill M, Rooney S, Falco G, Ferrari G, Mele S, Nita GE, Ugoletti L, Zizzo M, Confalonieri G, Pesenti G, Tagliabue F, Baronio G, Ongaro D, 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Belais F, Butt E, Joshi K, Kapur M, Shaw M, Townson A, Williams CYK, Gray T, Greig R, Husain M, Murray E, Mustafa A, Asif A, Gokul A, Shah M, Akitikori MT, Charalabopoulos A, Davidson S, McNally S, Rupani S, Juma F, Mills SC, Muirhead L, Sellars K, Walsh U, Warren O, Chambers A, Hunt R, Teasdale E, Boyce S, Cornwall H, Tol I, Argyriou EO, Eardley N, Povey M, Aithie JMS, Irfan A, McGuigan MC, Starr R, Warren CR, Archibald J, Kirby G, Kisyov I, Khoo CK, Lee R, Photiou D, Davis R, Prasad U, Yang PZ, Bird J, Leung E, Summerour V, Currow C, Kiam J, Tan GJS, Muthusami A, Pegba-Otemolu I, Urbonas T, Nunoo-Mensah J, Smolskas E, Boddy A, Gravante G, Hunter D, Andrew D, Koh A, Thompson A, Adams L, Clements HA, De Silva K, Ekpete O, Haque S, Henderson S, Ibrahim B, Jayasinghe T, Livie J, Mailley K, Nair G, Tan D, Baggaley C, Dawidziuk A, Szyszka B, Barter C, Gandhi N, Hassell K, Hitchin S, Kelsall J, Nagy E, Nessa A, Whisker L, Yanni F, Ali M, Arora D, Hediwattege S, Kumarasinghe N, Rathore M, Tennakoon A, Ali Ahmad SM, Bajomo O, Nadira F, Celentano V, Bhangu A, Glasbey J, Griffiths E, Karri RS, Mak JKC, Nepogodiev D, Pipe M, Bhatti MI, Rabie M, Boyle C, Hamilton D, Mihuna A, Ng JCK, Nicholson G, Oliwa A, Pearson R, Rose A, Yong SQ, Boereboom C, Hanna M, Walter C, Greensmith TS, Mitchell R, Monaghan E, Crawford J, Moug S, Blackwell J, Boyd-Carson H, Herrod P, Al-Allaf O, Beattie M, Bullock C, Burman S, Clark G, Flamey N, Flannery O, Harding A, Kodiatt B, Lawday S, Mahapatra S, Mukundu Nagesh N, Ng M, Rye D, Yoong A, Clark L, Deans C, Edirisooriya M, Fairfield CJ, Harrison EM, Carrington EV, Wong TLE, Yusuf B, Chamberlain C, Duke K, Kmiotek E, Botes A, Condie N, Schrire T, Shah R, Thomas-Jones I, Yates C, Anthony N, Matthews E, Sahnan K, Tankel J, Tucker S, Winter Beatty J, Ziprin P, Duggan W, Kantartzi A, Sridhar S, Khaw RA, Srivastava P, Underwood C, Alves do Canto Brum H, Chopra S, Davis L, Hughes R, Tulley J, Alberts J, Athisayaraj T, Olugbemi M, Ahmad K, Chan C, Chapman G, Fleming H, Fox B, Grewar J, Hulse K, Rutherford D, Sinead M, Smith S, Speake D, Vaughan-Shaw PG, Christodoulides N, Kudhail S, Welch M, Husaini SM, Lambracos S, Anyanwu C, Suresh R, Thomas JS, Gleeson E, Platoff R, Saif A, Enumah Z, Etchill E, Gabre-Kidan A, Bernstein M, Carrano FM, Connors J, Lynn P, Melis M, Newman E, Foster DS, Perrone K, Titan A, Weiser TG, Ahmad S, Bafford ACM, Dal Molin M, Hanna N, Zafar SN, Hemmila M, Napolitano L, Wong JJ, Chandler J, Wood L, Wren S, Ottesen T, You L, Yu K, Arciénega Yañez MDP, Ferreira Fernandes M, González D, Cubas S, González MC, Zubiaurre V, Demolin R, Giroff N, Sciuto P, Campos M, Rodríguez Cantera G, Wagner G, Deepika G, Maimbo M, Simuchimba E, Bulaya A, Chibuye C, Chirengendure B, Kabale MR, Kabongo K, Linyama D, Munthali J, Mweso O, Pikiti F, Otieno J, Chan E, Lai LT, Blackman B, Richards S, Subramaniam S, Karim R, Kok N, Lee YD, Ali S, Sinha A, Corrigan R, Barnes N, Wong F, Dennis G, Jedamzik J, Phillips E, Piette W, Van hentenryck M, Koco H, Lawani S, Kassa MW, Santos Bezerra T, Gribnev P, Dimitrov D, Krastev P, Oum S, Bonghaseh DT, Al Farsi M, Alsharqawi N, Agarwal A, Acevedo V, Castillo Barbosa AC, Giron F, Leon Rodriguez JP, Kucan D, Rosko D, Barsic N, Župan D, Hegazi A, Truncíková V, Fryba V, Mohamed M, Sultan A, Nagi A, Rashad Temerik A, Elshawy ME, Mahmoud MI, Omar S, Anwar M, Rageh T, Elmokadem A, Gaballa K, Teppo S, Turunen A, Pengermä P, Ballouhey Q, Bergeat D, Weyl A, Hain E, Gyedu A, Yenli E, Osei-Poku D, Rompou VA, Zoikas A, Gaitanidis A, Koukis G, Perivoliotis K, Tavlas P, Galanos-Demiris K, Zografos G, Karavokyros I, Xanthopoulou G, Iordanidou E, Ayau F, Garcia A, Damján P, Wason D, B L A, Rangganata E, Kamath P, O'Connor DB, Pinto M, Perrone F, Tropeano FP, Troilo F, Bossi D, Scala D, Pulitanò L, Carella M, Pietrabissa A, Gori A, Giraudo G, De Simone V, Russo AA, Braccio B, Al-Taher R, Athamneh S, Parker A, Sawiee A, Kattia A, Salem M, Tababa O, Shaeeb Z, Syminas V, Jurgaitis J, Damuleviciene G, Svagzdys S, Poskus T, Razafimanjato NNM, Chieng Loo L, Tiong IC, Wan Muhmad WF, Vijeyan H, Li Ying T, Grech G, Arrangoiz R, Jimenez Ley VB, Arizpe D, Jimenez Ley VB, Lagunes Lara E, Castro López EV, Eaazim J, Gordinou de Gouberville M, Bastiaenen V, Rottier S, Nahab F, Ji MY, Seyoji M, Nwachukwu C, Emeghara O, Muhammed SE, Idowu A, Sowemimo O, Ogundoyin O, Akande O, Lott A, Nadeem M, Laghari AA, Loya A, Mushtaq H, Abdullah MT, Abuhilal B, Atawneh M, Hamdan H, Alhabil B, Srour A, Mousa I, Da Silva Medina L, Sacdalan MD, Lapitan MC, Sacdalan MD, Sacdalan MD, Bartosiak K, Ferreira P, Francisco V, Lemos R, Frutuoso L, Fernandes S, Fonseca T, Pereira J, Rachadell J, Torre A, Madeira Martins F, Carvalho AC, Rodrigues Ferreira J, Ribeiro da Silva B, Devesa H, Vieira A, Mónica I, Amaro M, Sousa D, Reia M, Louro J, Martins A, Dominguez J, Santos I, Freitas Oliveira NM, Pereira JC, Silva-Vaz P, Freire L, Escrevente R, Negoita VM, Shakhmatov D, Nezerwa Y, Radulovic R, Moore R, Obery G, Viljoen F, Mendes T, Suarez A, Moncada E, Fernandez-Hevia M, Curtis Martínez C, Gil Garcia JM, González Zunzarren M, Idris T, Eklöv K, Grahn O, Amin L, Blomqvist M, Ajani C, Kraus R, Seeger N, Willemin M, Rayya F, Ayash M, Msouti R, Kannas I, Abazid E, Esper A, Slim S, Kavcar AS, Aytac E, Dural AC, Ilker A, Eray IC, Kurnaz E, Altiner S, Tepe MD, Sahin C, Savli E, Innocent A, Babirye L, Diachenko A, Hordoskiy V, Curry H, Chau CYC, Robertson H, Mahmoud A, Lennon H, Loi L, Kirkham E, McCann C, Watts D, Gurung B, Wilson M, Tribedi T, Garofalo E, Zahra B, MacDonald S, Daniels I, Ng N, Khosla S, Olivier J, Yue SYP, Suresh G, Wellington J, Lorejo E, Mossaad M, Tryliskyy Y, Crutcher M, Alimi M, Baiu I, Abdou H, Conway A, Peck C, Wagner G, Perdomo Perez MA, Trostchansky I, Zulu S, Nakazwe M, Knight SR, Drake TM, Nepogodiev D, Fitzgerald JE, Ademuyiwa A, Alexander P, Ingabire JA, Al-Saqqa SW, Biccard BM, Borda-Luque G, Borowski DW, Burger S, Chu K, Clarke D, Costas-Chavarri A, Davies J, Donaldson R, Ede C, Garden OJ, Ghosh D, Glasbey J, Kingham TP, Salem HK, Anyomih TTK, Koto MZ, Lapitan MC, Lawani I, Lesetedi C, Aguilera-Arevalo ML, Mabedi C, Maimbo M, Magill L, Makinde Alakaloko F, Makupe A, Martin J, Ramos-De la Medina A, Monahan M, Moore R, Msosa V, Mulira S, Mutabazi AZ, Muller E, Musowoyo J, Adisa AO, Olory-Togbe JL, Pius R, Qureshi AU, Rayne S, Roberts T, Sacdalan MD, Shaw CA, Smart N, Smith M, Spence R, Van Straten S, Tabiri S, Tayler V, Weiser TG, Windsor J, Yorke J, Yepez R, Lilford R, Morton D, Bhangu A, Sundar S, Harrison EM, Runigamugabo E, Verjee A, Chen J, Daya L, El Aroussi N, Farina V, Gnintedeme Olivier T, Gonzales Nacarino M, Hammani A, Honjo S, Jacobs R, Kimura H, Litvin A, Nkoronko M, Nour I, Oscullo Yepez JJ, Pagano G, Pata F, Pin Hung W, Raj A, Romani Pozo A, Rommaneh M, Sassamela Fabiano SC, Shiroma Gago CM, Shu Yip S, Srinivas A, Sung CY, Tai A, Valle Aranda YC, Venturini S, Vervoort D, Wilguens Lartigue J. Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries. Lancet 2021; 397:387-397. [PMID: 33485461 PMCID: PMC7846817 DOI: 10.1016/s0140-6736(21)00001-5] [Citation(s) in RCA: 125] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/02/2020] [Accepted: 12/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. METHODS This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. FINDINGS Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70-8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39-8·80) and upper-middle-income countries (2·06, 1·11-3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26-11·59) and upper-middle-income countries (3·89, 2·08-7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. INTERPRETATION Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. FUNDING National Institute for Health Research Global Health Research Unit.
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Reddavid R, Di Candido F, Ortenzi M, Elmore U, Rega D, Ricceri F, Delrio P, Borghi F, Guerrieri M, Spinelli A, Degiuli M, Cancer S.C.C. SC. Resection of the splenic flexure is the optimal treatment for cancer of the left colonic angle. A nationwide retrospective study of the Italian society of surgical oncology - colorectal cancer network (SICO-CCN) collaborative group. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020. [DOI: 10.1016/j.ejso.2020.06.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gavaruzzi T, Pace U, Giandomenico F, Pucciarelli S, Bianco F, Selvaggi F, Restivo A, Asteria CR, Morpurgo E, Cuicchi D, Jovine E, Coletta D, La Torre G, Amato A, Chiappa A, Marchegiani F, Rega D, De Franciscis S, Pellino G, Zorcolo L, Lotto L, Boccia L, Spolverato G, De Salvo GL, Delrio P, Del Bianco P. Colonic J-Pouch or Straight Colorectal Reconstruction After Low Anterior Resection For Rectal Cancer: Impact on Quality of Life and Bowel Function: A Multicenter Prospective Randomized Study. Dis Colon Rectum 2020; 63:1511-1523. [PMID: 33044292 DOI: 10.1097/dcr.0000000000001745] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patient-reported outcomes associated with different bowel reconstruction techniques following anterior resection for rectal cancer are still a matter of debate. OBJECTIVE This study aimed to assess quality of life and bowel function in patients who underwent colonic J-pouch or straight colorectal anastomosis reconstruction after low anterior resection. DESIGN Bowel function and quality of life were assessed within a multicenter randomized trial. Questionnaires were administered before the surgery (baseline) and at 6, 12, and 24 months after surgery. SETTINGS Patients were enrolled by 19 centers. The enrollment started in October 2009 and was stopped in February 2016. The study was registered at www.clinicaltrials.gov (Identifier: NCT01110798). PATIENTS Patients who underwent low anterior resection for primary mid-low rectal cancer and who were randomly assigned in a 1:1 ratio to receive either stapled colonic J-pouch or straight colorectal anastomosis were selected. MAIN OUTCOME MEASURES The primary outcomes measured were quality of life and bowel function. RESULTS Of the 379 patients who were evaluable, 312 (82.3%) completed the baseline, 259 (68.3%) the 6-month, 242 (63.9%) the 12-month, and 199 (52.5%) the 24-month assessment. Bowel functioning and quality of life did not significantly differ between arms for almost all domains. The total bowel function score, the urgency, and the stool fractionation scores significantly worsened after surgery and remained impaired over time in both arms (p < 0.0032), whereas constipation improved after surgery but recovered to baseline levels from 1 year onward (p < 0.0036). All patients showed a significant and continuous improvement in emotional functioning (p < 0.0013) and future perspective (p < 0.0001) from baseline to the end of the study. LIMITATIONS Limitations of the study include missing data, which increased over time; the possibility that some treatments have slightly changed since the study was conducted; and investigators not blind to treatment allocation. CONCLUSION The findings of this study do not support the routine use of colonic J-pouch reconstruction in patients with rectal cancer who undergo a low anterior resection. See Video Abstract at http://links.lww.com/DCR/B328. BOLSA J COLÓNICA O RECONSTRUCCIÓN COLORRECTAL RECTA DESPUÉS DE RESECCIÓN ANTERIOR BAJA PARA CÁNCER RECTAL: IMPACTO EN LA CALIDAD DE VIDA Y LA FUNCIÓN INTESTINAL: UN ESTUDIO ALEATORIZADO PROSPECTIVO MULTICÉNTRICO: Los resultados informados por el paciente asociados con diferentes técnicas de reconstrucción intestinal después de la resección anterior para el cáncer de recto aún son tema de debate.Evaluar la calidad de vida y la función intestinal en pacientes que se sometieron a una bolsa en J colónica o reconstrucción de anastomosis colorrectal recta después de una resección anterior baja.La función intestinal y la calidad de vida se evaluaron en un ensayo aleatorizado multicéntrico. Los cuestionarios se administraron antes de la cirugía (basal) y a los 6, 12 y 24 meses después de la cirugía.Los pacientes fueron incluidos en 19 centros. La inscripción comenzó en Octubre de 2009 y se detuvo en Febrero de 2016. El estudio se registró en www.clinicaltrials.gov (Identificador: NCT01110798).Pacientes que se sometieron a resección anterior baja por cáncer rectal primario medio-bajo y que fueron aleatorizados en una proporción de 1: 1 para recibir bolsa J colónica con grapas o anastomosis colorrectal recta.calidad de vida y función intestinal.De los 379 pacientes que fueron evaluables, 312 (82.3%) completaron la evaluación inicial, 259 (68.3%) a los 6 meses, 242 (63.9%) a los 12 meses y 199 (52.5%) a los 24 meses. . El funcionamiento intestinal y la calidad de vida no difirieron significativamente entre los dos grupos en casi todos los dominios. La puntuación total de la función intestinal, la urgencia y las puntuaciones de fraccionamiento de las heces empeoraron significativamente después de la cirugía y continuaron con el tiempo extra en ambos grupos (p <0.0032), mientras que el estreñimiento mejoró después de la cirugía pero se recuperó a los niveles basales a partir de 1 año en adelante (p <0.0036). Todos los pacientes mostraron una mejora significativa y continua en el funcionamiento emocional (p <0.0013) y la perspectiva futura (<0.0001) desde el inicio hasta el final del estudio.Datos faltantes, que aumentaron con el tiempo; la posibilidad de que algunos tratamientos hayan cambiado ligeramente desde que se realizó el estudio; investigadores no cegados a la asignación del tratamiento.Los hallazgos de este estudio no respaldan el uso rutinario de la reconstrucción de la bolsa J colónica en pacientes con cáncer rectal que se someten a una resección anterior baja. Consulte Video Resumen en http://links.lww.com/DCR/B328. (Traducción-Dr. Yesenia Rojas-Khalil).
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Dell-Kuster S, Gomes NV, Gawria L, Aghlmandi S, Aduse-Poku M, Bissett I, Blanc C, Brandt C, Ten Broek RB, Bruppacher HR, Clancy C, Delrio P, Espin E, Galanos-Demiris K, Gecim IE, Ghaffari S, Gié O, Goebel B, Hahnloser D, Herbst F, Orestis I, Joller S, Kang S, Martín R, Mayr J, Meier S, Murugesan J, Nally D, Ozcelik M, Pace U, Passeri M, Rabanser S, Ranter B, Rega D, Ridgway PF, Rosman C, Schmid R, Schumacher P, Solis-Pena A, Villarino L, Vrochides D, Engel A, O'Grady G, Loveday B, Steiner LA, Van Goor H, Bucher HC, Clavien PA, Kirchhoff P, Rosenthal R. Prospective validation of classification of intraoperative adverse events (ClassIntra): international, multicentre cohort study. BMJ 2020; 370:m2917. [PMID: 32843333 PMCID: PMC7500355 DOI: 10.1136/bmj.m2917] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To prospectively assess the construct and criterion validity of ClassIntra version 1.0, a newly developed classification for assessing intraoperative adverse events. DESIGN International, multicentre cohort study. SETTING 18 secondary and tertiary centres from 12 countries in Europe, Oceania, and North America. PARTICIPANTS The cohort study included a representative sample of 2520 patients in hospital having any type of surgery, followed up until discharge. A follow-up to assess mortality at 30 days was performed in 2372 patients (94%). A survey was sent to a representative sample of 163 surgeons and anaesthetists from participating centres. MAIN OUTCOME MEASURES Intraoperative complications were assessed according to ClassIntra. Postoperative complications were assessed daily until discharge from hospital with the Clavien-Dindo classification. The primary endpoint was construct validity by investigating the risk adjusted association between the most severe intraoperative and postoperative complications, measured in a multivariable hierarchical proportional odds model. For criterion validity, inter-rater reliability was evaluated in a survey of 10 fictitious case scenarios describing intraoperative complications. RESULTS Of 2520 patients enrolled, 610 (24%) experienced at least one intraoperative adverse event and 838 (33%) at least one postoperative complication. Multivariable analysis showed a gradual increase in risk for a more severe postoperative complication with increasing grade of ClassIntra: ClassIntra grade I versus grade 0, odds ratio 0.99 (95% confidence interval 0.69 to 1.42); grade II versus grade 0, 1.39 (0.97 to 2.00); grade III versus grade 0, 2.62 (1.31 to 5.26); and grade IV versus grade 0, 3.81 (1.19 to 12.2). ClassIntra showed high criterion validity with an intraclass correlation coefficient of 0.76 (95% confidence interval 0.59 to 0.91) in the survey (response rate 83%). CONCLUSIONS ClassIntra is the first prospectively validated classification for assessing intraoperative adverse events in a standardised way, linking them to postoperative complications with the well established Clavien-Dindo classification. ClassIntra can be incorporated into routine practice in perioperative surgical safety checklists, or used as a monitoring and outcome reporting tool for different surgical disciplines. Future studies should investigate whether the tool is useful to stratify patients to the appropriate postoperative care, to enhance the quality of surgical interventions, and to improve long term outcomes of surgical patients. TRIAL REGISTRATION ClinicalTrials.gov NCT03009929.
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Chapman SJ, Blanco-Colino R, Pérez-Ajates S, Bautista OA, Hodson J, Blanco-Colino R, Chapman SJ, Glasbey JC, Pata F, Pellino G, Soares ASA, van Elst T, Van Straten S, Nepogodiev D, Hodson J, Borakati A, Bath MF, Yasin IH, Mclean K, Arthur T, Kovacevic M, Delibegovic S, Karamanliev M, Swamad M, Žebrák R, Paramasivam R, Martensen A, Larsen HM, Rãdeker L, Frey PE, Kechagias A, Venara A, Duchalais E, Ioannidis A, Pata F, Pellino G, Pasquali S, Simioni ASA, Farina V, Podda M, Lorenzon L, ItSURG, Schaeff V, Otto A, Jakubauskas M, van Elst TR, Chu M, Fagan PVB, Wells CI, João AA, Soares A, Juloski J, Blanco-Colino R, Pérez-Ajates S, Bautista OA, El Kasmi YEK, Espin-Basany E, Clerc D, Ciubotaru C, Popescu S, Yanishev A, Lee S, Ozkan BB, Sen AY, Aktas MK, Baki BE, Yüksek B, Glasbey JC, Kamarajah S, Mclean K, Borakati A, Yasin IH, Khaw RA, Mills E, Goodson R, Thakral N, Ablett AD, Adra M, Kwek I, Khan SM, Quinn P, Manley LR, Badran A, Ramjeeawon A, Campbell A, Tan HL, Rye DS, Rajaraman N, Norman JG, Vutipongsatorn K, Solomou G, Akhbari M, Ali A, Brandao BD, Stainer B, Thavayogan R, Jones D, Onafowokan OO, Gharooni A, Dabab N, Carlton-Carew S, Kungwengwe G, Gabriel M, Sewart E, Shortland TC, Lawday S, Pockney P, Dawson A, Stewart P, Ng B, Luong JK, Delibegovic S, Ivanov V, Borisova A, Neykov V, Žebrák MFR, Harbjerg JL, Brandsborg S, Mark-Christensen A, Unbehaun KP, Dalsgaard P, Lycke KD, Kechagias A, LeNaoures P, Duchalais E, Brigand C, Dumange E, Gout M, Moehwald C, Prem M, Alhalabi O, Sliwinski S, Krupp J, Gablenz E, Schmitzer L, Kopp A, Steinle J, Gsenger J, Pohl LJ, Riccardi M, Christodoulou IM, Konstantinidis M, Machairas N, Zoikas A, Balalis D, Manatakis DK, Aguilera ML, Simioni ASA, Marano L, Fleres F, Lovisetto F, Sasia D, Segalini E, Pata G, Lucchi A, Sagnotta A, Campagnaro T, Petrelli F, Gallo G, Papandrea M, Testa V, Sinibaldi G, Di Candido F, Colombo F, Perrone G, Aresu S, Biancafarina A, Canonico G, Pagnanelli M, Curletti G, Bini R, de Manzoni Garberini A, Impellizzeri H, Cillara N, Tutino R, Picciariello A, Coletta D, Savino G, Ferrara F, Tamini N, Talamo G, Parini D, Giamundo P, Pagano G, Ripetti V, Pesce A, Menduni N, Pellino G, Giudicissi R, Podda M, Goldin E, Rega D, Belli A, Andriola V, Gordini L, Pata F, Foppa C, Piccolo G, Birindelli A, Ferrari C, Ballarini Z, Tirelli F, Milone M, De Rosa M, Federico NSP, Molteni B, Tilocca PL, Sancini G, Piozzi GN, Lauretta A, Mulas S, Schaeff V, Otto A, Jakubauskas M, Simcikas D, Portelli L, van Wijnbergen JWM, Dinger TL, ten Doesschate SFH, van Dalen ASHM, van den Bos DD, Hansmann M, Feliz JM, Kuiper SZ, Abdulrahman Z, Pruijssers SR, Geneta VP, Chu M, Wilton S, Kandelaki H, Peng SL, Campbell S, Lim YK, Yassaie SS, Murray M, Fagan PVB, Haran C, Tan J, Castro J, Laranjeira A, Catarino S, Neves-Marques C, Correia JG, Vieira BN, Quintela AC, Serra ML, Maciel J, Cunha M, Aparício DJ, Neves J, Azevedo J, Romano M, Eiró F, Romano J, Monteiro C, Claro M, Almeida, Peyroteo M, Machado ND, Capote H, Ferreira M, Sousa X, Devesa H, Cavadas D, Guerreiro I, Costa M, Rosete M, Salman M, English C, Mohammed N, Popescu S, Yanishev A, Litvin A, Ćuk VV, Mészárosová K, Van Straten S, Jaich R, De Lima H, Brooks S, Marx M, Salvation MN, Cardo JG, Mora-Guzmán I, Muriel JS, de Andres Olabarria U, Muriel P, Viñas CJ, Alconchel F, Sinovas OE, El Kasmi YEK, Oro CF, Pérez-Ajates S, Otero ML, Jiménez SF, Bellmunt OC, Caballero JM, Rubio-Pérez I, Aguilar-Martínez MM, Segura-Sampedro JJ, Moreno CO, Parra DN, Diz AME, Martín-Balbuena R, Recuenco CB, Bolaños REL, Fernández P, Padillo AD, Forero-Torres A, Román IAS, Rosés HS, Campos PV, Moreira CCL, Peralta PU, Navidad MS, Ripollés-Melchor J, Garcea A, Facundo HG, Bautista OA, Pereira PT, Guarinos CVP, Clerc D, Blaser B, Piazza G, Gagliardi B, Serin H, Sen AY, Yurdaor SS, Aktas MK, Arslan E, Kopac O, Uyanik A, Ozmen BB, Tiftik E, Aksoy B, Yalcinkaya A, Bilicen G, Cinar EN, Uslu Ö, Kaya Y, Wong J, Farhan-Alanie MMH, Suresh G, Asif A, Finch BJ, Bhahirathan 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Teixeira H, Pittet O, Haller ML, Gagliardi B, Huot A, Blaser B, Kefleyesus A, Bugmann A, Piotet LM, Meijers L, Kurtoglu GK, Sel EK, Isler VC, Güner B, İşlek EC, Tombul HB, Boztuğ CY, Tınaz A, Yılmaz M, Karaman Y, Akın FA, Dansuk S, Başçavuş M, Kaya M, Kutlu B, Seker MC, Erten V, Memis U, Koçak ZB, Karapinar YE, Fakirullahoglu M, Uslu Ö, Köseoglu E, Yeni M, Aktas MK, Aykun N, Agca MH, Bilen C, Kilinc I, Atar C, Kilic V, Aktuna C, Aba M, Alim YE, Binbuga M, Kürklü Ö, Yurdaor SS, Ceylan C, Yilmaz S, Çalar SN, Yildirim N, Yavuz G, Sen AY, Can B, Cesmeli E, Kus D, Kavar RC, Cevlik AD, Cengiz U, Turk EG, Yilmaz I, Yüksek B, Erdönmez H, Gürsoy F, Serin H, Kara H, Önsal U, Özbek M, Kasar PA, Ipor A, Özen D, Ölmez M, Altintas E, Kaya Y, Toklu R, Sariçiçek T, Tipi OU, Benli GE, Tasdelen I, Tura A, Ucar A, Ekci B, Bilgili AC, Kiraz IN, Aksoy H, Cinar EN, Basak A, Erdem M, Kayacan S, Sahin C, Uysal M, Karakus K, Altiner S, Demirci ZS, Eren E, Yavas M, Tiftik E, Aksoy AB, Karagöz E, Sabanci R, Tümer SS, Kargici K, Banaz T, Abdulrahman SMF, Yesilsancak M, Yanikoglu E, Karabulut A, Yilmaz D, Bilicen G, Yarenci E, Demiroglu Y, Sunal A, Baykan B, Abbasguliyev H, Mutlu V, Mahmoudi Y, Dossa SAA, Mizan SR, Demirtas B, Cavus T, Yuksek A, Mazlum SS, Yelkenci C, Baran T, Satilmisoglu M, Sahin AZ, Kilinç A, Isik K, Yumurtaci Ö, Emin A, Girit Ç, Yildirak MK, Senyigit E, Güldag A, Söyleyici B, Aytin YE, Akay FE, Iskan NG, Mutlu B, Sunay AO, Ablett AD, Tie-Gill T, Ramsay G, De Paola L, McGuckin S, Alshakhs A, Ahmeidat A, Wong J, Goergen N, Ali Z, Mullarkey L, Bath MF, Walshe R, Lewis E, Berry B, Moneim J, Mookerjee S, Christy S, Ojofeitimi O, Carroll L, Hylands A, Delaugere LP, Reveendran D, Coulter C, Ralston C, Laverty L, Gallagher P, Ahmed A, Yeo YQ, Elliott D, Bennett J, Mcnamara M, Sivarajah S, Dunmore C, Aitken G, Nair M, Aly MH, Buari M, Farhan-Alanie MMH, Ahmed K, Sheikh Z, Monks M, Lehmann J, Rotimi O, Bell T, Limnatitou D, Gormley S, Taleongpong P, Patel V, Macgregor L, Amini S, Turner C, Dwyer-Hemmings L, Busuttil A, Powell J, Hensher C, Vivian F, Wcislo K, Millar Z, Hirosue S, Ogunmwonyi I, Nakakande D, Kwek I, Gaze H, Pillai S, Khoury G, Powell T, Maleyko I, Sangheli A, Ransome M, Isse M, Aromolaran O, Bholah H, Anbarasan J, Rehman S, Hu E, Timms S, Reynolds W, Hotchkies A, Misra V, Suresh G, Murray V, Theocharidou L, Malik T, Janmohamed I, Carhart B, Khan A, Asif A, Hullait R, Quinn P, Rylance A, Butt S, Leathes J, Finch BJ, Rajathasan TP, Jeddy H, Kyaw HA, Wong N, Karelia S, Clements JM, Rainey M, Joshi N, Rahman A, Gallagher M, Rebuffa N, Abdelgalil R, Lai RSY, Laurence N, Thomas S, Green C, Frostick R, Khera R, Povey M, Wong HL, McCusker C, Hlukha L, Pike G, Kamel F, Thakkar R, Donaldson C, Campos MS, Bhahirathan Y, Herron J, Bradbury M, Osunronbi T, Tam LYC, Kaabneh AK, Lawther J, Fisher P, Tribedi T, Moosa A, Ramdin A, Goble M, Downs E, Wheldon L, Baggus E, Mandal A, Nayeem A, Ahmed S, Fradley W, Wilson C, Gallagher S, Criswell T, Ward J, Mukkavilli A, Stubbs B, Fordyce W, Suchdev N, Lim SW, Tew ZY, Sookramanien SR, Chan A, Bointas G, Paul M, Ward KL, Bagnall M, Pherwani SA, Wang K, Mitchell L, Heyworth J, Ayyar S, Obukofe R, Polson R, Mason D, Mackenzie E, Russell C, Doyle N, Habib Z, Zardab M, Sartaj F, Farooq H, Tabibi M, Drury DJ, James SJ, Barnett R, Cahya E, Lou G, Coyle M, Homyer K, Zhu LY, Woods M, Chang J, O'Callaghan H, Suchett-Kaye I, Mihailidis TH, Alawattegama H, Seite E, Barrett A, Riordan E, Lam W, Dowdeswell M, Mulvenna C, Netke T, Awokoya O, Gurowich L, Dhera K, Hayat S, Williams L, Tincknell L, Spazzapan M, Teeling F, Sysum K, Latter J, Latter M, Khan S, Woodmass M, Hayden H, Kisiel A, Ali Y, Husain S, Arnold A, Pedersen AC, Cunha P, Ahmed M, Al Zawawi S, Kudva V, Liu FY, Theodoropoulou K, Miscampbell M, Robinson AV, Johnston J, Dharni A, Lamb S, Westerman T, Evans E, Campbell L, Gillespie M, Cheong CM, Kulathevanayagam K, Varghese A, Ike SI, Chu TSM, Baljer B, Mogg JAW, Rai P, Claireaux HA, Williams M, Smillie R, Goetz J, Appleby E, Fadipe T, Vaughan-Burleigh S, Mondal A, Jovaisaite A, Shah SM, Khalid N, Gutmann D, Davison S, Alame YJ, Syed L, Owen WJ, Ahsan SD, Kalderon R, Anthony-Uzoeto U, Hall CM, Zheng S, Wynter K, James C, Sapre D, Ghosh R, Baird J, Cockburn L, Blackwood O, Nadama HH, Simpson W, Jeong S, Bishop S, Bate R, Hobson C, Adam AH, Redclift C, Do J, Adeleye O, Poli F, Batterham A, Brown S, Parekh JN, Clay W, Pieri K, Jackson A, Brown S, Saxena A, Gurung B, Oyebola T, O'Brien F, Djeugam B, Gardezi S, Ul-Hasan S, Martin-Hernandez MP, Sisley M, Modi S, Antakia R, Elbayouk A, Soh YJ, Mather J, Yusuf Z, Al-Sarraf Z, Naja M, Rassool SB, Convill J, Nikookam Y, Warsame A, Tam JPH, Pace C, Kiandee M, Ridwan R, Carey C, Hirri F, McMillan MJA, Ling JJ, Powell-Chandler A, Pendelbury L, Kerimzade K, Tang A, Howard EO, Humayun S, Wadsworth OJ, Tan K, Abdelhameed F, Haglund C, Radnaeva I, Hu N, Rambhatla S, Waldron D, Madahar P, Malik S, Campbell A, Meney LC, Ibrahim I, Kang CK, Chiu JZJ, Livie V, Ibrahim B, Khalil M, Pooley G, Shishkin B, Gorgievska R, Docherty J, Southgate A, Coomes A, McGee F, Flanagan S, Thakrar C, Tan QJ, Anwar H, Clough R, Chrisp B, Cassels J, Cross GWV, Ragavoodoo A, Mercer L, Mercer C, Refalo A, Hadley R, McTighe A, Farrow F, Brodie A, Davis G, Shah DR, Bowers C, Patel S, Morice O, Burzic A, Cheung J, Shashidhara A, Theodoraki G, Birk J, Ong A, Ng MPE, Wong RTW, Maese S, Yeap B, Iqbal Z, Melaugh T, Perchard W, Scurr T, Davidson K, Campbell E, Kelk L, Ghosh A, Gibbins A, Mala D, Loizidou A, Hall O, Mecia L, Hew C, Varathan K, Tong L, Chandrasekar B, Giacci L, Buchanan E, O'Connell M, Kwak SY, Ong EH, Gardner S, Lim J, Maden C, Illahi M, Hale J, Tan ZX, Edwards S, Stahl R, Stahl J, Hickman A, Collett D, Goolam-Mahomed Z, Allen B, Atiyah A, Ahmad H, Jones J, McGregor O, Ogundiya E, Gan FW, Boulbadaoui A, Kirnon-Jackman O, Lim QX, Peckham H, Yeoh T, Yong SQ, Chen JY, Siva S, Sam ZH, Gilani M, Goh YN, Muthukumar MG, Phillips S, Makin-Taylor R, Tjoakarfa J, Giri A, Suresan S, Thavayogan R, Hey CY, Thomas P, Johnson TA, Williams RI, Rashid A, Kushairi A, Rais A, James A, Bugelli M, Chechelnitskaya Y, Sandhu N, Toh C, Tandon R, Gray M, Kumar A, Ciurleo C, Nyamali I, Hiremath S, Sinha S, Chowdhary M, Bradley E, McTiernan M, Macdonald S, Sharkey S, McLaughlin N, Amey C, Kraria L, Skan O, Kind C, Findlay JM, Tupper P, Van Rhee C, Honeyman SI, Menon G, Ahmed M, Jegatheeswaran L, Griffiths N, Madhavan A, Warne M, Malcolm FL, Lessware T, Wilkerson HT, Chatterjee-Woolman S, Yoong A, Ahmed WUR, Longshaw A, Flannery O, Green R, Leaning M, Cragg J, Sharriff H, Doherty C, Ganesananthan S, Kwan KWL, Sanders-Crook L, Bhatia S, Eames S, Lewis F, Kirupananthan P, Boh ZY, Dass S, Soma A, Newton A, Hill M, Shafiq Y, Brkljac M, Boyce L, Jasionowska S, English WJ, Lam S, Chipeta C, Yilmaz D, Jain C, Garofalidou T, Novotny SA, Locke S, Bowman C, Begaj A, Murphy C, Radcliffe K, Chong JT, Poustie M, Jeffrey E, Chaudhury N, Rajendran K, Akbar Z, Walters B, Kulendrarajah B, Tran N, Shrestha S, Parmar S, Gallagher C, Hennessy L, Pentti E, Badhrinarayanan S, Fung A, Mansoor M, Kenny R, Kan P, Lee DE, Khosla S, Samake M, Shaban F, Aftab R, Gough M, Woodburn B, Vayalapra S, McMurrugh K, Wong C, Jimulia D, Deol S, Pike S, Embury-Young Y, Turner T, Patel M, Kilgallon E, Keating R, Walsh A, Khan H, Logue G, Orekoya M, Alasmar M, Charalambides M, Llavall AC, Williamson E, Bharwada Y, Zearmal S, Evans H, Panikkar M, de la Cruz G, Caplan J, Ruparelia A, Tanvir T, Soare C, Pang YL, Trotter J, Zaidi A, Thakrar V, Pulickal P, Ahmed H, Parnell J, Khan H, Lennock S, Ford V, Pyc W, Brignall R, O'Neill D, Hanna R, Kane R, Nicola M, Rajput K, Xiao Y, Warner C, Michael S, Wright E, Juniper S, Thompson E, Hoskyns L, Kanitkar A, Ross C, Unsworth A, Rshaidat H, Demarre K, Chiang A, Bareh A, van Dellen J, Faqihinejad C, Gadhvi A, Grant R, Lewsey J, Morris A, Martin H, McClarty C, Sanyal S, Alsaif A, Palkhi A, Bhopal S, Burford C, Huq T, Sloper W, Irwin E, Matthews L, Ngu WS, Hosfield T, Muneeb F, Page O, Zeb E, Coey J, Al-Azzawi A, McIntosh J, Vucicevic A, Hughes M, Brooks L, Fanibi B, Dixon M, Njoku P, Morris D, Jobson J, Chowdhury H, Joseph N, Zulkefley N, Hunt G, Christodoulou T, Wright O, Soman S, Jamal M, Beqiri S, Borgas P, Christie S, Pereira F, Browne S, Yiu J, Dworkin A, Brayley J, Palmer A, Charalambos M, Jones CS, Toner S, Cowden R, Lee L, Nicol P, Holman O, Imtiaz M, Albert V, Leung SP, Erotocritou M, Wong J, Stroud R, Mason D, Wilkin R, Thomson W, Mackee L, Kler A, Reynolds L, Mohamed SH, Majeed Y, Fakim B, Jones A, Kowal M, Liversedge G, Carrington Z, Windebank J, Izzarina A, Akbani U, Craven J, Aldarragi A, Harding S, Millward A, Shortland TC, Bedford M, Stroud R, Obukofe R, Mackenzie E, Gopalan V, Midgen A, Khadka P, Cheng O, Taneja S, Manobharath N, Kok JY, Lim DWE, Buick T, Boland M, Piya S, Devlin R, Fairfield CJ, George RJ, Rahi M, Zaman S, Hajiev S, Ross T, Owen M, Crisp E, Thompson C, Charalambous A, Hollywood JL, Saiyed A, Hammond RFL, Matthews J, Mendonca V, Spinty J, Khan K, Cheng J, Glynn N, Muhammad U, Khan M, Anderson L, Mccormack K, Mak J, Patrawala S, Milinkovic N, Schofield R, Chauhan M, Hartley L, Hind J, Ashworth I, Nelson L, Ratnasingham D, Akbari K, Whitehead T, Dimitriadis S, Marshall K, Flint EJ, Curran M, Horner C, Heybourne A, Morgan H, Wickstone C, Panagiotou D, O'Connell E, Dean K, Iqbal R, Walsh L, Yu N, Rana N, Massie E, Ng J, Jung M, Lee YD, Harris M, White S, Delibegovic S, Boev B, Tonchev P, Prochazka V, Örhalmi J, Riško J, Skalický A, Chrz K, Ravn S, Ojakããr A, Duchalais E, Dörr-Harim C, Herrle F, Koutserimpas C, Giraudo G, Armellini A, Ruzzenente A, Mazzeo C, De Padua C, Luc AR, Maroli A, Vitali M, Ceccarelli G, Gusai GP, Quattromani R, Virgilio E, Berti S, Mulas S, Di Mola FF, Papagni V, Tuminello F, Magnoli M, Vittori L, Longheu A, Loche GA, Braccio B, De Luca E, Resta G, Ancans G, Tamosiunas A, Petrulionis M, Abdulrahman N, van de Pas KGH, Thomas G, Brandsma AM, Davids J, Rottier SJ, de Roy van Zuidewijn D, Hawkins R, Ong HI, Li Y, Desmond B, Winstanley J, Martins M, Rosete M, Americano M, Santos M, Frade S, Senhorinho R, Peixoto R, João AA, Alves-Vale C, Lamas M, O'Connor DB, Hoo M, Gopaul A, Scanlon K, O'Dwyer N, Negoi I, Jovanović M, Panyko A, De Lima H, Van Vuuren S, Centeno A, Bernado IR, Señorans MPG, Amor LG, Ramírez AC, Abrisqueta J, Gomez ME, Arroyo A, Cerdán C, Romeu NG, Forero-Torres A, Enriquez-Navascues JM, Collado-Roura F, Curchod P, Gaspar S, Imadalou L, Mutlu D, Akyol C, Uygur FA, Eray IC, Biyiklioglu O, Çetin MF, Isik AE, Karip B, Dogan H, Sarıgül L, Tunc E, Aydin T, Bodur S, Karabulut K, Francis AA, Al-hadithi A, Lau ISF, Smith E, Mahapatra S, McAuliffe O, Francis AA, Imam L, Akram B, Hossaini S, Davies R, Ko M, Collins J, Pandya A, Reilly S, Archer J, Livie J, Chaudhry FA, Ntakomyti E, Diallo R, Bylinski T, Wright J, Lawday S, Masiha E, Tung J, Shirazi B, Neilson A, Epton S, Patel N, Trussell S, Couldrey A, Donnelly C, Eftychiou S. Safety of hospital discharge before return of bowel function after elective colorectal surgery. Br J Surg 2020; 107:552-559. [PMID: 31976560 DOI: 10.1002/bjs.11422] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/06/2019] [Accepted: 10/08/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. METHODS A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien-Dindo classification system. RESULTS A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4-7) and 7 (6-8) days respectively (P < 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110). CONCLUSION Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients.
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Milone M, Degiuli M, Allaix ME, Ammirati CA, Anania G, Barberis A, Belli A, Bianchi PP, Bianco F, Bombardini C, Burati M, Cavaliere D, Coco C, Coratti A, De Luca R, De Manzoni G, De Nardi P, De Rosa M, Delrio P, Di Cataldo A, Di Leo A, Donini A, Elmore U, Fontana A, Gallo G, Gentilli S, Giannessi S, Giuliani G, Graziosi L, Guerrieri M, Li Destri G, Longhin R, Manigrasso M, Mineccia M, Monni M, Morino M, Ortenzi M, Pecchini F, Pedrazzani C, Piccoli M, Pollesel S, Pucciarelli S, Reddavid R, Rega D, Rigamonti M, Rizzo G, Robustelli V, Rondelli F, Rosati R, Roviello F, Santarelli M, Saraceno F, Scabini S, Sica GS, Sileri P, Simone M, Siragusa L, Sofia S, Solaini L, Tribuzi A, Trompetto M, Turri G, Urso EDL, Vertaldi S, Vignali A, Zuin M, Zuolo M, D'Ugo D, De Palma GD. Mid-transverse colon cancer and extended versus transverse colectomy: Results of the Italian society of surgical oncology colorectal cancer network (SICO CCN) multicenter collaborative study. Eur J Surg Oncol 2020; 46:1683-1688. [PMID: 32220542 DOI: 10.1016/j.ejso.2020.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/03/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Transverse colon cancer (TCC) is poorly studied, and TCC cases are often excluded from large prospective randomized trials because of their complexity and their potentially high complication rate. The best surgical approach for TCC has yet to be established. The aim of this large retrospective multicenter Italian series is to investigate the advantages and disadvantages of both hemicolectomy and transverse colectomy in order to identify the best surgical approach. MATERIALS AND METHODS This was a retrospective cohort study of patients with mid-transverse colon cancer treated with a segmental colon resection or an extended hemicolectomy (right or left) between 2006 and 2016 in 28 high-volume (more than 70 procedures/year) Italian referral centers for colorectal surgery. RESULTS The study included 1529 patients, 388 of whom underwent a segmental resection while 1141 underwent an extended resection. A higher number of complications has been reported in the segmental group than in the extended group (30.1% versus 23.6%; p 0.010). In 42 cases the main complication was the anastomotic leak (4.4% versus 2.2%; p 0.020). Recovery outcomes also showed statistical differences: time to first flatus (p 0.014), time to first mobilization (p 0.040), and overall hospital stay (p < 0.001) were significantly shorter in the extended group. Even if overall survival were similar between the groups (95.1% versus 97%; p 0.384), 3-year disease-free survival worsened after segmental resection (78.1% versus 86.2%; p 0.001). CONCLUSIONS According to our results, an extended right colon resection for TCC seems to be surgically safer and more oncologically valid.
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Izzo F, Ionna F, Granata V, Albino V, Patrone R, Longo F, Guida A, Delrio P, Rega D, Scala D, Pezzuto R, Fusco R, Di Bernardo E, D’Alessio V, Grassi R, Contartese D, Palaia R. New Deployable Expandable Electrodes in the Electroporation Treatment in a Pig Model: A Feasibility and Usability Preliminary Study. Cancers (Basel) 2020; 12:cancers12020515. [PMID: 32102182 PMCID: PMC7072261 DOI: 10.3390/cancers12020515] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 02/07/2023] Open
Abstract
The aim of the study is to evaluate the usability aspects of new deployable, expandable, electrode prototypes, in terms of suitability solutions for laparoscopic applications on the liver, endoscopic trans-oral and trans-anal procedures, electroporation segmentation in several steps, mechanical functionality (flexibility, penetrability), visibility of the electrode under instrumental guidance, compatibility of the electrode with laparoscopic/endoscopic accesses, surgical instruments, and procedural room and safety compatibility. The electroporation was performed on an animal model (Sus Scrofa Large White 60 kg) both in laparoscopy and endoscopy, under ultrasound guidance, and in open surgery. Electrodes without divergence, with needles coming out straight, parallel to each other, and electrodes with peripheral needles (four needles), diverging from the electrode shaft axis (electrode with non-zero divergence) have been tested. To cause an evaluable necrosis effect, the number of electrical pulses was increased to induce immediate liver cell death. Histological samples were analyzed by staining with Haematoxylin/Eosin or by immunohistochemical staining to confirm complete necrosis. The prototypes of expandable electrodes, tested in laparoscopy and endoscopy and in open surgery, respectively, are suitable in terms of usability, electroporation segmentation in several steps, mechanical functionality (flexibility, penetrability), visibility under instrumental guidance, compatibility with laparoscopic/endoscopic accesses, surgical instruments and procedural room safety, patient safety (no bleeding and/or perforation), and treatment efficacy (adequate ablated volume). Electroporation treatment using new deployable expandable electrode prototypes is safe and feasible. Moreover, electrode configurations allow for a gradual increase in the ablated area in consecutive steps, as confirmed by histology and immunohistochemistry.
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Restivo A, Delrio P, Deidda S, Spolverato G, Rega D, Cerci M, Barina A, Perin A, Pace U, Zorcolo L, Pucciarelli S. Predictors of Early Distant Relapse in Rectal Cancer Patients Submitted to Preoperative Chemoradiotherapy. Oncol Res Treat 2020; 43:146-152. [PMID: 32036373 DOI: 10.1159/000505668] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 12/28/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Neoadjuvant chemoradiotherapy (CRT) is a standard treatment for locally advanced rectal cancer. CRT leads to a better local control; however, this does not translate into a survival benefit. Long-term survival is mostly affected by the development of distant metastases after surgery. This study aimed to evaluate predictive clinical factors for the development of early metastatic disease after CRT. METHODS Clinical data of patients with stage II/III rectal cancer submitted to CRT between January 2000 and October 2014 were collected from prospectively maintained electronic databases of three Italian institutes. Patients were divided into two groups: those who developed metastasis within 12 months from surgical resection (Group A) and patients without or with late distant relapse (Group B). RESULTS Among 635 patients, 86 (13.5%) had early distant relapse within 1 year from surgery (Group A), and 549 (86.5%) did not (Group B). A higher rate of early distant relapse was associated with CEA levels above 3 ng/dL (20% vs. 10%; p <0.001), tumor lying under 5 cm from anal verge (20% vs. 9%; p <0.001), and age under 63 years (17% vs. 11%; p = 0.036). Multivariate analysis confirmed these factors to be independently correlated with a higher risk of early metastasis. CONCLUSIONS Younger age, low tumors, and high serum CEA may be associated with unfavorable early oncological outcomes after CRT and surgery for rectal cancer. These clinical factors could be useful to select patients for more aggressive therapeutic strategies.
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AG, Galvão D, Mora A, Bettencourt R, Costa F, Gil I, Morgado J, Neves J, Mónica I, Oliveira S, Ribeiro H, Ferreira M, Guimarães N, Duarte M, Miranda J, Martins SF, Almeida MR, Parreira R, Faustino A, Medeiros N, Castro R, Soares B, Resendes M, Almeida P, Cruz A, Claro M, Vaz Pinto G, Sousa D, Costa Santos D, Silva A, Silva F, Fialho G, Reia M, Pratas N, Capote H, Costa C, Costa J, Morais S, Machado A, Horta V, Rocha-Melo M, Patrício J, Pereira M, Lima R, Cinza AM, Oliveira J, Velez C, Ferreira M, Borges F, Simões J, Eiró F, Botelho P, Cismasiu B, Alves D, Dias B, Costa C, Gonçalves JP, Valente P, Oliveira J, Freire L, Saraiva R, Moreira M, Fragoso M, Guimarães J, Cruz G, Aparício DJ, Ribeiro J, Borges da Ponte I, Almeida S, Martins AR, Louro T, Morgado M, Ferreira AS, Alves M, Oliveira N, Lérias R, Neves-Marques C, Estalagem I, Botelho C, Bártolo J, Fidalgo Antunes C, Cabral F, Brito Silva F, Dias Matos A, Santos M, Cunha R, Duarte M, Sousa M, Canotilho R, Peyroteo M, Correia AM, Martins PC, Jardim JAM, Domingos SP, Baião JM, Rocha BS, Lopes NMRO, Jordão DM, Correia JG, Ângelo MD, Caroço T, Romano M, Gomes JR, Monteiro RG, Varghese S, Boyle E, Aljohmani L, Alexander J, Graziadei V, McCaughey C, Jain A, Lee J, Ramanayake H, Sabnani R, Colon LF, Bansal N, Stephens I, Tan R, Sharma S, Doherty G, Fenn S, Mulhare E, Walsh M, Leavey C, Costigan O, Griffin S, Dockry É, Khogali E, Aly AK, McPhedran R, O'Gorman D, Vermeulen D, Dervan L, Kang SJ, Dixon O, Morrissey E, Compton M, Pentony AR, Piong CL, Nossier R, Hanna J, Sabir K, Eow SY, Ladak N, Boersma D, Kamath PJ, Soh TBW, Dyer AH, Chee SY, Tan IXH, Kelliher A, Adeusi L, Howarth N, McCawley N, O'Neill A, Jones MR, Saleh R, Singh A, Senaratne R, Kakodkar P, Subramanian I, Hogan A, Al-Salihi A, Vyas V, Vedadi A, Popescu SS, Piras K, Ciubotaru CI, Litvin A, Romanova E, Ponomarev N, Savchenko A, Yanishev A, Luzan R, Lutovinova E, Gavrilina A, Barkovskaya A, Kudelkina N, Topchubaev D, Radulović R, Miloševic K, Ćuk VV, Bojičić J, Juloski J, Genčić M, Janković U, Zubowicz M, Sucháň PK, Gerstmeier J, Mészárosová K, Brazitikou E, Fytrou E, Celik M, Dubovský M, Schmalenbeck J, Sautter SC, Ceyran H, Jaich R, Fitchat N, Mathebula S, Chauke J, Mculu W, Ngwenya Z, Withey K, Piperidis A, Toyi Y, Nicolaides A, Jaffer T, Sparke A, Van Staden N, McDuling CR, Claassen L, Kruger C, Weyers J, Marx M, Lecler J, Mignon G, Vanoni A, Henkens A, Jarrar G, Odovic M, Willemin M, Milliet O, Hahnloser D, Clerc D, Demartines N, Piazza G, Teixeira H, Pittet O, Haller ML, Gagliardi B, Huot A, Blaser B, Kefleyesus A, Bugmann A, Piotet LM, Meijers L, Kurtoglu GK, Sel EK, Isler VC, Yilmaz BS, Adiyaman C, Kara M, Demirkaya HC, Korkmaz HK, Pektas AM, Güner B, İşlek EC, Tombul HB, Boztuğ CY, Tınaz A, Yılmaz M, Karaman Y, Akın FA, Dansuk S, Başçavuş M, Kaya M, Kutlu B, Seker MC, Erten V, Memis U, Koçak ZB, Karapinar YE, Fakirullahoglu M, Uslu Ö, Köseoglu E, Yeni M, Aktas MK, Aykun N, Agca MH, Bilen C, Kilinc I, Atar C, Kilic V, Aktuna C, Aba M, Alim YE, Binbuga M, Kürklü Ö, Yurdaor SS, Ceylan C, Yilmaz S, Çalar SN, Yildirim N, Yavuz G, Yagız Sen A, Can B, Cesmeli E, Kus D, Kavar RC, Cevlik AD, Cengiz U, Turk EG, Yilmaz I, Yüksek B, Erdönmez H, Gürsoy F, Serin H, Kara H, Önsal U, Özbek M, Kasar PA, Ipor A, Özen D, Ölmez M, Altintas E, Kaya Y, Toklu R, Sariçiçek T, Tipi OU, Benli GE, Tasdelen I, Tura A, Ucar A, Ekci B, Bilgili AC, Kiraz IN, Aksoy H, Cinar EN, Basak A, Erdem M, Kayacan S, Sahin C, Uysal M, Karakus K, Altiner S, Demirci ZS, Eren E, Yavas M, Tiftik E, Aksoy AB, Karagöz E, Sabanci R, Tümer SS, Kargici K, Banaz T, Abdulrahman SMF, Yesilsancak M, Yanikoglu E, Karabulut A, Yilmaz D, Kuyumcu OF, Kutluk F, Emiroglu B, Aksoy B, Mollavelioglu B, Gereklioglu D, Guler M, Toprak S, Afsar HB, Guler SE, Alizade E, Baki BE, Alemdag G, Ulusahin M, Arslan E, Gul EB, Yildirim R, Semiz A, Bektur G, Tomas K, Bilicen G, Yarenci E, Demiroglu Y, Sunal A, Baykan B, Abbasguliyev H, Mutlu V, Mahmoudi Y, Dossa SAA, Mizan SR, Demirtas B, Cavus T, Yuksek A, Mazlum SS, Yelkenci C, Baran T, Satilmisoglu M, Sahin AZ, Kilinç A, Isik K, Yumurtaci Ö, Emin A, Girit Ç, Yildirak MK, Senyigit E, Güldag A, Söyleyici B, Aytin YE, Akay FE, Iskan NG, Mutlu B, Sunay AO, Ablett AD, Tie-Gill T, Ramsay G, De Paola L, McGuckin S, Alshakhs A, Ahmeidat A, Wong J, Goergen N, Ali Z, Mullarkey L, Bath MF, Walshe R, Lewis E, Berry B, Moneim J, Mookerjee S, Christy S, Ojofeitimi O, Carroll L, Hylands A, Delaugere LP, Reveendran D, Coulter C, Ralston C, Laverty L, Gallagher P, Ahmed A, Yeo YQ, Elliott D, Bennett J, Mcnamara M, Sivarajah S, Dunmore C, Aitken G, Nair M, Aly MH, Buari M, Farhan-Alanie MMH, Ahmed K, Sheikh Z, Monks M, Lehmann J, Rotimi O, Bell T, Limnatitou D, Gormley S, Taleongpong P, Patel V, Macgregor L, Amini S, Turner C, Dwyer-Hemmings L, Busuttil A, Powell J, Hensher C, Vivian F, Wcislo K, Millar Z, Hirosue S, Ogunmwonyi I, Nakakande D, Kwek I, Gaze H, Nirmalanantha A, Bin Amran AM, Foulkes A, Jones N, Pillai S, Khoury G, Powell T, Maleyko I, Sangheli A, Ransome M, Isse M, Aromolaran O, Bholah H, Anbarasan J, Rehman S, Hu E, Timms S, Reynolds W, Hotchkies A, Misra V, Suresh G, Murray V, Theocharidou L, Malik T, Janmohamed I, Carhart B, Khan A, Asif A, Hullait R, Quinn P, Rylance A, Butt S, Leathes J, Finch BJ, Philip Rajathasan T, Jeddy H, Kyaw HA, Wong N, Karelia S, Clements JM, Rainey M, Joshi N, Rahman A, Gallagher M, Rebuffa N, Abdelgalil R, Siaw Yen Lai R, Laurence N, Thomas S, Green C, Frostick R, Khera R, Povey M, Wong HL, McCusker C, Hlukha L, Pike G, Kamel F, Thakkar R, Donaldson C, Sequeira Campos M, Bhahirathan Y, Armitage MN, Hussain AS, Hardy B, Hassan Serry MY, Herron J, Bradbury M, Osunronbi T, Tam LYC, Khanan Kaabneh A, Lawther J, Fisher P, Tribedi T, Moosa A, Ramdin A, Goble M, Downs E, Wheldon L, Baggus E, Mandal A, Nayeem A, Ahmed S, Fradley W, Wilson C, Gallagher S, Criswell T, Ward J, Mukkavilli A, Stubbs B, Fordyce W, Suchdev N, Wei Lim S, Yi Tew Z, Sookramanien SR, Chan A, Bointas G, Paul M, Ward KL, Bagnall M, Pherwani SA, Wang K, Mitchell L, Heyworth J, Ayyar S, Obukofe R, Polson R, Mason D, Mackenzie E, Russell C, Doyle N, Habib Z, Zardab M, Sartaj F, Farooq H, Tabibi M, Drury DJ, James SJ, Barnett R, Teasdale AB, Richardson ETJ, Thomas DA, Ahmed S, Williams RL, Najabat-Lattif HF, Cahya E, Lou G, Coyle M, Homyer K, Zhu LY, Woods M, Chang J, O'Callaghan H, Suchett-Kaye I, Mihailidis TH, Alawattegama H, Seite E, Barrett A, Riordan E, Lam W, Dowdeswell M, Mulvenna C, Netke T, Awokoya O, Gurowich L, Dhera K, Hayat S, Williams L, Tincknell L, Spazzapan M, Teeling F, Sysum K, Latter J, Latter M, Khan S, Guruswamy M, Beedham W, Brazier E, Elghobashy M, Bajaj M, Mann H, Etel E, Woodmass M, Hayden H, Kisiel A, Ali Y, Husain S, Arnold A, Pedersen AC, Cunha P, Ahmed M, Al Zawawi S, Kudva V, Liu FY, Theodoropoulou K, Miscampbell M, Robinson AV, Johnston J, Dharni A, Lamb S, Westerman T, Evans E, Campbell L, Gillespie M, Cheong CM, Kulathevanayagam K, Varghese A, Ike SI, Chu TSM, Baljer B, Mogg JAW, Rai P, Claireaux HA, Williams M, Smillie R, Goetz J, Appleby E, Fadipe T, Vaughan-Burleigh S, Puri G, Hussain P, James P, Flather R, Cutler A, Pathak S, Sheldon J, Collicott T, al-Ausi M, Mondal A, Jovaisaite A, Shah SM, Khalid N, Gutmann D, Davison S, Alame YJ, Syed L, Owen WJ, Ahsan SD, Kalderon R, Anthony-Uzoeto U, Macleod Hall C, Zheng S, Wynter K, James C, Sapre D, Ghosh R, Baird J, Cockburn L, Blackwood O, Nadama HH, Simpson W, Jeong S, Bishop S, Bate R, Hobson C, Adam AH, Redclift C, Do J, Adeleye O, Poli F, Batterham A, Brown S, Parekh JN, Clay W, Pieri K, Jackson A, Brown S, Saxena A, Gurung B, Oyebola T, O'Brien F, Djeugam B, Gardezi S, Ul-Hasan S, Martin-Hernandez MP, Sisley M, Modi S, Antakia R, Elbayouk A, Soh YJ, Mather J, Yusuf Z, Al-Sarraf Z, Naja M, Rassool SB, Convill J, Nikookam Y, Warsame A, Tam JPH, Pace C, Kiandee M, Ridwan R, Carey C, Hirri F, McMillan MJA, Ling JJ, Powell-Chandler A, Pendelbury L, Kerimzade K, Tang A, Howard EO, Humayun S, Wadsworth OJ, Tan K, Abdelhameed F, Haglund C, Radnaeva I, Hu N, Rambhatla S, Waldron D, Madahar P, Malik S, Campbell A, Meney LC, Ibrahim I, Kang CK, Chiu JZJ, Livie V, Ibrahim B, Khalil M, Pooley G, Shishkin B, Gorgievska R, Docherty J, Southgate A, Coomes A, McGee F, Flanagan S, Thakrar C, Tan QJ, Anwar H, Clough R, Chrisp B, Cassels J, Cross GWV, Ragavoodoo A, Mercer L, Mercer C, Refalo A, Hadley R, McTighe A, Farrow F, Brodie A, Davis G, Shah DR, Bowers C, Patel S, Morice O, Burzic A, Cheung J, Shashidhara A, Theodoraki G, Birk J, Ong A, Ng MPE, Wong RTW, Maese S, Yeap B, Iqbal Z, Rojoa DM, Cabaleiro Barciela C, Hussain M, Ruddy CM, Lindwe S, Qamar Y, Chuita S, Melaugh T, Hall JD, Palmer C, Kouli O, Hassane ASI, Azhar AW, Tan TK, Perchard W, Scurr T, Davidson K, Campbell E, Kelk L, Ghosh A, Gibbins A, Mala D, Loizidou A, Hall O, Mecia L, Hew C, Varathan K, Tong L, Chandrasekar B, Giacci L, Buchanan E, O'Connell M, Kwak SY, Ong EH, Gardner S, Lim J, Maden C, Illahi M, Hale J, Xuan Tan Z, Edwards S, Stahl R, Stahl J, Hickman A, Collett D, Goolam-Mahomed Z, Allen B, Atiyah A, Ahmad H, Jones J, McGregor O, Ogundiya E, Gan FW, Boulbadaoui A, Kirnon-Jackman O, Lim QX, Peckham H, Yeoh T, Yong SQ, Chen JY, Siva S, Sam ZH, Gilani M, Goh YN, Muthukumar MG, Phillips S, Makin-Taylor R, Tjoakarfa J, Giri A, Suresan S, Thavayogan R, Hey CY, Thomas P, Johnson TA, Williams RI, Rashid A, Kushairi A, Rais A, James A, Bugelli M, Chechelnitskaya Y, Sandhu N, Toh C, Tandon R, Gray M, Kumar A, Ciurleo C, Nyamali I, Hiremath S, Sinha S, Chowdhary M, Bradley E, McTiernan M, Macdonald S, Sharkey S, McLaughlin N, Amey C, Kraria L, Skan O, Kind C, Findlay JM, Tupper P, Van Rhee C, Honeyman SI, Menon G, Ahmed M, Jegatheeswaran L, Griffiths N, Madhavan A, Warne M, Malcolm FL, Lessware T, Wilkerson HT, Chatterjee-Woolman S, Yoong A, Ahmed WUR, Longshaw A, Flannery O, Green R, Leaning M, Cragg J, Sharriff H, Doherty C, Ganesananthan S, Kwan KWL, Sanders-Crook L, Bhatia S, Eames S, Lewis F, Kirupananthan P, Boh ZY, Dass S, Soma A, Newton A, Hill M, Shafiq Y, Brkljac M, Boyce L, Jasionowska S, English WJ, Lam S, Chipeta C, Yilmaz D, Jain C, Garofalidou T, Novotny SA, Locke S, Bowman C, Begaj A, Murphy C, Radcliffe K, Chong JT, Poustie M, Jeffrey E, Chaudhury N, Rajendran K, Akbar Z, Walters B, Kulendrarajah B, Tran N, Shrestha S, Parmar S, Gallagher C, Hennessy L, Pentti E, Badhrinarayanan S, Fung A, Mansoor M, Kenny R, Kan P, Lee DE, Khosla S, Samake M, Shaban F, Aftab R, Gough M, Woodburn B, Vayalapra S, McMurrugh K, Wong C, Jimulia D, Deol S, Pike S, Embury-Young Y, Turner T, Patel M, Kilgallon E, Keating R, Walsh A, Khan H, Logue G, Orekoya M, Alasmar M, Charalambides M, Clavé Llavall A, Williamson E, Bharwada Y, Zearmal S, Evans H, Panikkar M, Cruz G, Caplan J, Ruparelia A, Tanvir T, Soare C, Pang YL, Trotter J, Zaidi A, Thakrar V, Pulickal P, Ahmed H, Parnell J, Khan H, Lennock S, Ford V, Pyc W, Brignall R, O'Neill D, Hanna R, Kane R, Nicola M, Rajput K, Xiao Y, Warner C, Michael S, Wright E, Juniper S, Thompson E, Hoskyns L, Kanitkar A, Ross C, Unsworth A, Rshaidat H, Demarre K, Chiang A, Bareh A, Dellen J, Faqihinejad C, Gadhvi A, Grant R, Lewsey J, Morris A, Martin H, McClarty C, Sanyal S, Alsaif A, Palkhi A, Bhopal S, Vishnu K S, Papanikolaou A, Mitra A, Nur A, Ali F, Burford C, Huq T, Sloper W, Irwin E, Matthews L, Ngu WS, Hosfield T, Muneeb F, Page O, Zeb E, Coey J, Al-Azzawi A, McIntosh J, Vucicevic A, Hughes M, Brooks L, Fanibi B, Dixon M, Njoku P, Morris D, Jobson J, Chowdhury H, Alawode DOT, Wynell-Mayow W, Udayachandran V, Alsoof D, Ekert J, Joseph N, Zulkefley N, Hunt G, Christodoulou T, Wright O, Soman S, Jamal M, Beqiri S, Borgas P, Christie S, Pereira F, Browne S, Yiu J, Dworkin A, Brayley J, Palmer A, Charalambos M, Jones CJ, Toner S, Cowden R, Lee L, Nicol P, Holman O, Imtiaz M, Albert V, Leung SP, Erotocritou M, Wong J, Stroud R, Mason D, Wilkin R, Thomson W, Mackee L, G N, Bei Y, Sait S, Mckenna Favier S, Ibrahim A, Kler A, Reynolds L, Mohamed SH, Majeed Y, Fakim B, Jones A, Kowal M, Liversedge G, Carrington Z, Windebank J, Izzarina A, Akbani U, Craven J, Aldarragi A, Harding S, Millward A, Shortland TC, Bedford M, Stroud R, Obukofe R, Mackenzie E, Gopalan V, Midgen A, Khadka P, Cheng O, Taneja S, Manobharath N, Kok JY, Lim DWE, Buick T, Boland M, Piya S, Devlin R, Fairfield CJ, George RJ, Rahi M, Zaman S, Hajiev S, Ross T, Owen M, Crisp E, Thompson C, Charalambous A, Hollywood JL, Saiyed A, Hammond RFL, Matthews J, Mendonca V, Spinty J, Khan K, Cheng J, Glynn N, Muhammad U, Khan M, Anderson L, Mccormack K, Mak J, Patrawala S, Milinkovic N, Schofield R, Chauhan M, Hartley L, Hind J, Ashworth I, Nelson L, Ratnasingham D, Akbari K, Whitehead T, Dimitriadis S, Marshall K, Flint EJ, Curran M, Horner C, Heybourne A, Morgan H, Wickstone C, Panagiotou D, O'Connell E, Dean K, Iqbal R, Walsh L, Yu N, Rana N, Massie E, Ng J, Jung M, Lee YD, Harris M, White S, Delibegovic S, Boev B, Tonchev P, Prochazka V, Örhalmi J, Riško J, Skalický A, Chrz K, Ravn S, Ojakäär A, Duchalais E, Dörr-Harim C, Herrle F, Koutserimpas C, Giraudo G, Armellini A, Ruzzenente A, Mazzeo C, De Padua C, Realis Luc A, Maroli A, Giani I, Cufari ME, Vitali M, Ceccarelli G, Gusai GP, Quattromani R, Virgilio E, Berti S, Mulas S, Di Mola FF, Papagni V, Tuminello F, Magnoli M, Vittori L, Longheu A, Loche GA, Braccio B, De Luca E, Resta G, Ancans G, Tamosiunas A, Petrulionis M, Andrejevic P, Stellingwerf ME, Abdulrahman N, Pas KGH, Thomas G, Brandsma AM, Davids J, Rottier SJ, Roy van Zuidewijn D, Hawkins R, Ong HI, Li Y, Desmond B, Winstanley J, Martins M, Rosete M, Americano M, Santos M, Frade S, Senhorinho R, Peixoto R, Alagoa João A, Alves-Vale C, Lamas M, O'Connor DB, Hoo M, Gopaul A, Scanlon K, O'Dwyer N, Negoi I, Jovanović M, Panyko A, De Lima H, Van Vuuren S, Curchod P, Gaspar S, Imadalou L, Mutlu D, Akyol C, Uygur FA, Eray IC, Biyiklioglu O, Çetin MF, Isik AE, Karip B, Dogan H, Sarıgül L, Tunc E, Aydin T, Bodur S, Karabulut K, Francis AA, Al-hadithi A, To N, Lau ISF, Smith E, Mahapatra S, McAuliffe O, Francis AA, Imam L, Akram B, Hossaini S, Davies R, Ko M, Collins J, Pandya A, Reilly S, Archer J, Auty C, Roche CD, Livie J, Chaudhry FA, Ntakomyti E, Diallo R, Bylinski T, Wright J, Lawday S, Masiha E, Tung J, Shirazi B, Neilson A, Epton S, Patel N, Trussell S, Couldrey A, Donnelly C, Eftychiou S. Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery. Br J Surg 2020; 107:e161-e169. [PMID: 31595986 DOI: 10.1002/bjs.11326] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/06/2019] [Accepted: 07/04/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non-steroidal anti-inflammatory drugs (NSAIDs) for reducing ileus after surgery. METHODS A prospective multicentre cohort study was delivered by an international, student- and trainee-led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre-specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. RESULTS A total of 4164 patients were included, with a median age of 68 (i.q.r. 57-75) years (54·9 per cent men). Some 1153 (27·7 per cent) received NSAIDs on postoperative days 1-3, of whom 1061 (92·0 per cent) received non-selective cyclo-oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4·6 versus 4·8 days; hazard ratio 1·04, 95 per cent c.i. 0·96 to 1·12; P = 0·360). There were no significant differences in anastomotic leak rate (5·4 versus 4·6 per cent; P = 0·349) or acute kidney injury (14·3 versus 13·8 per cent; P = 0·666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35·3 versus 56·7 per cent; P < 0·001). CONCLUSION NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement.
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Rega D, Pace U, Scala D, Chiodini P, Granata V, Fares Bucci A, Pecori B, Delrio P. Treatment of splenic flexure colon cancer: a comparison of three different surgical procedures: Experience of a high volume cancer center. Sci Rep 2019; 9:10953. [PMID: 31358904 PMCID: PMC6662908 DOI: 10.1038/s41598-019-47548-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 07/11/2019] [Indexed: 12/29/2022] Open
Abstract
Extended right or left hemicolectomy are the most common surgical treatments for splenic flexure colon cancer. Extended resection (including distal pancreasectomy and/or splenectomy), has been often indicated for the treatment for the splenic flexure cancer, because the lymphatic drainage at this site is poorly defined and assumed as heterogeneous. Between January 2006 and May 2016, 103 patients with splenic flexure colon cancer were enrolled in the study. We evaluated the clinicopathological findings and outcomes of all patients and associated them to the different surgical treatment. Out of 103 selected cases an extended right hemicolectomy was performed in 22 (21.4%) patients, an extended left hemicolectomy in 24 (23.3%) patients, a segmental resection of the splenic flexure in 57 (55.3%) patients; the combined resection of adjacent organs showing tumor adherence was carried out in 11 (10.7%) patients. The tumor infiltrated near organs (T4) in 5 patients. No significant differences in complications were found among the three groups. In all groups no differences were found in the total number of harvested lymphnodes. After a median follow-up of 42 months, 30 recurrences and 19 deaths occurred (12 for tumor progression). There was no difference in overall and progression free survival among the three different surgical treatments. According to our results, the partial resection of splenic flexure was not associated with a worse prognosis and it was leading for a satisfactory oncological outcome. It is our opinion that the extended surgery is seldomly indicated to cure splenic flexure cancer.
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Fusco R, Granata V, Rega D, Russo C, Pace U, Pecori B, Tatangelo F, Botti G, Izzo F, Cascella M, Avallone A, Delrio P, Petrillo A. Morphological and functional features prognostic factor of magnetic resonance imaging in locally advanced rectal cancer. Acta Radiol 2019; 60:815-825. [PMID: 30286607 DOI: 10.1177/0284185118803783] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Pucciarelli S, Del Bianco P, Pace U, Bianco F, Restivo A, Maretto I, Selvaggi F, Zorcolo L, De Franciscis S, Asteria C, Urso EDL, Cuicchi D, Pellino G, Morpurgo E, La Torre G, Jovine E, Belluco C, La Torre F, Amato A, Chiappa A, Infantino A, Barina A, Spolverato G, Rega D, Kilmartin D, De Salvo GL, Delrio P. Multicentre randomized clinical trial of colonic J pouch or straight stapled colorectal reconstruction after low anterior resection for rectal cancer. Br J Surg 2019; 106:1147-1155. [PMID: 31233220 DOI: 10.1002/bjs.11222] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/30/2019] [Accepted: 04/02/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Colonic J pouch reconstruction has been found to be associated with a lower incidence of anastomotic leakage than straight anastomosis. However, studies on this topic are underpowered and retrospective. This randomized trial evaluated whether the incidence of anastomotic leakage was reduced after colonic J pouch reconstruction compared with straight colorectal anastomosis following anterior resection for rectal cancer. METHODS This multicentre RCT included patients with rectal carcinoma who underwent low anterior resection followed by colorectal anastomosis. Patients were assigned randomly to receive a colonic J pouch or straight colorectal anastomosis. The main outcome measure was the occurrence of major anastomotic leakage. The incidence of global (major plus minor) anastomotic leakage and general complications were secondary outcomes. Risk factors for anastomotic leakage were identified by regression analysis. RESULTS Of 457 patients enrolled, 379 were evaluable (colonic J pouch arm 190, straight colorectal arm 189). The incidence of major and global anastomotic leakage, and general complications was 14·2, 19·5 and 34·2 per cent respectively in the colonic J pouch group, and 12·2, 19·0 and 27·0 per cent in the straight colorectal anastomosis group. No statistically significant differences were observed between the two arms. In multivariable logistic regression analysis, male sex (odds ratio 1·79, 95 per cent c.i. 1·02 to 3·15; P = 0·042) and high ASA fitness grade (odds ratio 2·06, 1·15 to 3·71; P = 0·015) were independently associated with the occurrence of anastomotic leakage. CONCLUSION Colonic J pouch reconstruction does not reduce the incidence of anastomotic leakage and postoperative complications compared with conventional straight colorectal anastomosis. Registration number NCT01110798 (http://www.clinicaltrials.gov).
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Rega D, Scala D, Pace U, Bucci AF, Patrone R, Rocca A, Delrio P. Closure of the defect after TAMIS for rectal tumor: which methods. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Petrillo A, Fusco R, Granata V, Filice S, Sansone M, Rega D, Delrio P, Bianco F, Romano GM, Tatangelo F, Avallone A, Pecori B. Assessing response to neo-adjuvant therapy in locally advanced rectal cancer using Intra-voxel Incoherent Motion modelling by DWI data and Standardized Index of Shape from DCE-MRI. Ther Adv Med Oncol 2018; 10:1758835918809875. [PMID: 30479672 PMCID: PMC6243411 DOI: 10.1177/1758835918809875] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/24/2018] [Indexed: 12/16/2022] Open
Abstract
Background: Our aim was to investigate preoperative chemoradiation therapy (pCRT) response in locally advanced rectal cancer (LARC) comparing standardized index of shape (SIS) obtained from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with intravoxel-incoherent-motion-modelling-derived parameters by diffusion-weighted imaging (DWI). Materials and methods: Eighty-eight patients with LARC were subjected to MRI before and after pCRT. Apparent diffusion coefficient (ADC), tissue diffusion (Dt), pseudodiffusion (Dp) and perfusion fraction (f) were calculated and percentage changes ∆ADC, ∆Dt, ∆Dp, ∆f were computed. SIS was derived comparing DCE-MRI pre- and post-pCRT. Nonparametric tests and receiver operating characteristic (ROC) curves were performed. Results: A total of 52 patients were classified as responders (tumour regression grade; TRG ⩽ 2) and 36 as not-responders (TRG > 3). Mann–Whitney U test showed statistically significant differences in SIS, ∆ADC and ∆Dt between responders and not-responders and between complete responders (19 patients with TRG = 1) versus incomplete responders. The best parameters to discriminate responders by nonresponders were SIS and ∆ADC, with an accuracy of 91% and 82% (cutoffs of −5.2% and 18.7%, respectively); the best parameters to detect pathological complete responders were SIS, ∆f and ∆Dp with an accuracy of 78% (cutoffs of 38.5%, 60.0% and 83.0%, respectively). No increase of performance was observed by combining linearly each possible couple of parameters or combining all parameters. Conclusion: SIS allows assessment of preoperative treatment response with high accuracy guiding the surgeon versus more or less conservative treatment. DWI-derived parameters reached less accuracy compared with SIS and combining linearly DCE- and DWI-derived parameters; no increase of accuracy was obtained.
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Belluco C, Forlin M, Delrio P, Rega D, Degiuli M, Sofia S, Olivieri M, Pucciarelli S, Zuin M, De Manzoni G, Di Leo A, Scabini S, Zorcolo L, Restivo A. Elevated platelet count is a negative predictive and prognostic marker in locally advanced rectal cancer undergoing neoadjuvant chemoradiation: a retrospective multi-institutional study on 965 patients. BMC Cancer 2018; 18:1094. [PMID: 30419864 PMCID: PMC6233528 DOI: 10.1186/s12885-018-5022-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 10/31/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND In patients with locally advanced rectal cancer treated by neoadjuvant chemoradiation, pathological complete response in the surgical specimen is associated with favourable long-term oncologic outcome. Based on this observation, nonoperative management is being explored in the subset of patients with clinical complete response. Whereas, patients with poor response have a high risk of local and distant recurrence, and appear to receive no benefit from standard neoadjuvant chemoradiation. Therefore, in order to develop alternative treatment strategies for non responding patients, predictive and prognostic factors are highly needed. Accumulating clinical observations indicate that elevated platelet count is associated with poor outcome in different type of tumors. In this study we investigated the predictive and prognostic impact of elevated platelet count on pathological response and long-term oncologic outcome in patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiation. METHODS A total of 965 patients were selected from prospectively maintained databases of seven Centers within the SICO Colorectal Cancer Network. Patients were divided into two groups based on a pre-neoadjuvant chemoradiation platelet count cut-off value of 300 × 109/L identified by receiver operating characteristic curve considering complete pathological response as the outcome. RESULTS Complete pathological response rate was lower in patients with elevated platelet count (12.8% vs. 22.1%, p = 0.001). Mean follow-up was 50.1 months. Comparing patients with elevated platelet count with patients with not elevated platelet count, 5-year overall survival was 69.5% vs.76.5% (p = 0.016), and 5-year disease free survival was 63.0% vs. 68.9% (p = 0.019). Local recurrence rate was higher in patients with elevated platelet count (11.1% vs. 5.3%, p = 0.001), as higher was the occurrence of distant metastasis (23.9% vs. 16.4%, p = 0.007). At multivariate analysis of potential prognostic factors EPC was independently associated with worse overall survival (HR 1.40, 95% CI 1.06-1.86), and disease free survival (HR 1.37, 95% CI 1.07-1.76). CONCLUSIONS In locally advanced rectal cancer elevated platelet count before neoadjuvant chemoradiation is a negative predictive and prognostic factor which might help to identify subsets of patients with more aggressive tumors to be proposed for alternative therapeutic strategies.
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Belluco C, Forlin M, Rega D, Scabini S, Degiuli M, Olivieri M, Zuin M, Di Leo A, Carboni A, Restivo A. Elevated platelet count is a negative predictive factor for pathological tumor response and long-term oncologic outcome in locally advanced rectal cancer undergoing preoperative chemoradiation. SICO – colorectal cancer network collaborative study. Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Turano M, Costabile V, Cerasuolo A, Duraturo F, Liccardo R, Delrio P, Pace U, Rega D, Dodaro CA, Milone M, Izzo P, De Rosa M. Characterisation of mesenchymal colon tumour-derived cells in tumourspheres as a model for colorectal cancer progression. Int J Oncol 2018; 53:2379-2396. [PMID: 30272331 PMCID: PMC6203159 DOI: 10.3892/ijo.2018.4565] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 07/25/2018] [Indexed: 12/21/2022] Open
Abstract
Cellular plasticity, the ability of cells to switch from an epitheial phenotype to a mesenchymal one and vice versa, plays a crucial role in tumour progression and metastases development. In 20-25% of patients with colon cancer and in 18% of patients with rectal cancer, metastases are present at the time of the first diagnosis. They are the first cause of colorectal cancer (CRC)-related mortality, defining stage IV CRC, which is characterized by a relatively short overall survival. We previously isolated two primary colon adenocarcinoma cell cultures that had undergone epithelial-mesenchymal transition (EMT), one with a high microsatellite instability phenotype (T88) and one with a chromosomal instability phenotype (T93). The aim of this study was to establish a model with which to study EMT, stemness features and cell plasticity in cancer progression and to examine the effects of incubation with lithium chloride (LiCl), a specific glycogen synthase kinase 3 β (GSK-3β) inhibitor, on these cellular processes. Indeed, GSK3β is an important regulator of cell survival, which promotes tumourigenesis in colon cells by facilitating the crosstalk between colorectal cancer pathways. Thus, we further characterized our system of adherent primary mesenchymal colon cancer cells and their paired tumourspheres by examining the expression and localisation of a panel of markers, including E- and N‑cadherin, CD133, CD44v6, aldehyde dehydrogenase 1 (ALDH1) and leucine-rich repeat‑containing G-protein coupled receptor 5 (LGR5). We also characterised the molecular features of these tumourspheres and examined their response to LiCl. Furthermore, we explored the effects of LiCl on cell motility and plasticity. We demonstrated that LiCl reduced cell migration, stemness features and cell plasticity. We also observed the atypical nuclear localisation of membrane proteins, including N‑cadherin, CD133 and CD44v6 in mesenchymal tumour cells. Of note, CD133 and CD44v6 appeared to localise at the plasma membrane in cells with a more epithelial phenotype, suggesting that the cytoplasmic/nuclear localisation of these proteins could favour and characterize cell plasticity in colorectal cancer progression.
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Reginelli A, Granata V, Fusco R, Granata F, Rega D, Roberto L, Pellino G, Rotondo A, Selvaggi F, Izzo F, Petrillo A, Grassi R. Diagnostic performance of magnetic resonance imaging and 3D endoanal ultrasound in detection, staging and assessment post treatment, in anal cancer. Oncotarget 2017; 8:22980-22990. [PMID: 28152518 PMCID: PMC5410279 DOI: 10.18632/oncotarget.14946] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 12/27/2016] [Indexed: 01/27/2023] Open
Abstract
We compared Magnetic Resonance Imaging (MRI) and 3D Endoanal Ultrasound (EAUS) imaging performance to confirm anal carcinoma and to monitor treatment response.58 patients with anal cancer were retrospectively enrolled. All patients underwent clinical examination, anoscopic examination; EAUS and contrast-enhanced MRI study before and after treatment. Four radiologists evaluated the presence of lesions, using a 4-point confidence scale, features of the lesion and nodes on EAUS images, T1-weighted (T1-W), T2-weighted (T2-W) and diffusion-weighted images (DWI) signal intensity (SI), the apparent diffusion coefficient (ADC) map for nodes and lesion, as well as enhancement pattern during dynamic MRI were assessed.All lesions were detected by EAUS while MRI detected 93.1% of anal cancer. MRI showed a good correlation with EAUS, anoscopy and clinical examination. The residual tissue not showed significant difference in EAUS assessment and T2-W SI in pre and post treatment. We found significant difference in dynamic study, in SI of DWI, in ADC map and values among responder's patients in pre and post treatment. The neoplastic nodes were hypoecoic on EAUS, with hyperintense signal on T2-W sequences and hypointense signal on T1-W. The neoplastic nodes showed SI on DWI sequences and ADC value similar to anal cancer. We found significant difference in nodes status in pre and post therapy on DWI data.3D EAUS and MRI are accurate techniques in anal cancer staging, although EAUS is more accurate than MRI for T1 stage. MRI allows correct detection of neoplastic nodes and can properly stratify patients into responders or non responders.
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Rega D, Pace U, Scala D, Delrio P. Feasibility and advantages of transanal minimally invasive surgery: a 7-year experience with 76 cases. ANNALS OF LAPAROSCOPIC AND ENDOSCOPIC SURGERY 2017. [DOI: 10.21037/ales.2017.08.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Lorenzon L, Parini D, Rega D, Mellano A, Vigorita V, Biondi A, Jaminez-Rosellon R, Scheiterle M, Giannini I, Gallo G, Marino G, Turati L, Marsanic P, De Franco L, Marano L, De Luca R. Long-term outcomes in ypT0 rectal cancers: An international multi-centric investigation on behalf of Italian Society of Surgical Oncology Young Board (YSICO). Eur J Surg Oncol 2017; 43:1472-1480. [PMID: 28571778 DOI: 10.1016/j.ejso.2017.04.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/12/2017] [Accepted: 04/30/2017] [Indexed: 12/26/2022] Open
Abstract
AIM To investigate the outcome and pattern of survivals of rectal cancer patients presenting a complete or nearly complete tumor response after neo-adjuvant treatment. METHODS Young surgeons <40 years old affiliated to the Italian Society of Surgical Oncology (YSICO) from 13 referral centers for colorectal cancer treatment, were invited to participate a retrospective study. Records from patients treated from 2005 to 2015 with a pathological diagnosis of ypT0/ypTis were retrieved and pooled in a common data-base for statistical purposes. All clinical and pathological variables were reviewed. Univariate and multivariate analyses were conducted with the end-point of survivals. RESULTS Two hundreds and sixty-one patients were analyzed including 237 ypT0 and 24 ypTis. Nodal positive patients were 8.7%. More than sixty-six percent of the patients did not perform adjuvant chemotherapy, with a statistical difference comparing N0 versus N+ patients (66.8% vs 40.9%, p 0.02). Mean follow-up was of 47.6 months. Twenty-two relapses were observed, 91.6% at a distant site. The mean time to recurrence was of 35.3 months. On univariate analysis, the use of adjuvant chemotherapy correlated with better OS exclusively in ypT0N + patients and not in ypT0N0. Univariate and multivariate analyses documented nodal positivity as the only prognostic factor correlated with a worse OS. CONCLUSION Recurrences were mostly diagnosed at a distant site and within the third year of follow-up. Nodal positivity was the only variable independently correlated with a worse OS. Univariate analysis documented a benefit for the use of adjuvant chemotherapy treatment exclusively in ypT0N + rectal cancers.
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Bianco F, De Franciscis S, Belli A, Falato A, Fusco R, Altomare DF, Amato A, Asteria CR, Avallone A, Binda GA, Boccia L, Buzzo P, Carvello M, Coco C, Delrio P, De Nardi P, Di Lena M, Failla A, La Torre F, La Torre M, Lemma M, Luffarelli P, Manca G, Maretto I, Marino F, Muratore A, Pascariello A, Pucciarelli S, Rega D, Ripetti V, Rizzo G, Serventi A, Spinelli A, Tatangelo F, Urso EDL, Romano GM. T1 colon cancer in the era of screening: risk factors and treatment. Tech Coloproctol 2017; 21:139-147. [DOI: 10.1007/s10151-017-1586-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/03/2016] [Indexed: 02/07/2023]
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Pecori B, Lastoria S, Caracò C, Celentani M, Tatangelo F, Avallone A, Rega D, De Palma G, Mormile M, Budillon A, Muto P, Bianco F, Aloj L, Petrillo A, Delrio P. Sequential PET/CT with [18F]-FDG Predicts Pathological Tumor Response to Preoperative Short Course Radiotherapy with Delayed Surgery in Patients with Locally Advanced Rectal Cancer Using Logistic Regression Analysis. PLoS One 2017; 12:e0169462. [PMID: 28060889 PMCID: PMC5217944 DOI: 10.1371/journal.pone.0169462] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 12/16/2016] [Indexed: 12/12/2022] Open
Abstract
Previous studies indicate that FDG PET/CT may predict pathological response in patients undergoing neoadjuvant chemo-radiotherapy for locally advanced rectal cancer (LARC). Aim of the current study is evaluate if pathological response can be similarly predicted in LARC patients after short course radiation therapy alone. Methods: Thirty-three patients with cT2-3, N0-2, M0 rectal adenocarcinoma treated with hypo fractionated short course neoadjuvant RT (5x5 Gy) with delayed surgery (SCRTDS) were prospectively studied. All patients underwent 3 PET/CT studies at baseline, 10 days from RT end (early), and 53 days from RT end (delayed). Maximal standardized uptake value (SUVmax), mean standardized uptake value (SUVmean) and total lesion glycolysis (TLG) of the primary tumor were measured and recorded at each PET/CT study. We use logistic regression analysis to aggregate different measures of metabolic response to predict the pathological response in the course of SCRTDS. Results: We provide straightforward formulas to classify response and estimate the probability of being a major responder (TRG1-2) or a complete responder (TRG1) for each individual. The formulas are based on the level of TLG at the early PET and on the overall proportional reduction of TLG between baseline and delayed PET studies. Conclusions: This study demonstrates that in the course of SCRTDS it is possible to estimate the probabilities of pathological tumor responses on the basis of PET/CT with FDG. Our formulas make it possible to assess the risks associated to LARC borne by a patient in the course of SCRTDS. These risk assessments can be balanced against other health risks associated with further treatments and can therefore be used to make informed therapy adjustments during SCRTDS.
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