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Brandl A, Lundon D, Lorenzon L, Schrage Y, Caballero C, Holmberg CJ, Santrac N, Smith H, Vasileva-Slaveva M, Montagna G, Bonci EA, Sgarbura O, Sayyed R, Ben-Yaacov A, Herrera Kok JH, Suppan I, Kaul P, Sochorova D, Vassos N, Carrico M, Mohan H, Ceelen W, Arends J, Sandrucci S. Current practice in assessment and management of malnutrition in surgical oncology practice - An ESSO-EYSAC snapshot analysis. Eur J Surg Oncol 2024; 50:106953. [PMID: 37429796 DOI: 10.1016/j.ejso.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Malnutrition is common in patients suffering from malignant diseases and has a major impact on patient outcomes. Prevention and early detection are crucial for effective treatment. This study aimed to investigate current international practice in the assessment and management of malnutrition in surgical oncology departments. MATERIAL AND METHODS The survey was designed by European Society of Surgical Oncology (ESSO) and ESSO Young Surgeons and Alumni Club (EYSAC) Research Academy as an online questionnaire with 41 questions addressing three main areas: participant demographics, malnutrition assessment, and perioperative nutritional standards. The survey was distributed from October to November 2021 via emails, social media and the ESSO website to surgical networks focussing on surgical oncologists. Results were collected and analysed by an independent team. RESULTS A total of 156 participants from 39 different countries answered the survey, reflecting a response rate of 1.4%. Surgeons reported treating a mean of 22.4 patients per month. 38% of all patients treated in surgical oncology departments were routinely screened for malnutrition. 52% of patients were perceived as being at risk for malnutrition. The most used screening tool was the "Malnutrition Universal Screening Tool" (MUST). 68% of participants agreed that the surgeon is responsible for assessing preoperative nutritional status. 49% of patients were routinely seen by dieticians. In cases of severe malnutrition, 56% considered postponing the operation. CONCLUSIONS The reported rate of malnutrition screening by surgical oncologists is lower than expected (38%). This indicates a need for improved awareness of malnutrition in surgical oncology, and nutritional screening.
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Affiliation(s)
- Andreas Brandl
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Germany.
| | - Dara Lundon
- Mount Sinai Department of Urology, New York, United States
| | - Laura Lorenzon
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Yvonne Schrage
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Carl Jacob Holmberg
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sweden
| | - Nada Santrac
- Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Henry Smith
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Denmark
| | | | - Giacomo Montagna
- Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eduard-Alexandru Bonci
- Surgical Oncology and Gynecologic Oncology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania; Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, Lisbon, Portugal
| | - Olivia Sgarbura
- Department of Surgical Oncology, Institut du Cancer Montpellier, University of Montpellier, France
| | - Raza Sayyed
- Department of Surgical Oncology, Patel Hospital, Karachi, Pakistan
| | - Almog Ben-Yaacov
- Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Ina Suppan
- Breast Center, Department of Gynaecology, Rottal-Inn-Kliniken Eggenfelden, Germany
| | - Pallvi Kaul
- Department of Surgical Oncology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, India
| | - Dana Sochorova
- Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Nikolaos Vassos
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Marta Carrico
- Nutrition Department - Champalimaud Foundation, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Helen Mohan
- Peter MacCallum Cancer Centre in Melbourne, Australia
| | - Wim Ceelen
- Department of GI Surgery and Cancer Research Institute Ghent (CRIG), Ghent University Hospital, Belgium
| | - Jann Arends
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Altaf K, Slawik S, Sochorova D, Gahunia S, Andrews T, Kehoe A, Ahmed S. Long-term outcomes of open versus closed rectal defect after transanal endoscopic microscopic surgery. Colorectal Dis 2021; 23:2904-2910. [PMID: 34288314 DOI: 10.1111/codi.15830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/17/2021] [Accepted: 07/10/2021] [Indexed: 12/13/2022]
Abstract
AIM Management of the rectal defect after transanal endoscopic microsurgery (TEM) is a matter of debate. Data are lacking on long term outcomes and continence of patients with open or closed rectal defect. We sought to analyse these in a retrospective cohort study. METHODS Patients undergoing TEM via the Specialist Early Rectal Cancer (SERC) MDT between 2012 and 2019 were included from a prospectively maintained database. These were divided into two groups - open and closed, based on management of rectal defect. Patient demographics and outcomes, including pre- and postoperative oncological staging, morbidity, mortality, length of stay and faecal incontinence severity score (FISI) scores were assessed. RESULTS A total of 170 matched patients were included (70-open, 100-closed rectal defects). Short-term complications (bleeding, infection, urinary retention and infection, length of stay and pain) were 18.8% with no significant difference between the two groups (22% vs. 16%). Most of the defects were well healed upon endoscopic follow-up; more unhealed/sinus formation was noticed in the open group (p = 0.01); more strictures were encountered in the closed group (p = 0.04). Comparing the open and closed defect groups, there was no difference in the functional outcome of patients in those who developed sinus (p = 0.87) or stricture (p = 0.79) but a significant difference in post-TEMS FISI scores in those with healed scar, with those in closed rectal defect group with worsening function (p = 0.02). CONCLUSION There are pros and cons associated with both rectal defect management approaches. Long-term complications should be expected and actively followed up. Patients should be thoroughly counselled about these and possible deterioration in continence post-TEM.
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Affiliation(s)
- Kiran Altaf
- Department of Surgery, Liverpool University Hospitals, NHS Foundation Trust, Liverpool, UK
| | - Simone Slawik
- Department of Surgery, Liverpool University Hospitals, NHS Foundation Trust, Liverpool, UK
| | - Dana Sochorova
- Department of Surgery, Liverpool University Hospitals, NHS Foundation Trust, Liverpool, UK
| | - Sukhpreet Gahunia
- Department of Surgery, Liverpool University Hospitals, NHS Foundation Trust, Liverpool, UK
| | - Timothy Andrews
- Department of Surgery, Liverpool University Hospitals, NHS Foundation Trust, Liverpool, UK
| | - Ashley Kehoe
- Department of Surgery, Liverpool University Hospitals, NHS Foundation Trust, Liverpool, UK
| | - Shakil Ahmed
- Department of Surgery, Liverpool University Hospitals, NHS Foundation Trust, Liverpool, UK
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Altaf K, Gahunia S, Sochorova D, Andrews T, Sarkar S, Ahmed S. EP.TU.393Management of Suspicious Neoplastic Rectal Lesions in Octogenarians by a Specialist Early Rectal Cancer MDT. Br J Surg 2021. [DOI: 10.1093/bjs/znab311.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Aims
To assess management of early rectal cancers in octogenarians going through a regional Small and Early Rectal Cancer MDT observing oncological outcomes, morbidity, mortality and quality of life after treatment
Methods
Consecutive octogenarian patients treated via the SERC MDT between Dec 2013 and Dec 2019 were examined retrospectively from a prospectively maintained database. Patients underwent transanal endoscopic microsurgery (TEMS), endoscopic submucosal dissection (ESD), contact radiotherapy or hybrid combinations. Patient demographics were recorded and outcomes assessed including pre and post-operative oncological staging, morbidity, mortality, length of stay and FISI scores
Results
85 patients were assessed. 38 had TEMS, 40 had EMR, ESD or hybrid procedures and 7 had contact radiotherapy. Of the 38 patients who underwent TEMS, there was minor morbidity in 5 patients, one cancer recurrence and no cancer related mortality. FISI scores pre- and post-procedure were markedly different with deterioration in control of flatus and mucus, but no faecal incontinence. Of the 40 patients who underwent EMR, ESD or hybrid procedures, 2 had minor morbidity and 3 had adenocarcinomas detected requiring further treatment
Conclusions
Management of octogenarians with early rectal cancer via a specialist MDT provides a safe option with minimal morbidity and no mortality in a subgroup of patients who would otherwise constitute a high risk cohort for surgical intervention. A deterioration in continence in this group highlights the need for careful counselling of patients to achieve the optimal balance between oncological outcomes and quality of life
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Affiliation(s)
- Kiran Altaf
- Royal Liverpool University Hospitals NHS Foundation Trust
| | | | - Dana Sochorova
- Royal Liverpool University Hospitals NHS Foundation Trust
| | | | - Sanchoy Sarkar
- Royal Liverpool University Hospitals NHS Foundation Trust
| | - Shakil Ahmed
- Royal Liverpool University Hospitals NHS Foundation Trust
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Thomas A, Altaf K, Sochorova D, Gur U, Parvaiz A, Ahmed S. Effective implementation and adaptation of structured robotic colorectal programme in a busy tertiary unit. J Robot Surg 2020; 15:731-739. [PMID: 33141410 PMCID: PMC8423644 DOI: 10.1007/s11701-020-01169-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/24/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Safety and feasibility of robotic colorectal surgery has been reported as increasing over the last decade. However safe implementation and adaptation of such a programme with comparable morbidities and acceptable oncological outcomes remains a challenge in a busy tertiary unit. We present our experience of implementation and adaptation of a structured robotic colorectal programme in a high-volume center in the United Kingdom. METHODS Two colorectal surgeons underwent a structured robotic colorectal training programme consisting of time on simulation console, dry and wet laboratory courses, case observation, and initial mentoring. Data were collected on consecutive robotic colorectal cancer resections over a period of 12 months and compared with colorectal cancer resections data of the same surgeons' record prior to the adaptation of the new technique. Patient demographics including age, gender, American Society of Anesthesiologist score (ASA), Clavien-Dindo grading, previous abdominal surgeries, and BMI were included. Short-term outcomes including conversion to open, length of stay, return to theatre, 30- and 90-days mortality, blood loss, and post-operative analgesia were recorded. Tumour site, TNM staging, diverting stoma, neo-adjuvant therapy, total mesorectal excision (TME) grading and positive resection margins (R1) were compared. p values less than or equal to 0.05 were considered statistically significant. RESULTS Ninety colorectal cancer resections were performed with curative intent from June 2018 to June 2020. Thirty robotic colorectal cancer resections (RCcR) were performed after adaption of programme and were compared with 60 non-robotic colorectal cancer resections (N-RCcR) prior to implementation of technique. There was no conversion in the RCcR group; however, in N-RCcR group, five had open resection from start and the rest had laparoscopic surgery. In laparoscopic group, there were six (10.9%) conversions to open (two adhesions, three multi-visceral involvements, one intra-operative bleed). Male-to-female ratio was 20:09 in RCcR group and 33:20 in N-RCcR groups. No significant differences in gender (p = 0.5), median age (p = 0.47), BMI (p = 0.64) and ASA scores (p = 0.72) were present in either groups. Patient characteristics between the two groups were comparable aside from an increased proportion of rectal and sigmoid cancers in RCcR group. Mean operating time, and returns to theaters were comparable in both groups. Complications were fewer in RCcR group as compared to N-RCcR (16.6% vs 25%). RCcR group patients have reduced length of stay (5 days vs 7 days) but this is not statistically significant. Estimated blood loss and conversion to open surgery was significantly lesser in the robotic group (p < 0.01). The oncological outcomes from surgery including TNM, resection margin status, lymph node yield and circumferential resection margin (for rectal cancers) were all comparable. There was no 30-day mortality in either group. CONCLUSION Implementation and integration of robotic colorectal surgery is safe and effective in a busy tertiary center through a structured training programme with comparable short-term survival and oncological outcomes during learning curve.
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Affiliation(s)
- A Thomas
- Department of Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Foundation Trust, Prescot Road, Liverpool, L7 8XP, UK
| | - K Altaf
- Department of Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Foundation Trust, Prescot Road, Liverpool, L7 8XP, UK
| | - D Sochorova
- Department of Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Foundation Trust, Prescot Road, Liverpool, L7 8XP, UK
| | - U Gur
- Department of Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Foundation Trust, Prescot Road, Liverpool, L7 8XP, UK
| | - A Parvaiz
- Faculty of Health Science, University of Portsmouth, Portsmouth, UK
| | - Shakil Ahmed
- Department of Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Foundation Trust, Prescot Road, Liverpool, L7 8XP, UK.
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