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Kosti A, Borakati A, Varma A, Gupta A, Mustafa A, Hakeem A, Quddus A, Sahl AB, Beniwal A, Adesuyi A, Krzak AM, Brooks A, Frampton A, Gadhvi A, Talbot A, Elnogoomi A, Mahgoub A, Naqvi A, Pervez A, Bodla AS, Taha A, Tawfik A, Prabhu A, Puri A, Belgaumkar A, Gupta A, McCrorie A, Findlay A, Healey A, De Prendergast A, Farrugia A, Dosis A, Adiamah A, Sallam A, Wong A, Bradley A, Martin A, Collins A, Awan A, Bond A, Koh A, Kourdouli A, Patel AG, Dhannoon A, Khalil A, Banerjee A, Khan A, Elserafy A, Alamassi A, Owen A, Benjafield A, Zuccarrelli A, Luhmann A, Jones A, Kennedy-Dalby A, Smith AM, Kaul A, Kumar A, White A, Baker A, Minicozzi A, Bardoli A, Golpe AL, Manzelli A, Sivakumar A, Saha A, Shajpal A, Lango A, Cotton A, Nair A, Brown A, Menon A, Tandon A, Afza A, Hassan A, Shamali A, Khalid A, Regan A, Piramanayagam B, Oyewole B, Ibrahim B, Murphy B, Clayton B, Jenkins B, Kumar B, Rybinski B, Khor BY, Davidson BR, Lees B, Blacklock C, Johnstone C, Salinas CH, Boven C, Wolstenholme C, Chin C, Gilmore C, Sharp C, Walker C, Harris C, Khanna C, Ferguson C, Kyriakides C, Bee C, Currow C, Parmar C, Collins C, Halloran C, Smart CJ, Neophytou C, Delaney C, Anele C, Heugh C, Choh CTP, Kenington C, Wyatt C, Borg CM, Mole D, Arumugam D, Gunia D, Porter D, Berry D, Griffith D, Hou D, Longbotham D, Mitton D, Strachan D, Di Mauro D, Worku D, Heaphy D, Dunne D, Yeung D, Arambepola D, Leswas DA, Pournaras DJ, Damaskos D, Saleh D, Osilli D, Pearman D, Whitelaw D, Haq EU, Mack E, Spurring E, Jamieson E, Lenzi E, Gemmill E, Gammeri E, Bota E, Britton E, Farrow E, Lloyd E, Moran E, Itobi E, Craig E, Tanaka E, Chohda E, Muhammad FU, Youssef F, Roslan F, Amir F, Froghi F, Di Franco F, Abbadessa F, DiMaggio F, Gurung G, Faulkner G, Choa G, Kerans G, Davis GN, Galanopoulos G, Karagiannidis G, McCabe G, Mohammadi-Zaniani G, Nawaz G, Van Boxel G, Bond-Smith G, Tierney GM, Muthukumarasamy G, Grey G, Wong G, Finch G, Khan H, Bourne H, Javanmard-Emamghissi H, Murray H, Rottenburg H, Wright H, Khalil H, Spiers HVM, Bashiti H, Shanti H, Ebied H, Ng HJ, Hamid HKS, Kim H, Wilson I, Rajendran I, Gerogiannis I, Patel I, El-Abbassy I, Burridge I, Caldwll J, Jackman J, Clark J, Duncan J, Milburn J, O’Kelly J, Olivier J, Rink J, Royle J, Rai J, Latif J, Ahmad J, Maliyil J, Carr J, Coles J, McGarry J, Apollos J, Lim J, Gray J, Thomas J, Bennett J, Findlay J, Spearman J, Young J, Lund JN, Meilak J, Alfred J, Welsh J, Chan JH, Martin J, Patel K, Ko KYK, Isand K, Razi K, Sarathy K, Powezka K, Foster K, Peleki K, Bevan K, Fox K, Edwards K, Larsen K, Spellar K, Oh KE, Kong K, Brown K, Roberts KJ, Seymour K, Beatson K, Etherson K, Willis K, Mann K, Nizami K, Rajput K, Lavery L, Sawdon L, Nip L, Al-Hamed L, Fagan L, Watton L, Saint-Grant AL, Convie L, Girard LP, Huppler L, Marsh L, Seretny L, Newton L, Buksh M, Sallam M, Mathew M, Prasanth MN, Nayar M, Wijeyaratne M, Hollyman M, Ransome M, Popa M, Galea M, Taylor M, Gismondi M, Michel M, Wadley M, Al-Azzawi M, Claxton M, Kuzman M, Bonomaully M, Newman M, Bhandari M, Courtney M, Jones M, Rarity M, Wilson M, Ebraheem M, Elnaghi M, Mohamed MSN, Al-Hijaji M, Al-Rashedy M, Qayum MK, Zourob M, Gaber M, Rao M, Islam MA, Rashid MU, Zafar M, Naqvi M, Ahmad MN, Telfah M, Merali N, Hanbali N, Gulnaz N, Kumar N, Husain N, Angamuthu N, Murali N, Kirmani N, Assaf N, Doshi N, Shah NS, Basra N, Menezes N, Dai N, Schuijtvlot N, Kansal N, Chidumije N, Yassin N, Babalola O, Oyende O, Williams O, Pawlik O, O'Connor O, Jalil OA, Ryska O, Vaz O, Sarmah P, Jayawardena P, Patel P, Hart P, Cromwell P, Manby P, Marriott P, Needham P, Ghaneh P, Rao PKD, Eves P, Coe PO, May-Miller P, Szatmary P, Ireland P, Seta P, Ravi P, Janardhanan P, Patil P, Mistry P, Heer P, Patel P, Nunes Q, Ain Q, Clifford R, Brindle R, Lee RXN, Lim RQH, Rahman R, Kumar RM, Lunevicius R, Mukherjee R, Lahiri R, Behmida R, Rajebhosale R, Levy R, Chhabra R, Oliphant R, Freeman R, Jones RM, Elkalbash R, Brignall R, Bell R, Byrom R, Laing RW, Patel R, Buhain R, Clark R, Sutton R, Presa R, Lawther R, Patel R, Zakeri R, Mashar R, Wei R, Baron R, Tasleem S, Kadambot SS, Azam S, Wajed S, Ali S, Body S, Saeed S, Bandyopadhyay S, Mohamed S, Pandanaboyana S, Hassasing S, Dyer S, Small S, Seeralakandapalan S, Arumugam S, Chakravartty S, Ong SL, Ooi SZY, Nazir S, Zafar S, Shirazi S, Bharucha S, Majid S, Ahmed S, Rajamanickam SK, Albalkiny S, Ng S, Chowdhury S, Yahia S, Handa S, Fallis S, Fisher S, Jones S, Phillips S, Mitra S, Aroori S, Thanki S, Rozwadowski S, Tucker S, Conroy S, Barman S, Bhat S, McCallion S, Knight SR, Tezas S, van Laarhoven S, Cowie S, Rao S, Sellahewa S, Bhatti S, Kaistha S, Moug SJ, Argyropoulos S, Virupaksha S, Difford T, Shikh-Bahaei T, Saafan T, Lo T, Magro T, Gala T, Katbeh T, Athwal T, Lo T, Fraser T, Anyomih T, Chase TJG, Walker T, Ward T, Gallagher TK, Richardson T, Wiggins T, Ali U, Patnam V, Kanakala V, Beynon V, Hudson VE, Morrison-Jones V, Korwar V, Massella V, Parekh V, Ng V, Toh WH, Toh W, Hawkins W, Cambridge W, Harrison W, Tan YY, Aal YA, Malam Y, Toumi Z, Khaddar ZA, Bleything Z. PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK. BJS Open 2023; 7:zrad008. [PMID: 37161673 PMCID: PMC10170253 DOI: 10.1093/bjsopen/zrad008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/01/2022] [Accepted: 01/04/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. METHODS All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. RESULTS A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. CONCLUSION Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions.
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Borakati A, Froghi F, Bhogal RH, Mavroeidis VK. Liver transplantation in the management of cholangiocarcinoma: Evolution and contemporary advances. World J Gastroenterol 2023; 29:1969-1981. [PMID: 37155529 PMCID: PMC10122785 DOI: 10.3748/wjg.v29.i13.1969] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/10/2023] [Accepted: 03/21/2023] [Indexed: 04/06/2023] Open
Abstract
Cholangiocarcinoma (CCA) is an aggressive malignancy arising from the biliary epithelium. It may occur at any location along the biliary tree with the perihilar area being the most common. Prognosis is poor with 5-year overall survival at less than 10%, typically due to unresectable disease at presentation. Radical surgical resection with clear margins offers a chance of cure in patients with resectable tumours, but is frequently not possible due to locally advanced disease. On the other hand, orthotopic liver transplantation (LT) allows for a radical and potentially curative resection for these patients, but has been historically controversial due to the limited supply of donor grafts and previously poor outcomes. In patients with perihilar CCA, within specific criteria and following the implementation of a protocol combining neoadjuvant chemoradiation and LT, excellent results have been achieved in the last decades, resulting in its increasing acceptance as an indication for LT and the standard of care in several centres with significant experience. However, in intrahepatic CCA, the role of LT remains controversial and owing to dismal previous results it is not an accepted indication. Nevertheless, more recent studies have demonstrated favourable results with LT in early intrahepatic CCA, indicating that, under defined criteria, its role may increase in the future. This review highlights the history and contemporary advances of LT in CCA, with particular focus on the improving outcomes of LT in intrahepatic and perihilar CCA and future perspectives.
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Affiliation(s)
- Aditya Borakati
- Department of HPB and Liver Transplantation Surgery, Royal Free Hospital NHS Foundation Trust, London NW3 2QG, United Kingdom
| | - Farid Froghi
- Department of HPB and Liver Transplantation Surgery, Royal Free Hospital NHS Foundation Trust, London NW3 2QG, United Kingdom
| | - Ricky H Bhogal
- Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, United Kingdom
| | - Vasileios K Mavroeidis
- Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, United Kingdom
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Vindrola-Padros C, Froghi F, Gopalan V, Maruthan S, Filipe H, McNeil M, Garcia SM, Davidson B. The integration of rapid qualitative research in clinical trials: reflections from the ward-based goal-directed fluid therapy (GDFT) in acute pancreatitis feasibility trial. Trials 2023; 24:227. [PMID: 36964583 PMCID: PMC10039605 DOI: 10.1186/s13063-023-07191-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 02/20/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND There has been an increase in the integration of qualitative studies in randomised controlled trials. The purpose of this article is to reflect on our experience of carrying out a rapid qualitative study during a feasibility trial of goal-directed fluid therapy (GDFT) in patients with acute pancreatitis, including our sharing of emerging findings and the use of these findings by the trial team. METHODS The study was designed as a rapid feedback evaluation and combined interviews with staff and patients who took part in the trial. FINDINGS The rapid qualitative study pointed to common problems in trial recruitment among multiple sites, where lack of engagement of clinical teams across sites might impact negatively on patient recruitment. The article describes how the use of rapid feedback loops can be used as the trial is ongoing to inform changes in implementation. It also covers the potential challenges of working rapidly and collaborative with the trial team. CONCLUSIONS Rapid feedback evaluations can be used to generate findings across all stages of trial design and delivery. Additional research is required to explore the implementation of this research design in other settings and trial designs.
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Affiliation(s)
- Cecilia Vindrola-Padros
- Department of Targeted Intervention, University College London, 3Rd Floor Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK.
| | - Farid Froghi
- Division of Surgery & Interventional Sciences, University College London, London, UK
| | | | | | | | | | | | - Brian Davidson
- Division of Surgery & Interventional Sciences, University College London, London, UK
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Pallett LJ, Swadling L, Diniz M, Maini AA, Schwabenland M, Gasull AD, Davies J, Kucykowicz S, Skelton JK, Thomas N, Schmidt NM, Amin OE, Gill US, Stegmann KA, Burton AR, Stephenson E, Reynolds G, Whelan M, Sanchez J, de Maeyer R, Thakker C, Suveizdyte K, Uddin I, Ortega-Prieto AM, Grant C, Froghi F, Fusai G, Lens S, Pérez-Del-Pulgar S, Al-Akkad W, Mazza G, Noursadeghi M, Akbar A, Kennedy PTF, Davidson BR, Prinz M, Chain BM, Haniffa M, Gilroy DW, Dorner M, Bengsch B, Schurich A, Maini MK. Tissue CD14 +CD8 + T cells reprogrammed by myeloid cells and modulated by LPS. Nature 2023; 614:334-342. [PMID: 36697826 DOI: 10.1038/s41586-022-05645-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/12/2022] [Indexed: 01/26/2023]
Abstract
The liver is bathed in bacterial products, including lipopolysaccharide transported from the intestinal portal vasculature, but maintains a state of tolerance that is exploited by persistent pathogens and tumours1-4. The cellular basis mediating this tolerance, yet allowing a switch to immunity or immunopathology, needs to be better understood for successful immunotherapy of liver diseases. Here we show that a variable proportion of CD8+ T cells compartmentalized in the human liver co-stain for CD14 and other prototypic myeloid membrane proteins and are enriched in close proximity to CD14high myeloid cells in hepatic zone 2. CD14+CD8+ T cells preferentially accumulate within the donor pool in liver allografts, among hepatic virus-specific and tumour-infiltrating responses, and in cirrhotic ascites. CD14+CD8+ T cells exhibit increased turnover, activation and constitutive immunomodulatory features with high homeostatic IL-10 and IL-2 production ex vivo, and enhanced antiviral/anti-tumour effector function after TCR engagement. This CD14+CD8+ T cell profile can be recapitulated by the acquisition of membrane proteins-including the lipopolysaccharide receptor complex-from mononuclear phagocytes, resulting in augmented tumour killing by TCR-redirected T cells in vitro. CD14+CD8+ T cells express integrins and chemokine receptors that favour interactions with the local stroma, which can promote their induction through CXCL12. Lipopolysaccharide can also increase the frequency of CD14+CD8+ T cells in vitro and in vivo, and skew their function towards the production of chemotactic and regenerative cytokines. Thus, bacterial products in the gut-liver axis and tissue stromal factors can tune liver immunity by driving myeloid instruction of CD8+ T cells with immunomodulatory ability.
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Affiliation(s)
- Laura J Pallett
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK.
| | - Leo Swadling
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | - Mariana Diniz
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | | | | | | | - Jessica Davies
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | - Stephanie Kucykowicz
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | | | - Niclas Thomas
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | - Nathalie M Schmidt
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | - Oliver E Amin
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | - Upkar S Gill
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kerstin A Stegmann
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | - Alice R Burton
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | - Emily Stephenson
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Gary Reynolds
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Matt Whelan
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | - Jenifer Sanchez
- School of Immunology and Microbial Sciences, Kings College London, London, UK
| | - Roel de Maeyer
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | - Clare Thakker
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | - Kornelija Suveizdyte
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | - Imran Uddin
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | | | | | - Farid Froghi
- Division of Surgery, University College London, London, UK
| | - Giuseppe Fusai
- Division of Surgery, University College London, London, UK
| | - Sabela Lens
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
- Liver Unit, Hospital Clinic, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Sofia Pérez-Del-Pulgar
- Liver Unit, Hospital Clinic, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Walid Al-Akkad
- Institute for Liver & Digestive Health, University College London, London, UK
| | - Giuseppe Mazza
- Institute for Liver & Digestive Health, University College London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
| | - Arne Akbar
- Division of Medicine, University College London, London, UK
| | - Patrick T F Kennedy
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Marco Prinz
- Institute of Neuropathology, University of Freiburg, Freiburg, Germany
- Center for Basics in NeuroModulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Signalling Research Centres BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - Benjamin M Chain
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
- Department of Computer Science, University College London, London, UK
| | - Muzlifah Haniffa
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Derek W Gilroy
- Division of Medicine, University College London, London, UK
| | - Marcus Dorner
- Department of Medicine, Imperial College London, London, UK
| | - Bertram Bengsch
- Signalling Research Centres BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Clinic for Internal Medicine II, Gastroenterology, Hepatology, Endocrinology, and Infectious Disease, University Medical Center Freiburg, Freiburg, Germany
| | - Anna Schurich
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK
- School of Immunology and Microbial Sciences, Kings College London, London, UK
| | - Mala K Maini
- Division of Infection & Immunity, Institute of Immunity & Transplantation, University College London, London, UK.
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Borakati A, Froghi F, Bhogal RH, Mavroeidis VK. Stereotactic radiotherapy for intrahepatic cholangiocarcinoma. World J Gastrointest Oncol 2022; 14:1478-1489. [PMID: 36160742 PMCID: PMC9412934 DOI: 10.4251/wjgo.v14.i8.1478] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/07/2022] [Accepted: 07/06/2022] [Indexed: 02/05/2023] Open
Abstract
Intrahepatic cholangiocarcinoma (iCCA) is an aggressive malignancy with an increasing incidence worldwide and poor prognosis, despite several advances and continuous efforts to develop effective treatments. Complete surgical resection is the mainstay of treatment and offers a potentially curative option, but is only possible in less than a third of patients, owing to advanced disease. Chemotherapy is a well-established treatment in the adjuvant and palliative setting, however, confers limited benefit. Conventional radiotherapy is challenging due to local toxicity. With recent advances in stereotactic ablative radiotherapy (SABR), it is now possible to focus ablative beams of radiotherapy precisely aimed at tumours to minimise damage to surrounding viscera. This review details the history, technical background and application of SABR to iCCA, with directions for future research suggested.
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Affiliation(s)
- Aditya Borakati
- Department of Surgery, The Royal London Hospital, Barts Health NHS Trust, London E1 1FR, United Kingdom
| | - Farid Froghi
- Department of HPB and Liver Transplantation Surgery, Royal Free Hospital NHS Foundation Trust, London NW3 2QG, United Kingdom
| | - Ricky H Bhogal
- Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, United Kingdom
| | - Vasileios K Mavroeidis
- Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, United Kingdom
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Borakati A, Froghi F, Shetye A, Fusai GK, Davidson BR, Mirnezami R. Assessing the Impact of Primary Tumour Location on Survival After Resection of Colorectal Liver Metastases: A Propensity Weighted Retrospective Cohort Study. World J Surg 2022; 46:1734-1755. [PMID: 35325347 DOI: 10.1007/s00268-022-06514-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Right-sided colonic tumours appear to have poorer survival after resection of colorectal liver metastases, although this may be confounded by various factors including advanced stage and emergency presentation. METHODS Medical records of consecutive patients undergoing resection of colorectal liver metastases at a single centre from 2008 to 2015 were retrospectively reviewed. Cases were categorised by primary tumour location (right colon, left colon, rectum). Each primary location was weighted using propensity scores to balance covariates, including staging and mode of presentation. Cox regression was then applied to derive multivariable hazard ratios (HR) of survival after liver resection. Primary outcomes were 10-year overall survival (OS) and 5-year disease-free survival (DFS) after liver resection based on PTL. RESULTS 414 patients were included in the analysis. Left colonic tumours were significantly associated with higher rates of bilobar liver metastasis (36.2% vs. 20.1% and 30.1%) and larger maximum size of liver metastases compared with rectal and right-sided tumours, respectively. There was no difference in rates of extra-hepatic metastases, recurrence in the liver after resection or RAS, BRAF or p53 mutational status. After propensity weighting and Cox-regression, right-sided tumours were independently associated with significantly reduced 10 year OS (HR 1.56, 95% CI 1.03-2.36, p = 0.04) but not 5 year DFS (HR 1.36, 95% CI 0.89-2.08, p = 0.15). CONCLUSIONS Compared with left colonic and rectal tumours, right-sided colonic tumours are independently associated with inferior OS after resection of CRLM. This is despite higher rates of bilobar liver metastases and larger metastases with left-sided tumours.
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Affiliation(s)
- Aditya Borakati
- University Department of Surgery, Royal Free Hospital, Pond Street, London, NW3 2QG, UK.,Division of Surgery and Interventional Science, University College London, London, UK
| | - Farid Froghi
- University Department of Surgery, Royal Free Hospital, Pond Street, London, NW3 2QG, UK.,Division of Surgery and Interventional Science, University College London, London, UK
| | - Alysha Shetye
- University Department of Surgery, Royal Free Hospital, Pond Street, London, NW3 2QG, UK
| | - Giuseppe K Fusai
- University Department of Surgery, Royal Free Hospital, Pond Street, London, NW3 2QG, UK.,Division of Surgery and Interventional Science, University College London, London, UK
| | - Brian R Davidson
- University Department of Surgery, Royal Free Hospital, Pond Street, London, NW3 2QG, UK.,Division of Surgery and Interventional Science, University College London, London, UK
| | - Reza Mirnezami
- University Department of Surgery, Royal Free Hospital, Pond Street, London, NW3 2QG, UK.
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Fung G, Sha M, Kunduzi B, Froghi F, Rehman S, Froghi S. Learning curves in minimally invasive pancreatic surgery: a systematic review. Langenbecks Arch Surg 2022; 407:2217-2232. [PMID: 35278112 PMCID: PMC9467952 DOI: 10.1007/s00423-022-02470-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 02/14/2022] [Indexed: 12/28/2022]
Abstract
Background The learning curve of new surgical procedures has implications for the education, evaluation and subsequent adoption. There is currently no standardised surgical training for those willing to make their first attempts at minimally invasive pancreatic surgery. This study aims to ascertain the learning curve in minimally invasive pancreatic surgery. Methods A systematic search of PubMed, Embase and Web of Science was performed up to March 2021. Studies investigating the number of cases needed to achieve author-declared competency in minimally invasive pancreatic surgery were included. Results In total, 31 original studies fulfilled the inclusion criteria with 2682 patient outcomes being analysed. From these studies, the median learning curve for distal pancreatectomy was reported to have been achieved in 17 cases (10–30) and 23.5 cases (7–40) for laparoscopic and robotic approach respectively. The median learning curve for pancreaticoduodenectomy was reported to have been achieved at 30 cases (4–60) and 36.5 cases (20–80) for a laparoscopic and robotic approach respectively. Mean operative times and estimated blood loss improved in all four surgical procedural groups. Heterogeneity was demonstrated when factoring in the level of surgeon’s experience and patient’s demographic. Conclusions There is currently no gold standard in the evaluation of a learning curve. As a result, derivations are difficult to utilise clinically. Existing literature can serve as a guide for current trainees. More work needs to be done to standardise learning curve assessment in a patient-centred manner.
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Affiliation(s)
- Gayle Fung
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Menazir Sha
- Medical School, University College London, London, UK
| | | | - Farid Froghi
- Department of HPB & Liver Transplantation, Royal Free Hospital, Pond St, Hampstead, NW3 2QG, London, UK.
- Division of Surgery & Interventional Sciences, Royal Free Campus, University College London, Hampstead, , London, UK.
| | - Saad Rehman
- Upper GI & Bariatric Unit, Royal Shrewsbury Hospital, Shrewsbury, UK
| | - Saied Froghi
- Department of HPB & Liver Transplantation, Royal Free Hospital, Pond St, Hampstead, NW3 2QG, London, UK.
- Division of Surgery & Interventional Sciences, Royal Free Campus, University College London, Hampstead, , London, UK.
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8
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Froghi F, Gopalan V, Anastasiou Z, Koti R, Gurusamy K, Eastgate C, McNeil M, Filipe H, Pinto M, Singh J, Longworth L, Mallett S, Schofield N, Thorburn D, Martin D, Davidson BR. Effect of post-operative goal-directed fluid therapy (GDFT) on organ function after orthotopic liver transplantation: Secondary outcome analysis of the COLT randomised control trial. Int J Surg 2022; 99:106265. [PMID: 35181556 DOI: 10.1016/j.ijsu.2022.106265] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/28/2021] [Accepted: 02/09/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Goal-directed fluid therapy (GDFT) has been shown to reduce the complications following a variety of major surgical procedures, possibly mediated by improved organ perfusion and function. We have shown that it is feasible to randomise patients to GDFT or standard fluid management following liver transplant in the cardiac-output optimisation following liver transplantation (COLT) trial. The current study compares end organ function in patients from the COLT trial who received GDFT in comparison to those receiving standard care (SC) following liver transplant. METHODS Adult patients with liver cirrhosis undergoing liver transplantation were randomised to GDFT or SC for the first 12 h following surgery as detailed in a published trial protocol. GDFT protocol was based on stroke volume (SV) optimisation using 250 ml crystalloid boluses. Total fluid administration and time to extubation were recorded. Hourly SV and cardiac output (CO) readings were recorded from the non-invasive cardiac output monitoring (NICOM) device in both groups. Pulmonary function was assessed by arterial blood gas (ABG) and ventilatory parameters. Lung injury was assessed using PaO2:FiO2 ratios and calculated pulmonary compliance. The KDIGO score was used for determining acute kidney injury. Renal and liver graft function were assessed during the post-operative period and at 3 months and 1-year. RESULTS 60 patients were randomised to GDFT (n = 30) or SC (n = 30). All patients completed the 12 h intervention period. GDFT group received a significantly higher total volume of fluid during the 12 h trial intervention period (GDFT 5317 (2335) vs. SC 3807 (1345) ml, p = 0.003); in particular crystalloids (GDFT 3968 (2073) vs. SC 2510 (1027) ml, p = 0.002). There was no evidence of significant difference between the groups in SV or CO during the assessment periods. Time to extubation, PaO2: FIO2 ratios, pulmonary compliance, ventilatory or blood gas measurements were similar in both groups. There was a significant rise in serum creatinine from baseline (77 μmol/L) compared to first (87 μmol/L, p = 0.039) and second (107 μmol/L, p = 0.001) post-operative days. There was no difference between GDFT and SC in the highest KDIGO scores for the first 7 days post-LT. At 1-year follow-up, there was no difference in need for renal replacement therapy or graft function. CONCLUSIONS In this randomised trial of fluid therapy post liver transplant, GDFT was associated with an increased volume of crystalloids administered but did not alter early post-operative pulmonary or renal function when compared with standard care.
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Affiliation(s)
- Farid Froghi
- UCL Division of Surgery & Interventional Sciences, HPB and Liver Transplantation, London, United Kingdom UCL Joint Research Office, Biostatistics Group, London, United Kingdom Royal Free Hospital, Critical Care Unit, London, United Kingdom PHMR Limited, London, United Kingdom UCL Institute for Liver and Digestive Health, London, United Kingdom UCL Division of Surgery & Interventional Sciences, London, United Kingdom Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom
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9
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Froghi F, Soggiu F, Ricciardi F, Vindrola-Padros C, Floros L, Martin D, Filipe H, Varcada M, Gurusamy K, Bhattacharya S, Fanshawe A, Dolcea B, Mathur P, Davidson B. P-P06 Ward based goal directed fluid therapy (GDFT) in acute pancreatitis (GAP) trial: a feasibility randomised controlled trial [ISRCTN 36077283]. Br J Surg 2021. [DOI: 10.1093/bjs/znab430.230] [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: 11/13/2022]
Abstract
Abstract
Background
Goal directed fluid therapy (GDFT) based on cardiac output assessment has been shown to reduce complications and improve survival for people undergoing major general surgery. There are no reports of cardiac output evaluation being used to optimise the fluid administration for patients with acute pancreatitis who are in a general surgery admission ward.
Methods
The trial protocol has been published. 50 patients with acute pancreatitis were recruited, consented and randomly allocated to either ward-based GDFT with intravenous (IV) fluids administered based on stroke volume optimisation or standard ward care but with blinded cardiac output evaluation for 48 hours following hospital admission.
Results
Over a period of 20 months 50 of 142 screened patients were recruited demonstrating that it was feasible to recruit into a randomised trial of this nature in ward patients with acute pancreatitis. 36 (72%) completed the allocated 48 hours of goal directed fluids with 10 (20%) discharged within 48 hours and 4 withdrawals (3 GDFT and 1 SC). Baseline characteristics of the groups were similar with only 3 participants having severe disease (6%, 1 GDFT, 2 SC). Similar volumes of IV fluids were administered in both groups (GDFT 5465 (1839) ml, SC 5211 (1745) ml). GDFT group had a lower heart rate, blood pressure and respiratory rate and improved oxygen saturations. GDFT was not associated with any harms. Complications of AP appear to be similar as was duration of stay in intensive care. Length of hospital stay was 5 (2.9) in GDFT and 6.3 (7.6) in SC groups.
Conclusions
Ward GDFT is feasible and shows a signal of possible efficacy in acute pancreatitis in this early-stage study. A larger multi-site RCT is required to confirm clinical and cost effectiveness.
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Affiliation(s)
- Farid Froghi
- UCL Division of Surgery and Interventional Science, London, United Kingdom
- Hepatopancreaticobiliary Surgery, Royal Free Hospital, London, United Kingdom
| | - Fiammetta Soggiu
- Hepatopancreaticobiliary Surgery, Royal Free Hospital, London, United Kingdom
| | | | | | - Lefteris Floros
- PHMR, Health Economics, Pricing & Reimbursement, London, United Kingdom
| | - Daniel Martin
- Peninsula Medical School, University of Plymouth, London, United Kingdom
| | - Helder Filipe
- Intensive Care Unit, Royal Free Hospital, London, United Kingdom
| | - Massimo Varcada
- General and Emergency Surgery Department, Royal Free Hospital, London, United Kingdom
| | - Kurinchi Gurusamy
- UCL Division of Surgery and Interventional Science, London, United Kingdom
| | | | - Angela Fanshawe
- General and Emergency Surgery Department, Barnet General Hospital, London, United Kingdom
| | - Bogdan Dolcea
- General and Emergency Surgery Department, Barnet General Hospital, London, United Kingdom
| | - Pawan Mathur
- General and Emergency Surgery Department, Barnet General Hospital, London, United Kingdom
| | - Brian Davidson
- UCL Division of Surgery and Interventional Science, London, United Kingdom
- Hepatopancreaticobiliary Surgery, Royal Free Hospital, London, United Kingdom
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10
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Swadling L, Pallett LJ, Diniz MO, Baker JM, Amin OE, Stegmann KA, Burton AR, Schmidt NM, Jeffery-Smith A, Zakeri N, Suveizdyte K, Froghi F, Fusai G, Rosenberg WM, Davidson BR, Schurich A, Simon AK, Maini MK. Human Liver Memory CD8 + T Cells Use Autophagy for Tissue Residence. Cell Rep 2021; 30:687-698.e6. [PMID: 31968246 PMCID: PMC6988113 DOI: 10.1016/j.celrep.2019.12.050] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/04/2019] [Accepted: 12/13/2019] [Indexed: 12/11/2022] Open
Abstract
Tissue-resident memory T cells have critical roles in long-term pathogen and tumor immune surveillance in the liver. We investigate the role of autophagy in equipping human memory T cells to acquire tissue residence and maintain functionality in the immunosuppressive liver environment. By performing ex vivo staining of freshly isolated cells from human liver tissue, we find that an increased rate of basal autophagy is a hallmark of intrahepatic lymphocytes, particularly liver-resident CD8+ T cells. CD8+ T cells with increased autophagy are those best able to proliferate and mediate cytotoxicity and cytokine production. Conversely, blocking autophagy induction results in the accumulation of depolarized mitochondria, a feature of exhausted T cells. Primary hepatic stellate cells or the prototypic hepatic cytokine interleukin (IL)-15 induce autophagy in parallel with tissue-homing/retention markers. Inhibition of T cell autophagy abrogates tissue-residence programming. Thus, upregulation of autophagy adapts CD8+ T cells to combat mitochondrial depolarization, optimize functionality, and acquire tissue residence. An increased rate of basal autophagy is a hallmark of liver-resident CD8+ T cells Enhanced T cell autophagy can be imprinted by IL-15 or hepatic stellate cells Autophagy induction is required for tissue-residence programming in vitro Enhanced autophagy maintains TRM mitochondrial fitness in the liver
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Affiliation(s)
- Leo Swadling
- Division of Infection and Immunity, University College London, London, UK.
| | - Laura J Pallett
- Division of Infection and Immunity, University College London, London, UK
| | - Mariana O Diniz
- Division of Infection and Immunity, University College London, London, UK
| | - Josephine M Baker
- Division of Infection and Immunity, University College London, London, UK
| | - Oliver E Amin
- Division of Infection and Immunity, University College London, London, UK
| | - Kerstin A Stegmann
- Division of Infection and Immunity, University College London, London, UK
| | - Alice R Burton
- Division of Infection and Immunity, University College London, London, UK
| | - Nathalie M Schmidt
- Division of Infection and Immunity, University College London, London, UK
| | - Anna Jeffery-Smith
- Division of Infection and Immunity, University College London, London, UK; Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine and Dentistry, QMUL, London, UK
| | - Nekisa Zakeri
- Division of Infection and Immunity, University College London, London, UK
| | | | - Farid Froghi
- Institute for Liver and Digestive Health, University College London, London, UK
| | - Giuseppe Fusai
- Institute for Liver and Digestive Health, University College London, London, UK
| | - William M Rosenberg
- Institute for Liver and Digestive Health, University College London, London, UK
| | - Brian R Davidson
- Institute for Liver and Digestive Health, University College London, London, UK
| | - Anna Schurich
- Division of Infection and Immunity, University College London, London, UK; Department of Infectious Diseases, Kings College London, London, UK
| | - A Katharina Simon
- The Kennedy Institute of Rheumatology, NDORMS, University of Oxford, Oxford, UK
| | - Mala K Maini
- Division of Infection and Immunity, University College London, London, UK.
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11
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Borakati A, Froghi F, Fusai G, Davidson B, Mirnezami R. Primary tumour location is independently associated with prognosis after resection of colorectal liver metastases: a propensity weighted retrospective cohort study. Eur J Surg Oncol 2021. [DOI: 10.1016/j.ejso.2020.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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12
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Pallett LJ, Burton AR, Amin OE, Rodriguez-Tajes S, Patel AA, Zakeri N, Jeffery-Smith A, Swadling L, Schmidt NM, Baiges A, Gander A, Yu D, Nasralla D, Froghi F, Iype S, Davidson BR, Thorburn D, Yona S, Forns X, Maini MK. Longevity and replenishment of human liver-resident memory T cells and mononuclear phagocytes. J Exp Med 2020; 217:e20200050. [PMID: 32602903 PMCID: PMC7478732 DOI: 10.1084/jem.20200050] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/07/2020] [Accepted: 05/15/2020] [Indexed: 12/13/2022] Open
Abstract
The human liver contains specialized subsets of mononuclear phagocytes (MNPs) and T cells, but whether these have definitive features of tissue residence (long-term retention, lack of egress) and/or can be replenished from the circulation remains unclear. Here we addressed these questions using HLA-mismatched liver allografts to discriminate the liver-resident (donor) from the infiltrating (recipient) immune composition. Allografts were rapidly infiltrated by recipient leukocytes, which recapitulated the liver myeloid and lymphoid composition, and underwent partial reprogramming with acquisition of CD68/CD206 on MNPs and CD69/CD103 on T cells. The small residual pool of donor cells persisting in allografts for over a decade contained CX3CR1hi/CD163hi/CD206hi Kupffer cells (KCs) and CXCR3hi tissue-resident memory T cells (TRM). CD8+ TRM were found in the local lymph nodes but were not detected egressing into the hepatic vein. Our findings inform organ transplantation and hepatic immunotherapy, revealing remarkably long-lived populations of KCs and TRM in human liver, which can be additionally supplemented by their circulating counterparts.
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Affiliation(s)
- Laura J. Pallett
- Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, UK
| | - Alice R. Burton
- Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, UK
| | - Oliver E. Amin
- Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, UK
| | - Sergio Rodriguez-Tajes
- Liver Unit, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Amit A. Patel
- Division of Medicine, University College London, London, UK
| | - Nekisa Zakeri
- Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, UK
| | - Anna Jeffery-Smith
- Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, UK
- Barts Liver Centre, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Leo Swadling
- Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, UK
| | - Nathalie M. Schmidt
- Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, UK
| | - Anna Baiges
- Liver Unit, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Amir Gander
- Division of Surgery, University College London, London, UK
| | - Dominic Yu
- Liver Transplant Unit, Royal Free Hospital, London, UK
| | | | - Farid Froghi
- Division of Surgery, University College London, London, UK
| | - Satheesh Iype
- Liver Transplant Unit, Royal Free Hospital, London, UK
| | | | | | - Simon Yona
- Institute of Dental Sciences, Hebrew University, Jerusalem, Israel
| | - Xavier Forns
- Liver Unit, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Mala K. Maini
- Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, UK
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13
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Froghi F, Soggiu F, Ricciardi F, Gurusamy K, Martin DS, Singh J, Siddique S, Eastgate C, Ciaponi M, McNeil M, Filipe H, Schwalowsky-Monks O, Asis G, Varcada M, Davidson BR. Ward-based Goal-Directed Fluid Therapy (GDFT) in Acute Pancreatitis (GAP) trial: study protocol for a feasibility randomised controlled trial. BMJ Open 2019; 9:e028783. [PMID: 31601585 PMCID: PMC6797248 DOI: 10.1136/bmjopen-2018-028783] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Acute pancreatitis is an inflammatory disease of the pancreas with high risk of developing multiorgan failure and death. There are no effective pharmacological interventions used in current clinical practice. Maintaining fluid and electrolyte balance is the mainstay of supportive management. Goal-directed fluid therapy (GDFT) has been shown to decrease morbidity and mortality in surgical conditions with systemic inflammatory response. There is currently no randomised controlled trial (RCT) investigating the role of GDFT based on cardiac output parameters in patients with acute pancreatitis in the ward setting. A feasibility trial was designed to determine patient and clinician support for recruitment into an RCT of ward-based GDFT in acute pancreatitis, adherence to a GDFT protocol, safety, participant withdrawal, and to determine appropriate endpoints for a subsequent larger trial to evaluate efficacy. METHODS AND ANALYSIS The GDFT in Acute Pancreatitis trial is a prospective two-centre feasibility RCT. Eligible adults admitted with new onset of acute pancreatitis will be enrolled and randomised into ward-based GDFT (n=25) or standard fluid therapy (n=25) within 6 hours from the diagnosis and continuing for the following 48 hours. Cardiac output parameters will be monitored with a non-invasive device (Cheetah NICOM; Cheetah Medical). The intervention group will consist of a protocolised GDFT approach consisting of stroke volume optimisation with crystalloid fluid boluses, while the control group will receive standard care fluid therapy as advised by the clinical team. The primary endpoint is feasibility. Secondary endpoints will include safety of the intervention, complications, mortality, admission to intensive care unit, cost and quality of life. ETHICS AND DISSEMINATION Ethics approval was granted by the London Central Research Ethics Committee (17/LO/1235, project ID: 221872). The results of this trial will be presented to international conference with interest in general surgery and acute care and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ISRCTN36077283.
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Affiliation(s)
- Farid Froghi
- Division of Surgery and Interventional Science, University College London, London, UK
- HPB and Liver Transplantation Surgery, Royal Free Hospital, London, UK
| | - Fiammetta Soggiu
- HPB and Liver Transplantation Surgery, Royal Free Hospital, London, UK
| | | | - Kurinchi Gurusamy
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Daniel S Martin
- Division of Surgery and Interventional Science, University College London, London, UK
- Critical Care Unit, Royal Free Hospital, London, UK
| | | | - Sulman Siddique
- Division of Surgery and Interventional Science, University College London, London, UK
| | | | | | | | | | | | | | - Massimo Varcada
- General and Emergency Surgery, Royal Free Hospital, London, UK
| | - Brian R Davidson
- HPB and Liver Transplantation Surgery, Royal Free Hospital, London, UK
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14
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Petrenko A, Carnevale M, Somov A, Osorio J, Rodríguez J, Guibert E, Fuller B, Froghi F. Organ Preservation into the 2020s: The Era of Dynamic Intervention. Transfus Med Hemother 2019; 46:151-172. [PMID: 31244584 PMCID: PMC6558325 DOI: 10.1159/000499610] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/04/2019] [Indexed: 12/12/2022] Open
Abstract
Organ preservation has been of major importance ever since transplantation developed into a global clinical activity. The relatively simple procedures were developed on a basic comprehension of low-temperature biology as related to organs outside the body. In the past decade, there has been a significant increase in knowledge of the sequelae of effects in preserved organs, and how dynamic intervention by perfusion can be used to mitigate injury and improve the quality of the donated organs. The present review focuses on (1) new information about the cell and molecular events impacting on ischemia/reperfusion injury during organ preservation, (2) strategies which use varied compositions and additives in organ preservation solutions to deal with these, (3) clear definitions of the developing protocols for dynamic organ perfusion preservation, (4) information on how the choice of perfusion solutions can impact on desired attributes of dynamic organ perfusion, and (5) summary and future horizons.
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Affiliation(s)
- Alexander Petrenko
- Department of Cryobiochemistry, Institute for Problems of Cryobiology and Cryomedicine, Ukraine Academy of Sciences, Kharkov, Ukraine
| | - Matias Carnevale
- Centro Binacional (Argentina-Italia) de Investigaciones en Criobiología Clínica y Aplicada (CAIC), Universidad Nacional de Rosario, Rosario, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Alexander Somov
- Department of Cryobiochemistry, Institute for Problems of Cryobiology and Cryomedicine, Ukraine Academy of Sciences, Kharkov, Ukraine
| | - Juliana Osorio
- Centro Binacional (Argentina-Italia) de Investigaciones en Criobiología Clínica y Aplicada (CAIC), Universidad Nacional de Rosario, Rosario, Argentina
| | - Joaquin Rodríguez
- Centro Binacional (Argentina-Italia) de Investigaciones en Criobiología Clínica y Aplicada (CAIC), Universidad Nacional de Rosario, Rosario, Argentina
| | - Edgardo Guibert
- Centro Binacional (Argentina-Italia) de Investigaciones en Criobiología Clínica y Aplicada (CAIC), Universidad Nacional de Rosario, Rosario, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Barry Fuller
- UCL Division of Surgery and Interventional Sciences, Royal Free Hospital, London, United Kingdom
| | - Farid Froghi
- UCL Division of Surgery and Interventional Sciences, Royal Free Hospital, London, United Kingdom
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15
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Froghi F, Koti R, Gurusamy K, Mallett S, Thorburn D, Selves L, James S, Singh J, Pinto M, Eastgate C, McNeil M, Filipe H, Jichi F, Schofield N, Martin D, Davidson B. Cardiac output Optimisation following Liver Transplant (COLT) trial: study protocol for a feasibility randomised controlled trial. Trials 2018. [PMID: 29514697 PMCID: PMC5842525 DOI: 10.1186/s13063-018-2488-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Indexed: 02/07/2023] Open
Abstract
Background Patients with liver cirrhosis undergoing liver transplantation have a hyperdynamic circulation which persists into the early postoperative period making accurate assessment of fluid requirements challenging. Goal-directed fluid therapy (GDFT) has been shown to reduce morbidity and mortality in a number of surgery settings. The impact of GDFT in patients undergoing liver transplantation is unknown. A feasibility trial was designed to determine patient and clinician support for recruitment into a randomised controlled trial of GDFT following liver transplantation, adherence to a GDFT protocol, participant withdrawal, and to determine appropriate endpoints for a subsequent larger trial to evaluate the efficacy of GDFT in patients undergoing liver transplantation. Methods The Cardiac output Optimisation following Liver Transplant (COLT) trial is designed as a prospective, single-centre, randomised controlled study to assess the feasibility and safety of GDFT in liver transplantation for patients with cirrhosis. Consenting adults (aged between 18 and 80 years) with biopsy-proven liver cirrhosis who have been selected to undergo a first liver transplantation will be included in the trial and randomised into GDFT or standard care starting immediately after surgery and continuing for the first 12 h thereafter. Both groups will have cardiac output and stroke volume monitored using the FloTrac (EV1000) device. The intervention will consist of a protocolised GDFT approach to patient management, using stroke volume optimisation. The control group will receive standard care, without stroke volume and cardiac output measurement. After 12 h the patient’s fluid management will revert to standard of care. The primary endpoint of this study is feasibility. Secondary endpoints will include a safety assessment of the intervention, graft and patient survival, liver function, postoperative complications graded by Clavien-Dindo criteria, length of intensive care and hospital stay and quality of life across the intervention and control groups. Discussion There is a growing body of evidence that the use of perioperative GDFT in surgical patients can improve outcomes; however, signals of harm have also been detected. Patients with liver cirrhosis undergoing liver transplantation have markedly different cardiovascular physiology than general surgical patients. If GDFT is proven to be feasible and safe in this patient group, then a multicentre trial to demonstrate efficacy and cost-effectiveness will be required. Trial registration International Standard Randomised Controlled Trial Registry, ID: ISRCTN10329248. Registered on 4 April 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2488-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Farid Froghi
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Rahul Koti
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Kurinchi Gurusamy
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Susan Mallett
- Critical Care Unit, Royal Free Hospital, London, NW3 2QG, UK
| | - Douglas Thorburn
- Institute for Liver and Digestive Health, University College London, London, UK
| | - Linda Selves
- Institute for Liver and Digestive Health, University College London, London, UK
| | - Sarah James
- Critical Care Unit, Royal Free Hospital, London, NW3 2QG, UK
| | - Jeshika Singh
- Health Economic Research Group, Brunel University, London, UK
| | - Manuel Pinto
- Critical Care Unit, Royal Free Hospital, London, NW3 2QG, UK
| | | | - Margaret McNeil
- Critical Care Unit, Royal Free Hospital, London, NW3 2QG, UK
| | - Helder Filipe
- Critical Care Unit, Royal Free Hospital, London, NW3 2QG, UK
| | - Fatima Jichi
- Biostatistics Group, Joint Research Office, University College London, London, UK
| | - Nick Schofield
- Royal Free Perioperative Research Group (RoFPoR), Royal Free Hospital, London, UK
| | - Daniel Martin
- Division of Surgery and Interventional Science, University College London, London, UK. .,Critical Care Unit, Royal Free Hospital, London, NW3 2QG, UK. .,Royal Free Perioperative Research Group (RoFPoR), Royal Free Hospital, London, UK.
| | - Brian Davidson
- Division of Surgery and Interventional Science, University College London, London, UK
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16
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Froghi F, Sanders G, Berrisford R, Wheatley T, Peyser P, Rahamim J, Lewis S. A randomised trial of post-discharge enteral feeding following surgical resection of an upper gastrointestinal malignancy. Clin Nutr 2017; 36:1516-1519. [DOI: 10.1016/j.clnu.2016.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/24/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
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DeAsis F, Gitelis M, Chao S, Lapin B, Linn J, Denham W, Haggerty S, Carbray J, Ujiki M, Olory-Togbe JL, Gbessi DG, Dossou FM, Lawani I, Souaibou YI, Gnangnon I, Denakpo M, Soton RR, Djrouo G, Gogan P, Trukhalev W, Kukosh M, Panyushkin A, Safronova E, Jairam A, Kaufmann R, Jeekel J, Lange JF, Volmer U, Kersten CC, Arlt G, Skach J, Harcubova R, Petrakova V, Mandoboy JD, Ngom G, Faye AL, Ndour O, Sankale AA, Ndoye M, Daneiii P, Leone N, Ballerini A, Bondurri A, Cavallaro G, Silecchia G, Raparelli L, Greco F, Iorio O, Iossa A, De Angelis F, Rizzello M, Olmi S, Cesana G, Baldazzi G, Manoocheri F, Campanile FC, Munipalle P, Khan S, Gwiti P, Kanakala V, Viswanath Y, Kokotovic D, Sjølander H, Gögenur I, Helgstrand F, Devadhar S, Hounnou G, Elegbede OTA, Hadonou AA, Mensah ED, Agossou-Voyeme AK, Konate I, Toure AO, Cisse M, Zaki M, Diao ML, Tendeng JN, Toure FB, Toure CT, Subramanian V, Froghi F, de Carvalho FC, Salimin L, Drabble E. Humbilical & Epigastric Hernia. Hernia 2015; 19 Suppl 1:S35-42. [PMID: 26518843 DOI: 10.1007/bf03355324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- F DeAsis
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA
| | - M Gitelis
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA
| | - S Chao
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA
| | - B Lapin
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA
| | - J Linn
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA.,Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, USA
| | - W Denham
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA.,Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, USA
| | - S Haggerty
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA.,Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, USA
| | - J Carbray
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA
| | - M Ujiki
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA.,Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, USA
| | | | - D G Gbessi
- Faculté des sciences de la Santé, Foto, Benin
| | - F M Dossou
- Faculté des sciences de la Santé, Foto, Benin
| | - I Lawani
- Faculté des sciences de la Santé, Foto, Benin
| | | | - I Gnangnon
- Faculté des sciences de la Santé, Foto, Benin
| | - M Denakpo
- Faculté des sciences de la Santé, Foto, Benin
| | - R R Soton
- Faculté des sciences de la Santé, Foto, Benin
| | - G Djrouo
- Faculté des sciences de la Santé, Foto, Benin
| | - P Gogan
- Faculté des sciences de la Santé, Foto, Benin
| | - W Trukhalev
- State Medical Academy, Nizhnij Novgorod, Russia
| | - M Kukosh
- State Medical Academy, Nizhnij Novgorod, Russia
| | | | | | - A Jairam
- Department of Surgery, Erasmus Medical Centre, Rotterdam, Netherlands
| | - R Kaufmann
- Department of Surgery, Erasmus Medical Centre, Rotterdam, Netherlands
| | - J Jeekel
- Department of Neuroscience, Erasmus Medical Centre, Rotterdam, Netherlands
| | - J F Lange
- Department of Surgery, Erasmus Medical Centre, Rotterdam, Netherlands
| | - U Volmer
- Department of Surgery, Park-Klinik Weissensee, Berlin, Germany
| | | | | | - J Skach
- Hernia Center, Regional Hospital Liberec, Liberec, Czech Republic
| | - R Harcubova
- Hernia Center, Regional Hospital Liberec, Liberec, Czech Republic
| | - V Petrakova
- Hernia Center, Regional Hospital Liberec, Liberec, Czech Republic
| | - J Danga Mandoboy
- Pediatric surgery service of Aristide Le Dantec Hospital, Dakar, Senegal
| | - G Ngom
- Pediatric surgery service of Aristide Le Dantec Hospital, Dakar, Senegal
| | - A L Faye
- Pediatric surgery service of Aristide Le Dantec Hospital, Dakar, Senegal
| | - O Ndour
- Pediatric surgery service of Aristide Le Dantec Hospital, Dakar, Senegal
| | - A A Sankale
- Pediatric surgery service of Aristide Le Dantec Hospital, Dakar, Senegal
| | - M Ndoye
- Pediatric surgery service of Aristide Le Dantec Hospital, Dakar, Senegal
| | | | | | | | | | - G Cavallaro
- Department of Medico - Surgical Sciences and Biotechnologies & Bariatric Center of Excellence, Sapienza University, Rome, Italy
| | - G Silecchia
- Department of Medico - Surgical Sciences and Biotechnologies & Bariatric Center of Excellence, Sapienza University, Rome, Italy
| | - L Raparelli
- General Surgery Unit, GB Grassi Hospital, Rome, Italy
| | - F Greco
- General Surgery Unit, Andosilla Hospital, Civita Castellana, VT, Italy
| | - O Iorio
- Department of Medico - Surgical Sciences and Biotechnologies & Bariatric Center of Excellence, Sapienza University, Rome, Italy
| | - A Iossa
- Department of Medico - Surgical Sciences and Biotechnologies & Bariatric Center of Excellence, Sapienza University, Rome, Italy
| | - F De Angelis
- Department of Medico - Surgical Sciences and Biotechnologies & Bariatric Center of Excellence, Sapienza University, Rome, Italy
| | - M Rizzello
- Department of Medico - Surgical Sciences and Biotechnologies & Bariatric Center of Excellence, Sapienza University, Rome, Italy
| | - S Olmi
- General and Oncologic Surgery Unit, San Marco Hospital, Zingonia, BG, Italy
| | - G Cesana
- General and Oncologic Surgery Unit, San Marco Hospital, Zingonia, BG, Italy
| | - G Baldazzi
- General and Mini-invasive Surgery Unit, Abano Terme Hospital, Abano Terme, PD, Italy
| | - F Manoocheri
- General and Mini-invasive Surgery Unit, Abano Terme Hospital, Abano Terme, PD, Italy
| | - F C Campanile
- General Surgery Unit, Andosilla Hospital, Civita Castellana, VT, Italy
| | - P Munipalle
- James Cook University Hospital, Middlesbrough, UK
| | | | | | | | | | - D Kokotovic
- Dept. of Surgery, Køge Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - S Devadhar
- Department of Surgery, Pune India, Devadhar Nursing Home, Pune, India
| | - G Hounnou
- CNHU, Clinique Universitaire de Chirurgie Pédiatrique, 03 BP 386, Cotonou, Benin
| | - O T A Elegbede
- CNHU, Clinique Universitaire de Chirurgie Pédiatrique, 03 BP 386, Cotonou, Benin
| | - A A Hadonou
- CNHU, Clinique Universitaire de Chirurgie Pédiatrique, 03 BP 386, Cotonou, Benin
| | - E D Mensah
- CHD/B, Service de Chirurgie Générale, Parakou, Benin
| | - A K Agossou-Voyeme
- CNHU, Clinique Universitaire de Chirurgie Pédiatrique, 03 BP 386, Cotonou, Benin
| | - I Konate
- Departement of Surgery, University Gaston Berger, Saint Louis, Senegal
| | - A O Toure
- Departement of Surgery, University Cheikh Anta Diop, Dakar, Senegal
| | - M Cisse
- Departement of Surgery, University Cheikh Anta Diop, Dakar, Senegal
| | - M Zaki
- Departement of Surgery, University Cheikh Anta Diop, Dakar, Senegal
| | - M L Diao
- Departement of Surgery, University Gaston Berger, Saint Louis, Senegal
| | - J N Tendeng
- Departement of Surgery, University Gaston Berger, Saint Louis, Senegal
| | - F B Toure
- Departement of Surgery, University Gaston Berger, Saint Louis, Senegal
| | - C T Toure
- Departement of Surgery, University Cheikh Anta Diop, Dakar, Senegal
| | | | - F Froghi
- Plymouth Hospitals NHS Trust, Plymouth, UK
| | | | - L Salimin
- Plymouth Hospitals NHS Trust, Plymouth, UK
| | - E Drabble
- Plymouth Hospitals NHS Trust, Plymouth, UK
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Amr B, Froghi F, Edmond M, Haq K, Thengungal Kochupapy R. Management and outcomes of appendicular neuroendocrine tumours: Retrospective review with 5-year follow-up. Eur J Surg Oncol 2015; 41:1243-6. [PMID: 26188371 DOI: 10.1016/j.ejso.2015.06.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/11/2015] [Accepted: 06/19/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neuroendocrine (NEN) tumours are the commonest type of tumours affecting the appendix. The majority of cases are diagnosed incidentally on post-operative histopathological examination of the resected appendicectomy specimen. Preoperative diagnosis remains a challenge, unless the patient presents with obvious features of carcinoid syndrome or signs of metastatic disease. Hence, the authors present our five-year experience in diagnosing and managing NEN tumours of the appendix. METHODS Retrospective review of all patients underwent an emergency appendicectomy with intention to treat clinically suspected appendicitis at Derriford Hospital (Plymouth, Devon, UK) was undertaken. Patients with diagnoses other than NEN of the appendix were excluded. For patients with appendicular NEN, demographic data, pre-operative inflammatory markers, post-operative histology results as well as follow-up investigations were obtained using patients' electronic records. Case notes were reviewed for clinical presentation, operative details and follow-up information. RESULTS 2724 patients underwent emergency appendicectomy between January 2009 and May 2014. Carcinoid tumours were identified in 17 histologically examined appendicectomy specimens. Clinically, all patients presented with acute appendicitis with raised inflammatory markers in 58.5% of patients. Median tumour size was 5 (1-20) mm. Median postoperative follow up was 2.9 (0.92-5.8) years. All patients remained tumour free with no evidence of metastasis or recurrence during the entire study period. CONCLUSION Appendicular NEN are rare and usually diagnosed incidentally; hence precise examination of routine appendicectomy specimens is fundamental in the diagnosis. Simple appendicectomy is sufficient for tumours less than 1 cm for adequate clearance, whilst right hemi-colectomy is recommended for larger tumours.
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Affiliation(s)
- B Amr
- Surgical Department, Derriford Hospital, Plymouth Hospitals NHS Trust, United Kingdom
| | - F Froghi
- Surgical Department, Derriford Hospital, Plymouth Hospitals NHS Trust, United Kingdom.
| | - M Edmond
- Surgical Department, Derriford Hospital, Plymouth Hospitals NHS Trust, United Kingdom
| | - K Haq
- Surgical Department, Derriford Hospital, Plymouth Hospitals NHS Trust, United Kingdom
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Froghi F, Sodergren MH, Wright VJ, Coomber R, Courtney AP, Darzi A, Paraskeva P. Single-Center Experience in Systemic Stress and Short-Term Morbidity of Single-Incision Cholecystectomy. Surg Innov 2011; 19:117-22. [DOI: 10.1177/1553350611420453] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Single-incision laparoscopic surgery (SILS) aims to reduce the number and size of skin incisions. The authors compared systemic stress and perioperative outcome of SILS and laparoscopic (LAP) cholecystectomy. Twenty-nine subjects (8 males and 21 females; mean age = 47 years; mean body mass index = 27) were included in the study. There was no statistical difference in mean operative time (LAP = 89 minutes; SILS = 113 minutes; P = ns), and no intraoperative complications were reported. There were no statistically significant differences observed in white cell count, C-reactive protein, interleukin-6, and tumor necrosis factor-α between SILS and LAP groups. The mean hospital length of stay (LAP = 1.8 days; SILS = 1.4 days) and Visual Analogue Scale scores for pain at 6 hours (LAP = 5.14; SILS = 4.46) and 24 hours (LAP = 3.9; SILS = 2.815) were similar with no perioperative morbidity. These results suggest that the systemic stress response in LAP and SILS cholecystectomy does not appear to be significantly different. SILS cholecystectomy appears safe with no perioperative morbidity or complications encountered in this series.
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Sodergren MH, Orihuela-Espina F, Froghi F, Clark J, Teare J, Yang GZ, Darzi A. Value of orientation training in laparoscopic cholecystectomy. Br J Surg 2011; 98:1437-45. [PMID: 21560124 DOI: 10.1002/bjs.7546] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2011] [Indexed: 11/12/2022]
Abstract
BACKGROUND It is well established that disorientation during laparoscopic operations such as cholecystectomy is associated with increased morbidity and mortality. The aim of the present study was to evaluate whether high-performance orientation strategies could be taught to a cohort without relevant experience of laparoscopic cholecystectomy, resulting in improved performance and spatial awareness, thereby reducing the need for operative experience to command this skill. METHODS Thirty medical students participated in a randomized controlled trial, with half randomized to a tutorial teaching orientation strategies at specific stages of laparoscopic cholecystectomy and half to a control group without any teaching. Attention as represented by gaze was captured using eye tracking as subjects were presented with 12 images of various stages of the operation, with the task of interpreting the orientation of the image. The primary outcome measure was subject performance in orientation. Secondary outcome measures were gaze dwell time on relevant anatomical structures within the images and comparison of individual behaviour using a visual behaviour profiling algorithm. RESULTS The intervention group was significantly more likely to orientate correctly than the control group (mean 75·6 versus 56·1 per cent; P = 0·019). A difference in visual attention behaviour between the two groups was apparent for the majority of images when examining the output of the visual profiling algorithm, in the form of increased homogeneity of visual behaviour and/or an overall difference in orientation strategy. The mean orientation rate of all surgeons under identical conditions in a previously published study was 78·6 per cent. CONCLUSION Training novices in orientation strategies improved their performance significantly and it could reach the level of a surgeon with several years of experience in laparoscopic surgery.
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Affiliation(s)
- M H Sodergren
- Department of Biosurgery and Surgical Technology, Imperial College London, London, UK.
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Gandhi A, Froghi F, Shepherd AC, Shalhoub J, Lim CS, Gohel MS, Davies AH. A Study of Patient Satisfaction Following Endothermal Ablation for Varicose Veins. Vasc Endovascular Surg 2010; 44:274-8. [DOI: 10.1177/1538574410363834] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To evaluate patient satisfaction following endothermal ablation for varicose veins (VVs). Methods: A 12-question survey was sent to consecutive patients treated with endothermal ablation—questions related to preprocedure symptoms, recurrence, further treatments, and patient satisfaction. Results: Questionnaires sent a median 12 (range 6-22) months postintervention were returned by 177 (60.0%) of 295 patients; 63 (35.6%) of 177 received treatment for recurrent VVs. Preintervention symptoms included aching (141 [79.7%] of 177), swelling (86 [48.6%] of 177), and heaviness (72 [40.7%] of 177). Improvements in preoperative symptoms were reported by 82.5% (146 of 177). Postintervention recurrence was reported by 87 (49.4%) of 177; 61 (70.1%) of 87 reported a few recurrent varicosities only. Further treatment was required by 11 (6.2%) of 177; 79 (44.6%) of 177 of patients reported no complications. The majority (151 [85.8%] of 176) were satisfied with their treatment. In all, 16 (25.4%) of 62 of patients treated for recurrent VVs were dissatisfied versus 9 (7.9%) of 114 of those with primary VVs (P = .0026). Conclusions: The majority of patients are satisfied with results following endothermal ablation. Dissatisfaction may be more likely following treatment for recurrent VVs.
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Affiliation(s)
| | | | | | - Joseph Shalhoub
- Imperial Vascular Unit, Imperial College London, United Kingdom,
| | - Chung S. Lim
- Imperial Vascular Unit, Imperial College London, United Kingdom
| | - Manjit S. Gohel
- Imperial Vascular Unit, Imperial College London, United Kingdom
| | - Alun H. Davies
- Imperial Vascular Unit, Imperial College London, United Kingdom
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