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Lahnaoui O, Houmada A, Benkabbou A, Ghannam A, Al Ahmadi B, Belkhadir Z, Mohsine R, Souadka A, Majbar MA. Enhancing patient safety: a system-based analysis of morbidity and mortality conferences in managing postoperative bleeding following gastric and pancreatic cancer surgery. BMJ Open Qual 2024; 13:e002657. [PMID: 38485113 PMCID: PMC10941144 DOI: 10.1136/bmjoq-2023-002657] [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: 10/19/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
Morbidity and mortality conferences (MMCs) have evolved beyond their traditional educational role to become instrumental in enhancing patient safety. System-based MMCs offer a unique perspective on patient safety by dissecting systemic factors contributing to adverse events. This paper reviews the impact of MMC in managing postoperative bleeding after gastric and pancreatic cancer surgery, within the constraints of limited resources. The study conducted at the National Institute of Oncology in Rabat, Morocco, analysed 18 MMC of haemorrhage following gastric and pancreatic surgeries and allowed to identify two patterns of cumulative factors contributing to adverse events. The first one relates to organisational issues and the second to postoperative management. Fifteen recommendations of improvement emerged from MMC addressing elements of these patterns with an implementation rate of 53.3%.
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Affiliation(s)
- Oumayma Lahnaoui
- National Institute of Oncology - Surgical Oncology Department, Mohammed V University in Rabat, Rabat, Morocco
| | - Amina Houmada
- National Institute of Oncology - Surgical Oncology Department, Mohammed V University in Rabat, Rabat, Morocco
| | - Amine Benkabbou
- National Institute of Oncology - Surgical Oncology Department, Mohammed V University in Rabat, Rabat, Morocco
| | - Abdelillah Ghannam
- National Institute of Oncology - Intensive Care Department, Mohammed V University in Rabat, Rabat, Morocco
| | - Brahim Al Ahmadi
- National Institute of Oncology - Intensive Care Department, Mohammed V Souissi University, Rabat, Morocco
| | - Zakaria Belkhadir
- National Institute of Oncology - Intensive Care Department, Mohammed V University in Rabat, Rabat, Morocco
| | - Raouf Mohsine
- National Institute of Oncology - Surgical Oncology Department, Mohammed V University in Rabat, Rabat, Morocco
| | - Amine Souadka
- National Institute of Oncology - Surgical Oncology Department, Mohammed V University in Rabat, Rabat, Morocco
| | - Mohammed Anass Majbar
- National Institute of Oncology - Surgical Oncology Department, Mohammed V University in Rabat, Rabat, Morocco
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Souadka A, Boutayeb S, El Khannoussi B, El Kacimi H, Lahnaoui O, Benkabbou A, Majbar MA, Ghannam A, Belkhadir ZH, Mohsine R, El Ahmadi B. Elevating standards: A comprehensive model for peritoneal surface malignancy management in developing healthcare systems. J Surg Oncol 2024; 129:659-661. [PMID: 38044744 DOI: 10.1002/jso.27522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Amine Souadka
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
- Centre d'investigation Clinique, Centre Hospitalier Universitaire Ibn Sina, Rabat, Morocco
- Equipe de Recherche en Oncologie Transationelle (EROT), University Mohammed V in Rabat, Rabat, Morocco
| | - Saber Boutayeb
- Centre d'investigation Clinique, Centre Hospitalier Universitaire Ibn Sina, Rabat, Morocco
- Equipe de Recherche en Oncologie Transationelle (EROT), University Mohammed V in Rabat, Rabat, Morocco
- Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Basma El Khannoussi
- Centre d'investigation Clinique, Centre Hospitalier Universitaire Ibn Sina, Rabat, Morocco
- Pathology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Hanane El Kacimi
- Radiotherapy Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Oumayma Lahnaoui
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Amine Benkabbou
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
- Equipe de Recherche en Oncologie Transationelle (EROT), University Mohammed V in Rabat, Rabat, Morocco
| | - Mohammed Anass Majbar
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
- Equipe de Recherche en Oncologie Transationelle (EROT), University Mohammed V in Rabat, Rabat, Morocco
| | - Abdelilah Ghannam
- Intensive Care Department. National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Zakaria Houssain Belkhadir
- Intensive Care Department. National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Raouf Mohsine
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Brahim El Ahmadi
- Intensive Care Department. National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
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Lahnaoui O, Essangri H, El Bahaoui N, Majbar MA, Benkabbou A, Mohsine R, Souadka A. From burden to relief: The economic and quality-of-life advantages of pseudo continent perineal colostomy in ultra-low rectal cancer patients. J Surg Oncol 2024; 129:297-307. [PMID: 37849420 DOI: 10.1002/jso.27484] [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: 09/08/2023] [Accepted: 10/09/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND AND OBJECTIVE Pseudo Continent Perineal Colostomy (PCPC) is an alternative technique to left iliac colostomy (LIC) after abdominoperineal resection for ultra low rectal cancer (ULRC). It allows placing the stoma in the perineum to preserve patients' body image. However, concerns about its impact on quality of life and management costs have limited its adoption. We aimed to compare the early outcomes and financial burden of PCPC and LIC in ULRC patients in Morocco, a low-middle-income country. METHODS From January 2018 to December 2019, all patients who underwent abdomino-perineal resection (APR) with LIC or PCPC were prospectively enrolled. For each patient, baseline characteristics, and in hospital and 90 days morbidity with a focus on perineal complications were reported. Quality of life (QOL) was assessed using the validated EORTC-C30 and CR29 questionnaires. Financial burden to patients was reported using declarative out-of-pocket costs (OOPC) analysis. RESULTS Among 49 patients who underwent APR, 33 received PCPC and 16 received definitive LIC. Similar rates of early perineal complications were observed between the two groups (p = 0.49). Readmission rate at POD90 was higher in the LIC-group due to perineal sepsis (p = 0.09). QOL analysis at 6 months revealed that patients with PCPC had a higher global health status (p = 0.006), a better physical functioning and reported fewer symptoms of flatulence and fecal incontinence (p = 0.001). Patients with a LIC reported more financial difficulties with higher median OOPC of stoma management up to €23 versus €0 per month for PCPC (p = 0.0024). PCPC was the only predictive factor of improved patient reported outcomes. CONCLUSIONS PCPC is a cost-effective alternative to the standard definitive colostomy without alteration of the QOL or additional perineal complications during the first 6 months following the surgery. These findings may help convince surgeons to offer this option to patients refusing definitive LIC.
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Affiliation(s)
- Oumayma Lahnaoui
- Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Mohammed Vth Unverisity, Rabat, Morocco
- Equipe de recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Hajar Essangri
- Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Mohammed Vth Unverisity, Rabat, Morocco
| | - Nezha El Bahaoui
- Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Mohammed Vth Unverisity, Rabat, Morocco
| | - Mohammed Anass Majbar
- Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Mohammed Vth Unverisity, Rabat, Morocco
- Equipe de recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Amine Benkabbou
- Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Mohammed Vth Unverisity, Rabat, Morocco
- Equipe de recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Raouf Mohsine
- Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Mohammed Vth Unverisity, Rabat, Morocco
- Equipe de recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Amine Souadka
- Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Mohammed Vth Unverisity, Rabat, Morocco
- Equipe de recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, Rabat, Morocco
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Avellaneda N, Al Masri M, Baimakhanov A, Balasubramaniam D, Bhangu A, Bouchagier K, Bozbiyik O, Carpelan A, Chwat C, Cunha M, Dawson BE, Mallen MVD, Ellebæk MB, Gonzalez TE, Elshami M, Fakhradiyev I, Ozkan OF, Fleres F, Futaba K, Gallo G, Ghosh D, Glasbey JC, Harrison E, Hooper RL, Jain R, Kamarajah S, Veetil SK, Kamer E, Keatley J, Knowles CH, Kulimbet M, Lal P, Li E, Polamreddy BM, Minaya-Bravo A, Mittal R, Morton DG, Nadal LRM, Negoi I, Nepogodiev D, Omar O, Pata F, Pinkney T, Potter MA, Rottoli M, Santos G, Smith I, Spinelli A, Venn M, Hooper R, Morton D, Bywater E, Evans J, Magill L, McKay S, Bordom DO, Simões J, Venn ML, Adeyeye A, Avellaneda N, Buchs N, Cato L, Finch D, Umar GI, Bravo AM, Junior HM, Neary P, Poskus T, Roslani A, Samadov E, Sbaih M, Shalaby M, Singh B, Sinha A, Vardanyan A, Chaudhry S, Frasson M, Millward J, Sánchez-Guillén L, Stijns J, Zimmerman DDE, Beard D, Campbell M, Moug S, Aytac E, Blackwell S, Buchwald P, Chowdhury SM, Dardanov D, Dulskas A, Elhadi M, El-Hussuna A, Garoufalia Z, Aslam MI, Kelly M, Knowles C, Mendes B, Ng S, Pellino G, Sebastian S, Sivrikoz E, Tejedor P, Vaizey C, Bianchi R, Christensen P, Lee SH, Lohsiriwat V, Mantoo SK, Mazlan L, Um JW, Wang JY, Watanabe J, Yao H, Bengueddach A, Tidjane A, Tabeti B, Behilil C, Boudjenan-Serradj N, Bensafir S, Meharzi SEI, Aissat A, Ghouali AK, Larabi K, Riffi O, Kacimi SEO, Mesli SN, Rezoug W, Mitidieri A, José A, Pablo C, Rodriguez CA, Panettiere MF, Barbalace N, Juan T, Lucena J, Houdin A, Fernandez E, Lococo J, Pedro L, Loban M, Vecchio P, Grinblat A, Carrie A, Veracierto F, Santillan M, Napolitano M, Rosa SL, Gonzalez CM, Ferro E, Muñoz JP, Ventorutti T, Cabrera C, Carrizo C, Mospane C, Leiro F, Espino J, Trama M, Potolicchio A, Dindri F, Buey L, Lucas N, Catalano P, Astilleta R, Quiroga Y, Valli D, Alexandre F, Martres G, Rosato G, Lemme G, Romero V, Doniquian AM, Pachajoa DAP, Llahi F, Fiorenza JM, Parodi M, Ocaña N, Gallardo A, Valenzuela A, Perriello J, Nador R, Fermani C, Garay L, Blanco P, Villalobos S, Posner F, Vieyra N, Fiorito P, Ciabattari P, de Kort C, Daryanani D, Smit J, Gosselink MP, Janssen N, Feiss A, Lee CHA, Taylor D, Edington J, Chen N, Ong WM, Aigner F, Moitzi G, Gemes G, Braumille M, Mitteregger M, Gerald S, Uranitsch S, Belarmino A, Waha J, Kahn J, Treiber M, Schemmer P, Mikalauskas S, Ibrahimli A, Orujova E, Namazov I, Alikhanli J, Asgarov M, Kutkut A, Almahmeed E, Aljawder H, Juma I, Johnston K, Saeed MF, Khairi S, Matovic E, Omerasevic M, Delibegovic S, Hodzic S, Rudell AG, Fuzari J, Farah JF, Dos Santos MBA, Lupinacci RA, Pereira TS, da Silveira Sete A, Filho AL, de Souza Pires BL, de Queiroz FL, Amaral HAT, Dos Santos MAM, de Miranda Silvestre SC, Hanan B, Reis C, Cassia G, da Luz M, Delgado M, Campanati R, Silva R, Bomfa-Barbosa A, Alves BC, Costa BXM, Cortes BGW, Lemos FHT, Arreguy-Borges K, Silva TB, Assis A, Freitas AH, Rezende D, Silva H, Alvarenga I, Cascais R, Silva T, Pinto H, Silva I, Leite L, Massahud M, Meyer M, Tibúrcio R, Martinez CAR, Espinha DR, Marson FAL, de Oliveira Góes IA, de Souza Artioli LM, Boschiero MN, Takahashi CY, de Oliveira FG, Junior HFL, de Oliveira JCC, Dos Santos JM, Gerber MT, Erdmann TR, Barbosa A, Fernandes A, Júnior AN, Júnior HM, Moreira J, Ribeiro M, Moreira P, Carvalho A, Santos B, Fidelis F, Cruz I, Codes L, Aibe R, Boudoux S, Favacho BC, Pinto F, Gava G, Pivati IR, Vilain LF, Kim N, Nunes RL, Dimitrov D, Peneva K, Karamanliev M, Dimitrova S, Ivanov T, Atanasov B, Dzharov G, Shtereva M, Slavchev M, Belev N, Krastev P, Arabadzhiev A, Tonova D, Tzoneva D, Sokolov M, Gribnev P, Maslyankov S, Pavlov V, Bakmaz B, Dijan E, Ćoza I, Mihanovic J, Kučić J, Sulen N, Katušić Z, Hudáček K, Farkašová M, Marková M, Grolich T, Kala Z, Pazdírek F, Hoch J, Filipová L, Kocián P, Přikryl P, Høgn A, Møller B, Slot DK, Bælum JK, Cour KL, Eriksen ND, Mahmoud A, Abdellatif A, Nafea A, Ewedah M, Soliman M, Yakout N, Argawy O, Sallam I, Kamel I, Sherif M, Ashmawy S, Ali A, Saad M, Ahmed M, Mohamed M, Mohamed N, Mahmoud S, Mahmoud S, Rashed AM, Abd-Errazik MA, Ammar MA, Mohammed R, Ebrahem A, Abd El Aal A, Abdou K, Wagdy M, Qassem M, Taha M, El-Wafa YA, Shehta A, El Metwally A, Hamed H, Ali MA, Elrefai M, El Sorogy M, Abdelkhalek M, Ragab A, Refky B, Metwally IH, Abdelkhalek M, Kamal M, Zuhdy M, Shetiwy M, Sakr A, Elfallal A, Elfeki H, Eldakroury I, Elbahrawy K, Mostafa M, Emile S, Tessema A, Tasew A, Gezahegn H, Bekele K, Belay M, Gudisa Z, Teferu Z, Väyrynen A, Kechagias A, Turunen A, Katunin J, Parhiala M, Pengerma P, Lahti P, Vihervaara H, Huhtinen H, Pasonen J, Heino R, Pakarinen S, Falenius V, Pinard B, Nobile C, Duchalais E, Drissi F, Meurette G, Podevin J, Lepenndu M, Hoetzel A, Jud A, Jauch D, Stefan FF, Neeff H, Holzner P, Nguyen P, Ryl A, Kehl F, Pullig F, Baral J, Münch S, Fütterer C, Reißfelder C, Sandra-Petrescu F, Herrle F, Hardt J, Lamm L, Seyfried S, Gharbi A, Aydin F, Stavrou G, Sperber J, de Deken J, Schwarzkopf K, Widyaningsih R, Polidorou A, Mpakas A, Tokidis E, Loun L, Petropoulou T, Balalis D, Korkolis D, Manatakis D, Assimakopoulou E, Bourazani M, Gklavas A, Kalamara E, Papaconstantinou I, Theodoraki K, Chardalias L, Konstadoulakis M, Theodosopoulos T, Soulioti E, Kavezou F, Filippou J, Papadoliopoulou M, Michalopoulos N, Vassiliu P, Sidiropoulos T, Charakopoulou A, Panagiotou A, Kokkinakis K, Lambridi E, Psarologos M, Maria S, Giannaraki S, Kapiris S, Triantafyllou A, Theodoropoulos C, Matthaiou G, Westzaan N, Etelka S, Triantafyllou T, Schizas D, Mpaili E, Karydakis L, Mpoura M, Danassi D, Karavokyros I, Dimitriou N, Livanou X, Kikira A, Tsourouflis G, Tomara NK, Nikiteas N, Dorovinis P, Tsiotos G, Stamou K, Kocka N, Ballian N, Kalakonas S, Athanasakis E, Chrysos E, Xynos E, Tsiaoussis J, Papadaki K, Xenaki S, Nyktari V, Sarakatsianou C, Bompou E, Arnaoutoglou E, Tzovaras G, Baloyiannis I, Mamaloudis I, Perivoliotis K, Apostolidi E, Mulita F, Karpetas G, Maroulis I, Vailas M, Petra A, Kontis E, Kaouras E, Katsaros I, Katsiaras L, Manikis P, Papadopoulou T, Papadopoulos A, Manioti E, Zeringa G, Katsinelis I, Mouzakis O, Kouki P, Nikolaou V, Marinis A, Alexopoulou K, Papadaki M, Vederaki SA, Samara A, Giakoustidis D, Christodoulidis G, Bareka M, Chatzikomnitsa P, Tsigara S, Papadopoulos V, Zarzava E, Anestiadou E, Lydia L, Apostolakidou M, Ioannidis O, Simeonidis S, Mpitsianis S, Tam PTH, Ng SSM, Lau VNM, Tse WK, Bánky B, Dolhai E, Horváth É, Golub J, Marton J, Lakatos L, Suszták N, Maurya AP, Kumawat H, Saxena P, Lather R, Waindeskar V, Khanduri A, Goyal L, Gupta R, Singh S, Saksena AR, Rayani BK, Kasula J, Raju K, Shah MM, Thammineedi SR, Patnaik SC, Rathod D, Poonia DR, Vishnoi JR, Sharma N, Byshetty R, Yadav RK, Misra S, Dhali A, Dhali GK, Biswas J, Ray S, Ghose T, Pipara A, Singh HM, Roy MK, Desai N, Thambudorai R, Ishwarappagol V, Chaturvedi A, Verma D, Akhtar N, Gupta S, Rajan S, Tiwari T, Kumar V, Mahajan A, Jain D, Liddle D, Jyoti J, Haque PD, Prem W, Lakshminarayana B, S BV, Poojary PH, Bhat RRK, Mathew S, Gupta L, Bains L, Kumar M, Singh N, Sharma A, Kumar A, Garg L, Aggarwal M, Jakhar R, Kumar A, Bose B, Huda F, Thakur N, Dhar P, Seenivasagam RK, Prakash S, Chaudhari A, Shukla A, Mahakalkar C, Saxena G, Mahuli K, Kaple M, Kshirsagar S, Mehraj A, Parray F, Aziz G, Chowdri N, Wani R, Gurcoo S, Shah Z, Madhavan S, Subbarayan S, Vino S, Aravindan U, George G, Ck H, Yadev IP, Chisthi M, Ps R, Sreekumar RC, Vijayan V, Theodore B, Victor C, Jesudason MR, Arulappan N, Philip R, Durai S, Creavin B, Cullinane C, Davis C, Flynn C, Liam D, Cooke F, Earley H, Peter M, Hamilton V, Trani AD, Conversano I, Cianci P, Petta R, Picciariello A, Altomare DF, Martines G, Grasso S, Moffa S, Papagni V, Zanoni A, Belvedere A, Romano A, Croce GD, Tanzanu M, Cardelli S, Lauro A, Sartarelli L, Binetti M, Cervellera M, Tonini V, Sanna B, Pusceddu E, Runfola M, Manunza R, Pisanu A, Cois A, Frongia F, Esposito G, Podda M, Mura P, Marzella A, Scotto B, Cuneo D, Ascari F, Giulino G, Varoli M, Laquatra N, Fortunato C, Marino F, Perrone F, Pace M, Convertini O, Cutellè C, Ammerata G, Sena G, Pignataro M, Scozzafava M, Mazza M, Bruni A, Curro G, Hila J, Ammendola M, Curcio S, Signorelli V, Marano A, Sasia D, Borghi F, Giuffrida MC, Bonardello M, Palmisano S, Testa V, Porta A, Scaltrini F, Iacob G, Gaspa I, Guatteri L, Coladonato M, Zapparoli A, Pesce A, Feo CV, Pindozzi F, Bigoni I, Torchiaro M, Fabbri N, Cianchi F, Staderini F, Elena F, Coratti F, Barbato G, Fortuna L, Romagnoli S, Bergamini C, Villa G, Cecchini I, Martellucci J, Izzo M, Trafeli M, Scheiterle M, Manoocheehri F, Cagnazzo F, Spampinato MG, Adam N, Depalma N, D'Ugo S, Garritano S, Mazzeo C, Cucinotta E, Melita F, Viscosi F, Biondo SA, Tripodi VF, Foppa C, Greco M, Sacchi M, Carvello M, Deac V, Laurenti V, Frontali A, Zappone A, Cammarata F, Colombo F, Ferrario L, Currà MC, Danelli P, Vignali A, Umberto C, Mastriale F, Riccardo R, Turi S, Elmore U, Galimberti A, Ceretti AP, Vespo D, Opocher E, Longhi M, Mariani NM, Flandoli C, Ciulli C, Vaira G, Ripamonti L, Cigagna L, Oldani M, Tamini N, Palumbo A, Castaldi A, Antropoli C, Rupealta N, Palmiero N, Donatiello V, Novi A, Cappiello A, Bianco F, de Luca M, Incollingo P, Esposito R, Gili S, Aprea G, de Simone G, Palomba G, Capuano M, Basile R, D'Angelo S, Tropeano FP, Luglio G, Pagano G, de Palma GD, Cricrì M, Milone M, Manigrasso M, Anoldo P, Boccia G, Raiano G, Nuzzo MMD, Calabria M, Peltrini R, Castiglioni S, Bracale U, Cervone C, Rega D, Caliendo D, Benetti E, Delrio P, Guarino R, de Franciscis S, Coppolino F, Romano FM, Selvaggi F, Sciaudone G, Selvaggi L, de Stefano M, Resendiz A, Carosso F, Degiuli M, Salusso P, Reddavid R, Benetti S, Callari C, Miceli DD, Pardo D, Sabatino G, Licari L, Lirosi MC, Sorce V, Peri A, Mori A, Pugliese L, Filardo M, Nuccio P, Dominioni T, Massimo C, Giuseppina F, Angelo F, Raffaele G, Michele M, Roberto P, Mondini A, Muratore A, Valentino C, Calabro' M, Danna R, Cremonini C, Sbarbaro C, Tartaglia D, Coccolini F, Chiarugi M, Musetti S, Pagani S, Neri CM, Leoni C, Rossi E, Randisi E, Puccini M, Buccianti P, Balestri R, Vasale A, Crescentini G, Ranieri G, Sinibaldi G, Biondi A, Sanesi AP, Vacca C, Lorenzon L, Sollazzi L, Persiani R, Pezzuto R, Ferroni AF, Stipa F, Volturo L, Moretti M, Tierno SM, Marina S, Mingoli A, Fiori E, Pugliese F, Brachini G, Carta G, Sapienza P, Lapolla P, Mazzotta E, Carannante F, Capolupo GT, Masciana G, Sica I, Caricato M, Antonelli S, Fiume D, Spoletini D, Lisi G, Carlini M, Menduni V, Arturi A, Proietto B, de Lucia C, Baldi C, Passantino DG, Romeo G, Paola MD, Sensi B, Sica G, Siragusa L, Dauri M, Franceschill M, Campanelli M, Bellato V, Porcu A, Garau AGG, Masala ML, Oggianu S, Tedde T, Perra T, Pazzola V, Venezia DF, Roviello F, Giacomini G, Carbone L, Marano L, Verre L, Marano M, Ciccarese AA, Bagnardi F, Shahu J, Siciliano W, Iacomino A, Armellin C, Marson F, Zanus G, Santoro GA, de Paoli M, Grossi U, Sekimoto M, Kobayashi T, Horiguchi A, Koike D, Yonekura H, Kato H, Yoshino K, Arakawa S, Asano Y, Alawneh F, Rajab I, Ramadan M, Masri MA, Qaisi MA, Alsamneh M, Mubaidin O, Al-Jarrah A, Ababneh H, Khdair K, Tawarh T, Sabri W, Arida ZA, Dzhumabekov B, Klyshbayeva D, Ispbayeva K, Nadyrov M, Tanabayeva S, Saliev T, Jumanov A, Aitbaeva A, Arynov A, Nadyrov M, Maulenov N, Dushimova Z, Park EJ, Kim H, Kang J, Baik SH, Song Y, Kwak HD, Kim J, Son JH, Chung JS, Lee H, Baek JH, Nam KH, Lee KC, Lee WS, Jeon Y, Kim CW, Park SE, Son GM, Ahn HM, Lee IY, Kim TK, Pcolkins A, Sivins A, Lobovs D, Ancans G, Kreice I, Budnikova I, Jelovskis I, Emhareb A, Abaidalla A, Hammed A, Khairallah M, Jibreel SS, Mohmmad WAS, Hasan W, Venskutonis D, Daugėla E, Dainius E, Juočas J, Kutkevičius J, Vaitkutė K, Bradulskis S, Macas A, Pauzas H, Jokubauskas M, Lizdenis P, Budrikienė R, Svagzdys S, Saladzinskas Z, Volkoviene G, Makauskiene J, Kuliavas J, Bernotaite V, Danys D, Kontrimaviciute E, Poskus E, Kryzauskas M, Jakubauskas M, Jotautas V, Zakaria AD, Kai MWP, Zainy RHM, Tan SS, Zain WZW, 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Khan FN, Bandar MA, Shamim R, Chowdhury S, Kovacevic B, Krdzic I, Zdravkovic M, Kenic M, Milentijevic M, Petkovic N, Radulovic R, Ngu J, Teo NZ, Singh PA, Ong SY, Li S, en Siew B, Chee C, Koh JJM, Lee KY, Tan KK, Wong SC, Loh W, Pujol AF, Rubio JC, Farrés LP, Vendrell LL, Del Olmo MIU, Pedregosa AB, Galmes C, Luckute D, Casanova D, Artigot M, Guedes X, Olivella Y, Sarda MS, Toscano MJ, Damieta MP, Pera M, Gonçalvez SA, Galvez ST, Ruiz SS, Espin-Basany E, Marinello F, Villarino-Villa L, Heras MVL, Martin-Sanchez R, Mata RM, Blanco-Colino R, Otero A, de Lacy AM, Sanahuja JM, Bravo R, Ferraz T, Gonzabay V, Gonzalez F, Menendez P, Del Castillo VCG, Lopez-Pelaez VM, Silva ÁS, Lillo-García C, Tauler EM, Manresa MCE, Pérez SL, Llopis SQ, Rubio AV, Castillo ER, Miramón FJJ, Rodriguez JLR, Rizo-Lamberti LA, Garrido PG, Carneros VJ, Alfonso BA, Sierra BG, Amador CG, Gomendio MDP, Palomino MVR, de La Plaza Llamas R, Cafranga EG, Ramos JLE, Estudillo MC, Pérez RE, Pernas RM, de Lebrusant Fernández S, Bautista WMS, Llamazares AL, Valbuena AL, Moran LA, Alvarez LJ, Raposo LG, Ceron SF, Calvo AC, Valcárcel CR, Peña JP, Gómez LMJ, Díez MC, Lindenbaum PD, Mata SK, Ruiz-De-La-Hermosa A, Abad-Motos A, Toribio-Combarro B, Ripollés-Melchor J, Fuenmayor-Valera ML, Ortega-Domene P, Loscos A, Del Pueblo CS, Dziakova J, Mugüerza JM, Carlin PS, Anula R, Mouvet Y, Forero-Torres A, Andrés BDS, Marcos CM, Rubio I, Pascual I, Yague J, Alcolea NG, Alonso A, Diéguez B, Ibañez I, Pérez JL, Losada M, García-Conde M, Hernández M, Blazquez-Martin A, Vera-Mansilla C, Mendoza-Moreno F, Hernandez-Salvan J, Diez-Alonso M, Hernandez-Juara P, Barrena-Blazquez S, Minaya-Bravo AM, Galván-Pérez A, Miguel-Méndez CS, Gonzalez-Gonzalez E, Alvarez-Díez M, García-Ureña MÁ, Llorente-Moreno M, Ruiz-Lozano C, Colás-Ruiz E, Pérez-Calvo J, Gomila-Sanso JA, Álvarez-Llano L, Serrano-Fuentes SC, Soto-Montesinos C, Dedeu-Bastardas I, Perez-Reche I, Labró-Ciurans M, Pardo-López S, Pérez EG, Fernández IO, Canals LO, Espino PC, Ruano PG, Ricardo V, Ros EP, Manuel EM, Buleje JAB, Prats MMC, Baños PAP, González PM, Celdrán RG, Pellicer-Franco EM, Valero-Navarro G, Vicente-Villena JP, Martinez-Mercader MM, Baeza-Murcia M, Mengual-Ballester M, Soria-Aledo V, Fernández-Martínez D, Varela-Rodríguez L, Garcia-Flórez LJ, Fernández-Hevia M, Gonzalez-Diaz MJ, Fernández-Arias S, Puertas CP, de San Pío Carvajal E, Cebolla ES, Brainsa E, Bayo JMM, Castro MC, Blanco RR, Gutierrez E, Pinto FL, Alegre JM, Flores N, ÓSullivan SN, Fernández BF, Alonso JE, Conde JGA, Ropero NM, Bayón RÁ, Dominguez SH, Ramirez S, Martin de Pablos A, Perez-Sanchez A, Cano-Matias A, Del-Rio-Lafuente FJ, Caballero-Delgado J, Valdes-Hernandez J, Gomez-Rosado JC, Martinez C, Cholewa H, Sancho-Muriel J, Alberola MJ, Navasquillo M, Primo V, Moreno V, Espí-Macías A, Moro-Valdezate D, Carrascosa-Morales I, Martín-Arévalo J, Soro-Domingo M, García-Botello S, Pla-Marti V, Abellán AM, Pérez CM, Cortés GFV, Blasco LF, Chornet MR, Martín RS, Diego ARD, Vázquez-Fernández A, Pascual A, de Andrés-Asenjo B, Beltrán de Heredia J, Ruiz-Soriano M, Rodríguez-Jiménez R, Iribarren EM, Rodríguez EVF, Del Carmen Casas García M, García-Señoráns MP, Valderrama ÓC, Rodríguez PF, Santos RS, Currás RP, Vigorita V, Roche CG, Delgado E, Lafuente F, Gascon I, Saudi S, Fraj V, Wickramasinghe D, de Zoysa I, Samarasekera N, Wickramarathne R, Dassanayake V, Balathayalan Y, de Silva D, Perera M, Pulleperuma S, Jayasekara S, Wijenayake W, Gunetilleke B, Abeysinghe N, Chandrasinghe P, Kumarage S, Abdalradiy AG, Widatalla ABH, Ahmed AY, Mohamed HA, Hamid HKS, Ali MH, Eldin SJ, Agger E, Jutesten H, Lindgren J, Lepsenyi M, Azhar N, Hansdotter P, Ekepil A, Lindén Å, Brandström G, Smedberg J, Schiffer E, Ris F, Longchamp G, Meyer J, Dupret L, Galetti K, Regusci L, Grischott M, Malugani M, Mouhandes AEF, Danial AK, Khayat M, Sbahi MHE, Marawy MK, Abdullah MA, Douba Z, Mansour A, Niazi A, Hamza A, Mohamad AH, Awead M, Mohammad S, Salloum S, Jabar AA, Zazo A, Shebli B, Ayoub K, Younes L, Bannoud MH, Zazo R, Saad A, Hamdan A, Wakkaf H, Adra L, Souliman M, Anton M, Hannouf S, Li KL, Cheng KI, Ji SJ, Hsieh YC, Parlak EA, Demir M, Kara U, Peker YS, Yiğit D, Unal N, Iflazoğlu N, Yalkin Ö, Topal S, Gulcu B, Ozturk E, Gümbelek G, Terkanlıoğlu S, Koklucan A, Ince G, Sen M, Isik O, Kural S, Akesen S, Yilmazlar T, Sungurtekin H, Sungurtekin U, Vural U, Ozgen U, Isik A, Onk D, Kurnaz E, Ozker TS, Ipek A, Ferlengez A, Erturk C, Tatar C, Sevik H, Akay O, Sensoy O, Hayirlioglu MB, Aktas S, Ozben V, Aliyeva Z, Mutlu AU, Gökay BV, Saraçoğlu C, Aytaç E, Gülmez M, Işık MÜ, Hacim A, Akbas A, Soyhan F, Turgut MA, Demirgan S, Meric S, Altinel Y, Baris B, Akova E, Kahraman E, Kucuk HF, Saracoglu KT, Kaya S, Lel S, Gurbulak EK, Caz E, Kostek M, Mihmanli M, Yazici P, Oba S, Kırkan EF, Ulgur HS, Kalın M, Dinkci MD, Duzgun O, Ozturk S, Zengin AK, Aşkar A, Şanlı AN, Erginöz E, Özçelik MF, Ergün S, Uludağ SS, Kara D, Yılmaz G, Sarıcı IŞ, Kara Y, Incesu A, Arican C, Atici SD, Kaya T, Gezer T, Kirmizi Y, Aydin G, Namdaroglu O, Adakaya S, Canda AE, Ozzeybek D, Coskun N, Sokmen S, Ozkardesler S, Bisgin T, Miftari A, Caliskan C, Akgun E, Avseren G, Deniz N, Yoldas T, Güreşin A, Zayakov G, Pösteki G, Utkan NZ, Tatar OC, Akçay Ö, Güler SA, Mantoğlu B, Demirel E, Akın E, Gonullu E, Altintoprak F, Palabıyık O, Bayhan Z, Ciftci AB, Colak E, Aybar E, Celik HK, Eraslan H, Yemez K, Ozbilgin SS, Senol S, Gultekin FA, Piskin O, Guler O, Karadere Y, Kakeeto A, Oguttu B, Sikakulya FK, Lule H, Rybachuk A, Shudrak A, Beznosenko A, Lisnyy I, Rozhkova V, Zvirych V, Alawlaqi D, El Jamali F, Balooshi IA, Ahmed M, Albers M, Ali NA, Church R, Dudas G, Wells J, Pavlova M, Sebastiani S, Paterson C, Kaushal M, Patel P, Panchal S, Handa S, Tezas S, Zaidi SN, Raj G, Wright J, Hallam S, Karandikar S, Gates Z, Marshall A, Thompson A, Tennakoon A, Rao M, Callan R, Tufail S, Rajendran G, Polisetty K, Husain N, Clarke N, Naranayanasamy S, Hallett A, Lorejo E, Ward N, Antakia R, Xanthis A, Simillis C, Tweedle E, Panagiotopoulou I, Grimes L, Mounstephen L, Bocancia R, Carden C, Lynch J, Noveros MS, Shaalan R, Khalil T, Marshall W, Hodge K, Balfour J, Mcintosh K, Buijs L, Yule M, Vaughan-Shaw PG, Smith S, Anderson T, Mcdermott FD, Daniels IR, Tapp J, Smart N, Rajaretnam N, Bethune R, Clark T, Delimpalta C, Liao C, Banham G, Induruwage L, Velchuru V, Lawrence A, Rahman A, Bennett J, Badawi M, Harshen R, Bhargava A, Gorrela K, Jumah M, Hanson M, Arya S, Atendido T, Shrestha A, Cook E, Rakhimov I, Collins J, Alamin N, Vigneswaran N, Basnyat P, Shamardal A, Chacko A, Wanshantha D, Bisheet G, Ebdewi H, Abdellatif M, Adu-Poku P, Tore A, Adams F, Allen K, Ahmed K, Kulkarni N, Chitnis A, Patel H, Magsino J, Sarodaya V, Minicozzi A, Dempsy C, Ahmed H, Jayasinghe JD, Okail MH, Thaha M, Hallworth S, Parmar C, Chua L, Pizanias M, Samin R, Young T, Sagar J, Yorkmui L, Cirocchi N, Ahmed S, Barreda SC, Kudchadkar S, Baker A, Jayasankar B, Jackson J, Abdelsaid K, Hassan M, Shetty S, Coldwell C, Davies E, Nader H, Raistrick M, Ryska O, Hawkin P, Raymond T, Witjes C, Van de Steen K, Crabtree N, Boyce S, Somera W, Woodward A, Ryan K, Kassai M, Aleem M, Ghosh A, Rixson D, Lewis E, Lynch N, Shovelton C, Zywicka E, Guest F, Barton J, Purnell R, Bamford R, Teare T, Adams B, Chmielewski G, Smith L, Connolly L, Niblett R, Singh A, Halliwell G, Paraoan M, Doree N, Asaad P, Kilbride C, Carpenter H, Wilson J, Fletcher J, Vijayagopal KA, Abbakar M, Zaimis T, Walsh A, Kubisz-Pudelko A, Nono J, Pippard L, Chowdhary M, Dalton R, Moussa T, Dominguez F, Solla G, Curbelo J, Laurini M, Viola M, Brito N, Al-Alnsi A, Al-Naggar H, Saryah L, Al-Shehari M, Alsayadi R, Al-Hutheifi R, Shream S, Saeed S, Spurring EM. Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries. Br J Surg 2024; 111:znad370. [PMID: 38029386 PMCID: PMC10771257 DOI: 10.1093/bjs/znad370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. METHODS The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. RESULTS A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). CONCLUSION Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov).
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Louafi MO, Lahnaoui O, Benkabbou A, Majbar MA, Mohsine R, El Khannoussi B, Boutayeb S, Souadka A. Striking a balance: Deciphering the dilemma of treatment equivalence in cardia gastric cancer. J Surg Oncol 2023; 128:1459-1460. [PMID: 37846129 DOI: 10.1002/jso.27452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 10/18/2023]
Affiliation(s)
- Mohammed Oussama Louafi
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Oumayma Lahnaoui
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Amine Benkabbou
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Mohammed Anass Majbar
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Raouf Mohsine
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Basma El Khannoussi
- Pathology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Saber Boutayeb
- Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Amine Souadka
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
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Aourarh B, Souadka A, Majbar MA, Benkabbou A, Chakkor A, Bakkar M, Mohsine R, Amrani L. Endoscopic management of anastomotic leakage after colorectal cancer surgery in a Moroccan center: A case series and literature review. SAGE Open Med Case Rep 2023; 11:2050313X231205716. [PMID: 37954544 PMCID: PMC10637152 DOI: 10.1177/2050313x231205716] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/19/2023] [Indexed: 11/14/2023] Open
Abstract
Endoscopic management has become an alternate treatment to a revision surgery for colorectal fistulas. Eight patients who were treated by endoscopy for postoperative anastomotic leakage to colorectal cancer were included. A univariate analysis was carried out to determine the predictive factors of success. All our patients were treated using metallic clips. The primary efficiency of this technique was 50%. In a univariate analysis, the size of the fistula and its distance from the anal margin had an influence on the efficiency of the endoscopic treatment, which was not the case for either the surgical technique or the use of neoadjuvant radiotherapy. This endoscopic treatment is effective and represents a more secure alternative than revision surgery. In our study, the use of metallic clips showed a 50% success rate, going up to 100% for the group of patients with a fistula ostium of a size ⩽1 cm, proving the necessity of using this technique.
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Affiliation(s)
- Benayad Aourarh
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Amine Souadka
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Mohamed Anass Majbar
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Amine Benkabbou
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Amal Chakkor
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Meriem Bakkar
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Raouf Mohsine
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Laila Amrani
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
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Bachri H, Essangri H, El Bahaoui N, Benkabbou A, Mohsine R, Majbar AM, Souadka A. External validation of the Moroccan Arabic version of the European Organization for Research and Treatment of Cancer colorectal (CR29) module: Monocentric study. World J Methodol 2023; 13:259-271. [PMID: 37771870 PMCID: PMC10523244 DOI: 10.5662/wjm.v13.i4.259] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 07/26/2023] [Accepted: 09/01/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Quality of life (QoL) outcomes are a focal endpoint of cancer treatment strategies. AIM To externally validate the Moroccan Arabic version of the European Organization for Research and Treatment of Cancer (EORTC) QoL Questionnaire (QLQ) for colorectal cancer (CRC) patients (CR29). METHODS Both Moroccan Arabic modules of QLQ-CR29 and QLQ-C30 were administered to Moroccan CRC. Psychometric properties were retested by measuring Cronbach's alpha coefficient for reliability and Intraclass correlation coefficient (ICC) to examine test-retest reproducibility. The multitrait-scaling analysis was performed to demonstrate the validity of the instrument and known-groups comparison was used to test the score's ability to discriminate between different groups of patients. RESULTS In total, 221 patients were included in our study and 34 patients completed the questionnaire twice. The Urinary Frequency scale and Stool Frequency scale had good internal consistency with alpha Cronbach coefficients of 0.79 and 0.83 respectively, while the same coefficients were moderately lower for the Blood and Mucus in Stool scale (0.61) and the Body Image scale (0.67). The ICCs ranged from 0.88 to 1 indicating good to excellent reproducibility. In multitrait scaling analyses, the criterion for item convergent and divergent validity was satisfactory. The known-group comparison showed statistically significant differences between patients according to age, gender, stoma status, tumor location, and radiotherapy. CONCLUSION The Moroccan Arabic version of the EORTC QLQ-CR29 is a valid and reliable tool that can be used safely for research and clinical purposes in Moroccan CRC patients.
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Affiliation(s)
- Houda Bachri
- Surgical Oncology Department, National Institute of Oncology, Mohammed Vth University in Rabat, Rabat 10100, Morocco
| | - Hajar Essangri
- Surgical Oncology Department, National Institute of Oncology, Mohammed Vth University in Rabat, Rabat 10100, Morocco
- Gynecology oncology Department, Royal London Hospital, Barts NHS Health, London SE18 6EY, United Kingdom
| | - Nezha El Bahaoui
- Surgical Oncology Department, National Institute of Oncology, Mohammed Vth University in Rabat, Rabat 10100, Morocco
| | - Amine Benkabbou
- Surgical Oncology Department, National Institute of Oncology, Mohammed Vth University in Rabat, Rabat 10100, Morocco
| | - Raouf Mohsine
- Surgical Oncology Department, National Institute of Oncology, Mohammed Vth University in Rabat, Rabat 10100, Morocco
| | - Anass Mohammed Majbar
- Surgical Oncology Department, National Institute of Oncology, Mohammed Vth University in Rabat, Rabat 10100, Morocco
| | - Amine Souadka
- Surgical Oncology Department, National Institute of Oncology, Mohammed Vth University in Rabat, Rabat 10100, Morocco
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Sekkat H, Souadka A, Alaoui L, Rafik A, Belkhadir Z, Amrani L, Benkabbou A, Mohsine R, Majbar AM. The learning curve of laparoscopic rectal cancer surgery of millennial surgeons: Lessons for a safe implementation in low- and middle-income countries. J Minim Access Surg 2023; 19:296-304. [PMID: 37056092 PMCID: PMC10246625 DOI: 10.4103/jmas.jmas_78_22] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/12/2022] [Accepted: 07/11/2022] [Indexed: 03/19/2023] Open
Abstract
Objective This study aimed to analyse the learning curve (LC) in laparoscopic rectal cancer resections of 2 millennial surgeons during the implementation of the first laparoscopic rectal cancer surgery programme in low- and middle-income country (LMIC) cancer centre. Methods All consecutive patients operated by two millennial surgeons for primary rectal adenocarcinoma between January 2018 and March 2020 were included. The LC was analysed for operative duration and conversion to open surgery using both cumulative sum (CUSUM) and/or variable life-adjusted display (VLAD) charts. Results Eighty-four patients were included, 45 (53.6%) men with a mean age of 57.3 years. Abdominoperineal resection was performed in 31 (36.9%) cases and resections were extended to other organs in 20 (23.8%) patients. Thirteen patients (15.5%) had conversion to open surgery. Using CUSUM, Learning curve based on conversion was completed at 12 cases for the first surgeon versus 10 cases for the second. While using VLAD and learning curve-CUSUM (LC-CUSUM), the cases needed were 26 vs 24 respectively. The median operative duration was 314 min with a LC completed at cases (17 vs. 26), and (18 vs. 29) using, respectively, standard and LC-CUSUM. Conclusions This study shows a safe and short LC of millennial surgeons during the implementation of a laparoscopic rectal cancer surgery in an LMIC cancer centre, and the valuable use of modern statistical methods in the prospective assessment of LC safety during surgical training.
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Affiliation(s)
- Hamza Sekkat
- Department of Digestive Surgical Oncology, National Institute of Oncology, IBN Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Amine Souadka
- Department of Digestive Surgical Oncology, National Institute of Oncology, IBN Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Leila Alaoui
- Department of Statistics, Cancer Research Institute, Fez, Morocco
| | - Ali Rafik
- Department of Digestive Surgical Oncology, National Institute of Oncology, IBN Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Zakaria Belkhadir
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
- Department of Anesthesiology and Intensive Care, National Institute of Oncology, IBN Sina University Hospital, Rabat, Morocco
| | - Laila Amrani
- Department of Digestive Surgical Oncology, National Institute of Oncology, IBN Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Amine Benkabbou
- Department of Digestive Surgical Oncology, National Institute of Oncology, IBN Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Raouf Mohsine
- Department of Digestive Surgical Oncology, National Institute of Oncology, IBN Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Anass Mohammed Majbar
- Department of Digestive Surgical Oncology, National Institute of Oncology, IBN Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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El Yaakoubi A, Lahmadi S, Benkabbou A, Mohsine R, Belkouchi A, El Harroudi T, Souadka A, Anass Majbar MM. Audit of laparoscopic surgery for colon cancer in Morocco: a multicenter prospective study. European Journal of Surgical Oncology 2023. [DOI: 10.1016/j.ejso.2022.11.348] [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: 02/23/2023]
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10
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Lahnaoui O, EL Bahaoui N, El Atiq S, Amrani L, Majbar MA, Benkabbou A, Mohsine R, Souadka A. Beware of lethal Wernicke's encephalopathy after cytoreductive surgery with HIPEC for peritoneal pseudomyxoma: Case report of morbidity and mortality review. Int J Surg Case Rep 2022; 98:107500. [PMID: 36029660 PMCID: PMC9424939 DOI: 10.1016/j.ijscr.2022.107500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/07/2022] [Accepted: 08/07/2022] [Indexed: 11/26/2022] Open
Abstract
Background Pseudomyxoma peritonei (PMP) arising from the appendix is a rare entity. Complete cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is the only established curative treatment, and is reputedly linked to high morbidity and mortality. We report, to our knowledge, the first case of delayed lethal Wernicke encephalopathy (WE) complicating CRS with HIPEC for an appendicular PMP. WE, caused by a thiamine deficiency, is characterized by ataxia, nystagmus and changes in consciousness. Methods A patient underwent complete CRS with HIPEC for a low grade mucinous appendicular tumor at the stage of PMP with a peritoneal index of 31, and was readmitted at POD 36 for persistent vomiting and vague neurological symptoms of mental confusion. The classic triad of WE appeared tardily. Although thiamine substitution was promptly applied, the patient died at POD53. Conclusion WE is an uncommon and severe neurological disorder with a mortality rate up to 20 % and only 16 % of treated patients can fully recover. This diagnosis should always be anticipated in patients undergoing major surgery such as CRS- HIPEC. Efficient treatment should be quickly introduced in order to avoid a lethal outcome. Pseudomyxoma peritonei is a rare entity, treatment consists of complete cytoreductive surgery and hyperthermic intra peritoneal chemotherapy with positive effects established in the literature. However, this combined treatment is a complex procedure and is associated with high morbidity and mortality. Wernicke’s encephalopathy is a rare complication of this procedure and has been reported once in the literature. Wernicke’s encephalopathy is a diagnosis to keep in mind and anticipate in patients undergoing cytoreductive surgery and hyperthermic intra peritoneal chemotherapy
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Essangri H, Bahaoui NE, Souadka A, Majbar MA, Benkabbou A, Mohsine R, Souadka A. 854 The Establishment of a National Peritoneal Surface Malignancy Programme: The Success, Pitfalls and Difficulties of the Moroccan Experience. Br J Surg 2022. [DOI: 10.1093/bjs/znac268.029] [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: 11/06/2022]
Abstract
Abstract
Aim
Peritoneal surface malignancy (PSM) programmes offer curative options to previously terminal cases through cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). However, this requires special expertise and resources, which may not be available to low- and middle-income countries (LMIC). The study aims to document the Moroccan experience of a national PSM programme.
Method
This is a mixed method study involving the retrospective assessment of patients with PSM following CRS between 2004 and 2018, alongside interviewing the founding surgeons leading the programme establishment to depict the pitfalls, difficulties, and processes of a PSM programme creation. This operation extended on an initiation, transition, and consolidation phase. Progress was demonstrated by outcome comparison of incomplete cytoreductive surgery (ICRS) rate, serious complications ≥ 3b according to the Clavien-Dindo scoring, and early oncologic failure (EOF; disease progression within 2 years of treatment) between periods.
Results
In total, 198 CRS procedures were performed in the three phases with outcome assessment showing significantly better results with lower ICRS (34%, 18% and4% p=<0.001), serious complications (30.6%, 20% and11.2%, p=0.019), and EOF (38.8%, 23.3% and12.4% p=0.002). Programme founders highlighted the importance of project initiators’ motivation and leadership qualities, team readiness to overcome resource’ restrictions while improving their surgical expertise in CRS techniques, and collaborations development to reinforce multidisciplinary and institutional progress before adding HIPEC.
Conclusions
Implementing a PSM programme in a LMIC can be a challenging process, which motivation, training and good resources usability can help overcome.
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Affiliation(s)
- Hajar Essangri
- Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, University Mohammed V , Rabat , Morocco
| | - Nezha El Bahaoui
- Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, University Mohammed V , Rabat , Morocco
| | - Abdelilah Souadka
- Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, University Mohammed V , Rabat , Morocco
| | - Mohammed Anass Majbar
- Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, University Mohammed V , Rabat , Morocco
| | - Amine Benkabbou
- Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, University Mohammed V , Rabat , Morocco
| | - Raouf Mohsine
- Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, University Mohammed V , Rabat , Morocco
| | - Amine Souadka
- Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, University Mohammed V , Rabat , Morocco
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El Yaakoubi A, Lahmadi S, Benkabbou A, Mohsine R, Belkouchi A, El Harroudi T, El Malki HO, Hrora A, Souadka A, Majbar MA. Audit of laparoscopic surgery for colon cancer in Morocco: A report of the results of a prospective multicentre cohort study. Ann Med Surg (Lond) 2022; 80:104290. [PMID: 35992209 PMCID: PMC9382411 DOI: 10.1016/j.amsu.2022.104290] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 11/29/2022] Open
Abstract
Background Patients and methods Results Conclusions Laparoscopy is the standard technique for colon cancer in rich countries. Little data exists about lower income countries. We evaluated laparoscopy for colon cancer by comparing it to open colon resections in a low-mid income country. We found that Laparoscopy is performed by few surgeons, who apply strict patient selection for laparoscopic cases. Patients in the laparoscopy group also had lower quality resections compared to open surgery. The challenges identified will require more focus on training, certification, centralization, and standardisation of care.
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Affiliation(s)
- Aya El Yaakoubi
- National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco
| | - Salma Lahmadi
- National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco
| | - Amine Benkabbou
- National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| | - Raouf Mohsine
- National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| | - Abdelkader Belkouchi
- Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
- Surgical Department A, Ibn Sina University Hospital, Rabat, Morocco
| | | | - Hadj Omar El Malki
- Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
- Surgical Department A, Ibn Sina University Hospital, Rabat, Morocco
| | - Abdelmalek Hrora
- Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
- Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
| | - Amine Souadka
- National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| | - Mohammed Anass Majbar
- National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
- Corresponding author. National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco.
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Lahnaoui O, Souadka A, El Ahmadi B, Ghannam A, Belkhadir Z, Amrani L, Benkabbou A, Mohsine R, Majbar MA. Evaluation of the implementation of a quality improvement program through morbidity and mortality reviews in a developing country. Ann Med Surg (Lond) 2022; 80:103987. [PMID: 35855883 PMCID: PMC9287764 DOI: 10.1016/j.amsu.2022.103987] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background Morbidity and mortality reviews represent an opportunity to discuss adverse events and healthcare issues. Aim: Report the first experience of implementing a procedure of MMR, and assess its impact on quality improvement. Methods From July 2019 to December 2019, members of the surgical and ICU departments designed and implemented a regular procedure of MMR. Cases of severe postoperative complications after curative resection for digestive cancer were selected to be presented by a surgical resident and discussed in an interdisciplinary conference following a standardized presentation based on an analysis tool adapted from the ALARM framework. Process was assessed by the number of MMRs held, number and type of recommendations issued and implemented. Results Among 13 serious complications during the study period, 10 were discussed. The “Tasks” category was activated in 90% of the cases where lack or misuse of protocols was identified in 90% of the events discussed. Test results availability or accuracy were incarnated in 30% of cases. Poor communication was a contributing factor in 60% of the cases. Written medical records were defective in 40% of the cases. From 16 recommendations for improvement emitted, 87.5% (14/16) were translated into projects and successfully implemented. Conclusions a standardized and regular procedure of morbidity and mortality reviews in a tertiary care facility in a developing country allowed a significant improvement in patient care through quality initiatives implementation. MMRs might be a strong tool for the improvement of surgical care particularly for low-mid income countries. Morbidity and mortality reviews (MMR) are an opportunity to discuss adverse events and healthcare issues. Experience of implementing a procedure of MMR in a tertiary care facility in a developing country. A standardized and regular procedure allowed a significant improvement in patient care through quality initiatives. MMR might be a strong tool for the improvement of surgical care particularly for low-mid income countries.
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Souadka A, Essangri H, Elazzaoui F, Majbar MA, Benkabbou A, Mohsine R. Staging laparoscopy in locally advanced gastric cancer: Beware the poorly differentiated histological subtype. J Surg Oncol 2022; 126:625-626. [PMID: 35775243 DOI: 10.1002/jso.26966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/14/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Amine Souadka
- Surgical Department, National Institute of Oncology, Mohammed Vth University, Rabat, Morocco
| | - Hajar Essangri
- Surgical Department, National Institute of Oncology, Mohammed Vth University, Rabat, Morocco
| | - Faysal Elazzaoui
- Surgical Department, National Institute of Oncology, Mohammed Vth University, Rabat, Morocco
| | - Mohammed Anass Majbar
- Surgical Department, National Institute of Oncology, Mohammed Vth University, Rabat, Morocco
| | - Amine Benkabbou
- Surgical Department, National Institute of Oncology, Mohammed Vth University, Rabat, Morocco
| | - Raouf Mohsine
- Surgical Department, National Institute of Oncology, Mohammed Vth University, Rabat, Morocco
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15
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Sekkat H, Souadka A, Courtot L, Rafik A, Amrani L, Benkabbou A, Peyrafort P, Giger-Pabst U, Karam E, Mohsine R, Majbar AM, Ouaissi M. Available prediction scores of conversion for laparoscopic rectal cancer surgery seem to be unsuitable for nowadays rectal cancer management. BMC Surg 2022; 22:162. [PMID: 35538528 PMCID: PMC9092680 DOI: 10.1186/s12893-022-01617-9] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction This study aimed to externally evaluate the accuracy of four predictive scores for conversion to open surgery after rectal laparoscopic resection. None of the four scores achieved external validation previously. Methods This was a retrospective analysis of two prospectively maintained databases from two academic centers in France and Morocco. All consecutive patients who underwent laparoscopic resection for rectal adenocarcinoma between 2005 and 2020 were included. Logistic regression was used to assess the association between the factors present in the four scores and conversion. The accuracy of each score was assessed using the area under the curve (AUC). Observed and predicted conversion rates were compared for each score using the Chi-square goodness-of-fit test. Results Four hundred patients were included. There were 264 men (66%) with a mean age of 65.95 years (standard deviation 12.2). The median tumor height was 7 cm (quartiles 4–11) and 29% of patients had low rectal tumors. Conversion rate was 21.75%. The accuracy to predict conversion was low with an AUC lower than 0,62 for the four models. The observed conversion rates were significantly different from the predicted rates, except for one score. Conclusions The four models had low accuracy in predicting the conversion to open surgery for laparoscopic rectal resection. There is a need for new well-designed studies, analyzing more specific variables, in a multicentric design to ensure generalizability of the results for daily surgical practice.
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Affiliation(s)
- Hamza Sekkat
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco.,Equipe de Recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Amine Souadka
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco.,Equipe de Recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Lise Courtot
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, France
| | - Ali Rafik
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco.,Equipe de Recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Laila Amrani
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco.,Equipe de Recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Amine Benkabbou
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco.,Equipe de Recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Pierre Peyrafort
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, France
| | - Urs Giger-Pabst
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, France.,EA4245 Transplantation, Immunologie, Inflammation, Université de Tours, Tours, France
| | - Elias Karam
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, France
| | - Raouf Mohsine
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco.,Equipe de Recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Anass M Majbar
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco. .,Equipe de Recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco.
| | - Mehdi Ouaissi
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, France.,EA4245 Transplantation, Immunologie, Inflammation, Université de Tours, Tours, France
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Souadka A, Essangri H, Majbar MA, Benkabbou A, Boutayeb S, You B, Glehen O, Mohsine R, Bakrin N. Hyperthermic Intraperitoneal Chemotherapy and Cytoreductive Surgery in Ovarian Cancer: An Umbrella Review of Meta-Analyses. Front Oncol 2022; 12:809773. [PMID: 35615149 PMCID: PMC9124965 DOI: 10.3389/fonc.2022.809773] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 11/05/2021] [Accepted: 02/28/2022] [Indexed: 01/08/2023] Open
Abstract
Background The utility of heated intraperitoneal chemotherapy (HIPEC) in the management of epithelial ovarian cancer (EOC) has been assessed in several randomised clinical trials and meta-analyses, and it is still a subject of controversy. Therefore, we performed an umbrella review of existing meta-analyses to summarise the outcomes of HIPEC and cytoreductive surgery (CRS) association in ovarian cancer. Methods We examined the MEDLINE, Cochrane Library, Scopus, Prospero, Web of Science and Science Direct from inception to May 30, 2020, for meta-analyses of randomised controlled trials and observational studies. Analyses of overall survival, disease free survival and progression survival were performed separately for primary and recurrent ovarian cancers. Results We identified 6 meta-analyses investigating the association of HIPEC with CRS in the management of ovarian cancer. Three year overall survival was significantly improved by the association of CRS and HIPEC for primary (HR: 0.66, 95%CI:0.56-0.78) and recurrent ovarian cancers (HR:0.50, 95%CI:0.38-0.64). This benefit was also demonstrated on disease-free survival for primary (HR: 0.54, 95%CI:0.48-0.61) and recurrent ovarian cancer (HR: 0.60, 95%CI:0.46-0.78). The pooled hazard ratios confirmed the advantage of HIPEC and CRS association with respect to CRS alone on progression free survival for primary and recurrent ovarian cancer respectively with HR: 0.50, 95%CI: 0.43-0.58 and HR: 0.59, 95%CI: 0.41-0.85. Conclusion While waiting for the results of the current prospective studies, the present umbrella study suggests that HIPEC performed at the end of CRS may be a complementary effective asset for ovarian cancer patient management.
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Affiliation(s)
- Amine Souadka
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Hajar Essangri
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Mohammed Anass Majbar
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Amine Benkabbou
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Saber Boutayeb
- Medical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Benoit You
- Département d’oncologie médicale Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
| | - Olivier Glehen
- Département de Chirurgie Digestive et Endocrinienne, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
| | - Raouf Mohsine
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Naoual Bakrin
- Département de Chirurgie Digestive et Endocrinienne, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
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Souadka A, Essangri H, El Bahaoui N, Ghannam A, El Ahmadi B, Benkabbou A, Majbar MA, El Khannoussi B, Abahssain H, Mohsine R, Belkhadir ZH. CRS and HIPEC: Best model of antifragility in surgical oncology. J Surg Oncol 2022; 126:396-397. [PMID: 35460520 DOI: 10.1002/jso.26882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Amine Souadka
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - Hajar Essangri
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - Nezha El Bahaoui
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - Abdelilah Ghannam
- Intensive Care Department, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - Brahim El Ahmadi
- Intensive Care Department, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - Amine Benkabbou
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - Mohammed Anass Majbar
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - Basma El Khannoussi
- Anatomopathology Department, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - Halima Abahssain
- Medical Oncology Department, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - Raouf Mohsine
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - Zakaria Houssain Belkhadir
- Intensive Care Department, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
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Selmouni F, Amrani L, Sauvaget C, Bakkar M, El Khannoussi B, Souadka A, Benkabbou A, Majbar MA, Belekhel L, Lucas E, Muwonge R, Chami Khazraji Y, Mohsine R, Bennani M, Sankaranarayanan R, Bekkali R, Basu P. Delivering colorectal cancer screening integrated with primary health care services in Morocco: Lessons learned from a demonstration project. Cancer 2022; 128:1219-1229. [PMID: 34985785 DOI: 10.1002/cncr.34061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/31/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) incidence and mortality rates are increasing rapidly in many low-income and middle-income countries. A demonstration project was implemented in Morocco in collaboration with the Ministry of Health to assess the feasibility, acceptability, and challenges of implementing CRC screening through routine primary care facilities. METHODS The objective of the project was to screen 10,000 men and women aged 50 to 75 years through 10 primary health centers (PHCs) in 2 provinces. All eligible men and women attending the selected PHCs were offered the fecal immunochemical test (FIT). Stool specimens brought to the PHCs were tested immediately by trained nurses. FIT-positive individuals were referred to the National Oncology Institute for colonoscopy. RESULTS In total, 9763 eligible men and women were screened by FIT between June 2017 and May 2019; most (73.3%) were women. The test was positive in 460 participants (4.7%). Among the individuals who had positive FIT results, 62.6% underwent colonoscopy. The main reasons for noncompliance to colonoscopy were competing life priorities (15.4%), other health problems (13%), and fear of getting a cancer diagnosis (12.3%). As the number of referrals to colonoscopy increased, the waiting time for the procedure increased, resulting in a drop in compliance. The detection rates of advanced adenomas and CRC were 4.0 in 1000 and 0.5 in 1000 individuals screened, respectively. CONCLUSIONS An effective strategy to reach the target populations (especially men), a pragmatic assessment of the health system's capacity to deal with large numbers of referrals, and a formal cost-effectiveness analysis are essential before making any decision to introduce CRC screening in Morocco.
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Affiliation(s)
- Farida Selmouni
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Laila Amrani
- Gastroenterology Unit, Surgical Oncology Department, National Institute of Oncology, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Catherine Sauvaget
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Meryem Bakkar
- Gastroenterology Unit, Surgical Oncology Department, National Institute of Oncology, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Basma El Khannoussi
- Department of Pathology, National Institute of Oncology, Faculty of Medicine and Pharmacy of Rabat Mohammed V University, Rabat, Morocco
| | - Amine Souadka
- Surgical Oncology Department, National Institute of Oncology, Faculty of Medicine and Pharmacy of Rabat Mohammed V University, Rabat, Morocco
| | - Amine Benkabbou
- Surgical Oncology Department, National Institute of Oncology, Faculty of Medicine and Pharmacy of Rabat Mohammed V University, Rabat, Morocco
| | - Mohammed Anass Majbar
- Surgical Oncology Department, National Institute of Oncology, Faculty of Medicine and Pharmacy of Rabat Mohammed V University, Rabat, Morocco
| | - Latifa Belekhel
- Noncommunicable Diseases Unit, Epidemiology and Disease Control Department, Ministry of Health, Rabat, Morocco
| | - Eric Lucas
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Richard Muwonge
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Raouf Mohsine
- Surgical Oncology Department, National Institute of Oncology, Faculty of Medicine and Pharmacy of Rabat Mohammed V University, Rabat, Morocco
| | - Maria Bennani
- Lalla Salma Foundation, Prevention and Treatment of Cancers, Rabat, Morocco
| | | | - Rachid Bekkali
- Lalla Salma Foundation, Prevention and Treatment of Cancers, Rabat, Morocco
| | - Partha Basu
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
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19
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Souadka A, Essangri H, Makni A, Abid M, Ayadi M, Ksantini F, Kordjani Z, Ballah Y, Bouka J, Benkabbou A, Majbar MA, El Khannoussi B, Mohsine R, Boutayeb S, Hubner M. Current Opinion and Practice on Peritoneal Carcinomatosis Management: The North African Perspective. Front Surg 2022; 9:798523. [PMID: 35350143 PMCID: PMC8957835 DOI: 10.3389/fsurg.2022.798523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background The status of peritoneal surface malignancy (PSM) management in North Africa is undetermined. The aim of this study was to assess and compare current practice and knowledge regarding PSM and examine satisfaction with available treatment options and need for alternative therapies in North Africa. Methods This is a qualitative study involving specialists participating in PSM management in North Africa. The survey analyzed demographic characteristics and current knowledge and opinions regarding PSM management in different institutions. We also looked at goals and priorities, satisfaction with treatment modalities and heated intraperitoneal chemotherapy (HIPEC) usefulness according to specialty, country, years of experience, and activity sector. Results One-hundred and three participants responded to the survey (response rate of 57%), including oncologists and surgeons. 59.2% of respondents had more than 10 years experience and 45.6% treated 20–50 PSM cases annually. Participants satisfaction with PSM treatment modalities was mild for gastric cancer (3/10 [IQR 2–3]) and moderate for colorectal (5/10 [IQR 3–5]), ovarian (5/10 [IQR 3–5]), and pseudomyxoma peritonei (5/10 [IQR 3–5]) type of malignancies. Good quality of life and symptom relief were rated as main priorities for treatment and the need for new treatment modalities was rated 9/10 [IQR 8–9]. The perceived usefulness of systemic chemotherapy in first intention was described as high by 42.7 and 39.8% of respondents for PSM of colorectal and gastric origins, while HIPEC was described as highly useful for ovarian (49.5%) and PMP (73.8) malignancies. Conclusions The management of PSM in the North African region has distinct differences in knowledge, treatments availability and priorities. Disparities are also noted according to specialty, country, years of expertise, and activity sector. The creation of referral structures and PSM networks could be a step forward to standardized PSM management in the region.
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Affiliation(s)
- Amine Souadka
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V, Rabat, Morocco
- *Correspondence: Amine Souadka
| | - Hajar Essangri
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - Amin Makni
- Surgical Department A, Rabta Hospital, Tunis, Tunisia
| | - Mourad Abid
- Surgical Oncology Department, Batna Cancer Institute, Batna, Algeria
| | - Mouna Ayadi
- Medical Oncology Department, Salah-Azaiz Institute, Tunis, Tunisia
| | - Feriel Ksantini
- Medical Oncology Department, Salah-Azaiz Institute, Tunis, Tunisia
| | - Zakia Kordjani
- Surgical Oncology Department, Batna Cancer Institute, Batna, Algeria
| | - Yousri Ballah
- Surgical Oncology Department, Batna Cancer Institute, Batna, Algeria
| | - Jemila Bouka
- Surgical Oncology Department, National Institute of Oncology, Nouakchott, Mauritania
| | - Amine Benkabbou
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - Mohammed Anass Majbar
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - Basma El Khannoussi
- Pathology Department, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - Raouf Mohsine
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - Saber Boutayeb
- Medical Oncology Department, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - Martin Hubner
- Department of Visceral Surgery, University Hospital Centre Hospitalier Universitaire Vaudois and University of Lausanne (UNIL), Lausanne, Switzerland
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Souadka A, Majbar MA, Essangri H, Benkabbou A, Amrani L, Mohsine R, Maggiori L. Comment on "Efficacy and Safety of Complete Mesocolic Excision in Patients With Colon Cancer: Three-year Results From a Prospective, Nonrandomized, Double-blind, Controlled Trial". Ann Surg 2021; 274:e754-e755. [PMID: 33074880 DOI: 10.1097/sla.0000000000004284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Amine Souadka
- Surgical Oncology Department, National Institute of Oncology, Faculté de Médecine, Mohammed V University in Rabat, Morocco
| | - Mohammed Anass Majbar
- Surgical Oncology Department, National Institute of Oncology, Faculté de Médecine, Mohammed V University in Rabat, Morocco
| | - Hajar Essangri
- Surgical Oncology Department, National Institute of Oncology, Faculté de Médecine, Mohammed V University in Rabat, Morocco
| | - Amine Benkabbou
- Surgical Oncology Department, National Institute of Oncology, Faculté de Médecine, Mohammed V University in Rabat, Morocco
| | - Laila Amrani
- Surgical Oncology Department, National Institute of Oncology, Faculté de Médecine, Mohammed V University in Rabat, Morocco
| | - Raouf Mohsine
- Surgical Oncology Department, National Institute of Oncology, Faculté de Médecine, Mohammed V University in Rabat, Morocco
| | - Leon Maggiori
- Colorectal Surgical Department, Hôpital Beaujon (AP-HP). Université Paris 7. 100 bd du général Leclerc, 92110 CLICHY France
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21
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Benkabbou A, Souadka A, Hachim H, Awab A, Alilou M, Serji B, El Malki HO, Mohsine R, Ifrine L, Vibert E, Belkouchi A. Risk factors for major complications after liver resection: A large liver resection study from Morocco and audit of a non-Eastern/non-Western experience. Arab J Gastroenterol 2021; 22:229-235. [PMID: 34538587 DOI: 10.1016/j.ajg.2021.05.019] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/11/2021] [Accepted: 05/31/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND STUDY AIMS In developing countries, endemic indications, blood shortages, and the scarcity of liver surgeons and intensive care providers can affect liver resection (LR) outcomes, but these have been rarely addressed in the literature. Therefore, in this study we determined risk factors for major complications after LR in a North African general surgery and teaching department. PATIENTS AND METHODS From January 2010 to December 2015, 213 consecutive LRs were performed on 203 patients. All patients underwent a postoperative follow-up of >90 days. Postoperative complications were assessed according to the Clavien-Dindo (CD) classification of surgical complications. A score of CD ≥III is considered as major postoperative complications. In this study, we analyzed the variables assumed to affect these complications. RESULTS The overall 90-day complication rate was 35.7% (n = 76), including a CD ≥III of 14% (n = 30) and a mortality rate of 6.1% (n = 14). According to the multivariate analysis, a preoperative performance status (PS) of ≥2 (P = 0.011; odds ratios [OR], 6.8; 95% confidence intervals [CI], 1.55-29.8), an estimated intraoperative blood loss of >500 ml (P = 0.002; OR, 3.71; 95% CI, 1.23-11.20), and bilioenteric anastomosis (P < 0.004; OR, 7.76; 95% CI, 1.5-3.89) were independent risk factors for major complications after LR. CONCLUSION We recommend that, in the setting of a non-Eastern/non-Western general surgery and teaching department, patients with a PS of ≥2 should undergo a specific selection and preoperative optimization protocol; intermittent clamping indications should be extended; and special attention should paid to patients undergoing LR associated with biliary reconstruction, such as for perihilar cholangiocarcinoma.
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Affiliation(s)
- A Benkabbou
- Faculty of Medicine, Mohammed V University, and Surgical Department A, Ibn Sina Hospital, Rabat, Morocco; Faculty of Medicine, Mohammed V University, and Surgical Oncology Department, National Institute of Oncology, Rabat, Morocco.
| | - A Souadka
- Faculty of Medicine, Mohammed V University, and Surgical Department A, Ibn Sina Hospital, Rabat, Morocco; Faculty of Medicine, Mohammed V University, and Surgical Oncology Department, National Institute of Oncology, Rabat, Morocco.
| | - H Hachim
- Faculty of Medicine, Mohammed V University, and Surgical Department A, Ibn Sina Hospital, Rabat, Morocco
| | - A Awab
- Faculty of Medicine, Mohammed V University, and Anesthesiology and Intensive Care Department, Ibn Sina Hospital, Rabat, Morocco
| | - M Alilou
- Faculty of Medicine, Mohammed V University, and Anesthesiology and Intensive Care Department, Ibn Sina Hospital, Rabat, Morocco
| | - B Serji
- Faculty of Medicine, Mohammed V University, and Surgical Department A, Ibn Sina Hospital, Rabat, Morocco
| | - H O El Malki
- Faculty of Medicine, Mohammed V University, and Surgical Department A, Ibn Sina Hospital, Rabat, Morocco
| | - R Mohsine
- Faculty of Medicine, Mohammed V University, and Surgical Department A, Ibn Sina Hospital, Rabat, Morocco; Faculty of Medicine, Mohammed V University, and Surgical Oncology Department, National Institute of Oncology, Rabat, Morocco
| | - L Ifrine
- Faculty of Medicine, Mohammed V University, and Surgical Department A, Ibn Sina Hospital, Rabat, Morocco
| | - E Vibert
- Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, Villejuif, France
| | - A Belkouchi
- Faculty of Medicine, Mohammed V University, and Surgical Department A, Ibn Sina Hospital, Rabat, Morocco
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22
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Majbar MA, Courtot L, Dahbi-Skali L, Rafik A, Jouppe PO, Moussata D, Benkabbou A, Mohsine R, Ouaissi M, Souadka A. Two-step pull-through colo-anal anastomosis aiming to avoid stoma in rectal cancer surgery: A "real life" study in a developing country. J Visc Surg 2021; 159:187-193. [PMID: 34092526 DOI: 10.1016/j.jviscsurg.2021.04.004] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Delayed colo-anal anastomosis (DCA) is an underused technique rarely performed after resection of primary low rectal adenocarcinoma. The objective of this study was to compare the short-term outcomes of DCA and classical colo-anal anastomosis (CAA). METHODS This is a retrospective comparative study carried out at two tertiary centres in Morocco and France. It included all patients who underwent colo-anal anastomosis after complete mesorectal excision for primary rectal adenocarcinoma between January 2018 and December 2019. The main outcomes were 90-day morbidity and rates completing the surgical steps of DCA and CAA. RESULTS Among 215 rectal resections, 45 patients received colo-anal anastomosis, including 19 DCA and 26 CAA. Seventeen patients in the DCA group completed the two steps compared to 16 in the CAA group (89.5% vs. 61.5%, P=0.04). The rates of severe complications (26.9% vs. 26.3%, P=0.96) and anastomotic leakage (42.3% vs. 31.6%, P=0.46) were not different between the two groups. CONCLUSION This study showed that DCA was associated with a higher rate of completing the two surgical steps, with no difference in overall and severe morbidity. DCA may be a strong alternative to classical colo-anal anastomosis.
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Affiliation(s)
- M A Majbar
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - L Courtot
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic, and Liver Transplant Surgery, Trousseau Hospital, Tours, France
| | - L Dahbi-Skali
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - A Rafik
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - P O Jouppe
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic, and Liver Transplant Surgery, Trousseau Hospital, Tours, France
| | - D Moussata
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic, and Liver Transplant Surgery, Trousseau Hospital, Tours, France
| | - A Benkabbou
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - R Mohsine
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - M Ouaissi
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic, and Liver Transplant Surgery, Trousseau Hospital, Tours, France
| | - A Souadka
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.
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Souadka A, Habbat H, Majbar MA, Benkabbou A, Amrani L, Ghannam A, El Ahmadi B, Belkhadir ZH, Mohsine R. Cancer patients should be considered as a high risk priority target in the coronavirus disease 2019 vaccination process. J Surg Oncol 2021; 124:453-454. [PMID: 33878206 PMCID: PMC8251233 DOI: 10.1002/jso.26508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 03/14/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Amine Souadka
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - Hajar Habbat
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - Mohammed Anass Majbar
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - Amine Benkabbou
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - Laila Amrani
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - Abdelilah Ghannam
- Intensive Care Department, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - Brahim El Ahmadi
- Intensive Care Department, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | | | - Raouf Mohsine
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V, Rabat, Morocco
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Lahfidi A, Imrani K, Youssef Y, Jerguigue H, Benkabbou A, Mohsine R, Latib R, Omor Y. Unusual presentation of gallbladder papillomatosis without bile duct involvement: A case report. Radiol Case Rep 2021; 16:1388-1390. [PMID: 33912252 PMCID: PMC8063703 DOI: 10.1016/j.radcr.2021.03.016] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 10/25/2022] Open
Abstract
The papillomatosis is a very rare benign pathology diagnosed histologically with a significant potential for malignant transformation. We report a case a 60-year-old female without comorbidity present the gallbladder papillomatosis without involvement of the intra or extra hepatic biliary tract. The interest in knowing the radiological aspect of this pathology and make the early diagnosis in order to oriented treatment.
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Affiliation(s)
- Amal Lahfidi
- Radiology Department, Institut National d'Oncologie (INO) à Rabat, Avenue Alla Fassi Hay Ryad Raba-Maroc, Rabat, Morocco
| | - Kaoutar Imrani
- Radiology Department, Institut National d'Oncologie (INO) à Rabat, Avenue Alla Fassi Hay Ryad Raba-Maroc, Rabat, Morocco
| | - Yaikoubi Youssef
- Surgical Oncology Department, Institut National d'Oncologie (INO) à Rabat, Avenue Alla Fassi Hay Ryad Raba-Maroc, Rabat, Morocco
| | - Hounayda Jerguigue
- Radiology Department, Institut National d'Oncologie (INO) à Rabat, Avenue Alla Fassi Hay Ryad Raba-Maroc, Rabat, Morocco
| | - Amine Benkabbou
- Surgical Oncology Department, Institut National d'Oncologie (INO) à Rabat, Avenue Alla Fassi Hay Ryad Raba-Maroc, Rabat, Morocco
| | - Raouf Mohsine
- Surgical Oncology Department, Institut National d'Oncologie (INO) à Rabat, Avenue Alla Fassi Hay Ryad Raba-Maroc, Rabat, Morocco
| | - Rachida Latib
- Radiology Department, Institut National d'Oncologie (INO) à Rabat, Avenue Alla Fassi Hay Ryad Raba-Maroc, Rabat, Morocco
| | - Youssef Omor
- Radiology Department, Institut National d'Oncologie (INO) à Rabat, Avenue Alla Fassi Hay Ryad Raba-Maroc, Rabat, Morocco
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25
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Houssaini K, Majbar MA, Souadka A, Lahnaoui O, El Ahmadi B, Ghannam A, Houssain Belkhadir Z, Mohsine R, Benkabbou A. Liver resection safety in a developing country: Analysis of a collective learning curve. J Visc Surg 2021; 159:5-12. [PMID: 33744246 DOI: 10.1016/j.jviscsurg.2021.02.006] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM OF THE STUDY To analyze the collective learning curve in the performance of safe liver resections, using the decrease of severe postoperative complications (SPC) as a proxy for overall safety competency. MATERIAL AND METHODS This was a retrospective analysis of a prospective database in the setting of a liver surgery program implementation in a tertiary center in Morocco. The 100 first consecutive cases of elective liver resections starting from January 1st, 2018 were included in the analysis. SPC were defined as CD>IIIa during the first 90 postoperative days. We used a cumulative sum (CUSUM) technique to determine the number of cases required to achieve safety competency. We then compared case characteristics before and after the learning curve completion. RESULTS SPC occurred in 15 cases (15%), including 5 deaths (5%). The CUSUM chart revealed a learning curve completion at the 49th case, marked by an inflection point towards the decrease in SPC (24.5% vs 5.9%; P=0.009). In period 2 (after), cases were associated with less diabetes, less synchronous digestive resection, more cirrhosis, and more prolonged preoperative chemotherapy. The rates of major resection (30.6% vs 29.9%; P=0.89) and biliary reconstruction were comparable, as were the operating time, and estimated blood loss. CONCLUSION Approximately 50 cases were required to complete the learning curve and improve the overall safety of liver resection. In our setting, the learning curve chronology was consistent with collective measures, including team stabilization and protocol development.
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Affiliation(s)
- K Houssaini
- Surgical oncology Department, National Institute of Oncology, Rabat, Morocco.
| | - M A Majbar
- Surgical oncology Department, National Institute of Oncology, Rabat, Morocco; Équipe de recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - A Souadka
- Surgical oncology Department, National Institute of Oncology, Rabat, Morocco; Équipe de recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - O Lahnaoui
- Surgical oncology Department, National Institute of Oncology, Rabat, Morocco; Équipe de recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - B El Ahmadi
- Intensive Care Department, National Institute of Oncology, Rabat, Morocco
| | - A Ghannam
- Intensive Care Department, National Institute of Oncology, Rabat, Morocco
| | | | - R Mohsine
- Surgical oncology Department, National Institute of Oncology, Rabat, Morocco; Équipe de recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - A Benkabbou
- Surgical oncology Department, National Institute of Oncology, Rabat, Morocco; Équipe de recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
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Essangri H, Majbar MA, Benkabbou A, Amrani L, Mohsine R, Souadka A. Transcultural adaptation and validation of the Moroccan Arabic dialect version of the Wexner incontinence score in patients with low anterior resection syndrome after rectal surgery. Surgery 2021; 170:47-52. [PMID: 33674127 DOI: 10.1016/j.surg.2021.01.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/17/2021] [Accepted: 01/21/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bowel dysfunction symptoms such as stool clustering, urgency, incomplete voiding, and fecal incontinence are frequent after colorectal surgery and known as the low anterior resection syndrome. The Wexner score is the most widely used tool for fecal incontinence assessment. We aimed to translate and test the psychometric properties of the Moroccan Arabic dialect version of the Wexner questionnaire in patients with low anterior resection syndrome after rectal surgery. METHODS The Wexner questionnaire was translated to Moroccan Arabic and administered to a group of 158 patients, among which a subgroup of 43 patients took the test for a second time to examine test-retest reliability. Cronbach alpha coefficient was used to determine internal consistency and correlation, and the European Organisation for the Research and Treatment of Cancer Quality of Life C30 and the low anterior resection syndrome questionnaires were assessed for convergent validity. Discriminant validity was demonstrated through the Wexner score ability to detect differences based on the patients' different clinical and pathological characteristics. RESULTS One hundred and fifty-eight patients completed the Moroccan Arabic dialect version of the Wexner score, which showed an excellent internal consistency with a Cronbach alpha score of 0.91. Test-retest reliability was established by a Bland-Altman plot with 95% limits of agreement. The score showed positive correlation to the low anterior resection syndrome score (r = 0.748; P < .001) and the European Organisation for the Research and Treatment of Cancer Quality of Life C30 diarrhea symptom scale (r = 0.519; P < .001). A negative correlation was also demonstrated for each one of the 5 European Organisation for the Research and Treatment of Cancer quality of life C30 functional scales, namely physical functioning (r = -0.217 ; P = .006), role functioning (r = -0.267; P = .001), emotional functioning (r = -0.266; P = .001), cognitive functioning (r = -0.283; P < .001), and social functioning (r = -0,283; P < .001). The Wexner score differed between patients according to tumor location, chemoradiotherapy, type of mesorectal excision, and anastomosis. CONCLUSION The Moroccan Arabic dialect version of the Wexner score shows good psychometric properties and can be used for fecal incontinence assessment, particularly in colorectal cancer patients.
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Affiliation(s)
- Hajar Essangri
- Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| | - Mohammed Anass Majbar
- Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| | - Amine Benkabbou
- Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| | - Laila Amrani
- Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| | - Raouf Mohsine
- Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| | - Amine Souadka
- Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco.
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Souadka A, Essangri H, Majbar MA, Benkabbou A, Boutayeb S, Amrani L, Ghannam A, El Ahmadi B, Belkhadir ZH, Mohsine R, Souadka A, Elias D. Mid-Term Audit of a National Peritoneal Surface Malignancy Program Implementation in a Low Middle Income Country: The Moroccan Experience. Cancers (Basel) 2021; 13:cancers13051088. [PMID: 33802609 PMCID: PMC7962020 DOI: 10.3390/cancers13051088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/27/2020] [Accepted: 12/30/2020] [Indexed: 12/02/2022] Open
Abstract
Simple Summary Complete cytoreductive surgery (CRS) is the backbone of peritoneal surface malignancies (PSM) management and a major prognostic factor to better survival outcomes. Implementing a PSM program is a steep and complex process, particularly in low-middle income countries (LMIC), where limited resources are an additional challenge to overcome. In this study, we present the results of a mid-term audit of the implementation of a PSM program in Morocco. The latter was successfully and safely launched according to predicted initiation, transition and consolidation periods and allowed the significant improvement of short term surgical and oncological outcomes and completeness of cytoreduction procedures. Abstract Implementing a multimodal management of peritoneal surface malignancies is a steep and complex process, especially as complete cytoreductive surgery (CRS) is the backbone and the major prognostic factor for hyperthermic intraperitoneal chemotherapy (HIPEC) procedures. The implementation of such a program is a challenging process, particularly in low-middle income (LMIC) countries where ressource restrictions may represent a major hurdle to HIPEC appliances acquisition. Herein is the first audit of the implementation of a national peritoneal malignancy program in a north African country. The audit process was performed according to the three implementation steps, namely initiation (“1”:2005–2008), transition (“2”:2009–2013) and consolidation (“3”:2014–2017). We included all consecutive CRS without HIPEC performed with curative intent for ovarian, gastric, colorectal and pseudomyxoma peritonei type of malignancies with an Eastern Cooperative Oncology Group (ECOG) performance Status ≤ 2. Target outcomes for incomplete cytoreduction (ICRS), serious complications ≥ 3b according to the Clavien-Dindo scoring, and early oncologic failure (EOF; disease progression within 2 years of treatment) were compared between the three phases. Independent risk factors correlated to these three outcomes were calculated using a logistic regression model.198 CRS procedures were completed with 49, 60 and 89 cases performed in the three phases, respectively. Overall, patients were comparable except for ECOG and ASA scores which were more severe in the third phase. The comparison of ICRS, serious complications and EOF rates showed a significant reduction between the three phases with (34%, 18% and 4% p = <0.001), (30.6%, 20% and 11.2%, p = 0.019) and (38.8%, 23.3% and 12.4% p = 0.002) respectively. Undergoing CRS in phase 3 on the other hand was a predictive factor of better short term surgical and oncological outcomes and completeness of cytoreduction, while ECOG performance status and spleno-pancreatectomy were also predictive factors of serious complications.
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Affiliation(s)
- Amine Souadka
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat 10100, Morocco; (H.E.); (M.A.M.); (A.B.); (L.A.); (R.M.); (A.S.)
- Correspondence:
| | - Hajar Essangri
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat 10100, Morocco; (H.E.); (M.A.M.); (A.B.); (L.A.); (R.M.); (A.S.)
| | - Mohammed Anass Majbar
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat 10100, Morocco; (H.E.); (M.A.M.); (A.B.); (L.A.); (R.M.); (A.S.)
| | - Amine Benkabbou
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat 10100, Morocco; (H.E.); (M.A.M.); (A.B.); (L.A.); (R.M.); (A.S.)
| | - Saber Boutayeb
- Medical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat 10100, Morocco;
| | - Laila Amrani
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat 10100, Morocco; (H.E.); (M.A.M.); (A.B.); (L.A.); (R.M.); (A.S.)
| | - Abdelilah Ghannam
- Intensive Care Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat 10100, Morocco; (A.G.); (B.E.A.); (Z.H.B.)
| | - Brahim El Ahmadi
- Intensive Care Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat 10100, Morocco; (A.G.); (B.E.A.); (Z.H.B.)
| | - Zakaria Houssaïn Belkhadir
- Intensive Care Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat 10100, Morocco; (A.G.); (B.E.A.); (Z.H.B.)
| | - Raouf Mohsine
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat 10100, Morocco; (H.E.); (M.A.M.); (A.B.); (L.A.); (R.M.); (A.S.)
| | - Abdelilah Souadka
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat 10100, Morocco; (H.E.); (M.A.M.); (A.B.); (L.A.); (R.M.); (A.S.)
| | - Dominique Elias
- Department of Surgical Oncology, Gustave Roussy, Cancer Campus, 114 Rue Edouard Vaillant, 94805 Villejuif, France;
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Majbar AM, Benkabbou A, Amrani L, Mohsine R, Souadka A. Clinical Outcomes of Two-Stages Delayed Colo-Anal Anastomosis: A Literature Review. JMSR 2021. [DOI: 10.46327/msrjg.1.000000000000194] [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: 11/30/2022] Open
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Belais F, Butt E, Joshi K, Kapur M, Shaw M, Townson A, Williams CYK, Gray T, Greig R, Husain M, Murray E, Mustafa A, Asif A, Gokul A, Shah M, Akitikori MT, Charalabopoulos A, Davidson S, McNally S, Rupani S, Juma F, Mills SC, Muirhead L, Sellars K, Walsh U, Warren O, Chambers A, Hunt R, Teasdale E, Boyce S, Cornwall H, Tol I, Argyriou EO, Eardley N, Povey M, Aithie JMS, Irfan A, McGuigan MC, Starr R, Warren CR, Archibald J, Kirby G, Kisyov I, Khoo CK, Lee R, Photiou D, Davis R, Prasad U, Yang PZ, Bird J, Leung E, Summerour V, Currow C, Kiam J, Tan GJS, Muthusami A, Pegba-Otemolu I, Urbonas T, Nunoo-Mensah J, Smolskas E, Boddy A, Gravante G, Hunter D, Andrew D, Koh A, Thompson A, Adams L, Clements HA, De Silva K, Ekpete O, Haque S, Henderson S, Ibrahim B, Jayasinghe T, Livie J, Mailley K, Nair G, Tan D, Baggaley C, Dawidziuk A, Szyszka B, Barter C, Gandhi N, Hassell K, Hitchin S, Kelsall J, Nagy E, Nessa A, Whisker L, Yanni F, Ali M, Arora D, Hediwattege S, Kumarasinghe N, Rathore M, Tennakoon A, Ali Ahmad SM, Bajomo O, Nadira F, Celentano V, Bhangu A, Glasbey J, Griffiths E, Karri RS, Mak JKC, Nepogodiev D, Pipe M, Bhatti MI, Rabie M, Boyle C, Hamilton D, Mihuna A, Ng JCK, Nicholson G, Oliwa A, Pearson R, Rose A, Yong SQ, Boereboom C, Hanna M, Walter C, Greensmith TS, Mitchell R, Monaghan E, Crawford J, Moug S, Blackwell J, Boyd-Carson H, Herrod P, Al-Allaf O, Beattie M, Bullock C, Burman S, Clark G, Flamey N, Flannery O, Harding A, Kodiatt B, Lawday S, Mahapatra S, Mukundu Nagesh N, Ng M, Rye D, Yoong A, Clark L, Deans C, Edirisooriya M, Fairfield CJ, Harrison EM, Carrington EV, Wong TLE, Yusuf B, Chamberlain C, Duke K, Kmiotek E, Botes A, Condie N, Schrire T, Shah R, Thomas-Jones I, Yates C, Anthony N, Matthews E, Sahnan K, Tankel J, Tucker S, Winter Beatty J, Ziprin P, Duggan W, Kantartzi A, Sridhar S, Khaw RA, Srivastava P, Underwood C, Alves do Canto Brum H, Chopra S, Davis L, Hughes R, Tulley J, Alberts J, Athisayaraj T, Olugbemi M, Ahmad K, Chan C, Chapman G, Fleming H, Fox B, Grewar J, Hulse K, Rutherford D, Sinead M, Smith S, Speake D, Vaughan-Shaw PG, Christodoulides N, Kudhail S, Welch M, Husaini SM, Lambracos S, Anyanwu C, Suresh R, Thomas JS, Gleeson E, Platoff R, Saif A, Enumah Z, Etchill E, Gabre-Kidan A, Bernstein M, Carrano FM, Connors J, Lynn P, Melis M, Newman E, Foster DS, Perrone K, Titan A, Weiser TG, Ahmad S, Bafford ACM, Dal Molin M, Hanna N, Zafar SN, Hemmila M, Napolitano L, Wong JJ, Chandler J, Wood L, Wren S, Ottesen T, You L, Yu K, Arciénega Yañez MDP, Ferreira Fernandes M, González D, Cubas S, González MC, Zubiaurre V, Demolin R, Giroff N, Sciuto P, Campos M, Rodríguez Cantera G, Wagner G, Deepika G, Maimbo M, Simuchimba E, Bulaya A, Chibuye C, Chirengendure B, Kabale MR, Kabongo K, Linyama D, Munthali J, Mweso O, Pikiti F, Otieno J, Chan E, Lai LT, Blackman B, Richards S, Subramaniam S, Karim R, Kok N, Lee YD, Ali S, Sinha A, Corrigan R, Barnes N, Wong F, Dennis G, Jedamzik J, Phillips E, Piette W, Van hentenryck M, Koco H, Lawani S, Kassa MW, Santos Bezerra T, Gribnev P, Dimitrov D, Krastev P, Oum S, Bonghaseh DT, Al Farsi M, Alsharqawi N, Agarwal A, Acevedo V, Castillo Barbosa AC, Giron F, Leon Rodriguez JP, Kucan D, Rosko D, Barsic N, Župan D, Hegazi A, Truncíková V, Fryba V, Mohamed M, Sultan A, Nagi A, Rashad Temerik A, Elshawy ME, Mahmoud MI, Omar S, Anwar M, Rageh T, Elmokadem A, Gaballa K, Teppo S, Turunen A, Pengermä P, Ballouhey Q, Bergeat D, Weyl A, Hain E, Gyedu A, Yenli E, Osei-Poku D, Rompou VA, Zoikas A, Gaitanidis A, Koukis G, Perivoliotis K, Tavlas P, Galanos-Demiris K, Zografos G, Karavokyros I, Xanthopoulou G, Iordanidou E, Ayau F, Garcia A, Damján P, Wason D, B L A, Rangganata E, Kamath P, O'Connor DB, Pinto M, Perrone F, Tropeano FP, Troilo F, Bossi D, Scala D, Pulitanò L, Carella M, Pietrabissa A, Gori A, Giraudo G, De Simone V, Russo AA, Braccio B, Al-Taher R, Athamneh S, Parker A, Sawiee A, Kattia A, Salem M, Tababa O, Shaeeb Z, Syminas V, Jurgaitis J, Damuleviciene G, Svagzdys S, Poskus T, Razafimanjato NNM, Chieng Loo L, Tiong IC, Wan Muhmad WF, Vijeyan H, Li Ying T, Grech G, Arrangoiz R, Jimenez Ley VB, Arizpe D, Jimenez Ley VB, Lagunes Lara E, Castro López EV, Eaazim J, Gordinou de Gouberville M, Bastiaenen V, Rottier S, Nahab F, Ji MY, Seyoji M, Nwachukwu C, Emeghara O, Muhammed SE, Idowu A, Sowemimo O, Ogundoyin O, Akande O, Lott A, Nadeem M, Laghari AA, Loya A, Mushtaq H, Abdullah MT, Abuhilal B, Atawneh M, Hamdan H, Alhabil B, Srour A, Mousa I, Da Silva Medina L, Sacdalan MD, Lapitan MC, Sacdalan MD, Sacdalan MD, Bartosiak K, Ferreira P, Francisco V, Lemos R, Frutuoso L, Fernandes S, Fonseca T, Pereira J, Rachadell J, Torre A, Madeira Martins F, Carvalho AC, Rodrigues Ferreira J, Ribeiro da Silva B, Devesa H, Vieira A, Mónica I, Amaro M, Sousa D, Reia M, Louro J, Martins A, Dominguez J, Santos I, Freitas Oliveira NM, Pereira JC, Silva-Vaz P, Freire L, Escrevente R, Negoita VM, Shakhmatov D, Nezerwa Y, Radulovic R, Moore R, Obery G, Viljoen F, Mendes T, Suarez A, Moncada E, Fernandez-Hevia M, Curtis Martínez C, Gil Garcia JM, González Zunzarren M, Idris T, Eklöv K, Grahn O, Amin L, Blomqvist M, Ajani C, Kraus R, Seeger N, Willemin M, Rayya F, Ayash M, Msouti R, Kannas I, Abazid E, Esper A, Slim S, Kavcar AS, Aytac E, Dural AC, Ilker A, Eray IC, Kurnaz E, Altiner S, Tepe MD, Sahin C, Savli E, Innocent A, Babirye L, Diachenko A, Hordoskiy V, Curry H, Chau CYC, Robertson H, Mahmoud A, Lennon H, Loi L, Kirkham E, McCann C, Watts D, Gurung B, Wilson M, Tribedi T, Garofalo E, Zahra B, MacDonald S, Daniels I, Ng N, Khosla S, Olivier J, Yue SYP, Suresh G, Wellington J, Lorejo E, Mossaad M, Tryliskyy Y, Crutcher M, Alimi M, Baiu I, Abdou H, Conway A, Peck C, Wagner G, Perdomo Perez MA, Trostchansky I, Zulu S, Nakazwe M, Knight SR, Drake TM, Nepogodiev D, Fitzgerald JE, Ademuyiwa A, Alexander P, Ingabire JA, Al-Saqqa SW, Biccard BM, Borda-Luque G, Borowski DW, Burger S, Chu K, Clarke D, Costas-Chavarri A, Davies J, Donaldson R, Ede C, Garden OJ, Ghosh D, Glasbey J, Kingham TP, Salem HK, Anyomih TTK, Koto MZ, Lapitan MC, Lawani I, Lesetedi C, Aguilera-Arevalo ML, Mabedi C, Maimbo M, Magill L, Makinde Alakaloko F, Makupe A, Martin J, Ramos-De la Medina A, Monahan M, Moore R, Msosa V, Mulira S, Mutabazi AZ, Muller E, Musowoyo J, Adisa AO, Olory-Togbe JL, Pius R, Qureshi AU, Rayne S, Roberts T, Sacdalan MD, Shaw CA, Smart N, Smith M, Spence R, Van Straten S, Tabiri S, Tayler V, Weiser TG, Windsor J, Yorke J, Yepez R, Lilford R, Morton D, Bhangu A, Sundar S, Harrison EM, Runigamugabo E, Verjee A, Chen J, Daya L, El Aroussi N, Farina V, Gnintedeme Olivier T, Gonzales Nacarino M, Hammani A, Honjo S, Jacobs R, Kimura H, Litvin A, Nkoronko M, Nour I, Oscullo Yepez JJ, Pagano G, Pata F, Pin Hung W, Raj A, Romani Pozo A, Rommaneh M, Sassamela Fabiano SC, Shiroma Gago CM, Shu Yip S, Srinivas A, Sung CY, Tai A, Valle Aranda YC, Venturini S, Vervoort D, Wilguens Lartigue J. Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries. Lancet 2021; 397:387-397. [PMID: 33485461 PMCID: PMC7846817 DOI: 10.1016/s0140-6736(21)00001-5] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/02/2020] [Accepted: 12/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. METHODS This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. FINDINGS Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70-8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39-8·80) and upper-middle-income countries (2·06, 1·11-3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26-11·59) and upper-middle-income countries (3·89, 2·08-7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. INTERPRETATION Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. FUNDING National Institute for Health Research Global Health Research Unit.
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Essangri H, Sabir M, Benkabbou A, Majbar MA, Amrani L, Ghannam A, Lekehal B, Mohsine R, Souadka A. Predictive Factors for Impaired Mental Health among Medical Students during the Early Stage of the COVID-19 Pandemic in Morocco. Am J Trop Med Hyg 2021; 104:95-102. [PMID: 33205748 PMCID: PMC7790070 DOI: 10.4269/ajtmh.20-1302] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The COVID-19 pandemic has great consequences on mental health. We aimed to assess medical students’ psychological condition and influencing factors as a baseline evidence for interventions promoting their mental wellbeing. We conducted an online survey from April 8 to April 18, 2020 to examine the mental health of medical students by the nine-item Patient Health Questionnaire, seven-item Generalized Anxiety Disorder Scale, seven-item Insomnia Severity Index, and six-item Kessler psychological distress scale. Factors associated with mental health outcomes were identified by multivariable logistic regression analysis. Five hundred forty-nine students completed the survey; 341 (62.3%), 410 (74.6%), 344 (62.6%), and 379 (69%) reported anxiety, depression, insomnia, and distress, respectively. Female students, living in high COVID-19 prevalence locations, more than 25 days confinement, psychiatric consult history, and being in a preclinical level of studies had higher median scores and severe symptom levels. Multivariable logistic regression showed female gender as a risk factor for severe symptoms of anxiety (odds ratio [OR]: 1.653; 95% CI: 1.020–2.679; P = 0.042), depression (OR: 2.167; 95% CI: 1.435–3.271; P < 0.001), insomnia (OR: 1.830; 95% CI: 1.176–2.847; P = 0.007), and distress (OR: 1.994; 95% CI: 1.338–2.972; P = 0.001); preclinical level of enrollment as a risk factor for depression (OR: 0.679; 95% CI: 0.521–0.885; P = 0.004), insomnia (OR: 0.720; 95% CI: 0.545–0.949; P = 0.02), and distress (OR: 0.650; 95% CI: 0.499–0.847; P = 0.001), whereas living in high COVID-19 prevalence locations was a risk factor for severe anxiety (OR: 1.628; 95% CI: 1.090–2.432; P = 0.017) and depression (OR: 1.438; 95% CI: 1.002–2.097; P = 0.05). Currently, medical students experience high levels of mental health symptoms, especially female students, those at a preclinical level and living in regions with a high prevalence of COVID-19 cases. Screening for mental health issues, psychological support, and long-term follow-up could alleviate the burden and protect future physicians.
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Affiliation(s)
- Hajar Essangri
- 1Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Maria Sabir
- 2Arrazi University Psychiatric Hospital, University Mohammed V in Rabat, Rabat, Morocco
| | - Amine Benkabbou
- 1Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco.,3Equipe de Recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, University Mohamed V in Rabat, Rabat, Morocco
| | - Mohammed Anass Majbar
- 1Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco.,3Equipe de Recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, University Mohamed V in Rabat, Rabat, Morocco
| | - Laila Amrani
- 1Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Abdelilah Ghannam
- 4Anesthesia and Intensive Care Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Brahim Lekehal
- 5Department of Academic Affairs, Faculty of Medicine and Pharmacy, University Mohammed V in Rabat, Rabat, Morocco
| | - Raouf Mohsine
- 1Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Amine Souadka
- 1Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco.,3Equipe de Recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, University Mohamed V in Rabat, Rabat, Morocco
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Ziati J, Souadka A, Benkabbou A, Boutayeb S, Ahmadi B, Amrani L, Mohsine R, Anass Majbar M. Transanal total mesorectal excision for patients with rectal cancer : a Systematic review and meta-analysis. Gulf J Oncolog 2021; 1:66-76. [PMID: 33716215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Transanal total mesorectal excision (TaTME) is a new technique that is designed to overcome the limits encountered during laparoscopic total mesorectal excision (LaTME) for rectal cancer, especially in male, obese patients with a narrow pelvis and mid and low rectal tumours. AIM The objective of our meta-analysis is to evaluate short-term oncological and perioperative outcomes of transanal total mesorectal excision (TaTME) compared to laparoscopic total mesorectal excision (LaTME) for rectal cancer. METHODS A meta-analysis based on Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was conducted in MEDLINE (PubMed). All original studies published in English that compared TaTME with laTME were included. The quality of the included studies was assessed by the Newcastle- Ottawa Quality Assessment Scale (NOS) and Cochrane Library Handbook 5.1.0. Data analysis was conducted using the Review Manager 5.3 software. RESULTS Twelve studies including 835 TaTME patients and 1707 LaTME patients with rectal cancer met the inclusion criteria in this meta-analysis. No statistical significant differences were observed in regard to positive circumferential resection margin (PCRM), positive distal resection margin (PDRM), macroscopic quality of mesorectum (MQM) and harvested lymph nodes (HLN). Concerning the perioperative outcomes, the results of conversion rates, operative time, hospital stay (HS), anastomotic leakage (AL) and postoperative complications were comparable between the two groups. CONCLUSION Our meta-analysis provides that TaTME may be a valid alternative approach for the treatment of rectal cancer in comparison with LaTME.
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Affiliation(s)
- Jihane Ziati
- Surgical Oncology Department National Institute of Oncology. Rabat, Morocco
- Faculté de Médecine. Mohammed V University in Rabat. Morocco
| | - Amine Souadka
- Surgical Oncology Department National Institute of Oncology. Rabat, Morocco
- Faculté de Médecine. Mohammed V University in Rabat. Morocco
- Equipe de recherce en oncologie translationnelle (EROT). Mohammed V University in Rabat. Morocco
| | - Amine Benkabbou
- Surgical Oncology Department National Institute of Oncology. Rabat, Morocco
- Faculté de Médecine. Mohammed V University in Rabat. Morocco
- Equipe de recherce en oncologie translationnelle (EROT). Mohammed V University in Rabat. Morocco
| | - Saber Boutayeb
- Faculté de Médecine. Mohammed V University in Rabat. Morocco
- Equipe de recherce en oncologie translationnelle (EROT). Mohammed V University in Rabat. Morocco
- Medical Oncology Department. National Institute of Oncology. Rabat, Morocco
| | - Brahim Ahmadi
- Faculté de Médecine. Mohammed V University in Rabat. Morocco
- Intensive care unit. National Institute of Oncology. Rabat, Morocco
| | - Laila Amrani
- Surgical Oncology Department National Institute of Oncology. Rabat, Morocco
- Faculté de Médecine. Mohammed V University in Rabat. Morocco
- Equipe de recherce en oncologie translationnelle (EROT). Mohammed V University in Rabat. Morocco
| | - Raouf Mohsine
- Surgical Oncology Department National Institute of Oncology. Rabat, Morocco
- Faculté de Médecine. Mohammed V University in Rabat. Morocco
- Equipe de recherce en oncologie translationnelle (EROT). Mohammed V University in Rabat. Morocco
| | - Mohammed Anass Majbar
- Surgical Oncology Department National Institute of Oncology. Rabat, Morocco
- Faculté de Médecine. Mohammed V University in Rabat. Morocco
- Equipe de recherce en oncologie translationnelle (EROT). Mohammed V University in Rabat. Morocco
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Souadka A, Essangri H, Boualaoui I, Ghannam A, Benkabbou A, Amrani L, Mohsine R, Majbar MA. Supraclavicular versus infraclavicular approach in inserting totally implantable central venous access for cancer therapy: A comparative retrospective study. PLoS One 2020; 15:e0242727. [PMID: 33232361 PMCID: PMC7685501 DOI: 10.1371/journal.pone.0242727] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 11/06/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The insertion of an implantable central venous access is performed according to a variety of approaches which allow the access to the subclavian vein, yet the supraclavicular technique has been underused and never compared to the other methods. The aim of this study was to testify on the efficacy and safety of the subclavian puncture without ultrasound guidance « Yoffa » in comparison with the classical infraclavicular approach (ICA). MATERIAL AND METHODS This is a retrospective study with prospective data collection on patients followed at the national oncology institute for cancer, in the period extending from May 1st 2017 to August 31st 2017. All patients had a totally implantable central venous access device inserted by the same surgeon AS for chemotherapy administration and demographic characteristics, as well as procedure details were examined. The primary outcomes were the intraoperative complications, while the secondary outcomes represented immediate postoperative and mid-term complications (at 15 months of follow up). Outcomes were compared between techniques by means of non parametric tests and the Fischer test. RESULTS Our study included 135 patients with 70 patients undergoing the subclavian technique, while 65 were subject to the infraclavicular approach. Both groups had no statistically significant demographic characteristics. The number of vein puncture attempts exceeding once, the accidental artery puncture and operative time were more significant in the ICA group; (39,6 vs 17,6 p = 0,01) (9.2% vs 0; p = 0,01) and (27± 13 vs 23± 8min, p = 0.045) respectively. There was no statistically significant difference in the immediate and midterm complication rate between the two methods 1(1,4) vs 2 (3) p = 0.5. CONCLUSION In case of unavailability of ultrasonographic guidance, the use of the supra-clavicular landmarks approach is linked to higher success rates and less arterial punctures, thereby proving to be a safe and reliable approach.
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Affiliation(s)
- Amine Souadka
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University Medical School, Rabat, Morocco
- * E-mail:
| | - Hajar Essangri
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University Medical School, Rabat, Morocco
| | - Imad Boualaoui
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University Medical School, Rabat, Morocco
| | - Abdelilah Ghannam
- Anesthesia and Intensive Care Department, National Institute of Oncology, Mohammed V University Medical School, Rabat, Morocco
| | - Amine Benkabbou
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University Medical School, Rabat, Morocco
| | - Laila Amrani
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University Medical School, Rabat, Morocco
| | - Raouf Mohsine
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University Medical School, Rabat, Morocco
| | - Mohammed Anass Majbar
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University Medical School, Rabat, Morocco
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Houssaini K, Lahnaoui O, Souadka A, Majbar MA, Ghannam A, El Ahmadi B, Belkhadir Z, Amrani L, Mohsine R, Benkabbou A. Correction to: Contributing factors to severe complications after liver resection: an aggregate root cause analysis in 105 consecutive patients. Patient Saf Surg 2020; 14:41. [PMID: 33292471 PMCID: PMC7661200 DOI: 10.1186/s13037-020-00268-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Kholoud Houssaini
- Surgical Oncology Department, National Institute of Oncology, MohammedV University in Rabat, Rabat, Morocco.
| | - Oumayma Lahnaoui
- Surgical Oncology Department, National Institute of Oncology, MohammedV University in Rabat, Rabat, Morocco
| | - Amine Souadka
- Surgical Oncology Department, National Institute of Oncology, MohammedV University in Rabat, Rabat, Morocco
| | - Mohammed Anass Majbar
- Surgical Oncology Department, National Institute of Oncology, MohammedV University in Rabat, Rabat, Morocco
| | - Abdelilah Ghannam
- Intensive Care Department, NationalInstitute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - Brahim El Ahmadi
- Intensive Care Department, NationalInstitute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - Zakaria Belkhadir
- Intensive Care Department, NationalInstitute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - Laila Amrani
- Surgical Oncology Department, National Institute of Oncology, MohammedV University in Rabat, Rabat, Morocco
| | - Raouf Mohsine
- Surgical Oncology Department, National Institute of Oncology, MohammedV University in Rabat, Rabat, Morocco
| | - Amine Benkabbou
- Surgical Oncology Department, National Institute of Oncology, MohammedV University in Rabat, Rabat, Morocco
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Essangri H, Majbar MA, Benkabbou A, Amrani L, Mohsine R, Souadka A. Validation of the Moroccan arabic version of the low anterior resection syndrome score. BMC Gastroenterol 2020; 20:333. [PMID: 33050906 PMCID: PMC7552529 DOI: 10.1186/s12876-020-01463-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 09/22/2020] [Indexed: 12/11/2022] Open
Abstract
Background Sphincter sparing surgery is oftentimes associated with bowel dysfunction complaints, namely the low anterior resection syndrome (LARS). The LARS questionnaire is widely used to assess this syndrome. The aim of this observational study is to translate this tool into arabic and test its psychometric properties in rectal cancer patients, in order to ease its use in clinical practice and future research. Methods The LARS questionnaire was translated to arabic and administered to a total of 143 patients. A subgroup of 42 patients took the test twice for test-retest reliability. Internal consistency was examined through cronbach’s alpha. The score results were correlated to the EORTC QLQ-C30 questionnaire for convergent validity assessment, while discriminant validity was established through the ability of the LARS score to differentiate patients with different clinical and pathological criteria. Results The Moroccan Arabic version of the LARS score was completed by 143 patients. The internal consistency was demonstrated through a cronbach alpha score of 0.66. The agreement between the test and retest was established by a Bland Altman plot with 95% limits of agreement. 85.6% of patients remained in the same LARS category. The LARS score showed negative correlation with all five of the QLQ-C30 functional scales as well as positive correlation to the diarrhea symptom scale. The questionnaire score differed between patients according to their tumor location, chemoradiotherapy, type of mesorectal excision and anastomosis. Conclusion The Moroccan Arabic version of the LARS score shows good psychometric properties and can be used for bowel dysfunction assessment in clinical and research settings.
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Affiliation(s)
- Hajar Essangri
- Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Mohammed Vth University in Rabat, Rabat, Morocco
| | - Mohammed Anass Majbar
- Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Mohammed Vth University in Rabat, Rabat, Morocco
| | - Amine Benkabbou
- Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Mohammed Vth University in Rabat, Rabat, Morocco
| | - Laila Amrani
- Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Mohammed Vth University in Rabat, Rabat, Morocco
| | - Raouf Mohsine
- Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Mohammed Vth University in Rabat, Rabat, Morocco
| | - Amine Souadka
- Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Mohammed Vth University in Rabat, Rabat, Morocco.
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Houssaini K, Lahnaoui O, Souadka A, Majbar MA, Ghanam A, El Ahmadi B, Belkhadir Z, Amrani L, Mohsine R, Benkabbou A. Contributing factors to severe complications after liver resection: an aggregate root cause analysis in 105 consecutive patients. Patient Saf Surg 2020; 14:36. [PMID: 33014137 PMCID: PMC7526378 DOI: 10.1186/s13037-020-00261-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 07/15/2020] [Accepted: 09/17/2020] [Indexed: 12/20/2022] Open
Abstract
Background The aggregate root cause analysis (AggRCA) was designed to improve the understanding of system vulnerabilities contributing to patient harm, including surgical complications. It remains poorly used due to methodological complexity and resource limitations. This study aimed to identify the main patterns contributing to severe complications after liver resection using an AggRCA. Methods This was a retrospective qualitative study aimed to identify the main patterns contributing to severe complications, defined as strictly higher than grade IIIa according to the Clavien-Dindo classification within the first 90 days after liver resection. All consecutive severe complications that occurred between January 1st, 2018 and December 31st, 2019 were identified from an electronic database and included in an AggRCA. This included a structured morbidity and mortality review (MMR) reporting tool based on 50 contributory factors adapted from 6 ALARM categories: "Patient", "Tasks", "Individual staff", "Team", "Work environment", and "Management and Institutional context". Data resulting from individual-participant root cause analysis (RCA) of single-cases were validated collectively then aggregated. The main patterns were suggested from the contributory factors reported in more than half of the cases. Results In 105 consecutive liver resection cases, 15 patients (14.3%) developed severe postoperative complications, including 5 (4.8%) who died. AggRCA resulted in the identification of 36 contributory factors. Eight contributory factors were reported in more than half of the cases and were compiled in three entangled patterns: (1) Disrupted perioperative process, (2) Unplanned intraoperative change, (3) Ineffective communication. Conclusion A pragmatic aggregated RCA process improved our understanding of system vulnerabilities based on the analysis of a limited number of events and a reasonable resource intensity. The identification of patterns contributing to severe complications lay the rationale of future contextualized safety interventions beyond the scope of liver resections.
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Affiliation(s)
- Kholoud Houssaini
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - Oumayma Lahnaoui
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - Amine Souadka
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - Mohamed-Anass Majbar
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - Abdelilah Ghanam
- Intensive Care Department, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - Brahim El Ahmadi
- Intensive Care Department, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - Zakaria Belkhadir
- Intensive Care Department, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - Leila Amrani
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - Raouf Mohsine
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - Amine Benkabbou
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
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Majbar MA, Majbar Y, Benkabbou A, Amrani L, Bougtab A, Mohsine R, Souadka A. Validation of the French translation of the Dutch residency educational climate test. BMC Med Educ 2020; 20:338. [PMID: 33008369 PMCID: PMC7531085 DOI: 10.1186/s12909-020-02249-4] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 09/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The learning environment is one of the most influential factors in training of medical residents. The Dutch Residency Educational Climate Test (D-RECT) is one of the strongest instruments for measuring the learning environment. However, it has not been translated in French. The objective of this study is the psychometric validation of the DRECT French version. MATERIAL AND METHODS After translation of the D-RECT questionnaire into French, residents of five Moroccan hospitals were invited to complete the questionnaire between July and September 2018. Confirmatory factor analysis was used to evaluate the validity of the construct using the standardized root mean square residual (SRMR), the root mean square error approximation (RMSEA), the Comparative Fit Index (CFI) and the Tucker- Lewis Index (TLI). Reliability analysis was analysed using Internal consistency and Test-retest. RESULTS During the study period, 211 residents completed the questionnaire. Confirmatory factor analysis showed an adequate model fit with the following indicators: SRMR = 0.058 / RMSEA = 0.07 / CFI = 0.88 / TLI = 0.87. The French translation had a good internal consistency (Cronbach alpha score > 0.7 for all subscales) and a good temporal stability (correlation score between two measurements = 0.89). CONCLUSION This French version has an acceptable validity of the construct, a good internal consistency and good temporal reliability, and may be used to evaluate the learning climate. Additional research is necessary in other French-speaking contexts, in order to confirm these results.
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Affiliation(s)
- Mohamed Anass Majbar
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital Centre, Rabat, Morocco.
- Surgery Department, Faculty of Medicine. Mohammed V University in Rabat, Rabat, Morocco.
| | - Yassin Majbar
- Faculty of Medicine, Sidi Mohamed Ben Abdellah University, Fes, Morocco
| | - Amine Benkabbou
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital Centre, Rabat, Morocco
- Surgery Department, Faculty of Medicine. Mohammed V University in Rabat, Rabat, Morocco
| | - Laila Amrani
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital Centre, Rabat, Morocco
- Surgery Department, Faculty of Medicine. Mohammed V University in Rabat, Rabat, Morocco
| | - Abdeslam Bougtab
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital Centre, Rabat, Morocco
- Surgery Department, Faculty of Medicine. Mohammed V University in Rabat, Rabat, Morocco
| | - Raouf Mohsine
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital Centre, Rabat, Morocco
- Surgery Department, Faculty of Medicine. Mohammed V University in Rabat, Rabat, Morocco
| | - Amine Souadka
- Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital Centre, Rabat, Morocco
- Surgery Department, Faculty of Medicine. Mohammed V University in Rabat, Rabat, Morocco
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Essangri H, Majbar MA, Benkabbou A, Belkhadir Z, Amrani L, Mohsine R, Souadka A. Do we have enough Foreknowledge to predict the low anterior resection syndrome (LARS) score preoperatively? Colorectal Dis 2020; 22:1445. [PMID: 32270539 DOI: 10.1111/codi.15062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 02/08/2023]
Affiliation(s)
- H Essangri
- National Institute of Oncology, Surgical Oncology Department, University Mohammed Vth Souissi, Rabat, Morocco
| | - M A Majbar
- National Institute of Oncology, Surgical Oncology Department, University Mohammed Vth Souissi, Rabat, Morocco
| | - A Benkabbou
- National Institute of Oncology, Surgical Oncology Department, University Mohammed Vth Souissi, Rabat, Morocco
| | - Z Belkhadir
- National Institute of Oncology Anesthesia and Intensive Care Department, University Mohammed Vth Souissi, Rabat, Morocco
| | - L Amrani
- National Institute of Oncology, Surgical Oncology Department, University Mohammed Vth Souissi, Rabat, Morocco
| | - R Mohsine
- National Institute of Oncology, Surgical Oncology Department, University Mohammed Vth Souissi, Rabat, Morocco
| | - A Souadka
- National Institute of Oncology, Surgical Oncology Department, University Mohammed Vth Souissi, Rabat, Morocco
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Souadka A, Majbar MA, Essangri H, Amrani L, Benkabbou A, Mohsine R, Souadka A. Functional outcomes over time following perineal pseudocontinent colostomy reconstruction after abdominoperineal resection for ultralow rectal adenocarcinoma. J Surg Oncol 2020; 122:753-759. [PMID: 32563198 DOI: 10.1002/jso.26074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 03/07/2020] [Accepted: 06/08/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVES Pseudocontinent-perineal colostomy (PCPC) following abdominoperineal resection (APR) is a promising technique associated with good quality of life. This study evaluates over time the functional results after PCPC using the Kirwan score. METHODS All PCPC patients operated on from January 2001 to January 2016 were followed with their functional results assessed at four checkpoints. A/B Kirwan scores and a 48 to 72 hours colonic irrigation rhythm were considered "good" and "convenient" and their overall variations over time were assessed by means of Cochran's Q test corrected by Bonferroni post hoc test. RESULTS Fifty-seven eligible patients were included in the study with 33 (58%) women. We noted a significant difference in both Kirwan score and colic irrigation rhythm during the four checkpoints in follow-up with Q(1) = 85.01 and Q(2) = 69. 86. By the fourth checkpoint, 86% of patients had a Kirwan score of A/B. Concerning the rhythm of colonic irrigation, there was a significant improvement between 6 months and other checkpoints. In the second year, 63% of patients reduced their colonic irrigation rhythm. CONCLUSIONS The functional results of PCPC after APR improve and stabilize from 6 months to 1 year after surgery thus making PCPC a good alternative that surgeons can present to their patients.
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Affiliation(s)
- Amine Souadka
- Surgical Oncology Department, Medical School, National Institute of Oncology, Mohammed V University, Rabat, Morocco
| | - Mohammed Anass Majbar
- Surgical Oncology Department, Medical School, National Institute of Oncology, Mohammed V University, Rabat, Morocco
| | - Hajar Essangri
- Surgical Oncology Department, Medical School, National Institute of Oncology, Mohammed V University, Rabat, Morocco
| | - Laila Amrani
- Surgical Oncology Department, Medical School, National Institute of Oncology, Mohammed V University, Rabat, Morocco
| | - Amine Benkabbou
- Surgical Oncology Department, Medical School, National Institute of Oncology, Mohammed V University, Rabat, Morocco
| | - Raouf Mohsine
- Surgical Oncology Department, Medical School, National Institute of Oncology, Mohammed V University, Rabat, Morocco
| | - Abdelilah Souadka
- Surgical Oncology Department, Medical School, National Institute of Oncology, Mohammed V University, Rabat, Morocco
- Surgical Department, Al Azhar Oncological Center, Rabat, Morocco
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Souadka A, Benkabbou A, Majbar MA, Essangri H, Amrani L, Ghannam A, El Ahmadi B, Belkhadir Z, Mohsine R. CRS and HIPEC: The need for an adaptable learning curve model. J Surg Oncol 2020; 122:1187-1188. [PMID: 32772363 DOI: 10.1002/jso.26123] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Amine Souadka
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Amine Benkabbou
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Mohammed Anass Majbar
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Hajar Essangri
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Laila Amrani
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Abdelilah Ghannam
- Intensive Care Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Brahim El Ahmadi
- Intensive Care Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Zakaria Belkhadir
- Intensive Care Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Raouf Mohsine
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
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Charoui C, Souadka A, Saber S, Latib R, Rifai L, Amrani L, Benkabbou A, Mohsine R, Majbar MA. Evaluation of the Decision-Making Mode during Digestive Oncology Multidisciplinary Meetings: a Prospective Study in a Moroccan Center. JMSR 2020. [DOI: 10.46327/msrjg.1.000000000000169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: The multidisciplinary team oncology meeting (MDT) has become a standard in oncology. The objective of this study was to evaluate the value of a validated tool, the Metric for the Observation of Decision-Making, in the evaluation of the decision-making mode during the digestive cancer MDT in order to reach recommendations for improvement.
Results: Eight consecutive MDTs were observed (N = 228 patients). On average, 32 patients were discussed by MDT with an average of 2 min 55 s (interval: 30 s-10 min 16 s) per patient. A decision was reached in 84.6% of the cases. Although the medical information was judged to be of good quality, the psychosocial information (average 1.29) and the patients' point of view (average 1.03) were judged to be of low quality. For teamwork, the contribution of surgeons (average 4.56) and oncologists (average 3.99) was greater than radiologists (3.12), radiotherapists (1.74) and pathologists (1.02).
Conclusions: The tool made it possible to identify a disparity in the quality of the different aspects of the information and in the participation of specialists, making it possible to identify specific improvement measures. Its regular use would improve the quality of patient care.
Keywords: Decision making, Quality improvement, Multidisciplinary Concertation meeting, MDT-MODe, Morocco
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Charoui C, Souadka A, Saber S, Latib R, Rifai L, Amrani L, Benkabbou A, Mohsine R, Majbar MA. Evaluation of the Decision-Making Mode during Digestive Oncology Multidisciplinary Meetings: a Prospective Study in a Moroccan Center. JMSR 2020. [DOI: 10.46327/msrjg.1.000000000000169bis] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: The multidisciplinary team oncology meeting (MDT) has become a standard in oncology. The objective of this study was to evaluate the value of a validated tool, the Metric for the Observation of Decision-Making, in the evaluation of the decision-making mode during the digestive cancer MDT in order to reach recommendations for improvement.
Results: Eight consecutive MDTs were observed (N = 228 patients). On average, 32 patients were discussed by MDT with an average of 2 min 55 s (interval: 30 s-10 min 16 s) per patient. A decision was reached in 84.6% of the cases. Although the medical information was judged to be of good quality, the psychosocial information (average 1.29) and the patients' point of view (average 1.03) were judged to be of low quality. For teamwork, the contribution of surgeons (average 4.56) and oncologists (average 3.99) was greater than radiologists (3.12), radiotherapists (1.74) and pathologists (1.02).
Conclusions: The tool made it possible to identify a disparity in the quality of the different aspects of the information and in the participation of specialists, making it possible to identify specific improvement measures. Its regular use would improve the quality of patient care.
Keywords: Decision making, Quality improvement, Multidisciplinary Concertation meeting, MDT-MODe, Morocco
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Souadka A, Benkabbou A, Majbar MA, Essangri H, Amrani L, Mohsine R, Ghannam A, El Ahmadi B, Belkhadir Z. Oncological Surgery During the COVID-19 Pandemic: The Need for Deep and Lasting Measures. Oncologist 2020; 25:e1424-e1425. [PMID: 32535974 PMCID: PMC7323022 DOI: 10.1634/theoncologist.2020-0360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 05/21/2020] [Indexed: 01/12/2023] Open
Affiliation(s)
- Amine Souadka
- Department of Surgical Oncology, National Institute of Oncology, University Mohammed VRabatMorocco
| | - Amine Benkabbou
- Department of Surgical Oncology, National Institute of Oncology, University Mohammed VRabatMorocco
| | - Mohammed Anass Majbar
- Department of Surgical Oncology, National Institute of Oncology, University Mohammed VRabatMorocco
| | - Hajar Essangri
- Department of Surgical Oncology, National Institute of Oncology, University Mohammed VRabatMorocco
| | - Laila Amrani
- Department of Surgical Oncology, National Institute of Oncology, University Mohammed VRabatMorocco
| | - Raouf Mohsine
- Department of Surgical Oncology, National Institute of Oncology, University Mohammed VRabatMorocco
| | - Abdelilah Ghannam
- Department of Intensive Care, National Institute of Oncology, University Mohammed VRabatMorocco
| | - Brahim El Ahmadi
- Department of Intensive Care, National Institute of Oncology, University Mohammed VRabatMorocco
| | - Zakaria Belkhadir
- Department of Intensive Care, National Institute of Oncology, University Mohammed VRabatMorocco
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Abstract
The COVID 19 outbreak has caused the cancellation of most elective oncological surgery around the world to limit the risk of virus dissemination. As we are exiting the crisis, surgical teams will face strong challenges while resuming normal elective surgery. The accumulation of cases will have to be managed by defining strong selection criteria, taking into account the patient and the disease conditions. In order to reduce the risk of infection, non-COVID patients should be treated in dedicated non-COVID areas, preferably in separate buildings or hospitals. Departments, units and operative theaters should put in place rigorous actions and protocols to protect the patient and healthcare workers. Adequate protective equipment must be readily available for healthcare workers and patients. Finally, teams should keep an adaptive mindset by preparing strategies to maintain surgical activity in case of repeated COVID 19 waves.
Keywords: COVID 19, Guidelines, Lockdown ease, Surgical oncology
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Souadka A, Benkabbou A, Majbar MA, Essangri H, Amrani L, Mohsine R, Akhnif ELH. Africa Against COVID-19: Can National Solidarity Complements Health System Weaknesses? -the Moroccan Experience-. JMSR 2020. [DOI: 10.46327/10.46327/msrjg.1.000000000000160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Souadka A, Majbar MA, Benkabbou A, Serji B, Souiki T, Bouchentouf SM, Abid M, El Khannousi B, El Harroudi T, El Malki HO, Raiss M, Ifrine L, Mazaz K, Zentar A, Mohsine R, Souadka A, Belkouchi A, Ahallat M, Hrora A. Predictive factors of disease-free survival after complete pathological response to neoadjuvant radiotherapy for rectal adenocarcinoma: retrospective case series. BMC Cancer 2019; 19:1008. [PMID: 31660903 PMCID: PMC6816192 DOI: 10.1186/s12885-019-6239-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 09/20/2018] [Accepted: 10/03/2019] [Indexed: 01/17/2023] Open
Abstract
Background Many data suggest that patients with low rectal adenocarcinoma who achieved ypT0N0 status have improved survival and disease-free survival (DFS) compared to all other stages however only few data are available regarding the specific prognosis factors of this subgroup. This study aimed to evaluate predictive factors for disease free survival after complete pathological response (CPR) in cases of low rectal adenocarcinoma. Materials and methods From January 2005 to December 2013, all patients with low rectal adenocarcinoma who underwent neoadjuvant chemoradiotherapy followed by total mesorectal excision and achieved CPR were included at 7 Moroccan and 1 Algerian centres. Predictive factors for disease-free survival were analysed by uni and multivariate analysis. Results Eigthy-four (12.1%) patients achieved a CPR (ypT0N0). Multivariate analysis revealed that both poorly differentiated tumors (OR, 9.23; 95 CI 1.35–62.82; P = 0.023) and the occurrence of perineal sepsis (OR, 13.51; 95 CI 1.96–93.12; P = 0.008) were independently associated with impaired DFS. Conclusions Patients with low rectal cancer who exhibited a CPR after neoadjuvant therapy have good prognoses; however, the occurrence of perineal sepsis and/or poor initial differentiation may be associated with impaired DFS in these patients. Trial registration: The study was retrospectively registered the 28th July 2018 in ClinicalTrials.gov register with the reference NCT03601689.
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Affiliation(s)
- Amine Souadka
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University Medical School, Rabat, Morocco.
| | - Mohammed Anass Majbar
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University Medical School, Rabat, Morocco
| | - Amine Benkabbou
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University Medical School, Rabat, Morocco
| | - Badr Serji
- Surgical Oncology, Hospital El Farabi, Mohammed Ist University, Oujda, Morocco
| | - Tarik Souiki
- Surgery Department, Sidi Mohammed Ben Abdellah University, Fes, Morocco
| | | | - Mourad Abid
- Batna Anticancer Center Alger, Batna, Algeria
| | - Basma El Khannousi
- Anatomopathology Department, National Institute of Oncology, Rabat, Morocco
| | - Tijani El Harroudi
- Surgical Oncology, Hospital El Farabi, Mohammed Ist University, Oujda, Morocco
| | | | - Mohammed Raiss
- Anatomopathology Department, National Institute of Oncology, Rabat, Morocco
| | - Lahsen Ifrine
- Surgical Department "A", Ibn Sina Hospital, Rabat, Morocco
| | - Khalid Mazaz
- Surgery Department, Sidi Mohammed Ben Abdellah University, Fes, Morocco
| | - Aziz Zentar
- Surgery Department, Military Hospital, Rabat, Morocco
| | - Raouf Mohsine
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University Medical School, Rabat, Morocco
| | | | | | | | - Abdelmalek Hrora
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University Medical School, Rabat, Morocco.,Surgical Department "C", Ibn Sina Hospital, Mohammed V University. Medical School, Rabat, Morocco
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Dahiri M, Souadka A, Majbar M, Benkabbou A, Benamr S, Bougtab A, Mohsine R. Rare case of breast apocrine carcinoma in men: diagnostic difficulties and contribution of HER 2. Int J Surg Med 2019. [DOI: 10.5455/ijsm.breast-apocrine-carcinoma-men] [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: 11/03/2022] Open
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Dahiri M, Salmi N, Ahallat A, El Bahaoui N, Belkouchi O, Souadka A, Majbar A, Benkabbou A, Bougtab A, Mohsine R. Radiation induced rectal cancer: a case report with review of the literature. AME Case Rep 2018; 2:31. [PMID: 30264027 DOI: 10.21037/acr.2018.06.01] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 05/23/2018] [Indexed: 11/06/2022]
Abstract
Cervical cancer is the second most common cancer and the third cause of cancer death in women. Radiotherapy occupies a prominent place in the therapeutic arsenal of cervical cancer in localized stages. Radiation induced secondary cancer is an entity that has been well described in the literature. We report a case of a rectal adenocarcinoma occurring in a woman previously treated by radiotherapy and brachytherapy for a squamous cell carcinoma of the cervix.
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Affiliation(s)
- Mustapha Dahiri
- Department of digestive surgery, National Institute of Oncology, Rabat, Morocco.,Faculty of Medicine and Pharmacy, Mohammed V University, Souissi, Rabat, Morocco
| | - Nariman Salmi
- Department of digestive surgery, National Institute of Oncology, Rabat, Morocco.,Faculty of Medicine and Pharmacy, Mohammed V University, Souissi, Rabat, Morocco
| | - Anas Ahallat
- Department of digestive surgery, National Institute of Oncology, Rabat, Morocco.,Faculty of Medicine and Pharmacy, Mohammed V University, Souissi, Rabat, Morocco
| | - Nezha El Bahaoui
- Department of digestive surgery, National Institute of Oncology, Rabat, Morocco.,Faculty of Medicine and Pharmacy, Mohammed V University, Souissi, Rabat, Morocco
| | - Omar Belkouchi
- Department of digestive surgery, National Institute of Oncology, Rabat, Morocco.,Faculty of Medicine and Pharmacy, Mohammed V University, Souissi, Rabat, Morocco
| | - Amine Souadka
- Department of digestive surgery, National Institute of Oncology, Rabat, Morocco.,Faculty of Medicine and Pharmacy, Mohammed V University, Souissi, Rabat, Morocco
| | - Anas Majbar
- Department of digestive surgery, National Institute of Oncology, Rabat, Morocco.,Faculty of Medicine and Pharmacy, Mohammed V University, Souissi, Rabat, Morocco
| | - Amine Benkabbou
- Department of digestive surgery, National Institute of Oncology, Rabat, Morocco.,Faculty of Medicine and Pharmacy, Mohammed V University, Souissi, Rabat, Morocco
| | - Abdeslam Bougtab
- Department of digestive surgery, National Institute of Oncology, Rabat, Morocco.,Faculty of Medicine and Pharmacy, Mohammed V University, Souissi, Rabat, Morocco
| | - Raouf Mohsine
- Department of digestive surgery, National Institute of Oncology, Rabat, Morocco.,Faculty of Medicine and Pharmacy, Mohammed V University, Souissi, Rabat, Morocco
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Serji B, Souadka A, Benkabbou A, Hachim H, Jaiteh L, Mohsine R, Ifrine L, Belkouchi A, El Malki HO. Feasibility and safety of laparoscopic adrenalectomy for large tumours. Arab J Urol 2016; 14:143-6. [PMID: 27489741 PMCID: PMC4963158 DOI: 10.1016/j.aju.2016.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 03/21/2016] [Accepted: 04/25/2016] [Indexed: 01/02/2023] Open
Abstract
Objective To verify the feasibility and safety of laparoscopic adrenalectomy for large tumours, as since it was described, the laparoscopic approach for adrenalectomy has become the ‘gold standard’ for small tumours and for large and non-malignant adrenal tumours many studies have reported acceptable results. Patients and methods This is a retrospective study from a general surgery department from January 2006 to December 2013 including 45 patients (56 laparoscopic adrenalectomies). We divided patients into two groups according to tumour size: <5 or ⩾5 cm, we compared demographic data and peri- and postoperative outcomes. Results There was no statistical difference between the two groups for conversion rate (3.7% vs 11.7% P = 0.32), postoperative complications (14% vs 12%, P = 0.4), postoperative length of hospital stay (5 vs 6 days P = 0.43) or mortality (3.5% vs 0% P = 0.99). The only statistical difference was the operating time, at a mean (SD) 155 (60) vs 247 (71) min (P < 0.001). Conclusion Laparoscopic adrenalectomy for large tumours needs more time but appears to be safe and feasible when performed by experienced surgeons.
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Affiliation(s)
- Badr Serji
- Surgery Department 'A', Ibn Sina Hospital, Medical School, Mohammed V University in Rabat, Morocco; Medical School, Mohammed the First University, Oujda, Morocco
| | - Amine Souadka
- Surgery Department 'A', Ibn Sina Hospital, Medical School, Mohammed V University in Rabat, Morocco
| | - Amine Benkabbou
- Surgery Department 'A', Ibn Sina Hospital, Medical School, Mohammed V University in Rabat, Morocco
| | - Hajar Hachim
- Surgery Department 'A', Ibn Sina Hospital, Medical School, Mohammed V University in Rabat, Morocco
| | - Lamin Jaiteh
- Surgery Department 'A', Ibn Sina Hospital, Medical School, Mohammed V University in Rabat, Morocco
| | - Raouf Mohsine
- Surgery Department 'A', Ibn Sina Hospital, Medical School, Mohammed V University in Rabat, Morocco
| | - Lahcen Ifrine
- Surgery Department 'A', Ibn Sina Hospital, Medical School, Mohammed V University in Rabat, Morocco
| | - Abdelkader Belkouchi
- Surgery Department 'A', Ibn Sina Hospital, Medical School, Mohammed V University in Rabat, Morocco
| | - Hadj Omar El Malki
- Surgery Department 'A', Ibn Sina Hospital, Medical School, Mohammed V University in Rabat, Morocco; Medical Centre of Clinical Trials and Epidemiological Study and Biostatistical, Clinical Research and Epidemiological Laboratory, Medical School, Mohammed V University in Rabat, Morocco; Abulcasis International University of Health Sciences, Abulcasis Medical School, Rabat, Morocco
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Souadka A, Naya MS, Serji B, El Malki HO, Mohsine R, Ifrine L, Belkouchi A, Benkabbou A. Impact of seniority on operative time and short-term outcome in laparoscopic cholecystectomy: Experience of an academic Surgical Department in a developing country. J Minim Access Surg 2016; 13:131-134. [PMID: 28281477 PMCID: PMC5363119 DOI: 10.4103/0972-9941.186687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION: Resident participation in laparoscopic cholecystectomy (LC) is one of the first steps of laparoscopic training. The impact of this training is not well-defined, especially in developing countries. However, this training is of critical importance to monitor surgical teaching programmes. OBJECTIVE: The aim of this study was to determine the impact of seniority on operative time and short-term outcome of LC. DESIGNS AND SETTINGS: We performed a retrospective study of all consecutive laparoscopic cholecystectomies for gallbladder lithiasis performed over 2 academic years in an academic Surgical Department in Morocco. PARTICIPANTS: These operations were performed by junior residents (post-graduate year [PGY] 4–5) or senior residents (PGY 6), or attending surgeons assisted by junior residents, none of whom had any advanced training in laparoscopy. All data concerning demographics (American Society of Anesthesiologists, body mass index and indications), surgeons, operative time (from skin incision to closure), conversion rate and operative complications (Clavien–Dindo classification) were recorded and analysed. One-way analysis of variance, Student's t-test and Chi-square tests were used as appropriate with statistical significance attributed to P < 0.05. RESULTS: One hundred thirty-eight LC were performed. No differences were found on univariate analysis between groups in demographics or diagnosis category. The overall rate of operative complications or conversions and hospital stay were not significantly different between the three groups. However, mean operative time was significantly longer for junior residents (n = 27; 115 ± 24 min) compared to senior residents (n = 37; 77 ± 35 min) and attending surgeons (n = 66; 55 ± 17 min) (P < 0.001). CONCLUSION: LC performed by residents appears to be safe without a significant difference in complication rate; however, seniority influences operative time. This information supports early resident involvement in laparoscopic procedures and also the need to develop cost-effective laboratory training programmes.
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Affiliation(s)
- Amine Souadka
- Surgical Department A, Ibn Sina Hospital, Faculty of Medicine, Mohammed V University in Rabat, Morocco
| | - Mohammed Sayed Naya
- Surgical Department A, Ibn Sina Hospital, Faculty of Medicine, Mohammed V University in Rabat, Morocco
| | - Badr Serji
- Surgical Department A, Ibn Sina Hospital, Faculty of Medicine, Mohammed V University in Rabat, Morocco
| | - Hadj Omar El Malki
- Surgical Department A, Ibn Sina Hospital, Faculty of Medicine, Mohammed V University in Rabat, Morocco
| | - Raouf Mohsine
- Surgical Department A, Ibn Sina Hospital, Faculty of Medicine, Mohammed V University in Rabat, Morocco
| | - Lahsen Ifrine
- Surgical Department A, Ibn Sina Hospital, Faculty of Medicine, Mohammed V University in Rabat, Morocco
| | - Abdelkader Belkouchi
- Surgical Department A, Ibn Sina Hospital, Faculty of Medicine, Mohammed V University in Rabat, Morocco
| | - Amine Benkabbou
- Surgical Department A, Ibn Sina Hospital, Faculty of Medicine, Mohammed V University in Rabat, Morocco
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Benkabbou A, Souadka A, Serji B, Hachim H, Mohsine R, Ifrine L, Belkouchi A, El Malki HO. Changing paradigms in the surgical management of cystic liver hydatidosis improve the postoperative outcomes. Surgery 2015; 159:1170-80. [PMID: 26747223 DOI: 10.1016/j.surg.2015.10.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 10/16/2015] [Accepted: 10/28/2015] [Indexed: 12/23/2022]
Abstract
AIM OF THE STUDY Our aim was to propose and examine the outcomes of a comprehensive strategy for the management of cystic liver hydatidosis (CLH) based on extensive intraoperative assessments and optimal management of cystobiliary communications. BACKGROUND DATA Although operative intervention remains the preferred treatment for CLH, and the presence of a cystobiliary communication remains a well-established predictive factor for postoperative complications, no internationally accepted management strategy integrates the specific management of cystobiliary communication into the choice of surgical approach. METHODS Early postoperative outcomes were compared before (1990-2004; P1 group; n = 664) and after (2005-2013; P2 group; n = 156) the implementation of a CLH surgical management strategy for CLH in our overall group of patients in subgroups selected by risk factors (as determined by multivariate analysis), and in 2 propensity score-matched groups. RESULTS Specific complications related to the hepatic procedure (intraabdominal complications) were independently associated with the presence of ≥ 3 cysts (P = .013), a fibrotic pericyst (P = .005), a cystobiliary communication (P < .001), and the P1 treatment period (P = .002). Between P1 and P2 groups, the rate of specific complications decreased in the overall group of patients with CLH (18.3% vs 4.5%; P < .001). The rate also decreased in risk factor-based subgroups: patients with ≥ 3 cysts (31.0% vs 4.0%; P = .005), a fibrotic pericyst (23.1% vs 9.2%; P = .011), and a cystobiliary communication (33.0% vs 13.2%; P = .006). After propensity score matching among 123 well-balanced matched pairs of patients, the overall complication rate, specific hepatic surgery-related complication rate, and median duration of hospital stay decreased between the P1 and P2 groups: 23.6% vs 12.2% (P = .02), 21.1% vs 4.9% (P < .001), and 7 vs 5 days (P < .001), respectively. CONCLUSION Implementation of a CLH surgical management strategy based on specific intraoperative assessment and optimal management of cystobiliary communications improved early postoperative outcomes.
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Affiliation(s)
- Amine Benkabbou
- Mohammed V University Medical School, Rabat, Morocco; Surgical Department A, Ibn Sina University Hospital, Rabat, Morocco
| | - Amine Souadka
- Mohammed V University Medical School, Rabat, Morocco; Surgical Department A, Ibn Sina University Hospital, Rabat, Morocco.
| | - Badr Serji
- Mohammed V University Medical School, Rabat, Morocco; Surgical Department A, Ibn Sina University Hospital, Rabat, Morocco
| | - Hajar Hachim
- Mohammed V University Medical School, Rabat, Morocco; Surgical Department A, Ibn Sina University Hospital, Rabat, Morocco
| | - Raouf Mohsine
- Mohammed V University Medical School, Rabat, Morocco; Surgical Department A, Ibn Sina University Hospital, Rabat, Morocco
| | - Lahsen Ifrine
- Mohammed V University Medical School, Rabat, Morocco; Surgical Department A, Ibn Sina University Hospital, Rabat, Morocco
| | - Abdelkader Belkouchi
- Mohammed V University Medical School, Rabat, Morocco; Surgical Department A, Ibn Sina University Hospital, Rabat, Morocco
| | - Hadj Omar El Malki
- Mohammed V University Medical School, Rabat, Morocco; Surgical Department A, Ibn Sina University Hospital, Rabat, Morocco
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