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Das B, Fehervari M, Hamrang-Yousefi S, Jiao LR, Pai M, Jenkins JT, Spalding DRC. Pancreaticoduodenectomy with right hemicolectomy for advanced malignancy: a single UK hepatopancreaticobiliary centre experience. Colorectal Dis 2023; 25:16-23. [PMID: 35975477 PMCID: PMC10087186 DOI: 10.1111/codi.16303] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/23/2022] [Revised: 08/01/2022] [Accepted: 08/08/2022] [Indexed: 02/02/2023]
Abstract
AIM Locally advanced intestinal neoplasms including colon cancer may require radical en bloc pancreaticoduodenectomy and right hemicolectomy (PD-RC) to achieve curative, margin-negative resection, but the safety and benefit of this uncommon procedure has not been established. The Association of Coloproctology of Great Britain and Ireland IMPACT initiative has also highlighted a lack of awareness about current services available within the UK for patients with advanced colorectal cancer and concerns about low-volume centres managing complex cases. Thus, we aimed to review the feasibility, safety and long-term outcomes of this procedure at a single high-volume hepatopancreaticobiliary surgery unit in the UK. METHOD A retrospective cohort study was performed using a database of all consecutive patients with intestinal cancer who had been referred to our regional advanced multidisciplinary team and undergone PD-RC in a 7-year period (2013-2020). Clinico-pathological and outcome data were reviewed. RESULTS Ten patients (mean age 54 ± 13, 8/10 men) were identified. Final histology revealed the primary tumour sites were colon (n = 7) and duodenum (n = 3). R0 resection was achieved in all cases. The major complication rate (Clavien-Dindo ≥ 3) was 10% (1/10) with no deaths within 90 days of surgery. The Kaplan-Meier estimated 5-year overall survival was 83.3% (95% CI 58.3%-100%). Univariate survival analysis identified perineural invasion and extra-colonic origin as predictors of poor survival (log-rank P < 0.05). CONCLUSION En bloc PD-RC for locally advanced intestinal cancer can be performed safely with a high proportion of margin-negative resections and resultant long-term survival in carefully selected patients.
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Affiliation(s)
- Bibek Das
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Hepatopancreaticobiliary Surgery, Hammersmith Hospital, London, UK
| | - Matyas Fehervari
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Hepatopancreaticobiliary Surgery, Hammersmith Hospital, London, UK
| | - Sahar Hamrang-Yousefi
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Hepatopancreaticobiliary Surgery, Hammersmith Hospital, London, UK
| | - Long R Jiao
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Hepatopancreaticobiliary Surgery, Hammersmith Hospital, London, UK
| | - Madhava Pai
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Hepatopancreaticobiliary Surgery, Hammersmith Hospital, London, UK
| | | | - Duncan R C Spalding
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Hepatopancreaticobiliary Surgery, Hammersmith Hospital, London, UK
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Fadel M, Hamrang-Yousefi S, Mills S, Warren O, Tekkis P, Kontovounisios C. 1252 A Systematic Review of International Colorectal Multidisciplinary Team Meetings: The Development of Best Practice Through Inter-Regional Learning. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
Colorectal multi-disciplinary teams (CR MDTs) were introduced to enhance the cancer care pathway and allow for early investigation and treatment of colorectal cancer. However, there are no gold standards set for this process. The aim of this study is to establish recommendations on the principles, organisation, structure and output of CR MDTs internationally.
Method
The available literature on the role of CR MDTs from January 1999 and March 2020 in the United Kingdom (UK), United States of America (USA) and continental Europe was evaluated. Historical background, structure, core members, education, frequency, patient selection criteria, quality assurance, output and outcomes were extracted from data from the UK, USA, and continental Europe.
Results
Fifty studies were identified that specifically met the inclusion criteria. CR MDTs should occur at least once a month with established key members. Generally, all colorectal cancer patients should be discussed and there should be a focus on education. There are noted differences in the lead member of the CR MDT, the use of information technology and storage of MDT information in databases and quality assurance internationally.
Conclusions
The most common issues facing MDTs internationally include a lack of staffing and resources as well as limited information on the patient’s fitness and preference for surgery. These factors are important and urgent improvements are required in these areas in CR MDTs. Quality assurance should be a mandatory component of every CR MDT.
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Affiliation(s)
- M Fadel
- Chelsea and Westminster Hospital, London, United Kingdom
| | | | - S Mills
- Chelsea and Westminster Hospital, London, United Kingdom
| | - O Warren
- Chelsea and Westminster Hospital, London, United Kingdom
| | - P Tekkis
- Chelsea and Westminster Hospital, London, United Kingdom
- Royal Marsden Hospital, London, United Kingdom
- Imperial College London, London, United Kingdom
| | - C Kontovounisios
- Chelsea and Westminster Hospital, London, United Kingdom
- Royal Marsden Hospital, London, United Kingdom
- Imperial College London, London, United Kingdom
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Fehervari M, Hamrang-Yousefi S, Fadel MG, Mills SC, Warren OJ, Tekkis PP, Kontovounisios C. A systematic review of colorectal multidisciplinary team meetings: an international comparison. BJS Open 2021; 5:6278497. [PMID: 34013317 PMCID: PMC8134530 DOI: 10.1093/bjsopen/zrab044] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/11/2021] [Indexed: 01/31/2023] Open
Abstract
Background Colorectal multidisciplinary teams (CR MDTs) were introduced to enhance the cancer care pathway and allow for early investigation and treatment of cancer. However, there are no ‘gold standards’ set for this process. The aim of this study was to review the literature systematically and provide a qualitative analysis on the principles, organization, structure and output of CR MDTs internationally. Methods Literature on the role of CR MDTs published between January 1999 and March 2020 in the UK, USA and continental Europe was evaluated. Historical background, structure, core members, education, frequency, patient-selection criteria, quality assurance, clinical output and outcomes were extracted from data from the UK, USA and continental Europe. Results Forty-eight studies were identified that specifically met the inclusion criteria. The majority of hospitals held CR MDTs at least fortnightly in the UK and Europe by 2002 and 2005 respectively. In the USA, monthly MDTs became a mandatory element of cancer programmes by 2013. In the UK, USA and in several European countries, the lead of the MDT meeting is a surgeon and core members include the oncologist, specialist nurse, histopathologist, radiologist and gastroenterologist. There were differences observed in patient-selection criteria, in the use of information technology, MDT databases and quality assurance internationally. Conclusion CR MDTs are essential in improving the patient care pathway and should express clear recommendations for each patient. However, a form of quality assurance should be implemented across all MDTs.
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Affiliation(s)
- M Fehervari
- Department of Surgery and Cancer, Imperial College, London, UK.,Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
| | | | - M G Fadel
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
| | - S C Mills
- Department of Surgery and Cancer, Imperial College, London, UK.,Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
| | - O J Warren
- Department of Surgery and Cancer, Imperial College, London, UK.,Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
| | - P P Tekkis
- Department of Surgery and Cancer, Imperial College, London, UK.,Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK.,Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
| | - C Kontovounisios
- Department of Surgery and Cancer, Imperial College, London, UK.,Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK.,Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
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Hamrang-Yousefi S, Kingsley-Smith H, Munroe-Gray T, Anyanechi M, Rollin M. Patterns of referral for fractured nose during major sporting events: a 10-year follow up. Ann R Coll Surg Engl 2021; 103:282-284. [PMID: 33682468 DOI: 10.1308/rcsann.2020.7082] [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] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Nasal fracture is a common form of ear, nose and throat (ENT) trauma with prompt referral required for assessment and potentially manipulation of nasal bones. The aetiology of nasal fracture is multifactorial, and injury occurs across all ages. Previous study has suggested a temporal relationship between nasal injury and major sporting events. METHODS A total of 1966 adult patients with nasal injuries referred to emergency clinics across three London ENT centres between September 2016 and August 2019 were analysed. RESULTS The majority of those referred were male (66.58%). Mean age at referral was 36.29±18.38 in males and 49.14±21.43 in females; 10.27% were 75 years and over. Incidence was highest during April-September 2018 (p=0.02). Mean incidence was higher in this period in the male 16-35 subgroup (p=0.039), with 53.1% of their injuries concentrated between Friday and Sunday. CONCLUSIONS Most nasal injuries occurred in young males. Mean age at referral was higher in females, and there was slightly increased incidence in over-75s, predominantly females. This incidence could be due to increased longevity or greater tendency to injury in females of this age. The injury patterns across the week also differed, with males injured proportionately more at the weekend. Nasal injury referrals of young men increased around the 2018 summer period, coinciding with the 2018 FIFA World Cup. This lends support to the association between major sporting events and the incidence of nasal injury, particularly in young males.
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Hotblack A, Seshadri S, Zhang L, Hamrang-Yousefi S, Chakraverty R, Escors D, Bennett CL. Dendritic Cells Cross-Present Immunogenic Lentivector-Encoded Antigen from Transduced Cells to Prime Functional T Cell Immunity. Mol Ther 2017; 25:504-511. [PMID: 28153097 PMCID: PMC5368353 DOI: 10.1016/j.ymthe.2016.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 11/10/2016] [Accepted: 11/11/2016] [Indexed: 12/03/2022] Open
Abstract
Recombinant lentiviral vectors (LVs) are highly effective vaccination vehicles that elicit protective T cell immunity in disease models. Dendritic cells (DCs) acquire antigen at sites of vaccination and migrate to draining lymph nodes, where they prime vaccine-specific T cells. The potency with which LVs activate CD8+ T cell immunity has been attributed to the transduction of DCs at the immunization site and durable presentation of LV-encoded antigens. However, it is not known how LV-encoded antigens continue to be presented to T cells once directly transduced DCs have turned over. Here, we report that LV-encoded antigen is efficiently cross-presented by DCs in vitro. We have further exploited the temporal depletion of DCs in the murine CD11c.DTR (diphtheria toxin receptor) model to demonstrate that repopulating DCs that were absent at the time of immunization cross-present LV-encoded antigen to T cells in vivo. Indirect presentation of antigen from transduced cells by DCs is sufficient to prime functional effector T cells that control tumor growth. These data suggest that DCs cross-present immunogenic antigen from LV-transduced cells, thereby facilitating prolonged activation of T cells in the absence of circulating LV particles. These are findings that may impact on the future design of LV vaccination strategies.
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Affiliation(s)
- Alastair Hotblack
- Institute for Immunity and Transplantation, University College London, London NW3 2PF, UK
| | - Sara Seshadri
- Institute for Immunity and Transplantation, University College London, London NW3 2PF, UK; Cancer Institute, University College London, London WC1E 6DD, UK
| | - Lei Zhang
- Institute for Immunity and Transplantation, University College London, London NW3 2PF, UK; Cancer Institute, University College London, London WC1E 6DD, UK
| | - Sahar Hamrang-Yousefi
- Institute for Immunity and Transplantation, University College London, London NW3 2PF, UK; Cancer Institute, University College London, London WC1E 6DD, UK
| | - Ronjon Chakraverty
- Institute for Immunity and Transplantation, University College London, London NW3 2PF, UK; Cancer Institute, University College London, London WC1E 6DD, UK
| | - David Escors
- Immunomodulation Group, Navarrabiomed-Fundaçion Miguel Servet, Calle de Irunlarrea 3, 31008 Pamplona, Spain
| | - Clare L Bennett
- Institute for Immunity and Transplantation, University College London, London NW3 2PF, UK; Cancer Institute, University College London, London WC1E 6DD, UK.
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