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Johnson DE, Granville R, Lovett E, Runau F, Chaudhri S. Pilonidal sinus laser-assisted closure (PiLAC) - a low-morbidity alternative to excision with excellent long-term outcomes. Ann R Coll Surg Engl 2023; 105:132-135. [PMID: 35446708 PMCID: PMC9889171 DOI: 10.1308/rcsann.2022.0005] [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] [Accepted: 01/04/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Recurrence after surgery for pilonidal sinus disease is a recognised problem and patients often re-present months after discharge. We routinely treat primary and recurrent pilonidal sinus disease with Pilonidal sinus Laser-Assisted Closure (PiLAC). Long-term outcomes following PiLAC surgery was examined following clinical and telephone review. METHODS All patients undergoing PiLAC as a day-case between April 2016 and July 2019 were included. Patients were followed up in a nurse-led clinic until complete healing or recurrence. A prospective database and retrospective audit of notes combined with longer-term follow-up by telephone were used. RESULTS A total of 35 patients underwent PiLAC, median age 28 (18-53 years), 28 males:7 females. A total of 28 patients had long-term (>60 days) follow-up, mean 407 days (range 67-887 days); 25/28 patients (89.3%) had healed with no recurrence on long-term follow-up. Of these 28 patients, 11 were first presentation of pilonidal disease and underwent PiLAC as their first treatment, with a 91% heal rate long term. A total of 15 patients had seton drainage prior to PiLAC, with a 93% heal rate versus no seton (83%). Fisher's exact test showed no significant difference between sex, new/recurrent pilonidal disease and seton placement (p>0.05). CONCLUSIONS Healing after PiLAC for the treatment of primary and recurrent pilonidal sinus disease is preserved with excellent long-term outcomes. We recommend it as an alternative to surgical excision.
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Affiliation(s)
- DE Johnson
- University Hospitals of Leicester NHS Trust, UK
| | - R Granville
- University Hospitals of Leicester NHS Trust, UK
| | - E Lovett
- University Hospitals of Leicester NHS Trust, UK
| | - F Runau
- University Hospitals of Leicester NHS Trust, UK
| | - S Chaudhri
- University Hospitals of Leicester NHS Trust, UK
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Blok RD, Sharabiany S, Stoker J, Laan ETM, Bosker RJI, Burger JWA, Chaudhri S, van Duijvendijk P, van Etten B, van Geloven AAW, de Graaf EJR, Hoff C, Hompes R, Leijtens JWA, Rothbarth J, Rutten HJT, Singh B, Vuylsteke RJCLM, de Wilt JHW, Dijkgraaf MGW, Bemelman WA, Musters GD, Tanis PJ. Cumulative 5-year Results of a Randomized Controlled Trial Comparing Biological Mesh With Primary Perineal Wound Closure After Extralevator Abdominoperineal Resection (BIOPEX-study). Ann Surg 2022; 275:e37-e44. [PMID: 33534231 DOI: 10.1097/sla.0000000000004763] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine long-term outcomes of a randomized trial (BIOPEX) comparing biological mesh and primary perineal closure in rectal cancer patients after extralevator abdominoperineal resection and preoperative radiotherapy, with a primary focus on symptomatic perineal hernia. SUMMARY BACKGROUND DATA BIOPEX is the only randomized trial in this field, which was negative on its primary endpoint (30-day wound healing). METHODS This was a posthoc secondary analysis of patients randomized in the BIOPEX trial to either biological mesh closure (n = 50; 2 dropouts) or primary perineal closure (n = 54; 1 dropout). Patients were followed for 5 years. Actuarial 5-year probabilities were determined by the Kaplan-Meier statistic. RESULTS Actuarial 5-year symptomatic perineal hernia rates were 7% (95% CI, 0-30) after biological mesh closure versus 30% (95% CI, 10-49) after primary closure (P = 0.006). One patient (2%) in the biomesh group underwent elective perineal hernia repair, compared to 7 patients (13%) in the primary closure group (P = 0.062). Reoperations for small bowel obstruction were necessary in 1/48 patients (2%) and 5/53 patients (9%), respectively (P = 0.208). No significant differences were found for chronic perineal wound problems, locoregional recurrence, overall survival, and main domains of quality of life and functional outcome. CONCLUSIONS Symptomatic perineal hernia rate at 5-year follow-up after abdominoperineal resection for rectal cancer was significantly lower after biological mesh closure. Biological mesh closure did not improve quality of life or functional outcomes.
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Affiliation(s)
- Robin D Blok
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- LEXOR, Center for Experimental and Molecular Medicine, Oncode Institute, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Sarah Sharabiany
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, the Netherlands
| | - Ellen T M Laan
- Department of Sexology and Psychosomatic Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Sanjay Chaudhri
- Department of Surgery, University Hospitals Leicester, Leicester, United Kingdom
| | | | - Boudewijn van Etten
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Eelco J R de Graaf
- Department of Surgery, IJsselland Hospital, Capelle aan de IJssel, the Netherlands
| | - Christiaan Hoff
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Roel Hompes
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Joost Rothbarth
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Harm J T Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Baljit Singh
- Department of Surgery, University Hospitals Leicester, Leicester, United Kingdom
| | | | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Willem A Bemelman
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Gijsbert D Musters
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Pieter J Tanis
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Chavda V, Siaw O, Chaudhri S, Runau F. Management of early rectal cancer; current surgical options and future direction. World J Gastrointest Surg 2021; 13:655-667. [PMID: 34354799 PMCID: PMC8316852 DOI: 10.4240/wjgs.v13.i7.655] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/13/2021] [Accepted: 06/16/2021] [Indexed: 02/06/2023] Open
Abstract
Rectal cancer is the second commonest cause of cancer death within the United Kingdom. Utilization of national screening programmes have resulted in a greater proportion of patients presenting with early-stage disease. The technique of transanal endoscopic microsurgery was first described in 1984 following which further options for local excision have emerged with transanal endoscopic operation and, more recently, transanal minimally invasive surgery. Owing to the risks of local recurrence, the current role of minimally invasive techniques for local excision in the management of rectal cancer is limited to the treatment of pre-invasive disease and low risk early-stage rectal cancer (T1N0M0 disease). The roles of chemotherapy and radiotherapy for the management of early rectal cancer are yet to be fully established. However, results of high-quality research such as the GRECCAR II, TESAR and STAR-TREC randomised control trials may highlight a wider role for local excision surgery in the future, when used in combination with oncological therapies. The aim of our review is to provide an overview in the current management of early rectal cancer, the surgical options available for local excision and the future multimodal direction of early rectal cancer treatment.
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Affiliation(s)
- Vijay Chavda
- Department of General Surgery, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Oliver Siaw
- Department of General Surgery, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Sanjay Chaudhri
- Department of General Surgery, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Franscois Runau
- Department of General Surgery, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
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Sharabiany S, van Dam JJW, Sparenberg S, Blok RD, Singh B, Chaudhri S, Runau F, van Geloven AAW, van de Ven AWH, Lapid O, Hompes R, Tanis PJ, Musters GD. A comparative multicentre study evaluating gluteal turnover flap for wound closure after abdominoperineal resection for rectal cancer. Tech Coloproctol 2021; 25:1123-1132. [PMID: 34263363 PMCID: PMC8419133 DOI: 10.1007/s10151-021-02496-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 05/10/2021] [Indexed: 11/25/2022]
Abstract
Background The aim of this study was to compare perineal wound healing between gluteal turnover flap and primary closure in patients undergoing abdominoperineal resection (APR) for rectal cancer. Methods Patients who underwent APR for primary or recurrent rectal cancer with gluteal turnover flap in two university hospitals (2016–2021) were compared to a multicentre cohort of primary closure (2000–2017). The primary endpoint was uncomplicated perineal wound healing within 30 days. Secondary endpoints were long-term wound healing, related re-interventions, and perineal herniation. The perineal hernia rate was assessed using Kaplan Meier analysis. Results Twenty–five patients had a gluteal turnover flap and 194 had primary closure. The uncomplicated perineal wound-healing rate within 30 days was 68% (17/25) after gluteal turnover flap versus 64% (124/194) after primary closure, OR 2.246; 95% CI 0.734–6.876; p = 0.156 in multivariable analysis. No major wound complications requiring surgical re-intervention occurred after flap closure. Eighteen patients with gluteal turnover flap completed 12-month follow-up, and none of them had chronic perineal sinus, compared to 6% (11/173) after primary closure (p = 0.604). The symptomatic 18-month perineal hernia rate after flap closure was 0%, compared to 9% after primary closure (p = 0.184). Conclusions The uncomplicated perineal wound-healing rate after the gluteal turnover flap and primary closure after APR is similar, and no chronic perineal sinus or perineal hernia occurred after flap closure. Future studies have to confirm potential benefits of the gluteal turnover flap.
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Affiliation(s)
- S Sharabiany
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Post-box 22660, 1100 DD, Amsterdam, The Netherlands
| | - J J W van Dam
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Post-box 22660, 1100 DD, Amsterdam, The Netherlands
| | - S Sparenberg
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Post-box 22660, 1100 DD, Amsterdam, The Netherlands
| | - R D Blok
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Post-box 22660, 1100 DD, Amsterdam, The Netherlands
| | - B Singh
- Department of Surgery, Leicester University Hospital, Leicester, UK
| | - S Chaudhri
- Department of Surgery, Leicester University Hospital, Leicester, UK
| | - F Runau
- Department of Surgery, Leicester University Hospital, Leicester, UK
| | | | | | - O Lapid
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Post-box 22660, 1100 DD, Amsterdam, The Netherlands
| | - R Hompes
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Post-box 22660, 1100 DD, Amsterdam, The Netherlands
| | - P J Tanis
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Post-box 22660, 1100 DD, Amsterdam, The Netherlands
| | - G D Musters
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Post-box 22660, 1100 DD, Amsterdam, The Netherlands.
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Morales-Cruz M, Oliveira-Cunha M, Chaudhri S. Perineal hernia repair after abdominoperineal rectal excision with prosthetic mesh-a single surgeon experience. Colorectal Dis 2021; 23:1569-1572. [PMID: 33567120 DOI: 10.1111/codi.15578] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 12/13/2022]
Abstract
AIM Extralevator abdominoperineal excision for rectal cancer is associated with an increased incidence of perineal hernia. The purpose of this study was to determine clinical outcome following perineal hernia repair with prosthetic mesh by a perineal open approach. METHODS We present a case series of 10 patients who underwent 12 repairs of their hernia using a prosthetic mesh placed by a perineal open technique. Patients were identified from a prospectively maintained database and their case records were retrieved along with their imaging and analysed retrospectively. RESULTS Perineal hernia incidence in our series is 10%. The median age was 73 ± 5.9 years. No gender predilection was found. The median time interval between extralevator abdominoperineal excision and surgical repair of perineal hernia was 25.3 months. The surgical approach was perineal with the use of a double layer prosthetic mesh. The recurrence ratio was 30% (n = 3). Overall morbidity was also 30% with no major complications (Clavien-Dindo I-II). Recurrence following primary repair was diagnosed in a median time interval of 28.3 ± 16.57 months. Two patients had repeat surgery to treat their recurrence. CONCLUSIONS Our small series supports the use of a prosthetic mesh repair of perineal hernias through a perineal approach. It is safe and effective with complication rates similar to those previously reported.
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Affiliation(s)
- Mariana Morales-Cruz
- Department of Colorectal Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Melissa Oliveira-Cunha
- Department of Colorectal Surgery, University Hospitals of Birmingham NHS Trust, Birmingham, UK
| | - Sanjay Chaudhri
- Department of Colorectal Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
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Sharabiany S, Blok RD, Lapid O, Hompes R, Bemelman WA, Alberts VP, Lamme B, Wijsman JH, Tuynman JB, Aalbers AGJ, Beets GL, Fabry HFJ, Cherepanin IM, Polat F, Burger JWA, Rutten HJT, Bosker RJI, Talsma K, Rothbarth J, Verhoef C, van de Ven AWH, van der Bilt JDW, de Graaf EJR, Doornebosch PG, Leijtens JWA, Heemskerk J, Singh B, Chaudhri S, Gerhards MF, Karsten TM, de Wilt JHW, Bremers AJA, Vuylsteke RJCLM, Heuff G, van Geloven AAW, Tanis PJ, Musters GD. Perineal wound closure using gluteal turnover flap or primary closure after abdominoperineal resection for rectal cancer: study protocol of a randomised controlled multicentre trial (BIOPEX-2 study). BMC Surg 2020; 20:164. [PMID: 32703182 PMCID: PMC7376711 DOI: 10.1186/s12893-020-00823-7] [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: 12/24/2019] [Accepted: 07/13/2020] [Indexed: 11/13/2022] Open
Abstract
Background Abdominoperineal resection (APR) for rectal cancer is associated with high morbidity of the perineal wound, and controversy exists about the optimal closure technique. Primary perineal wound closure is still the standard of care in the Netherlands. Biological mesh closure did not improve wound healing in our previous randomised controlled trial (BIOPEX-study). It is suggested, based on meta-analysis of cohort studies, that filling of the perineal defect with well-vascularised tissue improves perineal wound healing. A gluteal turnover flap seems to be a promising method for this purpose, and with the advantage of not having a donor site scar. The aim of this study is to investigate whether a gluteal turnover flap improves the uncomplicated perineal wound healing after APR for rectal cancer. Methods Patients with primary or recurrent rectal cancer who are planned for APR will be considered eligible in this multicentre randomised controlled trial. Exclusion criteria are total exenteration, sacral resection above S4/S5, intersphincteric APR, biological mesh closure of the pelvic floor, collagen disorders, and severe systemic diseases. A total of 160 patients will be randomised between gluteal turnover flap (experimental arm) and primary closure (control arm). The total follow-up duration is 12 months, and outcome assessors and patients will be blinded for type of perineal wound closure. The primary outcome is the percentage of uncomplicated perineal wound healing on day 30, defined as a Southampton wound score of less than two. Secondary outcomes include time to perineal wound closure, incidence of perineal hernia, the number, duration and nature of the complications, re-interventions, quality of life and urogenital function. Discussion The uncomplicated perineal wound healing rate is expected to increase from 65 to 85% by using the gluteal turnover flap. With proven effectiveness, a quick implementation of this relatively simple surgical technique is expected to take place. Trial registration The trial was retrospectively registered at Clinicaltrials.gov NCT04004650 on July 2, 2019.
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Affiliation(s)
- Sarah Sharabiany
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.
| | - Robin D Blok
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.,LEXOR, Centre for Experimental and Molecular Medicine, Oncode Institute, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Oren Lapid
- Department of Plastic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Roel Hompes
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Wilhelmus A Bemelman
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Victor P Alberts
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Bas Lamme
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Jan H Wijsman
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | - Jurriaan B Tuynman
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, Free University, Amsterdam, The Netherlands
| | - Arend G J Aalbers
- Department of Surgery, Antoni van Leeuwenhoek Hospital-Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Geerard L Beets
- Department of Surgery, Antoni van Leeuwenhoek Hospital-Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Hans F J Fabry
- Department of Surgery, Bravis Hospital, Roosendaal, The Netherlands
| | | | - Fatih Polat
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Harm J T Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.,GROW School of Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | | | - Koen Talsma
- Department of Surgery, Deventer Hospital, Deventer, The Netherlands
| | - Joost Rothbarth
- Department of Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Cees Verhoef
- Department of Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | | | - Eelco J R de Graaf
- Department of Surgery, IJsselland Hospital, Capelle aan den Ijssel, The Netherlands
| | - Pascal G Doornebosch
- Department of Surgery, IJsselland Hospital, Capelle aan den Ijssel, The Netherlands
| | | | - Jeroen Heemskerk
- Department of Surgery, Laurentius Hospital, Roermond, The Netherlands
| | - Baljit Singh
- Department of Surgery, Leicester Hospital, Leicester, UK
| | | | | | - Tom M Karsten
- Department of Surgery, OLVG Hospital, Amsterdam, The Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Andre J A Bremers
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Gijsbert Heuff
- Department of Surgery, Spaarne Gasthuis, Haarlem, The Netherlands
| | | | - Pieter J Tanis
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Gijsbert D Musters
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
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Gomez Ruiz M, Bianchi PP, Chaudhri S, Gerjy R, Gögenur I, Jayne D, Khan JS, Rautio T, Sánchez-Guillén L, Spinoglio G, Ulrich A, Rouanet P. Minimally invasive right colectomy anastomosis study (MIRCAST): protocol for an observational cohort study of surgical complications using four surgical techniques for anastomosis in patients with a right colon tumor. BMC Surg 2020; 20:151. [PMID: 32660467 PMCID: PMC7359244 DOI: 10.1186/s12893-020-00803-x] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/18/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Right colectomy is the standard surgical treatment for tumors in the right colon and surgical complications are reduced with minimally-invasive laparoscopy compared with open surgery, with potential further benefits achieved with robotic assistance. The anastomotic technique used can also have an impact on patient outcomes. However, there are no large, prospective studies that have compared all techniques. METHODS/DESIGN MIRCAST is the Minimally-Invasive Right Colectomy Anastomosis Study that will compare laparoscopy with robot-assisted surgery, using either intracorporeal or extracorporeal anastomosis, in a large prospective, observational, multicenter, parallel, four-cohort study in patients with a benign or malignant, non-metastatic tumor of the right colon. Over 2 years of follow-up, the study will prospectively evaluate peri- and postoperative complications, postoperative recovery, hospital stay, and mid-term results including survival, local recurrence, metastases rate, and conversion rate. The primary composite endpoint will be the efficacy of the surgical method regarding surgical wound infections and postoperative complications (Clavien-Dindo grade III-IV complications at 30 days post-surgery). Secondary endpoints include long-term oncologic results, conversion rate, operative time, length of stay, and quality of life. DISCUSSION This will be the first large, international study to prospectively evaluate the use of minimally-invasive laparoscopy or robot-assisted surgery during right hemicolectomy and to control for the impact of the anastomotic technique. The research will contribute to current knowledge regarding the medical care of patients with malignant or benign tumors of the right colon, and enable physicians to determine which technique may be the most appropriate for their patients. TRIAL REGISTRATION This study was registered on Clinicaltrials.gov (clinicaltrials.gov identifier: NCT03650517 ) on August 28th 2018 (study protocol version CI18/02 revision A, 21 February 2018).
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Affiliation(s)
- Marcos Gomez Ruiz
- Unidad de Cirugía Colorrectal, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Av. Valdecilla s/n, 39008 Santander, Spain
- IDIVAL, Instituto de Investigación Sanitaria, 39008 Santander, Spain
| | - Paolo Pietro Bianchi
- Department of Surgery, Division of General and Minimally-Invasive Surgery, International School of Robotic Surgery, Clinical Robotic Surgery Association (CRSA), Ospedale La Misericordia, Via Senese 170, 58100 Grosseto, Italy
| | - Sanjay Chaudhri
- Leicester General Hospital, University Hospitals Leicester NHS Trust, Leicester, UK
| | - Roger Gerjy
- Department of Surgery, Danderyd University Hospital, 182 88 Stockholm, Sweden
| | - Ismail Gögenur
- Department Surgery, Center for Surgical Science, Zealand University Hospital, Institute for Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - David Jayne
- Surgery, Level 7 Clinical Sciences Building St James’s University Hospital, Leeds, LS9 7TF UK
| | - Jim S. Khan
- Portsmouth Hospitals NHS Trust, University of Portsmouth, Portsmouth, UK
- Anglia Ruskin University, Chelmsford, England
| | - Tero Rautio
- Department of Surgery, Oulu University Hospital, PL 21 OYS, 90029 Oulu, Finland
| | - Luis Sánchez-Guillén
- Department of Surgery, General University Hospital Elche, University Miguel Hernández, Camí de l’Almazara 11, CP 03203 Elche, Spain
| | - Giuseppe Spinoglio
- Digestive Surgery and Robotic Surgeyi and Educational, IEO (European Institute of Oncology)-IRCCS-Milan, Milan, Italy
| | - Alexis Ulrich
- Department of Surgery, Rheinlandklinikum Lukaskrankenhaus Neuss, 84 41464 Neuss, Germany
| | - Philippe Rouanet
- Oncologic surgery, Montpellier Cancer Institute, 34298 Montpellier, France
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SHARMA K, Sharma S, Ghimire A, Pokharel S, Khanal V, Chaudhri S, Dreyer G, Drobniewski F, Chapagain A. SUN-117 CHRONIC KIDNEY DISEASE AND NON-COMMUNICABLE DISEASES IN TUBERCULOSIS PATIENTS OF SUNSARI DISTRICT IN EASTERN NEPAL AND ITS ASSOCIATED FACTORS. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.644] [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: 10/24/2022] Open
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Bhangu A, Nepogodiev D, Ives N, Magill L, Glasbey J, Forde C, Bisgaard T, Handley K, Mehta S, Morton D, Pinkney T, Mehta S, Handley K, Ives N, Bhangu A, Brown J, Forde C, Futaba K, Glasbey J, Handley K, Ives N, Khan S, Magill L, Mehta S, Morton D, Nepogodiev D, Pallan A, Patel A, Ashdown-Phillips S, Roberts T, Jowett S, Munetsi L, Pinkney T, Torrance A, Brown J, Handley K, Hilken N, Hill M, Hunter M, Ives N, Khan S, Leek S, Lilly H, Magill L, Mehta S, Sawant A, Vince A, Walters M, Bemelman W, Blussé M, Borstlap W, Busch ORC, Buskens C, Klaver C, Marsman H, van Ruler O, Tanis P, Westerduin E, Wicherts D, Das P, Essapen S, Frost V, Glennon A, Gray C, Hussain A, McNichol L, Nisar P, Scott H, Trickett J, Trivedi P, White D, Amarnath T, Ardley R, Gupta R, Hall E, Hodgkins K, Narula H, Sewell TA, Simms JM, Toms J, White T, Atkinson A, Beral D, Lancaster N, Mackenzie F, Wilson T, Cruttenden-Wood D, Gibbins J, Halls M, Hill D, Hogben K, Jones S, Lamparelli MJ, Lewis M, Moreton S, Ng P, Oglesby A, Orbell J, Stubbs B, Subramanian K, Talwar A, Wilsher S, Al-Rashedy M, Fensom C, Gok M, Hardstaff L, Malik K, Sadat M, Townley B, Wilkinson L, Cosier T, Mangam S, Rabie M, Broadley G, Canny J, Fallis S, Green N, Hawash A, Karandikar S, Mirza M, Rawstorne E, Reddan J, Richardson J, Thompson C, Waite K, Youssef H, Bisgaard T, De Nes L, Rosenstock S, Strandfelt P, Westen M, Aryal K, Kshatriya KS, Lal R, Velchuru V, Wilhelmsen E, Akbar A, Antoniou A, Clark S, Datt P, Goh J, Jenkins I, Kennedy R, Maeda Y, Nastro P, Owen H, Phillips RKS, Warusavitarne J, Bradley-Potts J, Charleston P, Clouston H, Duff S, Fatayer T, Gipson A, Heywood N, Junejo M, Kennedy J, Lalor H, Manning C, McCormick R, Parmar K, Preston S, Ramesh A, Sharma A, Telford K, Adeosun A, Hammond T, Smolen S, Topliffe J, Docherty JG, Lim M, Lim M, Macleod K, Monaghan E, Patience L, Thomas I, Walker KG, Walker M, Watson AJM, Burgess A, Ghanem Y, Glister G, Kapur S, Paily A, Pal A, Ravikumar R, Rosbergen M, Sargen K, Speakman C, Agarwal AK, Banerjee A, Borowski D, Garg D, Gill T, Johnston T, Kelsey S, Munipalle PC, Tabaqchali M, Wilson D, Acheson A, Cripps H, El-Sharkawy A, Ng O, Sharma P, Ward K, Chandler D, Courtney E, Bunni J, Butcher K, Dalton S, Flindall I, Katebe J, Roy P, Tate J, Vincent T, Williamson MER, Wood J, Bignell M, Branagan G, Broardhurst J, Chave H, Dean H, D'Souza N, Foster G, Sleight S, Sutaria R, Ahmed I, Budhoo MR, Colley J, Cruickshank N, Gill K, Hayes A, Joy H, Kamabjha C, Plowright J, Radley S, Rea M, Thumbe V, Torrance A, Varghese P, Wilkin R, Zulueta E, Allsop L, Atkari B, Badrinath K, Daliya P, Dube M, Heeley C, Hind R, Nash D, Palfreman A, Peacock O, Watson N, Blodwell M, Javaid A, Mohamad A, Muhammad K, Qureshi N, Ridgway S, Siddiqui K, Solkar M, Vere J, Wordie A, Chang J, Elgaddal S, Green M, Hollyman M, Mirza N, Rankin J, Williams G, Ali W, Hardwick A, Mohamed Z, Navid A, Netherton K, Obreja M, Rao M, Stringer J, Tennakoon A, Bullen T, Butt M, Dawson R, Dawson S, Farmer M, Garimella V, Gates Z, Wilkings L, Yeomans N, Adedeji O, Alalawi R, Al Araimi A, Ashraf S, Bach S, Beggs A, Cagigas C, Dattani M, Dimitriou N, Futaba K, Ghods-Ghorbani M, Glasbey J, Gourevitch D, Haydon G, Ismail T, Keh C, Morton DG, Narewal M, Nepogodiev D, Papettas T, Pinkney T, Poh A, Ranstorne E, Royle TJ, Shah T, Singh J, Smart C, Suggett N, Tayyab M, Vijayan D, Vohra R, Wairaich N, Yeung D, Bamford R, Chambers J, Cotton D, Houlihan R, Kynaston J, Longman R, Lowe A, Messenger D, Owais A, Phillpott C, Shabbir J, Baragwanath P, El-Sayed C, Gaunt A, Khatri C, McCullough P, Patel A, Ward S, Wilkin R, Obukofe R, Stroud R, Mason D, Williams N, Wong LS, Chaudhri S, Cooke J, Cunha M, Fairey H, Norwood M, Singh B, Thomasset S, Abbott S, Addison S, Archer J, Bhangu A, Church R, Holford E, Lenehan F, Odogwu S, Richardson L, Sidebotham J, Swan E, Tilley A, Wagstaff L, Amey I, Baird Y, Cripps N, Greenslade S, Harris G, Levy B, Mckenzie P, Misselbrook A, Moore S, Skull A, Nicol D, Reddy B, Thrush J, Iglesias Vecchio M, Dunn Y, Williams C, Furtado S, Gill M, Gilmore L, Goldsmith P, Kocialkowski C, Loganathan S, Nath R, Paraoan M, Taylor T, Allison A, Allison J, Curtis N, Dalton R, D'Costa C, Dennison G, Foster J, Francis N, Gibbons J, Hamdan M, Lewis A, Ockrim J, Sharma R, Spurdle K, Varadharajan S, Aghahoseini A, Alexander DJ, Bandyopadhyay D, Bradford I, Chitsabesan P, Coleman Z, Gibson A, Lasithiotakis K, Panagiotou D, Polyzois K, Stojkovic S, Woodcock N, Wright M, Hargest R, Jackson R, Rajesh A, Ogunbiyi O, Slater A, Yu LM. Prophylactic biological mesh reinforcement versus standard closure of stoma site (ROCSS): a multicentre, randomised controlled trial. Lancet 2020; 395:417-426. [PMID: 32035551 PMCID: PMC7016509 DOI: 10.1016/s0140-6736(19)32637-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [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: 09/04/2019] [Revised: 10/11/2019] [Accepted: 10/18/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Closure of an abdominal stoma, a common elective operation, is associated with frequent complications; one of the commonest and impactful is incisional hernia formation. We aimed to investigate whether biological mesh (collagen tissue matrix) can safely reduce the incidence of incisional hernias at the stoma closure site. METHODS In this randomised controlled trial (ROCSS) done in 37 hospitals across three European countries (35 UK, one Denmark, one Netherlands), patients aged 18 years or older undergoing elective ileostomy or colostomy closure were randomly assigned using a computer-based algorithm in a 1:1 ratio to either biological mesh reinforcement or closure with sutures alone (control). Training in the novel technique was standardised across hospitals. Patients and outcome assessors were masked to treatment allocation. The primary outcome measure was occurrence of clinically detectable hernia 2 years after randomisation (intention to treat). A sample size of 790 patients was required to identify a 40% reduction (25% to 15%), with 90% power (15% drop-out rate). This study is registered with ClinicalTrials.gov, NCT02238964. FINDINGS Between Nov 28, 2012, and Nov 11, 2015, of 1286 screened patients, 790 were randomly assigned. 394 (50%) patients were randomly assigned to mesh closure and 396 (50%) to standard closure. In the mesh group, 373 (95%) of 394 patients successfully received mesh and in the control group, three patients received mesh. The clinically detectable hernia rate, the primary outcome, at 2 years was 12% (39 of 323) in the mesh group and 20% (64 of 327) in the control group (adjusted relative risk [RR] 0·62, 95% CI 0·43-0·90; p=0·012). In 455 patients for whom 1 year postoperative CT scans were available, there was a lower radiologically defined hernia rate in mesh versus control groups (20 [9%] of 229 vs 47 [21%] of 226, adjusted RR 0·42, 95% CI 0·26-0·69; p<0·001). There was also a reduction in symptomatic hernia (16%, 52 of 329 vs 19%, 64 of 331; adjusted relative risk 0·83, 0·60-1·16; p=0·29) and surgical reintervention (12%, 42 of 344 vs 16%, 54 of 346: adjusted relative risk 0·78, 0·54-1·13; p=0·19) at 2 years, but this result did not reach statistical significance. No significant differences were seen in wound infection rate, seroma rate, quality of life, pain scores, or serious adverse events. INTERPRETATION Reinforcement of the abdominal wall with a biological mesh at the time of stoma closure reduced clinically detectable incisional hernia within 24 months of surgery and with an acceptable safety profile. The results of this study support the use of biological mesh in stoma closure site reinforcement to reduce the early formation of incisional hernias. FUNDING National Institute for Health Research Research for Patient Benefit and Allergan.
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Aslam MI, Baloch N, Mann C, Nilsson PJ, Maina P, Chaudhri S, Singh B. Simultaneous stoma reinforcement and perineal reconstruction with biological mesh - A multicentre prospective observational study. Ann Med Surg (Lond) 2018; 38:28-33. [PMID: 30595839 PMCID: PMC6308243 DOI: 10.1016/j.amsu.2018.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 12/07/2018] [Accepted: 12/13/2018] [Indexed: 12/17/2022] Open
Abstract
Introduction The optimal method for perineal reconstruction after extralevator abdominoperineal excision (elAPE) for low rectal cancer remains controversial. This study aimed to assess whether simultaneous perineal reconstruction and parastomal reinforcement with Strattice™ Reconstructive Tissue Matrix after elAPE could prevent hernia formation. Methods In this prospective, multicentre, observational, non-comparative study of consecutive patients undergoing elAPE for low rectal cancer underwent simultaneous perineal reconstruction and colostomy site reinforcement with Strattice™ mesh. All patients underwent long course chemoradiotherapy prior to surgery and had excision of the coccyx. Patients were assessed for perineal wound healing at 7 day, 1, 3, 6 and 12 months, perineal and parastomal hernia defects on clinical and radiological assessment at 1 year following surgery. Results 19 patients (median age = 67 years, median BMI = 26, M:F = 11:8) were entered the study. 10 (52.6%) patients underwent laparoscopic elAPE. The median length of post-operative stay was 9 days. Complete wound healing was observed for 8(42%) patients at 1 month, 12(63%) at 3 months, and 19(100%) patients at 12 months. Median time for radiological and clinical assessment for hernias was 12 months. No perineal hernia was detected in 17 patients following CT assessment. Dynamic MRI was undertaken in 11 patients at 12 months and all showed no evidence of perineal hernia. 3 (16%) patients had a parastomal hernia detected radiologically. No mesh was removed during the 12 months follow up period. Conclusion Perineal and parastomal reconstruction with biological mesh is a feasible approach for parastomal and perineal hernia prevention after laparoscopic and open elAPE. In this case series, consecutive patients underwent simultaneous perineal reconstruction and colostomy site reinforcement with Strattice™ biological mesh. Simultaneous perineal and parastomal reconstruction with Strattice™ mesh is an effective method of hernia prevention after elAPE. High quality prospective RCTs and national/international collaborative audits are required to compare this technique with others for perineal reconstruction.
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Affiliation(s)
- Muhammad Imran Aslam
- Department of Colorectal Surgery, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicestershire, UK
| | - Naseer Baloch
- Center for Digestive Diseases, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Christopher Mann
- Department of Colorectal Surgery, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicestershire, UK
| | - Per J Nilsson
- Center for Digestive Diseases, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Pierre Maina
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - Sanjay Chaudhri
- Department of Colorectal Surgery, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicestershire, UK
| | - Baljit Singh
- Department of Colorectal Surgery, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicestershire, UK
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Aslam MI, Chaudhri S, Singh B, Jameson JS. The “two-week wait” referral pathway is not associated with improved survival for patients with colorectal cancer. Int J Surg 2017; 43:181-185. [DOI: 10.1016/j.ijsu.2017.05.046] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 04/20/2017] [Accepted: 05/09/2017] [Indexed: 01/22/2023]
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Niraj G, Chaudhri S. Prospective Audit of a Pathway for In-Patient Pain Management of Chronic Abdominal Pain: A Novel and Cost-Effective Strategy. Pain Medicine 2017; 19:589-597. [DOI: 10.1093/pm/pnx118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
| | - Sanjay Chaudhri
- Department of Surgery, University Hospitals of Leicester, Leicester, UK
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Runau F, Collins A, Fenech GA, Ford E, Dimitriou N, Chaudhri S, Yeung JMC. A single institution's long-term follow-up of patients with pathological complete response in locally advanced rectal adenocarcinoma following neoadjuvant chemoradiotherapy. Int J Colorectal Dis 2017; 32:341-348. [PMID: 27885480 DOI: 10.1007/s00384-016-2712-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE This paper aimed to study the long term follow-up of patients with primary rectal adenocarcinoma receiving neoadjuvant chemoradiotherapy who obtained a pathological complete response (pCR) and identify factors predicting complete response. METHODS Retrospective review of notes, histology, pre-operative full blood count and imaging of patients with primary rectal adenocarcinoma diagnosed in our institute from 2000 to 2012 from a prospectively maintained database were used. SPSS version 22.0 was used for statistical analysis. RESULTS Three hundred eighty patients diagnosed with primary rectal adenocarcinoma were identified, 277 received neoadjuvant chemoradiotherapy followed by curative resection. Forty-six patients obtained a pCR (ypT0N0) with no local recurrence and two metastatic recurrences on follow-up. Patients with a pCR have a significantly improved overall survival and disease-free survival compared to a non-pCR (150.0 and 136.1 vs 77.5 and 84.7 months, p = 0.001). On univariate analysis, increased tumour height above anal verge, low lymph node yield, high pre-operative haemoglobin and a low neutrophil-lymphocyte ratio are significant factors identifying a pCR. Multivariable analysis of the above factors confirmed tumour height above anal verge as significant in obtaining a pCR. CONCLUSION Patients with rectal adenocarcinoma who develop a pCR following neoadjuvant chemoradiotherapy have improved overall and disease-free survival. We have identified distance from anal verge, low lymph node yield, high pre-operative haemoglobin and low neutrophil-lymphocyte ratio as significant predictors of developing a pCR.
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Affiliation(s)
- Franscois Runau
- Department of Colorectal Surgery, University Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, UK.
| | - Anna Collins
- Department of Colorectal Surgery, University Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, UK
| | - Glenn Ace Fenech
- Department of Colorectal Surgery, University Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, UK
| | - Eleanor Ford
- Department of Colorectal Surgery, University Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, UK
| | - Nikoletta Dimitriou
- Department of Colorectal Surgery, University Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, UK
| | - Sanjay Chaudhri
- Department of Colorectal Surgery, University Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, UK
| | - Justin M C Yeung
- Department of Colorectal Surgery, University Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, UK
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de Assis EM, Siddiqui YH, Kershaw R, Humphreys E, Chaudhri S, Jayaraman P, Gaston K. Protein kinase CK2 regulates prostate cancer cell migration and proliferation through phosphorylation of PRH/HHEX. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61340-0] [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: 10/21/2022]
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Aslam MI, Mykoniatis I, Mann C, Stephenson JA, Verma R, Chaudhri S, Singh B. Dynamic MRI to assess pelvic floor reconstruction with Strattice mesh after extralevator abdominoperineal excision for rectal cancer--a video vignette. Colorectal Dis 2016; 18:313-4. [PMID: 26663586 DOI: 10.1111/codi.13235] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 10/25/2015] [Indexed: 02/08/2023]
Affiliation(s)
- M I Aslam
- Department of Colorectal Surgery, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendoline Road, Leicester, LE5 4PW, UK.
| | - I Mykoniatis
- Department of Colorectal Surgery, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendoline Road, Leicester, LE5 4PW, UK
| | - C Mann
- Department of Colorectal Surgery, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendoline Road, Leicester, LE5 4PW, UK
| | - J A Stephenson
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendoline Road, Leicester, LE5 4PW, UK
| | - R Verma
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendoline Road, Leicester, LE5 4PW, UK
| | - S Chaudhri
- Department of Colorectal Surgery, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendoline Road, Leicester, LE5 4PW, UK
| | - B Singh
- Department of Colorectal Surgery, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendoline Road, Leicester, LE5 4PW, UK
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Runau F, Chaudhri S. Trephine defunctioning loop ileostomy: a simple technique using an Alexis wound protector - a video vignette. Colorectal Dis 2015; 17:827-8. [PMID: 26047125 DOI: 10.1111/codi.13020] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 05/26/2015] [Indexed: 02/08/2023]
Affiliation(s)
- F Runau
- Department of Colorectal Surgery, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK.
| | - S Chaudhri
- Department of Colorectal Surgery, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
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Ihedioha U, Esmail F, Lloyd G, Miller A, Singh B, Chaudhri S. Enhanced recovery programmes in colorectal surgery are less enhanced later in the week: An observational study. JRSM Open 2015; 6:2054270414562983. [PMID: 25780591 PMCID: PMC4349761 DOI: 10.1177/2054270414562983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives Since the introduction and favourable early results of the enhanced recovery programme more than a decade ago, it has become increasingly popular following major abdominal surgery. The programme has now been adopted in the UK. The aim of our study was to see if the day of surgery affected hospital stay and we compared patients who had colorectal surgery early in the week (Monday to Wednesday) with those who had it later in the week (Thursday to Friday). Design Patient outcomes were studied between May 2010 and April 2011 from a prospectively maintained database. All colorectal surgeons involved in the enhanced recovery programme in our unit have a flexible rota and so no surgeon was operating on a particular day to avoid bias. An enhanced recovery programme protocol was utilised for all the patients with no bowel preparation, early feeding and early mobilisation. Setting Study was carried out at the University Hospitals of Leicester. Participants Patients undergoing elective colorectal resection between Monday and Friday. Main outcome measure Hospital stay. Results Two hundred and twenty-seven patients underwent surgery and were on the enhanced recovery programme during this period. Two (0.9%) patients who had surgery on a Sunday were excluded. Two hundred and twenty-five patients were analysed of which 155 (69%) were in the group (Monday to Wednesday) and 70 (31%) in the group (Thursday to Friday). No significant differences were observed amongst the groups for age (p = 0.129), sex (p = 0.555), tumour location (p = 0.140), operation performed (p = 0.127), type of surgery (laparoscopy or open, p = 0.892), complications (p = 0.428). However, a significant shorter length of stay was present in the first group six days (interquartile range: 4–10) versus eight days (interquartile range: 5–11) (p = 0.045). Conclusion Operating on colorectal patients early in the week is associated with a significant decreased hospital stay. This should be put into consideration by units practising enhanced recovery programme if the maximal benefit of this is to be attained.
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Affiliation(s)
| | | | - G Lloyd
- Leicester General Hospital, Leicester LE5 4PW, UK
| | | | - Baljit Singh
- Leicester General Hospital, Leicester LE5 4PW, UK
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Niraj G, Kelkar A, Hart E, Horst C, Malik D, Yeow C, Singh B, Chaudhri S. Comparison of analgesic efficacy of four-quadrant transversus abdominis plane (TAP) block and continuous posterior TAP analgesia with epidural analgesia in patients undergoing laparoscopic colorectal surgery: an open-label, randomised, non-inferiority tri. Anaesthesia 2014; 69:348-55. [DOI: 10.1111/anae.12546] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2013] [Indexed: 01/08/2023]
Affiliation(s)
- G. Niraj
- Department of Anaesthesia; University Hospitals of Leicester NHS Trust; Leicester General Hospital; Leicester UK
| | - A. Kelkar
- Department of Anaesthesia; University Hospitals of Leicester NHS Trust; Leicester General Hospital; Leicester UK
| | - E. Hart
- Department of Anaesthesia; University Hospitals of Leicester NHS Trust; Leicester General Hospital; Leicester UK
| | - C. Horst
- Department of Anaesthesia; University Hospitals of Leicester NHS Trust; Leicester General Hospital; Leicester UK
| | - D. Malik
- Department of Anaesthesia; University Hospitals of Leicester NHS Trust; Leicester General Hospital; Leicester UK
| | - C. Yeow
- Department of Anaesthesia; University Hospitals of Leicester NHS Trust; Leicester General Hospital; Leicester UK
| | - B. Singh
- Department of Colorectal Surgery; University Hospitals of Leicester NHS Trust; Leicester General Hospital; Leicester UK
| | - S. Chaudhri
- Department of Colorectal Surgery; University Hospitals of Leicester NHS Trust; Leicester General Hospital; Leicester UK
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Ihedioha U, Vaughan S, Mastermann J, Singh B, Chaudhri S. Patient education videos for elective colorectal surgery: results of a randomized controlled trial. Colorectal Dis 2013; 15:1436-41. [PMID: 23841586 DOI: 10.1111/codi.12348] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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: 12/08/2012] [Accepted: 03/06/2013] [Indexed: 12/15/2022]
Abstract
AIM Recent advances in surgery have focused on peri-operative care and interventions to improve outcome following surgery. Psychological preparation has a positive impact on recovery and incorporates a range of strategies with dissemination of information as one of the key elements. Information can be given verbally, through printed information or through use of a video. Traditionally, reliance has been on the use of written material as an adjunct to patient education in clinic. The current study is a randomized trial on the use of video education in patients undergoing elective colorectal resection within an enhanced recovery programme. METHOD Sixty-five eligible patients undergoing elective colorectal surgery were identified and 61 were randomized between August 2010 and August 2011 to either video and information leaflets or information leaflets alone. A fast track protocol was established for all the patients. Clinicians in charge of postoperative recovery were blinded. Standard discharge criteria were employed for all patients. RESULTS Of 61 patients randomized, one dropped out and outcomes on 60 were analysed. There was no difference in baseline characteristics between the groups (age, P = 0.964; body mass index, P = 0.829). Twenty-eight (91%) patients in the video group had left sided resections while two (6%) had right sided resections. Nineteen (66%) in the non-video group had left sided resections while nine (31%) had right sided resections. One (3%) patient in the non-video group and one (3%) in the video group had a total colectomy. Fourteen (45%) patients in the video group and 12 (41%) in the non-video group had surgery completed laparoscopically. There was no difference in the primary (median hospital stay 5 vs 5 days; P = 0.239) or the secondary outcome measures (pain score on movement, P = 0.338; pain score at rest, P = 0.989; nausea score, P = 0.74; epidural use, P = 0.984; paracetamol use, P = 0.44; voltarol use, P = 0.506) between the groups. CONCLUSION Use of video education in the psychological preparation of patients undergoing elective colorectal surgery does not improve short-term outcomes.
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Affiliation(s)
- U Ihedioha
- Department of Surgery, University Hospitals of Leicester, Leicester, UK
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Butt HZ, Salem MK, Vijaynagar B, Chaudhri S, Singh B. Perineal reconstruction after extra-levator abdominoperineal excision (eLAPE): a systematic review. Int J Colorectal Dis 2013; 28:1459-68. [PMID: 23440362 DOI: 10.1007/s00384-013-1660-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE Extra-levator abdominal perineal excision of rectum (eLAPE) for low rectal tumours is associated with a lower incidence of circumferential resection involvement. However, there is no consensus on the ideal technique for perineal reconstruction following eLAPE. We thereby conducted a 5-year review of perineal closure outcomes following eLAPE. METHODS A systematic review of the literature was conducted between 2006 and July 2012. Perineal wound healing and complications in the post-operative period were examined. RESULTS Original data following eLAPE were found in 27 studies involving 963 individuals to inform a qualitative synthesis. Pooled analysis revealed that investigators most commonly employed either biomesh closure (12 studies, n = 149), myocutaneous flap closure (9 studies, n = 201) and primary closure (4, n = 578). The incidence of minor and major wound complications and perineal hernias across the latter groups was (27.5, 13.4 and 2.7 %), (29.4, 19.4 and 0 %) and (17.1, 6.4 and 1.2 %), respectively. Two studies utilised synthetic mesh closure (n = 4) and omentoplasty (n = 31). Objective assessment of wound healing was strikingly deficient across most studies, largely due to low level retrospective evidence lacking randomised controls. Modest cohort sizes with short follow-up data were evident due to the relative novelty of eLAPE. CONCLUSION The paucity of high quality data, suggests that a prospective, randomised trial is needed to determine the ideal technique for perineal reconstruction following eLAPE.
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Affiliation(s)
- Hisham Z Butt
- Department of Colorectal Surgery, Leicester General Hospital, University Hospitals of Leicester, Gwendolen Road, Leicester, Leicestershire, LE5 4PW, UK
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Krishnatry R, Mahantshetty U, Chaudhri S, Kanujia A, Engineer R, Chopra S, Shrivastava S. Comparison of 2 Contouring Methods of Bone Marrow on CT and Correlation With Hematological Toxicities (HT) in Non-bone Marrow Sparing Pelvic IMRT (NBM-IMRT) With Concurrent Cisplatin for Cervical Cancer. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1130] [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: 10/27/2022]
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Ihedioha U, Sangal S, Mastermann J, Singh B, Chaudhri S. Preparation for elective colorectal surgery using a video: a questionnaire-based observational study. JRSM Short Rep 2012; 3:58. [PMID: 23301146 PMCID: PMC3434430 DOI: 10.1258/shorts.2011.011126] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Objective Every patient has a perception about surgery and psychological preparation of the patient has an important impact on their postoperative recovery and outcome. In this study we looked at impact of a visual educational aid, in the form of a patient DVD on outcome following colorectal surgery within an enhanced recovery programme (ERP). Design We carried out a prospective analysis of a consecutive series of patients undergoing elective colorectal resection. All patients were given information about their operation in a clinic setting. Our intervention included a 15 minute patient educational video describing the preoperative assessment, post-operative recovery and advice on discharge. A questionnaire on patients' views of ERP and video education was given on discharge. Setting University teaching hospital Participants Patients undergoing elective colorectal resection Main Outcome Measures Outcomes studied included length of hospital stay, patient perception of ERP, postoperative complications and readmissions: Results Thirty-two patients underwent elective colorectal surgery over a 3 month period. Median length of stay in hospital was 5 days. The questionnaire response rate was 100%. All patients thought they were well informed of the enhanced recovery programme. Eighty-eight percent responded that the video information provided about their operation was adequate, with 28% finding the video very helpful and more useful than other forms of patient information. There were no major postoperative complications and no readmissions. Conclusion Audiovisual presentation in the form of a patient video is a useful tool in the psychological preparation of patients undergoing colorectal surgery.
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Affiliation(s)
- U Ihedioha
- Leicester General Hospital , Gwendolen Road, Leicester, LE5 4PW , UK
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Ward S, Jewkes A, Jones B, Chaudhri S, Hejmadi R, Ismail T, Hallissey M. The sensitivity of needle core biopsy in combination with other investigations for the diagnosis of phyllodes tumours of the breast. Int J Surg 2012; 10:527-31. [DOI: 10.1016/j.ijsu.2012.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 08/02/2012] [Accepted: 08/06/2012] [Indexed: 10/28/2022]
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Soumian S, Down SK, Roked F, Chaudhri S, Francis A. P5-12-02: Vacuum Assisted Biopsies of Ductal Carcinoma In Situ and Concordance with Post-Operative Histology: Implications for the Low Risk DCIS Trial. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p5-12-02] [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: 11/16/2022]
Abstract
Abstract
Aim The enormous increase in the diagnosis of ductal carcinoma in situ (DCIS) by the NHS Breast screening has not lead to an expected decrease in the incidence of invasive breast cancer. It is not clear if all grades of DCIS progress inexorably to invasive cancer if left untreated. There is recognition that DCIS is overtreated, ie if left alone may not cause harm during the woman's lifetime. In the absence of new clinical trial data, surgery still remains the universal treatment. It is known that a higher proportion of patients with screen detected DCIS receive mastectomy than those with screen detected invasive cancer. Recently a randomized trial called the Low risk DCIS Trial has been proposed which intends to specifically compare the current treatment of low grade DCIS ie surgery with active monitoring using annual mammography. In order to effectively implement this, concordance between diagnostic biopsy and excision histology is vital and therefore vacuum assisted mammotome biopsy (VAB) and a central pathology review of diagnostic biopsy specimens prior to randomization will be mandatory. Therefore, in this study, we assessed the concordance between diagnostic biopsies performed by VAB technique and the post operative histology for DCIS in our institution.
Methods Retrospective data of all diagnostic breast biopsies specifically using the VAB technique with the primary diagnosis of DCIS from year 2001 to 2010 in our institution was collected. Both screening and symptomatic patients were included. Concordance between diagnostic histology and post operative excision histology was assessed for high, intermediate and low grade DCIS. Demographic details and potential factors influencing concordance including number of cores taken and lesion size were also collected for analysis.
Results A total of 161 cases were identified out of which 102 (63%) were of high grade, 35 (22%) of intermediate grade and 24 (15%) were of low grade histology. In the High grade group, the concordance with final histology was 70% (72/102). In this group, the diagnosis was upgraded to invasive carcinoma in 21% (21/102). 9% (9/102) were downgraded to intermediate or low grade. In the intermediate grade group, the concordance with final histology was 66% (23/35). In this group, the diagnosis was upgraded to invasive carcinoma in 11% (4/35) and to high grade in 17% (6/35). 6% (2/35) were downgraded to low grade. In the low grade group, the concordance with final histology was 71% (17/24). In this group, the diagnosis was upgraded to intermediate grade in 17% (4/24) and invasive carcinoma in 12% (3/24). All factors associated with lack of concordance were noted.
Conclusion Concordance between VAB diagnostic biopsies of high, intermediate and low grade DCIS and post operative histology is good in this series and is to our knowledge the first to be reported using only large volume biopsies by VAB techniques. This audit has identified possible factors influencing the lack of concordance and these results with concordance data from other UK centres will be used by trial pathologists to refine protocols for the Low risk DCIS trial.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-12-02.
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Affiliation(s)
- S Soumian
- 1Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, England, United Kingdom
| | - SK Down
- 1Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, England, United Kingdom
| | - F Roked
- 1Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, England, United Kingdom
| | - S Chaudhri
- 1Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, England, United Kingdom
| | - A Francis
- 1Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, England, United Kingdom
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Singh B, Lloyd G, Nilsson PJ, Chaudhri S. Laparoscopic extralevator abdominal perineal excision of the rectum: the best of both worlds. Tech Coloproctol 2011; 16:73-5. [PMID: 22170251 DOI: 10.1007/s10151-011-0797-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Accepted: 11/23/2011] [Indexed: 12/13/2022]
Abstract
We report a combined laparoscopic and open technique for extralevator abdominal perineal excision of the rectum. The key steps are a laparoscopic rectal dissection limited distally by the coccyx. The open, prone, perineal dissection affords excellent views and allows a cylindrical specimen to be obtained. The resulting perineal defect is closed by a biological mesh. Extralevator abdominal perineal excision of the rectum offers a superior oncological specimen with reduced circumferential resection margin involvement compared to traditional techniques. Combined with a laparoscopic approach, this also has the potential to improve postoperative recovery and reduce morbidity.
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Affiliation(s)
- B Singh
- University Hospitals Leicester, Leicester, UK.
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McNicol FJ, Bruce CA, Chaudhri S, Francombe J, Kozman E, Taylor BA, Tighe MJ. Management of obstetric anal sphincter injuries--a role for the colorectal surgeon. Colorectal Dis 2010; 12:927-30. [PMID: 19508524 DOI: 10.1111/j.1463-1318.2009.01897.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM To determine if surgical repair of third and fourth degree obstetric perineal tears by an experienced colorectal surgeon produces satisfactory functional results in the short and long term. METHOD Consecutive deliveries were studied prospectively over a 32-month period. All patients with suspected third or fourth degree tears were referred to the colorectal team. Following confirmation of the injury, patients underwent surgical repair using a standard overlapped technique according to an established protocol. The patients were reviewed 2 months later. Long-term continence was determined, by postal and telephone follow up, after a minimum of 3 years. RESULTS Fifty-nine sphincter injuries were identified and repaired by the colorectal team. Two months following repair 51 (86%) of patients had normal continence, four (7%) had urgency, and five (8%) had occasional incontinence of flatus. All patients with any degree of incontinence underwent endoanal ultrasound at which no sphincter defects were noted, and all improved symptomatically following pelvic floor physiotherapy. Long-term follow up data was obtained in 45 women. Thirty-nine (87%) had normal continence scores, 11 (24%) described urgency, but only three (7%) were often incontinent of liquid stool. Seven (15%) were occasionally incontinent of flatus. CONCLUSION Excellent short and long-term functional results were obtained in the repair of third and fourth degree tears when performed by experienced colorectal surgeons. Since the protocol was established, obstetricians in North Cheshire have adopted the double overlapped technique, and now manage the majority of these injuries themselves.
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Affiliation(s)
- F J McNicol
- Department of Surgery, North Cheshire Hospitals NHS Trust, Warrington, CheshireUK.
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Sircar T, Chaudhri S, Francis A. 1303 Effect of neoadjuvant chemotherapy on oestrogen receptor, progesterone receptor and HER 2 receptor expression in breast cancer. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70476-8] [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: 12/01/2022] Open
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Sircar T, Chaudhri S, Francis A. Effect of neoadjuvant chemotherapy on oestrogen, progesterone, and HER-2 receptor expression in breast cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e11588] [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: 11/20/2022] Open
Abstract
e11588 Background: Neoadjuvant chemotherapy(NC) is used in treating locally advanced operable breast cancer. After surgery, further adjuvant treatment is offered based on the estrogen receptor (ER), progesterone receptor (PR) and HER2 status. Treatment post operatively can be based on the ER/PR/HER2 status of the core biopsy taken preoperatively. It is not a usual practice in the United Kingdom to repeat these markers on the surgical specimen. However a change in ER/PR or HER2 status following NC could have a profound effect on adjuvant treatment with the real possibility of appropriate therapy being unknowingly withheld. The aim of our study was to determine the percentage of patients whose ER/PR, HER2 receptor expression change with NC and if these changes lead to change in their adjuvant treatment. Methods: This is a retrospective study of 32 patients with locally advanced breast cancer who had NC followed by breast conservation surgery or mastectomy. Quick score (Q score) for ER/PR and the HER2 expression was measured both from the preoperative core biopsy and from the excision specimen following NC. Results: After NC, 5 patients had complete pathological response and 2 patients had residual ductal carcinoma in situ. 25(78%) patients had residual invasive malignancy. Quantitative change in Q scores for ER and PR was seen in 6 patients(24%) and 10 patients (40%) respectively. ER status changed from positive to negative in 1 patient(4%). PR status changed from positive to negative in 4 patients(16%) and from negative to positive in one patient (4%). One patient(4%) changed from HER2 negative to HER2 positive after NC. Conclusions: Change in 1 patient(4%) from HER2 negative to HER2 positive lead to change in adjuvant treatment who would have otherwise not received transzutumab.Q scores changed in 24% and 40% for ER and PR respectively, however, no change was observed with regards to hormonal adjuvant treatment. A study with a bigger cohort might address this issue. We suggest that ER/PR/HER2 status should routinely be checked in both core biopsy sample and also resection specimen. No significant financial relationships to disclose.
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Affiliation(s)
- T. Sircar
- University Hospital Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - S. Chaudhri
- University Hospital Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - A. Francis
- University Hospital Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
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Abstract
OBJECTIVES To establish the prevalence of small, flat carcinomas in surgically resected colon. To determine whether tumour morphology influences stage at presentation. METHOD 1763 surgically resected colorectal cancers from one UK centre excised between 1995 and 2004 were examined. Age 69 years, (42-90), M:F equal. Sixty-one tumours < or =20 mm across were identified. Slides were reviewed by a consultant histopathologist and classified using Japanese Research Society Classification, JRSC and TNM staging. Fisher's exact test was used for analysis. RESULTS In 61 small cancers, 64% (39/61) showed flat morphology and 33% (20/61) polypoid. Two lesions were unclassifiable. Prevalence was 2.2% of all resected colorectal cancers. More T1 tumours at presentation were polypoid, (30% vs. 8%; P = 0.033). T3 tumours were more likely to be flat than polypoid, (49% vs. 20%; P = 0.016). Infiltration into musclaris mucosa occurred in 77% (30/39) flat tumours. Rates of metastases were high in both groups, (30% polypoid vs. 39% flat, not significant). CONCLUSIONS The prevalence of small, flat cancers in resected specimens in the UK concurs with that of Japanese studies. Small, flat cancers should be staged carefully because of high rates of T3/4 disease. The results support the theory of accelerated carcinogenesis in flat cancers.
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Chaudhri S, Maruthachalam K, Kaiser A, Robson W, Pickard RS, Horgan AF. Successful voiding after trial without catheter is not synonymous with recovery of bladder function after colorectal surgery. Dis Colon Rectum 2006; 49:1066-70. [PMID: 16586141 DOI: 10.1007/s10350-006-0540-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE The need for monitoring postoperative urine output and the possibility of lower urinary tract dysfunction following colorectal surgery necessitates temporary urinary drainage. Current practice assumes recovery of lower urinary tract function to coincide with successful micturition after removal of urethral catheter. The aim of this study was to analyze the recovery of bladder function following colorectal surgery. METHODS Patients undergoing colorectal operations underwent preoperative and postoperative uroflowmetry and residual urine estimation. All patients were catheterized suprapubically at surgery. Uroflowmetry and postvoid residual volumes were recorded postoperatively until recovery of bladder function was complete. RESULTS Thirty consecutive patients underwent suprapubic catheterization, 25 of whom completed the study. Seventeen (68 percent) patients were able to pass urine within 72 hours of surgery. Recovery of lower urinary tract function was delayed in patients undergoing rectal vs. colonic resections (median, 6 vs. 3 days, P = 0.0015). Postvoid residual volumes greater than 200 ml were noted in three (20 percent) patients following rectal resections beyond the tenth postoperative day, with complete emptying achieved by six weeks. CONCLUSIONS Apparent successful micturition following rectal resections does not always indicate recovery of bladder function. The use of suprapubic catheters, in addition to being safe and effective, allows assessment of residual volumes postoperatively and smoothes the path to full recovery of lower urinary tract function.
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Affiliation(s)
- Sanjay Chaudhri
- Department of Colorectal Surgery, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
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Maruthachalam K, Stoker E, Chaudhri S, Noblett S, Horgan AF. Evolution of the two-week rule pathway--direct access colonoscopy vs outpatient appointments: one year's experience and patient satisfaction survey. Colorectal Dis 2005; 7:480-5. [PMID: 16108885 DOI: 10.1111/j.1463-1318.2005.00868.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Abstract Objectives The aim of this study was to compare the effectiveness of Direct access colonoscopy (DAC) vs outpatient appointments for two-week rule colorectal cancer referrals and to evaluate the satisfaction of patients referred through these routes. Patients and methods Data were collected prospectively from January 2003 to December 2003 on patients who were referred for DAC or outpatient appointments at the discretion of the referring General practitioner via the Lower GI two-week rule pathway. A postal questionnaire was used to survey patient satisfaction. Results Six hundred and thirty-nine patients were referred via the two-week rule pathway; 188 patients underwent colonoscopy at their initial hospital visit and 19 (10.1%) colorectal cancers were diagnosed; 442 patients had an outpatient appointment and 32 (7.2%) colorectal cancers were identified. There were 7 (1%) inappropriate referrals and 2 patients refused investigations. All outcome parameters measured were reduced for patients referred directly for colonoscopy including time to definitive investigations (Median 9 vs 52 days P < 0.0001), time to histological diagnosis (Median 14 vs 42 days P < 0.0001) and time to treatment (Median 55 vs 75 days P < 0.0483). One hundred and seventy patients were surveyed by the postal questionnaire of whom 127 (75%) responded. Ninety-eight percent of patients were satisfied with the service provided. Four (6.6%) of 60 patients who had undergone direct access colonoscopy expressed a desire to be seen at the outpatient department initially. Conclusions Direct access colonoscopy results in significantly reduced times to histological diagnosis and definitive treatment in patients with colorectal cancer. Patients can be directly admitted for investigations bypassing the outpatient clinic without affecting patient satisfaction.
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Affiliation(s)
- K Maruthachalam
- Freeman Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle, UK
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Abstract
PURPOSE Conventional practice in colorectal surgery involves stoma education being imparted postoperatively. Proficiency in stoma management often delays patients' discharge following colorectal surgery. The aim of this randomized, controlled trial was to compare preoperative intensive, community-based stoma education with conventional postoperative stoma education after elective colorectal surgery. METHODS Forty-two elective colorectal patients requiring a stoma were randomized into an intensive preoperative teaching (study) or postoperative (control) group. Intervention for the study group included two preoperative visits in the community during which patients were taught with audiovisual aids to use and change the stoma pouching system. Goal-directed postoperative stoma education was standardized for both groups. Outcomes measured included time to stoma proficiency, postoperative hospital stay, unplanned stoma-related interventions in the community within six weeks of discharge, and preoperative and postoperative hospital anxiety and depression scores. Cost-effectiveness of the intervention was also evaluated. RESULTS All outcomes measured were improved in the study group, including time to stoma proficiency (5.5 vs. 9 days; P = 0.0005), hospital stay (8 vs. 10 days; P = 0.029), and unplanned stoma-related community interventions per patient (median 0 vs. 0.5; P = 0.0309). No adverse effects of the intervention were noted. The average cost saving per patient was pound 1,119 (dollar 2,104) for the study group compared with the control group. CONCLUSIONS Stoma education is more effective if undertaken in the preoperative setting. It results in shorter times to stoma proficiency and earlier discharge from the hospital. It also reduces stoma-related interventions in the community and has no adverse effects on patient well-being.
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Affiliation(s)
- Sanjay Chaudhri
- University Hospital Aintree, Aintree Hospitals NHS Trust, Liverpool, United Kingdom
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Abstract
Vascular endothelial growth factor C (VEGF-C) has angiogenic and lymphangiogenic properties and is associated with the development of lymphatic metastases in a number of epithelial malignancies. The aim of this study was to determine VEGF-C protein expression in a series of breast carcinomas and correlate this with axillary lymph node (LN) metastases, the presence of lympho-vascular invasion (LVI), bone marrow micro-metastases (BMM) and other clinico-pathological data including oestrogen receptor (ER) and c-erbB2 status. VEGF-C expression was determined by immunohistochemistry (IHC) in 51 tumours. ER and c-erbB2 were also assessed by IHC. Bone marrow analysis was performed using a combination of immunomagnetic separation and immunocytochemistry. Overall, 30/51 (59%) of the tumours were positive for VEGF-C. There was no significant correlation between VEGF-C expression and LN status, LVI, BMM, tumour size, grade or ER status. However, there was an association between c-erbB2 and VEGF-C expression (P=0.013). The correlation between VEGF-C and c-erbB2 suggests a functional relationship and may, in part, explain the aggressive phenotype associated with c-erbB2-positive tumours.
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Affiliation(s)
- F J Hoar
- Department of Surgery, City Hospital, Birmingham B18 7QH, UK.
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Chaudhri S, Colvin JR, Todd JG, Kenny GN. Evaluation of closed loop control of arterial pressure during hypotensive anaesthesia for local resection of intraocular melanoma. Br J Anaesth 1992; 69:607-10. [PMID: 1467105 DOI: 10.1093/bja/69.6.607] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
We have studied 20 patients undergoing local resection of intraocular melanoma during hypotensive anaesthesia, allocated randomly to receive either manual control by an experienced anaesthetist or closed-loop computer control of an infusion of a 5:1 mixture of trimetaphan camsylate (TMP) and sodium nitroprusside (SNP). There were no significant differences in the smallest systolic and diastolic arterial pressures obtained, heart rate or infusion requirements between the two groups, but the duration of both the infusion and the operation were significantly longer in the computer-controlled group (P < 0.05). The quality of control of arterial pressure was assessed by the percentage of time spent at pressures greater and less than the prescribed target values, and was satisfactory in both groups during the critical period of profound hypotension. We conclude that the computer-controlled infusion performed satisfactorily during profound hypotension compared with an experienced anaesthetist.
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Affiliation(s)
- S Chaudhri
- University Department of Anaesthesia, Glasgow Royal Infirmary
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Abstract
Sixty patients premedicated with temazepam were allocated randomly to receive an infusion of propofol designed to achieve and maintain a target blood concentration of 3, 4 or 5 micrograms.ml-1. Induction time was measured from the start of infusion to loss of verbal contact. The success rate of inducing anaesthesia within 3 min of achieving the target concentration was 40% when the predicted target concentration was 3 micrograms.ml-1, 75% when the predicted target was 4 micrograms.ml-1 and 90% when the target was 5 micrograms.ml-1. There were no significant differences between the three groups for time to loss of verbal contact in patients who were induced successfully within 3 min. There were significant reductions in arterial pressure 3 min after achieving the target concentrations within the groups but not between them. The frequency of apnoea and pain on injection was small in all groups. Selecting a target concentration of 5 microgram.ml-1 would successfully induce anaesthesia in the majority of patients premedicated with temazepam without major haemodynamic or respiratory side effects.
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Affiliation(s)
- S Chaudhri
- University Department of Anaesthesia, Royal Infirmary, Glasgow
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Chaudhri S, Kenny GN. Sedation after cardiac bypass surgery: comparison of propofol and midazolam in the presence of a computerized closed loop arterial pressure controller. Br J Anaesth 1992; 68:98-9. [PMID: 1739576 DOI: 10.1093/bja/68.1.98] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Forty patients who had undergone coronary artery graft surgery and who required vasodilator therapy for postoperative hypertension were given infusions of either propofol (2,6,di-isopropylphenol) or midazolam, together with an infusion of morphine for analgesia while ventilation was controlled artificially. Sodium nitroprusside was administered to patients in both groups using a computer-controlled closed loop system. Both agents produced good quality of sedation. Overall times to spontaneous ventilation and tracheal extubation were shorter in the propofol group, but this was not statistically significant. Ease of control of arterial pressure was satisfactory clinically with both agents, although propofol appeared to be associated with a statistically greater incidence of hypotension.
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Affiliation(s)
- S Chaudhri
- University Department of Anaesthesia, Royal Infirmary, Glasgow
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Colvin JR, Chaudhri S, Kenny GN. Evaluation of dopexamine hydrochloride as an anti-hypertensive agent after cardiac surgery. Int J Clin Monit Comput 1991; 8:95-100. [PMID: 1683886 DOI: 10.1007/bf02915542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- J R Colvin
- University Dept. of Anaesthesia, Glasgow Royal Infirmary, Scotland
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Chaudhri S, Kenny GN. Nitroprusside-sparing effects of enoximone. Cardiology 1990; 77 Suppl 3:46-50; discussion 62-7. [PMID: 2148280 DOI: 10.1159/000174671] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Thirty patients who had undergone coronary artery bypass grafting and who required vasodilator therapy for control of arterial hypertension were allocated to receive either low-dose or high-dose enoximone or placebo infusions. A closed-loop arterial pressure control system was used to assess cardiovascular stability and the amount of sodium nitroprusside required to maintain control. There were no significant differences between the three groups in the time spent at 10, 20 and 30 mm Hg below the target pressure or at 10 and 20 mm Hg above the target pressure. However, the low-dose enoximone group spent a statistically greater amount of time at 30 mm Hg above the target pressure. There were no significant differences in the amount of sodium nitroprusside required to maintain control, in the duration of sodium nitroprusside infusion or in the heart rate. In conclusion, enoximone was not associated with a clinically significant effect on systolic pressure.
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Affiliation(s)
- S Chaudhri
- University Department of Anaesthesia, Glasgow Royal Infirmary, UK
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Abstract
We describe five cases of macroglossia in patients with posterior fossa disease and suggest that the primary mechanism is neurogenically determined rather than one of vascular obstruction or local trauma.
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