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Visaggi P, Ghisa M, Barberio B, Chiu PW, Ishihara R, Kohn GP, Morozov S, Thompson SK, Wong I, Hassan C, Savarino EV. Gastro-esophageal diagnostic workup before bariatric surgery or endoscopic treatment for obesity: position statement of the International Society of Diseases of the Esophagus. Dis Esophagus 2024; 37:doae006. [PMID: 38281990 DOI: 10.1093/dote/doae006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024]
Abstract
Obesity is a chronic and multifactorial condition characterized by abnormal weight gain due to excessive adipose tissue accumulation that represents a growing worldwide challenge for public health. In addition, obese patients have an increased risk of hiatal hernia, esophageal, and gastric dysfunction, as well as gastroesophageal reflux disease, which has a prevalence over 40% in those seeking endoscopic or surgical intervention. Surgery has been demonstrated to be the most effective treatment for severe obesity in terms of long-term weight loss, comorbidities, and quality of life improvements and overall mortality decrease. The recent emergence of bariatric endoscopic techniques promises less invasive, more cost-effective, and reproducible approaches to the treatment of obesity. With the endorsement of the International Society for Diseases of the Esophagus, we started a Delphi process to develop consensus statements on the most appropriate diagnostic workup to preoperatively assess gastroesophageal function before bariatric surgical or endoscopic interventions. The Consensus Working Group comprised 11 international experts from five countries. The group consisted of gastroenterologists and surgeons with a large expertise with regard to gastroesophageal reflux disease, bariatric surgery and endoscopy, and physiology. Ten statements were selected, on the basis of the agreement level and clinical relevance, which represent an evidence and experience-based consensus of the International Society for Diseases of the Esophagus.
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Affiliation(s)
- Pierfrancesco Visaggi
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Digestive Endoscopy Unit, Pisa University Hospital, Pisa, Italy
| | - Matteo Ghisa
- Digestive Endoscopy Unit, Department of Gastroenterology, Padua University Hospital, Padua, Italy
| | - Brigida Barberio
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Philip W Chiu
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Geoffrey P Kohn
- Department of Surgery, Monash University Eastern Health Clinical School, Melbourne, Australia
- Melbourne Upper GI Surgical Group, c/o Cabrini Hospital, Malvern, Australia
| | - Sergey Morozov
- Department of Gastroenterology, Hepatology and Nutrition, Federal Research Center of Nutrition, Biotechnology and Food Safety, Moscow, Russia
| | - Sarah K Thompson
- College of Medicine & Public Health, Flinders University, Bedford Park, Australia
| | - Ian Wong
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Biomedical Sciences, Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Milan, Italy
| | - Edoardo Vincenzo Savarino
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
- Gastroenterology Unit, Azienda Ospedale Università of Padua, Padua, Italy
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Marshall-Webb M, Myers JC, Watson DI, Bright T, Omari TI, Thompson SK. Mucosal impedance as a diagnostic tool for gastroesophageal reflux disease: an update for clinicians. Dis Esophagus 2024:doae037. [PMID: 38670809 DOI: 10.1093/dote/doae037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/27/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024]
Abstract
Mucosal impedance is a marker of esophageal mucosal integrity and a novel technique for assessing esophageal function and pathology. This article highlights its development and clinical application for gastroesophageal reflux disease (GERD), Barrett's esophagus, and eosinophilic esophagitis. A narrative review of key publications describing the development and use of mucosal impedance in clinical practice was conducted. A low mean nocturnal baseline impedance (MNBI) has been shown to be an independent predictor of response to anti-reflux therapy. MNBI predicts medication-responsive heartburn better than distal esophageal acid exposure time. Patients with equivocal evidence of GERD using conventional methods, with a low MNBI, had an improvement in symptoms following the initiation of PPI therapy compared to those with a normal MNBI. A similar trend was seen in a post fundoplication cohort. Strong clinical utility for the use of mucosal impedance in assessing eosinophilic esophagitis has been repeatedly demonstrated; however, there is minimal direction for application in Barrett's esophagus. The authors conclude that mucosal impedance has potential clinical utility for the assessment and diagnosis of GERD, particularly when conventional investigations have yielded equivocal results.
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Affiliation(s)
- Matthew Marshall-Webb
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Jennifer C Myers
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of Surgery, The University of Adelaide, Adelaide, SA, Australia
| | - David I Watson
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Tim Bright
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Taher I Omari
- Human Physiology and Centre for Neuroscience, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Sarah K Thompson
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Fantasia JJ, Cock C, Watson DI, Bright T, Thompson SK. Assessment of laparoscopic fundoplication with endoscopy: room for improvement. Surg Endosc 2024; 38:713-719. [PMID: 38036765 DOI: 10.1007/s00464-023-10570-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/22/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION Gastroesophageal reflux disease affects a significant portion of the Australian and world population. Minimally invasive laparoscopic fundoplication is a highly effective treatment in appropriately selected patients, with a 90% satisfaction rate. However, up to 5% will undergo revisional surgery. Endoscopy is an important investigation in the evaluation of persistent or new symptoms after fundoplication. Our study sought to evaluate the inter-rater reliability and variability in assessing fundoplication with endoscopy. METHODS Upper gastrointestinal (UGI) surgeons and gastroenterologists were invited to join the cohort study through their professional membership with two societies based in Australia. Participants completed a two part 25-item multiple choice questionnaire, involving the analysis of ten static endoscopic images post-fundoplication. RESULTS A total of 101 participants were included in the study (64 UGI surgeons and 37 gastroenterologists). Over 95% of participants were consultant level, working in non-rural tertiary hospitals. Total accuracy for all 10 cases combined was 76% for UGI surgeons and 69.9% for gastroenterologists. In three of the 10 cases, UGI surgeons performed significantly better than gastroenterologists (p < 0.05). When assessing performance across each of the 4 questions for each case, UGI surgeons were more accurate than gastroenterologists in describing the integrity of the wrap (p = 0.014). Inter-rater reliability was low across both groups for most domains (kappa < 1). CONCLUSION Our study confirms low inter-rater reliability between endoscopists and large variations in reporting. UGI surgeons performed better than gastroenterologists in certain cases, usually when describing the integrity of the fundoplication. Our study provides further support for the use of a standardized reporting system in post-fundoplication patients.
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Affiliation(s)
- Joseph J Fantasia
- Flinders Medical Centre, Flinders University Discipline of Surgery, College of Medicine & Public Health, Bedford Park, SA, 5042, Australia
| | - Charles Cock
- Department of Gastroenterology & Hepatology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - David I Watson
- Flinders Medical Centre, Flinders University Discipline of Surgery, College of Medicine & Public Health, Bedford Park, SA, 5042, Australia
| | - Tim Bright
- Flinders Medical Centre, Flinders University Discipline of Surgery, College of Medicine & Public Health, Bedford Park, SA, 5042, Australia
| | - Sarah K Thompson
- Flinders Medical Centre, Flinders University Discipline of Surgery, College of Medicine & Public Health, Bedford Park, SA, 5042, Australia.
- Flinders Medical Centre, Rm 5E221.3, Bedford Park, SA, 5042, Australia.
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4
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Thompson SK. Inspirational Women in Surgery: Professor Wendy Brown, Australia. World J Surg 2023; 47:2947-2948. [PMID: 37805924 DOI: 10.1007/s00268-023-07202-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/10/2023]
Affiliation(s)
- Sarah K Thompson
- Flinders Medical Centre, College of Medicine and Public Health, Flinders University, Rm 5E221.3, Bedford Park, SA, 5042, Australia.
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5
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Kunz S, Ashraf H, Klonis C, Thompson SK, Aly A, Liu DS. Surgical approaches for achalasia and obesity: a systematic review and patient-level meta-analysis. Langenbecks Arch Surg 2023; 408:403. [PMID: 37843694 PMCID: PMC10579133 DOI: 10.1007/s00423-023-03143-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 10/04/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE Synchronous and metachronous presentations of achalasia and obesity are increasingly common. There is limited data to guide the combined or staged surgical approaches to these conditions. METHODS A systematic review (MEDLINE, Embase, and Web of Science) and patient-level meta-analysis of published cases were performed to examine the most effective surgical approach for patients with synchronous or metachronous presentations of achalasia and obesity. RESULTS Thirty-three studies with 93 patients were reviewed. Eighteen patients underwent concurrent achalasia and bariatric surgery, with the most common (n = 12, 72.2%) being laparoscopic Heller's myotomy (LHM) and Roux-en-Y gastric bypass (RYGB). This combination achieved 68.9% excess weight loss and 100% remission of achalasia (mean follow-up: 3 years). Seven (6 RYGB, 1 biliopancreatic diversion) patients had bariatric surgery following achalasia surgery. Of these, all 6 RYGBs had satisfactory bariatric outcomes, with complete remission of their achalasia (mean follow-up: 1.8 years). Sixty-eight patients underwent myotomy following bariatric surgery; the majority (n = 55, 80.9%) were following RYGB. In this scenario, per-oral endoscopic myotomy (POEM) achieved higher treatment success than LHM (n = 33 of 35, 94.3% vs. n = 14 of 20, 70.0%, p = 0.021). Moreover, conversion to RYGB following a restrictive bariatric procedure during achalasia surgery was also associated with higher achalasia treatment success. CONCLUSION In patients with concurrent achalasia and obesity, LHM and RYGB achieved good outcomes for both pathologies. For those with weight gain post-achalasia surgery, RYGB provided satisfactory weight loss, without adversely affecting achalasia symptoms. For those with achalasia after bariatric surgery, POEM and conversion to RYGB produced greater treatment success.
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Affiliation(s)
- Stephen Kunz
- Upper Gastrointestinal Surgery Unit, Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
- Department of Surgery, Austin Precinct, Austin Health, The University of Melbourne, 145 Studley Road, Heidelberg, Victoria, 3084, Australia
- General and Gastrointestinal Surgery Research and Trials Group, Department of Surgery, Austin Precinct, Austin Health, The University of Melbourne, 145 Studley Road, Heidelberg, Victoria, 3084, Australia
| | - Hamza Ashraf
- Upper Gastrointestinal Surgery Unit, Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Christopher Klonis
- Department of Surgery, Austin Precinct, Austin Health, The University of Melbourne, 145 Studley Road, Heidelberg, Victoria, 3084, Australia
| | - Sarah K Thompson
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Ahmad Aly
- Upper Gastrointestinal Surgery Unit, Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
- Department of Surgery, Austin Precinct, Austin Health, The University of Melbourne, 145 Studley Road, Heidelberg, Victoria, 3084, Australia
| | - David S Liu
- Upper Gastrointestinal Surgery Unit, Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia.
- Department of Surgery, Austin Precinct, Austin Health, The University of Melbourne, 145 Studley Road, Heidelberg, Victoria, 3084, Australia.
- General and Gastrointestinal Surgery Research and Trials Group, Department of Surgery, Austin Precinct, Austin Health, The University of Melbourne, 145 Studley Road, Heidelberg, Victoria, 3084, Australia.
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia.
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Williams NA, Thompson SK. Hiatus hernia repair in the setting of pectus excavatum: an impossible combination! ANZ J Surg 2023; 93:2541. [PMID: 37489609 DOI: 10.1111/ans.18624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/08/2023] [Accepted: 07/12/2023] [Indexed: 07/26/2023]
Affiliation(s)
- Nicole A Williams
- College of Medicine & Public Health, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| | - Sarah K Thompson
- College of Medicine & Public Health, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
- Adelaide Gastrointestinal Specialists, North Adelaide, South Australia, Australia
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Thompson SK. Sentinel Node Biopsy in High-Risk pT1 Esophageal Cancer: A Long-Awaited Study. Ann Surg Oncol 2023; 30:3889-3891. [PMID: 37074520 DOI: 10.1245/s10434-023-13514-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/20/2023]
Affiliation(s)
- Sarah K Thompson
- College of Medicine and Public Health, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia.
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Affiliation(s)
| | - Sarah K Thompson
- College of Medicine & Public Health, Flinders University, SA, Adelaide, Australia.
- Adelaide Gastrointestinal Specialists, North Adelaide, Adelaide, South Australia, Australia.
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9
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Nathanson AL, Thompson SK. Stomal diameter in laparoscopic gastric bypass: surgical dogma put to the test! ANZ J Surg 2022; 92:2772-2773. [DOI: 10.1111/ans.18009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Andrew L. Nathanson
- Oesophago‐Gastric Surgery Unit Flinders Medical Centre Bedford Park South Australia Australia
| | - Sarah K. Thompson
- Oesophago‐Gastric Surgery Unit Flinders Medical Centre Bedford Park South Australia Australia
- College of Medicine & Public Health Flinders University Bedford Park South Australia Australia
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10
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Abstract
Achalasia is a rare disorder of the oesophageal smooth muscle characterized by impaired relaxation of the lower oesophageal sphincter (LES) and absent or spastic contractions in the oesophageal body. The key pathophysiological mechanism is loss of inhibitory nerve function that probably results from an autoimmune attack targeting oesophageal myenteric nerves through cell-mediated and, possibly, antibody-mediated mechanisms. Achalasia incidence and prevalence increase with age, but the disorder can affect all ages and both sexes. Cardinal symptoms consist of dysphagia, regurgitation, chest pain and weight loss. Several years can pass between symptom onset and an achalasia diagnosis. Evaluation starts with endoscopy to rule out structural causes, followed by high-resolution manometry and/or barium radiography. Functional lumen imaging probe can provide complementary evidence. Achalasia subtypes have management and prognostic implications. Although symptom questionnaires are not useful for diagnosis, the Eckardt score is a simple symptom scoring scale that helps to quantify symptom response to therapy. Oral pharmacotherapy is not particularly effective. Botulinum toxin injection into the LES can temporize symptoms and function as a bridge to definitive therapy. Pneumatic dilation, per-oral endoscopic myotomy and laparoscopic Heller myotomy can provide durable symptom benefit. End-stage achalasia with a dilated, non-functioning oesophagus may require oesophagectomy or enteral feeding into the stomach. Long-term complications can, rarely, include oesophageal cancer, but surveillance recommendations have not been established.
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Affiliation(s)
- Edoardo Savarino
- Gastroenterology Unit, Azienda Ospedale Università di Padova (AOUP), Padua, Italy. .,Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, Padua, Italy.
| | - Shobna Bhatia
- Department of Gastroenterology, Sir HN Reliance Foundation Hospital, Mumbai, India
| | - Sabine Roman
- Hospices Civils de Lyon, Digestive Physiology, Hopital E Herriot, Lyon, France.,Université Lyon 1, Villeurbanne, France.,Inserm U1032, LabTAU, Lyon, France
| | - Daniel Sifrim
- Wingate Institute of Neurogastroenterology, Queen Mary University of London, London, UK
| | - Jan Tack
- Division of Gastroenterology, University Hospital of Leuven, Leuven, Belgium
| | - Sarah K Thompson
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - C Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA
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11
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Hii A, Liu DS, Kholmurodova F, Irvine T, Bright T, Watson DI, Thompson SK. Partial Fundoplication is Effective Treatment for Female Patients with Gastroesophageal Reflux and Scleroderma: A Multicenter Comparative Cohort Study. World J Surg 2021; 46:147-153. [PMID: 34590163 DOI: 10.1007/s00268-021-06326-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with scleroderma often suffer from dysphagia and gastroesophageal reflux disease (GERD). Partial fundoplication is a validated anti-reflux procedure for GERD but may worsen dysphagia in scleroderma patients. Its utility in these patients is unknown. Here, we evaluate the efficacy and acceptability of partial fundoplication for the treatment of medically refractory GERD in patients with scleroderma. METHODS Analysis of a prospectively maintained database of patients who underwent fundoplication across 14 hospitals between 1991 and 2019. Perioperative outcomes, reintervention rates, heartburn, dysphagia, and patient satisfaction were assessed at 3 months, 1- and 3-years post-surgery. RESULTS A total of 17 patients with scleroderma were propensity score matched to 526 non-scleroderma controls. All underwent a partial fundoplication. Perioperative outcomes including complication rate, length of stay, and need for reoperation were similar between the two groups. Compared to baseline, both groups reported significantly improved heartburn at 3 months, 1- and 3-years following partial fundoplication. Surgery was equally effective at controlling heartburn across all follow-up timepoints in patients with or without scleroderma. Dysphagia to solids was more common in patients with scleroderma than controls at 3-months post-surgery, but was not significantly different to controls at 1- and 3-year follow-up. Satisfaction scores were high and comparable between both groups across all postoperative timepoints, with 100% of patients with scleroderma reporting that their initial choice to undergo surgery was correct. CONCLUSIONS Partial fundoplication controls reflux and is associated with a transient period of dysphagia to solids in patients with scleroderma. This approach is safe, effective and acceptable for patients with scleroderma and medically refractory GERD.
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Affiliation(s)
- Amanda Hii
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia
| | - David S Liu
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia. .,Department of Surgery, Austin Hospital, Heidelberg, VIC, 3084, Australia.
| | - Feruza Kholmurodova
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Tanya Irvine
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Tim Bright
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia.,Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - David I Watson
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia.,Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Sarah K Thompson
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia.,Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 5042, Australia
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Shukla RN, Schoeman MN, Thompson SK. How to insert a naso-enteric tube using an ultrathin scope. ANZ J Surg 2021; 91:1613-1614. [PMID: 33978297 DOI: 10.1111/ans.16932] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 11/28/2022]
Abstract
Although not a technically challenging procedure, the correct insertion of a naso-enteric feeding tube is an important skill for the surgeon. The described technique has been refined over two decades, and is well tolerated, reliable and reproducible.
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Affiliation(s)
- Rippan N Shukla
- Discipline of Surgery, College of Medicine & Public Health, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| | - Mark N Schoeman
- Department of Gastroenterology & Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Sarah K Thompson
- Discipline of Surgery, College of Medicine & Public Health, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
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13
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Liu DS, Bright T, Thompson SK, Irvine T, Watson DI, Aly A. Patients with Delayed Gastric Emptying Following Laparoscopic Repair of Large Hiatus Hernias Regain Long-Term Quality of Life. J Gastrointest Surg 2020; 24:2654-2657. [PMID: 32671804 DOI: 10.1007/s11605-020-04733-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/30/2020] [Indexed: 01/31/2023]
Affiliation(s)
- David S Liu
- Department of Surgery, Austin Hospital, Heidelberg, Victoria, 3084, Australia. .,Oesophagogastric Unit, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5042, Australia.
| | - Tim Bright
- Oesophagogastric Unit, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5042, Australia.,Flinders University Discipline of Surgery, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia
| | - Sarah K Thompson
- Oesophagogastric Unit, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5042, Australia.,Flinders University Discipline of Surgery, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia
| | - Tanya Irvine
- Flinders University Discipline of Surgery, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia
| | - David I Watson
- Oesophagogastric Unit, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5042, Australia.,Flinders University Discipline of Surgery, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia
| | - Ahmad Aly
- Department of Surgery, Austin Hospital, Heidelberg, Victoria, 3084, Australia.,University of Melbourne Department of Surgery, Austin Hospital, Heidelberg, Victoria, 3084, Australia
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14
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Wee M, Liu DS, Thompson SK. Acute gastric dilatation: a life-threatening early complication following laparoscopic hiatus hernia repair. ANZ J Surg 2020; 91:755-757. [PMID: 32820843 DOI: 10.1111/ans.16267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 06/18/2020] [Accepted: 08/06/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Melissa Wee
- Oesophago-Gastric Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - David S Liu
- Oesophago-Gastric Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Sarah K Thompson
- Oesophago-Gastric Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.,College of Medicine and Public Heath, Flinders University, Adelaide, South Australia, Australia
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Watson DI, Thompson SK, Devitt PG, Aly A, Irvine T, Woods SD, Gan S, Game PA, Jamieson GG. Five Year Follow-up of a Randomized Controlled Trial of Laparoscopic Repair of Very Large Hiatus Hernia With Sutures Versus Absorbable Versus Nonabsorbable Mesh. Ann Surg 2020; 272:241-247. [PMID: 32675536 DOI: 10.1097/sla.0000000000003734] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [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: 12/13/2022]
Abstract
OBJECTIVE To determine whether absorbable or nonabsorbable mesh repair of large hiatus hernias is followed by less recurrences at late follow-up compared to sutured repair. SUMMARY OF BACKGROUND DATA Radiological recurrences have been reported in up to 30% of patients after repair of large hiatus hernias, and mesh repair has been proposed as a solution. Earlier trials have revealed mixed outcomes and early outcomes from a trial reported previously revealed no short-term advantages for mesh repair. METHODS Multicentre prospective double-blind randomized controlled trial of 3 methods of hiatus hernia repair; sutures versus absorbable mesh versus nonabsorbable mesh. Primary outcome - hernia recurrence assessed by barium meal X-ray and endoscopy at 3-4 years. Secondary outcomes - clinical symptom scores at 2, 3, and 5 years. RESULTS 126 patients were enrolled - 43 sutures, 41 absorbable mesh, and 42 nonabsorbable mesh. Clinical outcomes were obtained at 5 years in 89.9%, and objective follow-up was obtained in 72.3%. A recurrent hernia (any size) was identified in 39.3% after suture repair, 56.7% - absorbable mesh, and 42.9% - nonabsorbable mesh (P = 0.371). Clinical outcomes were similar at 5 years, except chest pain, diarrhea, and bloat symptoms which were more common after repair with absorbable mesh. CONCLUSIONS No advantages were demonstrated for mesh repair at up to 5 years follow-up, and symptom outcomes were worse after repair with absorbable mesh. The longer-term results from this trial do not support mesh repair for large hiatus hernias.
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Affiliation(s)
- David I Watson
- Flinders University Discipline of Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Sarah K Thompson
- Flinders University Discipline of Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Peter G Devitt
- Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Ahmad Aly
- University of Melbourne Department of Surgery, Austin Hospital, Heidelberg, Victoria, Australia
| | - Tanya Irvine
- Flinders University Discipline of Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | | | - Susan Gan
- Flinders University Discipline of Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Philip A Game
- Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Glyn G Jamieson
- Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Chiam K, Mayne GC, Wang T, Watson DI, Irvine TS, Bright T, Smith LT, Ball IA, Bowen JM, Keefe DM, Thompson SK, Hussey DJ. Serum outperforms plasma in small extracellular vesicle microRNA biomarker studies of adenocarcinoma of the esophagus. World J Gastroenterol 2020; 26:2570-2583. [PMID: 32523312 PMCID: PMC7265139 DOI: 10.3748/wjg.v26.i20.2570] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/27/2020] [Accepted: 05/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Circulating microRNAs (miRNAs) are potential biomarkers for many diseases. However, they can originate from non-disease specific sources, such as blood cells, and compromise the investigations for miRNA biomarkers. While small extracellular vesicles (sEVs) have been suggested to provide a purer source of circulating miRNAs for biomarkers discovery, the most suitable blood sample for sEV miRNA biomarker studies has not been defined.
AIM To compare the miRNA profiles between matched serum and plasma sEV preparations to determine their suitability for biomarker studies.
METHODS Matched serum and plasma samples were obtained from 10 healthy controls and 10 patients with esophageal adenocarcinoma. sEV isolates were prepared from serum and plasma using ExoQuickTM and quantified using NanoSight. RNA was extracted from sEV preparations with the miRNeasy Serum/Plasma kit and profiled using the Taqman Openarray qPCR. The overall miRNA content and the expression of specific miRNAs of reported vesicular and non-vesicular origins were compared between serum and plasma sEV preparations. The diagnostic performance of a previously identified multi-miRNA biomarker panel for esophageal adenocarcinoma was also compared.
RESULTS The overall miRNA content was higher in plasma sEV preparations (480 miRNAs) and contained 97.5% of the miRNAs found in the serum sEV preparations (412 miRNAs).The expression of commonly expressed miRNAs was highly correlated (Spearman’s R = 0.87, P < 0.0001) between the plasma and serum sEV preparations, but was consistently higher in the plasma sEV preparations. Specific blood-cell miRNAs (hsa-miR-223-3p, hsa-miR-451a, miR-19b-3p, hsa-miR-17-5p, hsa-miR-30b-5p, hsa-miR-106a-5p, hsa-miR-150-5p and hsa-miR-92a-3p) were expressed at 2.7 to 9.6 fold higher levels in the plasma sEV preparations compared to serum sEV preparations (P < 0.05). In plasma sEV preparations, the percentage of protein-associated miRNAs expressed at relatively higher levels (Ct 20-25) was greater than serum sEV preparations (50% vs 31%). While the percentage of vesicle-associated miRNAs expressed at relatively higher levels was greater in the serum sEV preparations than plasma sEV preparations (70% vs 44%). A 5-miRNA biomarker panel produced a higher cross validated accuracy for discriminating patients with esophageal adenocarcinoma from healthy controls using serum sEV preparations compared with plasma sEV preparations (AUROC 0.80 vs 0.54, P < 0.05).
CONCLUSION Although plasma sEV preparations contained more miRNAs than serum sEV preparations, they also contained more miRNAs from non-vesicle origins. Serum appears to be more suitable than plasma for sEV miRNAs biomarkers studies.
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Affiliation(s)
- Karen Chiam
- Discipline of Surgery, College of Medicine and Public Health, Flinders University of South Australia, Adelaide, SA 5042, Australia
- Flinders Health and Medical Research Institute Cancer Program, College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
| | - George C Mayne
- Discipline of Surgery, College of Medicine and Public Health, Flinders University of South Australia, Adelaide, SA 5042, Australia
- Flinders Health and Medical Research Institute Cancer Program, College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
| | - Tingting Wang
- Discipline of Surgery, College of Medicine and Public Health, Flinders University of South Australia, Adelaide, SA 5042, Australia
- Flinders Health and Medical Research Institute Cancer Program, College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
| | - David I Watson
- Discipline of Surgery, College of Medicine and Public Health, Flinders University of South Australia, Adelaide, SA 5042, Australia
- Flinders Health and Medical Research Institute Cancer Program, College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
| | - Tanya S Irvine
- Discipline of Surgery, College of Medicine and Public Health, Flinders University of South Australia, Adelaide, SA 5042, Australia
- Flinders Health and Medical Research Institute Cancer Program, College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
| | - Tim Bright
- Discipline of Surgery, College of Medicine and Public Health, Flinders University of South Australia, Adelaide, SA 5042, Australia
- Flinders Health and Medical Research Institute Cancer Program, College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
| | - Lorelle T Smith
- Discipline of Surgery, College of Medicine and Public Health, Flinders University of South Australia, Adelaide, SA 5042, Australia
- Flinders Health and Medical Research Institute Cancer Program, College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
- Discipline of Surgery, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Imogen A Ball
- Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Joanne M Bowen
- Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Dorothy M Keefe
- Faculty of Health Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Sarah K Thompson
- Discipline of Surgery, College of Medicine and Public Health, Flinders University of South Australia, Adelaide, SA 5042, Australia
| | - Damian J Hussey
- Discipline of Surgery, College of Medicine and Public Health, Flinders University of South Australia, Adelaide, SA 5042, Australia
- Flinders Health and Medical Research Institute Cancer Program, College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
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17
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Currie AC, Bright T, Thompson SK, Smith L, Devitt PG, Watson DI. Acceptable outcomes after fundoplication-different views are held by patients, GPs, and surgeons. Dis Esophagus 2019; 32:5479249. [PMID: 31323089 DOI: 10.1093/dote/doz025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 02/06/2023]
Abstract
Antireflux surgery aims to improve quality of life. However, whether patients and clinicians agree on what this means, and what is an acceptable outcome following fundoplication, is unknown. This study used clinical scenarios pertinent to laparoscopic fundoplication for gastroesophageal reflux to define acceptable outcomes from the perspective of patients, surgeons, and general practitioners (GPs). Patients who had previously undergone a laparoscopic fundoplication, general practitioners, and esophagogastric surgeons were invited to rank 11 clinical scenarios of outcomes following laparoscopic fundoplication for acceptability. Clinicopathological and practice variables were collated for patients and clinicians, respectively. GPs and esophagogastric surgeons additionally were asked to estimate postfundoplication outcome probabilities. Descriptive and multivariate statistical analyses were undertaken to examine for associations with acceptability. Reponses were received from 331 patients (36.4% response rate), 93 GPs (13.4% response), and 60 surgeons (36.4% response). Bloating and inability to belch was less acceptable and dysphagia requiring intervention more acceptable to patients compared to clinicians. On regression analysis, female patients found bloating to be less acceptable (OR: 0.51 [95%CI: 0.29-0.91]; P = 0.022), but dysphagia more acceptable (OR: 1.93 [95%CI: 1.17-3.21]; P = 0.011). Postfundoplication estimation of reflux resolution was higher and that of bloating was lower for GPs compared to esophagogastric surgeons. Patients and clinicians have different appreciations of an acceptable outcome following antireflux surgery. Female patients are more concerned about wind-related side effects than male patients. The opposite holds true for dysphagia. Surgeons and GPs differ in their estimation of event probability for patient recovery following antireflux surgery, and this might explain their differing considerations of acceptable outcomes.
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Affiliation(s)
- Andrew C Currie
- Discipline of Surgery, Flinders University, Flinders Medical Centre, Adelaide, Australia
| | - Tim Bright
- Discipline of Surgery, Flinders University, Flinders Medical Centre, Adelaide, Australia
| | - Sarah K Thompson
- Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia
| | - Lorelle Smith
- Discipline of Surgery, Flinders University, Flinders Medical Centre, Adelaide, Australia.,Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia
| | - Peter G Devitt
- Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia
| | - David I Watson
- Discipline of Surgery, Flinders University, Flinders Medical Centre, Adelaide, Australia
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18
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Barnett DR, Cockbain AJ, Shenfine J, Thompson SK. Double trouble: two sites of internal hernia following total gastrectomy. ANZ J Surg 2018; 89:1497-1498. [PMID: 30362219 DOI: 10.1111/ans.14913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/14/2018] [Accepted: 09/18/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Dylan R Barnett
- Discipline of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Andrew J Cockbain
- Discipline of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jon Shenfine
- Discipline of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Sarah K Thompson
- Discipline of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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19
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Chiam K, Mayne GC, Watson DI, Woodman RJ, Bright TF, Michael MZ, Karapetis CS, Irvine T, Phillips WA, Hummel R, Wang T, Pimlott LK, Marri S, Astill DS, Ruszkiewicz AR, Thompson SK, Hussey DJ. Identification of microRNA Biomarkers of Response to Neoadjuvant Chemoradiotherapy in Esophageal Adenocarcinoma Using Next Generation Sequencing. Ann Surg Oncol 2018; 25:2731-2738. [PMID: 29987600 DOI: 10.1245/s10434-018-6626-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Clinical trials report improved overall survival following neoadjuvant chemoradiotherapy in patients undergoing surgery for esophageal adenocarcinoma, with a 10-15% survival improvement. MicroRNAs (miRNAs) are small noncoding RNAs that are known to direct the behavior of cancers, including response to treatment. We investigated the ability of miRNAs to predict outcomes after neoadjuvant chemoradiotherapy. METHODS Endoscopic biopsies from esophageal adenocarcinomas were obtained before neoadjuvant chemoradiotherapy and esophagectomy. miRNA levels were measured in the biopsies using next generation sequencing and compared with pathological response in the surgical resection, and subsequent survival. miRNA ratios that predicted pathological response were identified by Lasso regression and leave-one-out cross-validation. Association between miRNA ratio candidates and relapse-free survival was assessed using Kaplan-Meier analysis. Cox regression and Harrell's C analyses were performed to assess the predictive performance of the miRNAs. RESULTS Two miRNA ratios (miR-4521/miR-340-5p and miR-101-3p/miR-451a) that predicted the pathological response to neoadjuvant chemoradiotherapy were found to be associated with relapse-free survival. Pretreatment expression of these two miRNA ratios, pretreatment tumor differentiation, posttreatment AJCC histopathological tumor regression grading, and posttreatment tumor clearance/margins were significant factors associated with survival in Cox regression analysis. Multivariate analysis of the two ratios together with pretherapy factors resulted in a risk prediction accuracy of 85% (Harrell's C), which was comparable with the prediction accuracy of the AJCC treatment response grading (77%). CONCLUSIONS miRNA-ratio biomarkers identified using next generation sequencing can be used to predict disease free survival following neoadjuvant chemoradiotherapy and esophagectomy in patients with esophageal adenocarcinoma.
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Affiliation(s)
- Karen Chiam
- Cancer Research Division, Cancer Council New South Wales, Sydney, Australia.,Discipline of Surgery, College of Medicine and Public Health, Flinders University of South Australia, Adelaide, SA, Australia
| | - George C Mayne
- Discipline of Surgery, College of Medicine and Public Health, Flinders University of South Australia, Adelaide, SA, Australia.,Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - David I Watson
- Discipline of Surgery, College of Medicine and Public Health, Flinders University of South Australia, Adelaide, SA, Australia.,Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Richard J Woodman
- Flinders Centre for Epidemiology and Biostatistics, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Tim F Bright
- Discipline of Surgery, College of Medicine and Public Health, Flinders University of South Australia, Adelaide, SA, Australia.,Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Michael Z Michael
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Christos S Karapetis
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Tanya Irvine
- Discipline of Surgery, College of Medicine and Public Health, Flinders University of South Australia, Adelaide, SA, Australia.,Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Wayne A Phillips
- Cancer Biology and Surgical Oncology Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | - Richard Hummel
- Discipline of Surgery, College of Medicine and Public Health, Flinders University of South Australia, Adelaide, SA, Australia.,Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Tingting Wang
- Discipline of Surgery, College of Medicine and Public Health, Flinders University of South Australia, Adelaide, SA, Australia.,Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Letitia K Pimlott
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Shashikanth Marri
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - David StJ Astill
- Department of Anatomical Pathology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Andrew R Ruszkiewicz
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, SA, Australia
| | - Sarah K Thompson
- Department of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Damian J Hussey
- Discipline of Surgery, College of Medicine and Public Health, Flinders University of South Australia, Adelaide, SA, Australia. .,Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
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20
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Nguyen TMN, Hummel R, Bright T, Thompson SK, Tornqvist B, Watson DI. Pattern of care for cancer of the oesophagus in a western population. ANZ J Surg 2018; 89:E15-E19. [PMID: 29885201 DOI: 10.1111/ans.14685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/15/2018] [Accepted: 04/12/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Most oesophageal outcome research focuses on surgical treatment, despite most patients not undergoing surgery as they are unfit or have metastatic disease. Few studies have evaluated the patterns of care for all patients presenting with oesophageal cancer. METHODS All patients with oesophageal cancer, and high-grade dysplasia (HGD), presented at the South Australian state-wide upper gastrointestinal cancer multidisciplinary team from 2012 to 2015 were reviewed to determine the patterns of presentation and treatment. RESULTS A total of 375 patients were included. Diagnosis was adenocarcinoma in 69.6%, squamous cell carcinoma in 24.8% and HGD in 5.6%. The majority of patients presented with stages II and III disease (56.8%). A total of 51.5% were treated with curative intent, with 28.8% undergoing surgery and/or neoadjuvant therapy. Treatment was palliative in 48.5%, with chemoradiotherapy utilized in 20.8%. Disease stage and age impacted treatment intent. All patients with HGD received curative treatment versus 89.7%/63.8%/1% of patients with stage I/II and III/IV disease, respectively. A total of 56.9% of patients <80 years received curative treatment versus 25% of those >80 years old. CONCLUSION Whilst approximately half of patients underwent treatment with curative intent, only a minority underwent surgery. Future efforts to improve survival outcomes for oesophageal cancer should address patients who are unfit for surgery and those presenting with metastatic disease.
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Affiliation(s)
- Thuy-My N Nguyen
- Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Richard Hummel
- Department of Surgery, University of Lubeck, Lubeck, Germany
| | - Tim Bright
- Discipline of Surgery, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Sarah K Thompson
- Discipline of Surgery, The University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Bjorn Tornqvist
- Department of Surgery, Karolinska Institute, Danderyds Hospital, Stockholm, Sweden
| | - David I Watson
- Discipline of Surgery, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia
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21
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Cousins A, Tsopelas C, Balalis G, Thompson SK, Bartholomeusz D, Wedding AB, Thierry B. Hybrid 99mTc-magnetite tracer for dual modality sentinel lymph node mapping. J Mater Sci Mater Med 2018; 29:76. [PMID: 29845339 DOI: 10.1007/s10856-018-6080-2] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 04/21/2018] [Indexed: 06/08/2023]
Abstract
Accuracy of sentinel lymph node identification using radioactive tracers in non-superficial cancers can be limited by radiation shine through and low spatial resolution of detection systems such as intraoperative gamma probes. By utilising a dual radioactive/magnetic tracer, sensitive lymphoscintigraphy can be paired with high spatial resolution intraoperative magnetometer probes to improve the accuracy of sentinel node detection in cancers with complex multidirectional lymphatic drainage. Dextran-coated magnetite nanoparticles (33 nm mean hydrodynamic diameter) were labelled with 99mTc and applied as a lymphotropic tracer in small and large animal models. The dual tracer could be radiolabelled with 98 ± 2% efficiency after 10 min of incubation at room temperature. Biodistribution studies of the tracer were conducted in normal rats (subdermal and intravenous tail delivery, n = 3) and swine (subdermal hind limb delivery, n = 5). In rats the dual tracer migrated through four tiers of lymph node, 20 min after subdermal injection. Results from intravenous biodistribution test for radiocolloids demonstrated no aggregation in vivo, however indicated the presence of some lower-molecular weight radioactive impurities (99mTc-dextran). In swine, the dual tracer could be effectively used to map lymphatic drainage from hind hoof to popliteal and inguinal basins using intraoperative gamma and magnetometer probes. Of the eight primary nodes excised, eight were positively identified by gamma probe and seven by magnetometer probe. The high-purity dual tracer shows early promise for sentinel node identification in complex lymphatic environments by combining sensitive preoperative lymphoscintigraphy with a high-resolution intraoperative magnetometer probe.
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Affiliation(s)
- Aidan Cousins
- Future Industries Institute and ARC Centre of Excellence in Convergent Bio and Nano Science and Technology, University of South Australia, Mawson Lakes, SA, Australia
| | - Chris Tsopelas
- Nuclear Medicine Department, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - George Balalis
- Discipline of Surgery, University of Adelaide, Adelaide, SA, Australia
| | - Sarah K Thompson
- Discipline of Surgery, University of Adelaide, Adelaide, SA, Australia
| | - Dylan Bartholomeusz
- Nuclear Medicine Department, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - A Bruce Wedding
- School of Engineering (Applied Physics), University of South Australia, Mawson Lakes, SA, Australia
| | - Benjamin Thierry
- Future Industries Institute and ARC Centre of Excellence in Convergent Bio and Nano Science and Technology, University of South Australia, Mawson Lakes, SA, Australia.
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22
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Ireland CJ, Gordon AL, Thompson SK, Watson DI, Whiteman DC, Reed RL, Esterman A. Validation of a risk prediction model for Barrett's esophagus in an Australian population. Clin Exp Gastroenterol 2018; 11:135-142. [PMID: 29628770 PMCID: PMC5878665 DOI: 10.2147/ceg.s158627] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Esophageal adenocarcinoma is a disease that has a high mortality rate, the only known precursor being Barrett's esophagus (BE). While screening for BE is not cost-effective at the population level, targeted screening might be beneficial. We have developed a risk prediction model to identify people with BE, and here we present the external validation of this model. Materials and methods A cohort study was undertaken to validate a risk prediction model for BE. Individuals with endoscopy and histopathology proven BE completed a questionnaire containing variables previously identified as risk factors for this condition. Their responses were combined with data from a population sample for analysis. Risk scores were derived for each participant. Overall performance of the risk prediction model in terms of calibration and discrimination was assessed. Results Scores from 95 individuals with BE and 636 individuals from the general population were analyzed. The Brier score was 0.118, suggesting reasonable overall performance. The area under the receiver operating characteristic was 0.83 (95% CI 0.78-0.87). The Hosmer-Lemeshow statistic was p=0.14. Minimizing false positives and false negatives, the model achieved a sensitivity of 74% and a specificity of 73%. Conclusion This study has validated a risk prediction model for BE that has a higher sensitivity than previous models.
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Affiliation(s)
- Colin J Ireland
- School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Andrea L Gordon
- School of Pharmacy and Medical Science, Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Sarah K Thompson
- Discipline of Surgery, University of Adelaide, Adelaide, SA, Australia
| | - David I Watson
- Department of Surgery, Flinders University, Bedford Park, SA, Australia
| | - David C Whiteman
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Richard L Reed
- Discipline of General Practice, Flinders University, Bedford Park, SA, Australia
| | - Adrian Esterman
- School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Adelaide, SA, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
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23
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Ireland CJ, Fielder AL, Thompson SK, Laws TA, Watson DI, Esterman A. Development of a risk prediction model for Barrett's esophagus in an Australian population. Dis Esophagus 2017; 30:1-8. [PMID: 28881896 DOI: 10.1093/dote/dox033] [Citation(s) in RCA: 11] [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: 06/25/2016] [Accepted: 03/24/2017] [Indexed: 12/11/2022]
Abstract
Esophageal adenocarcinoma has poor 5-year survival rates. Increased survival might be achieved with earlier treatment, but requires earlier identification of the precursor, Barrett's esophagus. Population screening is not cost effective, this may be improved by targeted screening directed at individuals more likely to have Barrett's esophagus. To develop a risk prediction tool for Barrett's esophagus, this study compared individuals with Barrett's esophagus against population controls. Participants completed a questionnaire comprising 35 questions addressing medical history, symptom history, lifestyle factors, anthropomorphic measures, and demographic details. Statistical analysis addressed differences between cases and controls, and entailed initial variable selection, checking of model assumptions, and establishing calibration and discrimination. The area under the curve (AUC) was used to assess overall accuracy. One hundred and twenty individuals with Barrett's esophagus and 235 population controls completed the questionnaire. Significant differences were identified for age, gender, reflux history, family reflux history, history of hypertension, alcoholic drinks per week, and body mass index. These were used to develop a risk prediction model. The AUC was 0.82 (95% CI 0.78-0.87). Good calibration between predicted and observed risk was noted (Hosmer-Lemeshow test P = 0.67). At the point minimizing false positives and false negatives, the model achieved a sensitivity of 84.96% and a specificity of 66%. A well-calibrated risk prediction model with good discrimination has been developed to identify patients with Barrett's esophagus. The model needs to be externally validated before consideration for clinical practice.
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Affiliation(s)
| | - A L Fielder
- Schools of Nursing and Midwifery.,Pharmacy and Medical Science, University of South Australia
| | - S K Thompson
- Discipline of Surgery, University of Adelaide, Adelaide
| | - T A Laws
- Schools of Nursing and Midwifery.,School of Nursing and Midwifery, Keele University, Keele, UK
| | - D I Watson
- Department of Surgery, Flinders University, Bedford Park, South Australia
| | - A Esterman
- Schools of Nursing and Midwifery.,Centre for Chronic Disease Prevention, James Cook University, Cairns, Queensland
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24
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Tog C, Liu DS, Lim HK, Stiven P, Thompson SK, Watson DI, Aly A. Risk factors for delayed gastric emptying following laparoscopic repair of very large hiatus hernias. BJS Open 2017; 1:75-83. [PMID: 29951609 PMCID: PMC5989959 DOI: 10.1002/bjs5.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 06/28/2017] [Indexed: 01/20/2023] Open
Abstract
Background Delayed gastric emptying can complicate surgery for hiatus hernia. The aim of this study was to quantify its incidence following laparoscopic repair of very large hiatus hernias, identify key risk factors for its occurrence and determine its impact on clinical outcomes. Methods Data collected from a randomized trial of patients who underwent laparoscopic mesh versus sutured repair of very large hiatus hernias (more than 50 per cent of stomach in chest) were analysed retrospectively. Delayed gastric emptying was defined as endoscopic evidence of solid food in the stomach after fasting for 6 h at 6 months after surgery. Results Delayed gastric emptying occurred in 19 of 102 patients (18·6 per cent). In univariable analysis, type 2 paraoesophageal hernia (relative risk (RR) 3·15, 95 per cent c.i. 1·41 to 7·06), concurrent anterior and posterior hiatal repair (RR 2·66, 1·14 to 6·18), hernia sac excision (RR 4·85, 1·65 to 14·24), 270°/360° fundoplication (RR 3·64, 1·72 to 7·68), division of short gastric vessels (RR 6·82, 2·12 to 21·90) and revisional surgery (RR 3·69, 1·73 to 7·87) correlated with delayed gastric emptying. In multivariable analysis, division of short gastric vessels (RR 6·27, 1·85 to 21·26) and revisional surgery (RR 6·19, 1·32 to 28·96) were independently associated with delayed gastric emptying. Delayed gastric emptying correlated with adverse gastrointestinal symptomatology, including higher rates of bloating, nausea, vomiting and anorexia, as well as reduced patient satisfaction with the operation and recovery. Conclusion Delayed gastric emptying following large hiatus hernia repair is common and associated with adverse symptoms and reduced patient satisfaction. Division of short gastric vessels and revisional surgery were independently associated with its occurrence.
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Affiliation(s)
- C Tog
- Department of Surgery Austin Hospital Heidelberg Victoria Australia
| | - D S Liu
- Department of Surgery Austin Hospital Heidelberg Victoria Australia.,Division of Cancer Surgery Peter MacCallum Cancer Centre Melbourne Victoria Australia
| | - H K Lim
- Department of Surgery Austin Hospital Heidelberg Victoria Australia
| | - P Stiven
- Department of Surgery Austin Hospital Heidelberg Victoria Australia
| | - S K Thompson
- University of Adelaide Discipline of Surgery Royal Adelaide Hospital Adelaide South Australia Australia
| | - D I Watson
- Flinders University Department of Surgery Flinders Medical Centre Bedford Park South Australia Australia
| | - A Aly
- Department of Surgery Austin Hospital Heidelberg Victoria Australia
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Parameswaran R, Roberts RH, Brown WA, Aly A, Kiroff G, Epari K, MacCormick AD, Thomson IG, Thompson SK. Surgery for gastrointestinal stromal tumours in Australia and New Zealand: results from a bi-national audit. ANZ J Surg 2017; 87:220-221. [PMID: 28371039 DOI: 10.1111/ans.13840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 10/11/2016] [Accepted: 10/13/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Rajeev Parameswaran
- Department of Surgery, University of Adelaide, Adelaide, South Australia, Australia
| | - Ross H Roberts
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Wendy A Brown
- Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia
| | - Ahmad Aly
- Department of Surgery, The Austin Hospital, Melbourne, Victoria, Australia
| | - George Kiroff
- Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Krishna Epari
- Department of Surgery, Upper GI West, Murdoch, Western Australia, Australia.,Department of Surgery, Fremantle Hospital, Fremantle, Western Australia, Australia
| | | | - Iain G Thomson
- Department of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Sarah K Thompson
- Department of Surgery, University of Adelaide, Adelaide, South Australia, Australia
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Duffield JA, Hamer PW, Heddle R, Holloway RH, Myers JC, Thompson SK. Incidence of Achalasia in South Australia Based on Esophageal Manometry Findings. Clin Gastroenterol Hepatol 2017; 15:360-365. [PMID: 27266979 DOI: 10.1016/j.cgh.2016.05.036] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/05/2016] [Accepted: 05/25/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Achalasia is a disorder of esophageal motility with a reported incidence of 0.5 to 1.6 per 100,000 persons per year in Europe, Asia, Canada, and America. However, estimates of incidence values have been derived predominantly from retrospective searches of databases of hospital discharge codes and personal communications with gastroenterologists, and are likely to be incorrect. We performed a cohort study based on esophageal manometry findings to determine the incidence of achalasia in South Australia. METHODS We collected data from the Australian Bureau of Statistics on the South Australian population. Cases of achalasia diagnosed by esophageal manometry were identified from the 3 adult manometry laboratory databases in South Australia. Endoscopy reports and case notes were reviewed for correlations with diagnoses. The annual incidence of achalasia in the South Australian population was calculated for the decade 2004 to 2013. Findings were standardized to those of the European Standard Population based on age. RESULTS The annual incidence of achalasia in South Australia ranged from 2.3 to 2.8 per 100,000 persons. The mean age at diagnosis was 62.1 ± 18.1 years. The incidence of achalasia increased with age (Spearman rho, 0.95; P < .01). The age-standardized incidence ranged from 2.1 (95% CI, 1.8-2.3) to 2.5 (95% CI, 2.2-2.7). CONCLUSIONS Based on a cohort study of esophageal manometry, we determined the incidence of achalasia in South Australia to be 2.3 to 2.8 per 100,000 persons and to increase with age. South Australia's relative geographic isolation and the population's access to manometry allowed for more accurate identification of cases than hospital code analyses, with a low probability of missed cases.
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Affiliation(s)
- Jaime A Duffield
- Professorial Unit of Oesophagogastric Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Discipline of Surgery, The University of Adelaide, Adelaide, South Australia, Australia
| | - Peter W Hamer
- Professorial Unit of Oesophagogastric Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Discipline of Surgery, The University of Adelaide, Adelaide, South Australia, Australia
| | - Richard Heddle
- Oesophageal Function Laboratory, Repatriation General Hospital, Daw Park, South Australia, Australia
| | - Richard H Holloway
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jennifer C Myers
- Professorial Unit of Oesophagogastric Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Discipline of Surgery, The University of Adelaide, Adelaide, South Australia, Australia
| | - Sarah K Thompson
- Professorial Unit of Oesophagogastric Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Discipline of Surgery, The University of Adelaide, Adelaide, South Australia, Australia.
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27
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Marshall-Webb M, Bright T, Price T, Thompson SK, Watson DI. Venous thromboembolism in patients with esophageal or gastric cancer undergoing neoadjuvant chemotherapy. Dis Esophagus 2017; 30:1-7. [PMID: 27878904 DOI: 10.1111/dote.12516] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
There is a well-established link between cancer and venous thromboembolism (VTE), and patients receiving chemotherapy for esophageal or gastric cancer appear at high risk of developing VTE. The incidence of VTE in the neoadjuvant setting in these patients is poorly understood, as is the role for thromboprophylaxis during neoadjuvant chemotherapy. A PubMed search was conducted using a combination of terms including; esophageal & gastric cancer, deep venous thrombosis (DVT), VTE, neoadjuvant, chemotherapy and chemoradiotherapy. One hundred and fifty-four articles were retrieved and a narrative review was conducted. For patients with esophageal and gastric cancer the incidence of VTE ranged from 4 to 19%. Gastric cancer (Odds Ratio [OR] 6.38, [95% CI: 1.96-20.80]) and Stage III/IV disease, (OR 5.16 [95% CI: 1.29-20.73]) were identified as risk factors for developing VTE. Neoadjuvant chemotherapy was identified as an independent risk factor for developing VTE. Symptomatic and asymptomatic VTE have a similar effect on mortality. Median overall survival for asymptomatic VTE was 13.9 months (95% CI: 5.0-∞) versus 12.8 months (95% CI: 4.7-30.3) if the VTE was symptomatic. Neoadjuvant chemotherapy is a significant risk factor for VTE in patients with esophageal and gastric cancer. Intervention to minimize the risk using pharmacological and mechanical thromboprophylaxis should be considered, and this should start in the neoadjuvant period.
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Affiliation(s)
- M Marshall-Webb
- Department of Surgery, Flinders Medical Centre, Flinders University, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - T Bright
- Department of Surgery, Flinders Medical Centre, Flinders University, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - T Price
- Medical Oncology, Queen Elizabeth Hospital, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - S K Thompson
- Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - D I Watson
- Department of Surgery, Flinders Medical Centre, Flinders University, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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28
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Hoffmann R, Hebenstreit A, Game PA, Ruszkiewicz AR, Thompson SK. Verrucous carcinoma of the oesophagus. ANZ J Surg 2017; 88:E797-E798. [DOI: 10.1111/ans.13844] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 10/13/2016] [Accepted: 10/14/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Richard Hoffmann
- Discipline of Surgery; The University of Adelaide, Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Annie Hebenstreit
- Discipline of Surgery; The University of Adelaide, Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Philip A. Game
- Discipline of Surgery; The University of Adelaide, Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Andrew R. Ruszkiewicz
- Department of Gastroenterology Pathology; SA Pathology; Adelaide South Australia Australia
| | - Sarah K. Thompson
- Discipline of Surgery; The University of Adelaide, Royal Adelaide Hospital; Adelaide South Australia Australia
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29
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Hamer PW, Holloway RH, Heddle R, Devitt PG, Kiroff G, Burgstad C, Thompson SK. Evaluation of outcome after cardiomyotomy for achalasia using the Chicago classification. Br J Surg 2016; 103:1847-1854. [DOI: 10.1002/bjs.10285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/23/2016] [Accepted: 07/06/2016] [Indexed: 01/07/2023]
Abstract
Abstract
Background
Achalasia can be subdivided into manometric subtypes according to the Chicago classification. These subtypes are proposed to predict outcome after treatment. This hypothesis was tested using a database of patients who underwent laparoscopic Heller's cardiomyotomy with anterior fundoplication.
Methods
All patients who underwent Heller's cardiomyotomy for achalasia between June 1993 and March 2015 were identified from an institutional database. Manometry tracings were retrieved and re-reported according the Chicago classification. Outcome was assessed by a postal questionnaire, and designated a success if the modified Eckardt score was 3 or less, and the patient had not undergone subsequent surgery or pneumatic dilatation. Difference in outcome after cardiomyotomy was analysed with a mixed-effects logistic regression model.
Results
Sixty, 111 and 24 patients had type I, II and II achalasia respectively. Patients with type III achalasia were more likely to be older than those with type I or II (mean age 63 versus 50 and 49 years respectively; P = 0·001). Some 176 of 195 patients returned questionnaires after surgery. Type III achalasia was less likely to have a successful outcome than type II (odds ratio (OR) 0·38, 95 per cent c.i. 0·15 to 0·94; P = 0·035). There was no significant difference in outcome between types I and II achalasia (II versus I: OR 0·87, 0·47 to 1·60; P 0·663). The success rate at 3-year follow-up was 69 per cent (22 of 32) for type I, 66 per cent (33 of 50) for type II and 31 per cent (4 of 13) for type III.
Conclusion
Type III achalasia is a predictor of poor outcome after cardiomyotomy. There was no difference in outcome between types I and II achalasia.
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Affiliation(s)
- P W Hamer
- Professorial Unit of Oesophagogastric Surgery, Royal Adelaide Hospital, Adelaide, Australia
- Disciplines of Surgery, University of Adelaide, Adelaide, Australia
| | - R H Holloway
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
- Disciplines of Medicine, University of Adelaide, Adelaide, Australia
| | - R Heddle
- Oesophageal Function Laboratory, Repatriation General Hospital, Daw Park, South Australia, Australia
| | - P G Devitt
- Professorial Unit of Oesophagogastric Surgery, Royal Adelaide Hospital, Adelaide, Australia
- Disciplines of Surgery, University of Adelaide, Adelaide, Australia
| | - G Kiroff
- Professorial Unit of Oesophagogastric Surgery, Royal Adelaide Hospital, Adelaide, Australia
- Disciplines of Surgery, University of Adelaide, Adelaide, Australia
| | - C Burgstad
- Oesophageal Function Laboratory, Repatriation General Hospital, Daw Park, South Australia, Australia
| | - S K Thompson
- Professorial Unit of Oesophagogastric Surgery, Royal Adelaide Hospital, Adelaide, Australia
- Disciplines of Surgery, University of Adelaide, Adelaide, Australia
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30
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Block KI, Gyllenhaal C, Lowe L, Amedei A, Amin ARMR, Amin A, Aquilano K, Arbiser J, Arreola A, Arzumanyan A, Ashraf SS, Azmi AS, Benencia F, Bhakta D, Bilsland A, Bishayee A, Blain SW, Block PB, Boosani CS, Carey TE, Carnero A, Carotenuto M, Casey SC, Chakrabarti M, Chaturvedi R, Chen GZ, Chen H, Chen S, Chen YC, Choi BK, Ciriolo MR, Coley HM, Collins AR, Connell M, Crawford S, Curran CS, Dabrosin C, Damia G, Dasgupta S, DeBerardinis RJ, Decker WK, Dhawan P, Diehl AME, Dong JT, Dou QP, Drew JE, Elkord E, El-Rayes B, Feitelson MA, Felsher DW, Ferguson LR, Fimognari C, Firestone GL, Frezza C, Fujii H, Fuster MM, Generali D, Georgakilas AG, Gieseler F, Gilbertson M, Green MF, Grue B, Guha G, Halicka D, Helferich WG, Heneberg P, Hentosh P, Hirschey MD, Hofseth LJ, Holcombe RF, Honoki K, Hsu HY, Huang GS, Jensen LD, Jiang WG, Jones LW, Karpowicz PA, Keith WN, Kerkar SP, Khan GN, Khatami M, Ko YH, Kucuk O, Kulathinal RJ, Kumar NB, Kwon BS, Le A, Lea MA, Lee HY, Lichtor T, Lin LT, Locasale JW, Lokeshwar BL, Longo VD, Lyssiotis CA, MacKenzie KL, Malhotra M, Marino M, Martinez-Chantar ML, Matheu A, Maxwell C, McDonnell E, Meeker AK, Mehrmohamadi M, Mehta K, Michelotti GA, Mohammad RM, Mohammed SI, Morre DJ, Muralidhar V, Muqbil I, Murphy MP, Nagaraju GP, Nahta R, Niccolai E, Nowsheen S, Panis C, Pantano F, Parslow VR, Pawelec G, Pedersen PL, Poore B, Poudyal D, Prakash S, Prince M, Raffaghello L, Rathmell JC, Rathmell WK, Ray SK, Reichrath J, Rezazadeh S, Ribatti D, Ricciardiello L, Robey RB, Rodier F, Rupasinghe HPV, Russo GL, Ryan EP, Samadi AK, Sanchez-Garcia I, Sanders AJ, Santini D, Sarkar M, Sasada T, Saxena NK, Shackelford RE, Shantha Kumara HMC, Sharma D, Shin DM, Sidransky D, Siegelin MD, Signori E, Singh N, Sivanand S, Sliva D, Smythe C, Spagnuolo C, Stafforini DM, Stagg J, Subbarayan PR, Sundin T, Talib WH, Thompson SK, Tran PT, Ungefroren H, Vander Heiden MG, Venkateswaran V, Vinay DS, Vlachostergios PJ, Wang Z, Wellen KE, Whelan RL, Yang ES, Yang H, Yang X, Yaswen P, Yedjou C, Yin X, Zhu J, Zollo M. Designing a broad-spectrum integrative approach for cancer prevention and treatment. Semin Cancer Biol 2016; 35 Suppl:S276-S304. [PMID: 26590477 DOI: 10.1016/j.semcancer.2015.09.007] [Citation(s) in RCA: 190] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 08/12/2015] [Accepted: 09/14/2015] [Indexed: 12/14/2022]
Abstract
Targeted therapies and the consequent adoption of "personalized" oncology have achieved notable successes in some cancers; however, significant problems remain with this approach. Many targeted therapies are highly toxic, costs are extremely high, and most patients experience relapse after a few disease-free months. Relapses arise from genetic heterogeneity in tumors, which harbor therapy-resistant immortalized cells that have adopted alternate and compensatory pathways (i.e., pathways that are not reliant upon the same mechanisms as those which have been targeted). To address these limitations, an international task force of 180 scientists was assembled to explore the concept of a low-toxicity "broad-spectrum" therapeutic approach that could simultaneously target many key pathways and mechanisms. Using cancer hallmark phenotypes and the tumor microenvironment to account for the various aspects of relevant cancer biology, interdisciplinary teams reviewed each hallmark area and nominated a wide range of high-priority targets (74 in total) that could be modified to improve patient outcomes. For these targets, corresponding low-toxicity therapeutic approaches were then suggested, many of which were phytochemicals. Proposed actions on each target and all of the approaches were further reviewed for known effects on other hallmark areas and the tumor microenvironment. Potential contrary or procarcinogenic effects were found for 3.9% of the relationships between targets and hallmarks, and mixed evidence of complementary and contrary relationships was found for 7.1%. Approximately 67% of the relationships revealed potentially complementary effects, and the remainder had no known relationship. Among the approaches, 1.1% had contrary, 2.8% had mixed and 62.1% had complementary relationships. These results suggest that a broad-spectrum approach should be feasible from a safety standpoint. This novel approach has potential to be relatively inexpensive, it should help us address stages and types of cancer that lack conventional treatment, and it may reduce relapse risks. A proposed agenda for future research is offered.
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Affiliation(s)
- Keith I Block
- Block Center for Integrative Cancer Treatment, Skokie, IL, United States.
| | | | - Leroy Lowe
- Getting to Know Cancer, Truro, Nova Scotia, Canada; Lancaster Environment Centre, Lancaster University, Bailrigg, Lancaster, United Kingdom.
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - A R M Ruhul Amin
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Amr Amin
- Department of Biology, College of Science, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Katia Aquilano
- Department of Biology, University of Rome "Tor Vergata", Rome, Italy
| | - Jack Arbiser
- Winship Cancer Institute of Emory University, Atlanta, GA, United States; Atlanta Veterans Administration Medical Center, Atlanta, GA, United States; Department of Dermatology, Emory University School of Medicine, Emory University, Atlanta, GA, United States
| | - Alexandra Arreola
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
| | - Alla Arzumanyan
- Department of Biology, Temple University, Philadelphia, PA, United States
| | - S Salman Ashraf
- Department of Chemistry, College of Science, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Asfar S Azmi
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, United States
| | - Fabian Benencia
- Department of Biomedical Sciences, Ohio University, Athens, OH, United States
| | - Dipita Bhakta
- School of Chemical and Bio Technology, SASTRA University, Thanjavur, Tamil Nadu, India
| | | | - Anupam Bishayee
- Department of Pharmaceutical Sciences, College of Pharmacy, Larkin Health Sciences Institute, Miami, FL, United States
| | - Stacy W Blain
- Department of Pediatrics, State University of New York, Downstate Medical Center, Brooklyn, NY, United States
| | - Penny B Block
- Block Center for Integrative Cancer Treatment, Skokie, IL, United States
| | - Chandra S Boosani
- Department of BioMedical Sciences, School of Medicine, Creighton University, Omaha, NE, United States
| | - Thomas E Carey
- Head and Neck Cancer Biology Laboratory, University of Michigan, Ann Arbor, MI, United States
| | - Amancio Carnero
- Instituto de Biomedicina de Sevilla, Consejo Superior de Investigaciones Cientificas, Seville, Spain
| | - Marianeve Carotenuto
- Centro di Ingegneria Genetica e Biotecnologia Avanzate, Naples, Italy; Department of Molecular Medicine and Medical Biotechnology, Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Stephanie C Casey
- Stanford University, Division of Oncology, Department of Medicine and Pathology, Stanford, CA, United States
| | - Mrinmay Chakrabarti
- Department of Pathology, Microbiology, and Immunology, University of South Carolina, School of Medicine, Columbia, SC, United States
| | - Rupesh Chaturvedi
- School of Biotechnology, Jawaharlal Nehru University, New Delhi, India
| | - Georgia Zhuo Chen
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Helen Chen
- Department of Pediatrics, University of British Columbia, Michael Cuccione Childhood Cancer Research Program, Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Sophie Chen
- Ovarian and Prostate Cancer Research Laboratory, Guildford, Surrey, United Kingdom
| | - Yi Charlie Chen
- Department of Biology, Alderson Broaddus University, Philippi, WV, United States
| | - Beom K Choi
- Cancer Immunology Branch, Division of Cancer Biology, National Cancer Center, Goyang, Gyeonggi, Republic of Korea
| | | | - Helen M Coley
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| | - Andrew R Collins
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marisa Connell
- Department of Pediatrics, University of British Columbia, Michael Cuccione Childhood Cancer Research Program, Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Sarah Crawford
- Cancer Biology Research Laboratory, Southern Connecticut State University, New Haven, CT, United States
| | - Colleen S Curran
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Charlotta Dabrosin
- Department of Oncology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Giovanna Damia
- Department of Oncology, Istituto Di Ricovero e Cura a Carattere Scientifico - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Santanu Dasgupta
- Department of Cellular and Molecular Biology, the University of Texas Health Science Center at Tyler, Tyler, TX, United States
| | - Ralph J DeBerardinis
- Children's Medical Center Research Institute, University of Texas - Southwestern Medical Center, Dallas, TX, United States
| | - William K Decker
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, United States
| | - Punita Dhawan
- Department of Surgery and Cancer Biology, Division of Surgical Oncology, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Anna Mae E Diehl
- Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - Jin-Tang Dong
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Q Ping Dou
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, United States
| | - Janice E Drew
- Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Eyad Elkord
- College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Bassel El-Rayes
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, United States
| | - Mark A Feitelson
- Department of Biology, Temple University, Philadelphia, PA, United States
| | - Dean W Felsher
- Stanford University, Division of Oncology, Department of Medicine and Pathology, Stanford, CA, United States
| | - Lynnette R Ferguson
- Discipline of Nutrition and Auckland Cancer Society Research Centre, University of Auckland, Auckland, New Zealand
| | - Carmela Fimognari
- Dipartimento di Scienze per la Qualità della Vita Alma Mater Studiorum-Università di Bologna, Rimini, Italy
| | - Gary L Firestone
- Department of Molecular & Cell Biology, University of California Berkeley, Berkeley, CA, United States
| | - Christian Frezza
- Medical Research Council Cancer Unit, University of Cambridge, Hutchison/MRC Research Centre, Cambridge, United Kingdom
| | - Hiromasa Fujii
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Mark M Fuster
- Medicine and Research Services, Veterans Affairs San Diego Healthcare System & University of California, San Diego, CA, United States
| | - Daniele Generali
- Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy; Molecular Therapy and Pharmacogenomics Unit, Azienda Ospedaliera Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Alexandros G Georgakilas
- Physics Department, School of Applied Mathematics and Physical Sciences, National Technical University of Athens, Athens, Greece
| | - Frank Gieseler
- First Department of Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | | | - Michelle F Green
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, United States
| | - Brendan Grue
- Departments of Environmental Science, Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gunjan Guha
- School of Chemical and Bio Technology, SASTRA University, Thanjavur, Tamil Nadu, India
| | - Dorota Halicka
- Department of Pathology, New York Medical College, Valhalla, NY, United States
| | | | - Petr Heneberg
- Charles University in Prague, Third Faculty of Medicine, Prague, Czech Republic
| | - Patricia Hentosh
- School of Medical Laboratory and Radiation Sciences, Old Dominion University, Norfolk, VA, United States
| | - Matthew D Hirschey
- Department of Medicine, Duke University Medical Center, Durham, NC, United States; Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, United States
| | - Lorne J Hofseth
- College of Pharmacy, University of South Carolina, Columbia, SC, United States
| | - Randall F Holcombe
- Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY, United States
| | - Kanya Honoki
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Hsue-Yin Hsu
- Department of Life Sciences, Tzu-Chi University, Hualien, Taiwan
| | - Gloria S Huang
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States
| | - Lasse D Jensen
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Wen G Jiang
- Cardiff University School of Medicine, Heath Park, Cardiff, United Kingdom
| | - Lee W Jones
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | | | | | - Sid P Kerkar
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | | | - Mahin Khatami
- Inflammation and Cancer Research, National Cancer Institute (Retired), National Institutes of Health, Bethesda, MD, United States
| | - Young H Ko
- University of Maryland BioPark, Innovation Center, KoDiscovery, Baltimore, MD, United States
| | - Omer Kucuk
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Rob J Kulathinal
- Department of Biology, Temple University, Philadelphia, PA, United States
| | - Nagi B Kumar
- Moffitt Cancer Center, University of South Florida College of Medicine, Tampa, FL, United States
| | - Byoung S Kwon
- Cancer Immunology Branch, Division of Cancer Biology, National Cancer Center, Goyang, Gyeonggi, Republic of Korea; Department of Medicine, Tulane University Health Sciences Center, New Orleans, LA, United States
| | - Anne Le
- The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael A Lea
- New Jersey Medical School, Rutgers University, Newark, NJ, United States
| | - Ho-Young Lee
- College of Pharmacy, Seoul National University, South Korea
| | - Terry Lichtor
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, United States
| | - Liang-Tzung Lin
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jason W Locasale
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - Bal L Lokeshwar
- Department of Medicine, Georgia Regents University Cancer Center, Augusta, GA, United States
| | - Valter D Longo
- Andrus Gerontology Center, Division of Biogerontology, University of Southern California, Los Angeles, CA, United States
| | - Costas A Lyssiotis
- Department of Molecular and Integrative Physiology and Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, MI, United States
| | - Karen L MacKenzie
- Children's Cancer Institute Australia, Kensington, New South Wales, Australia
| | - Meenakshi Malhotra
- Department of Biomedical Engineering, McGill University, Montréal, Canada
| | - Maria Marino
- Department of Science, University Roma Tre, Rome, Italy
| | - Maria L Martinez-Chantar
- Metabolomic Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Technology Park of Bizkaia, Bizkaia, Spain
| | | | - Christopher Maxwell
- Department of Pediatrics, University of British Columbia, Michael Cuccione Childhood Cancer Research Program, Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Eoin McDonnell
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, United States
| | - Alan K Meeker
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mahya Mehrmohamadi
- Field of Genetics, Genomics, and Development, Department of Molecular Biology and Genetics, Cornell University, Ithaca, NY, United States
| | - Kapil Mehta
- Department of Experimental Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Gregory A Michelotti
- Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - Ramzi M Mohammad
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, United States
| | - Sulma I Mohammed
- Department of Comparative Pathobiology, Purdue University Center for Cancer Research, West Lafayette, IN, United States
| | - D James Morre
- Mor-NuCo, Inc, Purdue Research Park, West Lafayette, IN, United States
| | - Vinayak Muralidhar
- Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School, Boston, MA, United States; Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Irfana Muqbil
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, United States
| | - Michael P Murphy
- MRC Mitochondrial Biology Unit, Wellcome Trust-MRC Building, Hills Road, Cambridge, United Kingdom
| | | | - Rita Nahta
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | | | - Somaira Nowsheen
- Medical Scientist Training Program, Mayo Graduate School, Mayo Medical School, Mayo Clinic, Rochester, MN, United States
| | - Carolina Panis
- Laboratory of Inflammatory Mediators, State University of West Paraná, UNIOESTE, Paraná, Brazil
| | - Francesco Pantano
- Medical Oncology Department, University Campus Bio-Medico, Rome, Italy
| | - Virginia R Parslow
- Discipline of Nutrition and Auckland Cancer Society Research Centre, University of Auckland, Auckland, New Zealand
| | - Graham Pawelec
- Center for Medical Research, University of Tübingen, Tübingen, Germany
| | - Peter L Pedersen
- Departments of Biological Chemistry and Oncology, Member at Large, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, School of Medicine, Baltimore, MD, United States
| | - Brad Poore
- The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Deepak Poudyal
- College of Pharmacy, University of South Carolina, Columbia, SC, United States
| | - Satya Prakash
- Department of Biomedical Engineering, McGill University, Montréal, Canada
| | - Mark Prince
- Department of Otolaryngology-Head and Neck, Medical School, University of Michigan, Ann Arbor, MI, United States
| | | | - Jeffrey C Rathmell
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, United States
| | - W Kimryn Rathmell
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
| | - Swapan K Ray
- Department of Pathology, Microbiology, and Immunology, University of South Carolina, School of Medicine, Columbia, SC, United States
| | - Jörg Reichrath
- Center for Clinical and Experimental Photodermatology, Clinic for Dermatology, Venerology and Allergology, The Saarland University Hospital, Homburg, Germany
| | - Sarallah Rezazadeh
- Department of Biology, University of Rochester, Rochester, NY, United States
| | - Domenico Ribatti
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari Medical School, Bari, Italy & National Cancer Institute Giovanni Paolo II, Bari, Italy
| | - Luigi Ricciardiello
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - R Brooks Robey
- White River Junction Veterans Affairs Medical Center, White River Junction, VT, United States; Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Francis Rodier
- Centre de Rechercher du Centre Hospitalier de l'Université de Montréal and Institut du Cancer de Montréal, Montréal, Quebec, Canada; Université de Montréal, Département de Radiologie, Radio-Oncologie et Médicine Nucléaire, Montréal, Quebec, Canada
| | - H P Vasantha Rupasinghe
- Department of Environmental Sciences, Faculty of Agriculture and Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gian Luigi Russo
- Institute of Food Sciences National Research Council, Avellino, Italy
| | - Elizabeth P Ryan
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States
| | | | - Isidro Sanchez-Garcia
- Experimental Therapeutics and Translational Oncology Program, Instituto de Biología Molecular y Celular del Cáncer, CSIC-Universidad de Salamanca, Salamanca, Spain
| | - Andrew J Sanders
- Cardiff University School of Medicine, Heath Park, Cardiff, United Kingdom
| | - Daniele Santini
- Medical Oncology Department, University Campus Bio-Medico, Rome, Italy
| | - Malancha Sarkar
- Department of Biology, University of Miami, Miami, FL, United States
| | - Tetsuro Sasada
- Department of Immunology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Neeraj K Saxena
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Rodney E Shackelford
- Department of Pathology, Louisiana State University, Health Shreveport, Shreveport, LA, United States
| | - H M C Shantha Kumara
- Department of Surgery, St. Luke's Roosevelt Hospital, New York, NY, United States
| | - Dipali Sharma
- Department of Oncology, Johns Hopkins University School of Medicine and the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, United States
| | - Dong M Shin
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - David Sidransky
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Markus David Siegelin
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, United States
| | - Emanuela Signori
- National Research Council, Institute of Translational Pharmacology, Rome, Italy
| | - Neetu Singh
- Advanced Molecular Science Research Centre (Centre for Advanced Research), King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sharanya Sivanand
- Department of Cancer Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Daniel Sliva
- DSTest Laboratories, Purdue Research Park, Indianapolis, IN, United States
| | - Carl Smythe
- Department of Biomedical Science, Sheffield Cancer Research Centre, University of Sheffield, Sheffield, United Kingdom
| | - Carmela Spagnuolo
- Institute of Food Sciences National Research Council, Avellino, Italy
| | - Diana M Stafforini
- Huntsman Cancer Institute and Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - John Stagg
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Faculté de Pharmacie et Institut du Cancer de Montréal, Montréal, Quebec, Canada
| | - Pochi R Subbarayan
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Tabetha Sundin
- Department of Molecular Diagnostics, Sentara Healthcare, Norfolk, VA, United States
| | - Wamidh H Talib
- Department of Clinical Pharmacy and Therapeutics, Applied Science University, Amman, Jordan
| | - Sarah K Thompson
- Department of Surgery, Royal Adelaide Hospital, Adelaide, Australia
| | - Phuoc T Tran
- Departments of Radiation Oncology & Molecular Radiation Sciences, Oncology and Urology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Hendrik Ungefroren
- First Department of Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Matthew G Vander Heiden
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Vasundara Venkateswaran
- Department of Surgery, University of Toronto, Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Dass S Vinay
- Section of Clinical Immunology, Allergy, and Rheumatology, Department of Medicine, Tulane University Health Sciences Center, New Orleans, LA, United States
| | - Panagiotis J Vlachostergios
- Department of Internal Medicine, New York University Lutheran Medical Center, Brooklyn, New York, NY, United States
| | - Zongwei Wang
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Kathryn E Wellen
- Department of Cancer Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Richard L Whelan
- Department of Surgery, St. Luke's Roosevelt Hospital, New York, NY, United States
| | - Eddy S Yang
- Department of Radiation Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States
| | - Huanjie Yang
- The School of Life Science and Technology, Harbin Institute of Technology, Harbin, Heilongjiang, China
| | - Xujuan Yang
- University of Illinois at Urbana Champaign, Champaign, IL, United States
| | - Paul Yaswen
- Life Sciences Division, Lawrence Berkeley National Lab, Berkeley, CA, United States
| | - Clement Yedjou
- Department of Biology, Jackson State University, Jackson, MS, United States
| | - Xin Yin
- Medicine and Research Services, Veterans Affairs San Diego Healthcare System & University of California, San Diego, CA, United States
| | - Jiyue Zhu
- Washington State University College of Pharmacy, Spokane, WA, United States
| | - Massimo Zollo
- Centro di Ingegneria Genetica e Biotecnologia Avanzate, Naples, Italy; Department of Molecular Medicine and Medical Biotechnology, Federico II, Via Pansini 5, 80131 Naples, Italy
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Hamer PW, Holloway RH, Crosthwaite G, Devitt PG, Thompson SK. Update in achalasia: what the surgeon needs to know. ANZ J Surg 2016; 86:555-9. [DOI: 10.1111/ans.13497] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/06/2016] [Accepted: 01/19/2016] [Indexed: 01/15/2023]
Affiliation(s)
- Peter W. Hamer
- University of Adelaide Discipline of Surgery; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Richard H. Holloway
- Department of Gastroenterology and Hepatology; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Gary Crosthwaite
- Department of Surgery; The University of Melbourne; Parkville Victoria Australia
- Clinical Institute General Surgery and Gastroenterology Epworth Healthcare; Richmond Victoria Australia
| | - Peter G. Devitt
- University of Adelaide Discipline of Surgery; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Sarah K. Thompson
- University of Adelaide Discipline of Surgery; Royal Adelaide Hospital; Adelaide South Australia Australia
- University of South Australia; Adelaide South Australia Australia
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Ireland CJ, Thompson SK, Laws TA, Esterman A. Risk factors for Barrett’s esophagus: a scoping review. Cancer Causes Control 2016; 27:301-23. [DOI: 10.1007/s10552-015-0710-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 12/22/2015] [Indexed: 02/08/2023]
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Uzbas F, May ID, Parisi AM, Thompson SK, Kaya A, Perkins AD, Memili E. Molecular physiognomies and applications of adipose-derived stem cells. Stem Cell Rev Rep 2016; 11:298-308. [PMID: 25504377 DOI: 10.1007/s12015-014-9578-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Adipose-derived stromal/stem cells (ASC) are multipotent with abilities to differentiate into multiple lineages including connective tissue and neural cells. Despite unlimited opportunity and needs for human and veterinary regenerative medicine, applications of adipose-derived stromal/stem cells are at present very limited. Furthermore, the fundamental biological factors regulating stemness in ASC and their stable differentiation into other tissue cells are not fully understood. The objective of this review was to provide an update on the current knowledge of the nature and isolation, molecular and epigenetic determinants of the potency, and applications of adipose-derived stromal/stem cells, as well as challenges and future directions. The first quarter of the review focuses on the nature of ASC, namely their definition, origin, isolation and sorting methods and multilineage differentiation potential, often with a comparison to mesenchymal stem cells of bone marrow. Due to the indisputable role of epigenetic regulation on cell identities, epigenetic modifications (DNA methylation, chromatin remodeling and microRNAs) are described broadly in stem cells but with a focus on ASC. The final sections provide insights into the current and potential applications of ASC in human and veterinary regenerative medicine.
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Affiliation(s)
- F Uzbas
- Helmholtz Zentrum München, Institute of Stem Cell Research, Neuherberg, München, 85764, Germany
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34
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Knight BC, Devitt PG, Watson DI, Smith LT, Jamieson GG, Thompson SK. Long-term efficacy of laparoscopic anti-reflux surgery on regression of Barrett’s esophagus using BRAVO wireless ph monitoring. J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.08.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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Wang Z, Bright T, Irvine T, Thompson SK, Devitt PG, Watson DI. Outcome for Asymptomatic Recurrence Following Laparoscopic Repair of Very Large Hiatus Hernia. J Gastrointest Surg 2015; 19:1385-90. [PMID: 25822063 DOI: 10.1007/s11605-015-2807-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 03/17/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Radiological follow-up following repair of large hiatus hernias have identified recurrence rates of 20-30%, although most are small and asymptomatic. Whether patients will eventually develop clinical problems is uncertain. This study evaluated the outcome for individuals identified with an asymptomatic hiatus hernia following previous repair vs. asymptomatic controls. METHODS One hundred fifteen asymptomatic patients who had previously undergone sutured repair of a large hiatus hernia and then underwent barium meal X-ray 6-60 months after surgery within a clinical trial were identified and divided into two cohorts: with (n = 41) vs. without (n = 74) an asymptomatic hernia. Heartburn, dysphagia, and satisfaction with surgery were assessed prospectively using a standardized questionnaire applying analogue scales. Consumption of antisecretory medication and revision surgery were also determined. To determine the natural history of asymptomatic recurrent hiatus hernia, outcomes for the two groups were compared at 1 and 5 years and at most recent (late) follow-up. RESULTS Outcomes were available at 1 year for 98.2% and 5 years or the latest follow-up (range 6-237 months) for 100%. Heartburn and dysphagia scores were low and satisfaction scores high in both groups at all follow-up points, but heartburn scores and medication use were higher in the recurrent hernia group. At late follow-up, 94.6% of the recurrent hernia group vs. 98.5% without a hernia regarded their original decision for surgery to be correct. Two patients in recurrent hernia group underwent revision surgery. CONCLUSIONS Patients with an initially asymptomatic recurrent hiatus hernia are more likely to report heartburn and use antisecretory medication at later follow-up than controls. However, overall clinical outcomes remain good, with high satisfaction and low surgical revision rates. Additional interventions to reduce the risk of recurrence might not be warranted.
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Affiliation(s)
- Zhenyu Wang
- Flinders University Department of Surgery, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia
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36
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Cousins A, Balalis GL, Thompson SK, Forero Morales D, Mohtar A, Wedding AB, Thierry B. Novel handheld magnetometer probe based on magnetic tunnelling junction sensors for intraoperative sentinel lymph node identification. Sci Rep 2015; 5:10842. [PMID: 26038833 PMCID: PMC4454146 DOI: 10.1038/srep10842] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 12/22/2014] [Accepted: 02/26/2015] [Indexed: 11/17/2022] Open
Abstract
Using magnetic tunnelling junction sensors, a novel magnetometer probe for the identification of the sentinel lymph node using magnetic tracers was developed. Probe performance was characterised in vitro and validated in a preclinical swine model. Compared to conventional gamma probes, the magnetometer probe showed excellent spatial resolution of 4.0 mm, and the potential to detect as few as 5 μg of magnetic tracer. Due to the high sensitivity of the magnetometer, all first-tier nodes were identified in the preclinical experiments, and there were no instances of false positive or false negative detection. Furthermore, these preliminary data encourage the application of the magnetometer probe for use in more complex lymphatic environments, such as in gastrointestinal cancers, where the sentinel node is often in close proximity to other non-sentinel nodes, and high spatial resolution detection is required.
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Affiliation(s)
- A Cousins
- Ian Wark Research Institute, University of South Australia, Mawson Lakes, SA 5095, Australia
| | - G L Balalis
- Discipline of Surgery, University of Adelaide, Adelaide, SA 5000, Australia
| | - S K Thompson
- School of Engineering, University of South Australia, Mawson Lakes, SA 5095, Australia
| | - D Forero Morales
- School of Engineering, University of South Australia, Mawson Lakes, SA 5095, Australia
| | - A Mohtar
- Medical Device Research Institute, School of Computer Science, Engineering and Mathematics, Flinders University, Bedford Park, SA 5042, Australia
| | - A B Wedding
- School of Engineering, University of South Australia, Mawson Lakes, SA 5095, Australia
| | - B Thierry
- Ian Wark Research Institute, University of South Australia, Mawson Lakes, SA 5095, Australia
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Lam YH, Bright T, Leong M, Thompson SK, Mayne G, Watson DI. Oesophagectomy is a safe option for early adenocarcinoma arising from Barrett's oesophagus. ANZ J Surg 2015; 86:905-909. [DOI: 10.1111/ans.13023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Yick Ho Lam
- Department of Surgery; Flinders University; Adelaide South Australia Australia
| | - Tim Bright
- Department of Surgery; Flinders University; Adelaide South Australia Australia
| | - Matthew Leong
- Department of Surgery; Flinders University; Adelaide South Australia Australia
| | - Sarah K. Thompson
- Department of Surgery; University of Adelaide; Adelaide South Australia Australia
| | - George Mayne
- Department of Surgery; Flinders University; Adelaide South Australia Australia
| | - David I Watson
- Department of Surgery; Flinders University; Adelaide South Australia Australia
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39
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Wilson EE, Thompson SK, Bull J, Jones B, Price T, Devitt PG, Watson DI, Bright T. Improving care for patients with oesophageal and gastric cancer: impact of a statewide multidisciplinary team. ANZ J Surg 2014; 86:270-3. [DOI: 10.1111/ans.12869] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Eleanor E. Wilson
- Department of Surgery; Flinders University; Adelaide South Australia Australia
| | - Sarah K. Thompson
- Department of Surgery; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Jeff Bull
- Department of Surgery; Flinders University; Adelaide South Australia Australia
| | - Bronwyn Jones
- Department of Surgery; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Timothy Price
- Department of Medical Oncology; The Queen Elizabeth Hospital; Adelaide South Australia Australia
| | - Peter G. Devitt
- Department of Surgery; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - David I. Watson
- Department of Surgery; Flinders University; Adelaide South Australia Australia
| | - Tim Bright
- Department of Surgery; Flinders University; Adelaide South Australia Australia
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40
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Griffiths EA, Farfus AW, Devitt PG, Thompson SK. Response to Re: Current Australian practice in the diagnosis and management of Barrett's oesophagus. ANZ J Surg 2014; 84:597. [PMID: 25065430 DOI: 10.1111/ans.12663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ewen A Griffiths
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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41
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Knight BC, Rice SJ, Devitt PG, Lord A, Game PA, Thompson SK. Proximal anastomosis using the OrVil circular stapler in major upper gastrointestinal surgery. J Gastrointest Surg 2014; 18:1345-9. [PMID: 24553876 DOI: 10.1007/s11605-014-2478-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 01/28/2014] [Indexed: 01/31/2023]
Abstract
Anastomoses in major upper gastrointestinal surgery can be technically demanding, especially handsewn anastomoses traversing the diaphragmatic hiatus. The OrVil stapler is a unique circular stapler that allows rapid creation of various upper gastrointestinal anastomoses in technically challenging circumstances, particularly if additional proximal clearance is desirable. Little is reported in the literature regarding its outcomes and complication rates. In this 'How I do It' article, we describe our technique and experience with the OrVil in major upper gastrointestinal surgery.
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Affiliation(s)
- Benjamin C Knight
- Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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42
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Balalis GL, Thompson SK. Sentinel lymph node biopsy in esophageal cancer: an essential step towards individualized care. Ann Surg Innov Res 2014; 8:2. [PMID: 24829610 PMCID: PMC4019891 DOI: 10.1186/1750-1164-8-2] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 04/29/2014] [Indexed: 12/23/2022]
Abstract
Lymph node status is the most important prognostic factor in esophageal cancer. Through improved detection of lymph node metastases, using the sentinel lymph node concept, accurate staging and more tailored therapy may be achieved. This review article outlines two principle ways in which the sentinel lymph node concept could dramatically influence current standard of care for patients with esophageal cancer. We discuss three limitations to universal acceptance of the technique, and propose next steps for increasing enthusiasm amongst physicians and surgeons including the development of a universal tracer, and improved contrast agents with novel dual-modality 'visibility'.
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Affiliation(s)
- George L Balalis
- Department of Surgery, Level 5, Eleanor Harrald Building, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia
| | - Sarah K Thompson
- Department of Surgery, Level 5, Eleanor Harrald Building, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia
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43
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Griffiths EA, McDonald CR, Bryant RV, Devitt PG, Bright T, Holloway RH, Thompson SK. Retrospective analysis of surgery and trans-arterial embolization for major non-variceal upper gastrointestinal bleeding. ANZ J Surg 2014; 86:381-5. [DOI: 10.1111/ans.12588] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2014] [Indexed: 01/27/2023]
Affiliation(s)
- Ewen A. Griffiths
- Professorial Unit of Oesophagogastric Surgery; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Chris R. McDonald
- Department of Surgery; Flinders Medical Centre; Adelaide South Australia Australia
| | - Robert V. Bryant
- Department of Gastroenterology; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Peter G. Devitt
- Professorial Unit of Oesophagogastric Surgery; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Tim Bright
- Department of Surgery; Flinders Medical Centre; Adelaide South Australia Australia
| | - Richard H. Holloway
- Department of Gastroenterology; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Sarah K. Thompson
- Professorial Unit of Oesophagogastric Surgery; Royal Adelaide Hospital; Adelaide South Australia Australia
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44
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Winter M, Gibson R, Ruszkiewicz A, Thompson SK, Thierry B. Beyond conventional pathology: Towards preoperative and intraoperative lymph node staging. Int J Cancer 2014; 136:743-51. [DOI: 10.1002/ijc.28742] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 12/23/2013] [Indexed: 01/01/2023]
Affiliation(s)
- Marnie Winter
- Ian Wark Research Institute; University of South Australia; Adelaide SA Australia
| | - Rachel Gibson
- Discipline of Anatomy and Pathology School of Medical Sciences; University of Adelaide; Adelaide SA Australia
| | | | - Sarah K. Thompson
- Department of Surgery Royal Adelaide Hospital and School of Health Sciences; University of South Australia; Adelaide SA Australia
| | - Benjamin Thierry
- Ian Wark Research Institute; University of South Australia; Adelaide SA Australia
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45
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Farfus AW, Griffiths EA, Thompson SK, Devitt PG. Current Australian practice in the diagnosis and management of Barrett's oesophagus. ANZ J Surg 2014; 83:895-8. [PMID: 24436954 DOI: 10.1111/ans.12372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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46
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Daud WNW, Thompson SK, Jamieson GG, Devitt PG, Martin IJG, Watson DI. Randomized controlled trial of laparoscopic anterior 180° partial versus posterior 270° partial fundoplication. ANZ J Surg 2013; 85:668-72. [DOI: 10.1111/ans.12476] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2013] [Indexed: 01/30/2023]
Affiliation(s)
- Wan Najmi Wan Daud
- Department of Surgery; Flinders University; Adelaide South Australia Australia
| | - Sarah K. Thompson
- Discipline of Surgery; University of Adelaide; Adelaide South Australia Australia
| | - Glyn G. Jamieson
- Discipline of Surgery; University of Adelaide; Adelaide South Australia Australia
| | - Peter G. Devitt
- Discipline of Surgery; University of Adelaide; Adelaide South Australia Australia
| | - Ian J. G. Martin
- Department of Surgery; University of Queensland; Brisbane Queensland Australia
| | - David I. Watson
- Department of Surgery; Flinders University; Adelaide South Australia Australia
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47
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Varzaly JA, Devitt PG, Gossage J, Singh R, Thompson SK. Upper endoscopy and random biopsies: endoscopic findings with disconcordant pathology. ANZ J Surg 2013; 84:986-8. [PMID: 24172170 DOI: 10.1111/ans.12356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jason A Varzaly
- Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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48
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Cousins A, Thompson SK, Wedding AB, Thierry B. Clinical relevance of novel imaging technologies for sentinel lymph node identification and staging. Biotechnol Adv 2013; 32:269-79. [PMID: 24189095 DOI: 10.1016/j.biotechadv.2013.10.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 10/12/2013] [Accepted: 10/27/2013] [Indexed: 01/07/2023]
Abstract
The sentinel lymph node (SLN) concept has become a standard of care for patients with breast cancer and melanoma, yet its clinical application to other cancer types has been somewhat limited. This is mainly due to the reduced accuracy of conventional SLN mapping techniques (using blue dye and/or radiocolloids as lymphatic tracers) in cancer types where lymphatic drainage is more complex, and SLNs are within close proximity to other nodes or the tumour site. In recent years, many novel techniques for SLN mapping have been developed including fluorescence, x-ray, and magnetic resonant detection. Whilst each technique has its own advantages/disadvantages, the role of targeted contrast agents (for enhanced retention in the SLN, or for immunostaging) is increasing, and may represent the new standard for mapping the SLN in many solid organ tumours. This review article discusses current limitations of conventional techniques, limiting factors of nanoparticulate based contrast agents, and efforts to circumvent these limitations with modern tracer architecture.
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Affiliation(s)
- Aidan Cousins
- Ian Wark Research Institute, University of South Australia, Mawson Lakes Campus, Mawson Lakes, SA 5095, Australia
| | - Sarah K Thompson
- Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - A Bruce Wedding
- School of Engineering, University of South Australia, Mawson Lakes Campus, Mawson Lakes, SA 5095, Australia
| | - Benjamin Thierry
- Ian Wark Research Institute, University of South Australia, Mawson Lakes Campus, Mawson Lakes, SA 5095, Australia.
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Griffiths EA, Devitt PG, Bright T, Watson DI, Thompson SK. Surgical management of peptic ulcer bleeding by Australian and New Zealand upper gastrointestinal surgeons. ANZ J Surg 2013; 83:104-8. [PMID: 23586097 DOI: 10.1111/ans.12064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Ewen A Griffiths
- Professorial Unit of Oesophagogastric Surgery, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Brown CN, Smith LT, Watson DI, Devitt PG, Thompson SK, Jamieson GG. Outcomes for trainees vs experienced surgeons undertaking laparoscopic antireflux surgery - is equipoise achieved? J Gastrointest Surg 2013; 17:1173-80. [PMID: 23653375 DOI: 10.1007/s11605-013-2211-8] [Citation(s) in RCA: 14] [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] [Received: 04/11/2012] [Accepted: 04/15/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is a learning curve associated with laparoscopic antireflux surgery which has an impact on patient outcomes. It is unclear, however, whether this can be eliminated by supervision of early cases by experienced surgeons. The aim of this study was to evaluate the impact of training under supervision on outcomes for laparoscopic fundoplication. METHOD Patients undergoing primary laparoscopic antireflux surgery from 1995 to 2009 were identified from a prospective database. Patients were classified according to whether they were operated on by an experienced consultant or supervised trainee, and sub-categorised according to the presence of a very large hiatus hernia. A standardised questionnaire was used to assess outcomes for heartburn, dysphagia and satisfaction at 1 and 5 years follow-up. Outcomes for the study groups were compared. RESULTS One thousand seven hundred and ten patients underwent surgery; 1,112 were operated on by consultants and 598 by trainees. The peri-operative complication rate was not different between the groups, although in patients operated on by trainees, there were increased rates of endoscopic dilatation (9 vs. 5 % p = 0.014) and re-operation (9 vs. 6 %, p = 0.031), and a lower satisfaction rate (76 vs. 82 %, p = 0.044) within 5 years of surgery. All other outcomes were similar for trainees vs. consultants. CONCLUSION The learning curve for laparoscopic fundoplication had a small, but statistically significant, impact on patient outcomes, with slightly lesser outcomes when surgery was undertaken by trainees, even when supervised by experienced surgeons. Although the differences were not large, they raise questions about equipoise and highlight ethical dilemmas with teaching new generations of surgeons.
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Affiliation(s)
- Claire N Brown
- Department of Surgery and the Royal Adelaide Hospital, University of Adelaide, Level 5, Eleanor Harrald Building, Royal Adelaide Hospital, 5000 Adelaide, South Australia, Australia.
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