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Perrone G, Giuffrida M, Abu-Zidan F, Kruger VF, Livrini M, Petracca GL, Rossi G, Tarasconi A, Tian BWCA, Bonati E, Mentz R, Mazzini FN, Campana JP, Gasser E, Kafka-Ritsch R, Felsenreich DM, Dawoud C, Riss S, Gomes CA, Gomes FC, Gonzaga RAT, Canton CAB, Pereira BM, Fraga GP, Zem LG, Cordeiro-Fonseca V, de Mesquita Tauil R, Atanasov B, Belev N, Kovachev N, Meléndez LJJ, Dimova A, Dimov S, Zelić Z, Augustin G, Bogdanić B, Morić T, Chouillard E, Bajul M, De Simone B, Panis Y, Esposito F, Notarnicola M, Lauka L, Fabbri A, Hentati H, Fnaiech I, Aurélien V, Bougard M, Roulet M, Demetrashvili Z, Pipia I, Merabishvili G, Bouliaris K, Koukoulis G, Doudakmanis C, Xenaki S, Chrysos E, Kokkinakis S, Vassiliu P, Michalopoulos N, Margaris I, Kechagias A, Avgerinos K, Katunin J, Lostoridis E, Nagorni EA, Pujante A, Mulita F, Maroulis I, Vailas M, Marinis A, Siannis I, Bourbouteli E, Manatakis DK, Tasis N, Acheimastos V, Maria S, Stylianos K, Kuzeridis H, Korkolis D, Fradelos E, Kavalieratos G, Petropoulou T, Polydorou A, Papacostantinou I, Triantafyllou T, Kimpizi D, Theodorou D, Toutouzas K, Chamzin A, Frountzas M, Schizas D, Karavokyros I, Syllaios A, Charalabopoulos A, Boura M, Baili E, Ioannidis O, Loutzidou L, Anestiadou E, Tsouknidas I, Petrakis G, Polenta E, Bains L, Gupta R, Singh SK, Khanduri A, Bala M, Kedar A, Pisano M, Podda M, Pisanu A, Martines G, Trigiante G, Lantone G, Agrusa A, Di Buono G, Buscemi S, Veroux M, Gioco R, Veroux G, Oragano L, Zonta S, Lovisetto F, Feo CV, Pesce A, Fabbri N, Lantone G, Marino F, Perrone F, Vincenti L, Papagni V, Picciariello A, Rossi S, Picardi B, Del Monte SR, Visconti D, Osella G, Petruzzelli L, Pignata G, Andreuccetti J, D'Alessio R, Buonfantino M, Guaitoli E, Spinelli S, Sampietro GM, Corbellini C, Lorusso L, Frontali A, Pezzoli I, Bonomi A, Chierici A, Cotsoglou C, Manca G, Delvecchio A, Musa N, Casati M, Letizia L, Abate E, Ercolani G, D'Acapito F, Solaini L, Guercioni G, Cicconi S, Sasia D, Borghi F, Giraudo G, Sena G, Castaldo P, Cardamone E, Portale G, Zuin M, Spolverato Y, Esposito M, Isernia RM, Di Salvo M, Manunza R, Esposito G, Agus M, Asti ELG, Bernardi DT, Tonucci TP, Luppi D, Casadei M, Bonilauri S, Pezzolla A, Panebianco A, Laforgia R, De Luca M, Zese M, Parini D, Jovine E, De Sario G, Lombardi R, Aprea G, Palomba G, Capuano M, Argenio G, Orio G, Armellino MF, Troian M, Guerra M, Nagliati C, Biloslavo A, Germani P, Aizza G, Monsellato I, Chahrour AC, Anania G, Bombardini C, Bagolini F, Sganga G, Fransvea P, Bianchi V, Boati P, Ferrara F, Palmieri F, Cianci P, Gattulli D, Restini E, Cillara N, Cannavera A, Nita GE, Sarnari J, Roscio F, Clerici F, Scandroglio I, Berti S, Cadeo A, Filippelli A, Conti L, Grassi C, Cattaneo GM, Pighin M, Papis D, Gambino G, Bertino V, Schifano D, Prando D, Fogato L, Cavallo F, Ansaloni L, Picheo R, Pontarolo N, Depalma N, Spampinato M, D'Ugo S, Lepre L, Capponi MG, Campa RD, Sarro G, Dinuzzi VP, Olmi S, Uccelli M, Ferrari D, Inama M, Moretto G, Fontana M, Favi F, Picariello E, Rampini A, Barberis A, Azzinnaro A, Oliva A, Totaro L, Benzoni I, Ranieri V, Capolupo GT, Carannante F, Caricato M, Ronconi M, Casiraghi S, Casole G, Pantalone D, Alemanno G, Scheiterle M, Ceresoli M, Cereda M, Fumagalli C, Zanzi F, Bolzon S, Guerra E, Lecchi F, Cellerino P, Ardito A, Scaramuzzo R, Balla A, Lepiane P, Tartaglia N, Ambrosi A, Pavone G, Palini GM, Veneroni S, Garulli G, Ricci C, Torre B, Russo IS, Rottoli M, Tanzanu M, Belvedere A, Milone M, Manigrasso M, De Palma GD, Piccoli M, Pattacini GC, Magnone S, Bertoli P, Pisano M, Massucco P, Palisi M, Luzzi AP, Fleres F, Clarizia G, Spolini A, Kobe Y, Toma T, Shimamura F, Parker R, Ranketi S, Mitei M, Svagzdys S, Pauzas H, Zilinskas J, Poskus T, Kryzauskas M, Jakubauskas M, Zakaria AD, Zakaria Z, Wong MPK, Jusoh AC, Zakaria MN, Cruz DR, Elizalde ABR, Reynaud AB, Hernandez EEL, Monroy JMVP, Hinojosa-Ugarte D, Quiodettis M, Du Bois ME, Latorraca J, Major P, Pędziwiatr M, Pisarska-Adamczyk M, Walędziak M, Kwiatkowski A, Czyżykowski Ł, da Costa SD, Pereira B, Ferreira ARO, Almeida F, Rocha R, Carneiro C, Perez DP, Carvas J, Rocha C, Ferreira C, Marques R, Fernandes U, Leao P, Goulart A, Pereira RG, Patrocínio SDD, de Mendonça NGG, Manso MIC, Morais HMC, Cardoso PS, Calu V, Miron A, Toma EA, Gachabayov M, Abdullaev A, Litvin A, Nechay T, Tyagunov A, Yuldashev A, Bradley A, Wilson M, Panyko A, Látečková Z, Lacko V, Lesko D, Soltes M, Radonak J, Turrado-Rodriguez V, Termes-Serra R, Morales-Sevillano X, Lapolla P, Mingoli A, Brachini G, Degiuli M, Sofia S, Reddavid R, de Manzoni Garberini A, Buffone A, Del Pozo EP, Aparicio-Sánchez D, Dos Barbeito S, Estaire-Gómez M, Vitón-Herrero R, de Los Ángeles Gil Olarte-Marquez M, Gil-Martínez J, Alconchel F, Nicolás-López T, Rahy-Martin AC, Pelloni M, Bañolas-Suarez R, Mendoza-Moreno F, Nisa FGM, Díez-Alonso M, Rodas MEV, Agundez MC, Andrés MIP, Moreira CCL, Perez AL, Ponce IA, González-Castillo AM, Membrilla-Fernández E, Salvans S, Serradilla-Martín M, Pardo PS, Rivera-Alonso D, Dziakova J, Huguet JM, Valle NP, Ruiz EC, Valcárcel CR, Moreno CR, Salazar YTM, García JJR, Micó SS, López JR, Farré SP, Gomez MS, Petit NM, Titos-García A, Aranda-Narváez JM, Romacho-López L, Sánchez-Guillén L, Aranaz-Ostariz V, Bosch-Ramírez M, Martínez-Pérez A, Martínez-López E, Sebastián-Tomás JC, Jimenez-Riera G, Jimenez-Vega J, Cuellar JAN, Campos-Serra A, Muñoz-Campaña A, Gràcia-Roman R, Alegre JM, Pinto FL, O'Sullivan SN, Antona FB, Jiménez BM, López-Sánchez J, Carmona ZG, Fernández RT, Sierra IB, de León LRG, Moreno VP, Iglesias E, Cumplido PL, Bravo AA, Simó IR, Domínguez CL, Caamaño AG, Lozano RC, Martínez MD, Torres ÁN, de Quiros JTMB, Pellino G, Cloquell MM, Moller EG, Jalal-Eldin S, Abdoun AK, Hamid HKS, Lohsiriwat V, Mongkhonsupphawan A, Baraket O, Ayed K, Abbassi I, Ali AB, Ammar H, Kchaou A, Tlili A, Zribi I, Colak E, Polat S, Koylu ZA, Guner A, Usta MA, Reis ME, Mantoglu B, Gonullu E, Akin E, Altintoprak F, Bayhan Z, Firat N, Isik A, Memis U, Bayrak M, Altıntaş Y, Kara Y, Bozkurt MA, Kocataş A, Das K, Seker A, Ozer N, Atici SD, Tuncer K, Kaya T, Ozkan Z, Ilhan O, Agackiran I, Uzunoglu MY, Demirbas E, Altinel Y, Meric S, Hacım NA, Uymaz DS, Omarov N, Balık E, Tebala GD, Khalil H, Rana M, Khan M, Florence C, Swaminathan C, Leo CA, Liasis L, Watfah J, Trostchansky I, Delgado E, Pontillo M, Latifi R, Coimbra R, Edwards S, Lopez A, Velmahos G, Dorken A, Gebran A, Palmer A, Oury J, Bardes JM, Seng SS, Coffua LS, Ratnasekera A, Egodage T, Echeverria-Rosario K, Armento I, Napolitano LM, Sangji NF, Hemmila M, Quick JA, Austin TR, Hyman TS, Curtiss W, McClure A, Cairl N, Biffl WL, Truong HP, Schaffer K, Reames S, Banchini F, Capelli P, Coccolini F, Sartelli M, Bravi F, Vallicelli C, Agnoletti V, Baiocchi GL, Catena F. Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago. World J Emerg Surg 2024; 19:14. [PMID: 38627831 PMCID: PMC11020610 DOI: 10.1186/s13017-024-00543-w] [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: 11/01/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. METHODS This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. RESULTS 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. CONCLUSIONS After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception.
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Affiliation(s)
- Gennaro Perrone
- Department of Emergency Surgery, Maggiore Hospital, Parma, Italy
| | - Mario Giuffrida
- General Surgery Unit, Maggiore Hospital, Parma, Italy.
- Department of General Surgery, Ospedale Guglielmo da Saliceto, 29100, Piacenza, Italy.
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Vitor F Kruger
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Marco Livrini
- Department of Emergency Surgery, Maggiore Hospital, Parma, Italy
| | | | - Giorgio Rossi
- Department of Emergency Surgery, Maggiore Hospital, Parma, Italy
| | - Antonio Tarasconi
- General Surgery Department, UO Chirurgia Generale, ASST Cremona, Cremona, Italy
| | - Brian W C A Tian
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Elena Bonati
- General Surgery Unit, Maggiore Hospital, Parma, Italy
| | - Ricardo Mentz
- General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Federico N Mazzini
- General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan P Campana
- General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Elisabeth Gasser
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Reinhold Kafka-Ritsch
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel M Felsenreich
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Christopher Dawoud
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Riss
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Carlos Augusto Gomes
- Faculdade de Medicina, SUPREMA, Hospital Universitario Terezinha de Jesus de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Felipe Couto Gomes
- Faculdade de Medicina, SUPREMA, Hospital Universitario Terezinha de Jesus de Juiz de Fora, Juiz de Fora, MG, Brazil
| | | | - Cassio Alfred Brattig Canton
- Medical Course, Department of Surgery - Emergency Surgery and Trauma Sector, Padre Albino University Center, Catanduva, Brazil
| | | | - Gustavo P Fraga
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Leticia Gonçalves Zem
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | | | - Boyko Atanasov
- UMHAT Eurohospital-Plovdiv/Medical University Plovdiv, Plovdiv, Bulgaria
| | - Nikolay Belev
- UMHAT Eurohospital-Plovdiv/Medical University Plovdiv, Plovdiv, Bulgaria
| | - Nikola Kovachev
- UMHAT Eurohospital-Plovdiv/Medical University Plovdiv, Plovdiv, Bulgaria
| | - L Juan José Meléndez
- Trauma and Acute Care Surgeon Hospital Rafael Angel Calderón Guardia, San José, Costa Rica
| | - Ana Dimova
- General Hospital Zabok and Croatian War Veteran Hospital Bracak, Zabok, Croatia
| | - Stefan Dimov
- General Hospital Zabok and Croatian War Veteran Hospital Bracak, Zabok, Croatia
| | - Zdravko Zelić
- General Hospital Zabok and Croatian War Veteran Hospital Bracak, Zabok, Croatia
| | - Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Branko Bogdanić
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Trpimir Morić
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Elie Chouillard
- Department of General and Bariatric Surgery, American Hospital in Paris, Paris, France
| | - Melinda Bajul
- Emergency and General Minimally Invasive Surgery, Poissy and St Germain Hospital, Poissy, France
| | - Belinda De Simone
- Department of Emergency and General Minimally Invasive Surgery, Academic Hospital of Villeneuve St Georges, Villeneuve-Saint-Georges, France
| | - Yves Panis
- Colorectal Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly/Seine, France
| | - Francesco Esposito
- Department of Colorectal Surgery, Pôle Des Maladies de L'Appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | | | | | | | | | | | - Venara Aurélien
- Department of Visceral Surgery CHU Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France
| | - Marie Bougard
- Department of Visceral Surgery CHU Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France
| | - Maxime Roulet
- Department of Visceral Surgery CHU Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France
| | | | - Irakli Pipia
- N.Kipshidze Central University Hospital, Tbilisi, Georgia
| | | | | | | | | | - Sofia Xenaki
- Department of General Surgery - University Hospital of Heraklion Crete, Crete, Greece
| | - Emmanuel Chrysos
- Department of General Surgery - University Hospital of Heraklion Crete, Crete, Greece
| | - Stamatios Kokkinakis
- Department of General Surgery - University Hospital of Heraklion Crete, Crete, Greece
| | | | | | - Ioannis Margaris
- 4th Surgical Department "Attikon" University Hospital, Chaidari, Greece
| | | | | | - Jevgeni Katunin
- Department of Digestive Surgery, Athens Bioclinic Hospital, Athens, Greece
| | | | | | | | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Ioannis Maroulis
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Michail Vailas
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Athanasios Marinis
- Third Department of Surgery, Tzaneio General Hospital, Piraeus, GR, Greece
| | - Ioannis Siannis
- Third Department of Surgery, Tzaneio General Hospital, Piraeus, GR, Greece
| | - Eirini Bourbouteli
- Third Department of Surgery, Tzaneio General Hospital, Piraeus, GR, Greece
| | | | - Nikolaos Tasis
- 2nd Department of Surgery, Athens Naval and Veterans Hospital, Athens, Greece
| | | | | | | | | | - Dimitrios Korkolis
- Surgical Oncology Department of Agios Savvas Anticancer Hospital of Athens, Athens, Greece
| | - Evangelos Fradelos
- Surgical Oncology Department of Agios Savvas Anticancer Hospital of Athens, Athens, Greece
| | - George Kavalieratos
- Surgical Oncology Department of Agios Savvas Anticancer Hospital of Athens, Athens, Greece
| | | | | | | | - Tania Triantafyllou
- Department of Surgery, Hippocration General Hospital of Athens, University of Athens, Athens, Greece
| | - Despina Kimpizi
- Department of Surgery, Hippocration General Hospital of Athens, University of Athens, Athens, Greece
| | - Dimitrios Theodorou
- Department of Surgery, Hippocration General Hospital of Athens, University of Athens, Athens, Greece
| | | | - Alexandros Chamzin
- 1st Propaedeutic Department of Surgery, Hippocratio Hospital of Athens, Athens, Greece
| | - Maximos Frountzas
- 1st Propaedeutic Department of Surgery, Hippocratio Hospital of Athens, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Ioannis Karavokyros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Athanasios Syllaios
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | - Maria Boura
- National and Kapodistrian University of Athens, Athens, Greece
| | - Efstratia Baili
- National and Kapodistrian University of Athens, Athens, Greece
| | - Orestis Ioannidis
- 4th Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital "George Papanikolaou", Thessaloniki, Greece
| | - Lydia Loutzidou
- 4th Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital "George Papanikolaou", Thessaloniki, Greece
| | - Elissavet Anestiadou
- 4th Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital "George Papanikolaou", Thessaloniki, Greece
| | - Ioannis Tsouknidas
- 2n, Department of Surgery, General Hospital of Chania "St George", Chania, Greece
| | - Georgios Petrakis
- 2n, Department of Surgery, General Hospital of Chania "St George", Chania, Greece
| | - Eleni Polenta
- 2n, Department of Surgery, General Hospital of Chania "St George", Chania, Greece
| | - Lovenish Bains
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Rahul Gupta
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, India
| | - Sudhir K Singh
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, India
| | - Archana Khanduri
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, India
| | - Miklosh Bala
- General Surgery and Trauma Unit Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Asaf Kedar
- General Surgery and Trauma Unit Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Marcello Pisano
- Chirurgia d'Urgenza Policlinico Universitario di MonserratoAzienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Mauro Podda
- Chirurgia d'Urgenza Policlinico Universitario di MonserratoAzienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Adolfo Pisanu
- Chirurgia d'Urgenza Policlinico Universitario di MonserratoAzienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Gennaro Martines
- Chirurgia "M.Rubino" Azienda Ospedaliero Universitaria Policlinico Bari, Bari, Italy
| | - Giuseppe Trigiante
- Chirurgia "M.Rubino" Azienda Ospedaliero Universitaria Policlinico Bari, Bari, Italy
| | - Giuliano Lantone
- Chirurgia "M.Rubino" Azienda Ospedaliero Universitaria Policlinico Bari, Bari, Italy
| | - Antonino Agrusa
- Unit of General and Emergency Surgery, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University Hospital Policlinico "P. Giaccone, University of Palermo - Palermo, Palermo, Italy
| | - Giuseppe Di Buono
- Unit of General and Emergency Surgery, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University Hospital Policlinico "P. Giaccone, University of Palermo - Palermo, Palermo, Italy
| | - Salvatore Buscemi
- Unit of General and Emergency Surgery, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University Hospital Policlinico "P. Giaccone, University of Palermo - Palermo, Palermo, Italy
| | - Massimiliano Veroux
- General Surgery Unit and Organ Transplant Unit, University Hospital of Catania, Catania, Italy
| | - Rossella Gioco
- General Surgery Unit and Organ Transplant Unit, University Hospital of Catania, Catania, Italy
| | - Gastone Veroux
- General Surgery Unit and Organ Transplant Unit, University Hospital of Catania, Catania, Italy
| | - Luigi Oragano
- SOC Chirurgia Generale - ASL VCO (Piemonte), Verbania, Italy
| | - Sandro Zonta
- SOC Chirurgia Generale - ASL VCO (Piemonte), Verbania, Italy
| | | | - Carlo V Feo
- Unità Operativa Chirurgia Generale ProvincialeAzienda USL di Ferrara, Ferrara, Italy
| | - Antonio Pesce
- Unità Operativa Chirurgia Generale ProvincialeAzienda USL di Ferrara, Ferrara, Italy
| | - Nicolò Fabbri
- Unità Operativa Chirurgia Generale ProvincialeAzienda USL di Ferrara, Ferrara, Italy
| | - Giulio Lantone
- Surgery Unit, National Institute of Gastroenterology 'S. de Bellis', Research Hospital, Castellana Grotte, BA, Italy
| | - Fabio Marino
- Surgery Unit, National Institute of Gastroenterology 'S. de Bellis', Research Hospital, Castellana Grotte, BA, Italy
| | - Fabrizio Perrone
- Surgery Unit, National Institute of Gastroenterology 'S. de Bellis', Research Hospital, Castellana Grotte, BA, Italy
| | - Leonardo Vincenti
- Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari - Dept of Emergency and Organ Transplantation, Bari, Italy
| | - Vincenzo Papagni
- Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari - Dept of Emergency and Organ Transplantation, Bari, Italy
| | - Arcangelo Picciariello
- Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari - Dept of Emergency and Organ Transplantation, Bari, Italy
| | - Stefano Rossi
- Department of General and Emergency Surgery, San Filippo Neri Hospital, Rome, Italy
| | - Biagio Picardi
- Department of General and Emergency Surgery, San Filippo Neri Hospital, Rome, Italy
| | | | - Diego Visconti
- Chirurgia Generale d'Urgenza e PS - AOU Città della Salute e della Scienza di Torino, Presidio San Giovanni Battista - Molinette, Turin, Italy
| | - Giulia Osella
- Chirurgia Generale d'Urgenza e PS - AOU Città della Salute e della Scienza di Torino, Presidio San Giovanni Battista - Molinette, Turin, Italy
| | - Luca Petruzzelli
- Chirurgia Generale d'Urgenza e PS - AOU Città della Salute e della Scienza di Torino, Presidio San Giovanni Battista - Molinette, Turin, Italy
| | - Giusto Pignata
- Chirurgia Generale 2 ASST Spedali Civili di Brescia, Brescia, Italy
| | | | | | | | | | - Stefano Spinelli
- Chirurgia Generale PO Valle d'Itria ASL TA, Martina Franca, Italy
| | | | - Carlo Corbellini
- Unità Operativa di Chirurgia Generale Ospedale di Rho - ASST Rhodense, Milan, Italy
| | - Leonardo Lorusso
- Unità Operativa di Chirurgia Generale Ospedale di Rho - ASST Rhodense, Milan, Italy
| | - Alice Frontali
- General Surgery Unit, Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, AAST Fatebenefratelli Sacco, Milan, Italy
- General Surgery Unit, University of Milan, ASST Vimercate, Via Santi Cosma e Damiano 16, 20871, Vimercate, Italy
| | - Isabella Pezzoli
- General Surgery Unit, Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, AAST Fatebenefratelli Sacco, Milan, Italy
| | - Alessandro Bonomi
- General Surgery Unit, Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, AAST Fatebenefratelli Sacco, Milan, Italy
| | - Andrea Chierici
- General Surgery Unit, University of Milan, ASST Vimercate, Via Santi Cosma e Damiano 16, 20871, Vimercate, Italy
| | - Christian Cotsoglou
- General Surgery Unit, University of Milan, ASST Vimercate, Via Santi Cosma e Damiano 16, 20871, Vimercate, Italy
| | - Giuseppe Manca
- Unità Operativa Complessa di Chirurgia Generale, Presidio Ospedaliero "A. Perrino", Brindisi, Italy
| | - Antonella Delvecchio
- Unità Operativa Complessa di Chirurgia Generale, Presidio Ospedaliero "A. Perrino", Brindisi, Italy
| | - Nicola Musa
- Unità Operativa Complessa di Chirurgia Generale, Presidio Ospedaliero "A. Perrino", Brindisi, Italy
| | | | - Laface Letizia
- Ospedale Vittorio Emanuele III Carate Brianza, Carate Brianza, Italy
| | - Emmanuele Abate
- Ospedale Vittorio Emanuele III Carate Brianza, Carate Brianza, Italy
| | - Giorgio Ercolani
- UOC Chirurgia Generale e Terapie Oncologiche Avanzate Ospedale Morgagni-Pierantoni AUSLRomagna, Via Carlo Forlanini 34, 47121, Forlì, Italy
| | - Fabrizio D'Acapito
- UOC Chirurgia Generale e Terapie Oncologiche Avanzate Ospedale Morgagni-Pierantoni AUSLRomagna, Via Carlo Forlanini 34, 47121, Forlì, Italy
| | - Leonardo Solaini
- UOC Chirurgia Generale e Terapie Oncologiche Avanzate Ospedale Morgagni-Pierantoni AUSLRomagna, Via Carlo Forlanini 34, 47121, Forlì, Italy
| | - Gianluca Guercioni
- UOC ChirurgiaOspedale Provinciale "C. E G. Mazzoni" Ascoli Piceno, Area Vasta 5, Regione Marche, Italy
| | - Simone Cicconi
- UOC ChirurgiaOspedale Provinciale "C. E G. Mazzoni" Ascoli Piceno, Area Vasta 5, Regione Marche, Italy
| | - Diego Sasia
- Santa Croce and Carle Hospital, Cuneo, Italy
| | | | | | - Giuseppe Sena
- Dipartimento di Specialità Chirurgiche, Azienda Ospedaliera "Pugliese-Ciaccio" di Catanzaro, Catanzaro, Italy
| | - Pasquale Castaldo
- Dipartimento di Specialità Chirurgiche, Azienda Ospedaliera "Pugliese-Ciaccio" di Catanzaro, Catanzaro, Italy
| | - Eugenia Cardamone
- Dipartimento di Specialità Chirurgiche, Azienda Ospedaliera "Pugliese-Ciaccio" di Catanzaro, Catanzaro, Italy
| | - Giuseppe Portale
- Department of General Surgery, ULSS 6 Euganea, CittadellaPadua, Italy
| | - Matteo Zuin
- Department of General Surgery, ULSS 6 Euganea, CittadellaPadua, Italy
| | - Ylenia Spolverato
- Department of General Surgery, ULSS 6 Euganea, CittadellaPadua, Italy
| | | | | | | | - Romina Manunza
- Chirurgia d'Urgenza ospedale Brotzu - ARNAS, Palermo, Italy
| | | | - Marcello Agus
- Chirurgia d'Urgenza ospedale Brotzu - ARNAS, Palermo, Italy
| | | | | | | | - Davide Luppi
- Dipartimento di Chirurgia Generale 2 e D'Urgenza dell'Arcispedale Santa Maria Nuova - Ausl RE IRCCS, Reggio Emilia, Italy
| | - Massimiliano Casadei
- Dipartimento di Chirurgia Generale 2 e D'Urgenza dell'Arcispedale Santa Maria Nuova - Ausl RE IRCCS, Reggio Emilia, Italy
| | - Stefano Bonilauri
- Dipartimento di Chirurgia Generale 2 e D'Urgenza dell'Arcispedale Santa Maria Nuova - Ausl RE IRCCS, Reggio Emilia, Italy
| | - Angela Pezzolla
- U.O. di Chirurgia Videolaparoscopica della AOU Policlinico di Bari, Bari, Italy
| | | | - Rita Laforgia
- U.O. di Chirurgia Videolaparoscopica della AOU Policlinico di Bari, Bari, Italy
| | - Maurizio De Luca
- Department of General Surgery, Santa Maria della Misericordia Hospital, AULSS5 Polesana - Rovigo, Rovigo, Italy
| | - Monica Zese
- Department of General Surgery, Santa Maria della Misericordia Hospital, AULSS5 Polesana - Rovigo, Rovigo, Italy
| | - Dario Parini
- Department of General Surgery, Santa Maria della Misericordia Hospital, AULSS5 Polesana - Rovigo, Rovigo, Italy
| | - Elio Jovine
- Chirurgia A e d'Urgenza IRCCS Ospedale Maggiore Bologna Largo, Bartolo Nigrisoli 2, 40133, Bologna, Italy
| | - Giuseppina De Sario
- Chirurgia A e d'Urgenza IRCCS Ospedale Maggiore Bologna Largo, Bartolo Nigrisoli 2, 40133, Bologna, Italy
| | - Raffaele Lombardi
- Chirurgia A e d'Urgenza IRCCS Ospedale Maggiore Bologna Largo, Bartolo Nigrisoli 2, 40133, Bologna, Italy
| | - Giovanni Aprea
- UOC Chirurgia Endoscopica - AOU Federico II Di Napoli, Naples, Italy
| | - Giuseppe Palomba
- UOC Chirurgia Endoscopica - AOU Federico II Di Napoli, Naples, Italy
| | - Marianna Capuano
- UOC Chirurgia Endoscopica - AOU Federico II Di Napoli, Naples, Italy
| | - Giulio Argenio
- UOC Chirurgia d'Urgenza AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Gianluca Orio
- UOC Chirurgia d'Urgenza AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | | | - Marina Troian
- SC Chirurgia Generale, ASUGI - Ospedale San Giovanni di Dio, Gorizia, Italy
| | - Martina Guerra
- SC Chirurgia Generale, ASUGI - Ospedale San Giovanni di Dio, Gorizia, Italy
| | - Carlo Nagliati
- SC Chirurgia Generale, ASUGI - Ospedale San Giovanni di Dio, Gorizia, Italy
| | - Alan Biloslavo
- Clinica Chirurgica, Cattinara University Hospital, ASUGI Trieste, Trieste, Italy
| | - Paola Germani
- Clinica Chirurgica, Cattinara University Hospital, ASUGI Trieste, Trieste, Italy
| | - Giada Aizza
- Clinica Chirurgica, Cattinara University Hospital, ASUGI Trieste, Trieste, Italy
| | - Igor Monsellato
- SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | | | | | | | | | - Gabriele Sganga
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pietro Fransvea
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Bianchi
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Boati
- Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Francesco Ferrara
- Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Francesco Palmieri
- Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Pasquale Cianci
- Department of Surgery and Traumatology-General Surgery Unit, "Lorenzo Bonomo Hospital"-ASL BAT, Andria, Italy
| | - Domenico Gattulli
- Department of Surgery and Traumatology-General Surgery Unit, "Lorenzo Bonomo Hospital"-ASL BAT, Andria, Italy
| | - Enrico Restini
- Department of Surgery and Traumatology-General Surgery Unit, "Lorenzo Bonomo Hospital"-ASL BAT, Andria, Italy
| | - Nicola Cillara
- Chirurgia Generale PO Santissima Trinità - ASL Cagliari, Cagliari, Italy
| | | | - Gabriela Elisa Nita
- Chirurgia GeneraleOspedale Sant'Anna di AUSL di Reggio Emilia, Reggio Emilia, Italy
| | - Jlenia Sarnari
- Chirurgia GeneraleOspedale Sant'Anna di AUSL di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Roscio
- Division of General Surgery, ASST Valle Olona, Busto Arsizio, Italy
| | - Federico Clerici
- Division of General Surgery, ASST Valle Olona, Busto Arsizio, Italy
| | - Ildo Scandroglio
- Division of General Surgery, ASST Valle Olona, Busto Arsizio, Italy
| | - Stefano Berti
- S.C. Chirurgia Generale, S. Andrea Hospital - ASL 5, La Spezia, Italy
| | - Alessandro Cadeo
- S.C. Chirurgia Generale, S. Andrea Hospital - ASL 5, La Spezia, Italy
| | - Alice Filippelli
- S.C. Chirurgia Generale, S. Andrea Hospital - ASL 5, La Spezia, Italy
| | - Luigi Conti
- Acute Care Surgery Unit, Ospedale G. Da Saliceto, Piacenza, Italy
| | - Carmine Grassi
- Acute Care Surgery Unit, Ospedale G. Da Saliceto, Piacenza, Italy
| | | | - Marina Pighin
- Chirurgia Generale dell'Ospedale Sant'Anna di San Fermo della Battaglia, San Fermo Della Battaglia, Italy
| | - Davide Papis
- Chirurgia Generale dell'Ospedale Sant'Anna di San Fermo della Battaglia, San Fermo Della Battaglia, Italy
| | | | | | | | - Daniela Prando
- Uoc Chirurgia Ospedale Santa Maria degli Angeli Adria, Adria, Italy
| | - Luisella Fogato
- Uoc Chirurgia Ospedale Santa Maria degli Angeli Adria, Adria, Italy
| | - Fabio Cavallo
- Uoc Chirurgia Ospedale Santa Maria degli Angeli Adria, Adria, Italy
| | - Luca Ansaloni
- U.O.C. Chirurgia Generale 1 IRCCS Policlinico San Matteo Pavia, University of Pavia, Pavia, Italy
| | - Roberto Picheo
- U.O.C. Chirurgia Generale 1 IRCCS Policlinico San Matteo Pavia, University of Pavia, Pavia, Italy
| | - Nicholas Pontarolo
- U.O.C. Chirurgia Generale 1 IRCCS Policlinico San Matteo Pavia, University of Pavia, Pavia, Italy
| | - Norma Depalma
- Department of General and Emergency Surgery - "Vito Fazzi" Hospital, Lecce, Italy
| | - Marcello Spampinato
- Department of General and Emergency Surgery - "Vito Fazzi" Hospital, Lecce, Italy
| | - Stefano D'Ugo
- Department of General and Emergency Surgery - "Vito Fazzi" Hospital, Lecce, Italy
| | - Luca Lepre
- General and Emergency Surgery Unit, Emergency Dept, Ospedale Santo Spirito in Sassia, 00193, Rome, Italy
| | - Michela Giulii Capponi
- General and Emergency Surgery Unit, Emergency Dept, Ospedale Santo Spirito in Sassia, 00193, Rome, Italy
| | - Rossella Domenica Campa
- General and Emergency Surgery Unit, Emergency Dept, Ospedale Santo Spirito in Sassia, 00193, Rome, Italy
| | - Giuliano Sarro
- G.Fornaroli" Hospital, Magenta ASST Ovest Milanese, Milan, Italy
- Istituto Clinico San Gaudenzio - Novara, Novara, Italy
| | | | | | | | | | - Marco Inama
- Unità di Chirurgia GeneraleOspedale Pederzoli, Peschiera del Garda, VR, Italy
| | - Gianluigi Moretto
- Unità di Chirurgia GeneraleOspedale Pederzoli, Peschiera del Garda, VR, Italy
| | - Michele Fontana
- Unità di Chirurgia GeneraleOspedale Pederzoli, Peschiera del Garda, VR, Italy
| | - Francesco Favi
- Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | | | - Alessia Rampini
- Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | - Andrea Barberis
- S.C. Chirurgia Generale ed Epatobiliopancreatica, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Antonio Azzinnaro
- S.C. Chirurgia Generale ed Epatobiliopancreatica, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Alba Oliva
- S.C. Chirurgia Generale ed Epatobiliopancreatica, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | | | | | | | - Gabriella Teresa Capolupo
- Colorectal Surgery Unit, Fondazione Policlinico Campus Bio-Medico, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Filippo Carannante
- Colorectal Surgery Unit, Fondazione Policlinico Campus Bio-Medico, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Marco Caricato
- Colorectal Surgery Unit, Fondazione Policlinico Campus Bio-Medico, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Maurizio Ronconi
- S.C. Chirurgia Generale Ospedale Di Gardone Val Trompia - ASST Spedali Civili, Brescia, Italy
| | - Silvia Casiraghi
- S.C. Chirurgia Generale Ospedale Di Gardone Val Trompia - ASST Spedali Civili, Brescia, Italy
| | - Giovanni Casole
- S.C. Chirurgia Generale Ospedale Di Gardone Val Trompia - ASST Spedali Civili, Brescia, Italy
| | - Desire Pantalone
- Unit of Critical Care Surgery and Trauma-Trauma Team University Hospital Careggi, Florence, Italy
| | - Giovanni Alemanno
- Unit of Critical Care Surgery and Trauma-Trauma Team University Hospital Careggi, Florence, Italy
| | - Maximilian Scheiterle
- Unit of Critical Care Surgery and Trauma-Trauma Team University Hospital Careggi, Florence, Italy
| | | | | | | | - Federico Zanzi
- Ospedale Santa Maria delle Croci Ravenna Reparto di Chirurgia d'Urgenza, Ravenna, Italy
| | - Stefano Bolzon
- Ospedale Santa Maria delle Croci Ravenna Reparto di Chirurgia d'Urgenza, Ravenna, Italy
| | - Enrico Guerra
- Ospedale Santa Maria delle Croci Ravenna Reparto di Chirurgia d'Urgenza, Ravenna, Italy
| | - Francesca Lecchi
- UOC Chirurgia GeneraleOspedale Fatebenefratelli e Oftalmico, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Paola Cellerino
- UOC Chirurgia GeneraleOspedale Fatebenefratelli e Oftalmico, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Antonella Ardito
- UOC Chirurgia GeneraleOspedale Fatebenefratelli e Oftalmico, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Rosa Scaramuzzo
- General Surgery Unit, San Paolo Hospital, Civitavecchia, Italy
| | - Andrea Balla
- General Surgery Unit, San Paolo Hospital, Civitavecchia, Italy
| | | | - Nicola Tartaglia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Antonio Ambrosi
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giovanna Pavone
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | | | | | - Claudio Ricci
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Beatrice Torre
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Iris Shari Russo
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Matteo Rottoli
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Marta Tanzanu
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Angela Belvedere
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Marco Milone
- University of Naples "Federico II", Naples, Italy
| | | | | | - Micaela Piccoli
- General Surgery,Emergencies and New Technologies, Baggiovara Civil Hospital Modena, Baggiovara, Italy
| | | | - Stefano Magnone
- General Surgery, Ospedale Papa Giovanni XXIII, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Bertoli
- General Surgery, Ospedale Papa Giovanni XXIII, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Pisano
- General Surgery, Ospedale Papa Giovanni XXIII, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Massucco
- Chirurgia Generale e OncologicaOsp. Mauriziano - Torino, Turin, Italy
| | - Marco Palisi
- Chirurgia Generale e OncologicaOsp. Mauriziano - Torino, Turin, Italy
| | | | - Francesco Fleres
- General Surgery Unit - ASST Valtellina e Alto Lario, Sondrio Hospital - Sondrio, Sondrio, Italy
| | - Guglielmo Clarizia
- General Surgery Unit - ASST Valtellina e Alto Lario, Sondrio Hospital - Sondrio, Sondrio, Italy
| | - Alessandro Spolini
- General Surgery Unit - ASST Valtellina e Alto Lario, Sondrio Hospital - Sondrio, Sondrio, Italy
| | | | | | | | | | | | | | - Saulius Svagzdys
- Department of Surgery Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Henrikas Pauzas
- Department of Surgery Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Justas Zilinskas
- Department of Surgery Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Tomas Poskus
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Marius Kryzauskas
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Matas Jakubauskas
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Andee Dzulkarnaen Zakaria
- Department of Surgery, School of Medical Sciences and Hospital, Universiti Sains Malaysia, Gelugor, Malaysia
| | - Zaidi Zakaria
- Department of Surgery, School of Medical Sciences and Hospital, Universiti Sains Malaysia, Gelugor, Malaysia
| | - Michael Pak-Kai Wong
- Department of Surgery, School of Medical Sciences and Hospital, Universiti Sains Malaysia, Gelugor, Malaysia
| | - Asri Che Jusoh
- Department of General Surgery, Hospital Sultan Ismail Petra, Kuala Krai, Kelantan, Malaysia
| | | | - Daniel Rios Cruz
- Departamento de Cirugía Gastrointestinal y Enfermedades Digestivas "DR DANIEL RIOS CRUZ". Hospital Center Vista Hermosa, Cuernavaca Morelos, México
| | - Aurea Barbara Rodriguez Elizalde
- Departamento de Cirugía Gastrointestinal y Enfermedades Digestivas "DR DANIEL RIOS CRUZ". Hospital Center Vista Hermosa, Cuernavaca Morelos, México
| | - Alejandro Bañon Reynaud
- Departamento de Cirugía Gastrointestinal y Enfermedades Digestivas "DR DANIEL RIOS CRUZ". Hospital Center Vista Hermosa, Cuernavaca Morelos, México
| | | | | | | | | | | | | | - Piotr Major
- Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Pędziwiatr
- Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | | | - Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Andrzej Kwiatkowski
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Łukasz Czyżykowski
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | | | - Bela Pereira
- Centro Hospitalar de Vila Nova de Gaia e Espinho, EPE, Vila Nova de Gaia, Portugal
| | | | - Filipe Almeida
- Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Ricardo Rocha
- Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Carla Carneiro
- Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Diego Pita Perez
- Unidade Local de Saúde do Nordeste, EPE; Serviço de Cirurgia Geral, Bragança, Portugal
| | - João Carvas
- Unidade Local de Saúde do Nordeste, EPE; Serviço de Cirurgia Geral, Bragança, Portugal
| | - Catarina Rocha
- Unidade Local de Saúde do Nordeste, EPE; Serviço de Cirurgia Geral, Bragança, Portugal
| | | | | | | | - Pedro Leao
- General Surgery Grupo Trofa Saúde, Porto, Portugal
| | | | - Rita Gonçalves Pereira
- General Surgery Department, Centro Hospitalar Barreiro Montijo, E.P.E., Barreiro, Portugal
| | | | | | | | | | | | - Valentin Calu
- Carol Davila University of Medicine and Pharmacy Bucharest and Elias University Emergency Hospital Bucharest, Bucharest, Romania
| | - Adrian Miron
- Carol Davila University of Medicine and Pharmacy Bucharest and Elias University Emergency Hospital Bucharest, Bucharest, Romania
| | - Elena Adelina Toma
- Carol Davila University of Medicine and Pharmacy Bucharest and Elias University Emergency Hospital Bucharest, Bucharest, Romania
| | - Mahir Gachabayov
- Department of Abdominal Surgery, Vladimir City Emergency Hospital, Vladimir, Russia
| | - Abakar Abdullaev
- Department of Abdominal Surgery, Vladimir City Emergency Hospital, Vladimir, Russia
| | - Andrey Litvin
- Department of Surgical Diseases No. 3, Gomel State Medical University, University Clinic, Gomel, Belarus
| | - Taras Nechay
- Pirogov Medical University Research Institute of Clinical Surgery, Moscow, Russia
| | - Alexander Tyagunov
- Pirogov Medical University Research Institute of Clinical Surgery, Moscow, Russia
| | - Anvar Yuldashev
- Pirogov Medical University Research Institute of Clinical Surgery, Moscow, Russia
| | | | | | - Arpád Panyko
- 4t, Department of Surgery, University Hospital Bratislava, Bratislava, Slovakia
| | - Zuzana Látečková
- 4t, Department of Surgery, University Hospital Bratislava, Bratislava, Slovakia
| | - Vladimír Lacko
- 4t, Department of Surgery, University Hospital Bratislava, Bratislava, Slovakia
| | - Dusan Lesko
- 1s, Department of Surgery, UPJS and UNLP Kosice, Kosice, Slovak Republic
| | - Marek Soltes
- 1s, Department of Surgery, UPJS and UNLP Kosice, Kosice, Slovak Republic
| | - Jozef Radonak
- 1s, Department of Surgery, UPJS and UNLP Kosice, Kosice, Slovak Republic
| | - Victor Turrado-Rodriguez
- Gastrointestinal Surgery Department, Hospital Clinic de Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Roser Termes-Serra
- Gastrointestinal Surgery Department, Hospital Clinic de Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Xavier Morales-Sevillano
- Gastrointestinal Surgery Department, Hospital Clinic de Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Pierfrancesco Lapolla
- Policlinico Umberto I University Hospital - Sapienza University of Rome, Rome, Italy
| | - Andrea Mingoli
- Policlinico Umberto I University Hospital - Sapienza University of Rome, Rome, Italy
| | - Gioia Brachini
- Policlinico Umberto I University Hospital - Sapienza University of Rome, Rome, Italy
| | - Maurizio Degiuli
- Division of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, 10043, Orbassano (Turin), Italy
| | - Silvia Sofia
- Division of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, 10043, Orbassano (Turin), Italy
| | - Rossella Reddavid
- Division of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, 10043, Orbassano (Turin), Italy
| | | | | | | | | | | | - Mercedes Estaire-Gómez
- General and Colorectal Surgeon, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Rebeca Vitón-Herrero
- General and Colorectal Surgeon, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | - José Gil-Martínez
- General and Digestive Surgery. Virgen de la Arrixaca University Hospital (IMIB-Arrixaca), Murcia, Spain
| | - Felipe Alconchel
- General and Digestive Surgery. Virgen de la Arrixaca University Hospital (IMIB-Arrixaca), Murcia, Spain
| | - Tatiana Nicolás-López
- General and Digestive Surgery. Virgen de la Arrixaca University Hospital (IMIB-Arrixaca), Murcia, Spain
| | - Aida Cristina Rahy-Martin
- Emergency Surgery Unit, University Hospital of Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
| | - María Pelloni
- Emergency Surgery Unit, University Hospital of Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
| | - Raquel Bañolas-Suarez
- Emergency Surgery Unit, University Hospital of Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
| | | | | | - Manuel Díez-Alonso
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | | | | | | | | | | | | | | | | | - Silvia Salvans
- Emergency Surgery Unit, Department of General Surgery, Hospital del Mar, Barcelona, Spain
| | | | - Pablo Sancho Pardo
- Department of Surgery, Miguel Servet University Hospital, Saragossa, Spain
| | | | - Jana Dziakova
- Hospital Clínico San Carlos in Madrid, Madrid, Spain
| | | | | | | | | | | | | | - Juan Jesús Rubio García
- Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Silvia Sevila Micó
- Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Joaquín Ruiz López
- Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | | | | | | | - Alberto Titos-García
- Trauma and Emergency Surgery Unit General, Digestive and Transplantation Department, University Regional Hospital Málaga, Málaga, Spain
| | - Jose Manuel Aranda-Narváez
- Trauma and Emergency Surgery Unit General, Digestive and Transplantation Department, University Regional Hospital Málaga, Málaga, Spain
| | - Laura Romacho-López
- Trauma and Emergency Surgery Unit General, Digestive and Transplantation Department, University Regional Hospital Málaga, Málaga, Spain
| | - Luis Sánchez-Guillén
- Colorectal and Gastrointestinal Department Hospital General Universitario de Elche Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Veronica Aranaz-Ostariz
- Colorectal and Gastrointestinal Department Hospital General Universitario de Elche Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Marina Bosch-Ramírez
- Colorectal and Gastrointestinal Department Hospital General Universitario de Elche Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Aleix Martínez-Pérez
- Department of General and Digestive Surgery. Hospital, Universitario Doctor Peset, Valencia, Spain
| | - Elías Martínez-López
- Department of General and Digestive Surgery. Hospital, Universitario Doctor Peset, Valencia, Spain
| | | | - Granada Jimenez-Riera
- Hepatobiliar and Pancreatic Surgery Unit General and Digestive Surgery University Hospital Virgen de Valme, Seville, Spain
| | - Javier Jimenez-Vega
- Hepatobiliar and Pancreatic Surgery Unit General and Digestive Surgery University Hospital Virgen de Valme, Seville, Spain
| | - Jose Aurelio Navas Cuellar
- Hepatobiliar and Pancreatic Surgery Unit General and Digestive Surgery University Hospital Virgen de Valme, Seville, Spain
| | | | - Anna Muñoz-Campaña
- Emergency Surgery Unit at Hospital Universitari Parc Tauli, Sabadell, Spain
| | | | - Javier Martínez Alegre
- General and Colorectal Surgeon, Hospital Universitario Infanta Sofia Madrid, Madrid, Spain
| | - Francisca Lima Pinto
- General and Colorectal Surgeon, Hospital Universitario Infanta Sofia Madrid, Madrid, Spain
| | - Sara Nuñez O'Sullivan
- General and Colorectal Surgeon, Hospital Universitario Infanta Sofia Madrid, Madrid, Spain
| | | | | | - Jaime López-Sánchez
- General Surgery Service of the University Hospital of Salamanca, Salamanca, Spain
| | | | | | | | | | | | - Eva Iglesias
- Hospital Universtario Puerta de Hierro, Madrid, Spain
| | | | | | - Ignacio Rey Simó
- HPB and Transplantation Unit, Head of Emergency Surgery Unit, Seville, Spain
| | | | | | - Rafael Calleja Lozano
- General and Digestive Surgery Department, Reina Sofía University Hospital, Cordoba, Spain
| | - Manuel Durán Martínez
- General and Digestive Surgery Department, Reina Sofía University Hospital, Cordoba, Spain
| | - Álvaro Naranjo Torres
- General and Digestive Surgery Department, Reina Sofía University Hospital, Cordoba, Spain
| | | | - Gianluca Pellino
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | | | - Ahmed K Abdoun
- Department of Sugery, Almoalem Medical City, Khartoum, Sudan
| | | | - Varut Lohsiriwat
- Colorectal Surgery Unit, Department of Surgery and Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Aitsariya Mongkhonsupphawan
- Colorectal Surgery Unit, Department of Surgery and Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Oussama Baraket
- Department of General Surgery Bizerte Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Karim Ayed
- Department of General Surgery Bizerte Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Imed Abbassi
- Department of General Surgery Bizerte Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Ali Ben Ali
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunis, Tunisia
| | - Houssem Ammar
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunis, Tunisia
| | | | | | | | - Elif Colak
- Samsun Training and Research Hospital Colak, Samsun, Turkey
| | - Suleyman Polat
- Samsun Training and Research Hospital Colak, Samsun, Turkey
| | | | - Ali Guner
- Department of General Surgery, Division of Upper GI Surgery and Institute of Medical Science, Department of Biostatistics and Medical Informatics, Trabzon, Turkey
| | - Mehmet Arif Usta
- Department of General Surgery, Division of Upper GI Surgery and Institute of Medical Science, Department of Biostatistics and Medical Informatics, Trabzon, Turkey
| | - Murat Emre Reis
- Department of General Surgery, Division of Upper GI Surgery and Institute of Medical Science, Department of Biostatistics and Medical Informatics, Trabzon, Turkey
| | - Baris Mantoglu
- Department of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Emre Gonullu
- Department of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Emrah Akin
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Fatih Altintoprak
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Zulfu Bayhan
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Necattin Firat
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Arda Isik
- General Surgery Clinic, School of Medicine, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Ufuk Memis
- General Surgery Clinic, School of Medicine, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | | | | | - Yasin Kara
- General Surgery Clinic, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Abdussamet Bozkurt
- General Surgery Clinic, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Ali Kocataş
- General Surgery Clinic, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Koray Das
- University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Ahmet Seker
- University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Nazmi Ozer
- University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Semra Demirli Atici
- Department of General Surgery, University of Health Sciences Tepecik Training and Research Hospital, İzmir, Turkey
| | - Korhan Tuncer
- Department of General Surgery, University of Health Sciences Tepecik Training and Research Hospital, İzmir, Turkey
| | - Tayfun Kaya
- Department of General Surgery, University of Health Sciences Tepecik Training and Research Hospital, İzmir, Turkey
| | - Zeynep Ozkan
- Department of General Surgery Elazig, Elazig Health Practice and Research Center, Elazig, Turkey
| | - Onur Ilhan
- Department of General Surgery Elazig, Elazig Health Practice and Research Center, Elazig, Turkey
| | - Ibrahim Agackiran
- Department of General Surgery Elazig, Elazig Health Practice and Research Center, Elazig, Turkey
| | | | - Eren Demirbas
- Department of General Surgery, Bursa Kestel State Hospital, Kestel, Turkey
| | - Yuksel Altinel
- Department of General Surgery, Bagcilar Training and Research Hospital University of Health Science, Istanbul, Turkey
| | - Serhat Meric
- Department of General Surgery, Bagcilar Training and Research Hospital University of Health Science, Istanbul, Turkey
| | - Nadir Adnan Hacım
- Department of General Surgery, Bagcilar Training and Research Hospital University of Health Science, Istanbul, Turkey
| | - Derya Salim Uymaz
- Department of General Surgery, Koç University Hospital, Istanbul, Turkey
| | - Nail Omarov
- Department of General Surgery, Koç University Hospital, Istanbul, Turkey
| | - Emre Balık
- Department of General Surgery, Koç University Hospital, Istanbul, Turkey
| | - Giovanni D Tebala
- John Radcliffe Hospital Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Hany Khalil
- John Radcliffe Hospital Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mridul Rana
- John Radcliffe Hospital Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mansoor Khan
- Brighton and Sussex University Hospitals, Brighton, UK
| | | | | | - Cosimo Alex Leo
- Northwick Park and St Mark's Hospital - London North West NHS Trust, Harrow, UK
| | - Lampros Liasis
- Northwick Park and St Mark's Hospital - London North West NHS Trust, Harrow, UK
| | - Josef Watfah
- Northwick Park and St Mark's Hospital - London North West NHS Trust, Harrow, UK
| | | | - Edward Delgado
- Hospital de ClínicasClínica Quirúrgica ¨F¨, Montevideo, Uruguay
| | | | - Rifat Latifi
- Department of Surgery, School of Medicine, Westchester Medical Center, New York Medical College, Valhalla, USA
| | - Raul Coimbra
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - Sara Edwards
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - Ana Lopez
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - George Velmahos
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ander Dorken
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Anthony Gebran
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Amanda Palmer
- Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery, West Virginia University, Morgantown, USA
| | - Jeffrey Oury
- Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery, West Virginia University, Morgantown, USA
| | - James M Bardes
- Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery, West Virginia University, Morgantown, USA
| | | | | | | | | | | | | | | | | | | | - Jacob A Quick
- Department of Surgery, University of Missouri, Columbia, USA
| | - Tyler R Austin
- Department of Surgery, University of Missouri, Columbia, USA
| | | | | | | | | | | | | | | | | | - Filippo Banchini
- Department of General Surgery, Ospedale Guglielmo da Saliceto, 29100, Piacenza, Italy
| | - Patrizio Capelli
- Department of General Surgery, Ospedale Guglielmo da Saliceto, 29100, Piacenza, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | | | - Francesca Bravi
- Healthcare Administration, Santa Maria Delle Croci Hospital, AUSL Romagna, Ravenna, Italy
| | | | - Vanni Agnoletti
- Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | - Gian Luca Baiocchi
- General Surgery, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Fausto Catena
- Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
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Godet C, Sabbagh C, Beyer-Berjot L, Ouaissi M, Zerbib P, Valérie B, Manceau G, Panis Y, Buscail E, Venara A, Khaoudy I, Gaillard M, Viennet M, Thobie A, Menahem B, Eveno C, Bonnel C, Mabrut JY, Badic B, Chautard J, Eid Y, Duchalais E, Lakkis Z, Cotte E, Laforest A, Desfourneaux-Denis V, Maggiori L, Rebibo L, Niki C, Talal A, Mege D, Bonnamy C, Germain A, Mauvais F, Tresallet C, Roudie J, Laurent A, Trilling B, Bertrand M, Massalou D, Romain B, Tranchart H, Pellegrin A, Dejardin O, Alves A. Risk factors for emergency surgery for diverticulitis: A retrospective multicentric French study at 41 hospitals. Surgery 2024:S0039-6060(24)00072-2. [PMID: 38609785 DOI: 10.1016/j.surg.2024.02.009] [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] [Received: 09/21/2023] [Revised: 12/10/2023] [Accepted: 02/06/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND The observed increase in the incidence of complicated diverticulitis may lead to the performance of more emergency surgeries. This study aimed to assess the rate and risk factors of emergency surgery for sigmoid diverticulitis. METHOD The primary outcomes were the rate of emergency surgery for sigmoid diverticulitis and its associated risk factors. The urgent or elective nature of the surgical intervention was provided by the surgeon and in accordance with the indication for surgical treatment. A mixed logistic regression with a random intercept after multiple imputations by the chained equation was performed to consider the influence of missing data on the results. RESULTS Between 2010 and 2021, 6,867 patients underwent surgery for sigmoid diverticulitis in the participating centers, of which one-third (n = 2317) were emergency cases. In multivariate regression analysis with multiple imputation by chained equation, increasing age, body mass index <18.5 kg/m2, neurologic and pulmonary comorbidities, use of anticoagulant drugs, immunocompromised status, and first attack of sigmoid diverticulitis were independent risk factors for emergency surgery. The likelihood of emergency surgery was significantly more frequent after national guidelines, which were implemented in 2017, only in patients with a history of sigmoid diverticulitis attacks. CONCLUSION The present study highlights a high rate (33%) of emergency surgery for sigmoid diverticulitis in France, which was significantly associated with patient features and the first attack of diverticulitis.
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Affiliation(s)
- Camille Godet
- Department of Digestive Surgery, University Hospital of Caen, France.
| | - Charles Sabbagh
- Department of Digestive Surgery, Amiens University Hospital, France
| | - Laura Beyer-Berjot
- Department of Digestive Surgery Assistance Publique Hôpitaux de Marseille, North University Hospital, France
| | - Mehdi Ouaissi
- Department of Digestive, Oncological, Endocrine, Hepatobiliary, and Liver Transplant, Trousseau Hospital, University Hospital of Tours, France
| | - Philippe Zerbib
- Department of Digestive Surgery and Transplantation, Huriez Hospital, Universite Lille Nord de France, France
| | - Bridoux Valérie
- Department of Digestive Surgery, University Hospital of Rouen, France
| | - Gilles Manceau
- Department of Digestive and Oncological Surgery, European Georges Pompidou Hospital, Paris Cité University, AP-HP, Paris, France
| | - Yves Panis
- Colorectal surgery Center, Groupe Hospitalier Privé Ambroise-Paré Hartmann, Neuilly/Seine, France
| | - Etienne Buscail
- Department of Surgery, CHU Toulouse-Rangueil and Toulouse University, Toulouse, France
| | - Aurélien Venara
- Department of Digestive Surgery, University Hospital of Angers, Angers, France
| | - Iman Khaoudy
- Department of Digestive Surgery, Le Havre Hospital, Le Havre, France
| | - Martin Gaillard
- Department of Digestive Surgery, Cochin Hospital, Paris, France
| | - Manon Viennet
- Department of General Surgery, University Hospital of Bocage, Dijon, France
| | - Alexandre Thobie
- Department of Digestive Surgery, Avranches-Granville Hospital, Avranches, France
| | | | - Clarisse Eveno
- Department of Digestive Surgery, University Hospital of Lille, France
| | - Catherine Bonnel
- Department of Digestive Surgery, Nord-Essonne Hospital, Longjumeau, France
| | - Jean-Yves Mabrut
- Department of Digestive Surgery and Transplantation, Croix Rousse University Hospital, Lyon, France
| | - Bogdan Badic
- Department of General and Digestive Surgery, University Hospital, Brest, France
| | - Julien Chautard
- Department of Digestive Surgery, Memorial Hospital of Saint-Lô, France
| | - Yassine Eid
- 21 Department of Digestive Surgery, Robert Bisson Hospital, Lisieux, France
| | - Emilie Duchalais
- 22 Department of Oncological, Digestive and Endocrine Surgery, University Hospital of Nantes, France
| | - Zaher Lakkis
- Department of Digestive Surgical Oncology and Liver Transplantation, University Hospital of Besançon, France
| | - Eddy Cotte
- Department of Digestive Surgery, Hospital Lyon Sud, France
| | - Anaïs Laforest
- Department of Digestive Surgery, Montsouris Institut, Paris, France
| | | | - Léon Maggiori
- Department of Digestive Surgery, Hôpital Saint-Louis, Université Paris VII, APHP, France
| | - Lionel Rebibo
- Department of Digestive, Oesogastric and Bariatric Surgery, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Christou Niki
- Department of Digestive Surgery, Limoges Hospital, France
| | - Ali Talal
- Department of Digestive Surgery, Argentan Hospital, France
| | - Diane Mege
- Department of Digestive Surgery, Aix Marseille Univ, APHM, Timone University Hospital, Marseille, France
| | - Cécile Bonnamy
- Department of Digestive Surgery, Bayeux Hospital, France
| | | | | | - Christophe Tresallet
- Department of Digestive Surgical Oncology, Avicenne University Hospital, Bobigny, Sorbonne Paris Nord University, France
| | - Jean Roudie
- Department of Digestive Surgery, Martinique Hospital, Fort-de-France, France
| | - Alexis Laurent
- Department of Digestive Surgery, Créteil Hospital, France
| | - Bertrand Trilling
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, Grenoble, France; Department of Digestive Surgery and Emergency, University Hospital of Grenoble, Alpes, France
| | - Martin Bertrand
- Department of Digestive Surgery, University Hospital of Nîmes, France
| | - Damien Massalou
- Department of Digestive Surgery, Hospital L'Archet, Nice University, Nice, France
| | - Benoit Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, France
| | - Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | | | - Olivier Dejardin
- Department of Research; CHU de Caen, ANTICIPE, Inserm Unity UMR 1086, France
| | - Arnaud Alves
- Department of Digestive Surgery, University Hospital of Caen, France; Department of Research; CHU de Caen, ANTICIPE, Inserm Unity UMR 1086, France
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3
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Thibaut F, Veziant J, Warlaumont M, Gauthier V, Lefèvre J, Gronnier C, Bonnet S, Mabrut JY, Regimbeau JM, Benhaim L, Tiberio GAM, Mathonnet M, Regenet N, Chirica M, Glehen O, Mariani P, Panis Y, Genser L, Mutter D, Théreaux J, Bergeat D, Le Roy B, Brigand C, Eveno C, Guillaume P. Prognostic impact of positive microscopic margins (R1 resection) in patients with GIST (gastrointestinal stromal tumours): Results of a multicenter European study. Eur J Surg Oncol 2024; 50:108310. [PMID: 38598874 DOI: 10.1016/j.ejso.2024.108310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/28/2024] [Accepted: 03/24/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Although several prognostic factors in GIST have been well studied such as tumour size, mitotic rate, or localization, the influence of microscopic margins or R1 resection remains controversial. The aim of this study was to evaluate the influence of R1 resection on the prognosis of GIST in a large multicentre retrospective series of patients. METHODS From 2001 to 2013, 1413 patients who underwent surgery for any site of GIST were identified from 61 European centers. 1098 patients were included, excluding synchronous metastases, concurrent malignancies, R2 resection or GIST recurrence. Tumour rupture (TR) was reclassified according to the Oslo sarcoma classification. Cox proportional hazards ratio and Kaplan-Meier survival estimates were used to analyse 5-year recurrence-free survival (RFS). RESULTS Of 1098 patients, 38 (3%) underwent R1 resection with a risk of TR of 11%. The 5-year RFS was 89.6% with a median follow-up of 81 months [range: 31.2-152 months]. On univariate analysis, lower RFS was significantly associated with R1 resection [HR = 2.13; p = 0.04], high risk score according to the modified NIH classification, administration of adjuvant therapy [HR = 2.24; p < 0.001] and intraoperative complications [HR = 2.82; p < 0.001]. Only intraoperative complications [HR = 1.79; p = 0.02] and high risk according to the modified NIH classification including the updated definition of TR [HR = 3.43; p = 0.04] remained significant on multivariate analysis. CONCLUSION This study shows that positive microscopic margins are not an independent predictive factor for RFS in GIST when taking into account the up-dated classification of TR. R1 resection may be considered a reasonable alternative to avoid major functional sequelae and should not lead to reoperation.
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Affiliation(s)
- Flore Thibaut
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, F-59000, Lille, France; Department of General and Digestive Surgery, Seclin Hospital, rue d'Apolda, 59471, Seclin, France.
| | - Julie Veziant
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, F-59000, Lille, France; Univ. Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, F-59000, Lille, France
| | - Maxime Warlaumont
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, F-59000, Lille, France; Department of General and Digestive Surgery, Cambrai Hospital, 516 Avenue de Paris, 59400, Cambrai, France
| | - Victoria Gauthier
- Univ Lille, INSERM, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE- Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, F59-000, LILLE, France
| | - Jérémie Lefèvre
- Department of Digestive Surgery, Sorbonne Université, AP-HP, Saint-Antoine Hospital, Paris, France
| | - Caroline Gronnier
- Oeso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, 33600, Pessac, France; Faculty of Medicine, Bordeaux Ségalen University, 33000, Bordeaux, France
| | - Stephane Bonnet
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Jean-Yves Mabrut
- Department of Digestive Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices CIVils de Lyon, Lyon, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France; UR UPJV 7518, SSPC (Simplification of Surgical Patients Care), Picardie Jules Verne University, Amiens, France
| | - Léonor Benhaim
- Department of Digestive Surgery, Gustave Roussy Institute, Villejuif, France
| | - G A M Tiberio
- Surgical Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Muriel Mathonnet
- Department of Digestive Surgery, Dupuytren University Hospital, Limoges, France
| | - Nicolas Regenet
- Department of Digestive Surgery, Nantes University Hospital, Nantes, France
| | - Mircea Chirica
- Department of Digestive Surgery, Grenoble University Hospital, Grenoble, France
| | - Olivier Glehen
- Department of Surgical Oncology, Lyon Sud University Hospital, Lyon, France
| | | | - Yves Panis
- Department of Colorectal Surgery, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly-sur-Seine, France
| | - Laurent Genser
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris, AP-HP, Department of Hepato-Biliary and Pancreatic Surgery, liver transplantation, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France; INSERM, Nutrition and Obesities Systemic Approaches, NutriOmics Research Unit, Sorbonne Université, 91 Boulevard de l'Hôpital, Paris, France
| | - Didier Mutter
- Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France; Research Institute Against Digestive Cancer, IRCAD, Strasbourg, France
| | - Jérémie Théreaux
- Department of Visceral and Digestive Surgery, Cavale Blanche University Hospital, Brest, France; Inrae, Inserm, Univ Rennes, Nutrition Metabolisms and Cancer, NuMeCan, Rennes, St Gilles, France
| | | | - Bertrand Le Roy
- Department of Digestive and Oncologic Surgery, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Cécile Brigand
- Department of General and Digestive Surgery, University Hospital of Hautepierre, Strasbourg, France
| | - Clarisse Eveno
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, F-59000, Lille, France; Univ. Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, F-59000, Lille, France
| | - Piessen Guillaume
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, F-59000, Lille, France; Univ. Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, F-59000, Lille, France
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4
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Lucarini A, Guida AM, Orville M, Panis Y. Indocyanine green fluorescence angiography could reduce the risk of anastomotic leakage in rectal cancer surgery: a systematic review and meta-analysis of randomized controlled trials. Colorectal Dis 2024; 26:408-416. [PMID: 38247221 DOI: 10.1111/codi.16868] [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: 09/21/2023] [Revised: 12/17/2023] [Accepted: 12/24/2023] [Indexed: 01/23/2024]
Abstract
AIM Several papers have shown that use of indocyanine green (ICG) decreases incidence of anastomotic leakage (AL) during colonic surgery, but no clear evidence has been found for rectal cancer surgery. Therefore, with this systematic review and meta-analysis of randomized controlled trials (RCTs) we aimed to assess if ICG could also reduce risk of AL in rectal cancer surgery. METHOD PubMed, Scopus, CINAHL and Cochrane databases were searched for RCTs assessing the effect of intraoperative ICG on the incidence of AL of the colorectal anastomosis. Pooled relative risk (RR) and pooled risk difference (RD) were obtained using models with random effects. Risk of bias was evaluated with the Rob2 tool and the quality of evidence was assessed using the GRADE Pro tool. RESULTS Four RCTs were included for analysis, with a total of 1510 patients (743 controls and 767 ICG patients). The rate of AL was 9% in the ICG group (69/767) and 13.9% (103/743) in the control group (p = 0.003, RR -0.5, 95% CI -0.827 to -0.172, heterogeneity test 0%, p = 0.460). The RD in terms of incidence of AL was significantly decreased by 4.51% (p = 0.031, 95% CI -0.086 to -0.004, heterogeneity test 28%, p = 0.182) when using ICG. CONCLUSION Our meta-analysis suggested that use of ICG during rectal cancer surgery could reduce the rate of AL.
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Affiliation(s)
- Alessio Lucarini
- Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly/Seine, France
- Surgical and Medical Department of Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Andrea Martina Guida
- Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly/Seine, France
- Department of Surgical Science, University Tor Vergata, Rome, Italy
| | - Marion Orville
- Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly/Seine, France
| | - Yves Panis
- Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly/Seine, France
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5
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Lecomte T, Tougeron D, Chautard R, Bressand D, Bibeau F, Blanc B, Cohen R, Jacques J, Lagasse JP, Laurent-Puig P, Lepage C, Lucidarme O, Martin-Babau J, Panis Y, Portales F, Taieb J, Aparicio T, Bouché O. Non-metastatic colon cancer: French Intergroup Clinical Practice Guidelines for diagnosis, treatments, and follow-up (TNCD, SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, SFP, AFEF, and SFR). Dig Liver Dis 2024:S1590-8658(24)00257-3. [PMID: 38383162 DOI: 10.1016/j.dld.2024.01.208] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION This article is a summary of the French intergroup guidelines regarding the management of non-metastatic colon cancer (CC), revised in November 2022. METHODS These guidelines represent collaborative work of all French medical and surgical societies involved in the management of CC. Recommendations were graded in three categories (A, B, and C) according to the level of evidence found in the literature published up to November 2022. RESULTS Initial evaluation of CC is based on clinical examination, colonoscopy, chest-abdomen-pelvis computed tomography (CT) scan, and carcinoembryonic antigen (CEA) assay. CC is usually managed by surgery and adjuvant treatment depending on the pathological findings. The use of adjuvant therapy remains a challenging question in stage II disease. For high-risk stage II CC, adjuvant chemotherapy must be discussed and fluoropyrimidine monotherapy or oxaliplatin-based chemotherapy proposed according to the type and number of poor prognostic features. Oxaliplatin-based chemotherapy (FOLFOX or CAPOX) is the current standard for adjuvant therapy of patients with stage III CC. However, these regimens are associated with significant oxaliplatin-induced neurotoxicity. The results of the recent IDEA study provide evidence that 3 months of treatment with CAPOX is as effective as 6 months of oxaliplatin-based therapy in patients with low-risk stage III CC (T1-3 and N1). A 6-month oxaliplatin-based therapy remains the standard of care for high-risk stage III CC (T4 and/or N2). For patients unfit for oxaliplatin, fluoropyrimidine monotherapy is recommended. CONCLUSION French guidelines for non-metastatic CC management help to offer the best personalized therapeutic strategy in daily clinical practice. Each individual case must be discussed within a multidisciplinary tumor board and then the treatment option decided with the patient.
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Affiliation(s)
- Thierry Lecomte
- Department of Hepatogastroenterology and Digestive Oncology, Tours University Hospital, Tours, France; Inserm UMR 1069, Nutrition, Croissance et Cancer, Université de Tours, Tours, France.
| | - David Tougeron
- Department of Hepatogastroenterology, Poitiers University Hospital, Poitiers, France
| | - Romain Chautard
- Department of Hepatogastroenterology and Digestive Oncology, Tours University Hospital, Tours, France; Inserm UMR 1069, Nutrition, Croissance et Cancer, Université de Tours, Tours, France
| | - Diane Bressand
- Department of Hepatogastroenterology and Digestive Oncology, Tours University Hospital, Tours, France
| | - Frédéric Bibeau
- Department of Pathology, Besançon University Hospital, Besançon, France
| | - Benjamin Blanc
- Department of Digestive Surgery, Dax Hospital, Dax, France
| | - Romain Cohen
- Sorbonne Université, Department of Medical Oncology, Saint-Antoine hospital, AP-HP, Inserm, Unité Mixte de Recherche Scientifique 938 et SiRIC CURAMUS, Saint-Antoine Research Center, Paris, France
| | - Jérémie Jacques
- Department of Hepatogastroenterology, Limoges University Hospital, Limoges, France
| | - Jean-Paul Lagasse
- Department of Hepatogastroenterology and Digestive Oncology, Orléans University Hospital, Orléans, France
| | - Pierre Laurent-Puig
- Department of Biology, AP-HP, European Georges Pompidou Hospital, Paris, France
| | - Come Lepage
- Department of Hepatogastroenterology and Digestive Oncology, Dijon University Hospital, Dijon, France
| | - Olivier Lucidarme
- Department of Radiology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Jérôme Martin-Babau
- Armoricain Center of Radiotherapy, Radiology and Oncology, Côtes D'Armor Private Hospital, Plérin, France
| | - Yves Panis
- Department of Colorectal Surgery, AP-HP, Beaujon Hospital, Clichy, France
| | - Fabienne Portales
- Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - Julien Taieb
- Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, Paris, France
| | - Thomas Aparicio
- Department of Gastroenterology and Digestive Oncology, AP-HP, Saint-Louis Hospital, Paris, France
| | - Olivier Bouché
- Department of Digestive Oncology, Reims, CHU Reims, France
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6
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Sabbagh C, Beyer-Berjot L, Ouaissi M, Zerbib P, Bridoux V, Manceau G, Karoui M, Panis Y, Buscail E, Venara A, Khaoudy I, Gaillard M, Ortega-Deballon P, Viennet M, Thobie A, Menahem B, Eveno C, Bonnel C, Mabrut JY, Badic B, Godet C, Eid Y, Duchalais E, Lakkis Z, Cotte E, Laforest A, Defourneaux V, Maggiorri L, Rebibo L, Christou N, Talal A, Mege D, Bonnamy C, Germain A, Mauvais F, Tresallet C, Ahmed O, Regimbeau JM, Roudie J, Laurent A, Trilling B, Bertrand M, Massalou D, Romain B, Tranchart H, Giger U, Dejardin O, Pellegrin A, Alves A. Risk factors for severe morbidity and definitive stoma after elective surgery for sigmoid diverticulitis: a multicenter national cohort study. Tech Coloproctol 2024; 28:34. [PMID: 38369674 DOI: 10.1007/s10151-023-02906-y] [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: 10/16/2023] [Accepted: 12/18/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND In the decision to perform elective surgery, it is of great interest to have data about the outcomes of surgery to individualize patients who could safely undergo sigmoid resection. The aim of this study was to provide information on the outcomes of elective sigmoid resection for sigmoid diverticular disease (SDD) at a national level. METHODS All consecutive patients who had elective surgery for SDD (2010-2021) were included in this retrospective, multicenter, cohort study. Patients were identified from institutional review board-approved databases in French member centers of the French Surgical Association. The endpoints of the study were the early and the long-term postoperative outcomes and an evaluation of the risk factors for 90-day severe postoperative morbidity and a definitive stoma after an elective sigmoidectomy for SDD. RESULTS In total, 4617 patients were included. The median [IQR] age was 61 [18.0;100] years, the mean ± SD body mass index (BMI) was 26.8 ± 4 kg/m2, and 2310 (50%) were men. The indications for surgery were complicated diverticulitis in 50% and smoldering diverticulitis in 47.4%. The procedures were performed laparoscopically for 88% and with an anastomosis for 83.8%. The severe complication rate on postoperative day 90 was 11.7%, with a risk of anastomotic leakage of 4.7%. The independent risk factors in multivariate analysis were an American Society of Anesthesiologists (ASA) score ≥ 3, an open approach, and perioperative blood transfusion. Age, perioperative blood transfusion, and Hartmann's procedure were the three independent risk factors for a permanent stoma. CONCLUSIONS This series provides a real-life picture of elective sigmoidectomy for SDD at a national level. TRIAL REGISTRATION Comité National Information et Liberté (CNIL) (n°920361).
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Affiliation(s)
- C Sabbagh
- Department of Digestive Surgery Service, Amiens University Hospital, Rond Point du Pr Cabrol, 80054, Amiens Cedex 01, France.
| | - L Beyer-Berjot
- Department of Digestive Surgery Assistance Publique Hôpitaux de Marseille, North University Hospital, Marseille, France
| | - M Ouaissi
- Department of Digestive, Oncological, Endocrine, Hepatobiliary and Liver Transplant, Trousseau Hospital, University Hospital of Tours, Tours, France
| | - P Zerbib
- Department of Digestive Surgery and Transplantation, Huriez Hospital, Universite Lille Nord de France, Lille, France
| | - V Bridoux
- Department of Digestive Surgery, University Hospital of Rouen, Rouen, France
| | - G Manceau
- Department of Surgery, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - M Karoui
- Department of Surgery, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - Y Panis
- Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly, France
| | - E Buscail
- Department of Surgery, CHU Toulouse-Rangueil and Toulouse University, Toulouse, France
| | - A Venara
- Department of Digestive Surgery, University Hospital of Angers, Angers, France
| | - I Khaoudy
- Department of Digestive Surgery, Le Havre Hospital, Le Havre, France
| | - M Gaillard
- Department of Digestive Surgery, Cochin Hospital, Paris, France
| | - P Ortega-Deballon
- Department of General Surgery, University Hospital of Bocage, Dijon, France
| | - M Viennet
- Department of General Surgery, University Hospital of Bocage, Dijon, France
| | - A Thobie
- Department of Digestive Surgery, Avranches-Granville Hospital, Avranches, France
| | - B Menahem
- Department of Digestive Surgery, University Hospital of Caen, Caen, France
| | - C Eveno
- Department of Digestive Surgery, University Hospital of Lille, Lille, France
| | - C Bonnel
- Department of Digestive Surgery, Nord-Essonne Hospital, Longjumeau, France
| | - J-Y Mabrut
- Department of Digestive Surgery and Transplantation, Croix Rousse University Hospital, Lyon, France
| | - B Badic
- Department of General and Digestive Surgery, University Hospital, Brest, France
| | - C Godet
- Department of Digestive Surgery, Memorial Hospital of Saint-Lô, Saint-Lô, France
| | - Y Eid
- Department of Digestive Surgery, Robert Bisson Hospital, Lisieux, France
| | - E Duchalais
- Department of Oncological, Digestive and Endocrine Surgery, University Hospital of Nantes, Nantes, France
| | - Z Lakkis
- Department of Digestive Surgical Oncology and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | - E Cotte
- Department of Digestive Surgery, Hôpital Lyon Sud, Lyon, France
| | - A Laforest
- Department of Digestive Surgery, Montsouris Institut, Paris, France
| | - V Defourneaux
- Department of Digestive Surgery, CHU Rennes, Rennes, France
| | - L Maggiorri
- Department of Digestive Surgery, Hôpital Saint-Louis, Université Paris VII, APHP, Paris, France
| | - L Rebibo
- Department of Digestive, Oesogastric and Bariatric Surgery, Hôpital Bichat-Claude-Bernard, Paris, France
| | - N Christou
- Department of Digestive Surgery, Limoges Hospital, Limoges, France
| | - A Talal
- Department of Digestive Surgery, Argentan Hospital, Argentan, France
| | - D Mege
- Department of Digestive Surgery, Aix Marseille Univ, APHM, Timone University Hospital, Marseille, France
| | - C Bonnamy
- Department of Digestive Surgery, Bayeux Hospital, Bayeux, France
| | - A Germain
- Department of Digestive Surgery, CHRU Nancy, Nancy, France
| | - F Mauvais
- Department of Digestive Surgery, Beauvais Hospital, Beauvais, France
| | - C Tresallet
- Department of Digestive Surgical Oncology, Avicenne University Hospital, Paris, France
| | - O Ahmed
- Department of Digestive Surgical Oncology, Avicenne University Hospital, Paris, France
| | - J-M Regimbeau
- Department of Digestive Surgery Service, Amiens University Hospital, Rond Point du Pr Cabrol, 80054, Amiens Cedex 01, France
| | - J Roudie
- Department of Digestive Surgery, Martinique Hospital, Fort-de-France, France
| | - A Laurent
- Department of Digestive Surgery, Créteil Hospital, Créteil, France
| | - B Trilling
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - M Bertrand
- Department of Digestive Surgery, Universitary Hospital of Nîmes, Nîmes, France
| | - D Massalou
- Department of Digestive Surgery, Hôpital L'Archet, Nice University, Nice, France
| | - B Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - H Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - U Giger
- ANTICIPE, Inserm Unity, UMR 1086, Caen, France
| | - O Dejardin
- ANTICIPE, Inserm Unity, UMR 1086, Caen, France
- Department of Clinical Research, University Hospital of Caen, Caen, France
| | - A Pellegrin
- Department of Digestive Surgery Service, Amiens University Hospital, Rond Point du Pr Cabrol, 80054, Amiens Cedex 01, France
| | - A Alves
- Department of Digestive Surgery, University Hospital of Caen, Caen, France
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7
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Gil C, Beyer-Bergeot L, Sabbagh C, Zerbib P, Bridoux V, Manceau G, Panis Y, Buscail E, Venara A, Khaoudy I, Gaillard M, Viennet M, Thobie A, Menahem B, Eveno C, Bonnel C, Mabrut JY, Badic B, Godet C, Eid Y, Duchalais E, Lakkis Z, Cotte E, Laforest A, Defourneaux V, Maggiori L, Rebibo L, Christou N, Talal A, Mege D, Bonnamy C, Germain A, Mauvais F, Tresallet C, Roudie J, Laurent A, Trilling B, Bertrand M, Massalou D, Romain B, Tranchart H, Giger U, Alves A, Ouaissi M. Impact of the first wave of COVID-19 epidemy on the surgical management of sigmoid diverticular disease in France: National French retrospective study. Int J Colorectal Dis 2023; 38:276. [PMID: 38040936 DOI: 10.1007/s00384-023-04564-w] [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] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE To analyze the surgical management of sigmoid diverticular disease (SDD) before, during, and after the first containment rules (CR) for the first wave of COVID-19. METHODS From the French Surgical Association multicenter series, this study included all patients operated on between January 2018 and September 2021. Three groups were compared: A (before CR period: 01/01/18-03/16/20), B (CR period: 03/17/20-05/03/20), and C (post CR period: 05/04/20-09/30/21). RESULTS A total of 1965 patients (A n = 1517, B n = 52, C n = 396) were included. The A group had significantly more previous SDD compared to the two other groups (p = 0.007), especially complicated (p = 0.0004). The rate of peritonitis was significantly higher in the B (46.1%) and C (38.4%) groups compared to the A group (31.7%) (p = 0.034 and p = 0.014). As regards surgical treatment, Hartmann's procedure was more often performed in the B group (44.2%, vs A 25.5% and C 26.8%, p = 0.01). Mortality at 90 days was significantly higher in the B group (9.6%, vs A 4% and C 6.3%, p = 0.034). This difference was also significant between the A and B groups (p = 0.048), as well as between the A and C groups (p = 0.05). There was no significant difference between the three groups in terms of postoperative morbidity. CONCLUSION This study shows that the management of SDD was impacted by COVID-19 at CR, but also after and until September 2021, both on the initial clinical presentation and on postoperative mortality.
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Affiliation(s)
- Camille Gil
- Department of Digestive, Oncological, Endocrine, Hepatobiliary and Liver Transplant, Trousseau Hospital, University Hospital of Tours, Avenue de la République, F37044 Tours, France
| | - Laura Beyer-Bergeot
- Department of Digestive Surgery Assistance Publique Hôpitaux de Marseille, North University Hospital, Marseille, France
| | - Charles Sabbagh
- Department of Surgery Department, Amiens University Hospital, Amiens, France
| | - Philippe Zerbib
- Department of Digestive Surgery and Transplantation, Huriez Hospital, Universite Lille Nord de France, Lille, France
| | - Valérie Bridoux
- Department of Digestive Surgery, University Hospital of Rouen, Rouen, France
| | - Gilles Manceau
- Department of digestive Surgery, Assistance Publique Hôpitaux de Paris, Georges Pompidou University Hospital, univeristy Paris Cité, Paris, France
| | - Yves Panis
- Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly/Seine, France
| | - Etienne Buscail
- Department of Surgery, CHU Toulouse-Rangueil and Toulouse University, Toulouse, France
| | - Aurélien Venara
- Department of Digestive Surgery, University Hospital of Angers, Angers, France
| | - Iman Khaoudy
- Department of Digestive Surgery, Le Havre Hospital, Le Havre, France
| | - Martin Gaillard
- Department of Digestive Surgery, Cochin Hospital, Paris, France
| | - Manon Viennet
- Department of General Surgery, University Hospital of Bocage, Dijon, France
| | - Alexandre Thobie
- Department of Digestive Surgery, Avranches-Granville Hospital, Avranches, France
| | - Benjamin Menahem
- Unité INSERM UMR 1086 ANTICIPE Registre spécialisé des Tumeurs Digestives du calvados-Service de chirurgie digestive, Université de Caen Normandie 14000, Caen, France
| | - Clarisse Eveno
- Department of Digestive Surgery, University Hospital of Lille, Lille, France
| | - Catherine Bonnel
- Department of Digestive Surgery, Nord-Essonne Hospital, Longjumeau, France
| | - Jean-Yves Mabrut
- Department of Digestive Surgery and Transplantation, Croix Rousse University Hospital, Lyon, France
| | - Bodgan Badic
- Department of General and Digestive Surgery, University Hospital, Brest, France
| | - Camille Godet
- Department of Digestive Surgery, Memorial Hospital of Saint-Lô, Saint-Lô, France
| | - Yassine Eid
- Department of Digestive Surgery, Polyclinique de Lisieux, Lisieux, France
| | - Emilie Duchalais
- Department of Oncological, Digestive and Endocrine Surgery, University Hospital of Nantes, Nantes, France
| | - Zaher Lakkis
- Department of Digestive Surgical Oncology and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | - Eddy Cotte
- Department of Digestive Surgery, Hôpital Lyon Sud, Lyon, France
| | - Anais Laforest
- Department of Digestive Surgery, Montsouris Institut, Paris, France
| | | | - Léon Maggiori
- Department of Digestive Surgery, Hôpital Saint-Louis, Université Paris VII, APHP, Paris, France
| | - Lionel Rebibo
- Department of Digestive, Oesogastric and Bariatric Surgery, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Niki Christou
- Department of Digestive Surgery, Limoges Hospital, Limoges, France
| | - Ali Talal
- Department of Digestive Surgery, Argentan Hospital, Argentan, France
| | - Diane Mege
- Department of Digestive Surgery, Aix Marseille Univ, APHM, Timone University Hospital, Marseille, France
| | - Cécile Bonnamy
- Department of Digestive Surgery, Bayeux Hospital, Bayeux, France
| | | | - François Mauvais
- Department of Digestive Surgery, Beauvais Hospital, Beauvais, France
| | - Christophe Tresallet
- Department of Digestive Surgical Oncology, Avicenne University Hospital, Sorbonne Paris Nord University, Paris, France
| | - Jean Roudie
- Department of Digestive Surgery, Martinique Hospital, Fort-de-France, France
| | - Alexis Laurent
- Department of Digestive Surgery, Créteil Hospital, Créteil, France
| | - Bertrand Trilling
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Martin Bertrand
- Department of Digestive Surgery, Universitary Hospital of Nîmes, Nîmes, France
| | - Damien Massalou
- Department of Digestive Surgery, Hôpital L'Archet, Nice University, Nice, France
| | - Benoit Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Urs Giger
- Fliedner Fachhochschule, University of Applied Sciences, Düsseldorf, Germany
| | - Arnaud Alves
- Unité INSERM UMR 1086 ANTICIPE Registre spécialisé des Tumeurs Digestives du calvados-Service de chirurgie digestive, Université de Caen Normandie 14000, Caen, France
| | - Mehdi Ouaissi
- Department of Digestive, Oncological, Endocrine, Hepatobiliary and Liver Transplant, Trousseau Hospital, University Hospital of Tours, Avenue de la République, F37044 Tours, France.
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8
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Ferrante M, Pouillon L, Mañosa M, Savarino E, Allez M, Kapizioni C, Arebi N, Carvello M, Myrelid P, De Vries AC, Rivière P, Panis Y, Domènech E. Results of the Eighth Scientific Workshop of ECCO: Prevention and Treatment of Postoperative Recurrence in Patients With Crohn's Disease Undergoing an Ileocolonic Resection With Ileocolonic Anastomosis. J Crohns Colitis 2023; 17:1707-1722. [PMID: 37070324 DOI: 10.1093/ecco-jcc/jjad053] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/16/2023] [Indexed: 04/19/2023]
Abstract
Despite the introduction of biological therapies, an ileocolonic resection is often required in patients with Crohn's disease [CD]. Unfortunately, surgery is not curative, as many patients will develop postoperative recurrence [POR], eventually leading to further bowel damage and a decreased quality of life. The 8th Scientific Workshop of ECCO reviewed the available scientific data on both prevention and treatment of POR in patients with CD undergoing an ileocolonic resection, dealing with conventional and biological therapies, as well as non-medical interventions, including endoscopic and surgical approaches in case of POR. Based on the available data, an algorithm for the postoperative management in daily clinical practice was developed.
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Affiliation(s)
- Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Translational Research in Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Lieven Pouillon
- Imelda GI Clinical Research Center, Imelda General Hospital, Bonheiden, Belgium
| | - Míriam Mañosa
- Department of Gastroenterology and Hepatology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
- Gastroenterology Unit, Azienda Ospedale Università di Padova, Padua, Italy
| | - Matthieu Allez
- Gastroenterology Department, Hôpital Saint-Louis - APHP, Université Paris Cité, INSERM U1160, Paris, France
| | - Christina Kapizioni
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Naila Arebi
- Department of Inflammatory Bowel Disease, St Mark's Hospital, Harrow, London, UK
| | - Michele Carvello
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Pär Myrelid
- Department of Surgery, Linköping University Hospital and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Annemarie C De Vries
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Pauline Rivière
- Department of Gastroenterology and Hepatology, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, CHU de Bordeaux, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Yves Panis
- Paris IBD Center, Groupe Hospitalier Privé Ambroise-Paré Hartmann, Neuily/Seine, France
| | - Eugeni Domènech
- Department of Gastroenterology and Hepatology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
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9
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Greijdanus NG, Wienholts K, Ubels S, Talboom K, Hannink G, Wolthuis A, de Lacy FB, Lefevre JH, Solomon M, Frasson M, Rotholtz N, Denost Q, Perez RO, Konishi T, Panis Y, Rutegård M, Hompes R, Rosman C, van Workum F, Tanis PJ, de Wilt JHW. Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patients. Br J Surg 2023; 110:1863-1876. [PMID: 37819790 PMCID: PMC10638542 DOI: 10.1093/bjs/znad311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/01/2023] [Accepted: 09/09/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied. METHODS Patients from 216 centres and 45 countries with anastomotic leak after rectal cancer resection between 2014 and 2018 were included. Treatment was categorized as salvage surgery, faecal diversion with passive or active (vacuum) drainage, and no primary/secondary faecal diversion. The primary outcome was 1-year stoma-free survival. In addition, passive and active drainage were compared using propensity score matching (2 : 1). RESULTS Of 2470 evaluable patients, 388 (16.0 per cent) underwent salvage surgery, 1524 (62.0 per cent) passive drainage, 278 (11.0 per cent) active drainage, and 280 (11.0 per cent) had no faecal diversion. One-year stoma-free survival rates were 13.7, 48.3, 48.2, and 65.4 per cent respectively. Propensity score matching resulted in 556 patients with passive and 278 with active drainage. There was no statistically significant difference between these groups in 1-year stoma-free survival (OR 0.95, 95 per cent c.i. 0.66 to 1.33), with a risk difference of -1.1 (95 per cent c.i. -9.0 to 7.0) per cent. After active drainage, more patients required secondary salvage surgery (OR 2.32, 1.49 to 3.59), prolonged hospital admission (an additional 6 (95 per cent c.i. 2 to 10) days), and ICU admission (OR 1.41, 1.02 to 1.94). Mean duration of leak healing did not differ significantly (an additional 12 (-28 to 52) days). CONCLUSION Primary salvage surgery or omission of faecal diversion likely correspond to the most severe and least severe leaks respectively. In patients with diverted leaks, stoma-free survival did not differ statistically between passive and active drainage, although the increased risk of secondary salvage surgery and ICU admission suggests residual confounding.
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Affiliation(s)
- Nynke G Greijdanus
- Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Kiedo Wienholts
- Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Sander Ubels
- Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Kevin Talboom
- Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Gerjon Hannink
- Department of Medical Imaging, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | | | - F Borja de Lacy
- Gastrointestinal Surgery Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Jérémie H Lefevre
- Department of Digestive Surgery, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Michael Solomon
- Department of Surgery, University of Sydney Central Clinical School, Camperdown, New South Wales, Australia
| | - Matteo Frasson
- Department of Surgery, Valencia University Hospital La Fe, Valencia, Spain
| | | | - Quentin Denost
- Bordeaux Colorectal Institute, Clinique Tivoli, Bordeaux, France
| | - Rodrigo O Perez
- Colorectal Surgery, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Tsuyoshi Konishi
- Department of Colon and Rectal Surgery, University of Texas MD Anderson Cancer Center, Anderson, Texas, USA
| | - Yves Panis
- Colorectal Surgery Centre, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly Seine, France
| | - Martin Rutegård
- Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Roel Hompes
- Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Frans van Workum
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Pieter J Tanis
- Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
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10
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Rivière P, Bislenghi G, Hammoudi N, Verstockt B, Brown S, Oliveira-Cunha M, Bemelman W, Pellino G, Kotze PG, Ferrante M, Panis Y. Results of the Eighth Scientific Workshop of ECCO: Pathophysiology and Risk Factors of Postoperative Crohn's Disease Recurrence after an Ileocolonic Resection. J Crohns Colitis 2023; 17:1557-1568. [PMID: 37070326 DOI: 10.1093/ecco-jcc/jjad054] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/16/2023] [Indexed: 04/19/2023]
Abstract
Postoperative recurrence [POR] after an ileocolonic resection with ileocolonic anastomosis is frequently encountered in patients with Crohn's disease. The 8th Scientific Workshop of ECCO reviewed the available evidence on the pathophysiology and risk factors for POR. In this paper, we discuss published data on the role of the microbiome, the mesentery, the immune system and the genetic background. In addition to investigating the causative mechanisms of POR, identification of risk factors is essential to tailor preventive strategies. Potential clinical, surgical and histological risk factors are presented along with their limitations. Emphasis is placed on unanswered research questions, guiding prevention of POR based on individual patient profiles.
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Affiliation(s)
- Pauline Rivière
- Department of Gastroenterology and Hepatology, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, CHU de Bordeaux, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Gabriele Bislenghi
- Department of Abdominal Surgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Nassim Hammoudi
- Department of Gastroenteology, Hôpital Saint-Louis, APHP, INSERM U1160, Université Paris Cité, Paris, France
| | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Translational Research in Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Steven Brown
- Department of Surgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - Melissa Oliveira-Cunha
- Department of Colorectal Surgery, University Hospitals of Birmingham NHS Trust, Birmingham, UK
| | - Willem Bemelman
- Department of Surgery, Amsterdam University Medical Centers, location Meibergdreef, Amsterdam, the Netherlands
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Science, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Italy
| | - Paulo Gustavo Kotze
- IBD Outpatient Clinics, Colorectal Surgery Unit, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Translational Research in Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Yves Panis
- Paris IBD Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly/Seine, France
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11
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Greijdanus NG, Wienholts K, Ubels S, Talboom K, Hannink G, Wolthuis A, de Lacy FB, Lefevre JH, Solomon M, Frasson M, Rotholtz N, Denost Q, Perez RO, Konishi T, Panis Y, Rutegård M, Hompes R, Rosman C, van Workum F, Tanis PJ, de Wilt JH. Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage: Development and Validation of a Prediction Model in a Large International Cohort. Ann Surg 2023; 278:772-780. [PMID: 37498208 PMCID: PMC10549897 DOI: 10.1097/sla.0000000000006043] [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] [Indexed: 07/28/2023]
Abstract
OBJECTIVE To develop and validate a prediction model (STOMA score) for 1-year stoma-free survival in patients with rectal cancer (RC) with anastomotic leakage (AL). BACKGROUND AL after RC resection often results in a permanent stoma. METHODS This international retrospective cohort study (TENTACLE-Rectum) encompassed 216 participating centres and included patients who developed AL after RC surgery between 2014 and 2018. Clinically relevant predictors for 1-year stoma-free survival were included in uni and multivariable logistic regression models. The STOMA score was developed and internally validated in a cohort of patients operated between 2014 and 2017, with subsequent temporal validation in a 2018 cohort. The discriminative power and calibration of the models' performance were evaluated. RESULTS This study included 2499 patients with AL, 1954 in the development cohort and 545 in the validation cohort. Baseline characteristics were comparable. One-year stoma-free survival was 45.0% in the development cohort and 43.7% in the validation cohort. The following predictors were included in the STOMA score: sex, age, American Society of Anestesiologist classification, body mass index, clinical M-disease, neoadjuvant therapy, abdominal and transanal approach, primary defunctioning stoma, multivisceral resection, clinical setting in which AL was diagnosed, postoperative day of AL diagnosis, abdominal contamination, anastomotic defect circumference, bowel wall ischemia, anastomotic fistula, retraction, and reactivation leakage. The STOMA score showed good discrimination and calibration (c-index: 0.71, 95% CI: 0.66-0.76). CONCLUSIONS The STOMA score consists of 18 clinically relevant factors and estimates the individual risk for 1-year stoma-free survival in patients with AL after RC surgery, which may improve patient counseling and give guidance when analyzing the efficacy of different treatment strategies in future studies.
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Affiliation(s)
- Nynke G. Greijdanus
- Department of Surgery, Radboud university medical centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Kiedo Wienholts
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
- Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Sander Ubels
- Department of Surgery, Radboud university medical centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Kevin Talboom
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
- Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Gerjon Hannink
- Department of Medical Imaging, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | | | - Francisco B. de Lacy
- Department of Gastrointestinal Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Jérémie H. Lefevre
- Department of Digestive Surgery, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Michael Solomon
- Department of Surgery, University of Sydney Central Clinical School, Camperdown, New South Wales, Australia
| | - Matteo Frasson
- Department of Surgery, Valencia University Hospital La Fe, Valencia, Spain
| | | | - Quentin Denost
- Bordeaux Colorectal Institute, Clinique Tivoli, Bordeaux, France
| | - Rodrigo O. Perez
- Department of Colorectal Surgery, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Tsuyoshi Konishi
- Department of Colon and Rectal Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yves Panis
- Department of Colorectal Surgery, Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly Seine, France
| | - Martin Rutegård
- Department of Surgery, Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Roel Hompes
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
- Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud university medical centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Frans van Workum
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Pieter J. Tanis
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
- Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Johannes H.W. de Wilt
- Department of Surgery, Radboud university medical centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
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12
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Dragoni G, Allocca M, Myrelid P, Noor NM, Hammoudi N, Rivière P, Panis Y, Ferrante M. Results of the Eighth Scientific Workshop of ECCO: Diagnosing Postoperative Recurrence of Crohn's Disease After an Ileocolonic Resection With Ileocolonic Anastomosis. J Crohns Colitis 2023; 17:1373-1386. [PMID: 37070339 DOI: 10.1093/ecco-jcc/jjad055] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/16/2023] [Indexed: 04/19/2023]
Abstract
Despite the introduction of potent biologic therapies, many patients with Crohn's disease [CD] still require an ileocolonic resection [ICR] during the course of their disease. Furthermore, the need of redo ICR has not decreased over the past few decades, highlighting the need for better strategies to prevent and treat postoperative recurrence [POR]. The first step to develop such a strategy would be to define and standardise the description of POR with adequate diagnostic instruments. In this article, we will describe the different methodologies used to report POR [endoscopic, histological, radiological, biochemical, clinical, and surgical], and review their potential benefits and limitations, as well as the optimal timing of evaluation.
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Affiliation(s)
- Gabriele Dragoni
- IBD Referral Center, Department of Gastroenterology, Careggi University Hospital, Florence, Italy
- Gastroenterology Research Unit, Department of Experimental and Clinical Biochemical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - Mariangela Allocca
- Department of Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Pär Myrelid
- Department of Surgery, Linköping University Hospital and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Nurulamin M Noor
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Nassim Hammoudi
- Gastroenterology Department, Hôpital Saint-Louis - APHP, Université Paris Cité, INSERM U1160, Paris, France
| | - Pauline Rivière
- Department of Gastroenterology and Hepatology, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, CHU de Bordeaux, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Yves Panis
- Paris IBD Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly/Seine, France
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Translational Research in Gastrointestinal Disorders [TARGID], Department of Chronic Diseases and Metabolism [CHROMETA], KU Leuven, Leuven, Belgium
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13
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Calmels M, Labiad C, Lelong B, Lefevre JH, Tuech JJ, Benoist S, Mège D, Denost Q, Panis Y. Local excision after neoadjuvant chemoradiotherapy for mid and low rectal cancer: a multicentric French study from the GRECCAR group. Colorectal Dis 2023; 25:1973-1980. [PMID: 37679892 DOI: 10.1111/codi.16742] [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: 02/05/2023] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 09/09/2023]
Abstract
AIM A complete or subcomplete tumour response (CTR) is observed in 10%-25% of patients with mid/low rectal cancer after neoadjuvant chemoradiotherapy (CRT). The aim of our study was to report a multicentric French experience in local excision (LE) after CRT. METHOD All patients who underwent LE for mid/low rectal cancer with suspected CTR after CRT, from 2006 to 2019 in seven GRECCAR centres were included. LE was considered adequate if the specimen showed a ypT0/Tis/T1R0 tumour, otherwise, a completion total mesorectal excision (TME) was discussed. Morbi-mortality, functional results and oncological outcomes were studied. RESULTS A total of 257 patients were included. LE specimens showed 36% ypT0, 4% ypTis and 19% ypT1. Thus, 108 patients (42%) had theoretical indication of completion TME, which was performed in only 42 patients. Overall, 30-day morbidity after LE was 11%, including 2% Clavien-Dindo grade III or IV complications. After completion TME, 47% described major low anterior resection syndrome versus 5% after LE alone (p < 0.001). After a mean follow-up of 4 years (range 2-6 years), the recurrence rate was 11% after LE, 32% after completion TME and 20% in patients for whom completion TME was indicated but not performed (p = 0.021). CONCLUSION TME remains the gold standard for mid/low rectal cancer after CRT. LE in selected patients is safe for operative and functional, but also oncological, results. However, completion TME was indicated in 42% of patients after LE, highlighting the difficulty of the preoperative diagnosis of CTR after CRT.
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Affiliation(s)
- Mélanie Calmels
- Department of Colorectal Surgery, DMU Digest, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris-Cité, Clichy, France
| | - Camélia Labiad
- Department of Colorectal Surgery, DMU Digest, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris-Cité, Clichy, France
| | - Bernard Lelong
- Surgical Oncology Department, Institut Paoli Calmettes, Marseille, France
| | - Jérémie H Lefevre
- Surgery Department, Saint Antoine University Hospital, Paris, France
| | | | - Stéphane Benoist
- Digestive Surgery Department, Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - Diane Mège
- Surgery Department, Timone University Hospital, Marseille, France
| | - Quentin Denost
- Surgery Department, Saint André University Hospital, Bordeaux, France
| | - Yves Panis
- Centre de Chirurgie Colorectale, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly-sur-Seine, France
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14
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Piozzi GN, Khobragade K, Aliyev V, Asoglu O, Bianchi PP, Butiurca VO, Chen WTL, Cheong JY, Choi GS, Coratti A, Denost Q, Fukunaga Y, Gorgun E, Guerra F, Ito M, Khan JS, Kim HJ, Kim JC, Kinugasa Y, Konishi T, Kuo LJ, Kuzu MA, Lefevre JH, Liang JT, Marks J, Molnar C, Panis Y, Rouanet P, Rullier E, Saklani A, Spinelli A, Tsarkov P, Tsukamoto S, Weiser M, Kim SH. International standardization and optimization group for intersphincteric resection (ISOG-ISR): modified Delphi consensus on anatomy, definition, indication, surgical technique, specimen description and functional outcome. Colorectal Dis 2023; 25:1896-1909. [PMID: 37563772 DOI: 10.1111/codi.16704] [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: 01/07/2023] [Revised: 06/26/2023] [Accepted: 07/06/2023] [Indexed: 08/12/2023]
Abstract
AIM Intersphincteric resection (ISR) is an oncologically complex operation for very low-lying rectal cancers. Yet, definition, anatomical description, operative indications and operative approaches to ISR are not standardized. The aim of this study was to standardize the definition of ISR by reaching international consensus from the experts in the field. This standardization will allow meaningful comparison in the literature in the future. METHOD A modified Delphi approach with three rounds of questionnaire was adopted. A total of 29 international experts from 11 countries were recruited for this study. Six domains with a total of 37 statements were examined, including anatomical definition; definition of intersphincteric dissection, intersphincteric resection (ISR) and ultra-low anterior resection (uLAR); indication for ISR; surgical technique of ISR; specimen description of ISR; and functional outcome assessment protocol. RESULTS Three rounds of questionnaire were performed (response rate 100%, 89.6%, 89.6%). Agreement (≥80%) reached standardization on 36 statements. CONCLUSION This study provides an international expert consensus-based definition and standardization of ISR. This is the first study standardizing terminology and definition of deep pelvis/anal canal anatomy from a surgical point of view. Intersphincteric dissection, ISR and uLAR were specifically defined for precise surgical description. Indication for ISR was determined by the rectal tumour's maximal radial infiltration (T stage) below the levator ani. A new surgical definition of T3isp was reached by consensus to define T3 low rectal tumours infiltrating the intersphincteric plane. A practical flowchart for surgical indication for uLAR/ISR/abdominoperineal resection was developed. A standardized ISR surgical technique and functional outcome assessment protocol was defined.
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Affiliation(s)
| | | | - Vusal Aliyev
- Bogazici Academy for Clinical Sciences, Istanbul, Turkey
| | - Oktar Asoglu
- Bogazici Academy for Clinical Sciences, Istanbul, Turkey
| | | | - Vlad-Olimpiu Butiurca
- University of Medicine, Pharmacy Science, and Technology 'G.E. Palade', Târgu-Mureș, Romania
| | | | | | - Gyu-Seog Choi
- Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Andrea Coratti
- Azienda USL Toscana Sud Est-Misericordia Hospital, Grosseto, Italy
| | | | - Yosuke Fukunaga
- Cancer Institution Hospital, Japanese Foundation of Cancer Research, Tokyo, Japan
| | | | - Francesco Guerra
- Azienda USL Toscana Sud Est-Misericordia Hospital, Grosseto, Italy
| | - Masaaki Ito
- National Cancer Center Hospital East, Chiba, Japan
| | - Jim S Khan
- University of Portsmouth, Portsmouth, UK
| | - Hye Jin Kim
- Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Jin Cheon Kim
- University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | | | - Tsuyoshi Konishi
- M.D. Anderson Cancer Center, The University of Texas, Houston, Texas, USA
| | - Li-Jen Kuo
- Taipei Medical University Hospital, Taipei City, Taiwan
| | | | - Jeremie H Lefevre
- Department of Digestive Surgery, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Jin-Tung Liang
- National Taiwan University Hospital and College of Medicine, Taipei City, Taiwan
| | | | - Călin Molnar
- University of Medicine, Pharmacy Science, and Technology 'G.E. Palade', Târgu-Mureș, Romania
| | - Yves Panis
- Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly, Seine, France
| | | | - Eric Rullier
- Bordeaux University Hospital, Haut-Leveque Hospital, Pessac, France
| | | | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Petr Tsarkov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | | | - Martin Weiser
- Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Seon Hahn Kim
- Korea University Anam Hospital, Seoul, Korea
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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15
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Nuzzo A, Peoc'h K, Vaittinada Ayar P, Tran-Dinh A, Weiss E, Panis Y, Ronot M, Garzelli L, Eloy P, Ben Abdallah I, Castier Y, Corcos O. Improving clinical suspicion of acute mesenteric ischemia among patients with acute abdomen: a cross-sectional study from an intestinal stroke center. World J Emerg Surg 2023; 18:37. [PMID: 37287011 DOI: 10.1186/s13017-023-00505-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 05/25/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Early diagnosis of acute mesenteric ischemia (AMI) is essential for a favorable outcome. Selection of patients requiring a dedicated multiphasic computed tomography (CT) scan remains a clinical challenge. METHODS In this cross-sectional diagnostic study conducted from 2016 to 2018, we compared the presentation of AMI patients admitted to an intestinal stroke center to patients with acute abdominal pain of another origin admitted to the emergency room (controls). RESULTS We included 137 patients-52 with AMI and 85 controls. Patients with AMI [median age: 65 years (interquartile range 55-74)] had arterial and venous AMI in 65% and 35% of cases, respectively. Relative to controls, AMI patients were significantly older, more likely to have risk factors or a history of cardiovascular disease, and more likely to present with sudden-onset and morphine-requiring abdominal pain, hematochezia, guarding, organ dysfunction, higher white blood cell and neutrophil counts, and higher plasma C-reactive protein (CRP) and procalcitonin concentrations. On multivariate analysis, two independent factors were associated with the diagnosis of AMI: the sudden-onset (OR = 20, 95%CI 7-60, p < 0.001) and the morphine-requiring nature of the acute abdominal pain (OR = 6, 95%CI 2-16, p = 0.002). Sudden-onset and/or morphine-requiring abdominal pain was present in 88% of AMI patients versus 28% in controls (p < 0.001). The area under the receiver operating characteristic curve for the diagnosis of AMI was 0.84 (95%CI 0.77-0.91), depending on the number of factors. CONCLUSIONS Sudden onset and the need for morphine are suggestive of AMI in patients with acute abdominal pain and should prompt multiphasic CT scan including arterial and venous phase images for confirmation.
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Affiliation(s)
- Alexandre Nuzzo
- Université Paris Cité, INSERM UMR 1148, 75018, Paris, France.
- Department of Gastroenterology, IBD and Intestinal Failure, Intestinal Stroke Center, AP-HP. Nord, Beaujon Hospital, 92110, Clichy, France.
- Structure d'Urgences Vasculaires Intestinales (SURVI), Hôpital Beaujon, 100 bd du général Leclerc, 92110, Clichy, France.
| | - Katell Peoc'h
- Université Paris Cité, INSERM UMR 1149, 75018, Paris, France
- Department of Clinical Biochemistry, AP-HP. Nord, Beaujon Hospital, 92110, Clichy, France
| | | | - Alexy Tran-Dinh
- Université Paris Cité, INSERM UMR 1148, 75018, Paris, France
- Intensive Care Unit, AP-HP. Nord, Bichat Hospital, 75018, Paris, France
| | - Emmanuel Weiss
- Université Paris Cité, INSERM UMR 1149, 75018, Paris, France
- Intensive Care Unit, AP-HP. Nord, Beaujon Hospital, 92110, Clichy, France
| | - Yves Panis
- Department of Colorectal Surgery, AP-HP. Nord, Beaujon Hospital, 92110, Clichy, France
| | - Maxime Ronot
- Department of Clinical Biochemistry, AP-HP. Nord, Beaujon Hospital, 92110, Clichy, France
- Department of Radiology, AP-HP. Nord, Beaujon Hospital, 92110, Clichy, France
| | - Lorenzo Garzelli
- Department of Clinical Biochemistry, AP-HP. Nord, Beaujon Hospital, 92110, Clichy, France
- Department of Radiology, AP-HP. Nord, Beaujon Hospital, 92110, Clichy, France
| | - Philippine Eloy
- Department of Epidemiology, Biostatistics and Clinical Research, APHP. Nord, Bichat Hospital, 75018, Paris, France
- Université Paris Cité, INSERM CIC-EC 1425, 75018, Paris, France
| | - Iannis Ben Abdallah
- Department of Vascular Surgery, AP-HP. Nord, Bichat Hospital, 75018, Paris, France
| | - Yves Castier
- Department of Vascular Surgery, AP-HP. Nord, Bichat Hospital, 75018, Paris, France
| | - Olivier Corcos
- Université Paris Cité, INSERM UMR 1148, 75018, Paris, France
- Department of Gastroenterology, IBD and Intestinal Failure, Intestinal Stroke Center, AP-HP. Nord, Beaujon Hospital, 92110, Clichy, France
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16
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Benlice C, Parvaiz A, Baca B, Hohenberger W, Miskovic D, Stocchi L, Steele S, Kim SH, Holm T, Spinelli A, Gogenur I, Panis Y, Hasegawa H, Karachun A, Uriburu JCP, Ito M, Croner R, Kessler H, Kuzu MA. Standardization of the Definition and Surgical Management of Splenic Flexure Carcinoma by an International Expert Consensus Using the Delphi Technique: Room for Improvement? Dis Colon Rectum 2023; 66:805-815. [PMID: 36716403 DOI: 10.1097/dcr.0000000000002692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Surgical management of splenic flexure carcinoma remains controversial. OBJECTIVE This study aimed to establish an expert international consensus on splenic flexure carcinoma management. DESIGN A 3-round online-based Delphi study was conducted between September 2020 and April 2021. SETTING The first round included 18 experts from 12 different countries. For the second and third rounds, each expert in the first round was asked to invite 2 more colorectal surgeons (n = 47). Out of 47 invited experts, 89% (n = 42) participated in the second and third rounds of the consensus. INTERVENTIONS A total of 35 questions were created and sent via the online questionnaire tool. MAIN OUTCOME MEASURES Levels of recommendation based on voting concordance were graded as follows: more than 75% agreement was defined as strong, between 50% and 75% as moderate, and below 50% as weak. RESULTS There was moderate consensus on the definition of splenic flexure (55%) as 10 cm from either side where the distal transverse colon turns into the proximal descending colon. Also, experts recommended an abdominopelvic CT scan plus intraoperative exploration (moderate consensus, 72%) for tumor localization and cancer registry. Segmental colectomy was the preferred technique for the management of splenic flexure carcinoma in the elective setting (72%). Moderate consensus was achieved on the technique of complete mesocolic excision and central vascular ligation principles for splenic flexure carcinoma (74%). Only strong consensus was achieved on the surgical approach for minimally invasive surgery (88%). LIMITATIONS Subjective decisions are based on individual expert clinical experience and not evidence based. CONCLUSIONS This is the first internationally conducted Delphi consensus study regarding splenic flexure carcinoma. The definition of splenic flexure remains ambiguous. To more effectively compare oncologic outcomes among different cancer registries, guidelines need to be developed to standardize each domain and avoid arbitrary definitions. See Video Abstract at http://links.lww.com/DCR/C143 . ESTANDARIZACIN DE LA DEFINICIN Y MANEJO QUIRRGICO DEL CARCINOMA DE NGULO ESPLNICO ESTABLECIDO POR UN CONSENSO INTERNACIONAL DE EXPERTOS UTILIZANDO LA TCNICA DELPHI ESPACIO PARA MEJORAR ANTECEDENTES:El tratamiento quirúrgico del cáncer de ángulo esplénico sigue siendo controvertido.OBJETIVO:Establecer un consenso internacional de expertos sobre el manejo del cáncer del ángulo esplénico.DISEÑO:Se condujo un estudio Delphi en línea de 3 rondas entre septiembre de 2020 y febrero de 2021.ESCENARIO:La primera ronda incluyó a 18 expertos de 12 países distintos. Para la segunda y tercera rondas, a cada experto de la primera ronda se le pidió que invitara a 2 cirujanos colorrectales más de su región (n = 47). De los 47 expertos invitados, el 89% (n = 42) participó en la segunda y tercera ronda del consenso.INTERVENCIONES:Se crearon y enviaron un total de 35 preguntas a través de la herramienta de cuestionario en línea.PRINCIPALES MEDIDAS DE RESULTADO:Los niveles de recomendación basados en la concordancia de votos fueron jerarquizados de la siguiente manera: más del 75% de acuerdo se definió como fuerte, entre 50 y 75% como moderado y por debajo del 50% como débil.RESULTADOS:Hubo un consenso moderado sobre la definición de ángulo esplénico (55%) como 10 cm desde cualquier lado donde el colon transverso distal se convierte en el colon descendente proximal. Así también, los expertos recomendaron la tomografía computarizada abdominopélvica más la exploración intraoperatoria (consenso moderado, 72%) para la localización del tumor y el registro del ángulo esplénico. La colectomía segmentaria fue la técnica preferida para el tratamiento del cáncer de ángulo esplénico en el caso de ser electivo (72%). Se logró un consenso moderado sobre la técnica de escisión completa del mesocolon y los principios de ligadura vascular a nivel central para el cáncer de ángulo esplénico (74%). Solo se logró un fuerte consenso sobre el abordaje quirúrgico para la cirugía mínimamente invasiva (88%).LIMITACIONES:Decisiones subjetivas basadas en la experiencia clínica de expertos individuales y no basadas en evidencia.CONCLUSIONES:Este es el primer estudio internacional de consenso Delphi realizado sobre el cáncer de ángulo esplénico. Si bien encontramos un consenso moderado sobre las modalidades de diagnóstico preoperatorio y el manejo quirúrgico, la definición de ángulo esplénico sigue siendo ambigua. Para comparar de manera más efectiva los resultados oncológicos entre diferentes registros de cáncer, se deben desarrollar pautas para estandarizar cada dominio y evitar definiciones arbitrarias. Consulte Video Resumen en http://links.lww.com/DCR/C143 . (Traducción-Dr. Osvaldo Gauto ).
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Affiliation(s)
- Cigdem Benlice
- Department of General Surgery, School of Medicine; Ankara University, Ankara, Turkey
| | - Amjad Parvaiz
- Department of General Surgery, Champalimaud Cancer Foundation, Lisbon, Portugal
| | - Bilgi Baca
- Department of General Surgery, School of Medicine; Acibadem Mehmet Ali Aydinlar, Istanbul, Turkey
| | | | - Danilo Miskovic
- Department of General Surgery, St Marks Hospital, United Kingdom
| | - Luca Stocchi
- Division of Colorectal Surgery, Mayo Clinic, Jacksonville, Florida
| | - Scott Steele
- Department of Colorectal Surgery, DDSI, Celeveland Clinic, Cleveland, Ohio
| | - Seon-Hahn Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Torbjörn Holm
- Division of Coloproctology, Department of Surgical Gastroenterology, Karolinska University Hospital, Stockholm, Sweden
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of General Surgery, IRCCS Humanitas Research Hospital, Rozzano Milan, Italy
| | - Ismail Gogenur
- Department of Clinical Medicine, Center for Surgical Science, University of Copenhagen, Copenhagen, Denmark
| | - Yves Panis
- Department of Colorectal Surgery, Beaujon Hospital and University of Paris, France
| | - Hirotoshi Hasegawa
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Alexey Karachun
- Department of Abdominal Surgical Oncology, N.N. Petrov National Medical Research Center of Oncology, Saint Petersburg, Russia
| | - Juan C Patron Uriburu
- Department of General Surgery, Coloproctology Service, British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Masaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East Chiba, Japan
| | - Roland Croner
- Department of General, Abdominal and Vascular Surgery, University Hospital, Magdeburg, Germany
| | - Hermann Kessler
- Department of Colorectal Surgery, DDSI, Celeveland Clinic, Cleveland, Ohio
| | - Mehmet Ayhan Kuzu
- Department of General Surgery, School of Medicine; Ankara University, Ankara, Turkey
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Muller O, Labiad C, Frontali A, Giacca M, Monsinjon M, Panis Y. What is the best surgical option after failure of graciloplasty in patients with recurrent rectovaginal fistula? A study of 19 consecutive patients. Tech Coloproctol 2023; 27:453-458. [PMID: 36574114 DOI: 10.1007/s10151-022-02742-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 12/06/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Management of recurrent rectovaginal fistula (rRVF) remains challenging despite the good results of graciloplasty reported in the literature. However, little is known about how to avoid a permanent stoma if graciloplasty fails. The aim of our study was to report the management of rRVF after failure of graciloplasty. METHODS A retrospective study was performed on consecutive patients with rRVF after failure of graciloplasty treated at our institution in January 2005-December 2021. RESULTS There were 19 patients, with a median age at graciloplasty of 39 years (range 25-64 years). Etiologies of RVF were Crohn's disease (CD) (n = 10), postoperative (n = 5), post-obstetrical (n = 3), and unknown (n = 1). After failure of graciloplasty, 45 new procedures were performed, all of them with a covering stoma: trans-anal repairs (n = 31), delayed colo-anal anastomosis (DCAA) (n = 4), biological mesh interposition (n = 3), second graciloplasty (n = 3), stoma only (n = 2) and redo ileal pouch-anal anastomosis (IPAA) (n = 2). One patient was not re-operated on and instead treated medically for CD. After a mean follow-up of 63 ± 49 months, success (i.e., absence of stoma or RVF) was obtained in 11 patients (58%): 4/4 DCAA (100%), 5/31 after local repair (16%), 1 after stoma creation alone (50%) and 1 after redo IPAA (50%). Second graciloplasty and biologic mesh interposition all failed. All 8 patients with failed intervention had CD. CONCLUSIONS In cases of rRVF after failed graciloplasty, reoperation is possible, although the chance of success is relatively low. The best results were obtained with DCAA. CD is a predictor of poor outcome.
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Affiliation(s)
- O Muller
- Department of Colorectal Surgery, Pôle des Maladies de l'appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, 100 boulevard du Général Leclerc, 92110, Clichy, France
| | - C Labiad
- Department of Colorectal Surgery, Pôle des Maladies de l'appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, 100 boulevard du Général Leclerc, 92110, Clichy, France
| | - A Frontali
- Department of Colorectal Surgery, Pôle des Maladies de l'appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, 100 boulevard du Général Leclerc, 92110, Clichy, France
| | - M Giacca
- Department of Colorectal Surgery, Pôle des Maladies de l'appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, 100 boulevard du Général Leclerc, 92110, Clichy, France
| | - M Monsinjon
- Department of Colorectal Surgery, Pôle des Maladies de l'appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, 100 boulevard du Général Leclerc, 92110, Clichy, France
| | - Y Panis
- Department of Colorectal Surgery, Pôle des Maladies de l'appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, 100 boulevard du Général Leclerc, 92110, Clichy, France.
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18
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Sérénon V, Rouanet P, Charleux-Muller D, Eveno C, Poirot K, Trilling B, Benoist S, Manceau G, Panis Y, Alves A, Kartheuser A, Venara A, Pocard M, Sabbagh C, Laforest A, Lakkis Z, Badic B, Chau A, Christou N, Beyer-Berjot L, Dumont F, Germain A, Valverde A, Duchalais E, Ouaissi M, Benhaim L, Collard M, Tuech JJ, Buscail E, Mege D. Iatrogenic ureteral injury during colorectal surgery has a significant impact on patient outcomes: a French multicentric retrospective cohort study. Colorectal Dis 2023. [PMID: 37254657 DOI: 10.1111/codi.16630] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 04/10/2023] [Accepted: 04/13/2023] [Indexed: 06/01/2023]
Abstract
AIM The long-term urological sequelae after iatrogenic ureteral injury (IUI) during colorectal surgery are not clearly known. The aims of this work were to report the incidence of IUI and to analyse the long-term consequences of urological late complications and their impact on oncological results of IUI occurring during colorectal surgery through a French multicentric experience (GRECCAR group). METHOD All the patients who presented with IUI during colorectal surgery between 2010 and 2019 were retrospectively included. Patients with ureteral involvement needing en bloc resection, delayed ureteral stricture or noncolorectal surgery were not considered. RESULTS A total of 202 patients (93 men, mean age 63 ± 14 years) were identified in 29 centres, corresponding to 0.32% of colorectal surgeries (n = 63 562). Index colorectal surgery was mainly oncological (n = 130, 64%). IUI was diagnosed postoperatively in 112 patients (55%) after a mean delay of 11 ± 9 days. Intraoperative diagnosis of IUI was significantly associated with shorter length of stay (21 ± 22 days vs. 34 ± 22 days, p < 0.0001), lower rates of postoperative hydronephrosis (2% vs. 10%, p = 0.04), anastomotic complication (7% vs. 22.5%, p = 0.002) and thromboembolic event (0% vs. 6%, p = 0.02) than postoperative diagnosis of IUI. Delayed chemotherapy because of IUI was reported in 27% of patients. At the end of the follow-up [3 ± 2.6 years (1 month-13 years)], 72 patients presented with urological sequalae (36%). Six patients (3%) required a nephrectomy. CONCLUSION IUI during colorectal surgery has few consequences for the patients if recognized early. Long-term urological sequelae can occur in a third of patients. IUI may affect oncological outcomes in colorectal surgery by delaying adjuvant chemotherapy, especially when the ureteral injury is not diagnosed peroperatively.
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Affiliation(s)
- Victor Sérénon
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Marseille, Timone Hospital, Aix Marseille University, Marseille, France
| | - Philippe Rouanet
- Department of Digestive Surgery, Cancer Institute of Montpellier, Montpellier, France
| | | | - Clarisse Eveno
- Department of Digestive Surgery, Lille University Hospital, Lille, France
| | - Karine Poirot
- Department of Digestive Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Bertrand Trilling
- Department of Digestive Surgery, Grenoble University Hospital, Grenoble, France
| | - Stéphane Benoist
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Gilles Manceau
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Georges-Pompidou European Hospital, Paris, France
| | - Yves Panis
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Beaujon Hospital, Clichy, France
| | - Arnaud Alves
- Registre des Cancers Digestifs, Unité INSERM 1086 ANTICIPE, Department of Digestive Surgery, Caen University Hospital, University Caen Normandy, Caen, France
| | - Alex Kartheuser
- Department of Digestive Surgery, University Clinics Saint-Luc, Bruxelles, Belgium
| | - Aurélien Venara
- Department of Digestive Surgery, Angers University Hospital, Angers, France
| | - Marc Pocard
- Department of Digestive Surgery, Hepato-Biliary-pancreatic Gastrointestinal Surgery and Liver Transplantation, Pitié Salpêtrière Hospital, Paris, France
| | - Charles Sabbagh
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France
| | - Anaïs Laforest
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Zaher Lakkis
- Department of Digestive Surgery, Besançon University Hospital, Besançon, France
| | - Bogdan Badic
- Department of Digestive Surgery, Brest University Hospital, Brest, France
| | - Amélie Chau
- Department of Digestive Surgery, Hénin-Beaumont Hospital, Hauts-de-France, France
| | - Niki Christou
- Department of Digestive Surgery, Limoges University Hospital, Limoges, France
| | - Laura Beyer-Berjot
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Marseille, North Hospital, Marseille, France
| | - Frederic Dumont
- Department of Digestive Surgery, Cancer Institute of West, Saint-Herblain, France
| | - Adeline Germain
- Department of Digestive Surgery, Nancy University Hospital, Nancy, France
| | - Alain Valverde
- Department of Digestive Surgery, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Emilie Duchalais
- Department of Digestive Surgery, Nantes University Hospital, Nantes, France
| | - Mehdi Ouaissi
- Department of Digestive Surgery, Tours University Hospital, Tours, France
| | - Leonor Benhaim
- Department of Digestive Surgery, Gustave Roussy Institute, Villejuif, France
| | - Maxime Collard
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Saint-Antoine Hospital, Paris, France
| | - Jean-Jacques Tuech
- Department of Digestive Surgery, Rouen University Hospital, Charles Nicolle Hospital, Rouen, France
| | - Etienne Buscail
- Department of Digestive Surgery, Toulouse University Hospital, Toulouse, France
| | - Diane Mege
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Marseille, Timone Hospital, Aix Marseille University, Marseille, France
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Siragusa L, Pellino G, Sensi B, Panis Y, Bellato V, Khan J, Sica GS. Ambulatory laparoscopic colectomies: a systematic review. Colorectal Dis 2023. [PMID: 36790358 DOI: 10.1111/codi.16511] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/29/2022] [Accepted: 01/29/2023] [Indexed: 02/16/2023]
Abstract
AIM Ambulatory laparoscopic colectomy (ALC), meaning discharge within 24 h of surgical colonic resection, has recently been proposed in a few, selected patients. This systematic review was performed with the aim of reviewing protocols for ALC and assessing feasibility, safety and outcomes after ALC. METHOD A PRISMA-compliant systematic review and pooled analysis was performed searching all English studies published until October 2022 in PubMed, Cochrane Library, Web of Science (PROSPERO, CRD42022334463). Inclusion criteria were original articles including patients undergoing ALC, specifying at least one outcome of interest. Exclusion criteria were articles reporting a robotic-assisted procedure; unable to retrieve patient data from articles; the same patient series included in different studies. Primary outcomes were success, overall complications and readmission rates. Secondary outcomes included mortality and specific complications such us surgical site infection, anastomotic leak, ileus, bleeding, rate of ALC acceptance, and unscheduled consultation and reoperation rate. RESULTS Among 1087 studies imported for screening, 11 were included (1296 patients). The success rate was 47% with an overall morbidity of 14%. Readmission and reoperation rates were 5% and 1%, respectively. No mortality was recorded. Protocols of ALC differ significantly among published studies. CONCLUSIONS Overall, ALC appears to be safe and feasible in selected cases with an acceptable success rate and a low risk of readmission after hospital discharge. Future studies should evaluate patients' benefits and discharge criteria, as well as uniformity and standardization of eligibility criteria. This systematic review may help inform on ALC adoption in clinical practice.
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Affiliation(s)
- Leandro Siragusa
- Department of Surgical Sciences, Università degli studi di Roma 'Tor Vergata', Rome, Italy
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli studi della Campania Luigi Vanvitelli, Naples, Italy.,Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
| | - Bruno Sensi
- Department of Surgical Sciences, Università degli studi di Roma 'Tor Vergata', Rome, Italy
| | - Yves Panis
- Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly sur Seine, France
| | - Vittoria Bellato
- Department of Surgical Sciences, Università degli studi di Roma 'Tor Vergata', Rome, Italy
| | - Jim Khan
- Colorectal Surgery, Portsmouth Hospitals University NHS Trust, University of Portsmouth, Portsmouth, UK
| | - Giuseppe S Sica
- Department of Surgical Sciences, Università degli studi di Roma 'Tor Vergata', Rome, Italy
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20
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Collard MK, Tourneur-Marsille J, Uzzan M, Albuquerque M, Roy M, Dumay A, Freund JN, Hugot JP, Guedj N, Treton X, Panis Y, Ogier-Denis E. The Appendix Orchestrates T-Cell Mediated Immunosurveillance in Colitis-Associated Cancer. Cell Mol Gastroenterol Hepatol 2023; 15:665-687. [PMID: 36332814 PMCID: PMC9871441 DOI: 10.1016/j.jcmgh.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 10/11/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND & AIMS Although appendectomy may reduce colorectal inflammation in patients with ulcerative colitis (UC), this surgical procedure has been suggested to be associated with an increased risk of colitis-associated cancer (CAC). Our aim was to explore the mechanism underlying the appendectomy-associated increased risk of CAC. METHODS Five-week-old male BALB/c mice underwent appendectomy, appendicitis induction, or sham laparotomy. They were then exposed to azoxymethane/dextran sodium sulfate (AOM/DSS) to induce CAC. Mice were killed 12 weeks later, and colons were taken for pathological analysis and immunohistochemistry (CD3 and CD8 staining). Human colonic tumors from 21 patients with UC who underwent surgical resection for CAC were immunophenotyped and stratified according to appendectomy status. RESULTS Whereas appendectomy significantly reduced colitis severity and increased CAC number, appendicitis induction without appendectomy led to opposite results. Intratumor CD3+ and CD8+ T-cell densities were lower after appendectomy and higher after appendicitis induction compared with the sham laparotomy group. Blocking lymphocyte trafficking to the colon with the anti-α4β7 integrin antibody or a sphingosine-1-phosphate receptor agonist suppressed the inducing effect of the appendectomy on tumors' number and on CD3+/CD8+ intratumoral density. CD8+ or CD3+ T cells isolated from inflammatory neo-appendix and intravenously injected into AOM/DSS-treated recipient mice increased CD3+/CD8+ T-cell tumor infiltration and decreased tumor number. In UC patients with a history of appendectomy, intratumor CD3+ and CD8+ T-cell densities were decreased compared with UC patients without history of appendectomy. CONCLUSIONS In UC, appendectomy could suppress a major site of T-cell priming, resulting in a less efficient CAC immunosurveillance.
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Affiliation(s)
- Maxime K Collard
- Assistance Publique Hôpitaux de Paris, Service de Chirurgie Colorectale, Hôpital Beaujon, Clichy, France; Université de Paris, Centre de Recherche sur l'Inflammation, INSERM, U1149, CNRS, ERL8252, "Gut Inflammation", Paris, France
| | - Julien Tourneur-Marsille
- Université de Paris, Centre de Recherche sur l'Inflammation, INSERM, U1149, CNRS, ERL8252, "Gut Inflammation", Paris, France
| | - Mathieu Uzzan
- Université de Paris, Centre de Recherche sur l'Inflammation, INSERM, U1149, CNRS, ERL8252, "Gut Inflammation", Paris, France; Assistance Publique Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Beaujon, Clichy, France
| | - Miguel Albuquerque
- Assistance Publique Hôpitaux de Paris, Service d'Anatomopathologie, Hôpital Beaujon, Clichy, France
| | - Maryline Roy
- Université de Paris, Centre de Recherche sur l'Inflammation, INSERM, U1149, CNRS, ERL8252, "Gut Inflammation", Paris, France
| | - Anne Dumay
- Université de Paris, Centre de Recherche sur l'Inflammation, INSERM, U1149, CNRS, ERL8252, "Gut Inflammation", Paris, France
| | - Jean-Noël Freund
- Université de Strasbourg, Inserm, IRFAC / UMR-S1113, FHU ARRIMAGE, ITI InnoVec, FMTS, Strasbourg, France
| | - Jean-Pierre Hugot
- Université de Paris, Centre de Recherche sur l'Inflammation, INSERM, U1149, CNRS, ERL8252, "Gut Inflammation", Paris, France
| | - Nathalie Guedj
- Université de Paris, Centre de Recherche sur l'Inflammation, INSERM, U1149, CNRS, ERL8252, "Gut Inflammation", Paris, France; Assistance Publique Hôpitaux de Paris, Service d'Anatomopathologie, Hôpital Beaujon, Clichy, France
| | - Xavier Treton
- Université de Paris, Centre de Recherche sur l'Inflammation, INSERM, U1149, CNRS, ERL8252, "Gut Inflammation", Paris, France; Assistance Publique Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Beaujon, Clichy, France
| | - Yves Panis
- Assistance Publique Hôpitaux de Paris, Service de Chirurgie Colorectale, Hôpital Beaujon, Clichy, France; Université de Paris, Centre de Recherche sur l'Inflammation, INSERM, U1149, CNRS, ERL8252, "Gut Inflammation", Paris, France
| | - Eric Ogier-Denis
- Université de Paris, Centre de Recherche sur l'Inflammation, INSERM, U1149, CNRS, ERL8252, "Gut Inflammation", Paris, France; INSERM, Université Rennes, CLCC Eugène Marquis, «Chemistry, Oncogenesis, Stress Signaling» UMR_S 1242, Rennes, France.
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Balla A, Saraceno F, Rullo M, Morales-Conde S, Targarona Soler EM, Di Saverio S, Guerrieri M, Lepiane P, Di Lorenzo N, Adamina M, Alarcón I, Arezzo A, Bollo Rodriguez J, Boni L, Biondo S, Carrano FM, Chand M, Jenkins JT, Davies J, Delgado Rivilla S, Delrio P, Elmore U, Espin-Basany E, Fichera A, Flor Lorente B, Francis N, Gómez Ruiz M, Hahnloser D, Licardie E, Martinez C, Ortenzi M, Panis Y, Pastor Idoate C, Paganini AM, Pera M, Perinotti R, Popowich DA, Rockall T, Rosati R, Sartori A, Scoglio D, Shalaby M, Simó Fernández V, Smart NJ, Spinelli A, Sylla P, Tanis PJ, Valdes-Hernandez J, Wexner SD, Sileri P. Protective ileostomy creation after anterior resection of the rectum: Shared decision-making or still subjective? Colorectal Dis 2022; 25:647-659. [PMID: 36527323 DOI: 10.1111/codi.16454] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 04/20/2022] [Revised: 09/21/2022] [Accepted: 10/26/2022] [Indexed: 12/30/2022]
Abstract
AIM The choice of whether to perform protective ileostomy (PI) after anterior resection (AR) is mainly guided by risk factors (RFs) responsible for the development of anastomotic leakage (AL). However, clear guidelines about PI creation are still lacking in the literature and this is often decided according to the surgeon's preferences, experiences or feelings. This qualitative study aims to investigate, by an open-ended question survey, the individual surgeon's decision-making process regarding PI creation after elective AR. METHOD Fifty four colorectal surgeons took part in an electronic survey to answer the questions and describe what usually led their decision to perform PI. A content analysis was used to code the answers. To classify answers, five dichotomous categories (In favour/Against PI, Listed/Unlisted RFs, Typical/Atypical, Emotions/Non-emotions, Personal experience/No personal experience) have been developed. RESULTS Overall, 76% of surgeons were in favour of PI creation and 88% considered listed RFs in the question of whether to perform PI. Atypical answers were reported in 10% of cases. Emotions and personal experience influenced surgeons' decision-making process in 22% and 49% of cases, respectively. The most frequently considered RFs were the distance of the anastomosis from the anal verge (96%), neoadjuvant chemoradiotherapy (88%), a positive intraoperative leak test (65%), blood loss (37%) and immunosuppression therapy (35%). CONCLUSION The indications to perform PI following rectal cancer surgery lack standardization and evidence-based guidelines are required to inform practice. Until then, expert opinion can be helpful to assist the decision-making process in patients who have undergone AR for adenocarcinoma.
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Affiliation(s)
- Andrea Balla
- UOC of General and Minimally Invasive Surgery, Hospital 'San Paolo', Civitavecchia, Rome, Italy
| | - Federica Saraceno
- UOC of General and Minimally Invasive Surgery, Hospital 'San Paolo', Civitavecchia, Rome, Italy.,Ph.D. Program in Applied Medical-Surgical Sciences, Department of General Surgery, University of Rome 'Tor Vergata', Rome, Italy
| | - Marika Rullo
- Department of Social, Political and Cognitive Sciences, University of Siena, Siena, Italy
| | - Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital 'Virgen del Rocio', University of Sevilla, Sevilla, Spain
| | - Eduardo M Targarona Soler
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Salomone Di Saverio
- ASUR Marche 5, San Benedetto del Tronto General Hospital, San Benedetto del Tronto, Italy
| | - Mario Guerrieri
- Department of General Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - Pasquale Lepiane
- UOC of General and Minimally Invasive Surgery, Hospital 'San Paolo', Civitavecchia, Rome, Italy
| | - Nicola Di Lorenzo
- Ph.D. Program in Applied Medical-Surgical Sciences, Department of General Surgery, University of Rome 'Tor Vergata', Rome, Italy
| | - Michel Adamina
- Department of Surgery, Kantonsspital Winterthur and Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Isaias Alarcón
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital 'Virgen del Rocio', University of Sevilla, Sevilla, Spain
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Jesus Bollo Rodriguez
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | | | - Francesco Maria Carrano
- Ph.D. Program in Applied Medical-Surgical Sciences, Department of General Surgery, University of Rome 'Tor Vergata', Rome, Italy
| | - Manish Chand
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - John T Jenkins
- Department of Colorectal Surgery, North West London NHS Trust, St Mark's Hospital, London, UK
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge, UK.,University of Cambridge, Cambridge, UK
| | | | - Paolo Delrio
- Colorectal Surgical Oncology, Istituto Nazionale Dei Tumori, IRCCS Fondazione Pascale, Napoli, Italy
| | - Ugo Elmore
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Vita-Salute University, Milan, Italy
| | - Eloy Espin-Basany
- Colorectal Surgery Unit, Hospital Valle de Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Alessandro Fichera
- Division of Colorectal Surgery, Department of Surgery, Baylor University Medical Center, Texas, Dallas, USA
| | - Blas Flor Lorente
- Digestive Surgery Department, 'La Fe' University Hospital, Valencia, Spain
| | - Nader Francis
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, UK
| | - Marcos Gómez Ruiz
- Colorectal Surgery Unit, Hospital Universitario Marques de Valdecilla, Santander, Spain.,Valdecilla Biomedical Research Institute, IDIVAL, Santander, Spain
| | | | - Eugenio Licardie
- Unit of General and Digestive Surgery, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain
| | - Carmen Martinez
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Monica Ortenzi
- Department of General Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - Yves Panis
- Department of Colorectal Surgery, Hôpital Beaujon, Clichy, France
| | - Carlos Pastor Idoate
- Division of Colorectal Surgery, Department of General Surgery, University Clinic of Navarre, Madrid, Spain
| | - Alessandro M Paganini
- Department of General Surgery and Surgical Specialties 'Paride Stefanini', Sapienza University of Rome, Rome, Italy
| | - Miguel Pera
- Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Roberto Perinotti
- Department of General Surgery, SS Colo-Rectal and Proctological Surgery, Biella Hospital, Ponderano, Biella, Italy
| | | | - Timothy Rockall
- General Surgery at Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Vita-Salute University, Milan, Italy
| | - Alberto Sartori
- Department of General and Emergency Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
| | - Daniele Scoglio
- Department of General Surgery, AULSS 4 Veneto Orientale, San Donà di Piave General Hospital, San Donà di Piave, Italy
| | - Mostafa Shalaby
- Colorectal Surgery Unit, Department of General Surgery, Mansoura University Hospital, Mansoura University, Mansoura, Egypt
| | | | | | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Division of Colon and Rectal Surgery, Rozzano, Milan, Italy
| | | | - Pieter J Tanis
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.,Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Javier Valdes-Hernandez
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Sevilla, Spain
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Florida, Weston, USA
| | - Pierpaolo Sileri
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Vita-Salute University, Milan, Italy
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22
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Garzelli L, Nuzzo A, Hamon A, Ben Abdallah I, Gregory J, Raynaud L, Paulatto L, Dioguardi Burgio M, Castier Y, Panis Y, Vilgrain V, Corcos O, Ronot M. Reperfusion injury on computed tomography following endovascular revascularization of acute mesenteric ischemia: prevalence, risk factors, and patient outcome. Insights Imaging 2022; 13:194. [PMID: 36512135 PMCID: PMC9748024 DOI: 10.1186/s13244-022-01339-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Data about reperfusion injury (RI) following acute arterial mesenteric ischemia (AAMI) in humans are scarce. We aimed to assess the prevalence and risk factors of RI following endovascular revascularization of AMI and evaluate its impact on patient outcomes. METHODS Patients with AAMI who underwent endovascular revascularization (2016-2021) were included in this retrospective cohort. CT performed < 7 days after treatment was reviewed to identify features of RI (bowel wall hypoattenuation, mucosal hyperenhancement). Clinical, laboratory, imaging, and treatments were compared between RI and non-RI patients to identify factors associated with RI. Resection rate and survival were also compared. RESULTS Fifty patients (23 men, median 72-yrs [IQR 60-77]) were included, and 22 were diagnosed with RI (44%) after a median 28 h (22-48). Bowel wall hypoattenuation and mucosal hyperenhancement were found in 95% and 91% of patients with post-interventional RI, respectively. Patients with RI had a greater increase of CRP levels after endovascular treatment (p = 0.01). On multivariate analysis, a decreased bowel wall enhancement on baseline CT (HR = 8.2), an embolic cause (HR = 7.4), complete SMA occlusion (HR = 7.0), and higher serum lactate levels (HR = 1.4) were associated with RI. The three-month survival rate was 78%, with no difference between subgroups (p = 0.99). However, the resection rate was higher in patients with RI (32% versus 7%; p = 0.03). CONCLUSION RI is frequent after endovascular revascularization of AAMI, especially in patients who present with decreased bowel wall enhancement on pre-treatment CT, an embolic cause, and a complete occlusion of the SMA. However, its occurrence does not seem to negatively impact short-term survival.
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Affiliation(s)
- Lorenzo Garzelli
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411599.10000 0000 8595 4540Service de Radiologie, Hôpital Beaujon, APHP.Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France
| | - Alexandre Nuzzo
- grid.411599.10000 0000 8595 4540Intestinal Stroke Center, Service de Gastroenterology, MICI Et Insuffisance Intestinale, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Annick Hamon
- grid.411599.10000 0000 8595 4540Intestinal Stroke Center, Service de Gastroenterology, MICI Et Insuffisance Intestinale, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Iannis Ben Abdallah
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411119.d0000 0000 8588 831XService de Chirurgie Vasculaire, Hôpital Bichat, APHP.Nord, Paris, France
| | - Jules Gregory
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411599.10000 0000 8595 4540Service de Radiologie, Hôpital Beaujon, APHP.Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France
| | - Lucas Raynaud
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411599.10000 0000 8595 4540Service de Radiologie, Hôpital Beaujon, APHP.Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France
| | - Luisa Paulatto
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411599.10000 0000 8595 4540Service de Radiologie, Hôpital Beaujon, APHP.Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France
| | - Marco Dioguardi Burgio
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411599.10000 0000 8595 4540Service de Radiologie, Hôpital Beaujon, APHP.Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France
| | - Yves Castier
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411119.d0000 0000 8588 831XService de Chirurgie Vasculaire, Hôpital Bichat, APHP.Nord, Paris, France
| | - Yves Panis
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411119.d0000 0000 8588 831XService de Chirurgie Digestive, Hôpital Bichat, APHP.Nord, Paris, France
| | - Valérie Vilgrain
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411599.10000 0000 8595 4540Service de Radiologie, Hôpital Beaujon, APHP.Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France
| | - Olivier Corcos
- grid.411599.10000 0000 8595 4540Intestinal Stroke Center, Service de Gastroenterology, MICI Et Insuffisance Intestinale, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Maxime Ronot
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411599.10000 0000 8595 4540Service de Radiologie, Hôpital Beaujon, APHP.Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France
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23
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Hamon A, Cazals-Hatem D, Stefanescu C, Uzzan M, Treton X, Sauvanet A, Panis Y, Monsinjon M, Bonvalet F, Corcos O, Azouguene E, Cerf-Bensussan N, Bouhnik Y, Charbit-Henrion F. Crohn-like disease affecting small bowel due to monogenic SLCO2A1 mutations: First cases of Chronic Enteropathy Associated with SLCO2A1 gene (CEAS) in France. J Crohns Colitis 2022; 17:816-820. [PMID: 36480694 PMCID: PMC10155746 DOI: 10.1093/ecco-jcc/jjac181] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Multiple chronic ulcers of small intestine are mainly ascribed to Crohn's disease. Among possible differential diagnoses are chronic ulcers of small bowel caused by abnormal activation of the prostaglandin pathway either in the archetypal but uncommon non-steroidal anti-inflammatory drug (NSAID)-induced enteropathy, or in rare monogenic disorders due to PLA2G4A and SLCO2A1 mutations. SLCO2A1 variants are responsible for CEAS (Chronic enteropathy associated with SLCO2A1), a syndrome which was exclusively reported in patients of Asian origin. Herein, we report the case of two French female siblings with CEAS. CASE REPORT P1 underwent iterative bowel resections (removing 1 meter of small bowel in total) for recurrent strictures and perforations. Her sister P2 had a tight duodenal stricture which required partial duodenectomy. Next-generation sequencing was performed on P1's DNA and identified 2 compound heterozygous variants in exon 12 in SLCO2A1, which were also present in P2. CONCLUSION CEAS can be detected within the European population and raise the question of its incidence and recognition outside Asia. Presence of intractable recurrent ulcerations of the small intestine mimicking Crohn's disease with concentric stricture should motivate a genetic search for SLCO2A1 mutations, particularly in the context of family history or consanguinity.
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Affiliation(s)
- Annick Hamon
- Department of Gastroenterology, Beaujon Hospital, Assistance Publique - Hôpitaux de Paris-Cité, University of Paris, Paris, France
| | - Dominique Cazals-Hatem
- Department of Pathology, Beaujon Hospital, Assistance Publique - Hôpitaux de Paris-Cité, University of Paris, Paris, France
| | - Carmen Stefanescu
- Department of Gastroenterology, Beaujon Hospital, Assistance Publique - Hôpitaux de Paris-Cité, University of Paris, Paris, France.,Groupe hospitalier Ambroise Paré - Hartmann, Institut des MICI, Neuilly sur Seine, France
| | - Mathieu Uzzan
- Department of Gastroenterology, Mondor Hospital, Assistance Publique - Hôpitaux de Paris-Cité, University of Paris, Paris, France
| | - Xavier Treton
- Department of Gastroenterology, Beaujon Hospital, Assistance Publique - Hôpitaux de Paris-Cité, University of Paris, Paris, France.,Groupe hospitalier Ambroise Paré - Hartmann, Institut des MICI, Neuilly sur Seine, France
| | - Alain Sauvanet
- Department of Hepato-biliary Surgery, Beaujon Hospital, Assistance Publique - Hôpitaux de Paris-Cité, University of Paris, Paris, France
| | - Yves Panis
- Department of Hepato-biliary Surgery, Beaujon Hospital, Assistance Publique - Hôpitaux de Paris-Cité, University of Paris, Paris, France
| | - Marie Monsinjon
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique - Hôpitaux de Paris-Cité, University of Paris, Paris, France
| | - Fanny Bonvalet
- Department of Radiology, Beaujon Hospital, Assistance Publique - Hôpitaux de Paris-Cité, University of Paris, Paris, France
| | - Olivier Corcos
- Department of Gastroenterology, Beaujon Hospital, Assistance Publique - Hôpitaux de Paris-Cité, University of Paris, Paris, France
| | - Emilie Azouguene
- Department of Genomic Medecine for Rare Diseases, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, University of Paris-Cité, Paris, France
| | | | - Yoram Bouhnik
- Department of Gastroenterology, Beaujon Hospital, Assistance Publique - Hôpitaux de Paris-Cité, University of Paris, Paris, France.,Groupe hospitalier Ambroise Paré - Hartmann, Institut des MICI, Neuilly sur Seine, France
| | - Fabienne Charbit-Henrion
- Department of Genomic Medecine for Rare Diseases, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, University of Paris-Cité, Paris, France.,INSERM UMR1163, Intestinal Immunity, Institut Imagine, Paris, France
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24
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Pellino G, Rottoli M, Mineccia M, Frontali A, Celentano V, Colombo F, Baldi C, Ardizzone S, Martí Gallostra M, Espín-Basany E, Ferrero A, Panis Y, Poggioli G, Sampietro GM. Segmental Versus Total Colectomy for Crohn's Disease in the Biologic Era: Results From The SCOTCH International, Multicentric Study. J Crohns Colitis 2022; 16:1853-1861. [PMID: 35819368 DOI: 10.1093/ecco-jcc/jjac096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The extent of resection in colonic Crohn's disease [cCD] is still a topic of debate, depending on the number of locations, the risk of recurrence and permanent stoma, and the role of medical therapy. METHODS The Segmental COlecTomy for CroHn's disease [SCOTCH] international study is a retrospective analysis on six tertiary centre prospective databases, comprising all consecutive, unselected patients operated on between 2000 and 2019 with segmental colectomy [SC] or total colectomy [TC] for cCD. The primary aim was long-term surgical recurrence. Secondary aims were perioperative complications, stoma formation and predictors of recurrence. RESULTS Among 687 patients, SC was performed in 285 [41.5%] and TC in 402 [58.5%]. Mean age at diagnosis and surgery, disease duration, and follow-up were 30 ± 15.8, 40.4 ± 15.4, 10.4 ± 8.6 and 7.1 ± 5.2 years respectively. Isolated cCD, inflammatory pattern, perianal CD, younger age, longer disease duration and preoperative maximal therapy were more frequent in TC, while SC presented more small bowel locations and perforating disease, required fewer 90-day re-admissions, and fewer temporary and definitive stomas. Morbidity and mortality were similar. The 15-year surgical recurrence was 44% in TC and 27% in SC [p = 0.006]. In patients with one to three diseased segments, recurrence risk was related to the omission of biological therapy (hazard ratio [HR] 5.6), the number of segments [HR 2.5], perianal disease [HR 1.9] and paediatric diagnosis [HR 2.8]. CONCLUSION When technically feasible, SC is safe and reduces temporary and permanent stoma. Young age, number of locations and perianal disease adversely affect, but postoperative biological therapy significantly reduces, the long-term surgical recurrence.
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Affiliation(s)
- Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy.,Colorectal Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
| | - Matteo Rottoli
- Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Michela Mineccia
- Division of General and Oncologic Surgery, Ospedale Mauriziano 'Umberto I'. Torino, Italy
| | - Alice Frontali
- Division of General Surgery, 'Luigi Sacco' University Hospital, Milano, Italy.,Service de Chirurgie Colorectale, Hôpital Beaujon, Clichy and Université de Paris, France
| | - Valerio Celentano
- Portsmouth Hospital NHS Trust, Portsmouth, UK.,Department of Surgery and Cancer, Imperial College London, UK
| | - Francesco Colombo
- Division of General Surgery, 'Luigi Sacco' University Hospital, Milano, Italy
| | - Caterina Baldi
- Division of General Surgery, 'Luigi Sacco' University Hospital, Milano, Italy.,Division of General and HPB Surgery, ASST Rhodense, Rho Memorial Hospital, Milano, Italy
| | - Sandro Ardizzone
- Division of Gastroenterology, ASST Fatebenefratelli Sacco - Department of Biomedical and Clinical Sciences 'Luigi Sacco' University of Milan, Italy
| | - Marc Martí Gallostra
- Colorectal Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
| | - Eloy Espín-Basany
- Colorectal Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
| | - Alessandro Ferrero
- Division of General and Oncologic Surgery, Ospedale Mauriziano 'Umberto I'. Torino, Italy
| | - Yves Panis
- Service de Chirurgie Colorectale, Hôpital Beaujon, Clichy and Université de Paris, France
| | - Gilberto Poggioli
- Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Gianluca M Sampietro
- Division of General Surgery, 'Luigi Sacco' University Hospital, Milano, Italy.,Division of General and HPB Surgery, ASST Rhodense, Rho Memorial Hospital, Milano, Italy
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25
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de Ponthaud C, Guyard C, Blondeau M, Giacca M, Monsinjon M, Frontali A, Panis Y. Systematic C-reactive protein monitoring reduces hospital stay after laparoscopic ileal pouch-anal anastomosis. A comparative study of 158 consecutive patients with ulcerative colitis. Colorectal Dis 2022; 24:1543-1549. [PMID: 35778869 DOI: 10.1111/codi.16246] [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: 07/17/2021] [Revised: 06/18/2022] [Accepted: 06/23/2022] [Indexed: 01/07/2023]
Abstract
AIM C-reactive protein (CRP) is a common biomarker of inflammation which has largely been used to predict the risk of postoperative septic complications after colorectal surgery. However, no data exist concerning its potential benefit after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). The aim of this study was to evaluate a CRP-driven monitoring discharge strategy after laparoscopic IPAA for UC. METHODS Since 2012, 158 patients undergoing a laparoscopic IPAA for UC have been included: 66 patients (CRP group) operated since 2016 had a CRP-driven monitoring discharge on postoperative day 5 (POD 5) and were discharged on POD 6 if CRP < 100 mg/L; these patients were matched (according to age, gender, body mass index, IPAA in two or three steps) to 92 patients operated between 2012 and 2016 without any CRP monitoring (control group). RESULTS Median length of hospital stay was shorter in the CRP than the control group (7 vs. 9 days; P < 0.001) and discharge on POD 6 occurred more frequently in the CRP group (47% vs. 7%, P < 0.001). No difference was observed between the two groups concerning overall morbidity (P = 0.980), surgical site infection (P = 0.554), Clavien-Dindo ≥ IIIa morbidity (P = 0.523), unplanned rehospitalization (P = 0.734) and 30-day reoperation (P = 0.240). CONCLUSION CRP-driven monitoring discharge strategy after laparoscopic IPAA for UC is associated with a significant reduction in length of hospital stay, without increasing morbidity, reoperation or rehospitalization rates.
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Affiliation(s)
- Charles de Ponthaud
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université of Paris, Clichy, France
| | - Clémence Guyard
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université of Paris, Clichy, France
| | - Marc Blondeau
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université of Paris, Clichy, France
| | - Massimo Giacca
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université of Paris, Clichy, France
| | - Marie Monsinjon
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université of Paris, Clichy, France
| | - Alice Frontali
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université of Paris, Clichy, France
| | - Yves Panis
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université of Paris, Clichy, France
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26
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Mathilde A, Mege D, Monsinjon M, Giacca M, Panis Y. Recurrence of diverticulitis after prophylactic sigmoidectomy: an underestimated problem? Colorectal Dis 2022; 25:757-763. [PMID: 36464948 DOI: 10.1111/codi.16426] [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: 06/18/2022] [Revised: 09/27/2022] [Accepted: 11/01/2022] [Indexed: 11/23/2022]
Abstract
AIM Several papers have been published about the risk of recurrence after an attack of diverticulitis treated conservatively. However, very few papers have been devoted to the risk of postoperative recurrence of diverticulitis (PRD) after prophylactic sigmoidectomy (PS). The aim of this work was to report the rate of PRD after PS and to assess possible risk factors for recurrence after surgery. METHOD All consecutive patients who underwent elective laparoscopic PS for diverticulitis between 2005 and 2019 were retrospectively included. PRD was assessed. RESULTS Three hundred and sixty four patients (199 men, mean age 54 ± 13 years) were included. Among these, 26 (7%) presented with 1.7 ± 1 (range 1-4) episodes of recurrence of diverticulitis after a mean delay of 44 ± 39 months (1 month-11 years) after surgery. Patients who presented with postoperative recurrence of diverticulitis were younger (46 ± 11 vs. 55 ± 13 years, p = 0.002) and more frequently had uncomplicated diverticulitis [15/26 (58%) vs. 97/338 (29%), p = 0.002] and more than two previous episodes before PS [17/26 (65%) vs. 132/338 (39%), p = 0.009] than patients without PRD. After multivariate analysis, two independent risk factors for PRD were identified: patients with more than two episodes before PS (OR = 3.3, 95% CI = 1.2-9, p = 0.005) and age < 50 years (OR = 4.5, 95% CI = 2-11, p = 0.001). If both factors were present, recurrence reached 18% (9/51). CONCLUSION Postoperative recurrence of diverticulitis is rare (7%) after PS for diverticulitis. Some patients (i.e. those with more than two episodes before PS and/or age <50 years) could be exposed to a higher risk of recurrence (up to 18%), making prophylactic surgery questionable in these patients.
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Affiliation(s)
- Aubert Mathilde
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, Clichy and Université de Paris, France
| | - Diane Mege
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, Clichy and Université de Paris, France
| | - Marie Monsinjon
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, Clichy and Université de Paris, France
| | - Massimo Giacca
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, Clichy and Université de Paris, France
| | - Yves Panis
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, Clichy and Université de Paris, France
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27
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Staiger RD, Rössler F, Kim MJ, Brown C, Trenti L, Sasaki T, Uluk D, Campana JP, Giacca M, Schiltz B, Bahadoer RR, Lee KY, Kupper BEC, Hu KY, Corcione F, Paredes SR, Spampati S, Ukegjini K, Jedrzejczak B, Langer D, Stakelum A, Park JW, Phang PT, Biondo S, Ito M, Aigner F, Vaccaro CA, Panis Y, Kartheuser A, Peeters KCMJ, Tan KK, Aguiar S, Ludwig K, Bracale U, Young CJ, Dziki A, Ryska M, Winter DC, Jenkins JT, Kennedy RH, Clavien PA, Puhan MA, Turina M. Benchmarks in colorectal surgery: multinational study to define quality thresholds in high and low anterior resection. Br J Surg 2022; 109:1274-1281. [PMID: 36074702 DOI: 10.1093/bjs/znac300] [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] [Received: 05/12/2022] [Revised: 07/15/2022] [Accepted: 07/31/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Benchmark comparisons in surgery allow identification of gaps in the quality of care provided. The aim of this study was to determine quality thresholds for high (HAR) and low (LAR) anterior resections in colorectal cancer surgery by applying the concept of benchmarking. METHODS This 5-year multinational retrospective study included patients who underwent anterior resection for cancer in 19 high-volume centres on five continents. Benchmarks were defined for 11 relevant postoperative variables at discharge, 3 months, and 6 months (for LAR). Benchmarks were calculated for two separate cohorts: patients without (ideal) and those with (non-ideal) outcome-relevant co-morbidities. Benchmark cut-offs were defined as the 75th percentile of each centre's median value. RESULTS A total of 3903 patients who underwent HAR and 3726 who had LAR for cancer were analysed. After 3 months' follow-up, the mortality benchmark in HAR for ideal and non-ideal patients was 0.0 versus 3.0 per cent, and in LAR it was 0.0 versus 2.2 per cent. Benchmark results for anastomotic leakage were 5.0 versus 6.9 per cent for HAR, and 13.6 versus 11.8 per cent for LAR. The overall morbidity benchmark in HAR was a Comprehensive Complication Index (CCI®) score of 8.6 versus 14.7, and that for LAR was CCI® score 11.9 versus 18.3. CONCLUSION Regular comparison of individual-surgeon or -unit outcome data against benchmark thresholds may identify gaps in care quality that can improve patient outcome.
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Affiliation(s)
- Roxane D Staiger
- Department of Colorectal Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Fabian Rössler
- Department of Colorectal Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Min Jung Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Carl Brown
- Department of Surgery, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Loris Trenti
- Bellvitge University Hospital, Department of General and Digestive Surgery, and IDIBELL, University of Barcelona, Barcelona, Spain
| | - Takeshi Sasaki
- Department of Colorectal Surgery and Surgical Technology, National Cancer Centre Hospital East, Kashiwa, Chiba, Japan
| | - Deniz Uluk
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Juan P Campana
- Section of Colorectal Surgery, Hospital Italiano de Buenos Aires and Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), Buenos Aires, Argentina
| | - Massimo Giacca
- Department of Colorectal Surgery, Beaujon Hospital and University of Paris, Clichy, France
| | - Boris Schiltz
- Department of Colorectal Surgery, Cliniques Universitaires St-Luc - UCL, Brussels, Belgium
| | - Renu R Bahadoer
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Kai-Yin Lee
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, University Surgical Cluster, National University Health System, Singapore
| | | | - Katherine Y Hu
- Division of Colorectal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Francesco Corcione
- Department of General Surgery and Specialty, University Federico II of Naples, Naples, Italy
| | - Steven R Paredes
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Sebastiano Spampati
- Department of Colorectal Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Kristjan Ukegjini
- Department of Colorectal Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Daniel Langer
- Surgery Department, Charles University and Central Military Hospital, Prague, Czech Republic
| | - Aine Stakelum
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Ji Won Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - P Terry Phang
- Department of Surgery, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Sebastiano Biondo
- Bellvitge University Hospital, Department of General and Digestive Surgery, and IDIBELL, University of Barcelona, Barcelona, Spain
| | - Masaaki Ito
- Department of Colorectal Surgery and Surgical Technology, National Cancer Centre Hospital East, Kashiwa, Chiba, Japan
| | - Felix Aigner
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Carlos A Vaccaro
- Section of Colorectal Surgery, Hospital Italiano de Buenos Aires and Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), Buenos Aires, Argentina
| | - Yves Panis
- Department of Colorectal Surgery, Beaujon Hospital and University of Paris, Clichy, France
| | - Alex Kartheuser
- Department of Colorectal Surgery, Cliniques Universitaires St-Luc - UCL, Brussels, Belgium
| | - K C M J Peeters
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Ker-Kan Tan
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, University Surgical Cluster, National University Health System, Singapore
| | | | - Kirk Ludwig
- Division of Colorectal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Umberto Bracale
- Department of General Surgery and Specialty, University Federico II of Naples, Naples, Italy
| | - Christopher J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Adam Dziki
- Centre for Bowel Diseases, Brzeziny, Poland.,Department of General and Colorectal Surgery, Medical University, Lodz, Poland
| | - Miroslav Ryska
- Surgery Department, Charles University and Central Military Hospital, Prague, Czech Republic
| | - Des C Winter
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - John T Jenkins
- Department of Colorectal Surgery, St Mark's Hospital, London, UK
| | - Robin H Kennedy
- Department of Colorectal Surgery, St Mark's Hospital, London, UK
| | - Pierre-Alain Clavien
- Department of Colorectal Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Milo A Puhan
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Matthias Turina
- Department of Colorectal Surgery, University Hospital Zurich, Zurich, Switzerland
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Futier E, Jaber S, Garot M, Vignaud M, Panis Y, Slim K, Lucet JC, Lebuffe G, Ouattara A, El Amine Y, Couderc P, Dupré A, De Jong A, Lasocki S, Leone M, Pottecher J, Pereira B, Paugam-Burtz C. Effect of oral antimicrobial prophylaxis on surgical site infection after elective colorectal surgery: multicentre, randomised, double blind, placebo controlled trial. BMJ 2022; 379:e071476. [PMID: 36328372 PMCID: PMC9631300 DOI: 10.1136/bmj-2022-071476] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To investigate whether oral antimicrobial prophylaxis as an adjunct to intravenous antibiotic prophylaxis reduces surgical site infections after elective colorectal surgery. DESIGN Multicentre, randomised, double blind, placebo controlled trial. SETTING 11 university and non-university hospitals in France between 25 May 2016 and 8 August 2019. PARTICIPANTS 926 adults scheduled for elective colorectal surgery. INTERVENTION Patients were randomised to receive either a single 1 g dose of ornidazole (n=463) or placebo (n=463) orally 12 hours before surgery, in addition to intravenous antimicrobial prophylaxis before surgical incision. MAIN OUTCOME MEASURES The primary outcome was the proportion of patients with surgical site infection within 30 days after surgery. Secondary outcomes included individual types of surgical site infections and major postoperative complications (Clavien-Dindo classification grade 3 or higher) within 30 days after surgery. RESULTS Of the 960 patients who were enrolled, 926 (96%) were included in the analysis. The mean age of participants was 63 years and 554 (60%) were men. Surgical site infection within 30 days after surgery occurred in 60 of 463 patients (13%) in the oral prophylaxis group and 100 of 463 (22%) in the placebo group (absolute difference -8.6%, 95% confidence interval -13.5% to -3.8%; relative risk 0.60, 95% confidence interval 0.45 to 0.80). The proportion of patients with deep infections was 4.8% in the oral prophylaxis group and 8.0% in the placebo group (absolute difference -3.2%, 95% confidence interval -6.4% to -0.1%). The proportion of patients with organ space infections was 5.0% in the oral prophylaxis group and 8.4% in the placebo group (absolute difference -3.4%, -6.7% to -0.2%). Major postoperative complications occurred in 9.1% patients in the oral prophylaxis group and 13.6% in the placebo group (absolute difference -4.5%, -8.6% to -0.5%). CONCLUSION Among adults undergoing elective colorectal surgery, the addition of a single 1 g dose of ornidazole compared with placebo before surgery significantly reduced surgical site infections. TRIAL REGISTRATION ClinicalTrials.gov NCT02618720.
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Affiliation(s)
- Emmanuel Futier
- Département Anesthésie et Réanimation, Centre Hospitalier Universitaire de Clermont-Ferrand, Hôpital Estaing, Clermont-Ferrand, France
- Inserm U-1103, CNRS UMR 6293, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Samir Jaber
- Département Anesthésie et Réanimation B, Centre Hospitalier Universitaire de Montpellier, Hôpital Saint-Eloi, Montpellier, France
- Inserm U-1046, Université Montpellier, Montpellier, France
| | - Matthias Garot
- Pôle Anesthésie Réanimation, Centre Hospitalier Universitaire de Lille, Hôpital Claude Huriez, Lille, France
| | - Marie Vignaud
- Département Anesthésie et Réanimation, Centre Hospitalier Universitaire de Clermont-Ferrand, Hôpital Estaing, Clermont-Ferrand, France
| | - Yves Panis
- Département de Chirurgie Colorectale, Assistance publique-Hôpitaux de Paris, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, Clichy, France
| | - Karem Slim
- Service de Chirurgie Digestive et Hépatobiliaire, Centre Hospitalier Universitaire de Clermont-Ferrand, Hôpital Estaing, Clermont-Ferrand, France
| | - Jean-Christophe Lucet
- Unité d'Hygiène et de Lutte Contre les Infections Nosocomiales, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France
- IAME, Université Paris Sorbonne Nord, UMR 1137 Inserm, Paris, France
| | - Gilles Lebuffe
- Pôle Anesthésie Réanimation, Centre Hospitalier Universitaire de Lille, Hôpital Claude Huriez, Lille, France
| | - Alexandre Ouattara
- Service Anesthésie et Réanimation, Centre Medico-chirurgical Magellan, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
- Biologie des Maladies Cardiovasculaires, Université de Bordeaux, UMR 1034 Inserm, Pessac, France
| | - Younes El Amine
- Département Anesthésie et Réanimation, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Philippe Couderc
- Service de Chirurgie Viscérale et Digestive, Centre Hospitalier de Pau, Pau, France
| | - Aurélien Dupré
- Département de chirurgie oncologique, Centre Léon Bérard, Lyon, France
- Inserm, LabTAU, Université Claude Bernard Lyon 1, Lyon, France
| | - Audrey De Jong
- Département Anesthésie et Réanimation B, Centre Hospitalier Universitaire de Montpellier, Hôpital Saint-Eloi, Montpellier, France
| | - Sigismond Lasocki
- Département Anesthésie et Réanimation, Centre Hospitalier Universitaire de Angers, Angers, France
| | - Marc Leone
- Service Anesthésie et Réanimation, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Hôpital Nord, Marseille, France
| | - Julien Pottecher
- Service d'Anesthésie Réanimation et Médecine Périopératoire, Hôpitaux Universitaires de Strasbourg, Hôpital Hautepierre, Strasbourg, France
| | - Bruno Pereira
- Direction de la Recherche Clinique, Centre Hospitalier Universitaire de Clermont-Ferrand, Biostatistics Unit, Clermont-Ferrand, France
| | - Catherine Paugam-Burtz
- Département Anesthésie Réanimation, Assistance publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Beaujon, Clichy, France
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29
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Julien C, Anakok E, Treton X, Nachury M, Nancey S, Buisson A, Fumery M, Filippi J, Maggiori L, Panis Y, Zerbib P, François Y, Dubois A, Sabbagh C, Rahili A, Seksik P, Allez M, Lefevre JH, Le Corff S, Bonnet A, Beyer-Berjot L, Sokol H. Impact of the Ileal Microbiota on Surgical Site Infections in Crohn's Disease: A Nationwide Prospective Cohort. J Crohns Colitis 2022; 16:1211-1221. [PMID: 35218661 DOI: 10.1093/ecco-jcc/jjac026] [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: 09/20/2021] [Revised: 12/24/2021] [Accepted: 02/25/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Surgery is performed in 50-70% of Crohn's disease [CD] patients, and its main risk is surgical site infection [SSI]. The microbiota has been extensively assessed in CD but not as a potential risk factor for septic morbidity. The objective of this study was to assess the impact of the gut microbiota on SSI in CD. METHODS We used the multicentric REMIND prospective cohort to identify all patients who experienced SSI after ileocolonic resection for CD, defined as any postoperative local septic complication within 90 days after surgery: wound abscess, intra-abdominal collection, anastomotic leakage or enterocutaneous fistula. The mucosa-associated microbiota of the ileal resection specimen was analysed by 16S gene sequencing in 149 patients. The variable selection and prediction were performed with random forests [R package VSURF] on clinical and microbiotal data. The criterion of performance that we considered was the area under the Receiver Operating Characteristic [ROC] curve [AUC]. RESULTS SSI occurred in 24 patients [16.1%], including 15 patients [10.1%] with major morbidity. There were no significant differences between patients with or without SSI regarding alpha and beta diversity. The top selected variables for the prediction of SSI were all microbiota-related. The maximum AUC [0.796] was obtained with a model including 14 genera, but an AUC of 0.78 had already been obtained with a model including only six genera [Hungatella, Epulopiscium, Fusobacterium, Ruminococcaceae_ucg_009, Actinomyces and Ralstonia]. CONCLUSION The gut microbiota has the potential to predict SSI after ileocolonic resection for CD. It might play a role in this frequent postoperative complication.
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Affiliation(s)
- Clément Julien
- Department of Gastrointestinal Surgery, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille Univ., Chemin des Bourrely, 13015 Marseille, France
| | - Emré Anakok
- Sorbonne Université, UMR CNRS 8001, LPSM, 75005 Paris, France.,Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Saint Antoine Hospital, Gastroenterology Department, F-75012 Paris, France
| | - Xavier Treton
- Gastroenterology Department Hôpital Beaujon, MICI et Assistance Nutritive, Clichy, France
| | - Maria Nachury
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
| | - Stéphane Nancey
- Gastroenterology Department, Lyon Sud Hospital, Hospices Civils de Lyon, and INSERM U1111, CIRI, Lyon, France
| | - Anthony Buisson
- Gastroenterology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Mathurin Fumery
- Hepatogastroenterology Department, Amiens University Hospital, Amiens, France
| | - Jérôme Filippi
- Gastroenterology Department, Hopital Archet 2, Nice, France
| | - Léon Maggiori
- Digestive, Oncologic, and Endocrine Surgery Department, Hôpital Saint-Louis, AP-HP, Université de Paris, Paris, France
| | - Yves Panis
- Department of Colorectal Surgery, Beaujon Hospital and University of Paris, France
| | - Philippe Zerbib
- Digestive Surgery and Transplantation, Claude Huriez Hospital, CHRU de Lille, Lille Université Nord de France, Lille, France
| | - Yves François
- Surgery Department, Lyon Sud Hospital, Hospices Civils de Lyon , Lyon, France
| | - Anne Dubois
- Surgery Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Charles Sabbagh
- Surgery Department, Amiens University Hospital, Amiens, France
| | - Amine Rahili
- Surgery Department, Hopital Archet 2, Nice, France
| | - Philippe Seksik
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Saint Antoine Hospital, Gastroenterology Department, F-75012 Paris, France.,Paris Center for Microbiome Medicine (PaCeMM) FHU, Paris, France
| | - Matthieu Allez
- Gastroenterology Department, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Jérémie H Lefevre
- Paris Center for Microbiome Medicine (PaCeMM) FHU, Paris, France.,Sorbonne Université, Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, F-75012, Paris, France
| | | | - Sylvain Le Corff
- Paris Center for Microbiome Medicine (PaCeMM) FHU, Paris, France.,Samovar, Télécom SudParis, Institut Polytechnique de Paris , Paris, France
| | - Anna Bonnet
- Sorbonne Université, UMR CNRS 8001, LPSM, 75005 Paris, France.,Paris Center for Microbiome Medicine (PaCeMM) FHU, Paris, France
| | - Laura Beyer-Berjot
- Department of Gastrointestinal Surgery, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille Univ., Chemin des Bourrely, 13015 Marseille, France.,Laboratoire de biomécanique appliquée (LBA), UMR T24, Aix-Marseille Univ/Université Gustave Eiffel, Boulevard Pierre Dramard, Marseille, France.,Centre for Surgical Teaching and Research (CERC), Aix-Marseille Univ, Boulevard Pierre Dramard, Marseille, France
| | - Harry Sokol
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Saint Antoine Hospital, Gastroenterology Department, F-75012 Paris, France.,Paris Center for Microbiome Medicine (PaCeMM) FHU, Paris, France.,INRA, UMR1319 Micalis & AgroParisTech, Jouy en Josas, France
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30
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Bouchard D, Pigot F, de Parades V, Staumont G, Abramowitz L, Siproudhis L, Bouchard D, Pigot F, de Parades V, Staumont G, Abramowitz L, Siproudhis L, Tracanelli L, Fathallah N, Babin-Pigot E, Ferry M, Bouguen G, Laharie D, Cotte E, Panis Y, Peyrin-Biroulet L, Roblin X, Zerbib P. Management of perianal fistulas in Crohn’s disease: a 2021 update of the French National Society of Coloproctology consensus. Tech Coloproctol 2022; 26:805-811. [DOI: 10.1007/s10151-022-02678-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 07/29/2022] [Indexed: 11/28/2022]
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31
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Blondeau M, Labiad C, Melka D, de Ponthaud C, Giacca M, Monsinjon M, Panis Y. Postoperative rectovaginal fistula: Can colonic pull-through delayed coloanal anastomosis avoid the need for definitive stoma? An experience of 28 consecutives cases. Colorectal Dis 2022; 24:1000-1006. [PMID: 35332647 DOI: 10.1111/codi.16124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 02/09/2022] [Accepted: 02/18/2022] [Indexed: 12/28/2022]
Abstract
AIM Management of rectovaginal fistula (RVF) remains a challenge, especially in cases of postoperative RVF as they are often large and surrounded by inflammatory and fibrotic tissue, making local repair difficult or even impossible. In this situation, colonic pull-through delayed coloanal anastomosis (DCAA) could be an interesting option. The aim of this study was to assess the results of DCAA for RVF observed after rectal surgery. METHODS All patients who underwent DCAA for RVF were reviewed. Success was defined as a patient without stoma and without any symptoms of recurrent RVF at the end of follow-up. RESULTS From January 2010 to December 2020, 28 DCAA were performed for RVF after rectal surgery for rectal cancer (n = 21) or endometriosis (n = 7). Ten patients (36%) had at least one previous local procedure before DCAA. DCAA was associated with temporary ileostomy in 22/28 cases (79%). After a mean follow-up of 23 ± 23 (2-82) months, the success rate was 86% (24/28): three patients (11%) required a definitive stoma because of poor functional results (n = 1), chronic pelvic sepsis with anastomotic leakage (n = 1) or stoma reversal refused (n = 1). Another patient (3%) presented with recurrence of RVF, 26 months after DCAA. Although not significant, the success rate was higher in cases of DCAA with diverting stoma (20/22, 91%) than without (4/6, 67%) (p = 0.191). CONCLUSION In cases of postoperative RVF, DCAA is a safe option which can avoid definitive stoma in the great majority of the patients. Concomitant use of a temporary stoma appears to slightly increase the success rate.
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Affiliation(s)
- Marc Blondeau
- Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, Clichy, France
| | - Camélia Labiad
- Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, Clichy, France
| | - Dan Melka
- Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, Clichy, France
| | - Charles de Ponthaud
- Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, Clichy, France
| | - Massimo Giacca
- Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, Clichy, France
| | - Marie Monsinjon
- Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, Clichy, France
| | - Yves Panis
- Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, Clichy, France
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32
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Cazelles A, Collard MK, Lalatonne Y, Doblas S, Zappa M, Labiad C, Cazals-Hatem D, Maggiori L, Treton X, Panis Y, Jarry U, Desvallées T, Eliat PA, Pineau R, Motte L, Letourneur D, Simon-Yarza T, Ogier-Denis E. A Preclinical Validation of Iron Oxide Nanoparticles for Treatment of Perianal Fistulizing Crohn's Disease. Int J Mol Sci 2022; 23:8324. [PMID: 35955465 PMCID: PMC9368411 DOI: 10.3390/ijms23158324] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022] Open
Abstract
Fistulizing anoperineal lesions are severe complications of Crohn's disease (CD) that affect quality of life with a long-term risk of anal sphincter destruction, incontinence, permanent stoma, and anal cancer. Despite several surgical procedures, they relapse in about two-thirds of patients, mandating innovative treatments. Ultrasmall particles of iron oxide (USPIO) have been described to achieve in vivo rapid healing of deep wounds in the skin and liver of rats thanks to their nanobridging capability that could be adapted to fistula treatment. Our main purpose was to highlight preclinical data with USPIO for the treatment of perianal fistulizing CD. Twenty male Sprague Dawley rats with severe 2,4,6-trinitrobenzenesulfonic acid solution (TNBS)-induced proctitis were operated to generate two perianal fistulas per rat. At day 35, two inflammatory fistulas were obtained per rat and perineal magnetic resonance imaging (MRI) was performed. After a baseline MRI, a fistula tract was randomly drawn and topically treated either with saline or with USPIO for 1 min (n = 17 for each). The rats underwent a perineal MRI on postoperative days (POD) 1, 4, and 7 and were sacrificed for pathological examination. The primary outcome was the filling or closure of the fistula tract, including the external or internal openings. USPIO treatment allowed the closure and/or filling of all the treated fistulas from its application until POD 7 in comparison with the control fistulas (23%). The treatment with USPIO was safe, permanently closed the fistula along its entire length, including internal and external orifices, and paved new avenues for the treatment of perianal fistulizing Crohn's disease.
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Affiliation(s)
- Antoine Cazelles
- Département of Chirurgie Colorectale, Assistance Publique Hôpitaux de Paris, Hôpital Beaujon, CEDEX, 92110 Clichy, France; (A.C.); (M.K.C.); (C.L.); (L.M.); (Y.P.)
- Centre de Recherche sur l’Inflammation, INSERM, U1149, CNRS, ERL8252, Université Paris Cité, Team Gut Inflammation, BP 416, 75018 Paris, France; (D.C.-H.); (X.T.)
| | - Maxime K. Collard
- Département of Chirurgie Colorectale, Assistance Publique Hôpitaux de Paris, Hôpital Beaujon, CEDEX, 92110 Clichy, France; (A.C.); (M.K.C.); (C.L.); (L.M.); (Y.P.)
- Centre de Recherche sur l’Inflammation, INSERM, U1149, CNRS, ERL8252, Université Paris Cité, Team Gut Inflammation, BP 416, 75018 Paris, France; (D.C.-H.); (X.T.)
| | - Yoann Lalatonne
- Laboratory for Vascular Translational Science, Université Paris Cité, Université Sorbonne Paris Nord, LVTS, INSERM, UMR 1148, 75018 Paris, France; (Y.L.); (L.M.); (D.L.); (T.S.-Y.)
- Départements of Biochimie and de Médecine Nucléaire, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, 93009 Bobigny, France
| | - Sabrina Doblas
- Centre de Recherche sur l’Inflammation, INSERM, U1149, CNRS, ERL8252, Laboratory of Imaging Biomarkers, Université Paris Cité, BP 416, 75018 Paris, France; (S.D.); (M.Z.)
| | - Magaly Zappa
- Centre de Recherche sur l’Inflammation, INSERM, U1149, CNRS, ERL8252, Laboratory of Imaging Biomarkers, Université Paris Cité, BP 416, 75018 Paris, France; (S.D.); (M.Z.)
- Département of Radiologie, Assistance Publique Hôpitaux de Paris, Hôpital Beaujon, CEDEX, 92110 Clichy, France
| | - Camélia Labiad
- Département of Chirurgie Colorectale, Assistance Publique Hôpitaux de Paris, Hôpital Beaujon, CEDEX, 92110 Clichy, France; (A.C.); (M.K.C.); (C.L.); (L.M.); (Y.P.)
- Centre de Recherche sur l’Inflammation, INSERM, U1149, CNRS, ERL8252, Université Paris Cité, Team Gut Inflammation, BP 416, 75018 Paris, France; (D.C.-H.); (X.T.)
| | - Dominique Cazals-Hatem
- Centre de Recherche sur l’Inflammation, INSERM, U1149, CNRS, ERL8252, Université Paris Cité, Team Gut Inflammation, BP 416, 75018 Paris, France; (D.C.-H.); (X.T.)
- Département of Pathologie, Assistance Publique Hôpitaux de Paris, Hôpital Beaujon, CEDEX, 92110 Clichy, France
| | - Léon Maggiori
- Département of Chirurgie Colorectale, Assistance Publique Hôpitaux de Paris, Hôpital Beaujon, CEDEX, 92110 Clichy, France; (A.C.); (M.K.C.); (C.L.); (L.M.); (Y.P.)
- Centre de Recherche sur l’Inflammation, INSERM, U1149, CNRS, ERL8252, Université Paris Cité, Team Gut Inflammation, BP 416, 75018 Paris, France; (D.C.-H.); (X.T.)
| | - Xavier Treton
- Centre de Recherche sur l’Inflammation, INSERM, U1149, CNRS, ERL8252, Université Paris Cité, Team Gut Inflammation, BP 416, 75018 Paris, France; (D.C.-H.); (X.T.)
- Département Gastroentérologie, Assistance Publique Hôpitaux de Paris, Hôpital Beaujon, CEDEX, 92110 Clichy, France
| | - Yves Panis
- Département of Chirurgie Colorectale, Assistance Publique Hôpitaux de Paris, Hôpital Beaujon, CEDEX, 92110 Clichy, France; (A.C.); (M.K.C.); (C.L.); (L.M.); (Y.P.)
- Centre de Recherche sur l’Inflammation, INSERM, U1149, CNRS, ERL8252, Université Paris Cité, Team Gut Inflammation, BP 416, 75018 Paris, France; (D.C.-H.); (X.T.)
| | - Ulrich Jarry
- Université Rennes, CNRS, INSERM, BIOSIT UAR 3480, US_S 018, Oncotrial, 35000 Rennes, France; (U.J.); (T.D.)
- Biotrial Pharmacology, Unité De Pharmacologie Préclinique, 35000 Rennes, France
| | - Thomas Desvallées
- Université Rennes, CNRS, INSERM, BIOSIT UAR 3480, US_S 018, Oncotrial, 35000 Rennes, France; (U.J.); (T.D.)
| | - Pierre-Antoine Eliat
- Université Rennes, CNRS, INSERM, BIOSIT UAR 3480, US_S 018, PRISM, 35000 Rennes, France;
- INRAE, INSERM, Institute NUMECAN, UMR_A 1341, Université Rennes, UMR_S 1241, 35000 Rennes, France
| | - Raphaël Pineau
- INSERM, CLCC Eugène Marquis, Oncogenesis, Stress Signaling, Université Rennes, UMR_S 1242, 35000 Rennes, France;
| | - Laurence Motte
- Laboratory for Vascular Translational Science, Université Paris Cité, Université Sorbonne Paris Nord, LVTS, INSERM, UMR 1148, 75018 Paris, France; (Y.L.); (L.M.); (D.L.); (T.S.-Y.)
| | - Didier Letourneur
- Laboratory for Vascular Translational Science, Université Paris Cité, Université Sorbonne Paris Nord, LVTS, INSERM, UMR 1148, 75018 Paris, France; (Y.L.); (L.M.); (D.L.); (T.S.-Y.)
| | - Teresa Simon-Yarza
- Laboratory for Vascular Translational Science, Université Paris Cité, Université Sorbonne Paris Nord, LVTS, INSERM, UMR 1148, 75018 Paris, France; (Y.L.); (L.M.); (D.L.); (T.S.-Y.)
| | - Eric Ogier-Denis
- Centre de Recherche sur l’Inflammation, INSERM, U1149, CNRS, ERL8252, Université Paris Cité, Team Gut Inflammation, BP 416, 75018 Paris, France; (D.C.-H.); (X.T.)
- INSERM, CLCC Eugène Marquis, Oncogenesis, Stress Signaling, Université Rennes, UMR_S 1242, 35000 Rennes, France;
- INSERM U1242, Centre Eugène Marquis, Rue de la Bataille de Flandres-Dunkerque, 35042 Rennes, France
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Sensi B, Khan J, Warusavitarne J, Nardi A, Spinelli A, Zaghiyan K, Panis Y, Sampietro G, Fichera A, Garcia-Granero E, Espin-Basany E, Konishi T, Siragusa L, Stefan S, Bellato V, Carvello M, Adams E, Frontali A, Artigue M, Frasson M, Marti-Gallostra M, Pellino G, Sica GS. Long-term Oncological Outcome of Segmental Versus Extended Colectomy for Colorectal Cancer in Crohn's Disease: Results from an International Multicentre Study. J Crohns Colitis 2022; 16:954-962. [PMID: 34897426 DOI: 10.1093/ecco-jcc/jjab215] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/11/2021] [Accepted: 11/22/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Crohn's disease increases colorectal cancer risk, with high prevalence of synchronous and metachronous cancers. Current guidelines for colorectal cancer in Crohn's disease recommend pan-proctocolectomy. The aim of this study was to evaluate oncological outcomes of a less invasive surgical approach. METHODS This was a retrospective database analysis of Crohn's disease patients with colorectal cancer undergoing surgery at selected European and US tertiary centres. Outcomes of segmental colectomy were compared with those of extended colectomy, total colectomy, and pan-proctocolectomy. Primary outcome was progression-free survival. Secondary outcomes included overall survival, synchronous and metachronous colorectal cancer, and major postoperative complications. RESULTS Ninety-nine patients were included: 66 patients underwent segmental colectomy and 33 extended colectomy. Segmental colectomy patients were older [p = 0.0429], had less extensive colitis [p = 0.0002] and no preoperatively identified synchronous lesions [p = 0.0109].Median follow-up was 43 [31-62] months. There was no difference in unadjusted progression-free survival [p = 0.2570] or in overall survival [p = 0.4191] between segmental and extended colectomy. Multivariate analysis adjusting for age, sex, ASA score, and AJCC staging, confirmed no difference for progression-free survival (hazard ratio [HR] 1.00, p = 0.9993) or overall survival [HR 0.77, p = 0.6654]. Synchronous and metachronous cancers incidence was 9% and 1.5%, respectively. Perioperative mortality was nil and major complications were comparable [7.58% vs 6.06%, p = 0.9998]. CONCLUSIONS Segmental colectomy seems to offer similar long-term outcomes to more extensive surgery. Incidence of synchronous and metachronous cancers appears much lower than previously described. Further prospective studies are warranted to confirm these results.
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Affiliation(s)
- Bruno Sensi
- University of Rome Tor Vergata, Department of Surgery, Rome, Italy
| | - Jim Khan
- Portsmouth Hospital, NHS trust, Surgery, Portsmouth, UK
| | | | - Alessandra Nardi
- University of Rome Tor Vergata, Department of Mathematics, Rome, Italy
| | | | | | - Yves Panis
- Beaujon Hospital, Colorectal Surgery, Paris, France
| | | | | | | | | | | | - Leandro Siragusa
- University of Rome Tor Vergata, Department of Surgery, Rome, Italy
| | - Samuel Stefan
- Portsmouth Hospital, NHS trust, Surgery, Portsmouth, UK
| | | | | | - Evan Adams
- Cedars Sinai Hospital, Surgery, Los Angeles, CA, USA
| | | | | | | | | | - Gianluca Pellino
- Hospital Universitario Val d'Hebron, Surgery, Barcelona, Spain.,Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples,Italy
| | - Giuseppe S Sica
- University of Rome Tor Vergata, Department of Surgery, Rome, Italy
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34
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Sensi B, Khan J, Warusavitarne J, Nardi A, Spinelli A, Zaghiyan K, Panis Y, Sampietro G, Fichera A, Garcia-Granero E, Espin-Basany E, Konishi T, Siragusa L, Stefan S, Bellato V, Carvello M, Adams E, Frontali A, Artigue M, Frasson M, Marti-Gallostra M, Pellino G, Sica GS. Corrigendum to: Long-term Oncological Outcome of Segmental Versus Extended Colectomy for Colorectal Cancer in Crohn's Disease: Results from an International Multicentre Study. J Crohns Colitis 2022; 16:1009. [PMID: 35171229 DOI: 10.1093/ecco-jcc/jjac022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Bruno Sensi
- University of Rome Tor Vergata, Department of Surgery, Rome, Italy
| | - Jim Khan
- Portsmouth Hospital, NHS trust, Surgery, Portsmouth, UK
| | | | - Alessandra Nardi
- University of Rome Tor Vergata, Department of Mathematics, Rome, Italy
| | | | | | - Yves Panis
- Beaujon Hospital, Colorectal Surgery, Paris, France
| | | | | | | | | | | | - Leandro Siragusa
- University of Rome Tor Vergata, Department of Surgery, Rome, Italy
| | - Samuel Stefan
- Portsmouth Hospital, NHS trust, Surgery, Portsmouth, UK
| | | | | | - Evan Adams
- Cedars Sinai Hospital, Surgery, Los Angeles, CA, USA
| | | | | | | | | | - Gianluca Pellino
- Hospital Universitario Val d'Hebron, Surgery, Barcelona, Spain.,Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe S Sica
- University of Rome Tor Vergata, Department of Surgery, Rome, Italy
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35
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Zaborowski AM, Adamina AAM, Aigner F, d'Allens L, Allmer C, Álvarez A, Anula R, Andric M, Bach SAS, Bala M, Barussaud M, Bausys A, Beggs A, Bellolio F, Bennett MR, Berdinskikh A, Bevan V, Biondo S, Bislenghi G, Bludau M, Brouwer N, Brown C, Bruns C, Buchanan DD, Buchwald P, Burger JW, Burlov N, Campanelli M, Capdepont M, Carvello M, Chew HH, Christoforidis D, Clark D, Climent M, Collinson R, Cologne KG, Contreras T, Croner R, Daniels IR, Dapri G, Davies J, Delrio P, Denost Q, Deutsch M, Dias A, D’Hoore A, Drozdov E, Duek D, Dunlop M, Dziki A, Edmundson A, Efetov S, El-Hussuna A, Elliot B, Emile S, Espin E, Evans M, Faes S, Faiz O, Figueiredo N, Fleming F, Foppa C, Fowler G, Frasson M, Forgan T, Frizelle F, Gadaev S, Gellona J, Glyn T, Goran B, Greenwood E, Guren MG, Guillon S, Gutlic I, Hahnloser D, Hampel H, Hanly A, Hasegawa H, Iversen LH, Hill A, Hill J, Hoch J, Hompes R, Hurtado L, Iaquinandi F, Imbrasaite U, Islam R, Jafari MD, Salido AJ, Jiménez-Toscano M, Kanemitsu Y, Karachun A, Karimuddin AA, Keller DS, Kelly J, Kennelly R, Khrykov G, Kocian P, Koh C, Kok N, Knight KA, Knol J, Kontovounisios C, Korner H, Krivokapic Z, Kronberger I, Kroon HM, Kryzauskas M, Kural S, Kusters M, Lakkis Z, Lankov T, Larson D, Lázár G, Lee KY, Lee SH, Lefèvre JH, Lepisto A, Lieu C, Loi L, Lynch C, Maillou-Martinaud H, Maroli A, Martin S, Martling A, Matzel KE, Mayol J, McDermott F, Meurette G, Millan M, Mitteregger M, Moiseenko A, Monson JRT, Morarasu S, Moritani K, Möslein G, Munini M, Nahas C, Nahas S, Negoi I, Novikova A, Ocares M, Okabayashi K, Olkina A, Oñate-Ocaña L, Otero J, Ozen C, Pace U, Julião GPS, Panaiotti L, Panis Y, Papamichael D, Patel S, Uriburu JCP, Peng SL, Pera M, Perez RO, Petrov A, Pfeffer F, Phang TP, Poskus T, Pringle H, Proud D, Raguz I, Rama N, Rasheed S, Raval MJ, Rega D, Reissfelder C, Meneses JCR, Ris F, Riss S, Rodriguez-Zentner H, Roxburgh CS, Saklani A, Sammour T, Saraste D, Schneider M, Seishima R, Sekulic A, Seppala T, Sheahan K, Shlomina A, Sigismondo G, Singnomklao T, Siragusa L, Smart N, Solis-Peña A, Spinelli A, Staiger RD, Stamos MJ, Steele S, Tan KK, Tanis PJ, Tekkis P, Teklay B, Tengku S, Tsarkov P, Turina M, Ulrich A, Vailati BB, van Harten M, Verhoef C, Warrier S, Wexner S, de Wilt H, Weinberg BA, Wells C, Wolthuis A, Xynos E, You N, Zakharenko A, Zeballos J, Zhou J, Winter DC. Impact of microsatellite status in early-onset colonic cancer. Br J Surg 2022; 109:632-636. [PMID: 35522613 DOI: 10.1093/bjs/znac108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 03/04/2022] [Accepted: 03/11/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND The molecular profile of early-onset colonic cancer is undefined. This study evaluated clinicopathological features and oncological outcomes of young patients with colonic cancer according to microsatellite status. METHODS Anonymized data from an international collaboration were analysed. Criteria for inclusion were patients younger than 50 years diagnosed with stage I-III colonic cancer that was surgically resected. Clinicopathological features, microsatellite status, and disease-specific outcomes were evaluated. RESULTS A total of 650 patients fulfilled the criteria for inclusion. Microsatellite instability (MSI) was identified in 170 (26.2 per cent), whereas 480 had microsatellite-stable (MSS) tumours (relative risk of MSI 2.5 compared with older patients). MSI was associated with a family history of colorectal cancer and lesions in the proximal colon. The proportions with pathological node-positive disease (45.9 versus 45.6 per cent; P = 1.000) and tumour budding (20.3 versus 20.5 per cent; P = 1.000) were similar in the two groups. Patients with MSI tumours were more likely to have BRAF (22.5 versus 6.9 per cent; P < 0.001) and KRAS (40.0 versus 24.2 per cent; P = 0.006) mutations, and a hereditary cancer syndrome (30.0 versus 5.0 per cent; P < 0.001; relative risk 6). Five-year disease-free survival rates in the MSI group were 95.0, 92.0, and 80.0 per cent for patients with stage I, II, and III tumours, compared with 88.0, 88.0, and 65.0 per cent in the MSS group (P = 0.753, P = 0.487, and P = 0.105 respectively). CONCLUSION Patients with early-onset colonic cancer have a high risk of MSI and defined genetic conditions. Those with MSI tumours have more adverse pathology (budding, KRAS/BRAF mutations, and nodal metastases) than older patients with MSI cancers.
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Lakkis Z, Doussot A, Manfredelli S, Vernerey D, Meillat H, Ouaissi M, Cotte E, Faucheron JL, Piessen G, Tuech JJ, Lefevre JH, Panis Y, Beyer L, Brouquet A, Dumont F, Meurisse A, Rullier E, Heyd B. Is it safe to perform an anastomosis for rectal cancer after prostate cancer? A multicentre study of 126 patients from the GRECCAR group. Colorectal Dis 2022; 24:594-600. [PMID: 35038368 DOI: 10.1111/codi.16054] [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: 08/31/2021] [Revised: 10/28/2021] [Accepted: 01/08/2022] [Indexed: 02/08/2023]
Abstract
AIM To determine the safety of performing an anastomosis after rectal cancer (RC) resection in patients with a previously treated prostate cancer (PC). METHODS Patients with a previously treated PC who underwent rectal resection from 2008 to 2018 were retrospectively included. Outcomes were compared between patients who underwent rectal resection with anastomosis (restorative surgery, RS+ group) and those with a definitive stoma (RS- group). In the RS+ group, anastomotic leak (AL) rates were assessed according to the type of reconstruction. RESULTS A total of 126 patients underwent rectal surgery for mid-low RC after a previous PC treated by radiotherapy (RT) and/or radical prostatectomy. Overall, 80 patients (63%) underwent a RS and 46 patients (37%) underwent rectal surgery with a definitive stoma. There was no statistical difference between the two groups in terms of intraoperative data, except for the type of resection with more multivisceral resection in the RS- group (p < 0.01). In the RS+group, a diverting stoma was performed in 74% of cases. No difference between the two groups in terms of overall morbidity was found. In the RS+group (n = 80), 17 patients (21%) experienced AL. Of these, none was observed when delayed coloanal anastomosis was performed (p = 0.16). Long-term permanent stoma in the RS+ group was 16% (n = 13). CONCLUSION Restorative surgery after resection for RC in patients with a previous history of RT and/or radical prostatectomy for PC is safe without additional morbidity. In selected patients for restorative surgery, performing delayed coloanal anastomosis may represent a promising option.
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Affiliation(s)
- Zaher Lakkis
- Department of Digestive Surgical Oncology, University Hospital of Besançon, Besançon, France
| | - Alexandre Doussot
- Department of Digestive Surgical Oncology, University Hospital of Besançon, Besançon, France
| | - Simone Manfredelli
- Department of Digestive Surgical Oncology, University Hospital of Besançon, Besançon, France
| | - Dewi Vernerey
- Methodological and Quality of Life unit in Oncology, University Hospital of Besançon, Besançon, France
| | - Hélène Meillat
- Department of Digestive Surgical Oncology, Paoli Calmettes Institute, Marseille, France.,Department of Mini Invasive Interventions (DIMI), Paoli Calmettes Institute, Marseille, France
| | - Mehdi Ouaissi
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Tours, France
| | - Eddy Cotte
- Department of General Surgery, Lyon Sud University Hospital, Pierre Bénite, France
| | - Jean-Luc Faucheron
- Colorectal Unit, Department of Surgery, Michallon University Hospital, Grenoble, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
| | - Jean-Jacques Tuech
- Department of Digestive Surgery, Rouen University Hospital, Rouen, France
| | - Jérémie H Lefevre
- Sorbonne Université, Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Yves Panis
- Department of Colorectal Surgery, Beaujon Hospital, Clichy, France
| | - Laura Beyer
- Department of Digestive Surgery, Hôpital Nord, Marseille, France
| | - Antoine Brouquet
- Department of Digestive and Oncologic Surgery, Bicêtre Hospital, Paris, France
| | - Frédéric Dumont
- General Surgical Oncology Department, Gustave Roussy, Villejuif, France
| | - Aurélia Meurisse
- Methodological and Quality of Life unit in Oncology, University Hospital of Besançon, Besançon, France
| | - Eric Rullier
- Department of Colorectal Surgery, Haut-Lévèque Hospital, Pessac, France
| | - Bruno Heyd
- Department of Digestive Surgical Oncology, University Hospital of Besançon, Besançon, France
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Melka D, Leiritz E, Labiad C, Blondeau M, Frontali A, Giacca M, Monsinjon M, Panis Y. Delayed pull-through coloanal anastomosis without temporary stoma: an alternative to the standard manual side-to-end coloanal anastomosis with temporary stoma? A comparative study in 223 patients with low rectal cancer. Colorectal Dis 2022; 24:587-593. [PMID: 35094470 DOI: 10.1111/codi.16069] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 08/15/2021] [Revised: 11/28/2021] [Accepted: 01/16/2022] [Indexed: 02/08/2023]
Abstract
AIM After total mesorectal excision (TME) for low rectal cancer, current guideline recommendations for sphincter-saving surgery are to perform a side-to-end manual coloanal anastomosis (CAA) (or with J-pouch) with a temporary stoma. Our study aimed to evaluate if delayed pull-through coloanal anastomosis (DCAA) without a temporary stoma could represent a safe alternative in low rectal cancer. METHOD From 2003 to 2020, 223 consecutive patients with low rectal cancer undergoing TME were compared: CAA and diverting stoma (n = 190) versus DCAA without stoma (n = 33). RESULTS Overall 3-month and severe (Dindo ≥ IIIb) morbidity rates were similar in CAA versus DCAA groups: 34% (65/190) vs. 36% (12/33) and 2.6% (5/190) vs. 3% (1/33), respectively. In the DCAA group, only one patient (3%) underwent reoperation (Hartmann's procedure) at day 3 due to colon necrosis. The anastomotic leakage rate (both clinical and radiological) was significantly higher after CAA than DCAA: 28% (53/190) vs. 3% (1/33; p = 0.00138). Failure of the procedure (with return to stoma) was observed in 8% (15/190) vs. 6% (2/33) of patients after CAA and DCAA respectively (not significant). CONCLUSION Our comparative study suggested that in patients with low rectal cancer, DCAA without a temporary stoma could represent an interesting alternative to the actual recommended CAA with a temporary ileostomy. DCAA could offer two major advantages over CAA: a significantly lower rate of anastomotic leakage and absence of a temporary stoma and its potential complications (rehospitalization, dehydration, wound hernia after stoma closure).
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Affiliation(s)
- Dan Melka
- Department of Colorectal Surgery, DMU DIGEST Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, Clichy, France
| | - Elsa Leiritz
- Department of Colorectal Surgery, DMU DIGEST Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, Clichy, France
| | - Camélia Labiad
- Department of Colorectal Surgery, DMU DIGEST Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, Clichy, France
| | - Marc Blondeau
- Department of Colorectal Surgery, DMU DIGEST Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, Clichy, France
| | - Alice Frontali
- Department of Colorectal Surgery, DMU DIGEST Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, Clichy, France
| | - Massimo Giacca
- Department of Colorectal Surgery, DMU DIGEST Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, Clichy, France
| | - Marie Monsinjon
- Department of Colorectal Surgery, DMU DIGEST Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, Clichy, France
| | - Yves Panis
- Department of Colorectal Surgery, DMU DIGEST Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, Clichy, France
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Ksouri A, Copin P, Bonvalet F, Bozi L, Cazals-Hatem D, Garzelli L, Panis Y, Weiss E, Castier Y, Bouhnik Y, Corcos O, Vilgrain V, Ronot M, Nuzzo A. Colonic involvement in acute mesenteric ischemia: prevalence, risk factors, and outcomes. Eur Radiol 2022; 32:2813-2823. [PMID: 34657969 DOI: 10.1007/s00330-021-08318-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/30/2021] [Accepted: 09/04/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study aimed to investigate the prevalence, risk factors, and outcomes of colonic involvement in patients with acute mesenteric ischemia (AMI). METHODS CT scans from a prospective cohort of 114 AMI patients treated in an intestinal stroke center between 2009 and 2018 were blindly reviewed by two radiologists. Colon involvement was defined on CT scan by the presence of at least one of the following CT colonic features: wall thickening, pneumatosis, decreased wall enhancement, dilatation, or perforation. In addition, the clinical, biological, and radiological characteristics of patients with and without colonic involvement were compared to identify risk factors for colonic involvement on CT and its impact on morbidity and mortality. RESULTS Colonic involvement was identified in 32/114 (28%) patients with AMI, the right colon being more frequently involved (n = 29/32, 91%). Wall thickening (n = 27/32) was the most common CT finding. Occlusion of the inferior mesenteric artery was the only statistically significant risk factor for colonic involvement (35% vs. 15%, p = 0.02). Patients with colonic involvement on CT vs. those without had more frequently transmural colonic necrosis (13% vs. 0%, p = 0.006), short bowel syndrome (16% vs. 4%, p = 0.04), need for long-term parenteral support (19% vs. 5%, p = 0.03), and death during follow-up (22% vs. 10%, p = 0.03). DISCUSSION In patients with AMI, colonic involvement is associated with increased morbidity and mortality and should be carefully searched for during initial CT scan assessment. KEY POINTS • In a prospective cohort of acute mesenteric ischemia patients from an intestinal stroke center, 28% had an associated colonic involvement on CT. • Colonic involvement on CT most commonly affected the right colon, and the occlusion of the inferior mesenteric artery was the only risk factor. • Colonic involvement on CT was associated with increased morbidity and mortality and should be carefully searched for during initial CT scan assessment.
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Affiliation(s)
- Aida Ksouri
- Department of Radiology, Beaujon Hospital, APHP.Nord, 92110, Clichy, France
| | - Pauline Copin
- Department of Radiology, Beaujon Hospital, APHP.Nord, 92110, Clichy, France
| | - Fanny Bonvalet
- Department of Radiology, Beaujon Hospital, APHP.Nord, 92110, Clichy, France
| | - Lilian Bozi
- Department of Radiology, Beaujon Hospital, APHP.Nord, 92110, Clichy, France
| | | | - Lorenzo Garzelli
- Department of Radiology, Beaujon Hospital, APHP.Nord, 92110, Clichy, France
| | - Yves Panis
- Department of Colorectal Surgery, Beaujon Hospital, APHP.Nord, 92110, Clichy, France
- Université de Paris, INSERM UMR 1148, Laboratory for Vascular Translational Science, 75018, Paris, France
| | - Emmanuel Weiss
- Université de Paris, INSERM UMR 1148, Laboratory for Vascular Translational Science, 75018, Paris, France
- Intensive Care Unit, Beaujon HospitalAPHP.Nord, 92110, Clichy, France
| | - Yves Castier
- Université de Paris, INSERM UMR 1148, Laboratory for Vascular Translational Science, 75018, Paris, France
- Department of Vascular Surgery, Bichat Hospital, APHP.Nord, 75018, Paris, France
| | - Yoram Bouhnik
- Université de Paris, INSERM UMR 1148, Laboratory for Vascular Translational Science, 75018, Paris, France
- Intestinal Stroke Center, Department of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, APHP.Nord, 92110, Clichy, France
| | - Olivier Corcos
- Université de Paris, INSERM UMR 1148, Laboratory for Vascular Translational Science, 75018, Paris, France
- Intestinal Stroke Center, Department of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, APHP.Nord, 92110, Clichy, France
| | - Valérie Vilgrain
- Department of Radiology, Beaujon Hospital, APHP.Nord, 92110, Clichy, France
- UMR 1149, Université de Paris, INSERM, 75018, Paris, CRI, France
| | - Maxime Ronot
- Department of Radiology, Beaujon Hospital, APHP.Nord, 92110, Clichy, France.
- UMR 1149, Université de Paris, INSERM, 75018, Paris, CRI, France.
| | - Alexandre Nuzzo
- Université de Paris, INSERM UMR 1148, Laboratory for Vascular Translational Science, 75018, Paris, France
- Intestinal Stroke Center, Department of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, APHP.Nord, 92110, Clichy, France
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Najdawi M, Garzelli L, Nuzzo A, Huguet A, Raynaud L, Paulatto L, Panis Y, Ben Abdallah I, Castier Y, Sibert A, Vilgrain V, Corcos O, Ronot M. Endovascular revascularization of acute arterial mesenteric ischemia: report of a 3-year experience from an intestinal stroke center unit. Eur Radiol 2022; 32:5606-5615. [PMID: 35258671 DOI: 10.1007/s00330-022-08660-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/06/2021] [Accepted: 12/21/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To report the 3-year experience of endovascular revascularization of acute arterial mesenteric ischemia (AMI) from an intestinal stroke center unit (ISCU). METHOD All data from patients admitted to the ISCU between January 2016 and January 2019 for arterial AMI who underwent endovascular recanalization were prospectively acquired and retrospectively analyzed. Patient demographics, clinical and laboratory characteristics at presentation, and CT scans were reviewed. The type (thrombolysis, thrombectomy, stenting) and the outcome of endovascular procedures (technical success or failure, complications) were noted. Care pathways were described focusing on post-procedural treatments (surgical revascularization, bowel resection) and the mortality rate was evaluated in subgroups. RESULTS Fifty-eight patients (34 men [59%], mean 69 ± 29 years) were included. Endovascular revascularization was technically successful in 51/58 (88%) patients, and 10 (17%) patients had post-procedural complications. Stenting and in situ thrombolysis were performed in most patients (n = 33 and n = 19, respectively). Thirty-two patients (55%) were recurrence-free and required no further treatment after the procedure, while 9 (16%), 5 (9%), and 5 (9%) patients underwent 2nd-line bowel resection, surgical revascularization, or both. Overall, 46 (79%), 45 (78%), and 34 patients (63%) were alive at 3 months, 1 year, and 3 years. No significant difference in survival was found in care pathways or baseline characteristics. CONCLUSION Endovascular revascularization is highly feasible for the treatment of arterial AMI, and is associated with an acceptable rate of complications. Results of endovascular revascularization shall only be interpreted as part of a multidisciplinary patient management strategy. KEY POINTS • Endovascular revascularization is highly feasible for the treatment of arterial AMI, and is associated with an acceptable rate of complications. • Several techniques are available to perform endovascular revascularization, and their use depends on the cause, the location, and the quality of underlying arteries of patients. • Results of endovascular revascularization shall only be interpreted in relation to its role in an integrated multidisciplinary and patient management strategy.
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Affiliation(s)
- MiIan Najdawi
- Department of Radiology, Beaujon Hospital, AP-HP, 100 Boulevard du Général Leclerc, 92118, Clichy, Hauts-de-Seine, France
| | - Lorenzo Garzelli
- Department of Radiology, Beaujon Hospital, AP-HP, 100 Boulevard du Général Leclerc, 92118, Clichy, Hauts-de-Seine, France
- INSERM U1148, LVTS, Paris, France
| | - Alexandre Nuzzo
- INSERM U1148, LVTS, Paris, France
- Department of Gastroenterology, IBD and Intestinal Failure, APHP.Nord, Beaujon, Clichy, Hauts-de-Seine, France
- SURVI - Structure d'Urgences Vasculaires Intestinales (Intestinal Stroke), Clichy, France
| | - Audrey Huguet
- Department of Gastroenterology, IBD and Intestinal Failure, APHP.Nord, Beaujon, Clichy, Hauts-de-Seine, France
- SURVI - Structure d'Urgences Vasculaires Intestinales (Intestinal Stroke), Clichy, France
| | - Lucas Raynaud
- Department of Radiology, Beaujon Hospital, AP-HP, 100 Boulevard du Général Leclerc, 92118, Clichy, Hauts-de-Seine, France
- Université de Paris, Paris, France
| | - Luisa Paulatto
- Department of Radiology, Beaujon Hospital, AP-HP, 100 Boulevard du Général Leclerc, 92118, Clichy, Hauts-de-Seine, France
- Université de Paris, Paris, France
| | - Yves Panis
- Université de Paris, Paris, France
- Department of Colorectal Surgery, APHP.Nord, Hopital Beaujon, Clichy, Hauts-de-Seine, France
| | | | - Yves Castier
- Université de Paris, Paris, France
- Department of Vascular Surgery, APHP.Nord, Hopital Bichat, Paris, France
| | - Annie Sibert
- Department of Radiology, Beaujon Hospital, AP-HP, 100 Boulevard du Général Leclerc, 92118, Clichy, Hauts-de-Seine, France
| | - Valérie Vilgrain
- Department of Radiology, Beaujon Hospital, AP-HP, 100 Boulevard du Général Leclerc, 92118, Clichy, Hauts-de-Seine, France
- INSERM U1148, LVTS, Paris, France
- INSERM U1149, CRI, Paris, France
| | - Olivier Corcos
- Department of Gastroenterology, IBD and Intestinal Failure, APHP.Nord, Beaujon, Clichy, Hauts-de-Seine, France
- SURVI - Structure d'Urgences Vasculaires Intestinales (Intestinal Stroke), Clichy, France
| | - Maxime Ronot
- Department of Radiology, Beaujon Hospital, AP-HP, 100 Boulevard du Général Leclerc, 92118, Clichy, Hauts-de-Seine, France.
- INSERM U1148, LVTS, Paris, France.
- INSERM U1149, CRI, Paris, France.
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Guyard C, de Ponthaud C, Frontali A, Monsinjon M, Giacca M, Panis Y. C-reactive protein monitoring after ileocecal resection and stoma closure reduces length of hospital stay: a prospective case-matched study in 410 patients with Crohn's disease. Tech Coloproctol 2022; 26:443-451. [PMID: 35239097 DOI: 10.1007/s10151-022-02590-4] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/30/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The aim of this study was to evaluate a C-reactive protein (CRP)-driven monitoring discharge strategy for patients with Crohn's disease (CD) undergoing laparoscopic ileo-cecal resection (ICR) and if needed, temporary stoma closure (SC). METHODS Four hundred and ten patients who underwent laparoscopic ICR for CD: 153 patients (CRP group) between June 2016 and June 2020 at our department, had a CRP-driven monitoring discharge on postoperative day (POD) 3 and were discharged on POD 4 if CRP < 100 mg/L. These patients were matched (according to age, sex, body mass index, type of CD (and stoma or not) to 257 patients who underwent laparoscopic ICR for CD between January 2009 and May 2016, without CRP monitoring (Control group). For SC, 79 patients with CRP monitoring were matched with 88 control patients. Primary outcome was overall length of hospital stay (LHS). Secondary outcomes were discharge on POD 4 for SC and POD 4 and POD 6 for ICR, 3-month postoperative overall morbidity and severe morbidity rates, surgical site infection, readmission rates, and CRP level in cases of morbidity at 3 months. RESULTS For ICR without stoma, mean LHS was significantly shorter in the CRP group than in the control group (6.9 ± 2 days vs 8.3 ± 6 days, p = 0.017). Discharge occurred on POD 6 (or before) in 73% of the patients (CRP group) vs 60% (Control group) (p = 0.027). For ICR with stoma, LHS was 8 days for both groups (p = 0.612). For SC, LHS was significantly shorter in the CRP group than in the control group (5.5 ± 3 days vs 7.1 ± 4 days; p = 0.002). Discharge occurred on POD 4 in 62% (CRP group) vs 30% (Control) (p = 0.003). Postoperative 3-month overall and severe morbidity, and rehospitalization rates were similar between groups. CONCLUSIONS CRP-driven monitoring discharge strategy after laparoscopic ICR for CD is associated with a significant reduction of LHS, without increasing morbidity, reoperation or rehospitalisation rates.
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Affiliation(s)
- C Guyard
- Department of Colorectal Surgery, DMU DIGEST, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) and University of Paris, 100 boulevard du Général Leclerc, 92118, Clichy, France
| | - C de Ponthaud
- Department of Colorectal Surgery, DMU DIGEST, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) and University of Paris, 100 boulevard du Général Leclerc, 92118, Clichy, France
| | - A Frontali
- Department of Colorectal Surgery, DMU DIGEST, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) and University of Paris, 100 boulevard du Général Leclerc, 92118, Clichy, France
| | - M Monsinjon
- Department of Colorectal Surgery, DMU DIGEST, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) and University of Paris, 100 boulevard du Général Leclerc, 92118, Clichy, France
| | - M Giacca
- Department of Colorectal Surgery, DMU DIGEST, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) and University of Paris, 100 boulevard du Général Leclerc, 92118, Clichy, France
| | - Y Panis
- Department of Colorectal Surgery, DMU DIGEST, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) and University of Paris, 100 boulevard du Général Leclerc, 92118, Clichy, France.
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Zaborowski AM, Abdile A, Adamina M, Aigner F, d'Allens L, Allmer C, Álvarez A, Anula R, Andric M, Atallah S, Bach S, Bala M, Barussaud M, Bausys A, Beggs A, Bellolio F, Bennett MR, Berdinskikh A, Bevan V, Biondo S, Bislenghi G, Bludau M, Brouwer N, Brown C, Bruns C, Buchanan DD, Buchwald P, Burger JWA, Burlov N, Campanelli M, Capdepont M, Carvello M, Chew HH, Christoforidis D, Clark D, Climent M, Collinson R, Cologne KG, Contreras T, Croner R, Daniels IR, Dapri G, Davies J, Delrio P, Denost Q, Deutsch M, Dias A, D'Hoore A, Drozdov E, Duek D, Dunlop M, Dziki A, Edmundson A, Efetov S, El-Hussuna A, Elliot B, Emile S, Espin E, Evans M, Faes S, Faiz O, Figueiredo N, Fleming F, Foppa C, Fowler G, Frasson M, Forgan T, Frizelle F, Gadaev S, Gellona J, Glyn T, Goran B, Greenwood E, Guren MG, Guillon S, Gutlic I, Hahnloser D, Hampel H, Hanly A, Hasegawa H, Iversen LH, Hill A, Hill J, Hoch J, Hompes R, Hurtado L, Iaquinandi F, Imbrasaite U, Islam R, Jafari MD, Salido AJ, Jiménez Toscano M, Kanemitsu Y, Karachun A, Karimuddin AA, Keller DS, Kelly J, Kennelly R, Khrykov G, Kocian P, Koh C, Kok N, Knight KA, Knol J, Kontovounisios C, Korner H, Krivokapic Z, Kronberger I, Kroon HM, Kryzauskas M, Kural S, Kusters M, Lakkis Z, Lankov T, Larson D, Lázár G, Lee KY, Lee SH, Lefèvre JH, Lepisto A, Lieu C, Loi L, Lynch C, Maillou-Martinaud H, Maroli A, Martin S, Martling A, Matzel KE, Mayol J, McDermott F, Meurette G, Millan M, Mitteregger M, Moiseenko A, Monson JRT, Morarasu S, Moritani K, Möslein G, Munini M, Nahas C, Nahas S, Negoi I, Novikova A, Ocares M, Okabayashi K, Olkina A, Oñate-Ocaña L, Otero J, Ozen C, Pace U, Julião GPS, Panaiotti L, Panis Y, Papamichael D, Patel S, Uriburu JCP, Peng SL, Pera M, Perez RO, Petrov A, Pfeffer F, Phang TP, Poskus T, Pringle H, Proud D, Raguz I, Rama N, Rasheed S, Raval MJ, Rega D, Reissfelder C, Meneses JCR, Ris F, Riss S, Rodriguez-Zentner H, Roxburgh CS, Saklani A, Sammour T, Saraste D, Schneider M, Seishima R, Sekulic A, Seppala T, Sheahan K, Shlomina A, Sigismondo G, Singnomklao T, Siragusa L, Smart N, Solis-Peña A, Spinelli A, Staiger RD, Stamos MJ, Steele S, Tan KK, Tanis PJ, Tekkis P, Teklay B, Tengku S, Tsarkov P, Turina M, Ulrich A, Vailati BB, van Harten M, Verhoef C, Warrier S, Wexner S, de Wilt H, Weinberg BA, Wells C, Wolthuis A, Xynos E, You N, Zakharenko A, Zeballos J, Zhou J, Winter DC. Microsatellite instability in young patients with rectal cancer: molecular findings and treatment response. Br J Surg 2022; 109:251-255. [PMID: 35030243 DOI: 10.1093/bjs/znab437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 11/22/2021] [Indexed: 12/27/2022]
Abstract
In this study of 400 patients with early-onset rectal cancer, 12.5 per cent demonstrated microsatellite instability (MSI). MSI was associated with a reduced likelihood of nodal positivity, an increased rate of pathological complete response, and improved disease-specific survival.
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Spinelli A, Bonovas S, Burisch J, Kucharzik T, Adamina M, Annese V, Bachmann O, Bettenworth D, Chaparro M, Czuber-Dochan W, Eder P, Ellul P, Fidalgo C, Fiorino G, Gionchetti P, Gisbert JP, Gordon H, Hedin C, Holubar S, Iacucci M, Karmiris K, Katsanos K, Kopylov U, Lakatos PL, Lytras T, Lyutakov I, Noor N, Pellino G, Piovani D, Savarino E, Selvaggi F, Verstockt B, Doherty G, Raine T, Panis Y. ECCO Guidelines on Therapeutics in Ulcerative Colitis: Surgical Treatment. J Crohns Colitis 2022; 16:179-189. [PMID: 34635910 DOI: 10.1093/ecco-jcc/jjab177] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [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: 12/13/2022]
Abstract
This is the second of a series of two articles reporting the European Crohn's and Colitis Organisation [ECCO] evidence-based consensus on the management of adult patients with ulcerative colitis [UC]. The first article is focused on medical management, and the present article addresses medical treatment of acute severe ulcerative colitis [ASUC] and surgical management of medically refractory UC patients, including preoperative optimisation, surgical strategies, and technical issues. The article provides advice for a variety of common clinical and surgical conditions. Together, the articles represent an update of the evidence-based recommendations of the ECCO for UC.
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Affiliation(s)
- Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, and Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Stefanos Bonovas
- Department of Biomedical Sciences, and IRCCS Humanitas Research Hospital, Milan, Italy
| | - Johan Burisch
- Gastrounit, Medical Division, and Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Hvidovre Hospital, University of Copenhagen, Denmark
| | - Torsten Kucharzik
- Department of Gastroenterology, Lüneburg Hospital, University of Hamburg, Lüneburg, Germany
| | - Michel Adamina
- Department of Surgery, Clinic of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Zurich.,Department of Biomedical Engineering, Clinical Research and Artificial Intelligence in Surgery, Faculty of Medicine, University of Basel, Allschwil, Switzerland
| | - Vito Annese
- Department of Gastroenterology, Fakeeh University Hospital, Dubai, UAE
| | - Oliver Bachmann
- Department of Internal Medicine I, Siloah St. Trudpert Hospital, Pforzheim.,Hannover Medical School, Hannover, Germany
| | - Dominik Bettenworth
- University Hospital Munster, Department of Medicine B - Gastroenterology and Hepatology, Munster, Germany
| | - Maria Chaparro
- Gastroenterology Unit, IIS-IP, Universidad Autónoma de Madrid [UAM], CIBEREHD, Madrid, Spain
| | - Wladyslawa Czuber-Dochan
- King's College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, UK
| | - Piotr Eder
- Department of Gastroenterology, Dietetics and Internal Medicine, Poznań University of Medical Sciences, and Heliodor Święcicki University Hospital, Poznań, Poland
| | - Pierre Ellul
- Department of Medicine, Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - Catarina Fidalgo
- Gastroenterology Division, Hospital Beatriz Ângelo, Loures, Portugal
| | - Gionata Fiorino
- Department of Biomedical Sciences, Humanitas University, and IBD Center, Humanitas Clinical and Research Center, Milan, Italy
| | - Paolo Gionchetti
- IBD Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna DIMEC, University of Bologna, Bologna, Italy
| | - Javier P Gisbert
- Gastroenterology Unit, IIS-IP, Universidad Autónoma de Madrid [UAM], CIBEREHD, Madrid, Spain
| | - Hannah Gordon
- Department of Gastroenterology, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - Charlotte Hedin
- Karolinska Institutet, Department of Medicine Solna, and Karolinska University Hospital, Department of Gastroenterology, Dermatovenereology and Rheumatology, Stockholm, Sweden
| | - Stefan Holubar
- Department of Colon & Rectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Marietta Iacucci
- Institute of Immunology and Immunotherapy, University of Birmingham, and Division of Gastroenterology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | | | - Konstantinos Katsanos
- Department of Gastroenterology and Hepatology, Division of Internal Medicine, University and Medical School of Ioannina, Ioannina, Greece
| | - Uri Kopylov
- Department of Gastroenterology, Tel-HaShomer Sheba Medical Center, Ramat Gan, and Sackler Medical School, Tel Aviv, Israel
| | - Peter L Lakatos
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC, Canada.,1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Theodore Lytras
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Ivan Lyutakov
- Department of Gastroenterology, University Hospital 'Tsaritsa Yoanna - ISUL', Medical University Sofia, Sofia, Bulgaria
| | - Nurulamin Noor
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania "Luigi Vanvitelli", Naples, Italy, and Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, and IRCCS Humanitas Research Hospital, Milan, Italy
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Francesco Selvaggi
- Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, and Department of Chronic Diseases, Metabolism and Ageing, TARGID - IBD, KU Leuven, Leuven, Belgium
| | - Glen Doherty
- Department of Gastroenterology and Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Tim Raine
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Yves Panis
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy and Université of Paris, France
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Raine T, Bonovas S, Burisch J, Kucharzik T, Adamina M, Annese V, Bachmann O, Bettenworth D, Chaparro M, Czuber-Dochan W, Eder P, Ellul P, Fidalgo C, Fiorino G, Gionchetti P, Gisbert JP, Gordon H, Hedin C, Holubar S, Iacucci M, Karmiris K, Katsanos K, Kopylov U, Lakatos PL, Lytras T, Lyutakov I, Noor N, Pellino G, Piovani D, Savarino E, Selvaggi F, Verstockt B, Spinelli A, Panis Y, Doherty G. ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment. J Crohns Colitis 2022; 16:2-17. [PMID: 34635919 DOI: 10.1093/ecco-jcc/jjab178] [Citation(s) in RCA: 249] [Impact Index Per Article: 124.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Tim Raine
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University; IRCCS Humanitas Research Hospital, Milan, Italy
| | - Johan Burisch
- Gastrounit, Medical Division, Hvidovre Hospital; Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Hvidovre Hospital, University of Copenhagen, Denmark
| | - Torsten Kucharzik
- Department of Gastroenterology, Lüneburg Hospital, University of Hamburg, Lüneburg, Germany
| | - Michel Adamina
- Department of Surgery, Clinic of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland
- Department of Biomedical Engineering, Clinical Research and Artificial Intelligence in Surgery, Faculty of Medicine, University of Basel, Allschwil, Switzerland
| | - Vito Annese
- Department of Gastroenterology, Fakeeh University Hospital, Dubai, UAE
| | - Oliver Bachmann
- Department of Internal Medicine I, Siloah St. Trudpert Hospital, Pforzheim; Hannover Medical School, Hannover, Germany
| | - Dominik Bettenworth
- University Hospital Munster, Department of Medicine B - Gastroenterology and Hepatology, Munster, Germany
| | - Maria Chaparro
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Wladyslawa Czuber-Dochan
- King's College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, UK
| | - Piotr Eder
- Department of Gastroenterology, Dietetics and Internal Medicine - Poznań University of Medical Sciences; Heliodor Święcicki University Hospital, Poznań, Poland
| | - Pierre Ellul
- Department of Medicine, Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - Catarina Fidalgo
- Gastroenterology Division, Hospital Beatriz Ângelo, Loures, Portugal
| | - Gionata Fiorino
- Department of Biomedical Sciences, Humanitas University; IBD Center, Humanitas Clinical and Research Center, Milan, Italy
| | - Paolo Gionchetti
- IBD Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna DIMEC, University of Bologna, Bologna, Italy
| | - Javier P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Hannah Gordon
- Department of Gastroenterology, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - Charlotte Hedin
- Karolinska Institutet, Department of Medicine Solna; Karolinska University Hospital, Department of Gastroenterology, Dermatovenereology and Rheumatology, Stockholm, Sweden
| | - Stefan Holubar
- Department of Colon & Rectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Marietta Iacucci
- Institute of Immunology and Immunotherapy, NIHR Biomedical Research Centre, University of Birmingham; Division of Gastroenterology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | | | - Konstantinos Katsanos
- Department of Gastroenterology and Hepatology, Division of Internal Medicine, University and Medical School of Ioannina, Ioannina, Greece
| | - Uri Kopylov
- Department of Gastroenterology, Tel-HaShomer Sheba Medical Center, Ramat Gan, and Sackler Medical School, Tel Aviv, Israel
| | - Peter L Lakatos
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Theodore Lytras
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Ivan Lyutakov
- Department of Gastroenterology, University Hospital 'Tsaritsa Yoanna - ISUL', Medical University Sofia, Sofia, Bulgaria
| | - Nurulamin Noor
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University; IRCCS Humanitas Research Hospital, Milan, Italy
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Francesco Selvaggi
- Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven; Department of Chronic Diseases, Metabolism and Ageing, TARGID - IBD, Leuven, Belgium
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University; IRCCS Humanitas Research Hospital, Milan, Italy
| | - Yves Panis
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy and Université of Paris, France
| | - Glen Doherty
- Department of Gastroenterology and Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
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Collard MK, Rullier E, Panis Y, Manceau G, Benoist S, Tuech JJ, Alves A, Laforest A, Mege D, Cazelles A, Beyer-Berjot L, Christou N, Cotte E, Lakkis Z, O'Connell L, Parc Y, Piessen G, Lefevre JH. Nonmetastatic ypt0 rectal cancer after neoadjuvant treatment and total mesorectal excision: Lessons from a retrospective multicentric cohort of 383 patients. Surgery 2022; 171:1193-1199. [PMID: 35078629 DOI: 10.1016/j.surg.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND A better understanding of pathological features and oncological survival in ypT0 rectal cancer after neoadjuvant chemoradiotherapy is required to improve patient selection criteria for rectal-preserving approach by local excision. Our aim was to define risk of lymph node metastasis and oncological outcomes in ypT0 rectal cancer after chemoradiotherapy and total mesorectal excision. METHODS All consecutive patients who underwent total mesorectal excision for a nonmetastatic rectal adenocarcinoma classified ypT0 after neoadjuvant chemoradiotherapy, with or without locoregional lymph node involvement (ypN+ or ypN-), in 14 French academic centers between 2002 and 2015 were included. Data were collected retrospectively. Overall and disease-free survival were explored. RESULTS Among the 383 ypT0 patients, 6% were ypN+ (23/283). Before chemoradiotherapy, 86% (327/380) were staged cT3-T4 and 41% (156/378) were staged cN+. The risk of ypN+ did not differ between cT3-T4 and cT1-T2 patients (P = .345) or between cN+ and cN- patients (P = .384). After a median follow-up of 61.1 months, we observed 95% confidence interval (92%-97%) of 5-year overall survival and 93% confidence interval (91%-96%) of 5-year disease-free survival. In Cox multivariate analysis, overall survival was altered by intra-abdominal septic complications (hazard ratio = 2.53, confidence interval [1.11-5.78], P = .028). Regarding disease-free survival, ypN+ status and administration of adjuvant chemotherapy were associated with a reduced disease-free survival (P = .001 for both). cT3/T4 staging and cN+ staging did not modify overall survival (P = .332 and P = .450) nor disease-free survival (P = .862 and P = .124). CONCLUSION The risk of lymph node metastasis and the oncological survival do not depend on the initial cT or cN staging in cases of ypT0 complete rectal tumor regression.
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Affiliation(s)
- Maxime K Collard
- Department of Digestive Surgery, Saint Antoine Hospital, Sorbonne University Paris, France
| | - Eric Rullier
- Department of Digestive Surgery, Saint André Hospital, Bordeaux, France
| | - Yves Panis
- Department of Colorectal Surgery, Beaujon Hospital, Clichy, France
| | - Gilles Manceau
- Department of General and Digestive Surgery, Université de Paris, Faculté de Médecine, Paris, France
| | - Stéphane Benoist
- Department of Digestive Surgery, Kremlin-Bicêtre Hospital, France
| | | | - Arnaud Alves
- Department of Digestive Surgery, Rouen Hospital, France
| | - Anais Laforest
- Department of Digestive Surgery, Montsouris Institut, Paris, France
| | - Diane Mege
- Department of Digestive Surgery, Aix Marseille Univ, APHM, Timone University Hospital, Marseille, France
| | | | | | - Niki Christou
- Department of Digestive Surgery, Limoges Hospital, Limoges, France
| | - Eddy Cotte
- Department of Digestive Surgery, Hopital Lyon Sud, Lyon, France
| | - Zaher Lakkis
- Department of Digestive Surgery, Jean Minoz Hospital, Besançon, France
| | - Lauren O'Connell
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Yann Parc
- Department of Digestive Surgery, Saint Antoine Hospital, Sorbonne University Paris, France
| | | | - Jérémie H Lefevre
- Department of Digestive Surgery, Saint Antoine Hospital, Sorbonne University Paris, France.
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45
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Morilla I, Uzzan M, Cazals-Hatem D, Colnot N, Panis Y, Nancey S, Boschetti G, Amiot A, Tréton X, Ogier-Denis E, Daniel F. Computational Learning of microRNA-Based Prediction of Pouchitis Outcome After Restorative Proctocolectomy in Patients With Ulcerative Colitis. Inflamm Bowel Dis 2021; 27:1653-1660. [PMID: 33609036 DOI: 10.1093/ibd/izab030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 08/07/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Ileal pouch-anal anastomosis (IPAA) is the standard of care after total proctocolectomy for ulcerative colitis (UC). However, inflammation often develops in the pouch, leading to acute or recurrent/chronic pouchitis (R/CP). MicroRNAs (miRNA) are used as accurate diagnostic and predictive biomarkers in many human diseases, including inflammatory bowel diseases. Therefore, we aimed to identify an miRNA-based biomarker to predict the occurrence of R/CP in patients with UC after colectomy and IPAA. METHODS We conducted a retrospective study in 3 tertiary centers in France. We included patients with UC who had undergone IPAA with or without subsequent R/CP. Paraffin-embedded biopsies collected from the terminal ileum during the proctocolectomy procedure were used for microarray analysis of miRNA expression profiles. Deep neural network-based classifiers were used to identify biomarkers predicting R/CP using miRNA expression and relevant biological and clinical factors in a discovery cohort of 29 patients. The classification algorithm was tested in an independent validation cohort of 28 patients. RESULTS A combination of 11 miRNA expression profiles and 3 biological/clinical factors predicted the outcome of R/CP with 88% accuracy (area under the curve = 0.94) in the discovery cohort. The performance of the classification algorithm was confirmed in the validation cohort with 88% accuracy (area under the curve = 0.90). Apoptosis, cytoskeletal regulation by Rho GTPase, and fibroblast growth factor signaling were the most dysregulated targets of the 11 selected miRNAs. CONCLUSIONS We developed and validated a computational miRNA-based algorithm for accurately predicting R/CP in patients with UC after IPAA.
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Affiliation(s)
- Ian Morilla
- INSERM U1149, Université de Paris, Centre de Recherche sur l'inflammation, Team Gut Inflammation, Paris, France.,Laboratory of Excellence Labex INFLAMEX, Sorbonne Paris-Cité, Paris, France.,Université Sorbonne Paris-Nord, Laboratoire d'Excellence Inflamex, Villetaneuse, France
| | - Mathieu Uzzan
- INSERM U1149, Université de Paris, Centre de Recherche sur l'inflammation, Team Gut Inflammation, Paris, France.,Laboratory of Excellence Labex INFLAMEX, Sorbonne Paris-Cité, Paris, France.,Département de Gastroentérologie, Assistance Publique Hôpitaux de Paris, Hôpital Beaujon, Clichy la Garenne, Clichy Cedex, France
| | - Dominique Cazals-Hatem
- INSERM U1149, Université de Paris, Centre de Recherche sur l'inflammation, Team Gut Inflammation, Paris, France.,Laboratory of Excellence Labex INFLAMEX, Sorbonne Paris-Cité, Paris, France.,Service d'anatomopathologie, Assistance Publique Hôpitaux de Paris, Hôpital Beaujon, Clichy la Garenne, France
| | - Nathalie Colnot
- Service d'anatomopathologie, Assistance Publique Hôpitaux de Paris, Hôpital Beaujon, Clichy la Garenne, France
| | - Yves Panis
- INSERM U1149, Université de Paris, Centre de Recherche sur l'inflammation, Team Gut Inflammation, Paris, France.,Laboratory of Excellence Labex INFLAMEX, Sorbonne Paris-Cité, Paris, France.,Service de chirurgie colorectale, Assistance Publique Hôpitaux de Paris, Hôpital Beaujon, Clichy la Garenne, France
| | - Stéphane Nancey
- Service d'Hépato-Gastroentérologie, Hospices Civils de Lyon, Lyon, France
| | - Gilles Boschetti
- Service d'Hépato-Gastroentérologie, Hospices Civils de Lyon, Lyon, France
| | - Aurélien Amiot
- Service de Gastroentérologie, Hôpital Henri Mondor, Créteil, France
| | - Xavier Tréton
- INSERM U1149, Université de Paris, Centre de Recherche sur l'inflammation, Team Gut Inflammation, Paris, France.,Laboratory of Excellence Labex INFLAMEX, Sorbonne Paris-Cité, Paris, France.,Département de Gastroentérologie, Assistance Publique Hôpitaux de Paris, Hôpital Beaujon, Clichy la Garenne, Clichy Cedex, France
| | - Eric Ogier-Denis
- INSERM U1149, Université de Paris, Centre de Recherche sur l'inflammation, Team Gut Inflammation, Paris, France.,Laboratory of Excellence Labex INFLAMEX, Sorbonne Paris-Cité, Paris, France
| | - Fanny Daniel
- INSERM U1149, Université de Paris, Centre de Recherche sur l'inflammation, Team Gut Inflammation, Paris, France.,Laboratory of Excellence Labex INFLAMEX, Sorbonne Paris-Cité, Paris, France
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46
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Spinelli A, Carvello M, Adamina M, Panis Y, Warusavitarne J, Tulchinsky H, Bemelman WA, Kotze PG, D'Hoore A, Lastikova L, Danese S, Peyrin-Biroulet L, Avedano L, Pagnini F. Patients' perceptions of surgery for inflammatory bowel disease. Colorectal Dis 2021; 23:2690-2698. [PMID: 34268861 DOI: 10.1111/codi.15813] [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: 12/18/2020] [Revised: 04/20/2021] [Accepted: 07/10/2021] [Indexed: 02/08/2023]
Abstract
AIM Surgery is indicated in selected patients with inflammatory bowel disease (IBD). However, due to a negative perception, surgery may be delayed, leading to possible unfavourable outcomes. The aim of this work was to investigate patients' perceptions of surgery and the impact on reported outcomes. METHOD An international multilingual online survey was used to query IBD patients' experiences of surgery, information sources, expectations and concerns, quality of life (QoL) and feelings. RESULTS The survey was completed by 425 of 510 participants. Crohn's disease was more frequent (61%) than ulcerative colitis (36%). Most patients primarily learned about surgery from their gastroenterologist and were informed of the risks and benefits by the surgeon. In almost one-third of patients indication for surgery was not a shared decision between gastroenterologist and surgeon. Seventy per cent of patients naïve to surgery were not aware of any surgical options. The majority of patients (80%) perceived surgery as the last option after many medical treatments rather than an alternative therapeutic option (20%). Sixteen per cent of patients obtained their primary information from the Internet, while 82.4% used the Internet to obtain additional information. Fear of surgical complications was cited by 73% of patients, while relief from symptoms was indicated by 31%. Most patients coped with their stoma better than expected or as they expected. Negative feelings decreased after surgery, while a lasting improvement in positive feelings and QoL was reported. CONCLUSION Despite the negative perception of surgery and the delayed involvement of surgeons as a source of information and in the decision-making process, the majority of respondents experienced positive outcomes from surgery, including improvement QoL and acceptance of the stoma.
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Affiliation(s)
- Antonino Spinelli
- Colon and Rectal Surgery Division, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Michele Carvello
- Colon and Rectal Surgery Division, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Michel Adamina
- Department of Surgery, Clinic of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland.,Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Allschwil, Switzerland
| | - Yves Panis
- Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD, Beaujon Hospital, Assistance publique-Hôpitaux de Paris (AP-HP, University Denis Diderot (Paris VII, Clichy cedex, France
| | - Janindra Warusavitarne
- Department of Surgery and Cancer, Imperial College, London, UK.,Department of Colorectal Surgery, St Mark's Hospital, Harrow, UK
| | - Hagit Tulchinsky
- Department of Surgery B, Sourasky Medical Center, Tel Aviv, Israel
| | - Willem A Bemelman
- Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Paulo Gustavo Kotze
- Colorectal Surgery Unit, IBD Outpatient Clinics, Catholic University of Parana (PUCPR, Curitiba, Brazil
| | - Andre D'Hoore
- Department of Abdominal Surgery, University Hospital Gasthuisberg Leuven, Leuven, Belgium
| | - Lucie Lastikova
- European Federation of Crohn's and Ulcerative Colitis Associations (Youth Group, Brussels, Belgium
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France.,Inserm U1256 NGERE, Lorraine University, Vandoeuvre-lès-Nancy, France
| | - Luisa Avedano
- European Federation of Crohn's and Ulcerative Colitis Associations, Brussels, Belgium
| | - Francesco Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Psychology, Harvard University, Cambridge, MA, USA
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47
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Labiad C, Monsinjon M, Giacca M, Panis Y. Second redo surgery after two consecutive failures of a colorectal or coloanal anastomosis: is it reasonable? Int J Colorectal Dis 2021; 36:2057-2060. [PMID: 34169331 DOI: 10.1007/s00384-021-03982-y] [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] [Accepted: 06/16/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Colorectal redo surgery is well known to be a difficult procedure, associated with a high risk of failure. The aim of this study was to look into patients presenting two consecutive failed colorectal (CRA) or coloanal (CAA) anastomosis who underwent a second redo surgery (i.e., third anastomosis). METHODS A retrospective study based on a prospective database of second redo surgeries of CRA or CAA, in an expert center. Sixteen patients between 2005 and 2020 were analyzed. RESULTS After a mean follow-up of 28 ± 26 months, success of surgery (defined as no stoma at the end of follow-up) was reported in 10/16 patients (63%). One patient with chronic anastomotic leakage and another with early colonic ischemia had no defunctioning stoma reversal. In the remaining four patients with a failed second redo surgery, a definitive stoma was ultimately created for fistula recurrence (n = 1), poor functional results (n = 2), or local cancer recurrence (n = 1). Two risk factors for failure of this second redo surgery were significantly found in a univariate analysis: (1) nature of the primary anastomosis: 3/13 s redo surgeries failed (23%) if a CRA was first made and 3/3 (100%) if it was a CAA (p = 0.036); (2) age: patients with a failed second redo surgery were older (p = 0.04). CONCLUSION A 63% rate of success of second redo surgery was observed after two failed CRA or CAA. Although a demanding procedure, it can be proposed to carefully selected and motivated patients.
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Affiliation(s)
- Camélia Labiad
- Department of Colorectal Surgery, Pôle Des Maladies de L'Appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France.,Sorbonne Université, 15-21 rue de l'Ecole de Médecine, 75006, Paris, France
| | - Marie Monsinjon
- Department of Colorectal Surgery, Pôle Des Maladies de L'Appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Massimo Giacca
- Department of Colorectal Surgery, Pôle Des Maladies de L'Appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Yves Panis
- Department of Colorectal Surgery, Pôle Des Maladies de L'Appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France.
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48
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Zaborowski AM, Abdile A, Adamina M, Aigner F, d'Allens L, Allmer C, Álvarez A, Anula R, Andric M, Atallah S, Bach S, Bala M, Barussaud M, Bausys A, Bebington B, Beggs A, Bellolio F, Bennett MR, Berdinskikh A, Bevan V, Biondo S, Bislenghi G, Bludau M, Boutall A, Brouwer N, Brown C, Bruns C, Buchanan DD, Buchwald P, Burger JWA, Burlov N, Campanelli M, Capdepont M, Carvello M, Chew HH, Christoforidis D, Clark D, Climent M, Cologne KG, Contreras T, Croner R, Daniels IR, Dapri G, Davies J, Delrio P, Denost Q, Deutsch M, Dias A, D'Hoore A, Drozdov E, Duek D, Dunlop M, Dziki A, Edmundson A, Efetov S, El-Hussuna A, Elliot B, Emile S, Espin E, Evans M, Faes S, Faiz O, Fleming F, Foppa C, Fowler G, Frasson M, Figueiredo N, Forgan T, Frizelle F, Gadaev S, Gellona J, Glyn T, Gong J, Goran B, Greenwood E, Guren MG, Guillon S, Gutlic I, Hahnloser D, Hampel H, Hanly A, Hasegawa H, Iversen LH, Hill A, Hill J, Hoch J, Hoffmeister M, Hompes R, Hurtado L, Iaquinandi F, Imbrasaite U, Islam R, Jafari MD, Kanemitsu Y, Karachun A, Karimuddin AA, Keller DS, Kelly J, Kennelly R, Khrykov G, Kocian P, Koh C, Kok N, Knight KA, Knol J, Kontovounisios C, Korner H, Krivokapic Z, Kronberger I, Kroon HM, Kryzauskas M, Kural S, Kusters M, Lakkis Z, Lankov T, Larson D, Lázár G, Lee KY, Lee SH, Lefèvre JH, Lepisto A, Lieu C, Loi L, Lynch C, Maillou-Martinaud H, Maroli A, Martin S, Martling A, Matzel KE, Mayol J, McDermott F, Meurette G, Millan M, Mitteregger M, Moiseenko A, Monson JRT, Morarasu S, Moritani K, Möslein G, Munini M, Nahas C, Nahas S, Negoi I, Novikova A, Ocares M, Okabayashi K, Olkina A, Oñate-Ocaña L, Otero J, Ozen C, Pace U, São Julião GP, Panaiotti L, Panis Y, Papamichael D, Park J, Patel S, Patrón Uriburu JC, Pera M, Perez RO, Petrov A, Pfeffer F, Phang PT, Poskus T, Pringle H, Proud D, Raguz I, Rama N, Rasheed S, Raval MJ, Rega D, Reissfelder C, Reyes Meneses JC, Ris F, Riss S, Rodriguez-Zentner H, Roxburgh CS, Saklani A, Salido AJ, Sammour T, Saraste D, Schneider M, Seishima R, Sekulic A, Seppala T, Sheahan K, Shine R, Shlomina A, Sica GS, Singnomklao T, Siragusa L, Smart N, Solis A, Spinelli A, Staiger RD, Stamos MJ, Steele S, Sunderland M, Tan KK, Tanis PJ, Tekkis P, Teklay B, Tengku S, Jiménez-Toscano M, Tsarkov P, Turina M, Ulrich A, Vailati BB, van Harten M, Verhoef C, Warrier S, Wexner S, de Wilt H, Weinberg BA, Wells C, Wolthuis A, Xynos E, You N, Zakharenko A, Zeballos J, Winter DC. Characteristics of Early-Onset vs Late-Onset Colorectal Cancer: A Review. JAMA Surg 2021; 156:865-874. [PMID: 34190968 DOI: 10.1001/jamasurg.2021.2380] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance The incidence of early-onset colorectal cancer (younger than 50 years) is rising globally, the reasons for which are unclear. It appears to represent a unique disease process with different clinical, pathological, and molecular characteristics compared with late-onset colorectal cancer. Data on oncological outcomes are limited, and sensitivity to conventional neoadjuvant and adjuvant therapy regimens appear to be unknown. The purpose of this review is to summarize the available literature on early-onset colorectal cancer. Observations Within the next decade, it is estimated that 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in adults younger than 50 years. Potential risk factors include a Westernized diet, obesity, antibiotic usage, and alterations in the gut microbiome. Although genetic predisposition plays a role, most cases are sporadic. The full spectrum of germline and somatic sequence variations implicated remains unknown. Younger patients typically present with descending colonic or rectal cancer, advanced disease stage, and unfavorable histopathological features. Despite being more likely to receive neoadjuvant and adjuvant therapy, patients with early-onset disease demonstrate comparable oncological outcomes with their older counterparts. Conclusions and Relevance The clinicopathological features, underlying molecular profiles, and drivers of early-onset colorectal cancer differ from those of late-onset disease. Standardized, age-specific preventive, screening, diagnostic, and therapeutic strategies are required to optimize outcomes.
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Affiliation(s)
| | - Ahmed Abdile
- Department of Surgery, Middlemore Hospital, Auckland, New Zealand
| | - Michel Adamina
- Department of Surgery, Cantonal Hospital, Winterthur, Switzerland
| | - Felix Aigner
- Department of Surgery, Barmherzige Brüder Krankenhaus Graz, Graz, Austria
| | - Laura d'Allens
- Department of Surgery, Cantonal Hospital, Winterthur, Switzerland
| | - Caterina Allmer
- Department of Surgery, Barmherzige Brüder Krankenhaus Graz, Graz, Austria
| | - Andrea Álvarez
- Department of Surgery, Bellvitge University Hospital, Barcelona, Spain
| | - Rocio Anula
- Department of Surgery, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense de Madrid, Hospital Clínico San Carlos, Madrid, Spain
| | - Mihailo Andric
- Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Sam Atallah
- Department of Colorectal Surgery, AdventHealth, Orlando, Florida
| | - Simon Bach
- Department of Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Miklosh Bala
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Marie Barussaud
- Department of Surgery, University Hospital Poitiers, Poitiers, France
| | - Augustinas Bausys
- Department of Surgery, National Cancer Institute, Vilnius, Lithuania
| | - Brendan Bebington
- Department of Surgery, Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | - Andrew Beggs
- Department of Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Felipe Bellolio
- Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | | | - Anton Berdinskikh
- Department of Surgery, St-Petersburg Clinical Scientific and Practical Centre, St Petersburg, Russia
| | - Vicki Bevan
- Department of Surgery, Morriston Hospital, Swansea, Wales, United Kingdom
| | - Sebastiano Biondo
- Department of Surgery, Bellvitge University Hospital, Barcelona, Spain
| | | | - Marc Bludau
- Department of Surgery, University Hospital Cologne, Cologne, Germany
| | - Adam Boutall
- Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Nelleke Brouwer
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carl Brown
- Department of Surgery, St Paul's Hospital, the University of British Columbia, Vancouver, British Columbia, Canada
| | - Christiane Bruns
- Department of Surgery, University Hospital Cologne, Cologne, Germany
| | - Daniel D Buchanan
- Department of Clinical Pathology, the University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Pamela Buchwald
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | | | - Nikita Burlov
- Department of Surgery, Leningrad Regional Clinical Oncology Dispensary, Leningrad, Russia
| | | | - Maylis Capdepont
- Department of Surgery, Bordeaux University Hospital, Bordeaux, France
| | - Michele Carvello
- Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Hwee-Hoon Chew
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | | | - David Clark
- Department of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Marta Climent
- Department of Surgery, Bellvitge University Hospital, Barcelona, Spain
| | - Kyle G Cologne
- Department of Surgery, Keck Hospital, University of Southern California, Los Angeles
| | - Tomas Contreras
- Department of Surgery, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Roland Croner
- Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Ian R Daniels
- Department of Surgery, Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | - Giovanni Dapri
- Department of Surgery, St-Pierre University Hospital, Brussels, Belgium
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Paolo Delrio
- Colorectal Surgical Oncology, Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione G. Pascale" IRCSS, Naples, Italy
| | - Quentin Denost
- Department of Surgery, Bordeaux University Hospital, Bordeaux, France
| | - Michael Deutsch
- Department of Surgery, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Andre Dias
- Department of Surgery, Institute of Cancer of São Paulo, São Paulo, Brazil
| | | | - Evgeniy Drozdov
- Department of Surgery, Siberian State Medical University, Tomsk, Russia
| | - Daniel Duek
- Department of Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Malcolm Dunlop
- Department of Surgery, Western General Hospital, Edinburgh, United Kingdom
| | - Adam Dziki
- Department of Surgery, Military Medical Academy University Teaching Hospital, Łódź, Poland
| | - Aleksandra Edmundson
- Department of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Sergey Efetov
- Department of Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Alaa El-Hussuna
- Department of Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Brodie Elliot
- Department of Surgery, Whangarei Hospital, Whangarei, New Zealand
| | - Sameh Emile
- Department of Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - Eloy Espin
- Colorectal Surgery Unit, General Surgery Service, Hospital Vall de Hebron, Barcelona, Spain
| | - Martyn Evans
- Department of Surgery, Morriston Hospital, Swansea, Wales, United Kingdom
| | - Seraina Faes
- Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Omar Faiz
- Department of Surgery, St Mark's Hospital, London, United Kingdom
| | - Fergal Fleming
- Department of Surgery, University of Rochester, New York
| | - Caterina Foppa
- Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - George Fowler
- Department of Surgery, Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | - Matteo Frasson
- Department of Surgery, University Hospital La Fe, Valencia, Spain
| | - Nuno Figueiredo
- Department of Surgery, Champalimaud Clinical Centre, Lisbon, Portugal
| | - Tim Forgan
- Department of Surgery, Tygerberg Academic Hospital, Cape Town, South Africa
| | - Frank Frizelle
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Shamil Gadaev
- Fourth Coloproctology Department, St Petersburg Oncology Center, St Petersburg, Russia
| | - Jose Gellona
- Department of Colorectal Surgery, Clínica Santa María, Santiago, Chile
- Department of Colorectal Surgery, Hospital Militar de Santiago, Le Reina, Chile
| | - Tamara Glyn
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Jianping Gong
- Department of Surgery, Tongji Hospital, Wuhan, China
| | - Barisic Goran
- Department of Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Emma Greenwood
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Stephanie Guillon
- Department of Surgery, Bordeaux University Hospital, Bordeaux, France
| | - Ida Gutlic
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - Dieter Hahnloser
- Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Heather Hampel
- Division of Human Genetics, The Ohio State University Comprehensive Cancer Center, Columbus
| | - Ann Hanly
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Hirotoshi Hasegawa
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | | | - Andrew Hill
- Department of Surgery, Middlemore Hospital, Auckland, New Zealand
| | - James Hill
- Department of Surgery, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Jiri Hoch
- Department of Surgery, Motol University Hospital, Prague, Czech Republic
| | | | - Roel Hompes
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Luis Hurtado
- Department of Surgery, University Hospital La Fe, Valencia, Spain
| | | | | | - Rumana Islam
- Department of Surgery, Austin Hospital, Melbourne, Australia
| | | | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Aleksei Karachun
- Surgical Department of Abdominal Oncology, N. N. Petrov National Medical Research Centre of Oncology, St Petersburg, Russia
| | - Ahmer A Karimuddin
- Department of Surgery, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Deborah S Keller
- Division of Colorectal Surgery, Department of Surgery, University of California at Davis Medical Center, Sacramento
| | - Justin Kelly
- Advent Health Colorectal Surgery, Orlando, Florida
| | - Rory Kennelly
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Gleb Khrykov
- Department of Surgery, Leningrad Regional Clinical Oncology Dispensary, Leningrad, Russia
| | - Peter Kocian
- Department of Surgery, Motol University Hospital, Prague, Czech Republic
| | - Cherry Koh
- Department of Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Neils Kok
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Joep Knol
- Department of Surgery, Ziekenhuis Oost-Limburg, Belgium
| | | | - Hartwig Korner
- Department of Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Zoran Krivokapic
- Department of Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | | | - Hidde Maarten Kroon
- Department of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia
| | | | - Said Kural
- School of Medicine, Uludag University, Bursa, Turkey
| | - Miranda Kusters
- Department of Surgery, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Zaher Lakkis
- Department of Surgery, University Hospital Besançon, Besançon, France
| | - Timur Lankov
- Surgical Department of Abdominal Oncology, N. N. Petrov National Medical Research Centre of Oncology, St Petersburg, Russia
| | - Dave Larson
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - György Lázár
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Kai-Yin Lee
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Suk Hwan Lee
- Kyung Here University Hospital at Gangdong, Seoul, South Korea
| | - Jérémie H Lefèvre
- Sorbonne Université, Department of Digestive Surgery, Assistance Publique-Hôpitaux de Paris, Hôpital St Antoine, Paris, France
| | - Anna Lepisto
- Department of Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Christopher Lieu
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora
| | - Lynette Loi
- University of Glasgow, Glasgow, United Kingdom
| | - Craig Lynch
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | | | - Annalisa Maroli
- Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Sean Martin
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Anna Martling
- Department of Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Klaus E Matzel
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Julio Mayol
- Department of Surgery, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense de Madrid, Hospital Clínico San Carlos, Madrid, Spain
| | - Frank McDermott
- Department of Surgery, Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | | | - Monica Millan
- Department of Surgery, La Fe University Hospital, Valencia, Spain
| | - Martin Mitteregger
- Department of Surgery, Barmherzige Brüder Krankenhaus Graz, Graz, Austria
| | - Andrei Moiseenko
- Surgical Department of Abdominal Oncology, N. N. Petrov National Medical Research Centre of Oncology, St Petersburg, Russia
| | - John R T Monson
- AdventHealth Medical Group Colorectal Surgery, AdventHealth, Orlando, Florida
| | - Stefan Morarasu
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Konosuke Moritani
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Gabriela Möslein
- Department for Hereditary Tumors, Evangelisches Krankenhaus Bethesda, Duisburg, Germany
| | - Martino Munini
- Department of Surgery, Lugano Regional Hospital, Lugano, Switzerland
| | - Caio Nahas
- Department of Surgery, Institute of Cancer of São Paulo, São Paulo, Brazil
| | - Sergio Nahas
- Department of Surgery, Institute of Cancer of São Paulo, São Paulo, Brazil
| | - Ionut Negoi
- Department of Surgery, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Anastasia Novikova
- Department of Surgery, Pavlov First St Petersburg State Medical University's Clinic, St Petersburg, Russia
| | - Misael Ocares
- Department of Surgery, University Hospital Concepción, Concepción, Chile
| | | | - Alexandra Olkina
- Surgical Department of Abdominal Oncology, N. N. Petrov National Medical Research Centre of Oncology, St Petersburg, Russia
| | - Luis Oñate-Ocaña
- Department of Surgery, National Cancer Institute, Mexico City, Mexico
| | - Jaime Otero
- Department of Surgery, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense de Madrid, Hospital Clínico San Carlos, Madrid, Spain
| | - Cihan Ozen
- Department of Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Ugo Pace
- Colorectal Surgical Oncology, Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione G. Pascale" IRCSS, Naples, Italy
| | | | - Lidiia Panaiotti
- Surgical Department of Abdominal Oncology, N. N. Petrov National Medical Research Centre of Oncology, St Petersburg, Russia
| | - Yves Panis
- Department of Surgery, Beaujon Hospital, Paris, France
| | | | - Jason Park
- Department of Surgery, St Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Swati Patel
- Department of Gastroenterology, University of Colorado Anschutz Medical Campus, Aurora
| | | | - Miguel Pera
- Department of Surgery, Hospital del Mar, Barcelona, Spain
| | - Rodrigo O Perez
- Colorectal Surgery Division, Angelita and Joaquim Gama Institute, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Alexei Petrov
- Surgical Department of Abdominal Oncology, N. N. Petrov National Medical Research Centre of Oncology, St Petersburg, Russia
| | - Frank Pfeffer
- Department of Surgery, Haukeland University Hospital, Bergen, Norway
| | - P Terry Phang
- Department of Surgery, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Tomas Poskus
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Heather Pringle
- Department of Surgery, Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | - David Proud
- Department of Surgery, Austin Hospital, Melbourne, Australia
| | - Ivana Raguz
- Department of Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Nuno Rama
- Department of Surgery, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Shahnawaz Rasheed
- Department of Surgery, Royal Marsden Hospital, London, United Kingdom
| | - Manoj J Raval
- Department of Surgery, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Daniela Rega
- Colorectal Surgical Oncology, Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione G. Pascale" IRCSS, Naples, Italy
| | | | | | - Frederic Ris
- Department of Surgery, University Hospital Geneva, Geneva, Switzerland
| | - Stefan Riss
- Department of Surgery, Medical University Vienna, Vienna, Austria
| | | | - Campbell S Roxburgh
- Glasgow Royal Infirmary, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | | | | | - Tarik Sammour
- Department of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia
| | - Deborah Saraste
- Department of Surgery, Stockholm South General Hospital, Stockholm, Sweden
| | - Martin Schneider
- Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Ryo Seishima
- Department of Surgery, Keio University, Tokyo, Japan
| | | | - Toni Seppala
- Department of Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Kieran Sheahan
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Rebecca Shine
- Department of Surgery, Austin Hospital, Melbourne, Australia
| | - Alexandra Shlomina
- Department of Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | | | | | | | - Neil Smart
- Department of Surgery, Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | - Alejandro Solis
- Colorectal Surgery Unit, General Surgery Service, Hospital Vall de Hebron, Barcelona, Spain
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Roxane D Staiger
- Department of Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Scott Steele
- Department of Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Ker-Kan Tan
- Department of Surgery, School of Medicine, National University of Singapore, Singapore, Singapore
| | - Pieter J Tanis
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Centre Amsterdam, Amsterdam, The Netherlands
| | - Paris Tekkis
- Department of Surgery, Royal Marsden Hospital, London, United Kingdom
| | - Biniam Teklay
- Department of Surgery, Åbenrå Hospital, Åbenrå, Denmark
| | | | | | - Petr Tsarkov
- Department of Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Matthias Turina
- Department of Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Alexis Ulrich
- Department of Surgery, Lukas Hospital, Neuss, Germany
| | - Bruna B Vailati
- Department of Surgery, Angelita and Joaquim Gama Institute, São Paulo, Brazil
| | - Meike van Harten
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Cornelis Verhoef
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Satish Warrier
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Steve Wexner
- Department of Surgery, Cleveland Clinic Florida, Weston
| | - Hans de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Benjamin A Weinberg
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Cameron Wells
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | | | - Evangelos Xynos
- Department of Surgery, Creta Inter-Clinic Hospital, Heraklion, Crete, Greece
| | - Nancy You
- Department of Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Alexander Zakharenko
- Department of Surgery, Pavlov First St Petersburg State Medical University's Clinic, St Petersburg, Russia
| | | | - Des C Winter
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
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Bresteau C, Amiot A, Kirchgesner J, de'Angelis N, Lefevre JH, Bouhnik Y, Panis Y, Beaugerie L, Allez M, Brouquet A, Carbonnel F, Meyer A. Chronic pouchitis and Crohn's disease of the pouch after ileal pouch-anal anastomosis: Incidence and risk factors. Dig Liver Dis 2021; 53:1128-1135. [PMID: 33931341 DOI: 10.1016/j.dld.2021.03.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/07/2021] [Accepted: 03/24/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Restorative proctocolectomy with ileal-pouch anal-anastomosis (IPAA) is the operation of choice for patients with ulcerative colitis (UC) or with inflammatory bowel diseases unclassified (IBDU). AIMS to assess the incidence and risk factors of chronic pouchitis (CP) and Crohn's disease of the pouch (CDP) in patients with UC or IBDU. METHODS We conducted a retrospective study. We included consecutive patients who underwent IPAA between 2011 and 2019. The main outcome was the occurrence of CP or CDP. We looked for risk factors with multivariable and a least absolute shrinkage and selection operator (LASSO) Cox models. RESULTS 247 patients were included. The 5-year cumulative incidence of CP or CDP was 35.3% (95%CI: 26.2-43.2). In multivariable analysis, diagnosis of IBDU, age less than 35 years at surgery and extra-intestinal manifestations other than articular and primary sclerosing cholangitis were associated with higher incidence. The LASSO analysis identified these three prognostic factors and articular manifestations. In patients with two or more prognostic factors, 5-year cumulative incidence, was 65.2% (95%CI: 41.8-79.2). CONCLUSIONS Five years after IPAA, approximately one-third of patients had either CP or CDP. Risk factors were IBDU, an age less than 35 years at surgery, articular manifestations and other extra-intestinal manifestations.
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Affiliation(s)
- Clément Bresteau
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Université Paris Saclay, CHU Bicêtre, 78, rue du Général Leclerc, Le Kremlin Bicêtre 94270, France
| | - Aurélien Amiot
- Assitance-Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, EA7375, Universite Paris Est Creteil, Créteil, France
| | - Julien Kirchgesner
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Nicola de'Angelis
- Assitance-Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, EA7375, Universite Paris Est Creteil, Créteil, France
| | - Jérémie H Lefevre
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Yoram Bouhnik
- Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Université de Paris, Clichy, France
| | - Yves Panis
- Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Université de Paris, Clichy, France
| | - Laurent Beaugerie
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Matthieu Allez
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - Antoine Brouquet
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Université Paris Saclay, CHU Bicêtre, 78, rue du Général Leclerc, Le Kremlin Bicêtre 94270, France
| | - Franck Carbonnel
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Université Paris Saclay, CHU Bicêtre, 78, rue du Général Leclerc, Le Kremlin Bicêtre 94270, France.
| | - Antoine Meyer
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Université Paris Saclay, CHU Bicêtre, 78, rue du Général Leclerc, Le Kremlin Bicêtre 94270, France
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50
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Frontali A, Rottoli M, Sampietro G, Spinelli A, Celentano V, Colombo F, Frasson M, Poggioli G, Panis Y. Chirurgie des maladies inflammatoires chroniques de l’intestin et COVID-19 : étude européenne multicentrique (COVIBD-SURG). Journal de Chirurgie Viscérale 2021. [PMCID: PMC8361211 DOI: 10.1016/j.jchirv.2021.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
But Méthodes Résultats Conclusions
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