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Calini G, Abd El Aziz MA, Solafah A, Saeed HA, Lovely JK, D'Angelo AL, Larson DW, Kelley SR, Colibaseanu DT, Behm KT. Laparoscopic transversus abdominis plane block versus intrathecal analgesia in robotic colorectal surgery. Br J Surg 2021; 108:e369-e370. [PMID: 34459868 DOI: 10.1093/bjs/znab294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/21/2021] [Indexed: 11/14/2022]
Affiliation(s)
- G Calini
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - M A Abd El Aziz
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - A Solafah
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - H A Saeed
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - J K Lovely
- Department of Pharmacy Services, Mayo Clinic, Rochester, Minnesota, USA
| | - A-L D'Angelo
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - D W Larson
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - S R Kelley
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - D T Colibaseanu
- Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - K T Behm
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Quiram BJ, Crippa J, Grass F, Lovely JK, Behm KT, Colibaseanu DT, Merchea A, Kelley SR, Harmsen WS, Larson DW. Impact of enhanced recovery on oncological outcomes following minimally invasive surgery for rectal cancer. Br J Surg 2019; 106:922-929. [PMID: 30861099 DOI: 10.1002/bjs.11131] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/18/2018] [Accepted: 01/15/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Oncological outcomes of locally advanced rectal cancer depend on the quality of surgical and oncological management. Enhanced recovery pathways (ERPs) have yet to be assessed for their oncological impact when used in combination with minimally invasive surgery. This study assessed outcomes with or without an ERP in patients with rectal cancer. METHODS This was a retrospective analysis of all consecutive adult patients who underwent elective minimally invasive surgery for primary rectal adenocarcinoma with curative intent between February 2005 and April 2018. Both laparoscopic and robotic procedures were included. Short-term morbidity and overall survival were compared between patients treated according to the institutional ERP and those who received conventional care. RESULTS A total of 600 patients underwent minimally invasive surgery, of whom 320 (53·3 per cent) were treated according to the ERP and 280 (46·7 per cent) received conventional care. ERP was associated with less overall morbidity (34·7 versus 54·3 per cent; P < 0·001). Patients in the ERP group had improved overall survival on univariable (91·4 versus 81·7 per cent at 5 years; hazard ratio (HR) 0·53, 95 per cent c.i. 0·28 to 0·99) but not multivariable (HR 0·78, 0·41 to 1·50) analysis. Multivariable analysis revealed age (HR 1·46, 1·17 to 1·82), male sex (HR 1·98, 1·05 to 3·70) and complications (HR 2·23, 1·30 to 3·83) as independent risk factors for compromised overall survival. Disease-free survival was comparable for patients who had ERP or conventional treatment (80·5 versus 84·6 per cent at 5 years respectively; P = 0·272). CONCLUSION Treatment within an ERP was associated with a lower morbidity risk that may have had a subtle impact on overall but not disease-specific survival.
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Affiliation(s)
- B J Quiram
- St Olaf College, Northfield, Minnesota, USA
| | - J Crippa
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - F Grass
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - J K Lovely
- Mayo Clinic Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
| | - K T Behm
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - D T Colibaseanu
- Mayo Clinic Pharmacy, Mayo Clinic, Rochester, Minnesota, USA.,Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - A Merchea
- Mayo Clinic Pharmacy, Mayo Clinic, Rochester, Minnesota, USA.,Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - S R Kelley
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - W S Harmsen
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - D W Larson
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Behm KT, Cole JM, Joglekar AS, Gerstmayr E, Wood JC, Baird CD, Blackburn TG, Duff M, Harvey C, Ilderton A, Kuschel S, Mangles SPD, Marklund M, McKenna P, Murphy CD, Najmudin Z, Poder K, Ridgers CP, Sarri G, Samarin GM, Symes D, Warwick J, Zepf M, Krushelnick K, Thomas AGR. A spectrometer for ultrashort gamma-ray pulses with photon energies greater than 10 MeV. Rev Sci Instrum 2018; 89:113303. [PMID: 30501337 DOI: 10.1063/1.5056248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 10/16/2018] [Indexed: 06/09/2023]
Abstract
We present a design for a pixelated scintillator based gamma-ray spectrometer for non-linear inverse Compton scattering experiments. By colliding a laser wakefield accelerated electron beam with a tightly focused, intense laser pulse, gamma-ray photons up to 100 MeV energies and with few femtosecond duration may be produced. To measure the energy spectrum and angular distribution, a 33 × 47 array of cesium-iodide crystals was oriented such that the 47 crystal length axis was parallel to the gamma-ray beam and the 33 crystal length axis was oriented in the vertical direction. Using an iterative deconvolution method similar to the YOGI code, modeling of the scintillator response using GEANT4 and fitting to a quantum Monte Carlo calculated photon spectrum, we are able to extract the gamma ray spectra generated by the inverse Compton interaction.
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Affiliation(s)
- K T Behm
- Center for Ultrafast Optical Science, University of Michigan, Ann Arbor, Michigan 48109-2099, USA
| | - J M Cole
- The John Adams Institute for Accelerator Science, Imperial College London, London SW7 2AZ, United Kingdom
| | - A S Joglekar
- Physics and Astronomy, University of California, Los Angeles, Los Angeles, California 90095, USA
| | - E Gerstmayr
- The John Adams Institute for Accelerator Science, Imperial College London, London SW7 2AZ, United Kingdom
| | - J C Wood
- The John Adams Institute for Accelerator Science, Imperial College London, London SW7 2AZ, United Kingdom
| | - C D Baird
- York Plasma Institute, Department of Physics, University of York, York YO10 5DD, United Kingdom
| | - T G Blackburn
- Department of Physics, Chalmers University of Technology, SE-41296 Gothenburg, Sweden
| | - M Duff
- SUPA Department of Physics, University of Strathclyde, Glasgow G4 0NG, United Kingdom
| | - C Harvey
- Department of Physics, Chalmers University of Technology, SE-41296 Gothenburg, Sweden
| | - A Ilderton
- Department of Physics, Chalmers University of Technology, SE-41296 Gothenburg, Sweden
| | - S Kuschel
- Institut für Optik und Quantenelektronik, Friedrich-Schiller-Universität, 07743 Jena, Germany
| | - S P D Mangles
- The John Adams Institute for Accelerator Science, Imperial College London, London SW7 2AZ, United Kingdom
| | - M Marklund
- Department of Physics, Chalmers University of Technology, SE-41296 Gothenburg, Sweden
| | - P McKenna
- SUPA Department of Physics, University of Strathclyde, Glasgow G4 0NG, United Kingdom
| | - C D Murphy
- York Plasma Institute, Department of Physics, University of York, York YO10 5DD, United Kingdom
| | - Z Najmudin
- The John Adams Institute for Accelerator Science, Imperial College London, London SW7 2AZ, United Kingdom
| | - K Poder
- The John Adams Institute for Accelerator Science, Imperial College London, London SW7 2AZ, United Kingdom
| | - C P Ridgers
- York Plasma Institute, Department of Physics, University of York, York YO10 5DD, United Kingdom
| | - G Sarri
- School of Mathematics and Physics, The Queen's University of Belfast, BT7 1NN Belfast, United Kingdom
| | - G M Samarin
- School of Mathematics and Physics, The Queen's University of Belfast, BT7 1NN Belfast, United Kingdom
| | - D Symes
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot OX11 0QX, United Kingdom
| | - J Warwick
- School of Mathematics and Physics, The Queen's University of Belfast, BT7 1NN Belfast, United Kingdom
| | - M Zepf
- Institut für Optik und Quantenelektronik, Friedrich-Schiller-Universität, 07743 Jena, Germany
| | - K Krushelnick
- Center for Ultrafast Optical Science, University of Michigan, Ann Arbor, Michigan 48109-2099, USA
| | - A G R Thomas
- Center for Ultrafast Optical Science, University of Michigan, Ann Arbor, Michigan 48109-2099, USA
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Thiels CA, Bergquist JR, Meyers AJ, Johnson CL, Behm KT, Hayman AV, Habermann EB, Larson DW, Mathis KL. Outcomes with multimodal therapy for elderly patients with rectal cancer. Br J Surg 2015; 103:e106-14. [PMID: 26662377 DOI: 10.1002/bjs.10057] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 09/30/2015] [Accepted: 10/21/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Treatment guidelines for stage II and III rectal cancer include neoadjuvant chemoradiotherapy, surgery and postoperative adjuvant chemotherapy. Although data support this recommendation in younger patients, it is unclear whether this benefit can be extrapolated to elderly patients (aged 75 years or older). METHODS This was a retrospective review of patients aged at least 75 years with stage II or III rectal cancer who underwent surgery with curative intent from 1996 to 2013 at the Mayo Clinic. Kaplan-Meier analysis and log rank test were used to compare overall survival between therapy groups. Cox proportional hazards model was used to estimate the independent effect of treatment group on survival. RESULTS A total of 160 elderly patients (median age 80 years) with stage II (66) and stage III (94) rectal cancer underwent surgical resection. Only 30·0 and 33·8 per cent received neoadjuvant or adjuvant therapy respectively. Among patients with stage II disease, there was no significant difference in 60-month survival between patients who received any additional therapy and those who had surgery alone (55 versus 38 per cent respectively; P = 0·184), whereas additional therapy improved survival in patients with stage III tumours (58 versus 30 per cent respectively; P = 0·007). Multivariable analysis found a survival benefit for additional therapy in elderly patients with stage III disease (hazard ratio 0·58, 95 per cent c.i. 0·34 to 0·98). CONCLUSION A multimodal approach in elderly patients with stage III rectal cancer improved oncological outcomes.
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Affiliation(s)
- C A Thiels
- Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - J R Bergquist
- Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - A J Meyers
- Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - C L Johnson
- Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - K T Behm
- Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - A V Hayman
- Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - E B Habermann
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - D W Larson
- Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - K L Mathis
- Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
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