1
|
Morarasu S, Livadaru C, Dimofte GM. Quality assessment of surgery for colorectal cancer: Where do we stand? World J Gastrointest Surg 2024; 16:982-987. [PMID: 38690042 PMCID: PMC11056676 DOI: 10.4240/wjgs.v16.i4.982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/05/2024] [Accepted: 03/21/2024] [Indexed: 04/22/2024] Open
Abstract
Quality assurance in surgery has been one of the most important topics of debate among colorectal surgeons in the past decade. It has produced new surgical standards that led in part to the impressive oncological outcomes we see in many units today. Total mesorectal excision, complete mesocolic excision (CME), and the Japanese D3 lymphadenectomy are now benchmark techniques embraced by many surgeons and widely recommended by surgical societies. However, there are still ongoing discrepancies in outcomes largely based on surgeon performance. This is one of the main reasons why many countries have shifted colorectal cancer surgery only to high volume centers. Defining markers of surgical quality is thus a perquisite to ensure that standards and oncological outcomes are met at an institutional level. With the evolution of CME surgery, various quality markers have been described, mostly based on measurements on the surgical specimen and lymph node yield, while others have proposed radiological markers (i.e. arterial stumps) measured on postoperative scans as part of the routine cancer follow-up. There is no ideal marker; however, taken together and assembled into a new score or set of criteria may become a future point of reference for reporting outcomes of colorectal cancer surgery in research studies and defining subspecialization requirements both at an individual and hospital level.
Collapse
Affiliation(s)
- Stefan Morarasu
- The Second Department of Surgical Oncology, Regional Institute of Oncology, Iasi 707483, Romania
| | - Cristian Livadaru
- The Second Department of Surgical Oncology, Regional Institute of Oncology, Iasi 707483, Romania
| | - Gabriel-Mihail Dimofte
- The Second Department of Surgical Oncology, Regional Institute of Oncology, Iasi 707483, Romania
| |
Collapse
|
2
|
Xu W, Liu G, Varghese C, Wells C, Smith N, Windsor J, Gaborit L, Goh S, Basam A, Elhadi M, Soh RT, Saeed U, Abdulwahed E, Farrell M, Wright D, Martin J, Pockney P, Xu W, Basam A, Goh S, Li J, Shah J, Waraich A, Gaborit L, Pathak U, Hilder A, Elhadi M, Jabur A, Kalyanasundaram K, Ohis C, Ong CF, Park M, Siribaddana V, Raubenheimer K, Vu J, Wells C, Liu G, Ferguson L, Xu W, Varghese C, Pockney P, Atherton K, Dawson A, Martin J, Banerjee A, Dudi-Venkata N, Lightfoot N, Ludbrook I, Peters L, Sara R, Watson D, Wright D, Adeyeye A, Alvarez-Lozada LA, Atici SD, Buhavac M, Calini G, Elhadi M, Ioannidis O, Tepe MD, Nath U, Uzair A, Yang W, Zaidi F, Singh S, Abdullah B, Palacios DSG, Ragab A, Ahmed A, Raubenheimer K, Daudu D, Goh S, Benyani SV, Karthikeyan N, Mansour LT, Seow W, Tasi Z, Jabur A, Pathak U, Park M, Abdelmelek DE, Boussahel IFZ, Kaabache O, Lemdaoui N, Nebbar O, Rais M, Abdoun M, Kouicem AT, Bouaoud S, Bouchenak K, Saada H, Ouyahia A, Messai W, Choong ZS, Ting C, Larkin M, Fong PJ, Soh I, Grandi AD, Iftikhar H, Sinha A, Kapoor D, Chlebicka T, Singer D, Goddard K, Matthews L, Lin R, Chambers J, Chan J, Macnab B, Barker J, Mckenzie M, Ferguson N, Juwaheer G, Muralidharan V, Gill S, Sung N, Patel R, Walters C, Nguyen K, Liu D, Cabalag C, Lee J, Leow SHA, Ng SL, Ashraf H, Mulder F, Loo J, Proud D, Wong S, Zhou Y, Soh QR, Chye D, Stevens S, Tang P, Kritharides S, Dong J, Morice O, Huang D, Hardidge A, Amarasekara M, Kink A, Bolton D, Rawal A, Singh J, Heard M, Hassan Y, Naqeeb A, Cobden A, Prinsloo D, Quadros D, Gunn E, Kim HJ, Ekwebelam J, Shanahan J, Alkazali M, Hoosenally M, Nara N, Nguyen P, Barker S, Hilder A, Hui A, Karmakar A, Wang B, Goonawardena J, Cheung KT, Chan N, Natarajan R, Cade R, Jin R, Sengupta S, Snider R, Morisetty H, Weeda L, Sun P, Chilaka L, Cover J, Gunasekara ADSA, Senthilrajan R, Alwahaib A, Limmer A, Zamanbandhon B, Jaffry K, Shen Y, Chua A, Syed S, Saha S, Glynatsis J, Aitchison L, Lagana B, Crossman M, Watson D, Dawson A, Fong B, Harrison E, Horsburgh E, Glynatsis J, Khoo M, Mishra K, Hewton L, Mesecke A, Tu H, Tun T, Wong J, Ong E, Law TN, Landy A, Leano A, Li A, Soni A, Dowdle B, Pilgrim C, Abeysirigunawardana D, Jeyarajan DR, Patel D, Mckinnon K, Gould M, Gilmore P, Geng R, Loughnan R, Norton-Smith S, Nyame S, Tan S, Yoon SW, Wang Y, Zhang Y, Wang Z, Mare H, Withanage I, Khattar M, Toft A, Sivasuthan G, Zhao H, Addley J, O'brien L, Raza M, Bindra R, Sharma S, Cornwell C, Patil A, Cheung A, Lown A, Dawson A, Blassey A, Ochigbo B, Cheng F, Fatima A, Zhang E, Kocatekin H, Roth C, Brewster D, Kwok K, Chen P, Laura S, Tynan D, Latif E, Lun E, Honore E, Ziergiebel F, Blake J, Chandiok K, Bird K, Ngothanh L, Lee M, El-Masry M, Hamer P, Palaniappan RR, Mcgee R, Huang S, Zhang S, Hariharan S, Silva YD, Lee C, Fotheringham P, Incoll I, Cordingley T, Cheng F, Brown M, Kang L, Wijayaratne R, Moore P, Qian G, Elgindy Y, Carnuccio E, Rae H, Shehata M, Liu M, Lockwood B, Bockxmeer JV, Alsoudani A, Swan D, Hsieh J, Orchard-Hall F, Tay KYJ, Mehra R, Gebeh A, Bailey A, Brown G, Colaco A, Gopal H, Boyley J, Changati V, Fletcher J, Khandelwal T, House C, O'neil C, Jaarsma E, Ly V, Balogh Z, Shui A, Sathasivam V, Legge-Wilkinson H, Wong KH, Chen A, Tran A, Rehfisch P, Wang G, Nguyen J, Peker J, Gallert K, Komesaroff M, Namburi M, Goldfinch E, Muchabaiwa R, Jangam A, Taylor I, Nusem I, Park JH(D, Gundara J, Heigan R, Tran T, Mackay T, Butterworth Y, Sadauskas T, Tung M, Ellepola H, Gan C, Fong H, Das A, Naicker L, Hauptman S, Kamath A, Yew A, Parange A, Kim K, Kharwadkar S, Gamage T, Vance L, Seldon A, Ghaly M, Phan V, Chauhan K, Bassam A, Vollenhoven B, Jaffry K, Mandhan K, Sritharan M, Sakthivel M, Evans N, Robinson S, Sivakumar S, Marrison L, Jollow D, Joshi K, Tao S, Shrestha P, Nukala SK, Hodgson R, Crotty A, Esho A, Harris A, Surkitt A, Bland L, Mcleod B, Yin C, Keng C, Greenwood E, Yuan G, Haege E, Wu H, Xiao H, Pozzi I, Fu J, Ross JS, Gentle J, Gan K, Chang K, Sun K, Singh M, Xie M, Mccabe N, Slavec M, Clarnette N, Niknami B, Zou P, Flintoft S, Jayatilleke S, Sok R, Tan S, Wadhwa S, Swansson W, Abulafia D, Blundell J, Sweetapple A, Solar CD, Martin C, Bell D, Fernando I, Chang J, Vanzuylekom K, Zuylekom KV, Zuylekom KV, Hobbs K, Liang R, Jabur A, Tarmidi J, Ugool M, Beatson N, Bowman S, Moin S, Tan WPJ, Chidambaram S, Gan SW, Wang P, Naicker L, Kim K, Wang NQ, Kwan YX, Patil C, Joshi D, Kamath A, Hanan A, Sheriff A, Duffield J, Naiker L, Smitham P, Neo EL, Chua M, Prasad S, Nagaratnam A, Sammour T, Lin Y, Lee C, Hopping E, Jangra M, Das A, Lin K, Bunjo Z, Raubenheimer K, Yunos MHM, Yeung KL, Phu R, Betts A, Just B, Gera S, Leeson H, Jamieson J, Wang K, Luu E, Innes M, Vu J, Hong J, Dzator S, Flame A, Jiang V, Kwok J, Lawrence A, Meads K, Pearce L, Sarangadasa P, Shaw H, Yu V, Crostella ;E, Wong J, Bobba S, Muller M, Hau YCH, Wilson T, Markovic A, Green J, Forbes C, Burrows E, Hou L, O'sullivan C, Foo J, Greig H, Collins AJ, Chandler C, Heaney E, Gross H, Morgan M, Loder R, Rajesh K, Ananthapadmanabhan S, Razmi A, Vong C, Pothukuchi P, Theophilus M, Sriranjan R, Kaur S, Kanczuk M, Groot JD, Corrigan A, Li D, Badri D, Ciranni D, Needi ET, Clanfield M, Copertino N, Rumble W, Vanguardia MK, Lew C, Dennaoui R, Shah J, Kong J, Koh I, Zeng R, Baziotis-Kalfas K, Denby H, Li A, Tran W, Singh A, Lin O, Chau M, Donaldson O, Min C(S, Ballah S, Tsui SCT, Yong N, Standish L, Tan S, Fujihara A, Davies L, Odisho R, Ravi A, Collins J, Chandra P, Abdelmeguid R, Singh G, Feierdaiweisi X, Seneviratne D, Srivastava S, Yao M, Teng C, Chowdhury N, Vidanagama S, Lin C, Sampatha-Waduge T, Wang E, Yodkitydomying C, Koh I, Silverii J, Lam A, Zeng R, Solanki K, Franks A, Edwards L, Atilhan R, Nandurkar R, Wells O, Vanguardia K, King D, Edwards E, Edwards L, Tran Q, Chau M, Min S, Rauf A, Fu Y, Haximolla H, Shang M, Segaran S, Wang S, Sivakumar G, Sandhu JK, Mishra N, Hauptman S, Chua A, Chene D, Maddern G, Shaw H, Wang Q, Pang S, Lu C, Fung J, Cyr K, Lu K, How MZ, Hu N, Anderson P, Jakanovski P, Youssef A, Tang H, Keenan R, Chan A, Canny M, Tahir F, Egerton J, Yeung J, Chan J, Tiffany L, Bei M, Raj M, Williams P, Nagpal S, Outhred T, Krawitz R, Choi CCM, Younus K, Giurgius M, Kirk R, Pegorer AG, Tang-Ieam P, Ward J, Wijetunga A, Zhang C, Nahm C, Wang C, Golja D, Jenkins G, Qian H, Luong J, Nguyen K, Suttor S, Lai S, Ma V, Chen Y, Yu HH, Lee A, Barbaro A, Mcguinness C, Maddern G, Young S, Lim YF, Trotta G, Chao P, Ding G, Fang C, Lu A, Wagaarachchi P, Cornwell C, Gojnich A, Stewart P, Dong I, Wong K, Burruso L, Hogan L, Mcorist N, Singh R, Jeyamohan R, Hou Z, Lai W, Taylor E, Palacios DSG, Pantoja MAN, Nanez DMB, Hernandez GOP, Jimenez Ramirez LJ, Mohamed M, El-Taher AK, Elewa A, Soliman MA, Diab M, Ali R, Ahmed A, Galal A, Elkhodary A, Alaa A, Faisal A, Badawy A, Eldomiaty D, Sayed MA, Rasslan E, Ramadan M, Fares GE, Altabbaa H, Emad H, Alboridy M, Mongy M, Albarhomy O, Selim O, Rafaei R, Atta R, Altaweel A, Sherif Y, Elghoul Y, Tarek Y, Sabry AA, Moustafa A, AbouHiekal O, Shaqran OA, Haggag Z, Abbas AM, Temerik AR, Atef D, Mahmoud A, Saad MM, Ragab M, Mahmoud AO, Hussien A, Abdelbaky M, Muhammad I, Morad A, Ali A, Hussien A, Shipa A, Aboulfotouh A, Abdelaal AM, Hashem AM, Youssef AA, Morsi A, Ebrahim A, Sayed AM, Kamel AM, Elmaghrabey A, Elgharib AM, Abdelrahman A, Ali A, Abdelnaeam S, Emam A, el-mola AG, Shaban A, Shaltout AS, Nabil B, Barsoum F, Mostafa E, Abdelbaset D, Salah D, Othman D, Othman S, Khairallah NS, Hassan SA, Morsi S, Azer A, Abdelsamed EA, Ahmed R, Ibrahim I, AbdElbaset E, Hamoda E, Monib F, Harb F, Maher H, Ahmed H, Mohammed H, Hana K, Ayoub K, Henes K, Shamshoon K, Soliman K, Hassanein M, Abdelhamid MM, Mahdy M, Khalil M, Ali M, Khalifa M, Amary M, Suliman ME, Abdallah MM, Nasr MSA, Elia M, Adly M, Roshdy M, Ramadan MF, Shahat MA, Abdelnasser MK, Zaed M, Al-Quossi M, Zarzour MA, Hares MM, Abdelfatah MA, Abughanima M, Abdeljaber M, Saber M, Amin MK, Abbas M, Haroon O, Khalil O, Talaat O, Elnagar R, Soliman R, Aboelela R, Salah S, Abdelgawad S, Mohammed T, Hussien TA, Sobhy G, Sayed Y, Silem YOR, Dawood A, Hemaida T, Ahmed R, Kamaleldin A, Zakaria A, Salah M, Salem E, Rashed OFAA, Halawa M, Elfeki H, Mosaad A, Shaaban A, Abdelsalam H, Sakr A, Sanad A, Elsawy A, Maged BM, Hegazy D, Abdelmaksoud M, Laymon M, Taman M, Moawad ER, AboElfarh HE, Elkenawi K, Osama M, Sadek M, Elghazy MA, Attia M, Nader M, Shalaby M, Attiya O, Gaarour OS, Zaghloul A, Mikhail P, Badr K, Soltan H, Donia M, Gaafar M, Abdelwahab K, Sallam A, Eid A, Yousri M, Hamdy O, Al-Touny A, Alshawadfy A, Hamdy A, Ellilly A, Mahdy A, El-Sakka A, Hendawy H, Salah A, Raslan B, Teema E, Albayadi E, Nasser E, Mohamed H, Mahmoud M, Elsaied M, Taha O, Dahshan S, Al-Touny S, Karrar A, Khairy A, Farag A, Deafallah A, Ads AM, Alomar R, AbuShawareb I, Saeed A, Mashaal A, Ads AM, Ghanem S, Elghamry A, Nada EA, Noureldin YA, Fouda MF, Shaheen N, Allam S, Mazrou I, Shehab AF, Kussaili W, Korkolis D, Fradelos E, Sarafi A, Machairas N, Giannakopoulos KS, Stavratis F, Korovesis G, Tsourouflis G, Keramida MD, Kydonakis N, Kykalos S, Syllaios A, Dorovinis P, Schizas D, Ioannidis O, Malliora A, Anestiadou E, Zapsalis K, Kontidis F, Loutzidou L, Ouzounidis N, Bitsianis S, Symeonidis S, Skalidou S, Ioannidis O, Valaroutsou OM, Dagklis T, Arvanitaki A, Mamopoulos A, Athanasiadis A, Kopatsaris S, Kalogiannidis I, Tsakiridis I, Kapetanios G, Papanikolaou E, Tsakiridis N, Zachomitros F, Larentzakis A, Gyftopoulos A, Albanopoulos K, Champipis A, Yiannakopoulos C, Vrakopoulou GZ, Saliaris K, Lathouras K, Skoufias S, Doulami G, Bareka M, Arnaoutoglou E, Angelis F, Angeslis F, Hantes M, Ntalouka M, Al-Juaifari MA, Alwash M, Maala R, Zwain YA, Saleh SA, Khorsheed M, Pesce A, Feo CV, Bernabei M, Petrarulo F, Fabbri N, Labriola R, Barbara SJ, Bosi S, Romano A, Canavese A, Catalioto C, Isopi C, Larotonda C, Dajti G, Rottoli M, Russo IS, Cardelli S, Castagnini F, Traina F, Guizzardi G, Giuzzardi G, Gorgone M, Maestri M, Cianci P, Conversano I, Restini E, Gattulli D, Grillea G, Varesano M, Calini G, Andriani A, Gattesco D, Terrosu G, Zambon M, Cerinic PM, Moretti L, Muschitiello D, Polo S, Bresadola V, Wardeh SA, Al-Baw M, Alhaleeq S, Al-Issawi S, Alsaify E, Banihani F, Massadeh N, Massadeh N, Al-issawi D, Elyan B, Al-Shami Q, Alomari Y, Khamees A, Al-Tahayneh SA, Alsheik A, Sawaftah K, Sarhan O, Alkhatib AA, Alzghoul B, Saleh A, Yaghmour J, Shahin M, Maali M, Alatefi D, Al-Smirat H, Hezam A, Alathameen N, Kaddah AA, Al Hammoud A, Ayasrah S, Abuuqteish H, Al-Mwajeh T, Makableh R, Bataineh S, Shabaneh A, Alnatsheh W, Aldeges M, Hamad H, Shehahda S, Khassawneh D, Alzyoud O, Alrosan R, Awad H, Khaldoon T, Shannaq R, hamoud MA, fadalah BA, Al-Hazaimeh M, Khraise W, Alnajjar L, Alnajjar M, Al-Omary S, Ababneh A, Albashaireh A, Khadrawi M, Aljamal M, Athamneh T, Muqbel RA, Al-jammal M, Masarrat A, Al-zawaydeh A, Taha I, Qattawi T, Smadi R, Alhaleem A, Alboon M, Hazaymeh O, Karasneh L, Al-Haek S, Almahroush M, Alfrijat T, Elporgay A, Shanag H, Agilla H, Alameen H, Bensalem M, Altair M, Ghemmied M, Alarabi R, Alhudhairy S, Gweder R, Alzarroug A, Alabed E, Elreaid F, Elkharaz OA, Elreaid FF, Albatni SS, Elmehdawi H, Gahwagi M, Mohamed A, Alfrjani T, Khafifi K, Rasheed A, Akwaisah A, Bushaala H, Elfadli M, Moftah M, Algabbasi S, Esaiti S, Elfallah S, Alharam A, Alariby F, Isweesi M, Eldarat TA, Dabas AA, Alkaseek A, Abodina AM, Alqaarh A, Bakeer HB, Alhaddad HS, Aboudlal H, Alsaih S, Abubaker N, Abdelrahim N, Alzarga A, Omar B, Faris F, Alhadad Q, Abufanas A, Badi H, Benismai I, Obeid H, Abdalei A, Abdulrahman A, Swalem A, Alzarouq E, Safar A, Shagroun E, Hashem B, Elrishi F, Abdulali F, Ahmed H, Eltaib I, Elzoubia J, Albarki A, Mugassabi HE, Abushaala F, Abuzaho A, Juha N, Egzait R, Shetwan S, Lemhaishi A, Matoug F, Abdulwahed E, Askar A, Ashur AB, Bezweek A, Altughar B, Emhimmed D, Elferis D, Elgherwi L, Soula E, Gidiem D, Grada M, Derwish K, Alameen M, Algatanesh N, Elkheshebi A, Ghmagh R, Barka S, Ahmeed S, Aljamal S, Alragig Z, Addalla M, Atia A, Kharim A, Mahmoud F, Binnawara M, Alshareea E, Alsori M, Alshawesh A, Alrifae GMH, Ashour A, Abozid A, Alflite AOS, Mohamed A, Arebi J, Alagelli F, Gineeb HY, Ghmagh R, Omar RMB, Alaqoubi R, Mohammed S, Bensalem SH, Elgadi T, Sami W, Bariun Y, Alhashimi AMA, Abdulla DA, Rhuma H, Enaami H, Alboueishi AA, Alkchr HBHMAA, Albakosh BA, Hasan NB, Alsari N, Aldreawi M, Abushanab K, Yahya R, Samalavicius N, Eismontas V, Jurgaitis J, Aliosin O, Nutautiene V, Zakaria AD, Pillai AKSK, Vadioaloo DK, Daud MAM, Soh JY, Zakaria MZ, Rusli SM, Ashar NAK, Ahmad ZA, Ramlee AA, Alsagoff SNASAL, Sofian AA, Jamil MBHM, Abdullah B, Noorman MF, Abidin MFZ, Isahak MI, Adnan SNN, Noor ZHM, Alvarez-Lozada LA, Garza AQ, Leal AA, Reyes BAF, Guerra EVO, Garza FJA, Mey HEA, Isais JAR, Zertuche JTG, García PLG, Sánchez LAH, Mercado MPF, Sierra OAV, Morales PER, Fuentes SO, Martínez VMP, Guerra-Juárez YA, Flores-González AK, Singh S, Hadi A, Woodbridge C, Thornton-Hume D, Forsythe J, Dharmaratne I, Pai V, Windsor J, Zargar K, Waldin L, Winthrop L, Alvarez M, Huang M, Kumove M, Simonetti M, Chand N, Goldsmith O, Guo O, Monk P, Zhou K, Penneru SH, Prasad S, Ren S, Hill T, Mistry V, Sun S, Pereira A, Mclaughlin S, Stokes A, Sathiyaseelan A, Rossaak J, Lim J, Brooke K, Quinlan L, Pottier M, Podder N, Jinu P, Ramphal S, Vermeulen W, Jeffery F, Busaidi ISA, Divinagracia J, Ju W, Liu Y, Glyn T, Thompson N, Graziadei V, Canton J, Furey J, Choi H, Coomber G, Divekar T, English T, Gernhoefer E, Healy T, Chou J, Parajuli D, Reed C, Studd R, Lin A, Wells C, Xu C, Hadi A, Maccormick A, Park H, Rathnayake A, Williams B, Chan A, Smith C, Casciola F, Bhikha J, Luo J, Yi K, Singhal M, George R, Luo R, Frost T, Hakak F, George A, Carlos A, Ho A, Mcrae C, Lescheid J, Soek J, Pham A, Clair SS, Yee SA, Lim J, Wu CY, Kim T, Chua AQ, Harmston C, Boyes H, Cook H, Struthers J, Radovanovich J, Quek N, Fearnley-Fitzgerald C, Wright D, Ghandi K, Matheson N, McGuinness MJ, Chen B, Douglas RI, Richter K, Soliman NB, Bolam SM, Vimalan V, Currie W, Cuthbert M, Ross P, Nicholson A, Garton B, Agnew E, Conlon N, Waaka N, Kejriwal R, Nguyen S, Leung E, Ratnayake M, Smith Q, Joseph N, Yue B, Fraser C, Lam C, Figgitt E, Liu G, Tan K, You HS, Zheng H, Luo J, Sharp J, Khanna K, Simiona L, Luo M, Ratnayake M, Wong P, Luu R, Paul R, Nair S, Asadyari-Lupo S, Hung W, Ying G, Ho J, Wu A, Walsh E, Lee J, Liu J, Yao S, Nosseir O, Dang J, Young S, Zyul'korneeva S, Boyd T, Ho J, Wu A, Yao S, Kirfi AM, Ningi AB, Garba MA, Salihu MB, Ukwuoma OE, Ibrahim A, Sajo IM, Aminu MB, Usman LH, Lanre ON, Shuaibu IS, Yusuf S, Ismail T, Umar GI, Adeyeye A, Afeikhena E, Nnaji FC, Agu JO, Maxwell TP, Motajo OO, Ifoto O, Okon SAI, Makama JG, Mohammed-Durosinlorun AA, Aminu B, Onwuhafua PI, Mohammed C, Abdulrasheed L, Adze JA, Suleiman KR, Airede LR, Taingson MC, Bature SB, Kache SA, Ogbonna UO, Fufore MB, Iya A, Ajulo AA, Mahmud A, Yahya BS, Onimisi-Yusuf F, Isaac H, Jawa T, Joseph F, Kala B, Bakari MA, Ngwan DW, umar A, Filikus AL, Wycliff D, Okunlola A, Abiola O, Adeniyi A, Adeyemo O, Awoyinka B, Babalola O, Bakare A, Buari T, Okunlola C, Adeleye G, Salawu A, Abiyere H, Ogidi A, Orewole T, Abdullahi HI, Akaba G, Achem A, Bassey AO, Ayogu E, Sulaiman B, Isah DA, Akpamgbo CN, Asudo F, Adewole N, Oguche O, Ejembi P, Sani SA, Andrew PC, Isah A, Eniola B, Songden Z, Agida T, Atim T, Mohammed TO, Raji HO, Ibiyemi F, Salawu H, Fasiku O, Solagbade RS, Shiru MM, Ibraheem GH, Oruade J, Ezeoke G, Chawla T, Aziz AB, Marium A, Waheed AA, Aamir FB, Qureshi F, Ather MH, Ali IFM, Tahir I, Akbar MG, Ukrani RD, Raja S, Virani SS, Noordin S, Rehman SU, Golani S, Aamir SR, Mufarrih SM, Waqar U, Taufiq M, Ammar AS, Ejaz A, Sarwar A, Khalid AU, Khattak S, Imran A, Khalid OB, Kaleem U, Muneer U, Kashaf Y, Zafar F, Zaheer A, Ali M, Shafaat A, Qazi A, Tariq AI, Aslam MN, Ali S, Atiq T, Wasim T, Babar D, Zain A, Ibtisam M, Ahmed U, Aqeel STB, Muhib M, Abbal MA, Khan NA, Javed I, Alkaraja L, Amro D, Manasrah G, Hammouri I, Hilail IA, Zalloum J, Alamlih L, Nasereddin M, Rajabi M, Shalalfeh S, Natsheh Z, Elessi K, Jayyab MA, Astal M, Al-Dahdouh M, Salameh AE, Ayyad A, Dawod N, Alsaid H, Matar I, Hassan M, Bakeer M, Malasah M, Abuhashem S, Salem M, Lunca S, Dimofte MG, Morarasu S, Musina AM, Roata CE, Velenciuc N, Butyrskii A, Bozhko M, Ametov A, Chowdhury S, Bagazi D, Domenech J, Rosello-Añon A, Monis A, Chiappe C, Cuneo B, Clemente-Navarro P, Febre J, Sanz-Romera J, Lopez-Vega M, Miranda I, Valverde-Vazquez R, Garcia S, Sanguesa MJ, Balciscueta Z, Ruiz E, Marco E, Talavera E, Farre J, Bacariza L, Duart M, Ureña V, Carre X, Hamid HKS, Abd-Albain MA, Galal-Eldin S, Sarih M, Adam E, Ismail S, Azhari M, Hassan T, Salaheldein M, Abdalla Z, Ahmed W, Alhassan M, Mohamed A, Suliman HMA, Eltayeb MOM, Ahmed RAA, Babekir EMA, Khairy MAT, Mukhtar MMA, Ali RAH, Al-Shambaty YBA, Yousif FI, Mohammed HMH, Osher L, Osher L, Abdelbast M, Yassin M, Moawia N, Abdalsadeg R, Husein A, Elhassan B, Abdelbagi AY, Adam MA, Ali EM, Mohammed IAB, Mohamed M, Abdulaziz M, Akasha M, Hassan M, Hilal N, Mohamed NAA, Abubaker N, Mohammed O, Mohamed S, Osman W, Mustafa F, Salih AA, Ali D, Almakki DMA, Mohamed HE, Elmubark A, Hassan M, Alnour A, Elaagib A, Abdelrahman A, Abdelkhalig M, Eldaim KN, Babiker A, Ahmed E, Ali M, Hussain E, Wedatalla M, Ahmed A, Hamza AA, Mohammed M, Osman O, Ibrahim R, Ahmed R, Ahmed R, Yasir R, Awadallah S, Mohmmed S, Hassan S, Shaban W, Hussein A, Rafea R, Abdalla A, Ahmed A, Mohamed K, Mohammed M, Altahir M, Adam M, Mohamed O, Abdullah W, Fadlalmola H, Abdalla AY, Omer AA, Mustafa AA, Elhadi REH, Banaga EEA, Osman F, Abdalla MGA, Taha HAM, Abdalmahmoud NE, Nafie RH, Jamal S, Ahmed S, Ali RA, Aladna A, Aljoumaa A, Nawfal H, Jamali S, Khouja F, Niazi A, Al Rawashdeh T, Kechiche N, Gara M, Nasr M, Baccar M, Benamor O, Chakroun S, Sanli AN, Yildiz A, Demirkiran MA, Atadag YB, Tandogan YI, Ozkan E, Ozer Y, Ozkan E, Oncel MM, Kalkan S, Gover T, Manoglu B, Oksak I, Kurt I, Rifaioglu K, Sokmen S, Bisgin T, Yildirim Y, Keskin AY, Dogan T, Sahin Bİ, Aydin C, Benek DE, Tiras HN, Arslangilay M, Aslangilay M, Yaytokgil M, Capar MA, Yazgan Y, Bektas S, Alagoz AC, Dagsali AE, Izgis A, Uzel K, Soytas M, Cakir N, Askin AE, Azboy I, Sabuncu K, Aslan M, Sahin M, Oncel M, Okkabaz N, Sivrikaya RK, Saylar A, Saylar A, Yasar M, Erginoz E, Bozkir HO, Zengin K, Ozcelik MF, Uludag SS, Ozdemir Z, Sibic O, Telci H, Bozkurt MA, Kara Y, Tepe MD, Gündoğdu A, Akın B, Pehlivan D, Guner A, Baysallar D, Yıldız B, Cepe H, Reis ME, Yuzgec AN, Kıralı N, Kodalak TA, Ulusahin M, Selim K, Kale A, Gecici ME, Ozbilen M, Düzyol Z, Gemici A, Korkmaz E, Şen E, Taşcı ME, Camkıran E, Elieyioğlu G, Kayabaş İ, Uprak TK, Aral C, Saraçoğlu A, Uğurlu MÜ, Baltacı ZH, Akkaya EN, Fergar C, Tabak EZ, Kocyigit GZ, Kayilioglu I, Polat S, Çolak E, Kara ME, Candan M, Uyanık MS, Sarı AC, Ulkucu A, Certel AT, Dindar A, Durdu B, Bayram C, Kaya E, Akdere H, Cakcak IE, Yavuz I, Omur M, Ajredini M, Aydoğdu EO, Şenödeyici E, Koksoy UC, Kazbek BK, Korkmaz DS, Yavuz D, Yilmaz H, Cetınkaya ZS, Durmus E, Tuzuner F, Hokelekli F, Mutlu M, Akbuz SO, Kus ZC, Kus ZC, Farrell M, Craig-Lucas A, Painter M, Titan A, Narayan A, Fariyike B, Knowlton L, Yue T, Benham E, Nimeri A, Werenski H, Kaiser N, Reinke C. Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries. Br J Surg 2024; 111:znad421. [PMID: 38207169 PMCID: PMC10783642 DOI: 10.1093/bjs/znad421] [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: 10/14/2023] [Revised: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures. METHODS This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge. RESULTS The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (β coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not. CONCLUSION Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely.
Collapse
|
3
|
Iacob S, Morarasu S, Roata CE, Musina AM, Bargaoanu R, Ong WL, Baboi B, Lunca S, Dimofte GM. Splenectomy Does Not Increase Early Morbidity in Patients Undergoing Total Gastrectomy: A Case-Control Study with Propensity Score Analysis. Chirurgia (Bucur) 2023; 118:464-469. [PMID: 37965831 DOI: 10.21614/chirurgia.2023.v.118.i.5.p.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 11/16/2023]
Abstract
AIM In gastric cancer (GC), D2 lymph node dissection is, alongside negative-margins gastrectomy, of paramount importance. There is a debate between Western and Eastern scientific communities concerning the risk-benefit balance with respect to splenectomy, as Western countries are inclined to perform spleen-preserving gastrectomy due to an increased risk for postoperative complications. In Eastern countries (such as Japan) this is not the case. Our study aimed to determine whether or not spleen-sacrificing total gastrectomy for GC was associated with a higher rate of early postoperative morbidity or mortality. METHOD We performed a retrospective case-control study in which we included patients who underwent total gastrectomy with D2 lymphadenectomy for GC (stages I-III) with curative intent, in a single high-volume tertiary oncologic centre. We divided the cases into two groups: spleenpreserving (SP) and spleen-sacrificing (SS) and evaluated the early complications rate following surgery. Afterwards, we performed propensity score matching (PSM) and analysis of the two groups. Results: We included 74 patients, 29 in the SS group and 45 in the SP group. Fifteen cases (20.2%) developed early postoperative complications and the complication rate was 53% (n=8) in the SS group and 46% (n=7) in the SP group. The overall 30-day mortality rate was 2.7%. Conclusions: Splenectomy is not associated with increased early morbidity following total gastrectomy with D2 lymphadenectomy if performed by an experienced surgeon.
Collapse
|
4
|
Ong WL, Lunca S, Morarasu S, Musina AM, Puscasu A, Iacob S, Iftincai I, Marinca A, Ivanov I, Roata CE, Velenciuc N, Dimofte G. Evaluation of Changes in Circulating Cell-Free DNA as an Early Predictor of Response to Chemoradiation in Rectal Cancer-A Pilot Study. Medicina (Kaunas) 2023; 59:1742. [PMID: 37893461 PMCID: PMC10608193 DOI: 10.3390/medicina59101742] [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] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: The objective of this study was to investigate quantitative changes in cell-free DNA (cfDNA) found in the bloodstream of patients with locally advanced rectal cancer who received neoadjuvant long-course chemoradiation, assuming a change in DNA fragments release during therapeutic stress. Materials and Methods: This was a prospective observational study that involved 49 patients who had three distinct pathologies requiring neoadjuvant chemoradiation: 18 patients with breast cancer, 18 patients with cervical cancer, and 13 patients with rectal cancer. Both breast cancer and cervical cancer patients were used as a control groups. Breast cancer patients were used as a control group as irradiation targeted healthy tissue after the tumor resection (R0), while cervical cancer patients were used as a control group to evaluate the effect of chemoradiation regarding cfDNA in a different setting (squamous cell carcinomas) and a different tumor burden. Rectal cancer patients were the study group, and were prospectively evaluated for a correlation between fragmentation of cfDNA and late response to chemoradiation. Blood samples were collected before the initiation of treatment and after the fifth radiation dose delivery. cfDNA was quantified in peripheral blood and compared with the patients' clinicopathological characteristics and tumor volume. Conclusion: Thirteen patients with locally advanced rectal cancer (T3/T4/N+/M0) were included in the study, and all of them had their samples analyzed. Eight were male (61.54%) and five were female (38.46%), with an average age of 70.85 years. Most of the patients had cT3 (53.85%) or cT4 (46.15%) tumors, and 92.31% had positive lymph nodes (N2-3). Of the thirteen patients, only six underwent surgery, and one of them achieved a pathological complete response (pCR). The mean size of the tumor was 122.60 mm3 [35.33-662.60 mm3]. No significant correlation was found between cfDNA, tumor volume, and tumor regression grade. cfDNA does not seem to predict response to neoadjuvant chemoradiotherapy and it is not correlated to tumor volume or tumor regression grade.
Collapse
Affiliation(s)
- Wee Liam Ong
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), 700483 Iasi, Romania; (W.L.O.); (A.-M.M.); (A.P.); (S.I.); (C.E.R.); (N.V.); (G.D.)
| | - Sorinel Lunca
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), 700483 Iasi, Romania; (W.L.O.); (A.-M.M.); (A.P.); (S.I.); (C.E.R.); (N.V.); (G.D.)
- Department of Surgery, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Stefan Morarasu
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), 700483 Iasi, Romania; (W.L.O.); (A.-M.M.); (A.P.); (S.I.); (C.E.R.); (N.V.); (G.D.)
- Department of Surgery, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Ana-Maria Musina
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), 700483 Iasi, Romania; (W.L.O.); (A.-M.M.); (A.P.); (S.I.); (C.E.R.); (N.V.); (G.D.)
- Department of Surgery, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Alina Puscasu
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), 700483 Iasi, Romania; (W.L.O.); (A.-M.M.); (A.P.); (S.I.); (C.E.R.); (N.V.); (G.D.)
- Department of Surgery, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Stefan Iacob
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), 700483 Iasi, Romania; (W.L.O.); (A.-M.M.); (A.P.); (S.I.); (C.E.R.); (N.V.); (G.D.)
- Department of Surgery, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Irina Iftincai
- Radiotherapy Department, Regional Institute of Oncology (IRO), 700483 Iasi, Romania; (I.I.); (A.M.)
| | - Andreea Marinca
- Radiotherapy Department, Regional Institute of Oncology (IRO), 700483 Iasi, Romania; (I.I.); (A.M.)
| | - Iuliu Ivanov
- “TRANSCEND” Centre for Fundamental Research and Experimental Development in Translational Medicine, Regional Institute of Oncology (IRO), 700483 Iasi, Romania;
| | - Cristian Ena Roata
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), 700483 Iasi, Romania; (W.L.O.); (A.-M.M.); (A.P.); (S.I.); (C.E.R.); (N.V.); (G.D.)
- Department of Surgery, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Natalia Velenciuc
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), 700483 Iasi, Romania; (W.L.O.); (A.-M.M.); (A.P.); (S.I.); (C.E.R.); (N.V.); (G.D.)
- Department of Surgery, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Gabriel Dimofte
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), 700483 Iasi, Romania; (W.L.O.); (A.-M.M.); (A.P.); (S.I.); (C.E.R.); (N.V.); (G.D.)
- Department of Surgery, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| |
Collapse
|
5
|
Marciuc D, Morarasu S, Morarasu BC, Marciuc EA, Dobrovat BI, Pintiliciuc-Serban V, Popescu RM, Bida FC, Munteanu V, Haba D. Dental Appliances for the Treatment of Obstructive Sleep Apnea in Children: A Systematic Review and Meta-Analysis. Medicina (Kaunas) 2023; 59:1447. [PMID: 37629737 PMCID: PMC10456847 DOI: 10.3390/medicina59081447] [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] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023]
Abstract
Background and objectives: Obstructive sleep apnea (OSA) in children is a debilitating disease, difficult to treat. Dental appliances have been proposed as a valid therapy for improving functional outcomes with good compliance rates. Herein, we aimed to perform a meta-analysis comparing clinical outcomes between OSA children treated with dental appliances versus controls. Materials Methods: The study was registered with PROSPERO. A systematic search was performed for all comparative studies examining outcomes in pediatric patients who underwent treatment of OSA with oral appliances versus controls. Data was extracted and analyzed using a random effects model via Rev Man 5.3. Results: Six studies including 180 patients were analyzed split into two groups: patients treated with dental appliances (n = 123) and the controls (n = 119). Therapy with dental appliances was shown to significantly improve the apnea-hypopnea index (p = 0.009) and enlarge the superior posterior airway space (p = 0.02). Maxilla-to-mandible measurements were not significantly different between the two groups, nor was the mean SO2 (p = 0.80). Conclusions: This is the most updated meta-analysis assessing the role of dental appliances for OSA in children; it shows that such devices can improve functional outcomes by decreasing the apnea-hypopnea index.
Collapse
Affiliation(s)
- Daniel Marciuc
- Surgery Department, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.M.); (V.P.-S.); (R.M.P.)
| | - Stefan Morarasu
- 2nd Department of Surgical Oncology, Regional Institute of Oncology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Bianca Codrina Morarasu
- Department of Internal Medicine and Toxicology, “Saint Spiridon” University Regional Emergency Hospital, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Emilia Adriana Marciuc
- Department of Radiology, Emergency Hospital “Prof. Dr. Nicolae Oblu”, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (B.I.D.); (D.H.)
| | - Bogdan Ionut Dobrovat
- Department of Radiology, Emergency Hospital “Prof. Dr. Nicolae Oblu”, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (B.I.D.); (D.H.)
| | - Veronica Pintiliciuc-Serban
- Surgery Department, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.M.); (V.P.-S.); (R.M.P.)
| | - Roxana Mihaela Popescu
- Surgery Department, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.M.); (V.P.-S.); (R.M.P.)
| | - Florinel Cosmin Bida
- Department of Implantology, Removable Prostheses, Dental Prostheses Technology, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Valentin Munteanu
- Department of Intensive Care Unit, “Saint Mary” Emergency Children Hospital, 700309, Faculty of Medical Bioengineering, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Danisia Haba
- Department of Radiology, Emergency Hospital “Prof. Dr. Nicolae Oblu”, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (B.I.D.); (D.H.)
| |
Collapse
|
6
|
Simiras C, Morarasu S, Simiras DM, Iacob S, Ong WL, Musina AM, Velenciuc N, Roata CE, Lunca S, Dimofte GM. Predictive and Prognostic Role of Neutrophil to Lymphocyte Ratio in Rectal Cancer: A Case Control Study with Propensity Score Analysis. Chirurgia (Bucur) 2023; 118:399-409. [PMID: 37698002 DOI: 10.21614/chirurgia.2023.v.118.i.4.p.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2023] [Indexed: 09/13/2023]
Abstract
Background: Neutrophil to lymphocyte ratio (NLR) is promoted as a marker reflecting the antitumoral inflammatory response. Herein, we aim to assess whether NLR at the time of diagnosis can predict response to neoadjuvant therapy and long-term survival in a matched cohort of rectal cancer patients. Methods: This is a case control study on rectal cancer patients who underwent standard oncological treatment and had NLR sampled at each stage. ROC curve was used to establish the cut off value of NLR at diagnosis. Two groups (high and low NLR) were compared. Kaplan Meier overall and disease-free survival (DFS) analysis was done comparatively between two groups of patients: low and high NLR. Pearson and Log Rank tests were used to establish statistical significance. Propensity score matching (PSM) was performed, and all variables were compared again on the matched subgroups. Results: One hundred patients were included and 54 were compared again after PSM. NLR at diagnosis did not correlate with tumor regression grade (p=0.77). High NLR at diagnosis (NLR 2.58) was not found to be significantly associated with worse overall survival (p=0.096) or DFS (p=0.128). Similar results were achieved after PSM, except when stage III subgroups were compared, where higher NLR was associated with worse DFS (p=0.04), while results for OS were borderline (p=0.05). Conclusions: Overall, a pretherapeutic high NLR ( 2.58) was not found to predict survival or response do neoadjuvant therapy in patients with rectal cancer. However, a higher NLR may be associated with worse outcomes in advanced colorectal cancer.
Collapse
|
7
|
Morarasu BC, Sorodoc V, Haisan A, Morarasu S, Bologa C, Haliga RE, Lionte C, Marciuc EA, Elsiddig M, Cimpoesu D, Dimofte GM, Sorodoc L. Age, blood tests and comorbidities and AIMS65 risk scores outperform Glasgow-Blatchford and pre-endoscopic Rockall score in patients with upper gastrointestinal bleeding. World J Clin Cases 2023; 11:4513-4530. [PMID: 37469720 PMCID: PMC10353516 DOI: 10.12998/wjcc.v11.i19.4513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/14/2023] [Accepted: 05/30/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Upper gastrointestinal (GI) bleeding is a life-threatening condition with high mortality rates.
AIM To compare the performance of pre-endoscopic risk scores in predicting the following primary outcomes: In-hospital mortality, intervention (endoscopic or surgical) and length of admission (≥ 7 d).
METHODS We performed a retrospective analysis of 363 patients presenting with upper GI bleeding from December 2020 to January 2021. We calculated and compared the area under the receiver operating characteristics curves (AUROCs) of Glasgow-Blatchford score (GBS), pre-endoscopic Rockall score (PERS), albumin, international normalized ratio, altered mental status, systolic blood pressure, age older than 65 (AIMS65) and age, blood tests and comorbidities (ABC), including their optimal cut-off in variceal and non-variceal upper GI bleeding cohorts. We subsequently analyzed through a logistic binary regression model, if addition of lactate increased the score performance.
RESULTS All scores had discriminative ability in predicting in-hospital mortality irrespective of study group. AIMS65 score had the best performance in the variceal bleeding group (AUROC = 0.772; P < 0.001), and ABC score (AUROC = 0.775; P < 0.001) in the non-variceal bleeding group. However, ABC score, at a cut-off value of 5.5, was the best predictor (AUROC = 0.770, P = 0.001) of in-hospital mortality in both populations. PERS score was a good predictor for endoscopic treatment (AUC = 0.604; P = 0.046) in the variceal population, while GBS score, (AUROC = 0.722; P = 0.024), outperformed the other scores in predicting surgical intervention. Addition of lactate to AIMS65 score, increases by 5-fold the probability of in-hospital mortality (P < 0.05) and by 12-fold if added to GBS score (P < 0.003). No score proved to be a good predictor for length of admission.
CONCLUSION ABC score is the most accurate in predicting in-hospital mortality in both mixed and non-variceal bleeding population. PERS and GBS should be used to determine need for endoscopic and surgical intervention, respectively. Lactate can be used as an additional tool to risk scores for predicting in-hospital mortality.
Collapse
Affiliation(s)
- Bianca Codrina Morarasu
- Department of Internal Medicine and Toxicology, Saint Spiridon University Regional Emergency Hospital, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
| | - Victorita Sorodoc
- Department of Internal Medicine and Toxicology, Saint Spiridon University Regional Emergency Hospital, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
| | - Anca Haisan
- Department of Emergency Medicine, Saint Spiridon University Regional Emergency Hospital, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
| | - Stefan Morarasu
- Second Department of Surgical Oncology, Regional Institute of Oncology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
| | - Cristina Bologa
- Department of Internal Medicine and Toxicology, Saint Spiridon University Regional Emergency Hospital, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
| | - Raluca Ecaterina Haliga
- Department of Internal Medicine and Toxicology, Saint Spiridon University Regional Emergency Hospital, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
| | - Catalina Lionte
- Department of Internal Medicine and Toxicology, Saint Spiridon University Regional Emergency Hospital, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
| | - Emilia Adriana Marciuc
- Department of Radiology, Emergency Hospital “Prof. Dr. N. Oblu”, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700309, Romania
| | - Mohammed Elsiddig
- Department of Gatroenterology, Beaumont Hospital, Dublin D09V2N0, Ireland
| | - Diana Cimpoesu
- Department of Emergency Medicine, Saint Spiridon University Regional Emergency Hospital, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
| | - Gabriel Mihail Dimofte
- Second Department of Surgical Oncology, Regional Institute of Oncology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
| | - Laurentiu Sorodoc
- Department of Internal Medicine and Toxicology, Saint Spiridon University Regional Emergency Hospital, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
| |
Collapse
|
8
|
Morarasu S, Clancy C, Gorgun E, Yilmaz S, Ivanecz A, Kawakatsu S, Musina AM, Velenciuc N, Roata CE, Dimofte GM, Lunca S. Laparoscopic versus open resection of primary colorectal cancers and synchronous liver metastasis: a systematic review and meta-analysis. Int J Colorectal Dis 2023; 38:90. [PMID: 37017766 PMCID: PMC10076361 DOI: 10.1007/s00384-023-04375-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE Combined resection of primary colorectal cancer and associated liver metastases is increasingly common. This study compares peri-operative and oncological outcomes according to surgical approach. METHODS The study was registered with PROSPERO. A systematic search was performed for all comparative studies describing outcomes in patients that underwent laparoscopic versus open simultaneous resection of colorectal primary tumours and liver metastases. Data was extracted and analysed using a random effects model via Rev Man 5.3 RESULTS: Twenty studies were included with a total of 2168 patients. A laparoscopic approach was performed in 620 patients and an open approach in 872. There was no difference in the groups for BMI (mean difference: 0.04, 95% CI: 0.63-0.70, p = 0.91), number of difficult liver segments (mean difference: 0.64, 95% CI:0.33-1.23, p = 0.18) or major liver resections (mean difference: 0.96, 95% CI: 0.69-1.35, p = 0.83). There were fewer liver lesions per operation in the laparoscopic group (mean difference 0.46, 95% CI: 0.13-0.79, p = 0.007). Laparoscopic surgery was associated with shorter length of stay (p < 0.00001) and less overall postoperative complications (p = 0.0002). There were similar R0 resection rates (p = 0.15) but less disease recurrence in the laparoscopic group (mean difference: 0.57, 95% CI:0.44-0.75, p < 0.0001). CONCLUSION Synchronous laparoscopic resection of primary colorectal cancers and liver metastases is a feasible approach in selected patients and does not demonstrate inferior peri-operative or oncological outcomes.
Collapse
Affiliation(s)
- Stefan Morarasu
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
- Grigore T, Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Cillian Clancy
- Department of Colorectal Surgery, Tallaght University Hospital, Dublin 24, Ireland.
| | - Emre Gorgun
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Main Campus, Cleveland, USA
| | - Sumeyye Yilmaz
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Main Campus, Cleveland, USA
| | - Arpad Ivanecz
- Department of Abdominal and General Surgery, University Medical Center Maribor, Maribor, Slovenia
| | - Shoji Kawakatsu
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ana Maria Musina
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
- Grigore T, Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Natalia Velenciuc
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
- Grigore T, Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Cristian Ene Roata
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
- Grigore T, Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Gabriel Mihail Dimofte
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
- Grigore T, Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Sorinel Lunca
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
- Grigore T, Popa University of Medicine and Pharmacy, Iasi, Romania
| |
Collapse
|
9
|
O'Brien L, Morarasu S, Morarasu BC, Neary PC, Musina AM, Velenciuc N, Roata CE, Dimofte MG, Lunca S, Raimondo D, Seracchioli R, Casadio P, Clancy C. Conservative surgery versus colorectal resection for endometriosis with rectal involvement: a systematic review and meta-analysis of surgical and long-term outcomes. Int J Colorectal Dis 2023; 38:55. [PMID: 36847868 DOI: 10.1007/s00384-023-04352-6] [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] [Accepted: 02/20/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE The optimal surgical approach for removal of colorectal endometrial deposits is unclear. Shaving and discoid excision of colorectal deposits allow organ preservation but risk recurrence with associated functional issues and re-operation. Formal resection risks potential higher complications but may be associated with lower recurrence rates. This meta-analysis compares peri-operative and long-term outcomes between conservative surgery (shaving and disc excision) versus formal colorectal resection. METHODS The study was registered with PROSPERO. A systematic search was performed on PubMed and EMBASE databases. All comparative studies examining surgical outcomes in patients that underwent conservative surgery versus colorectal resection for rectal endometrial deposits were included. The two main groups (conservative versus resection) were compared in three main blocks of variables including group comparability, operative outcomes and long-term outcomes. RESULTS Seventeen studies including 2861 patients were analysed with patients subdivided by procedure: colorectal resection (n = 1389), shaving (n = 703) and discoid excision (n = 742). When formal colorectal resection was compared to conservative surgery there was lower risk of recurrence (p = 0.002), comparable functional outcomes (minor LARS, p = 0.30, major LARS, p = 0.54), similar rates of postoperative leaks (p = 0.22), pelvic abscesses (p = 0.18) and rectovaginal fistula (p = 0.92). On subgroup analysis, shaving had the highest recurrence rate (p = 0.0007), however a lower rate of stoma formation (p < 0.00001) and rectal stenosis (p = 0.01). Discoid excision and formal resection were comparable. CONCLUSION Colorectal resection has a significantly lower recurrence rate compared to shaving. There is no difference in complications or functional outcomes between discoid excision and formal resection and both have similar recurrence rates.
Collapse
Affiliation(s)
- Luke O'Brien
- Department of Colorectal Surgery, Tallaght University Hospital, Dublin 24, Ireland
| | - Stefan Morarasu
- Department of Colorectal Surgery, Tallaght University Hospital, Dublin 24, Ireland. .,2nd Department of Surgical Oncology, Regional Institute of Oncology, Iasi, Romania. .,Grigore T Popa, University of Medicine and Pharmacy, Iasi, Romania.
| | | | - Paul C Neary
- Department of Colorectal Surgery, Tallaght University Hospital, Dublin 24, Ireland
| | - Ana Maria Musina
- 2nd Department of Surgical Oncology, Regional Institute of Oncology, Iasi, Romania.,Grigore T Popa, University of Medicine and Pharmacy, Iasi, Romania
| | - Natalia Velenciuc
- 2nd Department of Surgical Oncology, Regional Institute of Oncology, Iasi, Romania.,Grigore T Popa, University of Medicine and Pharmacy, Iasi, Romania
| | - Cristian Ene Roata
- 2nd Department of Surgical Oncology, Regional Institute of Oncology, Iasi, Romania.,Grigore T Popa, University of Medicine and Pharmacy, Iasi, Romania
| | - Mihail Gabriel Dimofte
- 2nd Department of Surgical Oncology, Regional Institute of Oncology, Iasi, Romania.,Grigore T Popa, University of Medicine and Pharmacy, Iasi, Romania
| | - Sorinel Lunca
- 2nd Department of Surgical Oncology, Regional Institute of Oncology, Iasi, Romania.,Grigore T Popa, University of Medicine and Pharmacy, Iasi, Romania
| | - Diego Raimondo
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Renato Seracchioli
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Paolo Casadio
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Cillian Clancy
- Department of Colorectal Surgery, Tallaght University Hospital, Dublin 24, Ireland
| |
Collapse
|
10
|
Livadaru C, Morarasu S, Bargaoanu R, Iacob S, Frunza T, Musina AM, Velenciuc N, Roata CE, Zugun-Eloae F, Ferariu D, Lunca S, Dimofte MG. The mesocolic apical fragment in complete mesocolic excision colectomies: Should it be analysed separately? A proof-of-concept study. Colorectal Dis 2023; 25:234-242. [PMID: 36227063 DOI: 10.1111/codi.16362] [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: 02/05/2022] [Revised: 06/15/2022] [Accepted: 09/29/2022] [Indexed: 02/08/2023]
Abstract
AIM The aim of this work is to describe a protocol and assess the feasibility of harvesting and analysing the mesocolic apical fragment (MAF) for the presence of central lymph node (LN) metastasis and extra lymphatic free tumour cells in a random subgroup extracted from a cohort of complete mesocolic excision colectomies with central vascular ligation. METHOD Forty-seven patients diagnosed with colorectal cancer were included. A 2/2 cm pyramid of tissue was cut around the central tie and sent for pathological examination. The MAF was sectioned into 16 slices. High-definition images were taken from the slices which were merged into a panoramic three-dimensional image of the MAF. The distribution of LNs in the MAF was quantified. Immunohistochemistry staining for cytokeratin 14 was used to identify isolated tumour cells and micrometastases in the extranodal tissue. RESULTS No tumoural cells migrating through the apical zone, outside of the LNs, were identified. Margins of resection, mesocolic tissue and LNs were all negative in the subgroup of ultrastaged MAFs. The number of examined central LNs varied between 0 and 24, with positive MAF LNs being identified only in pN2 stages. The rate of positive apical LNs in our cohort was 4.2% (n = 2). CONCLUSIONS The MAF can be easily extracted from standard specimens, allowing for accurate analysis of lymphatic and extra-nodal tumour cells on the central resection margins, in central LNs and in the apical mesocolic tissue. Future research on larger cohorts is required to establish if analysing the MAF has an impact on patient staging, prognosis and management.
Collapse
Affiliation(s)
- Cristian Livadaru
- Radiology and Medical Imaging Department, St Spiridon University Hospital, Iași, Romania.,Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania
| | - Stefan Morarasu
- Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania.,2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iași, Romania
| | - Roxana Bargaoanu
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iași, Romania
| | - Stefan Iacob
- Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania.,2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iași, Romania
| | - Tudor Frunza
- Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania.,2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iași, Romania
| | - Ana Maria Musina
- Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania.,2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iași, Romania
| | - Natalia Velenciuc
- Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania.,2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iași, Romania
| | - Cristian Ene Roata
- Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania.,2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iași, Romania
| | - Florin Zugun-Eloae
- Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania.,Center of Fundamental Research and Experimental Development in Translational Medicine at Regional Institute of Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
| | - Dan Ferariu
- Department of Pathology, Regional Institute of Oncology (IRO), Iasi, Romania
| | - Sorinel Lunca
- Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania.,2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iași, Romania
| | - Mihail-Gabriel Dimofte
- Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania.,2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iași, Romania
| |
Collapse
|
11
|
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.
Collapse
|
12
|
Morarasu S, Clancy C, Ghetu N, Musina AM, Velenciuc N, Iacob S, Frunza T, Roata CE, Lunca S, Dimofte GM. ASO Visual Abstract: Impact of Quilting Sutures on Surgical Outcomes After Mastectomy: A Systematic Review and Meta-Analysis. Ann Surg Oncol 2022. [PMID: 35246809 DOI: 10.1245/s10434-022-11399-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Stefan Morarasu
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
| | - Cillian Clancy
- Department of Surgery, Saint Vincent's University Hospital, Dublin 4, Ireland.
| | - Nicolae Ghetu
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
| | - Ana Maria Musina
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
| | - Natalia Velenciuc
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
| | - Stefan Iacob
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
| | - Tudor Frunza
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
| | - Cristian Ene Roata
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
| | - Sorinel Lunca
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
| | - Gabriel-Mihail Dimofte
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
| |
Collapse
|
13
|
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.
Collapse
|
14
|
Morarasu S, Clancy C. ASO Author Reflections: Role of Quilting Sutures in Mastectomies. Ann Surg Oncol 2022; 29:3798. [DOI: 10.1245/s10434-022-11379-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/16/2022] [Indexed: 11/18/2022]
|
15
|
Morarasu S, Clancy C, Ghetu N, Musina AM, Velenciuc N, Iacob S, Frunza T, Roata CE, Lunca S, Dimofte GM. Impact of Quilting Sutures on Surgical Outcomes After Mastectomy: A Systematic Review and Meta-Analysis. Ann Surg Oncol 2022; 29:3785-3797. [PMID: 35103890 DOI: 10.1245/s10434-022-11350-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/05/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Seroma after mastectomy and/or axillary lymph node dissection (ALND) is among the most common issue surgeons have to face in the early postoperative management of breast cancer. Using quilting sutures (QS) to aid in tissue approximation and decrease dead space is proposed as a simple technique to reduce seroma rate. We aimed to perform a systematic review, and analyse, in a meta-analytical model, the role of QS in improving wound outcomes and decrease volume, duration of drainage, and length of stay in hospital. METHODS The study was registered with PROSPERO. A systematic search of the PubMed, EMBASE, and SCOPUS databases was performed for all comparative studies examining surgical outcomes in patients who underwent QS versus conventional closure (CC) after mastectomy ± ALND. RESULTS Twenty-one studies with a total of 3473 patients (1736 in the study group and 1737 in the control group) were included based on the selection criteria. The study group showed significantly lower rates of seroma (p < 0.00001), total volume of drainage (p < 0.0001), days to drain removal (p < 0.00001), and length of stay (p < 0.00001) compared with the control group, while wound complication rates (surgical site infection, flap necrosis, hematoma, skin dimpling) were comparable between the two groups. CONCLUSIONS QS are a reliable intraoperative technique that decrease seroma formation, volume of postoperative drainage, duration of drainage and length of hospital stay, and should be considered in mastectomies with or without ALND.
Collapse
Affiliation(s)
- Stefan Morarasu
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
| | - Cillian Clancy
- Department of Surgery, Saint Vincent's University Hospital, Dublin 4, Ireland.
| | - Nicolae Ghetu
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
| | - Ana Maria Musina
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
| | - Natalia Velenciuc
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
| | - Stefan Iacob
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
| | - Tudor Frunza
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
| | - Cristian Ene Roata
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
| | - Sorinel Lunca
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
| | - Gabriel-Mihail Dimofte
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
| |
Collapse
|
16
|
Morarasu S, Morarasu BC, Ghețu N, Dimofte MG, Iliescu R, Pieptu D. Experimental models for controlled burn injuries in rats: a systematic analysis of original methods and burn devices. J Burn Care Res 2021; 43:1055-1065. [PMID: 34888684 DOI: 10.1093/jbcr/irab234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIM Despite a wide variety of models found in literature, choosing the right one can be difficult as many of them are lacking precise methodology. This study aims to analyze and compare original burn models in terms of burn device and technique, parameters, and wound depth assessment. METHODS A systematic search was performed according to PRISMA guidelines on studies describing original experimental burn models in rats. The adapted PICO formula and ARRIVE checklist were followed for inclusion and assessment of quality of studies. Characteristics of animals, burn technique, burn parameters and method of histological confirmation of burn depth were recorded. RESULTS Twenty-seven studies were included in the final analysis. Most studies used direct contact with skin for burn infliction (n=20). The rat's dorsum was the most common site (n=18). Ten studies used manually controlled burn devices, while ten designed automatic burn devices with control over temperature (n=10), exposure time (n=5), and pressure (n=5). Most studies (n=7) used a single biopsy taken from the center of the wound to confirm burn depth immediately after burn infliction. CONCLUSION From the wide variety of burn models in current literature, our study provides an overview of the most relevant experimental burn models in rats aiding researchers to understand what needs to be addressed when designing their burn protocol. Models cannot be compared as burn parameters variate significantly. Assessment of burn depth should be done in a standardized, sequential fashion in future burn studies to increase reproducibility.
Collapse
Affiliation(s)
- Stefan Morarasu
- Center of Simulation and Training in Surgery (CSTC), Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania.,2nd Department of Surgical Oncology, Regional Oncology Institute, Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Bianca-Codrina Morarasu
- Center of Simulation and Training in Surgery (CSTC), Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Nicolae Ghețu
- Center of Simulation and Training in Surgery (CSTC), Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania.,Department of Plastic and Reconstructive Surgery, Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Mihail-Gabriel Dimofte
- 2nd Department of Surgical Oncology, Regional Oncology Institute, Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Radu Iliescu
- Department of Pharmacology, Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Dragos Pieptu
- Center of Simulation and Training in Surgery (CSTC), Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania.,Department of Plastic and Reconstructive Surgery, Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania
| |
Collapse
|
17
|
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: 96] [Impact Index Per Article: 32.0] [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] [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.
Collapse
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
| |
Collapse
|
18
|
Morarasu S, Ghetu N, Coman CG, Boicu D, Spiridon IA, Gardikiotis I, Danciu M, Pieptu D. New Chimeric Groin Flap: Experimental Model in Rats. Ann Plast Surg 2021; 86:721-725. [PMID: 33009145 DOI: 10.1097/sap.0000000000002561] [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] [Indexed: 11/25/2022]
Abstract
AIM Increased emphasis is on using tissue substitutes and stem cells to improve flap applicability and survival rates. To accomplish this, the first step is to have a versatile experimental flap, easy to harvest and use as a template. We sought to develop a reliable experimental chimeric groin flap with free mobility and reliable bloods supply that can be twisted, relocated, and integrated easily with other materials. MATERIALS AND METHODS Ten male Wistar rats were included. The flap consists of a 2.5-cm skin paddle centered on the medial branch of the inferior epigastric artery and a 4.5/2-cm fat pad supplied by the lateral branch of the inferior epigastric artery. After being raised, flaps were resutured in their anatomical position. Flaps were followed up for 15 days. At the end of the study, the viability of flaps was analyzed by ultrahigh-frequency ultrasound, nontargeted contrast study, and histology assessment. RESULTS All flaps survived without significant complications. Nontargeted microbubbles spread evenly in both the superficial and deep flap. Ultrasound assessment at day 15 showed no significant areas of necrosis or edema. Histology examination of 3 random flaps confirmed vessel patency and flap viability. CONCLUSION We propose a simple, easy to harvest and reliable experimental flap which offers a main advantage of all-around mobility through its chimeric design. It is a suitable model for bioengineering studies as it can be used as a template for integration of tissue substitutes or stem cells, between its 2 components.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Mihai Danciu
- Department of Pathology, Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania
| | | |
Collapse
|
19
|
Morarasu S, O'Brien L, Clancy C, Dietrich D, Maurer CA, Frasson M, Garcia-Granero E, Martin ST. A systematic review and meta-analysis comparing surgical and oncological outcomes of upper rectal, rectosigmoid and sigmoid tumours. Eur J Surg Oncol 2021; 47:2421-2428. [PMID: 34016500 DOI: 10.1016/j.ejso.2021.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/21/2021] [Accepted: 05/06/2021] [Indexed: 11/17/2022] Open
Abstract
AIM Management paradigms for tumours from the sigmoid colon to the lower rectum vary significantly. The upper rectum (UR) represents the transition point both anatomically and in treatment protocols. Above the UR is clearly defined and managed as colon cancer and below is managed as rectal cancer. This study compares outcomes between sigmoid, rectosigmoid and UR tumours to establish if differences exist in operative and oncological outcomes. METHODS Electronic databases were searched for published studies with comparative data on peri-operative and oncological outcome for upper rectal and sigmoid/rectosigmoid (SRS) tumours treated without neoadjuvant radiation. The search adhered to PRISMA guidelines (Preferred Reporting Items in Systematic Reviews and Meta-analyses) guidelines. Data was combined using random-effects models. RESULTS Seven comparative series examined outcomes in 4355 patients. There was no difference in ASA grade (OR, 1.28; 95% CI, 0.99-1.67; P = 0.06), T3/T4 tumours (OR, 1.24; 95% CI, 0.95-1.63; P = 0.12), or lymph node positivity (OR, 0.97; 95% CI, 0.70-1.36; P = 0.87). UR cancers had higher rates of operative morbidity (OR, 0.72; 95% CI, 0.55-0.93; P = 0.01) and anastomotic leak (OR, 0.47; 95% CI, 0.31-0.71; P = 0.0004). There was no difference in local recurrence (OR, 0.63; 95% CI, 0.37-1.08; P = 0.10). SRS tumours had lower rates of distant recurrence (OR, 0.83; 95% CI, 0.68-1.0; P = 0.05). Rectosigmoid operative and cancer outcomes were closer to UR than sigmoid. CONCLUSIONS Based on existing data, UR and rectosigmoid tumours have higher morbidity, leak rates and distant recurrence than more proximal tumours.
Collapse
Affiliation(s)
- Stefan Morarasu
- Centre for Colorectal Disease, Saint Vincent's University Hospital, Dublin 4, Ireland
| | - Luke O'Brien
- Department of Surgery, School of Medicine and Medical Sciences, University College Dublin, Ireland
| | - Cillian Clancy
- Centre for Colorectal Disease, Saint Vincent's University Hospital, Dublin 4, Ireland.
| | - Daniel Dietrich
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - Christoph A Maurer
- Hirslanden Group, Clinic Beau-Site, Schänzlihalde 11, 3000, Bern, Switzerland
| | - Matteo Frasson
- Department of Digestive Surgery, University Hospital La Fe, University of Valencia, Valencia, Spain
| | - Eduardo Garcia-Granero
- Department of Digestive Surgery, University Hospital La Fe, University of Valencia, Valencia, Spain
| | - Sean T Martin
- Centre for Colorectal Disease, Saint Vincent's University Hospital, Dublin 4, Ireland; Department of Surgery, School of Medicine and Medical Sciences, University College Dublin, Ireland
| |
Collapse
|
20
|
Morarasu S, Clancy C, Cronin CT, Matsuda T, Heneghan HM, Winter DC. Segmental versus extended colectomy for tumours of the transverse colon: a systematic review and meta-analysis. Colorectal Dis 2021; 23:625-634. [PMID: 33064881 DOI: 10.1111/codi.15403] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/22/2020] [Accepted: 09/26/2020] [Indexed: 02/08/2023]
Abstract
AIM There is no consensus on the appropriate extent of oncological resection for tumours of the transverse colon. Concerns regarding tumour factors such as pattern of lymph node spread and technical factors such as anastomotic perfusion lead to a variety of procedures being performed. METHODS A comprehensive search for published studies examining outcomes following segmental versus extended colectomy for transverse colon tumours was performed adhering to PRISMA (Preferred Reporting Items in Systematic Reviews and Meta-analyses) guidelines. Random effects methods were used to combine data. RESULTS Seven comparative series examining outcomes in 3395 patients were identified. Segmental colectomy results in shorter operating times (mean difference 15.80 min, 95% CI -20.98 to -10.62, P < 0.001) and less ileus (OR 0.52, 95% CI 0.33-0.81, P = 0.004). There was no difference in length of hospital stay (mean difference 1.53 days, 95% CI -3.79 to 0.73, P = 0.18). Extended colectomy results in a lower rate of anastomotic leak (OR 0.62, 95% CI 0.40-0.97, P = 0.04). There are fewer nodes retrieved in segmental colectomy (mean difference 7.60 nodes, 95% CI -9.60 to -5.61, P < 0.001) but no difference in disease recurrence (OR 0.88, 95% CI 0.59-1.34, P = 0.56) or overall survival (OR 0.98, 95% CI 0.68-1.4, P = 0.9). CONCLUSIONS Available data are limited due to a lack of randomized controlled trials. However, based on current evidence, segmental resection for transverse colon tumours is associated with less ileus but lower lymph node yields and higher anastomotic leak rates. Length of stay is similar. Oncological outcomes are equivalent.
Collapse
Affiliation(s)
- Stefan Morarasu
- Centre for Colorectal Disease, Saint Vincent's University Hospital, Dublin 4, Ireland
| | - Cillian Clancy
- Centre for Colorectal Disease, Saint Vincent's University Hospital, Dublin 4, Ireland
| | - Catherine T Cronin
- Centre for Colorectal Disease, Saint Vincent's University Hospital, Dublin 4, Ireland
| | - Takeru Matsuda
- Division of Minimally Invasive Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Helen M Heneghan
- Centre for Colorectal Disease, Saint Vincent's University Hospital, Dublin 4, Ireland.,Department of Surgery, School of Medicine and Medical Sciences, University College Dublin, Dublin 4, Ireland
| | - Desmond C Winter
- Centre for Colorectal Disease, Saint Vincent's University Hospital, Dublin 4, Ireland.,Department of Surgery, School of Medicine and Medical Sciences, University College Dublin, Dublin 4, Ireland
| |
Collapse
|
21
|
Morarasu S, Ghetu N, Coman CG, Morarasu BC, Boicu D, Spiridon IA, Gardikiotis I, Danciu M, Pieptu D. Role of Ultrahigh Frequency Ultrasound in Evaluating Experimental Flaps. J Reconstr Microsurg 2020; 37:385-390. [PMID: 33003232 DOI: 10.1055/s-0040-1718392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Experimental flap follow-up needs faster, safer, and less invasive techniques that can be easily correlated to clinical procedures. For this reason, we aimed to test the role of ultrahigh frequency ultrasound in follow-up of flap viability. Further on, we aimed to analyze if the chimeric groin flap can be mobilized in a sandwiched position without affecting its vascular supply by twisting its pedicle. METHODS A total of 12 male Wistar rats, split into three groups, were used. Group A (n = 4) had the chimeric groin flap repositioned in a sandwich position on the anterior abdominal wall and underwent ultrahigh frequency ultrasound follow-up at days 10 and 14. Group B (n = 4) also had the flaps sandwiched, however, at day 14 the vascularity of flaps was proven by infusion of nontargeted ultrasound contrast agents, after which flaps were sent for histological analysis. Group C (C1 n = 2, C2 n = 2) was the control group. In C1 the chimeric groin flap was harvested and sent for histology on day 0, acting as a histological benchmark of flap viability, and in C2 the chimeric groin flap was re-sutured in its anatomical position and after 14 days, flaps were harvested and sent for histological analysis, acting as a direct control for Group B. RESULTS Ultrasound showed constant vascular flow in both adipose and skin flaps in the sandwiched position. Microbubble study showed diffuse perfusion within flaps. Ultrasound measurements of flow velocity, flap volume, and percentage of vascularity showed a decrease in flap volume and increase in vascularity over 14 days. Histology showed similar viability in both groups. CONCLUSION Ultrahigh frequency ultrasound may be a valuable tool for postoperative flap assessment, while the chimeric flap can be moved freely in a sandwich position making it suitable for adding tissue substitutes within its components.
Collapse
Affiliation(s)
- Stefan Morarasu
- Center of Simulation and Training in Surgery, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.,Advanced Center for Research and Development in Experimental Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Nicolae Ghetu
- Center of Simulation and Training in Surgery, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.,Department of Plastic and Reconstructive Surgery, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Corneliu George Coman
- Center of Simulation and Training in Surgery, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.,Advanced Center for Research and Development in Experimental Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.,Department of Plastic and Reconstructive Surgery, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Bianca Codrina Morarasu
- Center of Simulation and Training in Surgery, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Daniel Boicu
- Center of Simulation and Training in Surgery, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | | | - Ioannis Gardikiotis
- Center of Simulation and Training in Surgery, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.,Advanced Center for Research and Development in Experimental Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Mihai Danciu
- Department of Pathology, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Dragos Pieptu
- Center of Simulation and Training in Surgery, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.,Department of Plastic and Reconstructive Surgery, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| |
Collapse
|
22
|
Wagner PDJ, Haroon M, Morarasu S, Eguare E, Al-Sahaf O. Does CT Reduce the Rate of Negative Laparoscopies for Acute Appendicitis? A Single-Center Retrospective Study. J Med Life 2020; 13:26-31. [PMID: 32341697 PMCID: PMC7175439 DOI: 10.25122/jml-2019-0099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In surgical practice, surgeons request CT scans to rule out acute appendicitis, even in young patients. We aimed to assess the feasibility of using a CT scan to reduce the rate of negative laparoscopies in patients younger than 40 with equivocal signs of acute appendicitis. Therefore, we conducted a retrospective observational study on the patients admitted with a provisional diagnosis of acute appendicitis. Patients younger than 40 and with the Alvarado score between 3 and 6 were included. These were divided into two groups: those who had or did not have a CT scan. Each group was further subdivided into patients that had a laparoscopy and those that did not. Out of 204 patients included in the study, 16% were included in the CT group, and 84% in the non-CT group. 71.9% of the patients that underwent a CT scan had appendicitis and underwent an appendectomy. Five patients with a normal CT scan had appendectomy due to persistent signs of acute appendicitis. The histopathology of the 23 patients with positive CT was positive, and 3 of the 5 patients with negative CT that underwent appendectomy had positive histology results. The negative appendectomy rate for patients that had preoperative CT is 7.14% compared to 32.4% in patients without preoperative CT. The rate of negative laparoscopy in patients younger than 40 years old that undergo preoperative CT is significantly lower with a p-value of .00667.
Collapse
Affiliation(s)
| | - Muthana Haroon
- Department of Surgery, Naas General Hospital, Naas, Ireland
| | | | - Emmanuel Eguare
- Department of Surgery, Naas General Hospital, Naas, Ireland.,Trinity College, Dublin, Ireland
| | - Osama Al-Sahaf
- Department of Surgery, Naas General Hospital, Naas, Ireland.,Trinity College, Dublin, Ireland
| |
Collapse
|
23
|
Abstract
Analyzing colon biopsies is becoming time consuming and a financial burden as colonoscopy is now the main screening and diagnostic procedure of the main gastrointestinal diseases. Colon sampling can provide important information when used accordingly; otherwise it may only load the medical system unnecessarily. Our aim was to retrospectively analyze criteria for colon biopsies and correlate the diagnostic value of randomly sampling colon, especially in patients with diarrhea. This was a retrospective study on 2109 colonoscopies done over one year. Data was collected from the ENDORAD system and included variables such as: age, gender, quality of preparation, procedure, symptoms, biopsies (type, location), and endoscopy and histology findings. Data was analyzed in a descriptive manner. Out of 496 random biopsies, only 7.4% had positive histology findings. The main symptom was diarrhea and 186 cases of patients complaining of diarrhea with normal colonoscopy had random colon sampling. In 5.3% of these cases histology assessment showed changes of microscopic colitis. Fisher’s test was significant when correlating the odds of having random biopsies in patients with and without diarrhea and patients younger and older than 60. Random sampling of colon during colonoscopies should be done only in selected patients otherwise it has a low diagnostic value.
Collapse
Affiliation(s)
- Stefan Morarasu
- Naas General Hospital, Department of Surgery, Ireland.,Griore T Popa University of Medicine and Pharmacy, Iasi Romania.,Regional Oncology Institute, 2nd Clinic of Surgical Oncology, Iasi Romania
| | | | - Bianca Codrina Morarasu
- Naas General Hospital, Department of Surgery, Ireland.,Griore T Popa University of Medicine and Pharmacy, Iasi Romania
| | - Kirshan Lal
- Naas General Hospital, Department of Surgery, Ireland
| | - Emmanuel Eguare
- Naas General Hospital, Department of Surgery, Ireland.,Trinity College Dublin, Department of Surgery, Ireland
| |
Collapse
|
24
|
Livadaru C, Morarasu S, Frunza TC, Ghitun FA, Paiu-Spiridon EF, Sava F, Terinte C, Ferariu D, Lunca S, Dimofte GM. Post-operative computed tomography scan – reliable tool for quality assessment of complete mesocolic excision. World J Gastrointest Oncol 2019; 11:208-226. [PMID: 30918594 PMCID: PMC6425332 DOI: 10.4251/wjgo.v11.i3.208] [Citation(s) in RCA: 5] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/06/2018] [Accepted: 01/10/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Quality control in colon cancer surgery is an ongoing debate ever since standardization proved to be highly efficient in improving survival in rectal cancer. Complete mesocolic excision (CME) is widely acclaimed as the new gold-standard in colon cancer resections, thus it is imperative to establish quality criteria of CME in order to make it easily understood and verified by surgeons worldwide. One simple and reproducible tool could be the measurement of arterial stumps postoperatively and a straightforward way to test its reliability is to test it in a comparative study between CME and non-CME surgery.
AIM To validate arterial stump measurement as a surgical quality tool by comparing CME with conventional radical colectomies.
METHODS This was a retrospective study, carried out on a prospective database. We collected data from two groups of patients, divided according to standard CME with D2 central vascular ligation (group A) and non-standardized surgery (group B). The two groups were compared with regard to the arterial stump length after right- and left-sided colectomies for colon cancer. The actual stump lengths of the ileocolic artery (ICA) and inferior mesenteric artery (IMA) were compared with their theoretical best D2 position of predicted ligation levels (D2PLLs) for calculating the potential for improvement. Measurements on follow-up computed tomography scans were carried out by three observers. Pathological data were recorded (specimen length, lymph node yield) and correlated with stump length.
RESULTS We analysed 58 colectomies. The stump lengths (mean ± SD) in group A were 16.97 ± 4.77 mm for ICA and 31.70 ± 15.71 mm for IMA, whereas group B had 49.93 ± 20.29 mm for ICA and 67.24 ± 28.71 mm for IMA. Shorter lengths were obtained in group A, by a mean difference of 35.66 mm (χ2 = 27.38, P < 0.001), which was significant for all types of colectomies. Except for a 5.85 ± 4.71 mm difference for right colectomies, all the ligations from group A significantly reached their potential height (0.26 ± 12.18 mm from D2PLL; χ2 = 0.005, P = 0.944). Apart from three left colectomies, group B failed to reach D2PLL, by a mean difference of 32.14 ± 26.15 mm (χ2 = 21.77, P < 0.001). The calculated improvement potentials were significantly shorter in group A than in group B, by a mean of 31.88 mm (χ2= 22.13, P < 0.001). The large spread of results in group B showed that there is significant variability (P = 0.004) when compared to standard surgery. Significant correlations were found between stump length, specimen length and number of lymph nodes (P = 0.018 and P = 0.008 respectively). No statistical difference was found between observers’ measurements (P = 0.866).
CONCLUSION Arterial stump monitoring is a significant step in defining surgical quality, as longer stumps contain residual mesocolic tissue and correlate with major prognostic factors.
Collapse
Affiliation(s)
- Cristian Livadaru
- ”Grigore T Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Stefan Morarasu
- 2nd Clinic of Surgical Oncology, Regional Oncology Institute, “Grigore T Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Tudor Cristian Frunza
- 2nd Clinic of Surgical Oncology, Regional Oncology Institute, “Grigore T Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Florina A Ghitun
- ”Grigore T Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Elena Florina Paiu-Spiridon
- Department of Radiology, Regional Oncology Institute, “Grigore T Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Florina Sava
- Department of Radiology, Regional Oncology Institute, “Grigore T Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Cristina Terinte
- Department of Pathology, Regional Oncology Institute, “Grigore T Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Dan Ferariu
- Department of Pathology, Regional Oncology Institute, “Grigore T Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Sorinel Lunca
- 2nd Clinic of Surgical Oncology, Regional Oncology Institute, “Grigore T Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Gabriel Mihail Dimofte
- 2nd Clinic of Surgical Oncology, Regional Oncology Institute, “Grigore T Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
| |
Collapse
|
25
|
Haroon M, Al-Sahaf O, Eguare E, Morarasu S, Wagner P, Batt R, Subramanian K, Anike-Nweze CS, Ponniah R, O'Riordan F. Postoperative Outcomes and Patient's Satisfaction after Hybrid TIPP with UHS and TEP Repair for Inguinal Hernias: A Single-Centre Retrospective Comparative Study. Chirurgia (Bucur) 2019; 114:57-66. [PMID: 30830845 DOI: 10.21614/chirurgia.114.1.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2019] [Indexed: 11/23/2022]
Abstract
Background: Transabdominal Preperitoneal (TAPP) and Totally Extraperitoneal (TEP) inguinal hernia repairs are largely acclaimed for their lower risk of chronic postoperative pain and acceptable recurrence rates. However, hybrid/combined open procedures are still a reliable option among surgeons. Our aim is to compare the outcomes and patients satisfaction of hybrid TIPP (hTIPP) procedure using the Ultrapro Hernia System with laparoscopic pre-peritoneal mesh repair approaches (TEP) to assess its safety and effectiveness. Patients and Methods: The study design is a single center, retrospective comparative study on 90 patients who had hTIPP and TEP inguinal hernia repair in the NAAS General Hospital, over a four-year period (2013-2017). Results: Unplanned postoperative hospital admission was comparable both groups, the figures were 3 patients for hTIPP and 3 patients for TEP. There was no statistically significant difference in the immediate, early and late postoperative pain and complications in both groups. The recurrence rate was nil in hTIPP group compared to one recurrent case in TEP. There is no statistical difference in the five outcomes of the PROM questionnaire and satisfaction rate between hTIPP and TEP. Conclusions: There is no significant difference between hTIPP and TEP in terms of postoperative outcomes and patient satisfaction. hTIPP approach is a safe and feasible alternative to TEP.
Collapse
|
26
|
Roata EC, Morosanu C, Makkai-Popa ST, Morarasu S, Lunca S, Dimofte G. Stenotic ligature: a simple technique for managing distal hypoperfusion ischemic syndrome following arteriovenous fistulas. J Clin Invest Surg 2018. [DOI: 10.25083/2559.5555/31.1419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction. Distal Hypoperfusion Ischemic Syndrome (DHIS) is a multifactorial debilitating condition causing peripheral ischemia and potentially tissue necrosis. In an effort to further refine its surgical treatment we aim to describe a modified, simple and reliable technique for managing DHIS in patients with arteriovenous fistulas. Materials and Methods. Twenty-nine consecutive patients with DHIS operated by a single surgical team over a period of 7 years were included in the study. All patients underwent the same surgical technique: stenotic ligature. Outcomes were analyzed clinically and the effectiveness of the procedure was proven using McNemar test. Clinical variables were statistically analyzed in SPSS 17.0 for Windows. Results. The technique we used consists in performing a stenosing ligature on the vein, using a 0-silk suture, and adjusting the suture in order to achieve either a radial pulse or capillary pulse, while maintaining a good thrill at palpation of the vein. The procedure was successful in 83% of patients proved by immediate symptomatic relief. Paired data analysis showed significant decrease of all symptoms: cold extremity (p=0,021), paraesthesia (p less 0,001), pain (p less 0,001). History of coronary artery disease, arteriopathy or the absence of radial pulse is statistically correlated with an increased risk of developing DHIS. Conclusions. Stenotic ligature is a simple, cheap and reliable technique for managing DHIS with lower septic risks which can be easily performed under local anesthesia.
Collapse
|
27
|
Morarasu S, Eguare M, Bashir Y, ul Ain Q, Bradu A. Transanal Hemorrhoid Dearterialization and mucopexy: a minimal invasive approach for prolapsed hemorrhoids. Four cases report. Arch Clin Cases 2016. [DOI: 10.22551/2016.10.0301.10062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
28
|
Ghetu N, Danciu M, Coman C, Morarasu S, Lupascu C. LOP19. Plast Reconstr Surg 2015. [DOI: 10.1097/01.prs.0000470711.04471.0b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|