1
|
Garcia-Granero A, Pellino G, Fletcher-Sanfeliu D, Millan M, Primo-Romaguera V, Garcia-Gausí M, Fernandez M, Gonzalez-Argente X, Spinelli A, Valverde-Navarro A, Garcia-Granero E. "Near-TME": proposed standardisation of the technique for proctectomy in male patients with ulcerative colitis. Tech Coloproctol 2022; 26:217-226. [PMID: 35103902 PMCID: PMC8857132 DOI: 10.1007/s10151-022-02579-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/17/2022] [Indexed: 12/19/2022]
Abstract
Background The aim of the present study was to describe in detail an approach to proctectomy in ulcerative colitis (UC), which can be standardized; near-total mesorectal excision (near-TME), to prevent injuries to autonomic pelvic nerves and subsequent sexual dysfunction. Methods We demonstrate the technique ex vivo on a cadaver from a male patient in lithotomy position and on a sagittal section of a male pelvis. We also demonstrate the technique in vivo in two male patients diagnosed with UC, with no history of sexual dysfunction or bowel neoplasia. The study was performed at the Human Embryology and Anatomy Department. University of Valencia, Spain. Results The posterolateral dissection during a near-TME is similar to that of an oncologic TME, whereas the anterolateral is similar to that of a close rectal dissection. The near-TME technique preserves the superior hypogastric plexus, the hypogastric nerves, the nervi erigentes, the inferior hypogastric plexus, the pelvic plexus and the cavernous nerves. Conclusion The near-TME technique is the standardisation of the technique for proctectomy in male patients with ulcerative colitis. Near-TME requires experience in pelvic surgery and an exhaustive knowledge of the embryological development and of the surgical anatomy of the pelvis. Supplementary Information The online version contains supplementary material available at 10.1007/s10151-022-02579-z.
Collapse
Affiliation(s)
- A Garcia-Granero
- Colorectal Unit, Hospital Universitario Son Espases, Palma de Mallorca, Spain.,Applied Surgical Anatomy Unit, Human Embryology and Anatomy Department, University of Valencia, Valencia, Spain.,Human Embryology and Anatomy Department, University of Islas Baleares, Palma, Spain
| | - G Pellino
- Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy. .,Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - D Fletcher-Sanfeliu
- Cardiac Surgery Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - M Millan
- Colorectal Surgery, Hospital Universitario Y Politecnico "La Fe", Valencia, Spain
| | - V Primo-Romaguera
- Colorectal Surgery, Hospital Universitario Y Politecnico "La Fe", Valencia, Spain
| | - M Garcia-Gausí
- Applied Surgical Anatomy Unit, Human Embryology and Anatomy Department, University of Valencia, Valencia, Spain
| | - M Fernandez
- Colorectal Unit, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - X Gonzalez-Argente
- Colorectal Unit, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - A Spinelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - A Valverde-Navarro
- Applied Surgical Anatomy Unit, Human Embryology and Anatomy Department, University of Valencia, Valencia, Spain
| | - E Garcia-Granero
- Colorectal Surgery, Hospital Universitario Y Politecnico "La Fe", Valencia, Spain
| |
Collapse
|
2
|
Garcia-Granero A, Pellino G, Giner F, Frasson M, Fletcher-Sanfeliu D, Primo Romeguera V, Flor Lorente B, Gamundi M, Brogi L, Garcia-Calderón D, González-Argente FX, Garcia-Granero E. A video demonstration of three-dimensional imaging to assess the circumferential resection margin in locally advanced rectal cancer and recurrent rectal cancer - a video vignette. Colorectal Dis 2020; 22:2340-2341. [PMID: 32702181 DOI: 10.1111/codi.15281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/02/2020] [Indexed: 01/15/2023]
Affiliation(s)
- A Garcia-Granero
- Colorectal Surgery Unit, Hospital Universitario Son Espases, Mallorca, Spain
| | - G Pellino
- Colorectal Surgery Unit, Hospital Vall d'Hebron, Barcelona, Spain
| | - F Giner
- Department of Pathology, Hospital Universitario y Politéctico la Fe, Valencia, Spain
| | - M Frasson
- Colorectal Surgery Unit, Hospital Universitario y Politéctico la Fe, Valencia, Spain
| | - D Fletcher-Sanfeliu
- Cardiovascular Surgery Department, Hospital Universitario Son Espases, Mallorca, Spain
| | - V Primo Romeguera
- Colorectal Surgery Unit, Hospital Universitario y Politéctico la Fe, Valencia, Spain
| | - B Flor Lorente
- Colorectal Surgery Unit, Hospital Universitario y Politéctico la Fe, Valencia, Spain
| | - M Gamundi
- Colorectal Surgery Unit, Hospital Universitario Son Espases, Mallorca, Spain
| | - L Brogi
- 3D-Reconstruction Unit and Simulation Center, Hospital Universitario Son Espases, Mallorca, Spain
| | | | | | - E Garcia-Granero
- Colorectal Surgery Unit, Hospital Universitario y Politéctico la Fe, Valencia, Spain
| |
Collapse
|
3
|
Garcia-Granero A, Pellino G, Giner F, Frasson M, Fletcher-Sanfeliu D, Romaguera VP, Flor-Lorente B, Gamundi M, Brogi L, Garcia-Calderón D, Gonzalez-Argente FX, Garcia-Granero E. A mathematical 3D-method applied to MRI to evaluate prostatic infiltration in advanced rectal cancer. Tech Coloproctol 2020; 24:605-607. [PMID: 32107687 DOI: 10.1007/s10151-020-02170-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/07/2020] [Indexed: 12/30/2022]
Affiliation(s)
- A Garcia-Granero
- Colorectal Surgery Unit, Hospital Universitario Son Espases, Mallorca, Spain
| | - G Pellino
- Colorectal Surgery Unit, Hospital Vall D'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain. .,Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy.
| | - F Giner
- Department of Pathology Hospital, Universitario y Politéctico la Fe, Valencia, Spain
| | - M Frasson
- Colorectal Surgery Unit, Hospital Universitario y Politéctico la Fe, Valencia, Spain
| | - D Fletcher-Sanfeliu
- Cardiovascular Surgery Department, Hospital, Universitario Son Espases, Mallorca, Spain
| | - V P Romaguera
- Colorectal Surgery Unit, Hospital Universitario y Politéctico la Fe, Valencia, Spain
| | - B Flor-Lorente
- Colorectal Surgery Unit, Hospital Universitario y Politéctico la Fe, Valencia, Spain
| | - M Gamundi
- Colorectal Surgery Unit, Hospital Universitario Son Espases, Mallorca, Spain
| | - L Brogi
- 3D-Reconstruction Unit and Simulation Center, Hospital Universitario Son Espases, Mallorca, Spain
| | | | | | - E Garcia-Granero
- Colorectal Surgery Unit, Hospital Universitario y Politéctico la Fe, Valencia, Spain
| |
Collapse
|
4
|
Kroon HM, Dudi-Venkata N, Bedrikovetski S, Thomas M, Kelly M, Aalbers A, Abdul Aziz N, Abraham-Nordling M, Akiyoshi T, Alberda W, Andric M, Antoniou A, Austin K, Baker R, Bali M, Baseckas G, Bednarski B, Beets G, Berg P, Beynon J, Biondo S, Bordeianou L, Brunner M, Buchwald P, Burger J, Burling D, Campain N, Chan K, Chang G, Chew M, C Chong P, Christensen H, Codd M, Colquhoun A, Corr A, Coscia M, Coyne P, Creavin B, Damjanovic L, Daniels I, Davies M, Davies R, de Wilt J, Denost Q, Dietz D, Dozois E, Duff M, Eglinton T, Enriquez-Navascues J, Evans M, Fearnhead N, Frizelle F, Garcia-Granero E, Garcia-Sabrido J, Gentilini L, George M, Glynn R, Golda T, Griffiths B, Harris D, Evans M, Hagemans J, Harji D, Heriot A, Hohenberger W, Holm T, Jenkins J, Kapur S, Kanemitsu Y, Kelley S, Keller D, Kim H, Koh C, Kok N, Kokelaar R, Kontovounisios C, Kusters M, Larson D, Law W, Laurberg S, Lee P, Lydrup M, Lynch A, Mantyh C, Mathis K, Martling A, Meijerink W, Merkel S, Mehta A, McDermott F, McGrath J, Mirnezami A, Morton J, Mullaney T, Mesquita-Neto J, Nielsen M, Nieuwenhuijzen G, Nilsson P, O'Connell P, Palmer G, Patsouras D, Pellino G, Poggioli G, Quinn M, Quyn A, Radwan R, Rasheed S, Rasmussen P, Regenbogen S, Rocha R, Rothbarth J, Roxburgh C, Rutten H, Ryan É, Sagar P, Saklani A, Schizas A, Schwarzkopf E, Scripcariu V, Shaikh I, Shida D, Simpson A, Smart N, Smith J, Solomon M, Sørensen M, Steele S, Steffens D, Stocchi L, Stylianides N, Tekkis P, Taylor C, Tsarkov P, Tsukamoto S, Turner W, Tuynman J, van Ramshorst G, van Zoggel D, Vasquez-Jimenez W, Verhoef C, Verstegen M, Wakeman C, Warrier S, Wasmuth H, Weiser M, Wheeler J, Wild J, Yip J, Winter D, Sammour T. Palliative pelvic exenteration: A systematic review of patient-centered outcomes. Eur J Surg Oncol 2019; 45:1787-1795. [DOI: 10.1016/j.ejso.2019.06.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/02/2019] [Accepted: 06/07/2019] [Indexed: 12/13/2022] Open
|
5
|
Pellino G, Frasson M, García-Granero A, Granero-Castro P, Ramos Rodríguez JL, Flor-Lorente B, Bargallo Berzosa J, Alonso Hernández N, Labrador Vallverdú FJ, Parra Baños PA, Ais Conde G, Garcia-Granero E. Predictors of complications and mortality following left colectomy with primary stapled anastomosis for cancer: results of a multicentric study with 1111 patients. Colorectal Dis 2018; 20:986-995. [PMID: 29920911 DOI: 10.1111/codi.14309] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 04/21/2018] [Accepted: 05/14/2018] [Indexed: 12/16/2022]
Abstract
AIM Reports detailing the morbidity-mortality after left colectomy are sparse and do not allow definitive conclusions to be drawn. We aimed to identify risk factors for anastomotic leakage, perioperative mortality and complications following left colectomy for colonic malignancies. METHOD We undertook a STROBE-compliant analysis of left colectomies included in a national prospective online database. Forty-two variables were analysed as potential independent risk factors for anastomotic leakage, postoperative morbidity and mortality. Variables were selected using the 'least absolute shrinkage and selection operator' (LASSO) method. RESULTS We analysed 1111 patients. Eight per cent of patients had a leakage and in 80% of them reoperation or surgical drainage was needed. A quarter of patients (24.9%) experienced at least one minor complication. Perioperative mortality was 2%, leakage being responsible for 47.6% of deaths. Obesity (OR 2.8, 95% CI 1.00-7.05, P = 0.04) and total parenteral nutrition (TPN) (OR 3.7, 95% CI 1.58-8.51, P = 0.002) were associated with increased risk of leakage, whereas female patients had a lower risk (OR 0.36, 95% CI 0.18-0.67, P = 0.002). Corticosteroids (P = 0.03) and oral anticoagulants (P = 0.01) doubled the risk of complications, which was lower with hyperlipidaemia (OR 0.3, P = 0.02). Patients on TPN had more complications (OR 4.02, 95% CI 2.03-8.07, P = 0.04) and higher mortality (OR 8.7, 95% CI 1.8-40.9, P = 0.006). Liver disease and advanced age impaired survival, corticosteroids being the strongest predictor of mortality (OR 21.5, P = 0.001). CONCLUSION Requirement for TPN was associated with more leaks, complications and mortality. Leakage was presumably responsible for almost half of deaths. Hyperlipidaemia and female gender were associated with lower rates of complications. These findings warrant a better understanding of metabolic status on perioperative outcome after left colectomy.
Collapse
Affiliation(s)
- G Pellino
- Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain.,Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, Università della Campania 'Luigi Vanvitelli', Naples, Italy
| | - M Frasson
- Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain
| | - A García-Granero
- Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain.,Human Anatomy and Embryology Department, University of Valencia, Valencia, Spain
| | - P Granero-Castro
- Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain
| | | | - B Flor-Lorente
- Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain
| | | | | | | | | | | | - E Garcia-Granero
- Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain
| | | |
Collapse
|
6
|
Garcia-Granero A, Sánchez-Guillén L, Fletcher-Sanfeliu D, Flor-Lorente B, Frasson M, Sancho Muriel J, Alvarez Serrado E, Pellino G, Grifo Albalat I, Giner F, Roca Estelles MJ, Esclapez Valero P, Garcia-Granero E. Application of three-dimensional printing in laparoscopic dissection to facilitate D3-lymphadenectomy for right colon cancer. Tech Coloproctol 2018; 22:129-133. [PMID: 29353427 DOI: 10.1007/s10151-018-1746-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 12/20/2017] [Indexed: 12/30/2022]
Affiliation(s)
- A Garcia-Granero
- Colorectal Surgery Unit, Hospital Universitario y Politecnico La Fe, Avda Abril Martorell 106, piso 5, torre G, 46023, Valencia, Spain.
| | - L Sánchez-Guillén
- Colorectal Surgery Unit, Hospital Universitario y Politecnico La Fe, Avda Abril Martorell 106, piso 5, torre G, 46023, Valencia, Spain
| | - D Fletcher-Sanfeliu
- Cardiovascular Surgery Department, University Hospital Son Espases, Palma de Mallorca, Spain
| | - B Flor-Lorente
- Colorectal Surgery Unit, Hospital Universitario y Politecnico La Fe, Avda Abril Martorell 106, piso 5, torre G, 46023, Valencia, Spain
| | - M Frasson
- Colorectal Surgery Unit, Hospital Universitario y Politecnico La Fe, Avda Abril Martorell 106, piso 5, torre G, 46023, Valencia, Spain
| | - J Sancho Muriel
- Colorectal Surgery Unit, Hospital Universitario y Politecnico La Fe, Avda Abril Martorell 106, piso 5, torre G, 46023, Valencia, Spain
| | - E Alvarez Serrado
- Colorectal Surgery Unit, Hospital Universitario y Politecnico La Fe, Avda Abril Martorell 106, piso 5, torre G, 46023, Valencia, Spain
| | - G Pellino
- Colorectal Surgery Unit, Hospital Universitario y Politecnico La Fe, Avda Abril Martorell 106, piso 5, torre G, 46023, Valencia, Spain
| | - I Grifo Albalat
- Colorectal Surgery Unit, Hospital Universitario y Politecnico La Fe, Avda Abril Martorell 106, piso 5, torre G, 46023, Valencia, Spain
| | - F Giner
- Department of Pathology, University Hospital La Fe, Valencia, Spain
| | | | - P Esclapez Valero
- Colorectal Surgery Unit, Hospital Universitario y Politecnico La Fe, Avda Abril Martorell 106, piso 5, torre G, 46023, Valencia, Spain
| | - E Garcia-Granero
- Colorectal Surgery Unit, Hospital Universitario y Politecnico La Fe, Avda Abril Martorell 106, piso 5, torre G, 46023, Valencia, Spain
| |
Collapse
|
7
|
Pous-Serrano S, Frasson M, Palasí Giménez R, Sanchez-Jordá G, Pamies-Guilabert J, Llavador Ros M, Nos Mateu P, Garcia-Granero E. Accuracy of magnetic resonance enterography in the preoperative assessment of patients with Crohn's disease of the small bowel. Colorectal Dis 2017; 19:O126-O133. [PMID: 28116809 DOI: 10.1111/codi.13613] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 11/24/2016] [Indexed: 12/19/2022]
Abstract
AIM To assess the accuracy of magnetic resonance enterography in predicting the extension, location and characteristics of the small bowel segments affected by Crohn's disease. METHOD This is a prospective study including a consecutive series of 38 patients with Crohn's disease of the small bowel who underwent surgery at a specialized colorectal unit of a tertiary hospital. Preoperative magnetic resonance enterography was performed in all patients, following a homogeneous protocol, within the 3 months prior to surgery. A thorough exploration of the small bowel was performed during the surgical procedure; calibration spheres were used according to the discretion of the surgeon. The accuracy of magnetic resonance enterography in detecting areas affected by Crohn's disease in the small bowel was assessed. The findings of magnetic resonance enterography were compared with surgical and pathological findings. RESULTS Thirty-eight patients with 81 lesions were included in the study. During surgery, 12 lesions (14.8%) that were not described on magnetic resonance enterography were found. Seven of these were detected exclusively by the use of calibration spheres, passing unnoticed at surgical exploration. Magnetic resonance enterography had 90% accuracy in detecting the location of the stenosis (75.0% sensitivity, 95.7% specificity). Magnetic resonance enterography did not precisely diagnose the presence of an inflammatory phlegmon (accuracy 46.2%), but it was more accurate in detecting abscesses or fistulas (accuracy 89.9% and 98.6%, respectively). CONCLUSION Magnetic resonance enterography is a useful tool in the preoperative assessment of patients with Crohn's disease. However, a thorough intra-operative exploration of the entire small bowel is still necessary.
Collapse
Affiliation(s)
- S Pous-Serrano
- Department of General Surgery, Colorectal Unit, La Fe University Hospital, Valencia, Spain
| | - M Frasson
- Department of General Surgery, Colorectal Unit, La Fe University Hospital, Valencia, Spain
| | - R Palasí Giménez
- Department of General Surgery, Colorectal Unit, La Fe University Hospital, Valencia, Spain
| | - G Sanchez-Jordá
- Department of Radiology, La Fe University Hospital, Valencia, Spain
| | | | - M Llavador Ros
- Department of Pathology, La Fe University Hospital, Valencia, Spain
| | - P Nos Mateu
- Department of Gastroenterology, Inflammatory Bowel Disease Unit, La Fe University Hospital, Valencia, Spain
| | - E Garcia-Granero
- Department of General Surgery, Colorectal Unit, La Fe University Hospital, Valencia, Spain
| |
Collapse
|
8
|
Frasson M, Garcia-Granero E, Parajó A, Garcia-Mayor L, Flor B, Garcia-Granero A, Lavery I. Rectal cancer threatening or affecting the prostatic plane: is partial prostatectomy oncologically adequate? Results of a multicentre retrospective study. Colorectal Dis 2015; 17:689-97. [PMID: 25735444 DOI: 10.1111/codi.12933] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 01/20/2015] [Indexed: 02/08/2023]
Abstract
AIM The management of rectal cancer threatening or affecting the prostatic plane is still under debate. The role of preoperative chemo radiotherapy and the extent of prostatectomy seem to be key points in the treatment of these tumours. The aim of the present study was to evaluate the pathological circumferential margin status and the local recurrence rate following different therapeutic options. METHOD A multicentre, retrospective study was conducted of patients with rectal cancer threatening or affecting the prostatic plane, but not the bladder, judged by magnetic resonance imaging (MRI). The use of preoperative chemoradiotherapy and the type of urologic resection were correlated with the status of the pathological circumferential resection margin (CRM) and local recurrence. RESULTS A consecutive series of 126 men with rectal cancer threatening (44) or affecting (82) the prostatic plane on preoperative staging and operated with local curative intent between 1998 and 2010 was analysed. In patients who did not have chemoradiotherapy but had a preoperative threatened anterior margin the CRM-positive rate was 25.0%. In patients who did not have preoperative chemoradiotherapy but did have an affected margin, the CRM-positive rate was 41.7%. When preoperative radiotherapy was given, the respective CRM infiltration rates were 7.1 and 20.7%. In patients having preoperative chemoradiotherapy followed by prostatic resection the rate of CRM positivity was 2.4%. Partial prostatectomy after preoperative chemoradiotherapy resulted in a free anterior CRM in all cases, but intra-operative urethral damage occurred in 36.4% of patients who underwent partial prostatectomy, resulting in a postoperative urinary fistula in 18.2% of patients. CONCLUSION Preoperative chemoradiation is mandatory in male patients with a threatened or affected anterior circumferential margin on preoperative MRI. In patients with preoperative prostatic infiltration, prostatic resection is necessary. In this group of patients partial prostatectomy seems to be oncologically safe.
Collapse
Affiliation(s)
- M Frasson
- Colorectal Unit, Department of General Surgery, Hospital La Fe, University of Valencia, Valencia, Spain
| | - E Garcia-Granero
- Colorectal Unit, Department of General Surgery, Hospital La Fe, University of Valencia, Valencia, Spain
| | - A Parajó
- Colorectal Unit, Department of General Surgery, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - L Garcia-Mayor
- Colorectal Unit, Department of General Surgery, Hospital La Fe, University of Valencia, Valencia, Spain
| | - B Flor
- Colorectal Unit, Department of General Surgery, Hospital La Fe, University of Valencia, Valencia, Spain
| | - A Garcia-Granero
- Spanish Association of Coloproctology (AECP), Bellvitge University Hospital and Valle de Hebron University Hospital, Barcelona, Spain
| | - I Lavery
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
9
|
García-Granero A, Granero-Castro P, Frasson M, Flor-Lorente B, Carreño O, Garcia-Granero E. The use of an endostapler in the treatment of supralevator abscess of intersphincteric origin. Colorectal Dis 2014; 16:O335-8. [PMID: 24853735 DOI: 10.1111/codi.12670] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 04/23/2014] [Indexed: 12/13/2022]
Abstract
AIM This technical note describes the use of an endostapler for the definitive treatment of supralevator abscess upward from an intersphincteric origin. METHOD A two-stage treatment was performed. First an endoanal drainage was performed by inserting a mushroom catheter in the supralevator abscess cavity. In the second stage transanal unroofing of the fistula was performed with an endostapler. RESULTS Since 2011, three patients have been treated in this way. After 2 years of follow up, none of the patients had recurrence of the abscess or been referred for anal incontinence. CONCLUSION The use of an endostapler in the treatment of supralevator abscess of intersphincteric origin may be an alternative to decrease the risk of recurrence and incontinence.
Collapse
Affiliation(s)
- A García-Granero
- Department of General Surgery, Hospital Arnau de Vilanova, Valencia, Spain
| | | | | | | | | | | |
Collapse
|
10
|
Ortiz H, Ciga MA, Armendariz P, Kreisler E, Codina-Cazador A, Gomez-Barbadillo J, Garcia-Granero E, Roig JV, Biondo S. Multicentre propensity score-matched analysis of conventional versus extended abdominoperineal excision for low rectal cancer. Br J Surg 2014; 101:874-82. [PMID: 24817654 DOI: 10.1002/bjs.9522] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Abdominal perineal excision (APE) was originally described with levator ani removal for rectal cancer. An even wider, more aggressive extralevator resection for APE has been proposed. Although some surgeons are performing a very wide 'extralevator APE (ELAPE)', there are few data to recommend it routinely. This multicentre study aimed to compare outcomes of APE and ELAPE. METHODS A multicentre propensity case-matched analysis comparing two surgical approaches (APE and ELAPE) was performed. All patients who underwent abdominoperineal resection of a rectal tumour were considered for the analysis. Tumour height was defined by magnetic resonance imaging measurement and patients with stage II-III tumours had neoadjuvant radiochemotherapy. Involvement of the circumferential resection margin (CRM) and intraoperative tumour perforation were the main outcome measures. A logistic regression model was used to study the relationship between the surgical approaches and outcomes. RESULTS From January 2008 to March 2013 a total of 1909 consecutive patients underwent APE or ELAPE, of whom 914 matched patients (457 in each group) formed the cohort for analysis. Intraoperative tumour perforation occurred in 7.9 and 7.7 per cent of patients during APE and ELAPE respectively (P = 0.902), and there was CRM involvement in 13.1 and 13.6 per cent (P = 0.846). There were no differences between APE and ELAPE in terms of postoperative complication rates (52.3 versus 48.1 per cent; P = 0.209), need for reoperation (7.7 versus 7.0 per cent; P = 0.703), perineal wound problems (26.0 versus 21.9 per cent; P = 0.141), mortality rate (2.0 versus 2.0 per cent; P = 1.000) and local recurrence rate at 2 years (2.7 versus 5.6 per cent; P = 0.664). CONCLUSION ELAPE does not improve rates of CRM involvement, intraoperative tumour perforation, local recurrence or mortality.
Collapse
Affiliation(s)
- H Ortiz
- Departments of Surgery, Public University of Navarra and Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Biondo S, Ortiz H, Lujan J, Codina-Cazador A, Espin E, Garcia-Granero E, Kreisler E, de Miguel M, Alos R, Echeverria A. Quality of mesorectum after laparoscopic resection for rectal cancer - results of an audited teaching programme in Spain. Colorectal Dis 2010; 12:24-31. [PMID: 19175653 DOI: 10.1111/j.1463-1318.2008.01720.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of this prospective observational study was to compare the quality of total mesorectal excision between laparoscopic and open surgery for rectal cancer. METHOD In April 2006, the Spanish Association of Surgeons started an audited teaching programme. The project was similar to the Norwegian one and several training courses were arranged. Patients were classified into two groups: laparoscopic rectal resection (LR) and open rectal resection (OR). The quality of the mesorectum was scored: complete, nearly complete or incomplete. The circumferential margin (CRM) was considered positive, if tumour was located 1 mm or less from the surface of the specimen. RESULTS Between 2006 and 2008, 604 patients underwent rectal resection with total mesorectal excision for rectal cancer: 209 patients were included in the LR group and 395 patients in the OR group. There were no differences in terms of number of lymph nodes affected, distance of the tumour from CRM. The mesorectum was complete in 464 (76.8%), nearly complete in 91 (15.1%) and incomplete in 49 patients (8.1%). CRM was negative in 534 patients (88.4%). No differences were observed between the two groups. The overall postoperative morbidity rate was 38.8% in LR group and 44.6% in OR group (P = 0.170). Overall postoperative mortality rate was 2.5%. One patient died (0.5%) in the LR group and 14 patients died (3.5%) in the OR group (P = 0.021). CONCLUSION Laparoscopic resection for rectal cancer is feasible with the quality of mesorectal excision and postoperative outcomes similar to those of open surgery.
Collapse
Affiliation(s)
- S Biondo
- Department of Surgery, Colorectal Unit, Hospital Universitario de Bellvitge, 08907 Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Lledó SM, Garcia-Granero E, Dasí F, Ripoli R, García SA, Cervantes A, Aliño SF. Real time quantification in plasma of human telomerase reverse transcriptase (hTERT) mRNA in patients with colorectal cancer. Colorectal Dis 2004; 6:236-42. [PMID: 15206965 DOI: 10.1111/j.1463-1318.2004.00627.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Increased telomerase activity can be found in almost 90% of colorectal tumours. We aim to describe the preliminary results for quantification in plasma of hTERT mRNA in colorectal cancer patients. MATERIALS AND METHODS Fifty patients undergoing surgery for colorectal cancer and a control group of 50 healthy volunteers were prospectively studied. Pre-operative venous blood samples were taken from all cancer patients and volunteers. Plasma hTERT expression was determined from peripheral blood based on real-time quantitative RT-PCR (qRT-PCR) method normalized to the amount of RNA input using 18S rRNA gene expression. Plasma pre-operative CEA levels were also determined. RESULTS Median values for normalized hTERT (hTERT(N)) gene expression were higher in colorectal cancer patients (11.62, range 0.23-47.67) than healthy volunteers (0.29, range 0.00-4.63) (P < 0.001). Individual data showed that 82% of colorectal cancer patients had hTERT(N) expression values superior to the maximum value observed in the control group. Sensitivity and specificity of the assay for colorectal cancer detection were 98% and 64%, respectively. No significant differences in hTERT(N) expression between gender or with age (P > 0.05). No significant correlation was found between hTERT(N) expression and CEA values (Spearman's rank test = 0.136, P = 0.348). CONCLUSIONS These results show that detection of mRNA based on the qRT-PCR of the telomerase hTERT(N) gene in plasma clearly differentiates between healthy and colorectal cancer patients and that hTERT(N) can be detected and quantified in plasma. This opens up a new field as a noninvasive blood test for colorectal cancer diagnosis.
Collapse
Affiliation(s)
- S M Lledó
- Department of General Surgery, Hospital Clinico Universitario, Valencia, Spain.
| | | | | | | | | | | | | |
Collapse
|
13
|
Garcia-Granero E, Garcia SA, Alos R, Calvete J, Flor-Lorente B, Willatt J, Lledo S. Use of photoplethysmography to determine gastrointestinal perfusion pressure: an experimental canine model. Dig Surg 2003; 20:222-8. [PMID: 12759502 DOI: 10.1159/000070389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2002] [Accepted: 11/05/2002] [Indexed: 12/10/2022]
Abstract
OBJECTIVES To develop an experimental model to assess the parietal perfusion pressure (PPP) of the digestive tract using photoplethysmography. MATERIALS AND METHODS Twenty-two mongrel dogs were used. Progressive external compression was applied to the intestinal wall and the PPP was assessed with photoplethysmography. The study group was divided into two groups. In group 1 PPP was measured at the levels of the stomach, duodenum, jejunum and transverse colon. In group 2 PPP was measured after temporary occlusion of the truncal and marginal circulation of the jejunum to provide further variables. RESULTS The PPP decreased significantly for each successive distal section. Correlation coefficients and indices for PPP and mean arterial pressures were statistically significant (p < 0.005). Truncal occlusion provoked a drop in PPP whereas marginal occlusion scarcely modified the basal results. CONCLUSIONS Photoplethysmography, through measurements of the residual arterial wave amplitude, is a valid method of determining quantitatively the PPP of the digestive tract and could be useful in a clinical environment.
Collapse
Affiliation(s)
- E Garcia-Granero
- Department of General Surgery and Coloproctology Unit, Hospital Clínico Universitario, University of Valencia, Valencia, Spain.
| | | | | | | | | | | | | |
Collapse
|
14
|
Garcia-Armengol J, Hinojosa J, Lledo S, Roig JV, Garcia-Granero E, Martinez B. Prospective study of morphologic and functional changes with time in the mucosa of the ileoanal pouch: functional appraisal using transmucosal potential differences. Dis Colon Rectum 1998; 41:846-53. [PMID: 9678369 DOI: 10.1007/bf02235364] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This study was undertaken to investigate the morphologic and functional changes with time in the mucosa of the ileoanal pouch. METHODS A morphologic study by histopathologic analysis, mucosal morphometry, and mucin histochemistry and a functional study by analysis of transmucosal potential difference were performed in 27 patients with an ileoanal J-pouch after restorative proctocolectomy for ulcerative colitis. In 19 patients with a normal ileoanal pouch, two prospective follow-up analyses were performed after median functional pouch times of 14 and 39 months. We also evaluated eight patients with the diagnosis of pouchitis (median follow-up, 52.5 months). RESULTS In the normal ileoanal pouch group, some degree of chronic and acute inflammatory infiltration was identified in 100 percent and 63.2 percent of cases, respectively, with no significant differences being observed between the two follow-up analyses. The mean villous atrophy index at the first and second follow-up was 0.54 and 0.52, respectively, significantly lower (P < 0.001; an indication of a greater degree of villous atrophy) than the value obtained from the control group with a healthy terminal ileum (0.77). The group of patients with pouchitis exhibited statistically significant differences in the degree of acute and chronic inflammatory infiltration, the extent of ulceration, the crypt depth, and the villous atrophy index, compared with patients without pouchitis. In the normal ileoanal pouch group, the median percentage of sulfomucin with each degree of atrophy (1=mild; 2=moderate; and 3=severe) was 2.6, 4.5, and 20.9 percent, respectively. In patients with pouchitis, the median percentage of sulfomucin was 5.9 percent. The mean transmucosal potential difference at the first follow-up (-25.3 mV) was significantly lower (P=0.001) than at the second (-30.4 mV). Significant differences were apparent with respect to both the normal ileum (-8.9 mV) and the normal rectum (-40.2 mV). CONCLUSION These results suggest that the ileal pouch behaves as a neorectum, with different degrees of colonic metaplasia from a morphologic and a functional perspective.
Collapse
Affiliation(s)
- J Garcia-Armengol
- Department of General Surgery, University Clinic Hospital, University of Valencia, Spain
| | | | | | | | | | | |
Collapse
|
15
|
Garcia-Granero E, Alos R, Uribe N, Sala C, Lledo S. Intraoperative photoplethysmographic diagnosis of ischemic colitis. Am Surg 1997; 63:765-8. [PMID: 9290517] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Intraoperative evaluation of ischemic colitis presents several problems related to diagnosis, severity, and extension. The aim of this study was to determine the usefulness of photopletysmography (PPG) to detect colonic arterial wave amplitude changes in patients operated on for ischemic colitis, comparing the affected area with a control area on the transverse colon. Four patients were studied, two with gangrenous colitis, and two with protracted "transient" ischemic colitis. All four patients survived. PPG is a useful method for intraoperative diagnosis and surgical assessment of ischemic colitis.
Collapse
Affiliation(s)
- E Garcia-Granero
- General Surgery Department, Clinic University Hospital, University of Valencia, Spain
| | | | | | | | | |
Collapse
|
16
|
Alós R, Garcia-Granero E, Calvete J, Uribe N. The use of photoplethysmography and Doppler ultrasound to predict anastomotic viability after segmental intestinal ischaemia in dogs. Eur J Surg 1993; 159:35-41. [PMID: 8095805] [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] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To compare photoplethysmography and Doppler ultrasonography in the prediction of the viability of experimental jejunoileal anastomoses in the presence of arterial (n = 11), venous (n = 11), and mixed arterial and venous (n = 9) segmental ischaemia. DESIGN Experimental open study. MATERIAL 31 Mongrel dogs. INTERVENTIONS Laparotomy, selective devascularisation, and anastomosis. In 20 of the experiments a bolus injection of papaverine was given into the superior mesenteric artery. Second laparotomy on day 15, or earlier if indicated. OUTCOME MEASURES Correlation between photoplethysmography, Doppler ultrasonography, and macroscopic and histological findings. RESULTS All non-viable anastomoses had photoplethysmographic wave amplitudes of less than 10% of the control value, with sensitivity and specificity of 100%. Venous volume and maximum venous outflow had a sensitivity of 72% and a specificity of 77%. Doppler ultrasonography had a sensitivity of 100%, but a specificity of only 67%. Papaverine had no effect on photoplethysmographic wave amplitude in these experiments. CONCLUSION Photoplethysmography is the preferred method of assessing intestinal viability in the presence of ischaemia.
Collapse
Affiliation(s)
- R Alós
- Department of Surgery, Clinic Hospital, University of Valencia, Spain
| | | | | | | |
Collapse
|
17
|
Gil-Salmon M, Garcia-Granero E, Garcia-Granero M, Chuan P, Espí A. Effect of intraperitoneal sterile urine injection on abdominal myoelectrical activity in the spinal rat model. Urol Int 1991; 46:135-9. [PMID: 1828918 DOI: 10.1159/000282118] [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: 12/29/2022]
Abstract
The abdominal muscle reflex contractions in response to intraperitoneal injection of homologous sterile urine and acid, alkaline, hypo- and hyperosmolar solutions are studied in an acute spinal rat model by conventional and integrated electromyographic techniques. Intraperitoneal injection of homologous sterile urine causes a powerful and almost immediate abdominal muscle contracture of relative short duration. This response seems not to be related to urine pH or osmolarity, since only when solutions with extreme variations in these parameters are injected intraperitoneally are significant abdominal muscle contractions observed.
Collapse
Affiliation(s)
- M Gil-Salmon
- Service of Urology, Hospital Clínico Universitario, Faculty of Medicine, University of Valencia, Spain
| | | | | | | | | |
Collapse
|
18
|
Tejerina Botella E, Garcia-Granero E, Carbonell Canti C, Martínez Leon J, Calvete Chornet J. [Evaluation using basal Doppler and reactive hyperemia of the results of deep aorto-femoral bypass in combined aorto-iliac and femoro-popliteal lesions]. Angiologia 1985; 37:270-5. [PMID: 4073587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|