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Gavriilidis P, Askari A, Gavriilidis E, de’Angelis N, Di Saverio S, Wheeler J, Davies RJ. Appraisal of the current guidelines for the management of diverticular disease using the Appraisal of Guidelines Research and Evaluation II (AGREE II) instrument. Ann R Coll Surg Engl 2021; 103:471-477. [PMID: 33851878 PMCID: PMC9774019 DOI: 10.1308/rcsann.2021.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Diverticular disease is one of the most frequent reasons for attending emergency departments and surgical causes of hospital admission. In the past decade, many surgical and gastroenterological societies have published guidelines for the management of diverticular disease. The aim of the present study was to appraise the methodological quality of these guidelines using the Appraisal of Guidelines Research and Evaluation II (AGREE II) tool. METHODS PubMed, Embase, Cochrane Library and Google Scholar databases were searched systematically. The methodological quality of the guidelines was appraised independently by five appraisers using the AGREE II instrument. FINDINGS A systematic search of the literature identified 12 guidelines. The median overall score of all guidelines was 68%. Across all guidelines, the highest score of 85% was demonstrated in the domain 'Scope and purpose'. The domains 'Clarity and presentation' and 'Editorial independence' both scored a median of 72%. The lowest scores were demonstrated in the domains 'Stakeholder involvement' and 'Applicability' at 46% and 40%, respectively. Overall, the National Institute for Health and Care Excellence (NICE) guidelines performed consistently well, scoring 100% in five of six domains; NICE was one of the few guidelines that specifically reported stakeholder involvement, scoring 97%. Generally, the domain of 'Stakeholder involvement' ranked poorly with seven of twelve guidelines scoring below 50%, with the worst score in this domain demonstrated by Danish guidelines at 25%. CONCLUSION Six of twelve guidelines (NICE, American Society of Colon & Rectal Surgeons (ASCRS), European Society of Coloproctology (ESCP), American Gastroenterological Association, German Society of Gastroenterology/German Society for General and Visceral Surgery (German), Netherlands Society of Surgery) scored above 70%. Only three, NICE, ASCRS and ESCP, scored above 75% and were voted unanimously by the appraisers for use as they are. Therefore, use of AGREE II may help improve the methodological quality of guidelines and their future updates.
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Affiliation(s)
- P Gavriilidis
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, UK
| | - A Askari
- Cambridge University Hospitals NHS Foundation Trust, UK
| | - E Gavriilidis
- University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | | | | | - J Wheeler
- Cambridge University Hospitals NHS Foundation Trust, UK
| | - RJ Davies
- Cambridge University Hospitals NHS Foundation Trust, UK
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Gavriilidis P, de'Angelis N, Wheeler J, Askari A, Di Saverio S, Davies JR. Diversion, resection, or stenting as a bridge to surgery for acute neoplastic left-sided colonic obstruction: a systematic review and network meta-analysis of studies with curative intent. Ann R Coll Surg Engl 2021; 103:235-244. [PMID: 33682486 DOI: 10.1308/rcsann.2020.7137] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The debate on the best surgical management strategy for acute malignant left-sided colonic obstruction is ongoing. Decompressing colostomy (DC) and stenting as a bridge to surgery (SBTS) are the currently proposed alternative approaches to emergency colectomy (EC). However, the results of a traditional meta-analysis were inconclusive. Therefore, a network meta-analysis (NMA) was conducted to compare the three approaches for acute left-sided colonic obstruction. METHODS A systematic literature search of Embase, PubMed, Google Scholar and the Cochrane library was performed. A traditional meta-analysis and subsequent NMA were conducted. FINDINGS A significantly greater number of primary anastomoses were performed in the DC cohort than in the EC and SBTS cohorts. The 90-day mortality rate was significantly lower in the DC cohort than in the EC and SBTS cohorts. Higher costs were associated with the SBTS cohort (by US$2,000) than with the EC cohort. The locoregional recurrence rate was higher for the SBTS cohort than for the EC cohort. CONCLUSIONS Evidence from the first NMA suggests there may be some clinical advantages associated with DC as an alternative approach to the EC and SBTS approaches for adequately selected patients with malignant large bowel obstruction.
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Affiliation(s)
| | - N de'Angelis
- University Hospital Henri Mondor (AP-HP), Créteil, France
| | - J Wheeler
- Cambridge University Hospitals NHS Foundation Trust, UK
| | - A Askari
- Luton and Dunstable University Hospitals NHS Trust, UK
| | | | - J R Davies
- Cambridge University Hospitals NHS Foundation Trust, UK
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Gavriilidis P, Wheeler J, Spinelli A, de'Angelis N, Simopoulos C, Di Saverio S. Robotic vs laparoscopic total mesorectal excision for rectal cancers: has a paradigm change occurred? A systematic review by updated meta-analysis. Colorectal Dis 2020; 22:1506-1517. [PMID: 32333491 DOI: 10.1111/codi.15084] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 03/05/2020] [Indexed: 12/30/2022]
Abstract
AIM The debate about the oncological adequacy, safety and efficiency of robotic vs laparoscopic total mesorectal excision for rectal cancers continues. Therefore, an updated, traditional and cumulative meta-analysis was performed with the aim of assessing the new evidence on this topic. METHOD A systematic search of the literature for data pertaining to the last 25 years was performed. Fixed- and random-effects models were used to cumulatively assess the accumulation of evidence over time. RESULTS Patients with a significantly higher body mass index (BMI), tumours located approximately 1 cm further distally and more patients undergoing neoadjuvant therapy were included in the robotic total mesorectal excision (RTME) cohort compared with those in the laparoscopic total mesorectal excision (LTME) cohort [RTME, mean difference (MD) = 0.22 (0.07, 0.36), P = 0.005; LTME, MD = -0.97 (-1.57, 0.36), P < 0.002; OR = 1.47 (1.11, 1.93), P = 0.006]. Significantly lower conversion rates to open surgery were observed in the RTME cohort than in the LTME cohort [OR = 0.33 (0.24, 0.46), P < 0.001]. Operative time in the LTME cohort was significantly reduced (by 50 min) compared with the RTME cohort. Subgroup analysis of the three randomized controlled trials (RCTs) challenged all the significant results of the main analysis and demonstrated nonsignificant differences between the RTME cohort and LTME cohort. CONCLUSION Although the RTME cohort included patients with a significantly higher BMI, more distal tumours and more patients undergoing neoadjuvant therapy, this cohort demonstrated lower conversion rates to open surgery when compared with the LTME cohort. However, subgroup analysis of the RCTs demonstrated nonsignificant differences between the two procedures.
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Affiliation(s)
- P Gavriilidis
- Division of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - J Wheeler
- Colorectal Surgery Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - A Spinelli
- Department of Biomedical Sciences, Humanitas University, Rozzano Milano, Italy.,Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center IRCCS, Rozzano Milano, Italy
| | - N de'Angelis
- Department of Digestive Surgery, AP-HP, University Hospital Henri Mondor, Créteil, France.,University Paris Est, Créteil, France
| | - C Simopoulos
- 2nd Department of Surgery, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - S Di Saverio
- Colorectal Surgery Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK.,Department of General Surgery, ASST Sette Laghi, University of Insubria, University Hospital of Varese, Regione Lombardia, Italy
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Gavriilidis P, Davies RJ, Wheeler J, de'Angelis N, Di Saverio S. Analysing topics using different methods promotes constructive debates: authors' reply. Hernia 2020; 24:1135-1137. [PMID: 32318886 DOI: 10.1007/s10029-020-02191-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 04/06/2020] [Indexed: 11/30/2022]
Affiliation(s)
- P Gavriilidis
- Division of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, W12 0HS, UK
| | - R J Davies
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - J Wheeler
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - N de'Angelis
- Department of Digestive Surgery, Henri Mondor University Hospital, 94010, Créteil, France
| | - S Di Saverio
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK. .,Department of General Surgery, University of Insubria, University Hospital of Varese, ASST Sette Laghi, Regione Lombardia, Varese, Italy.
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Gavriilidis P, Davies RJ, Wheeler J, de'Angelis N, Di Saverio S. Numbers speak louder and communicate a clearer message than words: author's reply. Hernia 2020; 24:1131-1133. [PMID: 32036546 DOI: 10.1007/s10029-020-02125-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 01/05/2020] [Indexed: 11/24/2022]
Affiliation(s)
- P Gavriilidis
- Division of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, W12 0HS, UK
| | - R J Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - J Wheeler
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - N de'Angelis
- Department of Digestive Surgery, Henri Mondor University Hospital, 94010, Créteil, France
| | - S Di Saverio
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.
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Segalini E, Gori A, Birindelli A, Gavriilidis P, Affinita A, Tartaglia D, Tugnoli G, Di Saverio S. Laparoscopic concomitant management of an incidental splenic artery aneurysm and splenectomy for trauma after unsuccessful endovascular treatment - a video vignette. Colorectal Dis 2020; 22:107-108. [PMID: 31466134 DOI: 10.1111/codi.14840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 08/12/2019] [Indexed: 02/08/2023]
Affiliation(s)
- E Segalini
- Department of General and Emergency Surgery, Azienda Socio Sanitaria Territoriale Crema (CR), Crema, Italy
| | - A Gori
- University of Bologna, Bologna, Italy
| | - A Birindelli
- Department of General Surgery, Azienda Socio Sanitaria Territoriale di Valle Camonica (BS), Breno, Italy
| | - P Gavriilidis
- Department of General and Colorectal Surgery, William Harvey Hospital, East Kent Hospitals University NHS Trust, Ashford, UK
| | - A Affinita
- Department of Radiology, Maggiore Hospital, Bologna, Italy
| | - D Tartaglia
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - G Tugnoli
- Trauma Surgery Unit, Maggiore Hospital, Bologna, Italy
| | - S Di Saverio
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Gavriilidis P, Davies RJ, Wheeler J, de'Angelis N, Di Saverio S. Total extraperitoneal endoscopic hernioplasty (TEP) versus Lichtenstein hernioplasty: a systematic review by updated traditional and cumulative meta-analysis of randomised-controlled trials. Hernia 2019; 23:1093-1103. [PMID: 31602585 PMCID: PMC6938473 DOI: 10.1007/s10029-019-02049-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/04/2019] [Indexed: 01/17/2023]
Abstract
Background–purpose Totally extraperitoneal (TEP) endoscopic hernioplasty and Lichtenstein hernioplasty are the most commonly used approaches for inguinal hernia repair. However, current evidence on which is the preferred approach is inconclusive. This updated meta-analysis was conducted to track the accumulation of evidence over time. Methods Studies were identified by a systematic literature search of the EMBASE, PubMed, Cochrane Library, and Google Scholar databases. Fixed- and random-effects models were used to cumulatively assess the accumulation of evidence over time. Results The TEP cohort showed significantly higher rates of recurrences and vascular injuries compared to the Lichtenstein cohort; [Peto Odds ratio (OR) = 1.58 (1.22, 2.04), p = 0.005], [Peto OR = 2.49 (1.05, 5.88), p = 0.04], respectively. In contrast, haematoma formation rate, time to return to usual activities, and local paraesthesia were significantly lower in the TEP cohort compared to the Lichtenstein cohort; [Peto OR = 0.26 (0.16, 0.41), p ≤ 0.001], [mean difference = − 6.32 (− 8.17, − 4.48), p ≤ 0.001], [Peto OR = 0.26 (0.17, 0.40), p ≤ 0.001], respectively. Conclusions This study, which is based on randomised-controlled trials (RCTs) of high quality, showed significantly higher rates of recurrences and vascular injuries in the TEP cohort than in the Lichtenstein cohort. In contrast, rate of postoperative haematoma formation, local paraesthesia, and time to return to usual activities were significantly lower in the TEP cohort than in the Lichtenstein cohort. Future multicentre RCTs with strict adherence to the standards recommended in the Consolidated Standards of Reporting Trials guidelines will shed further light on the topic. Electronic supplementary material The online version of this article (10.1007/s10029-019-02049-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- P Gavriilidis
- Division of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, W12 0HS, UK
| | - R J Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - J Wheeler
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - N de'Angelis
- Department of Digestive Surgery, Henri Mondor University Hospital, 94010, Créteil, France
| | - S Di Saverio
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.
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Gavriilidis P, Moula E, Nikolaidou A. Primary rectal malignant melanoma-case report. Hippokratia 2013; 17:380-381. [PMID: 25031524 PMCID: PMC4097426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Primary malignant melanoma that arises from the true anatomic rectal mucosa is extremely rare. CASE REPORT An endoscopic investigation of a 79-year-old woman with long history of tenesmus and rectal bleeding revealed posterior fleshy mass 4.5 cm from the anal verge. Biopsies demonstrated malignant melanoma. She underwent abdominoperineal resection and is doing well one year after the operation. CONCLUSION Owing to its rarity and histologic variability, misdiagnosis as lymphoma, carcinoma or sarcoma is common.
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Affiliation(s)
- P Gavriilidis
- Department of Surgical Oncology, Theageneio Anticancer Hospital, Thessaloniki, Greece
| | - E Moula
- Department of Pathology, Theageneio Anticancer Hospital, Thessaloniki, Greece
| | - A Nikolaidou
- Department of Pathology, Theageneio Anticancer Hospital, Thessaloniki, Greece
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Gavriilidis P. Is Sentinel lymph node biopsy profitable in melanoma patients? Hippokratia 2013; 17:288. [PMID: 24470749 PMCID: PMC3872475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- P Gavriilidis
- Department of surgical oncology, Theageneio Anticancer Hospital, Thessaloniki, Greece
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Gavriilidis P, Themeli I, Nikolaidou A. Alveolar soft-part sarcoma with synchronous bone metastasis: Rare manifestation of one of the least common soft-tissue sarcomas. Hippokratia 2013; 17:192. [PMID: 24376336 PMCID: PMC3743635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
| | - I Themeli
- Department of Pathology, Theageneio Anticancer Hospital, Thessaloniki, Greece
| | - A Nikolaidou
- Department of Pathology, Theageneio Anticancer Hospital, Thessaloniki, Greece
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Gavriilidis P, Ananiadis A, Theodoulidis V, Toskas I, Barbanis S. Ovarian metastasis from breast invasive ductal carcinoma. Hippokratia 2012; 16:391. [PMID: 23935333 PMCID: PMC3738628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- P Gavriilidis
- Department of Surgical Oncology, Theageneio Anticancer Hospital, Thessaloniki, Greece
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