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Broholm M, Vogelsang R, Bulut M, Gögenur M, Stigaard T, Orhan A, Schefte X, Fiehn AMK, Gehl J, Gögenur I. Neoadjuvant calcium electroporation for potentially curable colorectal cancer. Surg Endosc 2024; 38:697-705. [PMID: 38017160 DOI: 10.1007/s00464-023-10557-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/22/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND The development of new perioperative treatment modalities to activate the immune system in colorectal cancer might have a beneficial effect on reducing the risk of recurrence after surgery. Calcium electroporation is a promising treatment modality that potentially modulates the tumor microenvironment. The aim of this study was to evaluate the safety of the procedure in the neoadjuvant setting in localized left-sided colorectal cancer (CRC). METHODS The study included patients with potentially curable sigmoid or rectal cancer with no indication for other neoadjuvant treatment. Patients were offered calcium electroporation as a neoadjuvant treatment before elective surgery. Follow-up visits were conducted on the preoperative day before elective surgery, POD2, POD14, and POD30, with an evaluation of adverse events, impact on elective surgery, clinical examination, and quality of recovery. RESULTS Endoscopic calcium electroporation was performed as an outpatient procedure in all 21 cases, with no procedure-related complications reported. At follow-up, five adverse events were registered, two of which were classified as serious adverse events. Surgery was performed as planned in 19 patients (median time to surgery, 8 days), and the final two patients underwent surgery with a delay due to adverse events (14 and 33 days). No significant impact on the quality of recovery scores nor inflammatory markers were seen before and after calcium electroporation, nor baseline and POD30. CONCLUSIONS Endoscopic calcium electroporation is a safe and feasible procedure in patients with potentially curable CRC. The study showed limited side effects and limited impact on the following elective surgical resection.
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Affiliation(s)
- M Broholm
- Department of Surgery, Zealand University Hospital, Center for Surgical Science, Lykkebaekvej 1, 4600, Koege, Denmark.
| | - R Vogelsang
- Department of Surgery, Zealand University Hospital, Center for Surgical Science, Lykkebaekvej 1, 4600, Koege, Denmark
| | - M Bulut
- Department of Surgery, Zealand University Hospital, Center for Surgical Science, Lykkebaekvej 1, 4600, Koege, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - M Gögenur
- Department of Surgery, Zealand University Hospital, Center for Surgical Science, Lykkebaekvej 1, 4600, Koege, Denmark
| | - T Stigaard
- Department of Surgery, Zealand University Hospital, Center for Surgical Science, Lykkebaekvej 1, 4600, Koege, Denmark
| | - A Orhan
- Department of Surgery, Zealand University Hospital, Center for Surgical Science, Lykkebaekvej 1, 4600, Koege, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
| | - X Schefte
- Department of Surgery, Zealand University Hospital, Center for Surgical Science, Lykkebaekvej 1, 4600, Koege, Denmark
| | - A M K Fiehn
- Department of Surgery, Zealand University Hospital, Center for Surgical Science, Lykkebaekvej 1, 4600, Koege, Denmark
- Department of Pathology, Zealand University Hospital, Roskilde, Denmark
| | - J Gehl
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - I Gögenur
- Department of Surgery, Zealand University Hospital, Center for Surgical Science, Lykkebaekvej 1, 4600, Koege, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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Broholm M, Vogelsang R, Bulut M, Stigaard T, Falk H, Frandsen S, Pedersen DL, Perner T, Fiehn AMK, Mølholm I, Bzorek M, Rosen AW, Andersen CSA, Pallisgaard N, Gögenur I, Gehl J. Endoscopic calcium electroporation for colorectal cancer: a phase I study. Endosc Int Open 2023; 11:E451-E459. [PMID: 37180313 PMCID: PMC10169226 DOI: 10.1055/a-2033-9831] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/09/2023] [Indexed: 05/16/2023] Open
Abstract
Background and study aims Colorectal cancer is one of the most common malignancies, with approximately 20 % of patients having metastatic disease. Local symptoms from the tumor remain a common issue and affect quality of life. Electroporation is a method to permeabilize cell membranes with high-voltage pulses, allowing increased passage of otherwise poorly permeating substances such as calcium. The aim of this study was to determine the safety of calcium electroporation for advanced colorectal cancer. Patients and methods Six patients with inoperable rectal and sigmoid colon cancer were included, all presenting with local symptoms. Patients were offered endoscopic calcium electroporation and were followed up with endoscopy and computed tomography/magnetic resonance scans. Biopsies and blood samples were collected at baseline and at follow-up, 4, 8, and 12 weeks after treatment. Biopsies were examined for histological changes and immunohistochemically with CD3/CD8 and PD-L1. In addition, blood samples were examined for circulating cell-free DNA (cfDNA). Results A total of 10 procedures were performed and no serious adverse events occurred. Prior to inclusion, patients reported local symptoms, such as bleeding (N = 3), pain (N = 2), and stenosis (N = 5). Five of six patients reported symptom relief. In one patient, also receiving systemic chemotherapy, clinical complete response of primary tumor was seen. Immunohistochemistry found no significant changes in CD3 /CD8 levels or cfDNA levels after treatment. Conclusions This first study of calcium electroporation for colorectal tumors shows that calcium electroporation is a safe and feasible treatment modality for colorectal cancer. It can be performed as an outpatient treatment and may potentially be of great value for fragile patients with limited treatment options.
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Affiliation(s)
- Malene Broholm
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Denmark
| | - Rasmus Vogelsang
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Denmark
| | - Mustafa Bulut
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Trine Stigaard
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Denmark
| | - Hanne Falk
- Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Stine Frandsen
- Center for Experimental Drug and Gene Electrotransfer (C*EDGE), Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
| | | | - Trine Perner
- Department of Radiology, Zealand University Hospital, Denmark
| | - Anne-Marie Kanstrup Fiehn
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Pathology, Zealand University Hospital, Denmark
| | | | - Michael Bzorek
- Department of Pathology, Zealand University Hospital, Denmark
| | | | | | | | - Ismail Gögenur
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julie Gehl
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
- Center for Experimental Drug and Gene Electrotransfer (C*EDGE), Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
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Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) has until now always been performed using a reusable non-sterile duodenoscope. The introduction of the new single-use disposable duodenoscope makes it possible to perform perioperative transgastric and rendezvous ERCP in an almost sterile manner. It also eliminates the risk of patient-to-patient transmission of infection in non-sterile settings. We present four patients who underwent different types of ERCP using a sterile single-use duodenoscope. This case report aims to demonstrate the use and the many potential advantages of the new disposable single-use duodenoscope in both sterile and non-sterile settings.
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Affiliation(s)
- Ronja Lagström
- Department of Surgery, Zealand University Hospital Koge, Køge, Denmark
| | - Svend Knuhtsen
- Department of Surgery, Zealand University Hospital Koge, Køge, Denmark
| | - Trine Stigaard
- Department of Surgery, Zealand University Hospital Koge, Køge, Denmark
| | - Mustafa Bulut
- Department of Surgery, Zealand University Hospital Koge, Køge, Denmark.,Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
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Affiliation(s)
- Ronja Lagström
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - Trine Stigaard
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - Svend Knuhtsen
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - Mustafa Bulut
- Department of Surgery, Zealand University Hospital, Koege, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Bulut M, Hjørne F, Knuhtsen S, Stigaard T, Bremholm Hansen L. Sterile laparoscopic transgastric ERCP with single-use disposable duodenoscope. Endoscopy 2022; 54:E268-E270. [PMID: 34144613 DOI: 10.1055/a-1508-5664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Mustafa Bulut
- Department of Surgery, Zealand University Hospital, Koege, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Flemming Hjørne
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - Svend Knuhtsen
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - Trine Stigaard
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - Lasse Bremholm Hansen
- Department of Surgery, Zealand University Hospital, Koege, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark
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Falk Hansen H, Bourke M, Stigaard T, Clover J, Buckley M, O’Riordain M, Winter DC, Hjorth Johannesen H, Hansen RH, Heebøll H, Forde P, Jakobsen HL, Larsen O, Rosenberg J, Soden D, Gehl J. Electrochemotherapy for colorectal cancer using endoscopic electroporation: a phase 1 clinical study. Endosc Int Open 2020; 8:E124-E132. [PMID: 32010744 PMCID: PMC6976320 DOI: 10.1055/a-1027-6735] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/16/2019] [Indexed: 12/21/2022] Open
Abstract
Background and study aims Electrochemotherapy is an anticancer treatment that uses electric pulses to facilitate uptake of chemotherapeutic drugs in tumor cells and has proven to have a high local cytotoxic effect with minimal adverse events. Electrochemotherapy has mostly been used in treatment of cutaneous metastases but development of a new endoscopic electrode device has made treatment of colorectal tumors possible. This first-in-man multicenter phase I study investigated safety and efficacy of electrochemotherapy using endoscopic electroporation in patients with colorectal tumors. Patients and methods Seven patients with colorectal tumors who were deemed ineligible for or had declined standard treatment were included. They were treated with bleomycin either intratumorally or intravenously and the electric pulses were delivered through the endoscopic electrode device. Safety and efficacy were assessed clinically and by scans immediately after treatment and adverse events were reported. Response was evaluated up to 6 months after treatment by scans (magnetic resonance imaging or computed tomography) and endoscopic examinations. Results Seven patients aged 62 to 88 years with multiple comorbidities were included and had one or two treatments each. Post-treatment scans showed tumor responses in the treated areas and no damage to surrounding tissues. Only a few grade one adverse events were reported. Three patients had preoperative rectal bleeding, of which two reported cessation of bleeding and one reported decreased bleeding. Conclusion This first-in-man study shows that electrochemotherapy for colorectal tumors using the endoscopic electrode device can induce local tumor response and is safe also for fragile elderly patients with comorbidities.
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Affiliation(s)
- Hanne Falk Hansen
- Center for experimental drug and gene electrotransfer (C*EDGE), Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Michael Bourke
- Cork Cancer Research Centre, University College Cork, Ireland
| | - Trine Stigaard
- Gastro Unit, Department of Surgical Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - James Clover
- Cork Cancer Research Centre, University College Cork, Ireland
| | - Martin Buckley
- Gastroenterology Department, Mercy University Hospital, Cork, Ireland
| | | | - Des C. Winter
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin, Ireland
| | - Helle Hjorth Johannesen
- Department of Radiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Rasmus Hvass Hansen
- Department of Radiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Hanne Heebøll
- Department of Radiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Patrick Forde
- Cork Cancer Research Centre, University College Cork, Ireland
| | - Henrik Loft Jakobsen
- Gastro Unit, Department of Surgical Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Ole Larsen
- Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen. Denmark
| | - Jacob Rosenberg
- Gastro Unit, Department of Surgical Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Declan Soden
- Cork Cancer Research Centre, University College Cork, Ireland
| | - Julie Gehl
- Center for experimental drug and gene electrotransfer (C*EDGE), Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark,Center for Experimental Drug and Gene Electrotransfer (C*EDGE), Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,Corresponding author Prof. Julie Gehl Center for Experimental Drug and Gene Electrotransfer (C*EDGE)Department of Clinical Oncology and Palliative CareZealand University HospitalSygehusvej 104000 RoskildeDenmark+46326994
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Cherciu I, Cartana T, Brink L, Malmstrom M, Stigaard T, Klausen P, Karstensen J, Hassan H, Saftoiu A, Vilmann P. P-202 Molecular confocal laser endomicroscopy (CLE) for the assessment of prognosis in colorectal carcinoma, based on evaluation of putative cancer stem cell markers. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv233.200] [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: 11/13/2022] Open
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Westen M, Christoffersen MW, Jorgensen LN, Stigaard T, Bisgaard T. Chronic complaints after simple sutured repair for umbilical or epigastric hernias may be related to recurrence. Langenbecks Arch Surg 2013; 399:65-9. [PMID: 24037253 DOI: 10.1007/s00423-013-1119-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 09/06/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE Umbilical and epigastric hernia repairs are minor, but are commonly conducted surgical procedures. Long-term results have only been sparsely investigated. Our objective was to investigate the risk of chronic complaints after a simple sutured repair for small umbilical and epigastric hernias. METHODS A retrospective cohort study with a 5-year questionnaire and clinical follow-up was conducted. Patients undergoing primary elective, open non-mesh umbilical or epigastric sutured hernia repair were included. Patients completed a structured questionnaire regarding chronic complaints during work and leisure activities using a verbal rating scale. The primary outcome was chronic complaints. RESULTS A total of 295 patients were included for analysis after a median of 5.0-year (range 2.8-8.0) follow-up period. Follow-up results were achieved from 262 of the included patients (90 % response rate). Up till 5.8 % of the patients reported moderate or severe pain and discomfort. Work and leisure activities were restricted in 8.5 and 10.0 % of patients, respectively. Patients with chronic complaints had a higher incidence of recurrence (clinical and reoperation), than patients with none or mild complaints (78.6 vs. 22.2 % (P < 0.001)). The recurrence rate was significantly higher after a repair with absorbable suture (20.1 %) compared with non-absorbable suture repair (4.2 %) (P < 0.001). CONCLUSION We found that chronic complaints after a simple sutured umbilical or epigastric repair was in the level of 5.5 % and could in part be explained by recurrence. Furthermore, absorbable suture should be omitted to reduce risk of recurrence.
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Affiliation(s)
- Mikkel Westen
- Gastrounit, Surgical Divison, Hvidovre University Hospital, Kettegård Alle 30, 2650, Hvidovre, Denmark
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Stigaard T, Meisner S. [Novel methods for gastrointestinal endoscopy]. Ugeskr Laeger 2010; 172:2105-2110. [PMID: 20654277] [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: 05/29/2023]
Abstract
The development of diagnostic and therapeutic flexible endoscopy is vivid. This article describes some of the most recent diagnostic techniques: Narrow Band Imaging, Fujinon Intelligent Color Enhancement, Autofluorescence Imaging, Optical Coherence Tomography, Confocal Laser Endomicroscopy. Literature was found through searches on PUBMED and written information from Olympus, Fujinon and Pentax. Which techniques will be used in the future? Will optical biopsy soon be possible? We need more controlled studies.
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