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Mata R, Sahnan K, Pellino G, Spinelli A, Espín-Basany E. Robotic Total Mesorectal Excision With Transanal Transection and Single-Stapled Anastomosis: A Step-By-Step Video Demonstration. Dis Colon Rectum 2024; 67:e289-e290. [PMID: 38294827 DOI: 10.1097/dcr.0000000000003243] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 02/01/2024]
Affiliation(s)
- Rodrigo Mata
- Colorectal Surgery Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
| | - Kapil Sahnan
- Department of Colorectal Surgery, St. Mark's Hospital and Academic Institute, London, United Kingdom
- Department of Surgery and Cancer, Imperial College, St. Mary's Hospital, London, United Kingdom
| | - Gianluca Pellino
- Colorectal Surgery Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital -, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Eloy Espín-Basany
- Colorectal Surgery Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
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Mirnezami AH, Drami I, Glyn T, Sutton PA, Tiernan J, Behrenbruch C, Guerra G, Waters PS, Woodward N, Applin S, Charles SJ, Rose SA, Denys A, Pape E, van Ramshorst GH, Baker D, Bignall E, Blair I, Davis P, Edwards T, Jackson K, Leendertse PG, Love-Mott E, MacKenzie L, Martens F, Meredith D, Nettleton SE, Trotman MP, van Hecke JJM, Weemaes AMJ, Abecasis N, Angenete E, Aziz O, Bacalbasa N, Barton D, Baseckas G, Beggs A, Brown K, Buchwald P, Burling D, Burns E, Caycedo-Marulanda A, Chang GJ, Coyne PE, Croner RS, Daniels IR, Denost QD, Drozdov E, Eglinton T, Espín-Basany E, Evans MD, Flatmark K, Folkesson J, Frizelle FA, Gallego MA, Gil-Moreno A, Goffredo P, Griffiths B, Gwenaël F, Harris DA, Iversen LH, Kandaswamy GV, Kazi M, Kelly ME, Kokelaar R, Kusters M, Langheinrich MC, Larach T, Lydrup ML, Lyons A, Mann C, McDermott FD, Monson JRT, Neeff H, Negoi I, Ng JL, Nicolaou M, Palmer G, Parnaby C, Pellino G, Peterson AC, Quyn A, Rogers A, Rothbarth J, Abu Saadeh F, Saklani A, Sammour T, Sayyed R, Smart NJ, Smith T, Sorrentino L, Steele SR, Stitzenberg K, Taylor C, Teras J, Thanapal MR, Thorgersen E, Vasquez-Jimenez W, Waller J, Weber K, Wolthuis A, Winter DC, Brangan G, Vimalachandran D, Aalbers AGJ, Abdul Aziz N, Abraham-Nordling M, Akiyoshi T, Alahmadi R, Alberda W, Albert M, Andric M, Angeles M, Antoniou A, Armitage J, Auer R, Austin KK, Aytac E, Baker RP, Bali M, Baransi S, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Bui A, Burgess A, Burger JWA, Campain N, Carvalhal S, Castro L, Ceelen W, Chan KKL, Chew MH, Chok AK, Chong P, Christensen HK, Clouston H, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Damjanovic L, Davies M, Davies RJ, Delaney CP, de Wilt JHW, Deutsch C, Dietz D, Domingo S, Dozois EJ, Duff M, Egger E, Enrique-Navascues JM, Espín-Basany E, Eyjólfsdóttir B, Fahy M, Fearnhead NS, Fichtner-Feigl S, Fleming F, Flor B, Foskett K, Funder J, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Giner F, Ginther N, Glover T, Golda T, Gomez CM, Harris C, Hagemans JAW, Hanchanale V, Harji DP, Helbren C, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Holmström A, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Jenkins JT, Jourand K, Kaffenberger S, Kapur S, Kanemitsu Y, Kaufman M, Kelley SR, Keller DS, Kersting S, Ketelaers SHJ, Khan MS, Khaw J, Kim H, Kim HJ, Kiran R, Koh CE, Kok NFM, Kontovounisios C, Kose F, Koutra M, Kraft M, Kristensen HØ, Kumar S, Lago V, Lakkis Z, Lampe B, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Loria A, Lynch AC, Mackintosh M, Mantyh C, Mathis KL, Margues CFS, Martinez A, Martling A, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, McArthur DR, McCormick JJ, McGrath JS, McPhee A, Maciel J, Malde S, Manfredelli S, Mikalauskas S, Modest D, Morton JR, Mullaney TG, Navarro AS, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, O’Dwyer ST, Paarnio K, Pappou E, Park J, Patsouras D, Peacock O, Pfeffer F, Piqeur F, Pinson J, Poggioli G, Proud D, Quinn M, Oliver A, Radwan RW, Rajendran N, Rao C, Rasheed S, Rasmussen PC, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Seifert G, Selvasekar C, Shaban M, Shaikh I, Shida D, Simpson A, Skeie-Jensen T, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Spasojevic M, Steffens D, Stocchi L, Stylianides NA, Swartling T, Sumrien H, Swartking T, Takala H, Tan EJ, Taylor D, Tejedor P, Tekin A, Tekkis PP, Thaysen HV, Thurairaja R, Toh EL, Tsarkov P, Tolenaar J, Tsukada Y, Tsukamoto S, Tuech JJ, Turner G, Turner WH, Tuynman JB, Valente M, van Rees J, van Zoggel D, Vásquez-Jiménez W, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weiser MR, Westney OL, Wheeler JMD, Wild J, Wilson M, Yano H, Yip B, Yip J, Yoo RN, Zappa MA. The empty pelvis syndrome: a core data set from the PelvEx collaborative. Br J Surg 2024; 111:znae042. [PMID: 38456677 PMCID: PMC10921833 DOI: 10.1093/bjs/znae042] [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: 12/13/2023] [Accepted: 01/15/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Empty pelvis syndrome (EPS) is a significant source of morbidity following pelvic exenteration (PE), but is undefined. EPS outcome reporting and descriptors of radicality of PE are inconsistent; therefore, the best approaches for prevention are unknown. To facilitate future research into EPS, the aim of this study is to define a measurable core outcome set, core descriptor set and written definition for EPS. Consensus on strategies to mitigate EPS was also explored. METHOD Three-stage consensus methodology was used: longlisting with systematic review, healthcare professional event, patient engagement, and Delphi-piloting; shortlisting with two rounds of modified Delphi; and a confirmatory stage using a modified nominal group technique. This included a selection of measurement instruments, and iterative generation of a written EPS definition. RESULTS One hundred and three and 119 participants took part in the modified Delphi and consensus meetings, respectively. This encompassed international patient and healthcare professional representation with multidisciplinary input. Seventy statements were longlisted, seven core outcomes (bowel obstruction, enteroperineal fistula, chronic perineal sinus, infected pelvic collection, bowel obstruction, morbidity from reconstruction, re-intervention, and quality of life), and four core descriptors (magnitude of surgery, radiotherapy-induced damage, methods of reconstruction, and changes in volume of pelvic dead space) reached consensus-where applicable, measurement of these outcomes and descriptors was defined. A written definition for EPS was agreed. CONCLUSIONS EPS is an area of unmet research and clinical need. This study provides an agreed definition and core data set for EPS to facilitate further research.
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Marinello F, Fraccalvieri D, Planellas P, Adell Trapé M, Gil JM, Kreisler E, Pellino G, Espín-Basany E. Sacral Neuromodulation in Patients With Low Anterior Resection Syndrome: The SANLARS Randomized Clinical Trial. Dis Colon Rectum 2024; 67:435-447. [PMID: 38084933 PMCID: PMC10846591 DOI: 10.1097/dcr.0000000000003143] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND Sacral neuromodulation might be effective to palliate low anterior resection syndrome after rectal cancer surgery, but robust evidence is not available. OBJECTIVE To assess the impact of sacral neuromodulation on low anterior resection syndrome symptoms as measured by validated scores and bowel diaries. DESIGN Randomized, double-blind, 2-phased, controlled, multicenter crossover trial (NCT02517853). SETTINGS Three tertiary hospitals. PATIENTS Patients with major low anterior resection syndrome 12 months after transit reconstruction after rectal resection who had failed conservative treatment. INTERVENTIONS Patients underwent an advanced test phase by stimulation for 3 weeks and received the pulse generator implant if a 50% reduction in low anterior resection syndrome score was achieved. These patients entered the randomized phase in which the generator was left active or inactive for 4 weeks. After a 2-week washout, the sequence was changed. After the crossover, all generators were left activated. MAIN OUTCOME MEASURES The primary outcome was low anterior resection syndrome score reduction. Secondary outcomes included continence and bowel symptoms. RESULTS After testing, 35 of 46 patients (78%) had a 50% or greater reduction in low anterior resection syndrome score. During the crossover phase, all patients showed a reduction in scores and improved symptoms, with better performance if the generator was active. At 6- and 12-month follow-up, the mean reduction in low anterior resection syndrome score was -6.2 (95% CI -8.97 to -3.43; p < 0.001) and -6.97 (95% CI -9.74 to -4.2; p < 0.001), with St. Mark's continence score -7.57 (95% CI -9.19 to -5.95, p < 0.001) and -8.29 (95% CI -9.91 to -6.66; p < 0.001). Urgency, bowel emptiness sensation, and clustering episodes decreased in association with quality-of-life improvement at 6- and 12-month follow-up. LIMITATIONS The decrease in low anterior resection syndrome score with neuromodulation was underestimated because of an unspecific measuring instrument. There was a possible carryover effect in sham stimulation sequence. CONCLUSIONS Neuromodulation provides symptoms and quality-of-life amelioration, supporting its use in low anterior resection syndrome. See Video Abstract . NEUROMODULACIN SACRA EN PACIENTES CON SNDROME DE RESECCIN ANTERIOR BAJA ENSAYO CLNICO ALEATORIZADO SANLARS ANTECEDENTES:La neuromodulación sacra podría ser eficaz para paliar el síndrome de resección anterior baja después de la cirugía de cáncer de recto, pero no hay pruebas sólidas disponibles.OBJETIVO:Evaluar el impacto de la neuromodulación sacra en los síntomas del síndrome de resección anterior baja, medido mediante puntuaciones validadas y diarios intestinales.DISEÑO:Ensayo cruzado multicéntrico, controlado, aleatorizado, doble ciego, de dos fases (NCT02517853).LUGARES:Tres hospitales terciarios.PACIENTES:Pacientes con puntuación de resección anterior baja importante, 12 meses después de la reconstrucción del tránsito después de la resección rectal en quienes había fracasado el tratamiento conservador.INTERVENCIONES:Los pacientes se sometieron a una fase de prueba avanzada mediante estimulación durante tres semanas y se les implantó el generador de impulsos si se lograba una reducción del 50% en la puntuación del síndrome de resección anterior baja, ingresando a la fase aleatorizada en la que el generador se dejaba activo o inactivo durante cuatro semanas. Después de observar por 2 semanas, se cambió la secuencia. Después del cruce, todos los generadores quedaron activados.PRINCIPALES MEDIDAS DE RESULTADO:El resultado primario fue la reducción de la puntuación del síndrome de resección anterior baja. Los resultados secundarios incluyeron continencia y síntomas intestinales.RESULTADOS:Después de las pruebas, 35 de 46 pacientes (78%) tuvieron una reducción ≥50% en la puntuación del síndrome de resección anterior baja. Durante el cruce, todos los pacientes mostraron una reducción en las puntuaciones y una mejora de los síntomas, con un mejor rendimiento si el generador estaba activo. A los 6 y 12 meses de seguimiento, la reducción media en la puntuación del síndrome de resección anterior baja fue -6,2 (-8,97; -3,43; p < 0,001) y -6,97 (-9,74; -4,2; p < 0,001), con Puntuación de continencia de St. Mark's -7,57 (-9,19; -5,95, p < 0,001) y -8,29 (-9,91; -6,66; p < 0,001). La urgencia, la sensación de vacío intestinal y los episodios de agrupamiento disminuyeron en asociación con una mejora en la calidad de vida a los 6 y 12 meses de seguimiento.LIMITACIONES:La disminución en la puntuación del síndrome de resección anterior baja con neuromodulación se subestimó debido a un instrumento de medición no específico. Posible efecto de arrastre en la secuencia de estimulación simulada.CONCLUSIONES:La neuromodulación mejora los síntomas y la calidad de vida, lo que respalda su uso en el síndrome de resección anterior baja. (Traducción-Dr. Mauricio Santamaria ).
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Affiliation(s)
- Franco Marinello
- Colorectal Surgery Unit, Hospital Universitari Vall d’Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Doménico Fraccalvieri
- Colorectal Surgery Unit, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Pere Planellas
- Colorectal Surgery Unit, Hospital Universitari Josep Trueta, Universitat de Girona, Girona, Spain
| | - Montse Adell Trapé
- Colorectal Surgery Unit, Hospital Universitari Vall d’Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julia M. Gil
- Colorectal Surgery Unit, Hospital Universitari Josep Trueta, Universitat de Girona, Girona, Spain
| | - Esther Kreisler
- Colorectal Surgery Unit, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Gianluca Pellino
- Colorectal Surgery Unit, Hospital Universitari Vall d’Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eloy Espín-Basany
- Colorectal Surgery Unit, Hospital Universitari Vall d’Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain
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Huerta García M, Martí Gallostra M, Pellino G, Espín-Basany E. Side-to-side isoperistaltic strictureplasty (Michelassi technique) in extensive Crohn's disease: a step-by-step video demonstration. Tech Coloproctol 2023; 28:11. [PMID: 38091127 DOI: 10.1007/s10151-023-02877-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 07/14/2023] [Accepted: 10/17/2023] [Indexed: 12/18/2023]
Affiliation(s)
- M Huerta García
- Colorectal Surgery Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
| | - M Martí Gallostra
- Colorectal Surgery Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain.
| | - G Pellino
- Colorectal Surgery Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain.
| | - E Espín-Basany
- Colorectal Surgery Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
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West CT, West MA, Mirnezami AH, Drami I, Denys A, Glyn T, Sutton PA, Tiernan J, Behrenbruch C, Guerra G, Waters PS, Woodward N, Applin S, Charles SJ, Rose SA, Pape E, van Ramshorst GH, Aalbers AGJ, Abdul AN, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alahmadi R, Alberda W, Albert M, Andric M, Angeles M, Angenete E, Antoniou A, Armitage J, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brown K, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelen W, Chan KKL, Chang GJ, Chew MH, Chok AK, Chong P, Christensen HK, Clouston H, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovic L, Daniels IR, Davies M, Davies RJ, Delaney CP, de Wilt JHW, Denost QD, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Egger E, Eglinton T, Enrique-Navascues JM, Espín-Basany E, Evans MD, Eyjólfsdóttir B, Fahy M, Fearnhead NS, Fichtner-Feigl S, Flatmark K, Fleming F, Flor B, Folkesson J, Foskett K, Frizelle FA, Funder J, Gallego MA, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Ginther N, Glover T, Goffredo P, Golda T, Gomez CM, Griffiths B, Gwenaël F, Harris C, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helbren C, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Holmström A, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kaufman M, Kazi M, Kelley SR, Keller DS, Kelly ME, Kersting S, Ketelaers SHJ, Khan MS, Khaw J, Kim H, Kim HJ, Kiran R, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kraft M, Kristensen HØ, Kumar S, Kusters M, Lago V, Lakkis Z, Lampe B, Langheinrich MC, Larach T, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Loria A, Lydrup ML, Lyons A, Lynch AC, Mackintosh M, Mann C, Mantyh C, Mathis KL, Margues CFS, Martinez A, Martling A, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, McArthur DR, McCormick JJ, McDermott FD, McGrath JS, McPhee A, Maciel J, Malde S, Manfredelli S, Mikalauskas S, Modest D, Monson JRT, Morton JR, Mullaney TG, Navarro AS, Neeff H, Negoi I, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, O’Dwyer ST, Paarnio K, Palmer G, Pappou E, Park J, Patsouras D, Peacock A, Pellino G, Peterson AC, Pfeffer F, Piqeur F, Pinson J, Poggioli G, Proud D, Quinn M, Oliver A, Quyn A, Radwan RW, Rajendran N, Rao C, Rasheed S, Rasmussen PC, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Seifert G, Selvasekar C, Shaban M, Shaikh I, Shida D, Simpson A, Skeie-Jensen T, Smart NJ, Smart P, Smith JJ, Smith T, Solbakken AM, Solomon MJ, Sørensen MM, Spasojevic M, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Swartling T, Sumrien H, Swartking T, Takala H, Tan EJ, Taylor C, Taylor D, Tejedor P, Tekin A, Tekkis PP, Teras J, Thanapal MR, Thaysen HV, Thorgersen E, Thurairaja R, Toh EL, Tsarkov P, Tolenaar J, Tsukada Y, Tsukamoto S, Tuech JJ, Turner G, Turner WH, Tuynman JB, Valente M, van Rees J, van Zoggel D, Vásquez-Jiménez W, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weber K, Weiser MR, Westney OL, Wheeler JMD, Wild J, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, Zappa MA, Winter DC. Empty pelvis syndrome: PelvEx Collaborative guideline proposal. Br J Surg 2023; 110:1730-1731. [PMID: 37757457 PMCID: PMC10805575 DOI: 10.1093/bjs/znad301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023]
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Planellas P, Marinello F, Elorza G, Golda T, Farrés R, Espín-Basany E, Enríquez-Navascués JM, Kreisler E, Cornejo L, Codina-Cazador A. Impact on defecatory, urinary and sexual function after high-tie sigmoidectomy: a post-hoc analysis of a multicenter randomized controlled trial comparing extended versus standard complete mesocolon excision. Langenbecks Arch Surg 2023; 408:293. [PMID: 37526748 DOI: 10.1007/s00423-023-03026-9] [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: 10/28/2022] [Accepted: 07/21/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE To assess the effect of high inferior mesenteric artery tie on defecatory, urinary, and sexual function after surgery for sigmoid colon cancer. Performing a sigmoidectomy poses a notable risk of causing injury to the preaortic sympathetic nerves during the high ligation of the inferior mesenteric artery, as well as to the superior hypogastric plexus during dissection at the level of the sacral promontory. Postoperative defecatory and genitourinary dysfunction after sigmoid colon resection are often underestimated and underreported. METHODS This study is a secondary research of a multicenter, single-blind, randomized clinical trial. The trial involved patients with sigmoid cancer who underwent either extended complete mesocolic excision (e-CME) or standard CME (s-CME). Patients completed questionnaires to assess defecatory, urinary, and sexual function before, 1 month after surgery, and 1 year after surgery. Multivariate analysis was conducted to identify factors associated with functional dysfunction. RESULTS Seventy-nine patients completed functional assessments before and 1 year after surgery. One year after sigmoidectomy with a high tie of the inferior mesenteric artery, 15.2% of patients had minor low anterior resection syndrome (LARS) and 12.7% had major LARS; 22.2% of males and 29.4% of females had urinary dysfunction; and 43.8% of males and 27.3% of females had sexual dysfunction. After multivariate analysis, no significant associations were found between clinical and surgical factors and gastrointestinal or urinary dysfunction after 1 year of surgery. Age was identified as the only factor linked to sexual dysfunction in both sexes (women, β = - 0.54, p = 0.002; men β = - 0.38, p = 0.010). Regarding recovery outcomes, diabetes mellitus was identified as a contributing factor to suboptimal gastrointestinal recovery (p = 0.033) and urinary recovery in women (p = 0.039). Furthermore, the treatment arm was found to be significantly associated with the recovery of erectile function after 1 year of surgery (p = 0.046). CONCLUSIONS A high tie of the inferior mesenteric artery during sigmoidectomy is associated with a high incidence of defecatory and genitourinary dysfunction. Age was identified as a significant factor associated with sexual dysfunction 1 year after sigmoid colon resection in both sexes. TRIAL REGISTRATION Clinical trials NCT03083951 HIGHLIGHTS: • One year after high-tie sigmoidectomy, 27.9% of patients had LARS; 22.2% of the men and 29.4% of the women had urinary dysfunction; and 43.8% of the men and 27.3% of the women had sexual dysfunction. • e-CME is associated with a high rate of urinary dysfunction in men 1 year after surgery. However, after multivariate analysis, no association was found between e-CME and urinary dysfunction in men. • Age was correlated with the recovery of sexual function in both sexes 1 year after surgery. Furthermore, diabetes mellitus was identified as the factor associated with poorer recovery of urinary function in females.
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Affiliation(s)
- Pere Planellas
- Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Girona, 17007, Girona, Spain.
- Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain.
- Girona Biomedical Research Institute (IDIBGI), Girona, Spain.
| | - Franco Marinello
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Garazi Elorza
- Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Donostia, Donostia, Spain
| | - Thomas Golda
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Ramon Farrés
- Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Girona, 17007, Girona, Spain
- Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain
- Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Eloy Espín-Basany
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Jose Maria Enríquez-Navascués
- Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Donostia, Donostia, Spain
| | - Esther Kreisler
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Lídia Cornejo
- Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Antoni Codina-Cazador
- Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Girona, 17007, Girona, Spain
- Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain
- Girona Biomedical Research Institute (IDIBGI), Girona, Spain
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Pellino G, Espín-Basany E. Comment on the robot smoke suction technique. Colorectal Dis 2023. [PMID: 36974426 DOI: 10.1111/codi.16559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 03/08/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Gianluca Pellino
- Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
| | - Eloy Espín-Basany
- Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
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8
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Kristensen HØ, Thyø A, Emmertsen KJ, Smart NJ, Pinkney T, Warwick AM, Pang D, Elfeki H, Shalaby M, Emile SH, Abdelkhalek M, Zuhdy M, Poskus T, Dulskas A, Horesh N, Furnée EJB, Verkuijl SJ, Rama NJ, Domingos H, Maciel J, Solis-Peña A, Espín-Basany E, Hidalgo-Pujol M, Biondo S, Sjövall A, Christensen P. Surviving rectal cancer at the cost of a colostomy: global survey of long-term health-related quality of life in 10 countries. BJS Open 2022; 6:6955596. [PMID: 36546340 PMCID: PMC9772877 DOI: 10.1093/bjsopen/zrac085] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/22/2022] [Accepted: 05/20/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Colorectal cancer management may require an ostomy formation; however, a stoma may negatively impact health-related quality of life (HRQoL). This study aimed to compare generic and stoma-specific HRQoL in patients with a permanent colostomy after rectal cancer across different countries. METHOD A cross-sectional cohorts of patients with a colostomy after rectal cancer in Denmark, Sweden, Spain, the Netherlands, China, Portugal, Australia, Lithuania, Egypt, and Israel were invited to complete questionnaires regarding demographic and socioeconomic factors along with the Colostomy Impact (CI) score, European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30) and five anchor questions assessing colostomy impact on HRQoL. The background characteristics of the cohorts from each country were compared and generic HRQoL was measured with the EORTC QLQ-C30 presented for the total cohort. Results were compared with normative data of reference European populations. The predictors of reduced HRQoL were investigated by multivariable logistic regression, including demographic and socioeconomic factors and stoma-related problems. RESULTS A total of 2557 patients were included. Response rates varied between 51-93 per cent. Mean time from stoma creation was 2.5-6.2 (range 1.1-39.2) years. A total of 25.8 per cent of patients reported that their colostomy impairs their HRQoL 'some'/'a lot'. This group had significantly unfavourable scores across all EORTC subscales compared with patients reporting 'no'/'a little' impaired HRQoL. Generic HRQoL differed significantly between countries, but resembled the HRQoL of reference populations. Multivariable logistic regression showed that stoma dysfunction, including high CI score (OR 3.32), financial burden from the stoma (OR 1.98), unemployment (OR 2.74), being single/widowed (OR 1.35) and young age (OR 1.01 per year) predicted reduced stoma-related HRQoL. CONCLUSION Overall HRQoL is preserved in patients with a colostomy after rectal cancer, but a quarter of the patients interviewed reported impaired HRQoL. Differences among several countries were reported and socioeconomic factors correlated with reduced quality of life.
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Affiliation(s)
- Helle Ø Kristensen
- Correspondence to: Helle Ø Kristensen, Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens Blvd 35, DK-8200 Aarhus N, Denmark (e-mail: )
| | - Anne Thyø
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark,Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus, Denmark,Surgical Department, Randers Regional Hospital, Randers, Denmark
| | - Katrine J Emmertsen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark,Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus, Denmark,Surgical Department, Randers Regional Hospital, Randers, Denmark
| | - Neil J Smart
- Royal Devon and Exeter NHS Foundation Trust, Royal Devon and Exeter Hospital, Exeter, UK
| | - Thomas Pinkney
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Andrea M Warwick
- Brisbane Academic Functional Colorectal Unit, QEII Hospital, Brisbane, Queensland, Australia
| | - Dong Pang
- Peking University School of Nursing, Peking, China
| | - Hossam Elfeki
- Colorectal Surgery Unit, Mansoura University Hospital, Mansoura, Egypt
| | - Mostafa Shalaby
- Colorectal Surgery Unit, Mansoura University Hospital, Mansoura, Egypt
| | - Sameh H Emile
- Colorectal Surgery Unit, Mansoura University Hospital, Mansoura, Egypt
| | - Mohamed Abdelkhalek
- Surgical Oncology Department, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Mohammad Zuhdy
- Surgical Oncology Department, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Tomas Poskus
- Department of Abdominal and General Surgery and Oncology, Faculty of Medicine, Vilnius University, National Cancer Institute, Vilnius, Lithuania
| | - Audrius Dulskas
- Department of Abdominal and General Surgery and Oncology, Faculty of Medicine, Vilnius University, National Cancer Institute, Vilnius, Lithuania
| | | | - Edgar J B Furnée
- Department of Surgery, Division of Abdominal Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sanne J Verkuijl
- Department of Surgery, Division of Abdominal Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nuno José Rama
- Surgery Colorectal Unit, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Hugo Domingos
- Colorectal Surgery Unit, Champalimaud Foundation, Lisbon, Portugal
| | - João Maciel
- Colorectal Surgery Unit, Instituto Português de Oncologia, Lisbon, Portugal
| | - Alejandro Solis-Peña
- Colorectal Surgery Unit, General Surgery Department, Universitat Autonoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain
| | - Eloy Espín-Basany
- Colorectal Surgery Unit, General Surgery Department, Universitat Autonoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain
| | - Marta Hidalgo-Pujol
- Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain
| | - Sebastiano Biondo
- Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain
| | - Annika Sjövall
- Division of Coloproctology, Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockhom, Sweden
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9
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Pellino G, Rottoli M, Mineccia M, Frontali A, Celentano V, Colombo F, Baldi C, Ardizzone S, Martí Gallostra M, Espín-Basany E, Ferrero A, Panis Y, Poggioli G, Sampietro GM. Segmental Versus Total Colectomy for Crohn's Disease in the Biologic Era: Results From The SCOTCH International, Multicentric Study. J Crohns Colitis 2022; 16:1853-1861. [PMID: 35819368 DOI: 10.1093/ecco-jcc/jjac096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Indexed: 12/12/2022]
Abstract
BACKGROUND The extent of resection in colonic Crohn's disease [cCD] is still a topic of debate, depending on the number of locations, the risk of recurrence and permanent stoma, and the role of medical therapy. METHODS The Segmental COlecTomy for CroHn's disease [SCOTCH] international study is a retrospective analysis on six tertiary centre prospective databases, comprising all consecutive, unselected patients operated on between 2000 and 2019 with segmental colectomy [SC] or total colectomy [TC] for cCD. The primary aim was long-term surgical recurrence. Secondary aims were perioperative complications, stoma formation and predictors of recurrence. RESULTS Among 687 patients, SC was performed in 285 [41.5%] and TC in 402 [58.5%]. Mean age at diagnosis and surgery, disease duration, and follow-up were 30 ± 15.8, 40.4 ± 15.4, 10.4 ± 8.6 and 7.1 ± 5.2 years respectively. Isolated cCD, inflammatory pattern, perianal CD, younger age, longer disease duration and preoperative maximal therapy were more frequent in TC, while SC presented more small bowel locations and perforating disease, required fewer 90-day re-admissions, and fewer temporary and definitive stomas. Morbidity and mortality were similar. The 15-year surgical recurrence was 44% in TC and 27% in SC [p = 0.006]. In patients with one to three diseased segments, recurrence risk was related to the omission of biological therapy (hazard ratio [HR] 5.6), the number of segments [HR 2.5], perianal disease [HR 1.9] and paediatric diagnosis [HR 2.8]. CONCLUSION When technically feasible, SC is safe and reduces temporary and permanent stoma. Young age, number of locations and perianal disease adversely affect, but postoperative biological therapy significantly reduces, the long-term surgical recurrence.
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Affiliation(s)
- Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy.,Colorectal Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
| | - Matteo Rottoli
- Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Michela Mineccia
- Division of General and Oncologic Surgery, Ospedale Mauriziano 'Umberto I'. Torino, Italy
| | - Alice Frontali
- Division of General Surgery, 'Luigi Sacco' University Hospital, Milano, Italy.,Service de Chirurgie Colorectale, Hôpital Beaujon, Clichy and Université de Paris, France
| | - Valerio Celentano
- Portsmouth Hospital NHS Trust, Portsmouth, UK.,Department of Surgery and Cancer, Imperial College London, UK
| | - Francesco Colombo
- Division of General Surgery, 'Luigi Sacco' University Hospital, Milano, Italy
| | - Caterina Baldi
- Division of General Surgery, 'Luigi Sacco' University Hospital, Milano, Italy.,Division of General and HPB Surgery, ASST Rhodense, Rho Memorial Hospital, Milano, Italy
| | - Sandro Ardizzone
- Division of Gastroenterology, ASST Fatebenefratelli Sacco - Department of Biomedical and Clinical Sciences 'Luigi Sacco' University of Milan, Italy
| | - Marc Martí Gallostra
- Colorectal Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
| | - Eloy Espín-Basany
- Colorectal Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
| | - Alessandro Ferrero
- Division of General and Oncologic Surgery, Ospedale Mauriziano 'Umberto I'. Torino, Italy
| | - Yves Panis
- Service de Chirurgie Colorectale, Hôpital Beaujon, Clichy and Université de Paris, France
| | - Gilberto Poggioli
- Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Gianluca M Sampietro
- Division of General Surgery, 'Luigi Sacco' University Hospital, Milano, Italy.,Division of General and HPB Surgery, ASST Rhodense, Rho Memorial Hospital, Milano, Italy
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10
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Fahy MR, Kelly ME, Aalbers AGJ, Abdul Aziz N, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alberda W, Albert M, Andric M, Angeles MA, Angenete E, Antoniou A, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Beynon J, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelan W, Chan KKL, Chang GJ, Chang M, Chew MH, Chok AY, Chong P, Clouston H, Codd M, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovich L, Daniels IR, Davies M, Delaney CP, de Wilt JHW, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Eglinton T, Enriquez-Navascues JM, Espín-Basany E, Evans MD, Eyjólfsdóttir B, Fearnhead NS, Ferron G, Flatmark K, Fleming FJ, Flor B, Folkesson J, Frizelle FA, Funder J, Gallego MA, Gargiulo M, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Ginther DN, Glyn T, Glynn R, Golda T, Griffiths B, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kazi M, Kelley SR, Keller DS, Ketelaers SHJ, Khan MS, Kiran RP, Kim H, Kim HJ, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kristensen HØ, Kroon HM, Kumar S, Kusters M, Lago V, Lampe B, Lakkis Z, Larach JT, Larkin JO, Larsen SG, Larson DW, Law WL, Lee PJ, Limbert M, Loria A, Lydrup ML, Lyons A, Lynch AC, Maciel J, Manfredelli S, Mann C, Mantyh C, Mathis KL, Marques CFS, Martinez A, Martling A, Mehigan BJ, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, Mikalauskas S, McArthur DR, McCormick JJ, McCormick P, McDermott FD, McGrath JS, Malde S, Mirnezami A, Monson JRT, Navarro AS, Negoi I, Neto JWM, Ng JL, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, Nugent T, Oliver A, O’Dwyer ST, O’Sullivan NJ, Paarnio K, Palmer G, Pappou E, Park J, Patsouras D, Peacock O, Pellino G, Peterson AC, Pinson J, Poggioli G, Proud D, Quinn M, Quyn A, Rajendran N, Radwan RW, Rajendran N, Rao C, Rasheed S, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Selvasekar C, Shaikh I, Simpson A, Skeie-Jensen T, Smart NJ, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Sorrentino L, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Swartling T, Spasojevic M, Sumrien H, Sutton PA, Swartking T, Takala H, Tan EJ, Taylor C, Tekin A, Tekkis PP, Teras J, Thaysen HV, Thurairaja R, Thorgersen EB, Toh EL, Tsarkov P, Tsukada Y, Tsukamoto S, Tuech JJ, Turner WH, Tuynman JB, Valente M, van Ramshorst GH, van Zoggel D, Vasquez-Jimenez W, Vather R, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Urrejola G, Wakeman C, Warrier SK, Wasmuth HH, Waters PS, Weber K, Weiser MR, Wheeler JMD, Wild J, Williams A, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, Zappa MA, Winter DC. Minimum standards of pelvic exenterative practice: PelvEx Collaborative guideline. Br J Surg 2022; 109:1251-1263. [PMID: 36170347 DOI: 10.1093/bjs/znac317] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/18/2022] [Accepted: 08/18/2022] [Indexed: 12/31/2022]
Abstract
This document outlines the important aspects of caring for patients who have been diagnosed with advanced pelvic cancer. It is primarily aimed at those who are establishing a service that adequately caters to this patient group. The relevant literature has been summarized and an attempt made to simplify the approach to management of these complex cases.
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11
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Bemelman WA, Arezzo A, Banasiewicz T, Brady R, Espín-Basany E, Faiz O, Jimenez-Rodriguez RM. Use of sponge-assisted endoluminal vacuum therapy for the treatment of colorectal anastomotic leaks: expert panel consensus. BJS Open 2022; 6:6765232. [PMID: 36268752 PMCID: PMC9585396 DOI: 10.1093/bjsopen/zrac123] [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] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/17/2022] [Accepted: 08/25/2022] [Indexed: 11/12/2022] Open
Abstract
Background Anastomotic leaks represent one of the most significant complications of colorectal surgery and are the primary cause of postoperative mortality and morbidity. Sponge-assisted endoluminal vacuum therapy (EVT) has emerged as a minimally invasive technique for the management of anastomotic leaks; however, there are questions regarding patient selection due to the heterogeneous nature of anastomotic leaks and the application of sponge-assisted EVT by surgeons. Method Seven colorectal surgical experts participated in a modified nominal group technique to establish consensus regarding key questions that arose from existing gaps in scientific evidence and the variability in clinical practice. After a bibliographic search to identify the available evidence and sequential meetings with participants, a series of recommendations and statements were formulated and agreed upon. Results Thirty-seven recommendations and statements on the optimal use of sponge-assisted EVT were elaborated on and unanimously agreed upon by the group of experts. The statements and recommendations answer 10 key questions about the indications, benefits, and definition of the success rate of sponge-assisted EVT for the management of anastomotic leaks. Conclusion Although further research is needed to resolve clinical and technical issues associated with sponge-assisted EVT, the recommendations and statements produced from this project summarize critical aspects to consider when using sponge-assisted EVT and to assist those involved in the management of patients with colorectal anastomotic leaks.
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Affiliation(s)
- Willem A Bemelman
- Correspondence to: Willem A. Bemelman, Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands (e-mail: )
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Tomasz Banasiewicz
- Poznan University of Medical Sciences, Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznań, Poland
| | - Richard Brady
- Newcastle Centre for Bowel Disease Research Group, Department of Colorectal Surgery, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Eloy Espín-Basany
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d’Hebron-Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Rosa M Jimenez-Rodriguez
- Unidad de Coloproctología, Department of Surgery, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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12
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Marinello F, Pellino G, Espín-Basany E. Low anterior resection syndrome: An unavoidable price to pay to preserve the rectum? Front Oncol 2022; 12:994720. [PMID: 36313684 PMCID: PMC9614064 DOI: 10.3389/fonc.2022.994720] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Franco Marinello
- Colorectal Surgery Unit – Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- *Correspondence: Franco Marinello,
| | - Gianluca Pellino
- Colorectal Surgery Unit – Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Eloy Espín-Basany
- Colorectal Surgery Unit – Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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13
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Martí Gallostra M, Dalmau Romero M, Pellino G, Solis Peña A, Espín-Basany E. Laparoscopic Deloyers procedure: A step-by-step video demonstration. Colorectal Dis 2022; 24:1260-1261. [PMID: 35567767 DOI: 10.1111/codi.16189] [Citation(s) in RCA: 1] [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: 02/02/2022] [Accepted: 05/01/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Marc Martí Gallostra
- Colorectal Surgery, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Mar Dalmau Romero
- Colorectal Surgery, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Gianluca Pellino
- Colorectal Surgery, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain.,Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Alejandro Solis Peña
- Colorectal Surgery, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Eloy Espín-Basany
- Colorectal Surgery, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
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14
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Marinello F, Fleming CA, Möeslein G, Khan J, Espín-Basany E, Pellino G. Diversity bias in colorectal surgery: a global perspective. Updates Surg 2022; 74:1915-1923. [PMID: 36083460 PMCID: PMC9674724 DOI: 10.1007/s13304-022-01355-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/08/2022] [Indexed: 12/04/2022]
Abstract
There is a specific lack of data on equity and injustices among colorectal surgeons regarding diversity. This study aimed to explore colorectal surgeon’s lived experience of diversity bias with a specific focus on gender, sexual orientation or gender identity and race or religion. A bespoke questionnaire was designed and disseminated to colorectal surgeons and trainees through specialty association mailing lists and social media channels. Quantitative and qualitative data points were analysed. 306 colorectal surgeons responded globally. 58.8% (n = 180) identified as male and 40.5% (n = 124) as female. 19% were residents/registrars. 39.2% stated that they had personally experienced or witnessed gender inequality in their current workplace, 4.9% because of sexual orientation, and 7.5% due to their race or religion. Sexist jokes, pregnancy-related comments, homophobic comments, liberal use of offensive terms and disparaging comments and stereotypical jokes were commonly experienced. 44.4% (n = 135) did not believe their institution of employer guaranteed an environment of respect for diversity and only 20% were aware of society guidelines on equality and diversity. Diversity bias is prevalent in colorectal surgery. It is necessary to work towards real equality and inclusivity and embrace diversity, both to promote equity among colleagues and provide better surgical care to patients.
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Affiliation(s)
- Franco Marinello
- Colorectal Surgery, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona UAB, Barcelona, Spain
| | - Christina A. Fleming
- Department of Colorectal Surgery, CHU Bordeaux, Bordeaux, France
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gabriela Möeslein
- Center for Hereditary Tumors, Ev. Krankenhaus BETHESDA, University of Düsseldorf, Duisburg, Germany
| | - Jim Khan
- Colorectal Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
- School of Health and Social Care, University of Portsmouth, Portsmouth, UK
| | - Eloy Espín-Basany
- Colorectal Surgery, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona UAB, Barcelona, Spain
| | - Gianluca Pellino
- Colorectal Surgery, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona UAB, Barcelona, Spain
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
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15
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Krogsgaard M, Kristensen HØ, Furnée EJB, Verkuijl SJ, Rama NJ, Domingos H, Maciel J, Solis-Peña A, Espín-Basany E, Hidalgo-Pujol M, Biondo S, Sjövall A, Emmertsen KJ, Thyø A, Christensen P. Life with a stoma across five European countries-a cross-sectional study on long-term rectal cancer survivors. Support Care Cancer 2022; 30:8969-8979. [PMID: 35930059 DOI: 10.1007/s00520-022-07293-y] [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] [Received: 01/26/2022] [Accepted: 07/19/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Stoma-related problems are known to be important to patients and potentially affect everyday life. The prevalence of stoma-related problems in rectal cancer survivors remains undetermined. This study aimed to examine aspects of life with a long-term stoma, stoma management, and stoma-related problems and explore the impact of stoma-related problems on daily life. METHODS In total, 2262 patients from 5 European countries completed a multidimensional survey. Stoma-related problems were assessed using the Colostomy Impact score. Multivariable regression analysis, after adjusting for potential confounding factors, provided odds ratio (OR) and 95% confidence intervals (CI) for stoma-related problems' association with restrictions in daily life. RESULTS The 2262 rectal cancer survivors completed the questionnaire at a median of 5.4 years (interquartile range 3.8-7.6) after stoma formation. In the total sample, leakage (58%) and troublesome odour (55%) were most prevalent followed by skin problems (27%) and pain (21%). Stoma-related problems were more prevalent in patients with parastomal bulging. A total of 431 (19%) reported feeling restricted in daily activities in life with a stoma. Leakage, odour, skin problems, stool consistency, and frequent appliance changes were significantly associated with restrictions in daily life. The highest risk of experiencing restrictions was seen for patients having odour (OR 2.74 [95% CI: 1.99-3.78]) more than once a week and skin problems (OR 1.77 [95% CI: 1.38-2.27]). CONCLUSION In this large cohort with rectal cancer, stoma-related problems were highly prevalent and impacted daily life. Supportive care strategies should entail outreach to patients with a long-term stoma.
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Affiliation(s)
- Marianne Krogsgaard
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Lykkebækvej 1, 4600, Koege, Denmark.
| | - Helle Ø Kristensen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.,Danish Cancer Society Centre for Research On Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus, Denmark
| | - Edgar J B Furnée
- Department of Surgery, Division of Abdominal Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sanne J Verkuijl
- Department of Surgery, Division of Abdominal Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Nuno José Rama
- Surgery - Colorectal Unit, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Hugo Domingos
- Colorectal Surgery Unit, Champalimaud Foundation, Lisbon, Portugal
| | - João Maciel
- Colorectal Surgery Unit, Instituto Português de Oncologia, Lisbon, Portugal
| | - Alejandro Solis-Peña
- Colorectal Surgery Unit, General Surgery Department, Universitat Autonoma de Barcelona, Hospital Vall d'Hebron, Barcelona, Spain
| | - Eloy Espín-Basany
- Colorectal Surgery Unit, General Surgery Department, Universitat Autonoma de Barcelona, Hospital Vall d'Hebron, Barcelona, Spain
| | - Marta Hidalgo-Pujol
- Department of General and Digestive Surgery, Coloproctology Unit, Bellvitge University Hospital, Barcelona, Spain.,University of Barcelona and IBIDELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain
| | - Sebastiano Biondo
- Department of General and Digestive Surgery, Coloproctology Unit, Bellvitge University Hospital, Barcelona, Spain.,University of Barcelona and IBIDELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain
| | - Annika Sjövall
- Division of Coloproctology, Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Katrine J Emmertsen
- Danish Cancer Society Centre for Research On Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus, Denmark.,Department of Surgery, Regional Hospital Randers, Randers, Denmark
| | - Anne Thyø
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.,Danish Cancer Society Centre for Research On Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus, Denmark.,Department of Surgery, Regional Hospital Randers, Randers, Denmark
| | - Peter Christensen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.,Danish Cancer Society Centre for Research On Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus, Denmark
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16
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Pera M, Barrios O, Pellino G, Golda T, Biondo S, Espín-Basany E. Turnbull-Cutait pull-through technique for delayed coloanal anastomosis after ultralow rectal resection: A step-by-step video vignette. Colorectal Dis 2022; 24:889-890. [PMID: 35277909 DOI: 10.1111/codi.16114] [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] [Received: 12/27/2021] [Revised: 01/28/2022] [Accepted: 02/13/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Meritxell Pera
- Colorectal Surgery, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Oriana Barrios
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona, C/Feixa Llarga S/N, L' Hospitalet de Llobregat, 08907, IDIBELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain
| | - Gianluca Pellino
- Colorectal Surgery, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain.,Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Thomas Golda
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona, C/Feixa Llarga S/N, L' Hospitalet de Llobregat, 08907, IDIBELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain
| | - Sebastiano Biondo
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona, C/Feixa Llarga S/N, L' Hospitalet de Llobregat, 08907, IDIBELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain
| | - Eloy Espín-Basany
- Colorectal Surgery, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
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17
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Barrios O, Pera M, Golda T, Pellino G, Espín-Basany E, Biondo S. Double-barrelled wet colostomy for urinary reconstruction after pelvic exenteration: a step-by-step video vignette demonstration. Colorectal Dis 2022; 24:883-884. [PMID: 35184339 DOI: 10.1111/codi.16097] [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] [Received: 12/21/2021] [Revised: 01/28/2022] [Accepted: 02/09/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Oriana Barrios
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona, IDIBELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain
| | - Meritxell Pera
- Colorectal Surgery, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Thomas Golda
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona, IDIBELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain
| | - Gianluca Pellino
- Colorectal Surgery, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain.,Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - Eloy Espín-Basany
- Colorectal Surgery, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Sebastiano Biondo
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona, IDIBELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain
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18
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Pellino G, Harrison EM, Biondo S, Espín-Basany E. Observational studies in surgical research. Cir Esp 2022; 100:445-447. [PMID: 35483587 DOI: 10.1016/j.cireng.2021.11.015] [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] [Received: 10/14/2021] [Accepted: 11/16/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Gianluca Pellino
- Unidad de Cirugía Colorrectal, Servicio de Cirugía General, Hospital Universitario Valle de Hebrón, Barcelona, Spain; Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania «Luigi Vanvitelli», Naples, Italy
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edimburgo, United Kingdom
| | - Sebastiano Biondo
- Servicio de Cirugía General, Hospital Universitario Bellvitge, Barcelona, Spain
| | - Eloy Espín-Basany
- Unidad de Cirugía Colorrectal, Servicio de Cirugía General, Hospital Universitario Valle de Hebrón, Barcelona, Spain.
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19
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Ielpo B, Podda M, Burdio F, Sanchez-Velazquez P, Guerrero MA, Nuñez J, Toledano M, Morales-Conde S, Mayol J, Lopez-Cano M, Espín-Basany E, Pellino G. Cost-Effectiveness of Robotic vs. Laparoscopic Surgery for Different Surgical Procedures: Protocol for a Prospective, Multicentric Study (ROBOCOSTES). Front Surg 2022; 9:866041. [PMID: 36227017 PMCID: PMC9549953 DOI: 10.3389/fsurg.2022.866041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/31/2022] [Indexed: 11/29/2022] Open
Abstract
Background The studies which address the impact of costs of robotic vs. laparoscopic approach on quality of life (cost-effectiveness studies) are scares in general surgery. Methods The Spanish national study on cost-effectiveness differences among robotic and laparoscopic surgery (ROBOCOSTES) is designed as a prospective, multicentre, national, observational study. The aim is to determine in which procedures robotic surgery is more cost-effective than laparoscopic surgery. Several surgical operations and patient populations will be evaluated (distal pancreatectomy, gastrectomy, sleeve gastrectomy, inguinal hernioplasty, rectal resection for cancer, Heller cardiomiotomy and Nissen procedure). Discussion The results of this study will demonstrate which treatment (laparoscopic or robotic) and in which population is more cost-effective. This study will also assess the impact of previous surgical experience on main outcomes.
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Affiliation(s)
- Benedetto Ielpo
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital del Mar, Barcelona, Spain
- *Correspondence: Benedetto Ielpo
| | - Mauro Podda
- Department of Surgical Science, Emergency Surgery Unit, University of Cagliari, Cagliari, Italy
| | - Fernando Burdio
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital del Mar, Barcelona, Spain
| | | | - Maria-Alejandra Guerrero
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital del Mar, Barcelona, Spain
| | - Javier Nuñez
- IVEC (Instituto de Validación de la Eficiencia Clínica), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - Miguel Toledano
- General Surgery Department, University Hospital Rio Hortega, Valladolid, Spain
| | - Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of Surgery, University Hospital Virgen del Rocio, University of Seville, Seville, Spain
| | - Julio Mayol
- Department of Surgery, Hospital Clinico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Lopez-Cano
- Abdominal Wall Surgery Unit, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, UAB, Barcelona, Spain
| | - Eloy Espín-Basany
- Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, UAB, Barcelona, Spain
| | - Gianluca Pellino
- Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, UAB, Barcelona, Spain
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
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20
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Gómez-Jurado MJ, Martí-Gallostra M, Pellino G, Galvez A, Kreisler E, Biondo S, Espín-Basany E. Long-term outcomes of an acellular dermal matrix for the treatment of complex cryptoglandular anal fistula: a pilot study. Tech Coloproctol 2022; 26:453-459. [PMID: 35212835 PMCID: PMC9072521 DOI: 10.1007/s10151-022-02593-1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 02/01/2022] [Indexed: 11/26/2022]
Abstract
Backgound Effective, standardized treatments for complex anal fistula (CAF) still represent a clinical challenge. Emerging procedures attempted to achieve the healing rates of fistulotomy whilst preserving sphincter function. Acellular dermal matrix (ADM) used as a plug inserted through the fistulous tract is among newer treatment options. Varying success rates have been reported, most with short-term follow-up. The aim of this study was to report the long-term results of ADM-plug for CAF. Methods Retrospective analysis of a prospective database of patients treated with CAF. All consecutive patients presenting at two tertiary centers (Vall d’Hebron University Hospital and Bellvitge University Hospital, Barcelona, Spain) between November 2015 and March 2019 with a single, cryptoglandular CAF were evaluated for treatment with an ADM-plug were included. The primary endpoint was absence of discharge at clinical examination at 12 month follow-up. Results Twenty-two patients were included [7 women and 15 men, median age 56 (33–74) years]. Most patients had high transsphincteric fistulas (63.6%). The median follow-up was 42 (21–53) months. The 12 month success rate was 68.2%, with an overall healing rate of 59.1%. 77.8% of recurrences occurred within 12 months from surgery. One plug extrusion was observed. No major complications or mortality occurred during the follow-up. Patients did not report any worsening of fecal continence. Conclusions This pilot study showed that more than half of patients with CAF could benefit from ADM-plug placement, preserving continence. A minimum follow-up of 12 months is recommended, because most recurrences occur during the first year. Supplementary Information The online version contains supplementary material available at 10.1007/s10151-022-02593-1.
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Affiliation(s)
- M. J. Gómez-Jurado
- Department of Advanced Medical and Surgical Sciences, Colorectal Surgery, Vall d’Hebron University Hospital, Barcelona, Spain
| | - M. Martí-Gallostra
- Department of Advanced Medical and Surgical Sciences, Colorectal Surgery, Vall d’Hebron University Hospital, Barcelona, Spain
| | - G. Pellino
- Department of Advanced Medical and Surgical Sciences, Colorectal Surgery, Vall d’Hebron University Hospital, Barcelona, Spain
- Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania “Luigi Vanvitelli”, Naples, Italy
| | - A. Galvez
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona, and IDIBELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain
| | - E. Kreisler
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona, and IDIBELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain
| | - S. Biondo
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona, and IDIBELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain
| | - E. Espín-Basany
- Department of Advanced Medical and Surgical Sciences, Colorectal Surgery, Vall d’Hebron University Hospital, Barcelona, Spain
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21
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Abstract
Several strategies are available to reduce adverse events after colonic and rectal surgery. Oral and intravenous antibiotics have proven efficacy in reducing surgical-site infections, and might be beneficial against anastomotic leaks. The role of mechanical bowel preparation needs further elucidation.
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Affiliation(s)
- Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitellii', Naples, Italy.,Colorectal Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Eloy Espín-Basany
- Colorectal Unit, Vall d'Hebron University Hospital, Barcelona, Spain
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22
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23
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Marinello FG, Jiménez LM, Talavera E, Fraccalvieri D, Alberti P, Ostiz F, Frago R, Blanco A, Pellino G, Espín-Basany E. Percutaneous tibial nerve stimulation in patients with severe low anterior resection syndrome: randomized clinical trial. Br J Surg 2021; 108:380-387. [PMID: 33793754 DOI: 10.1093/bjs/znaa171] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/31/2020] [Accepted: 12/12/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Treatment of low anterior resection syndrome (LARS) is challenging. Percutaneous tibial nerve stimulation (PTNS) can improve select bowel disorders. An RCT was conducted to assess the efficacy of PTNS compared with sham stimulation in patients with severe LARS. METHOD This was a multicentre, double-blind RCT. Patients with major LARS score were allocated to receive PTNS or sham therapy (needle placement simulation without nerve stimulation). The study included 16 sessions of 30 min once a week for 12 consecutive weeks, followed by four additional sessions once a fortnight for the following 4 weeks. The primary endpoint was efficacy of PTNS defined by the LARS score 12 months after treatment. Secondary endpoints included faecal incontinence, quality of life (QoL), and sexual function. RESULTS Between September 2016 and July 2018, 46 eligible patients were assigned randomly in a 1 : 1 ratio to PTNS or sham therapy. Baseline characteristics were similar. LARS scores were reduced in both groups, but only patients who received PTNS maintained the effect in the long term (mean(s.d.) score 36.4(3.9) at baseline versus 30.7(11.5) at 12 months; P = 0.018; effect size -5.4, 95 per cent c.i. -9.8 to -1.0), with a mean reduction of 15.7 per cent at 12-month follow-up. The faecal incontinence score was improved after 12 months in the PTNS group (mean(s.d.) score 15.4(5.2) at baseline versus 12.5(6.4) at 12 months; P = 0.018). No major changes in QoL and sexual function were observed in either group. There was no therapy-associated morbidity. Three patients discontinued the study, but none owing to study-related issues. CONCLUSION PTNS has positive effects in some patients with major LARS, especially in those with faecal incontinence. Registration number: NCT02517853 (http://www.clinicaltrials.gov).
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Affiliation(s)
- F G Marinello
- Colorectal Surgery Unit, Vall d'Hebrón University Hospital, Barcelona, Spain
| | - L M Jiménez
- Colorectal Surgery Unit, Hospital Gregorio Marañón, Madrid, Spain
| | - E Talavera
- Colorectal Surgery Unit, Vall d'Hebrón University Hospital, Barcelona, Spain
| | - D Fraccalvieri
- Colorectal Surgery Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - P Alberti
- Colorectal Surgery Unit, Vall d'Hebrón University Hospital, Barcelona, Spain
| | - F Ostiz
- Rehabilitation Unit, CAP Sant Andreu, Barcelona, Spain
| | - R Frago
- Colorectal Surgery Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - A Blanco
- Colorectal Surgery Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - G Pellino
- Colorectal Surgery Unit, Vall d'Hebrón University Hospital, Barcelona, Spain
| | - E Espín-Basany
- Colorectal Surgery Unit, Vall d'Hebrón University Hospital, Barcelona, Spain
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24
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Pellino G, Solís-Peña A, Kraft M, Huguet BM, Espín-Basany E. Preoperative oral antibiotics with versus without mechanical bowel preparation to reduce surgical site infections following colonic resection: Protocol for an international randomized controlled trial (ORALEV2). Colorectal Dis 2021; 23:2173-2181. [PMID: 33872448 DOI: 10.1111/codi.15681] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 04/05/2021] [Accepted: 04/10/2021] [Indexed: 12/13/2022]
Abstract
AIM Surgical site infections (SSIs) are common after colonic surgery. SSIs can cause relevant morbidity and increase costs of care. Preoperative oral antibiotics can reduce the incidence of SSIs after resection of the colon, but the role of mechanical bowel preparation (MBP) is debated. This study aims to assess the impact of a combined regimen of oral antibiotics and MBP on SSIs after colonic surgery. METHODS An international, multicentre, pragmatic, adaptive, parallel-group, randomized controlled trial will be conducted across Europe. Adult patients scheduled to undergo elective colonic resection will be assessed for inclusion. Patients will be randomized into one of two treatment arms: (1) preoperative oral antibiotics without MBP (control); (2) preoperative oral antibiotics with MBP (experimental). All patients will receive intravenous antibiotics at anaesthetic induction. The primary aim will be 30-day SSI, assessed by a blinded nurse. Additional end-points include safety, morbidity and mortality, satisfaction with the preparation, time to return of bowel function, time to complete recovery and time to discharge, long-term results. Analyses will be performed with a modified intention-to-treat approach. Interim analyses are planned. DISCUSSION This will be the first randomized clinical trial to assess the efficacy and safety of preoperative oral antibiotics plus MBP versus preoperative oral antibiotics only, before colonic surgery. The knowledge obtained could help to establish the ideal preparation for patients scheduled to undergo resection of the colon. Full protocol NCT04161599.
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Affiliation(s)
- Gianluca Pellino
- Colorectal Surgery Unit, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - Alejandro Solís-Peña
- Colorectal Surgery Unit, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - Miquel Kraft
- Colorectal Surgery Unit, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - Bernat Miguel Huguet
- Colorectal Surgery Unit, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - Eloy Espín-Basany
- Colorectal Surgery Unit, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
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25
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García Botella A, Gómez Bravo MA, Di Martino M, Gastaca M, Martín-Pérez E, Sánchez Cabús S, Sánchez Pérez B, López Ben S, Rodríguez Sanjuán JC, López-Andújar R, Barrera M, Balibrea JM, Rubio-Pérez I, Badia JM, Martin-Antona E, Peña EÁ, Garcia-Botella A, Martín-Pérez E, Gallego MÁ, Cortijo SM, Migueláñez IP, Díaz LP, Ramos Rodríquez JL, Espín-Basany E, Santos RS, Garriga XG, Aranda Narváez JM, Morales-Conde S. Recommendations on intervention for hepatobiliary oncological surgery during the COVID-19 pandemic. Cirugía Española (English Edition) 2021. [PMCID: PMC7901494 DOI: 10.1016/j.cireng.2020.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The SARS-CoV-2 (COVID-19) pandemic requires an analysis in the field of oncological surgery, both on the risk of infection, with very relevant clinical consequences, and on the need to generate plans to minimize the impact on possible restrictions on health resources. The AEC is making a proposal for the management of patients with hepatopancreatobiliary (HPB) malignancies in the different pandemic scenarios in order to offer the maximum benefit to patients, minimising the risks of COVID-19 infection, and optimising the healthcare resources available at any time. This requires the coordination of the different treatment options between the departments involved in the management of these patients: medical oncology, radiotherapy oncology, surgery, anaesthesia, radiology, endoscopy department and intensive care. The goal is offer effective treatments, adapted to the available resources, without compromising patients and healthcare professionals’ safety.
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26
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García Botella A, Gómez Bravo MA, Di Martino M, Gastaca M, Martín-Pérez E, Sánchez Cabús S, Sánchez Pérez B, López Ben S, Rodríguez Sanjuán JC, López-Andújar R, Barrera M, Balibrea JM, Rubio-Pérez I, Badia JM, Martin-Antona E, Álvarez Peña E, Garcia-Botella A, Martín-Pérez E, Álvarez Gallego M, Martínez Cortijo S, Pascual Migueláñez I, Pérez Díaz L, Ramos Rodríquez JL, Espín-Basany E, Sánchez Santos R, Guirao Garriga X, Aranda Narváez JM, Morales-Conde S. Recommendations on intervention for hepatobiliary oncological surgery during the COVID-19 pandemic. Cir Esp 2021; 99:174-182. [PMID: 33341242 PMCID: PMC7744030 DOI: 10.1016/j.ciresp.2020.10.010] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/14/2020] [Accepted: 10/18/2020] [Indexed: 12/30/2022]
Abstract
The SARS-CoV-2 (COVID-19) pandemic requires an analysis in the field of oncological surgery, both on the risk of infection, with very relevant clinical consequences, and on the need to generate plans to minimize the impact on possible restrictions on health resources. The AEC is making a proposal for the management of patients with hepatopancreatobiliary (HPB) malignancies in the different pandemic scenarios in order to offer the maximum benefit to patients, minimising the risks of COVID-19 infection, and optimising the healthcare resources available at any time. This requires the coordination of the different treatment options between the departments involved in the management of these patients: medical oncology, radiotherapy oncology, surgery, anaesthesia, radiology, endoscopy department and intensive care. The goal is offer effective treatments, adapted to the available resources, without compromising patients and healthcare professionals safety.
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Affiliation(s)
| | - Miguel Angel Gómez Bravo
- Cirugía general y del aparato digestivo, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Marcello Di Martino
- Cirugía general y del aparato digestivo, Hospital Universitario de La Princesa, Madrid, España
| | - Mikel Gastaca
- Cirugía general y del aparato digestivo, Hospital Universitario Cruces, Bilbao, España
| | - Elena Martín-Pérez
- Cirugía general y del aparato digestivo, Hospital Universitario de La Princesa, Madrid, España
| | - Santiago Sánchez Cabús
- Cirugía general y del aparato digestivo, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | - Santiago López Ben
- Cirugía general y del aparato digestivo, Hospital Dr. Josep Trueta, Girona, España
| | | | - Rafael López-Andújar
- Cirugía general y del aparato digestivo, Hospital Universitario y Politécnico La Fe, Valencia, España; CIBERehd, Instituto de Salud Carlos III, Madrid, España
| | - Manuel Barrera
- Cirugía general y del aparato digestivo, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España
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27
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Vallribera F, Kraft M, Pera M, Vidal L, Espín-Basany E. Outcomes of Intra- versus Extra-Corporeal Ileocolic Anastomosis after Minimally Invasive Right Colectomy for Cancer: An Observational Study. J Clin Med 2021; 10:307. [PMID: 33467636 PMCID: PMC7830629 DOI: 10.3390/jcm10020307] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 12/23/2022] Open
Abstract
Intracorporeal anastomoses (IA) are increasingly being used in colorectal surgery. Some data suggest that these might confer benefits compared with extracorporeal anastomoses (EA). The aim of this study is to compare the short-term complications associated with IA versus EA for minimally invasive right colectomy. This is a single-centre, retrospective study on a prospective database. Patients who underwent minimally invasive right colectomy for cancer between January 2017 and December 2019 were assessed for inclusion. The primary outcome was global 30-day morbidity. Overall, 189 patients were included, of whom 102 had IA. Global morbidity and medical complications were higher in patients with EA (23.5% vs. 40.2%, p = 0.014; 5.9% vs. 14.9%, p = 0.039, respectively). None of the patients with IA had non-infectious surgical wound complications, compared to 4.6% in the EA group (p = 0.029). No differences were found in anastomotic leakage (9.8% vs. 10.3%, p = 0.55). At multivariable analysis, EA was an independent risk factor for both surgical (OR = 3.71 95% CI: 1.06-12.91, p = 0.04) and overall complications (OR = 3.58 95% CI: 1.06-12.12, p = 0.04). IA lowers the risk for global, medical, and surgical complications with minimum risk for wound complications, without increasing the risk of AL.
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Affiliation(s)
| | | | | | | | - Eloy Espín-Basany
- Colorectal Surgery, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (F.V.); (M.K.); (M.P.); (L.V.)
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28
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Espín-Basany E, Pellino G, Lorente García D. Robotic right hemicolectomy and partial nephrectomy for synchronous malignancies - a video vignette. Colorectal Dis 2020; 22:1770-1771. [PMID: 32470996 DOI: 10.1111/codi.15161] [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] [Received: 05/04/2020] [Accepted: 05/15/2020] [Indexed: 02/08/2023]
Affiliation(s)
- E Espín-Basany
- Colorectal Surgery Unit, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - G Pellino
- Colorectal Surgery Unit, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - D Lorente García
- Colorectal Surgery Unit, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.,Urology Service, Vall d'Hebron University Hospital, Barcelona, Spain
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Maravic Z, Rawicka I, Benedict A, Wyrwicz L, Horvath A, Fotaki V, Carrato A, Borras JM, Ruiz-Casado A, Petrányi A, Lemmens L, Espín-Basany E, Stanisic Trenevski J. A European survey on the insights of patients living with metastatic colorectal cancer: the patient journey before, during and after diagnosis - an Eastern European perspective. ESMO Open 2020; 5:e000850. [PMID: 32998966 PMCID: PMC7528429 DOI: 10.1136/esmoopen-2020-000850] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/25/2020] [Accepted: 07/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background Despite being highly preventable and treatable if diagnosed early, colorectal cancer (CRC) remains the second leading cause of cancer-related death in Europe. Limited information is available from the patient perspective on the persisting unmet needs of the journey of the patient with CRC. Objective To capture European metastatic CRC (mCRC) patients’ insights during the patient journey (prediagnosis; diagnosis; postdiagnosis) through a patient survey. Methods In total, 883 patients from 15 European countries participated. Participants were divided into four groups from Hungary, Poland, Serbia and ‘other European countries’ (n=103, 163, 170 and 447 patients, respectively). Results General awareness of CRC and its symptoms prediagnosis varied among groups, with patients from Poland recording the lowest levels. Screening practices and attitudes also varied; while more patients from Serbia had been invited to CRC screening (~15%) compared with the other groups, the ones not invited claimed mostly (~20%) that would not have attended if they had been invited. Whereas most patients were diagnosed within a month after the first consultation/positive screening, the percentages varied substantially being lowest among patients in Poland (~30%) and Serbia (~25%). Although CRC-related information provision varied, with most informed patients from Hungary (~90%) and least from Serbia (~50%), all groups requested an easier-to-understand language by the healthcare team. Approximately 50% of patients from Eastern Europe had to wait longer than a month to receive treatment, in contrast to ~30% from other European countries. All groups emphasised the unmet need for support from psychologists and other patients. Conclusions Our survey reveals the key aspects of the journey of the patient with mCRC and highlights the areas of similarities and differences between patients with mCRC from Eastern Europe versus those from other European countries as well as among patients from different Eastern European countries, calling for improvement particularly around awareness, screening, treatment availability, communication and support networks.
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Affiliation(s)
| | | | | | - Lucjan Wyrwicz
- Department of Oncology and Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland
| | - Anna Horvath
- Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | | | - Alfredo Carrato
- Medical Oncology Research Laboratory, Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Josep M Borras
- Department of Clinical Sciences, University of Barcelona, Barcelona, Catalunya, Spain
| | - Ana Ruiz-Casado
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Comunidad de Madrid, Spain
| | - Agota Petrányi
- Department of Oncology, Semmelweis University of Medicine, Budapest, Hungary
| | | | - Eloy Espín-Basany
- Department of Surgery, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
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30
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Pellino G, Adell Trape M, Marinello F, Martí Gallostra M, Espín-Basany E. Laparoscopic Hartmann's reversal: a step-by-step video demonstration - a video vignette. Colorectal Dis 2020; 22:1462-1463. [PMID: 32338822 DOI: 10.1111/codi.15090] [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] [Received: 02/11/2020] [Accepted: 02/28/2020] [Indexed: 02/08/2023]
Affiliation(s)
- G Pellino
- Colorectal Surgery Unit, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - M Adell Trape
- Colorectal Surgery Unit, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - F Marinello
- Colorectal Surgery Unit, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - M Martí Gallostra
- Colorectal Surgery Unit, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - E Espín-Basany
- Colorectal Surgery Unit, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
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31
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Kraft M, Pellino G, Jofra M, Sorribas M, Solís-Peña A, Biondo S, Espín-Basany E. Incidence, features, outcome and impact on health system of de-novo abdominal surgical diseases in patients admitted with COVID-19. Surgeon 2020; 19:e53-e58. [PMID: 32972853 PMCID: PMC7455107 DOI: 10.1016/j.surge.2020.08.006] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/02/2020] [Accepted: 08/17/2020] [Indexed: 02/06/2023]
Abstract
Objective to assess the epidemiology and features of de novo surgical diseases in patients admitted with COVID-19, and their impact on patients and healthcare system. Summary background data Gastrointestinal involvement has been described in COVID-19; however, no clear figures of incidence, epidemiology and economic impact exist for de-novo surgical diseases in hospitalized patients. Methods This is a prospective study including all patients admitted with confirmed SARS-CoV-2 rT-PCR, between 1 March and 15 May 2020 at two Tertiary Hospitals. Patients with known surgical disease at admission were excluded. Sub-analyses were performed with a consecutive group of COVID-19 patients admitted during the study period, who did not require surgical consultation. Results Ten out of 3089 COVID-19 positive patients (0.32%) required surgical consultation. Among those admitted in intensive care unit (ICU) incidence was 1.9%. Mortality was 40% in patients requiring immediate surgery and 20% in those suitable for conservative management. The overall median length of stay (LOS) of patients admitted to ICU was longer in those requiring surgical consultation compared with those who did not (51.5 vs 25 days, p = 0.0042). Patients requiring surgical consultation and treatment for de-novo surgical disease had longer median ICU-LOS (31.5 vs 12 days, p = 0.0004). A median of two post-surgical complications were registered for each patient undergoing surgery. Complication-associated costs were as high as 38,962 USD per patient. Conclusions Incidence of de-novo surgical diseases is low in COVID-19, but it is associated with significant morbidity and mortality. Future studies should elucidate the mechanism underlying the condition and identify strategies to prevent the need for surgery.
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Affiliation(s)
- Miquel Kraft
- Colorectal Surgery Unit, Department of General and Digestive Surgery, IDIBELL (Bellvitge Biomedical Investigation Institute), Hospital de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Gianluca Pellino
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain; Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Mariona Jofra
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Maria Sorribas
- Colorectal Surgery Unit, Department of General and Digestive Surgery, IDIBELL (Bellvitge Biomedical Investigation Institute), Hospital de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | | | - Sebastiano Biondo
- Colorectal Surgery Unit, Department of General and Digestive Surgery, IDIBELL (Bellvitge Biomedical Investigation Institute), Hospital de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Eloy Espín-Basany
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.
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Pellino G, Alós R, Biondo S, Codina-Cazador A, Enríquez-Navascues JM, Espín-Basany E, Roig-Vila JV, Cervantes A, García-Granero E. Trends and outcome of neoadjuvant treatment for rectal cancer: A retrospective analysis and critical assessment of a 10-year prospective national registry on behalf of the Spanish Rectal Cancer Project. Eur J Surg Oncol 2020; 47:276-284. [PMID: 32950316 DOI: 10.1016/j.ejso.2020.04.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/25/2020] [Accepted: 04/30/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Preoperative treatment and adequate surgery increase local control in rectal cancer. However, modalities and indications for neoadjuvant treatment may be controversial. Aim of this study was to assess the trends of preoperative treatment and outcomes in patients with rectal cancer included in the Rectal Cancer Registry of the Spanish Associations of Surgeons. METHOD This is a STROBE-compliant retrospective analysis of a prospective database. All patients operated on with curative intention included in the Rectal Cancer Registry were included. Analyses were performed to compare the use of neoadjuvant/adjuvant treatment in three timeframes: I)2006-2009; II)2010-2013; III)2014-2017. Survival analyses were run for 3-year survival in timeframes I-II. RESULTS Out of 14,391 patients,8871 (61.6%) received neoadjuvant treatment. Long-course chemo/radiotherapy was the most used approach (79.9%), followed by short-course radiotherapy ± chemotherapy (7.6%). The use of neoadjuvant treatment for cancer of the upper third (15-11 cm) increased over time (31.5%vs 34.5%vs 38.6%,p = 0.0018). The complete regression rate slightly increased over time (15.6% vs 16% vs 18.5%; p = 0.0093); the proportion of patients with involved circumferential resection margins (CRM) went down from 8.2% to 7.3%and 5.5% (p = 0.0004). Neoadjuvant treatment significantly decreased positive CRM in lower third tumors (OR 0.71, 0.59-0.87, Cochrane-Mantel-Haenszel P = 0.0008). Most ypN0 patients also received adjuvant therapy. In MR-defined stage III patients, preoperative treatment was associated with significantly longer local-recurrence-free survival (p < 0.0001), and cancer-specific survival (p < 0.0001). The survival benefit was smaller in upper third cancers. CONCLUSION There was an increasing trend and a potential overuse of neoadjuvant treatment in cancer of the upper rectum. Most ypN0 patients received postoperative treatment. Involvement of CRM in lower third tumors was reduced after neoadjuvant treatment. Stage III and MRcN + benefited the most.
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Affiliation(s)
- Gianluca Pellino
- Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Spain; Department of General Surgery, Colorectal Surgery Unit, Hospital Valle de Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - Rafael Alós
- Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Spain
| | - Sebastiano Biondo
- Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain
| | - Antonio Codina-Cazador
- Department of General and Digestive Surgery--Colorectal Unit, Josep Trueta University Hospital, Girona, Spain
| | | | - Eloy Espín-Basany
- Department of General Surgery, Colorectal Surgery Unit, Hospital Valle de Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Andrés Cervantes
- CIBERONC, Biomedical Research Institute INCLIVA, University of Valencia, Spain
| | - Eduardo García-Granero
- Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Spain.
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Morales-Conde S, Balla A, Álvarez Gallego M, Aranda Narváez JM, Badia JM, Balibrea JM, García-Botella A, Guirao X, Espín-Basany E, Martín-Antona E, Pérez EM, Martínez Cortijo S, Pascual Miguelañez I, Pérez Díaz L, Ramos Rodríguez JL, Rubio Pérez I, Sánchez Santos R, Soria-Aledo V. A dynamic scale for surgical activity (DYSSA) stratification during the COVID-19 pandemic. Br J Surg 2020; 107:e425-e426. [PMID: 32735347 PMCID: PMC7929180 DOI: 10.1002/bjs.11870] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", University of Sevilla, Sevilla, Spain.,Unit of General and Digestive Surgery, Hospital QuironSalud Sagrado Corazón, Sevilla, Spain
| | - Andrea Balla
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", University of Sevilla, Sevilla, Spain
| | - Mario Álvarez Gallego
- Department of General and Digestive Surgery, Hospital Universitario La Paz, Madrid, Spain
| | | | - Josep María Badia
- Unit of General and Digestive Surgery, Hospital General de Granollers, Barcelona, Spain
| | - José María Balibrea
- Department of Gastrointestinal Surgery (ICMDiM), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Alejandra García-Botella
- HBP Surgery Unit. Derpartment of General and Digestive Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | - Xavier Guirao
- Unit of Endocrine and Head and Neck Surgery.Department of General and Digestive Surgery, Parc Tauli, Hospital Universitari, Sabadell, Spain
| | - Eloy Espín-Basany
- Colorectal Surgery Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Esteban Martín-Antona
- HBP Surgery Unit. Derpartment of General and Digestive Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | - Elena Martín- Pérez
- Unit of General and Digestive Surgery, Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | - Lola Pérez Díaz
- Unit of General and Digestive Surgery, Hospital Gregorio Marañón, Madrid, Spain
| | | | - Inés Rubio Pérez
- Department of General and Digestive Surgery, Hospital Universitario La Paz, Madrid, Spain
| | | | - Victor Soria-Aledo
- Servicio de Cirugía General, Hospital Morales Meseguer, Universidad de Murcia, Campus Mare Nostrum, Murcia, Spain
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34
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Pellino G, Solis-Peña A, Espín-Basany E. Repair of a rectovaginal fistula using a robotic transanal minimally invasive surgical technique - a video vignette. Colorectal Dis 2020; 22:724-725. [PMID: 31943678 DOI: 10.1111/codi.14965] [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] [Received: 10/05/2019] [Accepted: 11/26/2019] [Indexed: 02/08/2023]
Affiliation(s)
- G Pellino
- Colorectal Surgery Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - A Solis-Peña
- Colorectal Surgery Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - E Espín-Basany
- Colorectal Surgery Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
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35
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Pellino G, Pata F, Lui R, Espín-Basany E. A word of caution and call for cross-society collaboration to develop surgical guidance about COVID-19. Br J Surg 2020; 107:e245. [PMID: 32418196 PMCID: PMC7276747 DOI: 10.1002/bjs.11689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 11/09/2022]
Affiliation(s)
- 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
| | - F Pata
- General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy.,La Sapienza University, Rome, Italy
| | - R Lui
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - E Espín-Basany
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
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Moro-Valdezate D, Royo-Aznar A, Martín-Arévalo J, Pla-Martí V, García-Botello S, León-Espinoza C, Fernández-Moreno MC, Espín-Basany E, Espí-Macías A. Outcomes of Hartmann's procedure and subsequent intestinal restoration. Which patients are most likely to undergo reversal? Am J Surg 2019; 218:918-927. [PMID: 30853093 DOI: 10.1016/j.amjsurg.2019.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/06/2019] [Accepted: 02/14/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Aim of the study was to describe characteristics and outcomes of Hartmann's procedure (HP) and subsequent intestinal restoration. METHODS Retrospective study including all patients who underwent HP over a period of 16 consecutive years. We propose a classification and regression tree for a more accurate view of the relationship between the variables related to intestinal restoration and their weighting in the decision to reverse HP. RESULTS 533 patients were included. Overall morbidity rate of HP was 53.5% and mortality 21.0%. Overall morbidity of the intestinal continuity reconstruction was 47.3% and mortality 0.9%. Patients with a benign disease, aged under 69 years and with low comorbidity, had an 84.4% probability of undergoing intestinal reconstruction. CONCLUSIONS HP is associated with high morbidity and mortality. Restoration of intestinal continuity involves minor, but frequent, morbidity and a low mortality rate. Age and comorbidities can decrease, and even override, the decision to reverse HP.
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Affiliation(s)
- D Moro-Valdezate
- Department of Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain.
| | - A Royo-Aznar
- Department of Surgery, Universtitat Autònoma de Barcelona, Barcelona, Spain
| | - J Martín-Arévalo
- Department of Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - V Pla-Martí
- Department of Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - S García-Botello
- Department of Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - C León-Espinoza
- Department of Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - M C Fernández-Moreno
- Department of Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - E Espín-Basany
- Department of Surgery, Universtitat Autònoma de Barcelona, Barcelona, Spain
| | - A Espí-Macías
- Department of Surgery, University of Valencia, Valencia, Spain
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Pellino G, Biondo S, Codina Cazador A, Enríquez-Navascues JM, Espín-Basany E, Roig-Vila JV, García-Granero E. Pelvic exenterations for primary rectal cancer: Analysis from a 10-year national prospective database. World J Gastroenterol 2018; 24:5144-5153. [PMID: 30568391 PMCID: PMC6288654 DOI: 10.3748/wjg.v24.i45.5144] [Citation(s) in RCA: 8] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 11/05/2018] [Accepted: 11/16/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To identify short-term and oncologic outcomes of pelvic exenterations (PE) for locally advanced primary rectal cancer (LAPRC) in patients included in a national prospective database. METHODS Few studies report on PE in patients with LAPRC. For this study, we included PE for LAPRC performed between 2006 and 2017, as available, from the Rectal Cancer Registry of the Spanish Association of Surgeons [Asociación Española de Cirujanos (AEC)]. Primary endpoints included procedure-associated complications, 5-year local recurrence (LR), disease-free survival (DFS) and overall survival (OS). A propensity-matched comparison with patients who underwent non-exenterative surgery for low rectal cancers was performed as a secondary endpoint. RESULTS Eight-two patients were included. The mean age was 61.8 ± 11.5 years. More than half of the patients experienced at least one complication. Surgical site infections were the most common complication (abdominal wound 18.3%, perineal closure 19.4%). Thirty-three multivisceral resections were performed, including two hepatectomies and four metastasectomies. The long-term outcomes of the 64 patients operated on before 2013 were assessed. The five-year LR was 15.6%, the distant recurrence rate was 21.9%, and OS was 67.2%, with a mean survival of 43.8 mo. R+ve resection increased LR [hazard ratio (HR) = 5.58, 95%CI: 1.04-30.07, P = 0.04]. The quality of the mesorectum was associated with DFS. Perioperative complications were independent predictors of shorter survival (HR = 3.53, 95%CI: 1.12-10.94, P = 0.03). In the propensity-matched analysis, PE was associated with better quality of the specimen and tended to achieve lower LR with similar OS. CONCLUSION PE is an extensive procedure, justified if disease-free margins can be obtained. Further studies should define indications, accreditation policy, and quality of life in LAPRC.
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Affiliation(s)
- Gianluca Pellino
- Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia 46026, Spain
| | - Sebastiano Biondo
- Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona and IDIBELL, L’Hospitalet de Llobregat, Barcelona 08907, Spain
| | - Antonio Codina Cazador
- Department of General and Digestive Surgery--Colorectal Unit, Josep Trueta University Hospital, Girona 17001, Spain
| | | | - Eloy Espín-Basany
- Department of General Surgery, Colorectal Surgery Unit, Hospital Valle de Hebron, Autonomous University of Barcelona, Barcelona 08035, Spain
| | | | - Eduardo García-Granero
- Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia 46026, Spain
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Royo-Aznar A, Moro-Valdezate D, Martín-Arévalo J, Pla-Martí V, García-Botello S, Espín-Basany E, Espí-Macías A. Reversal of Hartmann's procedure: a single-centre experience of 533 consecutive cases. Colorectal Dis 2018; 20:631-638. [PMID: 29430804 DOI: 10.1111/codi.14049] [Citation(s) in RCA: 18] [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] [Received: 06/04/2017] [Accepted: 01/07/2018] [Indexed: 12/12/2022]
Abstract
AIM Hartmann's procedure (HP) is common. However, restoration of intestinal continuity is not so frequent. The aim of this study was to determine predictive factors which might influence outcomes following the reversal of HP. METHOD All consecutive patients who underwent elective and emergency HP in a single institution between January 1999 and December 2014 were included. Data concerning patient, disease and treatment features were collected. Univariate and multivariate binary logistic regression models were used to determine prognostic factors. RESULTS A total of 533 consecutive patients underwent HP over the 16-year period. Factors that were associated with a higher probability of reversal were age (< 69 years), American Society of Anesthesiologists (ASA) grade (I or II), indication for HP (likelihood of anastomotic leakage) and length of rectal stump reaching or exceeding the sacral promontory. A reduced probability of intestinal reconstruction was associated with anal incontinence, Stage IV cancer, postoperative transfusion or elective surgery. CONCLUSION Age, ASA grade, the indication for HP, the length of rectal stump, anal incontinence, tumour stage, postoperative transfusion and elective surgery determine the probability of reversal.
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Affiliation(s)
- A Royo-Aznar
- Department of Surgery, Universtitat Autònoma de Barcelona, Barcelona, Spain
| | - D Moro-Valdezate
- Department of Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - J Martín-Arévalo
- Department of Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - V Pla-Martí
- Department of Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - S García-Botello
- Department of Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - E Espín-Basany
- Department of Surgery, Universtitat Autònoma de Barcelona, Barcelona, Spain
| | - A Espí-Macías
- Department of Surgery, University of Valencia, Valencia, Spain
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Enríquez-Navascués JM, Espín-Basany E, Jiménez-Escobar F. AECP Report, 2017. Colorectal Dis 2017; 19:417. [PMID: 28470906 DOI: 10.1111/codi.13629] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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40
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Enríquez-Navascues JM, Espín-Basany E, Jiménez-Escobar F. Report of the Asociación Española de Coloproctología President. Colorectal Dis 2016; 18:440. [PMID: 27138711 DOI: 10.1111/codi.13337] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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de León-Rendón JL, Vallribera-Valls F, Caspari C, Espín-Basany E. [Turnbull-cutait technique in low rectal cancer: Case report]. CIR CIR 2016; 84:425-8. [PMID: 26769521 DOI: 10.1016/j.circir.2015.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 05/19/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND The surgical treatment for low rectal cancer involves an ultra-low anterior resection with complete mesorectal resection and coloanal anastomosis. Two-stage coloanal anastomosis such as the Turnbull-Cutait technique represents an option for patients with low rectal cancer. CLINICAL CASE A 69 year-old female patient with a diagnosis of adenocarcinoma (T2N1), located 4 cm from the anal margin. She received neoadjuvant radiotherapy. An ultra-low anterior resection and total resection of the mesorectum were performed. The intestinal transit was reconstructed by coloanal anastomosis using the Turnbull-Cutait technique. CONCLUSION Coloanal anastomosis with the Turnbull-Cutait technique represents a primary option for patients with low rectal cancer, avoiding a loop ileostomy, its economic impact and on their quality of life.
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Affiliation(s)
- Jorge Luis de León-Rendón
- Servicio de Cirugía General, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México.
| | - Francesc Vallribera-Valls
- Unidad de Cirugía Colorrectal, Servicio de Cirugía General y Digestiva, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Cristina Caspari
- Center of Colorectal and Pelvic Floor Surgery, Waldfriede Hospital, Berlín, Alemania
| | - Eloy Espín-Basany
- Unidad de Cirugía Colorrectal, Servicio de Cirugía General y Digestiva, Hospital Universitario Vall d'Hebron, Barcelona, España
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Llopis M, Antolin M, Carol M, Borruel N, Casellas F, Martinez C, Espín-Basany E, Guarner F, Malagelada JR. Lactobacillus casei downregulates commensals' inflammatory signals in Crohn's disease mucosa. Inflamm Bowel Dis 2009; 15:275-83. [PMID: 18839424 DOI: 10.1002/ibd.20736] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [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: 12/21/2022]
Abstract
BACKGROUND The interaction of commensal bacteria with the intestinal immune system is an essential factor in the development of inflammatory bowel disease (IBD). The study of isolated commensal bacteria's effects on the mucosal immune response might be relevant for a better understanding of pathophysiological mechanisms in IBD. METHODS We investigated the immune responses to signals from the commensal Escherichia coli ATCC 35345 and the probiotic Lactobacillus casei DN-114 001 in Crohn's disease (CD) mucosa. Ileal specimens were obtained during surgery from CD patients. Mucosal explants were incubated with L. casei or its genomic DNA; TNF-alpha, IFN-gamma, IL-2, IL-6, IL-8, and CXCL1 were measured in the supernatant. Second, tissue expression of key proinflammatory cytokines (IL-6, TGF-beta, IL-23p19, IL-12p35, IL-17F), and chemokines (IL-8, CXCL1, CXCL2) was evaluated after incubation with L. casei or E. coli. Finally, combination experiments were carried out by incubating both strains with mucosal explants at different timepoints. RESULTS Live L. casei significantly decreased secretion of TNF-alpha, IFN-gamma, IL-2, IL-6, IL-8, and CXCL1 by CD mucosa, but the effect was not reproduced by L. casei DNA. Second, live L. casei downregulated expression of IL-8, IL-6, and CXCL1 and did not modify expression of IL-23p19, IL-12p35, and IL-17F. In contrast, E. coli significantly upregulated expression of all these cytokines. Interestingly, combination experiments revealed the ability of L. casei to prevent and counteract the proinflammatory effects of E. coli. CONCLUSIONS Live L. casei can counteract the proinflammatory effects of E. coli on CD inflamed mucosa by specific downregulation of key proinflammatory mediators.
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Affiliation(s)
- Marta Llopis
- Digestive System Research Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain
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