111 results on '"Flor Lorente B"'
Search Results
2. A mathematical 3D-method applied to MRI to evaluate prostatic infiltration in advanced rectal cancer
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Garcia-Granero, A., Pellino, G., Giner, F., Frasson, M., Fletcher-Sanfeliu, D., Romaguera, V. P., Flor-Lorente, B., Gamundi, M., Brogi, L., Garcia-Calderón, D., Gonzalez-Argente, F. X., and Garcia-Granero, E.
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- 2020
- Full Text
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3. Application of three-dimensional printing in laparoscopic dissection to facilitate D3-lymphadenectomy for right colon cancer
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Garcia-Granero, A., Sánchez-Guillén, L., Fletcher-Sanfeliu, D., Flor-Lorente, B., Frasson, M., Sancho Muriel, J., Alvarez Serrado, E., Pellino, G., Grifo Albalat, I., Giner, F., Roca Estelles, M. J., Esclapez Valero, P., and Garcia-Granero, E.
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- 2018
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4. Importance of the Moskowitz artery in the laparoscopic medial approach to splenic flexure mobilization: a cadaveric study
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Garcia-Granero, A., Sánchez-Guillén, L., Carreño, O., Sancho Muriel, J., Alvarez Sarrado, E., Fletcher Sanfeliu, D., Flor Lorente, B., Frasson, M., Martinez Soriano, F., and Garcia-Granero, E.
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- 2017
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5. Observational cross-sectional study of compliance with the fast track protocol in elective surgery for colon cancer in Spain
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Alcántara-Moral, Manuel, Serra-Aracil, X., Gil-Egea, M. J., Frasson, M., Flor-Lorente, B., Garcia-Granero, E., and E.B.S.Q.-C on behalf of the collaborative Group of Coloproctology Section of The Spanish Association of Surgeons
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- 2014
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6. Nomograms for morbidity and mortality after oncologic colon resection in the enhanced recovery era: results from a multicentric prospective national study
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Sanchez-Guillen L., Frasson M., Pellino G., Fornes-Ferrer V., Ramos J. L., Flor-Lorente B., Garcia-Granero A., Sierra I. B., Jimenez-Gomez L. M., Moya-Martinez A., Garcia-Granero E., Alvarez R. M. A., Garcia B. M. J., Gonzalez J. M. S., Braithwaite M. M., Martinez E. M., Perez J. A. A., Espi A., Anoro M. T., Scheiding M. M., Diaz O. M., Lindenbaum P. D., Abad A. M., Simo M. R., Rufino J. E., Olabarrieta M. S., Martinez J. V., Banaeres M. L., Villaro F. F., Lucia J. A., Berzosa J. B., Hernandez N. A., Vallverdu F. J. L., Banos P. A. P., Farres R., Villalba J. H., Laso C. A., Alcaide S. M., Alvarado M. N. C., Simo I. R., Garcia J. M., Fadrique A. G., Diago V. A., Septiem J. G., Garcia J. G., Ponchietti L., Navarro M. S. C., Fernandez M. R., Muino R. C., Alvarez D. H., Sanchez P. M., Bienert C. M., Martinez M. T. G., Muzas C. M., Idoate C. P., Andicoechea A., Casado A. P. A., Vila J. V. R., Broto I. G., Collera P., Sebastian A. A., Sanchez-Guillen, L., Frasson, M., Pellino, G., Fornes-Ferrer, V., Ramos, J. L., Flor-Lorente, B., Garcia-Granero, A., Sierra, I. B., Jimenez-Gomez, L. M., Moya-Martinez, A., Garcia-Granero, E., Alvarez, R. M. A., Garcia, B. M. J., Gonzalez, J. M. S., Braithwaite, M. M., Martinez, E. M., Perez, J. A. A., Espi, A., Anoro, M. T., Scheiding, M. M., Diaz, O. M., Lindenbaum, P. D., Abad, A. M., Simo, M. R., Rufino, J. E., Olabarrieta, M. S., Martinez, J. V., Banaeres, M. L., Villaro, F. F., Lucia, J. A., Berzosa, J. B., Hernandez, N. A., Vallverdu, F. J. L., Banos, P. A. P., Farres, R., Villalba, J. H., Laso, C. A., Alcaide, S. M., Alvarado, M. N. C., Simo, I. R., Garcia, J. M., Fadrique, A. G., Diago, V. A., Septiem, J. G., Garcia, J. G., Ponchietti, L., Navarro, M. S. C., Fernandez, M. R., Muino, R. C., Alvarez, D. H., Sanchez, P. M., Bienert, C. M., Martinez, M. T. G., Muzas, C. M., Idoate, C. P., Andicoechea, A., Casado, A. P. A., Vila, J. V. R., Broto, I. G., Collera, P., and Sebastian, A. A.
- Subjects
Male ,medicine.medical_specialty ,Colon ,Colorectal cancer ,Surgical planning ,Nomogram ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Enhanced recovery ,Risk Factors ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Mortality ,Colectomy ,business.industry ,Mortality rate ,Gastroenterology ,Cancer ,Hepatology ,medicine.disease ,Surgery ,Colon cancer ,Short-term outcome ,Nomograms ,030220 oncology & carcinogenesis ,National study ,030211 gastroenterology & hepatology ,Morbidity ,business ,Length-of-stay - Abstract
Purpose: Predicting postoperative complications and mortality is important to plan the surgical strategy. Different scores have been proposed before to predict them but none of them have been yet implemented into the routine clinical practice because their difficulties and low accuracy with new surgical strategies and enhanced recovery. The main aim of this study is to identify risk factors for postoperative morbidity and mortality after colonic resection (CR) without protective stomas, in order to develop a comprehensive, up-to-date, simple, reliable, and applicable model for the preoperative assessment of patients with colon cancer. Methods: Multivariable analysis was performed to identify risk factors for 60-day morbidity and mortality. Coefficients derived from the regression model were used in the nomograms to predict morbidity and mortality. Results: Three thousand one hundred ninety-three patients from 52 hospitals were included into the analysis. Sixty-day postoperative complications rate was 28.3% and the mortality rate was 3%. In multivariable analysis the independent risk factors for postoperative complications were age, male gender, liver and pulmonary diseases, obesity, preoperative albumin, anticoagulant treatment, open surgery, intraoperative complications, and urgent surgery. Independent risk factors for mortality were age, preoperative albumin anticoagulant treatment, and intraoperative complications. Conclusions: Risk factors for morbidity and mortality after CR for cancer were identified and two easy predictive tools were developed. Both of them could provide important information for preoperative consultation and surgical planning in the time of enhance recovery.
- Published
- 2020
7. An international multicentre prospective audit of elective rectal cancer surgery; operative approach versus outcome, including transanal total mesorectal excision (TaTME)
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Bhangu, Aneel, Minaya-Bravo, Ana María, Gallo, Gaetano, Glasbey, James C., Kamarajah, Sivesh, Pinkney, Thomas, El-Hussuna, Alaa, Battersby, Nick J., Buchs, Nicolas C., Buskens, Christianne, Chaudri, Sanjay, Frasson, Matteo, Glasbey, James, Morton, Dion, Negoi, Ionut, Nepogodiev, Dmitri, Pata, Francesco, Sánchez-Guillén, Luis, Singh, Baljit, Zmora, Oded, Perry, Rita, Magill, Laura, Altomare, Donato, Bemelman, Willem, Brown, Steven, Denost, Quentin, Knowles, Charles, Laurberg, Søren, Lefevre, Jérémie H., Möeslein, Gabriela, Pinkney, Tom, Vaizey, Carolynne, Bilali, S., Bilali, V., Salomon, M., Cillo, M., Estefania, D., Patron Uriburu, J., Ruiz, H., Farina, P., Carballo, F., Guckenheimer, S., Proud, D., Brouwer, R., Bui, A., Nguyen, B., Smart, P., Warwick, A., Theodore, J. E., Herbst, F., Birsan, T., Dauser, B., Ghaffari, S., Hartig, N., Stift, A., Argeny, S., Unger, L., Strouhal, R., Heuberger, A., Varabei, A., Lahodzich, N., Makhmudov, A., Selniahina, L., Feryn, T., Leupe, T., Maes, L., Reynvoet, E., Van Langenhove, K., Nachtergaele, M., Monami, B., Francart, D., Jehaes, C., Markiewicz, S., Weerts, J., Van Belle, K., Bomans, B., Cavenaile, V., Nijs, Y., Vertruyen, M., Pletinckx, P., Claeys, D., Defoort, B., Muysoms, F., Van Cleven, S., Lange, C., Vindevoghel, K., Wolthuis, A., Todorovic, M., Dabic, S., Kenjic, B., Lovric, S., Vidovic, J., Delibegovic, S., Mehmedovic, Z., Christiano, A., Lombardi, B., Marchiori, M., Tercioti, V., Dardanov, D., Petkov, P., Simonova, L., Yonkov, A., Zhivkov, E., Maslyankov, S., Pavlov, V., Sokolov, M., Todorov, G., Stoyanov, V., Batashki, I., Iarumov, N., Lozev, I., Moshev, B., Slavchev, M., Atanasov, B., Belev, N., Krstev, P., Penkov, R., Šantak, G., Ćosić, J., Previšić, A., Vukušić, L., Zukanović, G., Zelić, M., Kršul, D., Lekić Vitlov, V., Mendrila, D., Orhalmi, J., Dusek, T., Maly, O., Paral, J., Sotona, O., Skrovina, M., Bencurik, V., Machackova, M., Kala, Z., Farkašová, M., Grolich, T., Procházka, V., Hoch, J., Kocian, P., Martinek, L., Antos, F., Pruchova, V., Ceccotti, A., Madsbøll, T., Straarup, D., Uth Ovesen, A., Christensen, P., Bondeven, P., Edling, P., Elfeki, H., Alexandrovich Gameza, V., Michelsen Bach, S., Zheltiakova, I., Krarup, P. M., Krogh, A., Rolff, H. -C., Lykke, J., Juvik, A. F., Lóven, H. H. K., Marckmann, M., Osterkamp, J. T. F., Madsen, A. H., Worsøe, J., Ugianskis, A., Kjær, M. D., Youn Cho Lee, B., Khalid, A., Kristensen, M. H., El Sorogy, M., Elgeidie, A., Elhemaly, M., El Nakeeb, A., Elrefai, M., Shalaby, M., Emile, S., Omar, W., Sakr, A., Thabet, W., Awny, S., Metwally, I., Refky, B., Shams, N., Zuhdy, M., Lepistö, A., Keränen, I., Kivelä, A., Lehtonen, T., Siironen, P., Rautio, T., Ahonen-Siirtola, M., Klintrup, K., Paarnio, K., Takala, H., Hyöty, M., Haukijärvi, E., Kotaluoto, S. -M., Lehto, K., Tomminen, T., Huhtinen, H., Carpelan, A., Karvonen, J., Rantala, A., Varpe, P., Cotte, E., Francois, Y., Glehen, O., Passot, G., D'Alessandro, A., Chouillard, E., Etienne, J. C., Ghilles, E., Vinson-Bonnet, B., Germain, A., Ayav, A., Bresler, L., Chevalier, R., Denost, Q., Didailler, R., Rullier, E., Tiret, E., Chafai, N., Lefevre, J. H., Parc, Y., Sielezneff, I., Mege, D., Lakkis, Z., Barussaud, M., Krones, C., Bock, B., Webler, R., Baral, J., Lang, T., Münch, S., Pullig, F., Schön, M., Hinz, S., Becker, T., Möller, T., Richter, F., Schafmayer, C., Hardt, J., Kienle, P., Crescenti, F., Ahmad, M., Soleiman, Y., Papaconstantinou, I., Gklavas, A., Nastos, K., Theodosopoulos, T., Vezakis, A., Stamou, K., Saridaki, A., Xynos, E., Paraskakis, S., Zervakis, N., Skroubis, G., Amanatidis, T., Germanos, S., Maroulis, I., Papadopoulos, G., Dimitriou, N., Alexandrou, A., Felekouras, E., Griniatsos, J., Karavokyros, I., Papadopoulos, A., Chouliaras, C., Ioannidis, P., Katsounis, D., Kefalou, E., Katsoulis, I. E., Balalis, D., Korkolis, D. P., Manatakis, D., Tzovaras, G., Baloyiannis, I., Mamaloudis, I., Lázár, G., Ábraham, S., Paszt, A., Simonka, Z., Tóth, I., Zaránd, A., Baranyai, Z., Ferreira, G., Harsányi, L., Ónody, P., Banky, B., Burány, Ã., Lakatos, M., Marton, J., Solymosi, A., Besznyák, I., Bursics, A., Papp, G., Saftics, G., Svastics, I., Valsdottir, E., Atladottir, J., Jonsson, T., Moller, P., Sigurdsson, H., Gupta, S. K., Gupta, S., Kaul, N., Mohan, S., Sharma, G., Wani, R., Chowdri, N., Khan, M., Mehraj, A., Parray, F. Q., Coveney, A., Burke, J., Deasy, J., El-Masry, S., Mcnamara, D., Khan, M. F., Cahill, R., Faul, E., Mulsow, J., Shields, C., Kelly, M. E., Bass, G., Martin, S. T., O'Connell, R., Ryan, E., Connelly, T., Ahmad, G., Bukhari, W., Cooke, F., Zmora, O., Gold Deutch, R., Haim, N., Lavy, R., Moscovici, A., Shussman, N., Gefen, R., Marom, G., Pikarsky, A., Weiss, D., Avital, S., Hermann, N., Raguan, B., Slavin, M., White, I., Wasserberg, N., Arieli, H., Gurevich, N., Freund, M. R., Dorot, S., Edden, Y., Halfteck, G., Reissman, P., Pery, R., Tulchinsky, H., Weizman, A., Agresta, F., Curinga, R., Finotti, E., Savino, G., Verza, L. A., Asteria, C. R., Boccia, L., Pascariello, A., Tamini, N., Bugatti, A., Gianotti, L., Totis, M., Vincenti, L., Andriola, V., Giannini, I., Travaglio, E., Balestri, R., Buccianti, P., Roffi, N., Rossi, E., Urbani, L., Mellano, A., Cinquegrana, A., Lauretta, A., Belluco, C., Mistrangelo, M., Allaix, M. E., Arolfo, S., Morino, M., Testa, V., Delrio, P., Pace, U., Rega, D., Scala, D., Gallo, G., Clerico, G., Cornaglia, S., Realis Luc, A., Trompetto, M., Ugolini, G., Antonacci, N., Fabbri, S., Montroni, I., Zattoni, D., D'Urbano, C., Cornelli, A., Viti, M., Inama, M., Bacchion, M., Casaril, A., Impellizzeri, H., Moretto, G., Spinelli, A., Carvello, M., David, G., Di Candido, F., Sacchi, M., Frontali, A., Ceriani, V., Molteni, M., Rosati, R., Aleotti, F., Elmore, U., Lemma, M., Vignali, A., Scabini, S., Casoni Pattacini, G., Luzzi, A., Romairone, E., Marino, F., Lorusso, D., Pezzolla, F., Colombo, F., Baldi, C., Foschi, D., Sampietro, G., Sorrentino, L., Di Saverio, S., Birindelli, A., Segalini, E., Spacca, D., Romano, G. M., Belli, A., Bianco, F., De franciscis, S., Falato, A., Muratore, A., Marsanic, P., Grimaldi, S., Castaldo, N., Ciolli, M. G., Picarella, P., Porfidia, R., Tugnoli, G., Bondurri, A., Cavallo, D., Maffioli, A., Pertusati, A., Pulighe, F., Balestra, F., De Nisco, C., Podda, M., Opocher, E., Longhi, M., Mariani, N. M., Maroni, N., Pisani Ceretti, A., Galleano, R., Aonzo, P., Curletti, G., Reggiani, L., Marconi, M., Del Prete, L., Oldani, M., Pappalardo, R., Zaccone l, S., Scatizzi, M., Baraghini, M., Cantafio, S., Feroci, F., Giani, I., Tutino, R., Cocorullo, G., Gulotta, G., Licari, L., Salamone, G., Sileri, P., Saraceno, F., La Torre, F., Chirletti, P., Coletta, D., De Toma, G., Mingoli, A., Papandrea, M., De Luca, E., Sacco, R., Sammarco, G., Vescio, G., Tonini, V., Bianchini, S., Cervellera, M., Vaccari, S., Cracco, N., Barugola, G., Bertocchi, E., Rossini, R., Ruffo, G., Sartori, A., Clemente, N., De Luca, M., De Luca, A., Scaffidi, G., Lorenzon, L., Balducci, G., Bocchetti, T., Ferri, M., Mercantini, P., Pata, F., Bauce, S., Benevento, A., Bottini, C., Crapa, P. R., Rubbini, M., Anania, G., Carcoforo, P., Cavallesco, G., Feo, C., Yamamoto, T., Sivins, A., Ancans, G., Gerkis, S., Lunis, R., Pcolkins, A., Venskutonis, D., Bradulskis, S., Dainius, E., Subocius, A., Vencius, J., Zeromskas, P., Eismontas, V., Nutautiene, V., Simcikas, D., Tamosiunas, A., Svagzdys, S., Latkauskas, T., Lizdenis, P., Saladzinskas, Z., Tamelis, A., Dulskas, A., Kuliavas, J., Samalavicius, N. E., Poskus, T., Jotautas, V., Mikalauskas, S., Poskus, E., Strupas, K., Zakaria, A. D., Lah, N. N., Wong, M., Zain, W. Z., Zakaria, Z., Mazlan, L., Mohd Azman, Z. A., Sagap, I., Psaila, J., Andrejevic, P., Cini, C., Ellul, S., Pace, K., Ahallat, M., Hamid, M., Hrora, A., Majbar, M. A., Raiss, M., Westerduin, E., Bemelman, W., Buskens, C., Tanis, P., van der Sluis, P. C., Davids, P. H., Pronk, A., Schiphorst, A. H. W., Smakman, N., Zimmerman, D., Koeter, T., Stijns, J., van Loon, Y. -T., Vermaas, M., de Graaf, E., Doornebosch, P., van Hagen, P., van Ruler, O., Toorenvliet, B., Nonner, J., van den Berg, I., van Steensel, L., Vles, W., Melenhorst, J., Orsini, R., Visschers, R., Hoff, C., Blom, R., Marsman, H., Mulder, I., Cense, H., de Castro, S., Demirkiran, A., Hunfeld, M., van Geloven, A., de Groof, J., Hendriks, E., Leeuwenburg, M., van Oorschot, N., Wit, F., Rupert, C., Veldman, P., Keijzers, M., Konsten, J., Den Boer, F., Corver, M., Boerma, E. G., Koolen, L., Martens, M., Van Wijck, K., Ignjatovic, D., Breuer, R., Gurpreet, B., Oresland, T., Tetens Moe, T., Nesbakken, A., Flaaten Backe, I., Wik, T. -A., Radiya, K., Dehli, T., Gjessing, P., Norderval, S., Woll, K., Anwer, M., Qureshi, M. S., Qureshi, A. U., Billah, M., Jawad, M. Y., Raza, A., Urooj, N., Wang, X., Li, L., Jajtner, D., Gasinski, B., Kabiesz, W., Walega, P., Romaniszyn, M., Zawadzki, M., Czarnecki, R., Obuszko, Z., Rzaca, M., Sitarska, M., Silva, P., Duarte, A., Gonçalves, D., Morais, M., Rama, N., Nobre, J., Sales, I., Costa Pereira, J., Costa, S., Costa Pereira, C., Insua, C., Romero, I., Figueiredo, N., Cunha, J., Domingos, H., Vieira, P., Cunha, M., Americano, M., Amorim, E., Rachadell, J., Carvas, J. M., Armas, I., Fernandes, P., Pires, C., Reis, R., Martins, R., Dos Santos, M., Henriques, P., Oliveira, O., Duarte, M., Ferreira, L., Miranda, J., Vilela, N., Corte Real, J., Carlos, S., Frois Borges, M., Moniz Pereira, P., Simões, J., Silva-vaz, P., Bettencourt, V., Gouveia, A., Perez, H., Rainho, R., Bintintan, V., Ciuce, C., Dindelegan, G., Scurtu, R., Seicean, R., Cristian, D., Burcos, T., Grama, F., Mandi, D. M., Richiteanu, G., Miron, A., Calu, V., Enciu, O., Nadragea, M., Parvuletu, R., Mogoanta, S. S., Crafciuc, A., Paitici, S., Negoi, I., Beuran, M., Ciubotaru, C., Prodan, A., Vartic, M., Tomulescu, V., Copaescu, C., Yanishev, A., Abelevich, A., Kokobelyan, A., Lebedeva, M., Luzan, R., Pozdnyakov, A., Cherdancev, D., Mahotin, D., Nesytykh, A., Samsonyuk, V., Pravosudov, I., Ivlev, D., Karachun, A., Lebedev, K., Samsonov, D., Aiupov, R., Feoktistov, D., Garipov, M., Suleymanov, N., Tarasov, N., Rasulov, A., Dzhumabaev, H., Mamedli, Z., Bedzhanyan, A., Popov, D., Sednev, A., Klimenko, A., Semenov, A., Vasilyev, S., Khazov, A., Khanevich, M., Khrykov, G., Katorkin, S., Andreev, P., Chernov, A., Davidova, O., Zhuravlev, A., Achkasov, S., Shakhmatov, D., Shelygin, Y., Sushkov, O., Vardanyan, A., Ilkanich, A., Barbashinov, N., Darvin, V., Onishchenko, S., Voronin, Y., Krivokapić, Z., Barišić, G., Dimitrijević, I., Marković, V., Sekulić, A., Stanojevic, G., Brankovic, B., Nestorovic, M., Pecic, V., Petrovic, D., Kostic, I., Aleksic, A., Dabic, D., Maric, B., Perunicic, V., Radovanovic, Z., Djuric, M., Lukic, D., Radovanovic, D., Cuk, V., Juloski, J., Kenic, M., Krdzic, I., Ngu, J. C., Y. Y., Ng, Teo, N., Korcek, J., Lazorisak, A., Rems, M., Ramovš Trampuš, Å ., Tomazic, A., Grosek, J., Kosir, J., Norcic, G., Vigorita, V., Caceres, N., Casal, E., Ruano, A., Trostchansky, I., Golda, T., Galvez Saldaña, A., Kreisler Moreno, E., Lopez Dominguez, J., Vila Tura, M., Labarga, F., Galvez, P., Maderuelo, V., Suero, C., Bargallo, J., Cayetano, L., Lamas, S., Silva, M. C., Bernal-Sprekelsen, J. C., Gómez, R., Jareño, S., Ríos, A., Vercher, D., García-González, J. -M., Cervera-Aldama, J., Ramos-Prada, J., Santamaría-Olabarrieta, M., Borda, N., Enrriquez-Navascués, J. M., Saralegui, Y., Calero-Lillo, A., Aznar-Puig, S., López-Lara, M. A., Muñoz-Collado, S., Valverde-Sintas, J., Menendez, P., Leon, C., Truan, N., Baldonedo, R., Fernández-Martínez, D., Otero, J., Solar-García, L., Turrado-Rodriguez, V., de Lacy Oliver, F., Lacy Fortuny, A. M., Martin Perez, B., Otero Piñeiro, A. M., Paredes, J., Fernandez, F., Ladra, M. J., Paulos, A., Prieto, D., Beltrán de Heredia, J. P., Blanco Antona, F., de Andrés Asenjo, B., Ferreras García, C., Romero de Diego, A., Cordoba Diaz de Laspra, E., Echazarreta Gallego, E., Elia Guedea, M., Escola, D., Martinez, S., Primo Romaguera, V., Parreño, R., Pastor, L., Rosell, E., Lozoya Trujillo, R., Alós Company, R., Ruiz Carmona, M. D., Solana Bueno, A., Salvans Ruiz, S., Alonso Gonçalves, S., Jiménez- Toscano, M., Pascual Damieta, M., Pera Roman, M., Pellicer-Franco, E. M., Garcia-Marin, J. A., Mengual-Ballester, M., Soria-Aledo, V., Valero-Navarro, G., Vicente-Ruiz, M., Garcia-Zamora, C., Gonzalez-Gil, A., Montoya-Tabares, M. J., Paredes-Quiles, M., Die Trill, J., Abadia, P., Moreno, I., Pina, J. D., Ramos Rubio, D., Escartin, J., Blas, J. L., Fernando, J., Ferrer, R., Garcia Egea, J., Pros, I., Martinez, W., Rius, J., Socías, M., Sabia, D., Castellvi Valls, J., Gonzalez Santin, V., Mompart Garcia, S., Viso Pons, L., Julià, D., Codina-Cazador, A., Farrés, R., Gómez, N., Planellas, P., Cuadrado, M., Camps, I., Rufas, M., Escoll, J., Fermiñán, A., Muriel, P., Sierra, E., Alvarez-Laso, C., Lora, P., Padin, H., Garcia-Septiem, J., Bustamante, C., Jimenez, V., Jimenez-Miramon, J., Ramos, J. L., Gallardo, A. B., Benito, P., Colao, L., Galindo, P., Garcia, C., Forero-Torres, A., Alonso Poza, A., Dieguez Fernandez, B., Gilsanz Martin, C., Hernandez Garcia, M., Rojo López, J. A., Gil López, J. M., González Zunzárren, M., Martínez Alegre, J., Zorrilla Matilla, L. P., Navarro-Sánchez, A., Alcalá Serrano, F. J., López-Fernández, J., Montesdeoca Cabrera, D., Alvarez-Gallego, M., Guevara, J., Pascual Miguelañez, I., Rubio-Perez, I., Gomez Ruiz, M., Alonso Martín, J., Cagigas Fernández, C., Castillo Diego, J., Pando, J. 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P., Blanco Antona, F., de Andrés Asenjo, B., Ferreras García, C., Romero de Diego, A., Cordoba Diaz de Laspra, E., Echazarreta Gallego, E., Elia Guedea, M., Escola, D., Martinez, S., Primo Romaguera, V., Parreño, R., Pastor, L., Rosell, E., Lozoya Trujillo, R., Alós Company, R., Ruiz Carmona, M. D., Solana Bueno, A., Salvans Ruiz, S., Alonso Gonçalves, S., Jiménez- Toscano, M., Pascual Damieta, M., Pera Roman, M., Pellicer-Franco, E. M., Garcia-Marin, J. A., Mengual-Ballester, M., Soria-Aledo, V., Valero-Navarro, G., Vicente-Ruiz, M., Garcia-Zamora, C., Gonzalez-Gil, A., Montoya-Tabares, M. J., Paredes-Quiles, M., Die Trill, J., Abadia, P., Moreno, I., Pina, J. D., Ramos Rubio, D., Escartin, J., Blas, J. L., Fernando, J., Ferrer, R., Garcia Egea, J., Pros, I., Martinez, W., Rius, J., Socías, M., Sabia, D., Castellvi Valls, J., Gonzalez Santin, V., Mompart Garcia, S., Viso Pons, L., Julià, D., Codina-Cazador, A., Farrés, R., Gómez, N., Planellas, P., Cuadrado, M., Camps, I., Rufas, M., Escoll, J., Fermiñán, A., Muriel, P., Sierra, E., Alvarez-Laso, C., Lora, P., Padin, H., Garcia-Septiem, J., Bustamante, C., Jimenez, V., Jimenez-Miramon, J., Ramos, J. L., Gallardo, A. B., Benito, P., Colao, L., Galindo, P., Garcia, C., Forero-Torres, A., Alonso Poza, A., Dieguez Fernandez, B., Gilsanz Martin, C., Hernandez Garcia, M., Rojo López, J. A., Gil López, J. M., González Zunzárren, M., Martínez Alegre, J., Zorrilla Matilla, L. P., Navarro-Sánchez, A., Alcalá Serrano, F. J., López-Fernández, J., Montesdeoca Cabrera, D., Alvarez-Gallego, M., Guevara, J., Pascual Miguelañez, I., Rubio-Perez, I., Gomez Ruiz, M., Alonso Martín, J., Cagigas Fernández, C., Castillo Diego, J., Pando, J. A., Maristany, C., Muñoz-Duyos, A., Rada-Palomino, A., Vargas-Pierola, H., Peña Ros, E., Benavides Buleje, J. A., Muñoz Camarena, J. M., Parra Baños, P. A., Ramirez Faraco, M., Arenal, J. J., Citores, M. A., Marcos, J. L., Sánchez, J., Tinoco, C., García Flórez, L. J., Arias Pacheco, R. D., Mínguez Ruiz, G., Gutiérrez Corral, N., Rodríguez Infante, A., Carrillo López, M. J., Carrasco Prats, M. M., Lage Laredo, A., Martínez Manzano, Ã ., Rodríguez García, P., Segura-Sampedro, J. J., Alonso-Hernández, N., Fernandez Isart, M., Gamundi Cuesta, M., Ochogavia Segui, A., Ibañez, N., Abrisqueta, J., Lujan, J., Gómez Pérez, R., Corrales Valero, E., Monje Salazar, C., Sanchiz Cardenas, E., Soler Humanes, R., Jimenez-Rodriguez, R. M., De la Portilla, F., Diaz Pavon, J. M., Garcia Cabrera, A. M., Reyes Diaz, M. L., Espin, E., Marinello, F., Martí, M., Sanchez, J. L., Vallribera, F., Orts Mico, F. J., Ortin Navarro, M., Perez Climent, M., Serra Diaz, C., Millan, M., Caro, A., Escuder, J., Espina, B., Feliu, F., Climent Aira, A., Estévez Diz, A., Moreno Asencio, M. T., Varela Mato, A., Vázquez Bouzán, R., Minaya-Bravo, A. M., Diez-Alonso, M. M., Villeta-Plaza, R., Guadalajara, H., Alías, D., García Olmo, D., Pastor, C., Valverde, I., Sanchez Romero, A., Gardea, A., Gil Santos, M., Nimmersgern, T., Serrano Paz, P., Romero-Simó, M., Blasco-Segura, T., Caravaca-García, I., Costa-Navarro, D., Zarco-Pleguezuelos, A., Sánchez-Guillén, L., Flor-Lorente, B., Frasson, M., García-Granero, Ã ., García-Granero, E., Arencibia, B., Alonso, J., Febles, G., Nogués, E. M., Roque, C., Segelman, J., Nygren, J., Nestler, G., Abraham-Nordling, M., Egenvall, M., Myrelid, P., Jung, B., Loftås, P., Lydrup, M. -L., Azahr, N., Buchwald, P., Mangell, P., Syk, I., Nikberg, M., Carlander, J., Chabok, A., Smedh, K., Tiselius, C., Haapaniemi, S., Benckert, A., Adamina, M., Freil-Lanter, C., Gingert, C., Müller, P., Schäfli, J., Regusci, L., Brenna, M., Fasolini, F., Misteli, H., Kirchhoff, P., Oertli, D., Hahnloser, D., Clerc, D., Hübner, M., Ris, F., Buchs, N. C., Chevallay, M., Morel, P., Schiltz, B., Wang, J. Y., Su, W. -C., Huang, C. -W., Ma, C. -J., Tsai, H. -L., Bugra, D., Agalar, F., Baloglu, H., Basoglu, I., Okkabaz, N., Binboga, E., Biricik, A., Celik, A., Yavuz, E., Canda, A. E., Agalar, C., Fuzun, M., Sokmen, S., Terzi, C., Isik, A., Karip, B., Bilgili, A. C., Leventoğlu, S., Aytac, B., Küçükdiler, E., Yıldız, A., Yuksel, O., Sinan, H., Hancerliogullari, O., Kaymak, S., Kozak, O., Ozer, M. T., Sarici, I. S., Akca, O., Kalayci, M. U., Kara, Y., Agcaoglu, O., Balik, E., Bayram, O., Özbalcı, G. S., Özkan, B. B., Karabacak, U., Sungurtekin, U., Ozgen, U., Demirbas, S., Öztürk, E., Isik, O., Yilmazlar, T., Colak, E., Karagul, S., Kinas, V., Fearnhead, N., Lord, I., Stewart, P., Zammit, M., Arnold, S., Battersby, N. J., Broadhurst, J., Moran, S., Seretis, F., Shabbir, J., Jones, C., Kynaston, J., Vimalachandran, D., Blower, E., Mcfaul, C., Mcwhirter, D., Pilkington, J., Wilson, T., Chowdhary, M., Stubbs, B., Abdalkoddus, M., Lai, C., Thavanesan, N., Yao, C., Agarwal, T., Dindyal, S., Hill, R. M. C., Reade, S., Slesser, A., Paterson, H., Balfour, A., Boland, M., Geraghty, A., O'Kelly, J., Patel, P., Tezas, S., Yahia, S., Jadhav, V., Marimuthu, K., Narayanan, A., Piramanayagam, B., Bradley, N., Buchanan, F., Paul, K., Singh, J., Thomson, K., Korsgen, S., Bedford, M., Lee, K., Leong, K., Mcarthur, D., Bhangu, A., Malik, S., Mohamed, I., Cunha, P., Pilavas, A., Reddy, A., Ahmed, S., Ahmed, A., Voll, J., Velchuru, V., Lal, R., Mirshekar-Syahkal, B., Kassai, M., Aleem, M., Keogh-Bootland, S., Sarmah, P., Brown, S., Keegan, R., Kelkar, A., Sen, P., Oliveira-Cunha, M., Chaudhri, S., Fares, R., Singh, B., Thomas, W. M., Aslam, M. I., Boyle, K., Hemingway, D., Miller, A., Norwood, M., Gurjar, S., Al-Saeedi, M., Anandan, L., Sudlow, A., Zampitis, N., Malik, K., Bogdan, M., Smart, C., Iqbal, M. R., Bailey, S., Lawes, D., Omar, G., Tamhane, R., Evans, M., Ather, S., Lim, J., Nageswaran, H., Taylor, G., Hunt, L., Nicholls, J., Shaikh, I., Muscara, F., O'Brien, J., Photi, E., Stearns, A., Meylemans, D., Cunningham, C., Hompes, R., Tennakoon, A., Kumarasinghe, N., Rao, M., Upanishad, I., Khan, J., Ahmad, N., Shweejawee, Z., Stefan, S., Smart, N., Daniels, I., Gregoir, T., Longstaff, L., Mcdermott, F., Varcada, M., Drami, I., Gala, T., Moggia, E., Ratnatunga, K., Harries, R., Hayes, J., Williams, G., Raymond, T., Bronder, C., Davies, E., Hawkin, P., Ryska, O., Ayral, K., Beveridge, A., Bhowmik, A., Gill, M., Simpson, R., Schofield, A., Mcardle, K., Parmar, M., Williamson, M., Burton, H., Courtney, E., Grant, C., Saracino, A., Newton, K., Epstein, J., Branagan, G., Bignell, M., Symankewicz, M., Zaman, S., Mankotia, R., Siddiqui, Z., Torrance, A., Artioukh, D., Eggleston, M., Gokul, K., Selwyn, D., Warusavitarne, J., Chandrasinghe, P., Grainger, J., Leo, C. A., Vaizey, C. J., Harris, G., Levy, B., Skull, A., Thaha, M., Garg, A., Patel, H., Ramsanahie, A., Mondragon-Pritchard, M., Cuinas Leon, K., Shukla, A., Brewer, H., Fitzgerald, J., Kho, H., Torkington, J., Tate, S., Wheat, J., Smolarek, S., Platt, E., Rossi, B., Tham, J. C., Knight, J., Richardson, J., Tzivanakis, A., Gregori, M., Ashraf, M. A., Atif, M., Santos, J., Saffaf, N., Canning, L., Chandratreya, N., Bowen, M., Graham, B., Hamad, Y., Kaubrys, M., Chaudhry, Z. U., Bhan, C., Mukhtar, H., Oshowo, A., Wilson, J., Gouvas, N., Nicol, D., Pandey, S., Zilvetti, M., Sharma, A., Fatayer, T., Mothe, S., Rahman, M., Curtis, N., Allison, A., Dalton, R., Francis, N., Ockrim, J., Psaras, G., Dudarovaska, H., Marharint, T., Mostovoy, E., Voloshin, S., Kolesnik, O., Makhmudov, D., Altinel, Y., Iqbal, A., Cunningham, L., Go, K., Tan, S., R. Tutino, G. salamone, L. Licari, G. Cocorullo, G. Gulotta, AGEM - Digestive immunity, AGEM - Re-generation and cancer of the digestive system, and CCA - Cancer Treatment and Quality of Life
- Subjects
Male ,Laparoscopic surgery ,medicine.medical_specialty ,Colorectal cancer ,medicine.medical_treatment ,Operative Time ,Anastomosis ,Malignancy ,rectal cancer ,laparoscopic surgery ,TME ,transanal TME ,TaTME ,robotic surgery ,randomized clinical-trial ,short-term outcomes ,laparoscopic-assisted resection ,pathological outcomes ,anastomotic leakage ,initial-experience ,risk ,NO ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Robotic Surgical Procedures ,Humans ,Medicine ,Robotic surgery ,Prospective Studies ,Rectal cancer ,Gastroenterology ,Aged ,Transanal Endoscopic Surgery ,ta3126 ,Medical Audit ,Univariate analysis ,Proctectomy ,Rectal Neoplasms ,business.industry ,Rectum ,Margins of Excision ,Middle Aged ,medicine.disease ,Total mesorectal excision ,Surgery ,Treatment Outcome ,Elective Surgical Procedures ,030220 oncology & carcinogenesis ,Rectal cancer surgery ,Female ,Laparoscopy ,030211 gastroenterology & hepatology ,business - Abstract
Introduction: Transanal total mesorectal excision (TaTME) has rapidly emerged as a novel approach for rectal cancer surgery. Safety profiles are still emerging and more comparative data is urgently needed. This study aimed to compare indications and short-term outcomes of TaTME, open, laparoscopic, and robotic TME internationally. Methods: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients undergoing elective total mesorectal excision (TME) for malignancy between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak. Results: Of 2579 included patients, 76.2% (1966/2579) underwent TME with restorative anastomosis of which 19.9% (312/1966) had a minimally invasive approach (laparoscopic or robotic) which included a transanal component (TaTME). Overall, 9.0% (175/1951, 15 missing outcome data) of patients suffered an anastomotic leak. On univariate analysis both laparoscopic TaTME (OR 1.61, 1.02–2.48, P=0.04) and robotic TaTME (OR 3.05, 1.10–7.34, P=0.02) were associated with a higher risk of anastomotic leak than non-transanal laparoscopic TME. However this association was lost in the mixed-effects model controlling for patient and disease factors (OR 1.23, 0.77–1.97, P=0.39 and OR 2.11, 0.79–5.62, P=0.14 respectively), whilst low rectal anastomosis (OR 2.72, 1.55–4.77, P 
- Published
- 2018
8. Evaluating the incidence of pathological complete response in current international rectal cancer practice: the barriers to widespread safe deferral of surgery
- Author
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Battersby, Nick, Glasbey, James C., Neary, Peter, Negoi, Ionut, Kamarajah, Sivesh, Sgro, Alessandro, Bhangu, Aneel, Pinkney, Thomas, Frasson, Matteo, El-Hussuna, Alaa, Battersby, Nick J., Buchs, Nicolas C., Buskens, Christianne, Chaudri, Sanjay, Gallo, Gaetano, Glasbey, James, Minaya-Bravo, Ana María, Morton, Dion, Nepogodiev, Dmitri, Pata, Francesco, Sánchez-Guillén, Luis, Singh, Baljit, Zmora, Oded, Perry, Rita, Magill, Laura, Altomare, Donato, Bemelman, Willem, Brown, Steven, Denost, Quentin, Knowles, Charles, Laurberg, Søren, Lefevre, Jérémie H., Möeslein, Gabriela, Pinkney, Tom, Vaizey, Carolynne, Bilali, S., Bilali, V., Salomon, M., Cillo, M., Estefania, D., Patron Uriburu, J., Ruiz, H., Farina, P., Carballo, F., Guckenheimer, S., Proud, D., Brouwer, R., Bui, A., Nguyen, B., Smart, P., Warwick, A., Theodore, J. 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Jimenez-Miramon, J, Ramos, J, Gallardo, A, Benito, P, Colao, L, Galindo, P, Garcia, C, Forero-Torres, A, Alonso Poza, A, Dieguez Fernandez, B, Gilsanz Martin, C, Hernandez Garcia, M, Rojo Lopez, J, Gil Lopez, J, Gonzalez Zunzarren, M, Martinez Alegre, J, Zorrilla Matilla, L, Navarro-Sanchez, A, Alcala Serrano, F, Lopez-Fernandez, J, Montesdeoca Cabrera, D, Alvarez-Gallego, M, Guevara, J, Pascual Miguelanez, I, Rubio-Perez, I, Gomez Ruiz, M, Alonso Martin, J, Cagigas Fernandez, C, Castillo Diego, J, Pando, J, Maristany, C, Munoz-Duyos, A, Rada-Palomino, A, Vargas-Pierola, H, Pena Ros, E, Benavides Buleje, J, Munoz Camarena, J, Parra Banos, P, Ramirez Faraco, M, Arenal, J, Citores, M, Marcos, J, Sanchez, J, Tinoco, C, Garcia Florez, L, Arias Pacheco, R, Minguez Ruiz, G, Gutierrez Corral, N, Rodriguez Infante, A, Carrillo Lopez, M, Carrasco Prats, M, Lage Laredo, A, Martinez Manzano, A, Rodriguez Garcia, P, Segura-Sampedro, J, Alonso-Hernandez, N, Fernandez Isart, M, Gamundi Cuesta, M, Ochogavia Segui, A, Ibanez, N, Abrisqueta, J, Lujan, J, Gomez Perez, R, Corrales Valero, E, Monje Salazar, C, Sanchiz Cardenas, E, Soler Humanes, R, Jimenez-Rodriguez, R, De la Portilla, F, Diaz Pavon, J, Garcia Cabrera, A, Reyes Diaz, M, Espin, E, Marinello, F, Marti, M, Vallribera, F, Orts Mico, F, Ortin Navarro, M, Perez Climent, M, Serra Diaz, C, Millan, M, Caro, A, Escuder, J, Espina, B, Feliu, F, Climent Aira, A, Estevez Diz, A, Moreno Asencio, M, Varela Mato, A, Vazquez Bouzan, R, Diez-Alonso, M, Villeta-Plaza, R, Guadalajara, H, Alias, D, Garcia Olmo, D, Pastor, C, Valverde, I, Sanchez Romero, A, Gardea, A, Gil Santos, M, Nimmersgern, T, Serrano Paz, P, Romero-Simo, M, Blasco-Segura, T, Caravaca-Garcia, I, Costa-Navarro, D, Zarco-Pleguezuelos, A, Flor-Lorente, B, Garcia-Granero, A, Garcia-Granero, E, Arencibia, B, Alonso, J, Febles, G, Nogues, E, Roque, C, Segelman, J, Nygren, J, Nestler, G, Abraham-Nordling, M, Egenvall, M, Myrelid, P, Jung, B, Loftas, P, Lydrup, M, Azahr, N, Buchwald, P, Mangell, P, Syk, I, Nikberg, M, Carlander, J, Chabok, A, Smedh, K, Tiselius, C, Haapaniemi, S, Benckert, A, Adamina, M, Freil-Lanter, C, Gingert, C, Muller, P, Schafli, J, Regusci, L, Brenna, M, Fasolini, F, Misteli, H, Kirchhoff, P, Oertli, D, Hahnloser, D, Clerc, D, Hubner, M, Ris, F, Chevallay, M, Morel, P, Schiltz, B, Wang, J, Su, W, Huang, C, Ma, C, Tsai, H, Bugra, D, Agalar, F, Baloglu, H, Basoglu, I, Okkabaz, N, Binboga, E, Biricik, A, Celik, A, Yavuz, E, Canda, A, Agalar, C, Fuzun, M, Sokmen, S, Terzi, C, Isik, A, Karip, B, Bilgili, A, Leventoglu, S, Aytac, B, Kucukdiler, E, Yildiz, A, Yuksel, O, Sinan, H, Hancerliogullari, O, Kaymak, S, Kozak, O, Ozer, M, Sarici, I, Akca, O, Kalayci, M, Kara, Y, Agcaoglu, O, Balik, E, Bayram, O, Ozbalci, G, Ozkan, B, Karabacak, U, Sungurtekin, U, Ozgen, U, Demirbas, S, Ozturk, E, Isik, O, Yilmazlar, T, Colak, E, Karagul, S, Kinas, V, Fearnhead, N, Lord, I, Stewart, P, Zammit, M, Arnold, S, Broadhurst, J, Moran, S, Seretis, F, Shabbir, J, Jones, C, Kynaston, J, Vimalachandran, D, Blower, E, Mcfaul, C, Mcwhirter, D, Pilkington, J, Wilson, T, Chowdhary, M, Stubbs, B, Abdalkoddus, M, Lai, C, Thavanesan, N, Yao, C, Agarwal, T, Dindyal, S, Hill, R, Reade, S, Slesser, A, Paterson, H, Balfour, A, Boland, M, Geraghty, A, O'Kelly, J, Patel, P, Tezas, S, Yahia, S, Jadhav, V, Marimuthu, K, Narayanan, A, Piramanayagam, B, Bradley, N, Buchanan, F, Paul, K, Singh, J, Thomson, K, Korsgen, S, Bedford, M, Lee, K, Leong, K, Mcarthur, D, Malik, S, Mohamed, I, Cunha, P, Pilavas, A, Reddy, A, Ahmed, S, Ahmed, A, Voll, J, Velchuru, V, Lal, R, Mirshekar-Syahkal, B, Kassai, M, Aleem, M, Keogh-Bootland, S, Sarmah, P, Keegan, R, Kelkar, A, Sen, P, Oliveira-Cunha, M, Chaudhri, S, Fares, R, Thomas, W, Aslam, M, Boyle, K, Hemingway, D, Miller, A, Norwood, M, Gurjar, S, Al-Saeedi, M, Anandan, L, Sudlow, A, Zampitis, N, Malik, K, Bogdan, M, Smart, C, Iqbal, M, Bailey, S, Lawes, D, Omar, G, Tamhane, R, Evans, M, Ather, S, Lim, J, Nageswaran, H, Taylor, G, Hunt, L, Nicholls, J, Shaikh, I, Muscara, F, O'Brien, J, Photi, E, Stearns, A, Meylemans, D, Cunningham, C, Hompes, R, Tennakoon, A, Kumarasinghe, N, Rao, M, Upanishad, I, Khan, J, Ahmad, N, Shweejawee, Z, Stefan, S, Smart, N, Daniels, I, Gregoir, T, Longstaff, L, Mcdermott, F, Varcada, M, Drami, I, Gala, T, Moggia, E, Ratnatunga, K, Harries, R, Hayes, J, Williams, G, Raymond, T, Bronder, C, Davies, E, Hawkin, P, Ryska, O, Ayral, K, Beveridge, A, Bhowmik, A, Gill, M, Simpson, R, Schofield, A, Mcardle, K, Parmar, M, Williamson, M, Burton, H, Courtney, E, Grant, C, Saracino, A, Newton, K, Epstein, J, Branagan, G, Bignell, M, Symankewicz, M, Zaman, S, Mankotia, R, Siddiqui, Z, Torrance, A, Artioukh, D, Eggleston, M, Gokul, K, Selwyn, D, Warusavitarne, J, Chandrasinghe, P, Grainger, J, Leo, C, Harris, G, Levy, B, Skull, A, Thaha, M, Garg, A, Patel, H, Ramsanahie, A, Mondragon-Pritchard, M, Cuinas Leon, K, Shukla, A, Brewer, H, Fitzgerald, J, Kho, H, Torkington, J, Tate, S, Wheat, J, Smolarek, S, Platt, E, Rossi, B, Tham, J, Knight, J, Richardson, J, Tzivanakis, A, Gregori, M, Ashraf, M, Atif, M, Santos, J, Saffaf, N, Canning, L, Chandratreya, N, Bowen, M, Graham, B, Hamad, Y, Kaubrys, M, Chaudhry, Z, Bhan, C, Mukhtar, H, Oshowo, A, Wilson, J, Gouvas, N, Nicol, D, Pandey, S, Zilvetti, M, Sharma, A, Fatayer, T, Mothe, S, Rahman, M, Curtis, N, Allison, A, Dalton, R, Francis, N, Ockrim, J, Psaras, G, Dudarovaska, H, Marharint, T, Mostovoy, E, Voloshin, S, Kolesnik, O, Makhmudov, D, Altinel, Y, Iqbal, A, Cunningham, L, Go, K, Tan, S, R. Tutino, G. Salamone, L. Licari, G. Cocorullo, and G. Gulotta
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Male ,Colorectal cancer ,deferral of surgery ,neoadjuvant therapy ,pathology ,radiology ,rectal cancer ,Rectal surgery ,surgical oncology ,Gastroenterology ,0302 clinical medicine ,Prospective Studies ,Prospective cohort study ,Complete response ,Medical Audit ,integumentary system ,Incidence (epidemiology) ,Incidence ,Remission Induction ,Middle Aged ,Magnetic Resonance Imaging ,Europe ,Treatment Outcome ,Response Evaluation Criteria in Solid Tumors ,030220 oncology & carcinogenesis ,Preoperative Period ,030211 gastroenterology & hepatology ,Female ,Adult ,medicine.medical_specialty ,NO ,03 medical and health sciences ,medicine ,Humans ,Intensive care medicine ,Deferral ,Pathological ,Aged ,Neoplasm Staging ,ta3126 ,business.industry ,Rectal Neoplasms ,Reproducibility of Results ,Chemoradiotherapy, Adjuvant ,medicine.disease ,Rectal Neoplasms/diagnostic imaging ,Neoplasm Staging/methods ,business - Abstract
INTRODUCTION: The mainstay of management for locally advanced rectal cancer is chemoradiotherapy followed by surgical resection. Following chemoradiotherapy, a complete response may be detected clinically and radiologically (cCR) prior to surgery or pathologically after surgery (pCR). We aim to report the overall complete pathological response (pCR) rate and the reliability of detecting a cCR by conventional pre-operative imaging.METHODS: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients treated by elective rectal resection were included. A pCR was defined as a ypT0 N0 EMVI negative primary tumour; a partial response represented any regression from baseline staging following chemoradiotherapy. The primary endpoint was the pCR rate. The secondary endpoint was agreement between post-treatment MRI restaging (yMRI) and final pathological staging.RESULTS: Of 2572 patients undergoing rectal cancer surgery in 277 participating centres across 44 countries, 673 (26.2%) underwent chemoradiotherapy and surgery. The pCR rate was 10.3% (67/649), with a partial response in 35.9% (233/649) patients. Comparison of AJCC stage determined by post-treatment yMRI with final pathology showed understaging in 13% (55/429) and overstaging in 34% (148/429). Agreement between yMRI and final pathology for T-stage, N-stage, or AJCC status were each graded as 'fair' only (n = 429, Kappa 0.25, 0.26 and 0.35 respectively).CONCLUSION: The reported pCR rate of 10% highlights the potential for non-operative management in selected cases. The limited strength of agreement between basic conventional post-chemoradiotherapy imaging assessment techniques and pathology suggest alternative markers of response should be considered, in the context of controlled clinical trials.
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- 2018
9. The use of an endostapler in the treatment of supralevator abscess of intersphincteric origin
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García-Granero, A., Granero-Castro, P., Frasson, M., Flor-Lorente, B., Carreño, O., and Garcia-Granero, E.
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- 2014
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10. Prospective evaluation of intraoperative peripheral nerve injury in colorectal surgery
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Navarro-Vicente, F., García-Granero, A., Frasson, M., Blanco, F., Flor-Lorente, B., García-Botello, S., and García-Granero, E.
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- 2012
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11. Is always necessary preoperative chemo-radiotherapy in uT3 rectal cancer? Preoperative tumour thickness assessment with endorectal ultrasound is a prognostic factor: 137
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Flor-Lorente, B., Frasson, M., Esclapez, P., Espi, A., Garcia-Botello, S., Roda, D., Cervantes, A., Navarro, S., Garcia-Fuster, M., Puga, R., and Garcia-Granero, E.
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- 2011
12. Wongʼs classification for improved staging of rectal cancer with rectal ultrasound and pelvic magnetic resonance imaging: 045
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Muñoz, E., Garcia-Granero, E., Frasson, M., Esclapez, P., Campos, S., Flor-Lorente, B., Navarro, S., Garcia-Botello, S., Puga, R., Garcia-Fuster, M., and Cervantes, A.
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- 2011
13. Prognostic implications of circumferential location of distal rectal cancer
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García-Granero, E., Faiz, O., Flor-Lorente, B., García-Botello, S., Esclápez, P., and Cervantes, A.
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- 2011
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14. Predictors of complications and mortality following left colectomy with primary stapled anastomosis for cancer: results of a multicentric study with 1111 patients
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Pellino, G., Frasson, M., García-Granero, A., Granero-Castro, P., Ramos Rodríguez, J. L., Flor-Lorente, B., Bargallo Berzosa, J., Alonso Hernández, N., Labrador Vallverdú, F. J., Parra Baños, P. A., Ais Conde, G., Garcia-Granero, E., Alvarez Rico, Miguel Angel, García Brao, Maria Jesus, Sanchez Gonzalez, Juan Manuel, Braithwaite, Mariela, Martí Martínez, Eva, Álvarez Pérez, Jose Antonio, Espí, Alejandro, Trallero, A., Millán Scheiding, Mónica, Maseda Díaz, Olga, Dujovne Lindenbaum, Paula, Monzón Abad, Andrés, Romero Simó, Manuel, Escoll Rufino, Jordi, Santamaría Olabarrieta, Marta, Viñas Martínez, José, López Bañeres, Manolo, Blesa Sierra, Isabel, Feliú Villaró, Francesc, Lucía, Javier Aguiló, Codina Cazador, Antonio, Villalba, Juan Hernandis, Álvarez Laso, Carlos, Alcaide, Sonia Martínez, Cáceres Alvarado, Maria Nieves, Simó, Ignacio Rey, Montero García, Josep, García Fadrique, Alfonso, Aguilella Diago, Vicente, García Septiem, Javier, García, Jacinto García, Ponchietti, Luca, Carceller Navarro, Maria Soledad, Ramos Fernández, María, Conde Muiño, Raquel, Huerga Álvarez, Daniel, Sánchez, Pablo Menéndez, Maristany Bienert, Carlos, García Martínez, Maria Teresa, Muzas, Celia Moreno, Pastor Idoate, Carlos, Alonso Casado, Adolfo Pedro, Roig Vila, Jose Vicente, Goded Broto, Ignacio, Collera, Pablo, Sebastián, Antonio Arroyo, Pellino, G., Frasson, M., García-Granero, A., Granero-Castro, P., Ramos Rodríguez, J. L., Flor-Lorente, B., Bargallo Berzosa, J., Alonso Hernández, N., Labrador Vallverdú, F. J., Parra Baños, P. A., Ais Conde, G., Garcia-Granero, E., Alvarez Rico, Miguel Angel, García Brao, Maria Jesu, Sanchez Gonzalez, Juan Manuel, Braithwaite, Mariela, Martí Martínez, Eva, Álvarez Pérez, Jose Antonio, Espí, Alejandro, Trallero, A., Millán Scheiding, Mónica, Maseda Díaz, Olga, Dujovne Lindenbaum, Paula, Monzón Abad, André, Romero Simó, Manuel, Escoll Rufino, Jordi, Santamaría Olabarrieta, Marta, Viñas Martínez, José, López Bañeres, Manolo, Blesa Sierra, Isabel, Feliú Villaró, Francesc, Lucía, Javier Aguiló, Codina Cazador, Antonio, Villalba, Juan Hernandi, Álvarez Laso, Carlo, Alcaide, Sonia Martínez, Cáceres Alvarado, Maria Nieve, Simó, Ignacio Rey, Montero García, Josep, García Fadrique, Alfonso, Aguilella Diago, Vicente, García Septiem, Javier, García, Jacinto García, Ponchietti, Luca, Carceller Navarro, Maria Soledad, Ramos Fernández, María, Conde Muiño, Raquel, Huerga Álvarez, Daniel, Sánchez, Pablo Menéndez, Maristany Bienert, Carlo, García Martínez, Maria Teresa, Muzas, Celia Moreno, Pastor Idoate, Carlo, Alonso Casado, Adolfo Pedro, Roig Vila, Jose Vicente, Goded Broto, Ignacio, Collera, Pablo, and Sebastián, Antonio Arroyo
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Male ,medicine.medical_specialty ,Colectomies ,Databases, Factual ,Colorectal cancer ,Colon ,anastomotic leak ,030230 surgery ,Lower risk ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Risk Factors ,Surgical Stapling ,medicine ,Humans ,stapled anastomosi ,postoperative complication ,Prospective Studies ,left colectomy ,Colectomy ,Aged ,business.industry ,Anastomosis, Surgical ,Gastroenterology ,Postoperative complication ,Perioperative ,Middle Aged ,medicine.disease ,Surgery ,Colon cancer ,Parenteral nutrition ,Treatment Outcome ,030220 oncology & carcinogenesis ,Colonic Neoplasms ,Female ,business ,Complication - Abstract
Aim Reports detailing the morbidity-mortality after left colectomy are sparse and do not allow definitive conclusions to be drawn. We aimed to identify risk factors for anastomotic leakage, perioperative mortality and complications following left colectomy for colonic malignancies. Method We undertook a STROBE-compliant analysis of left colectomies included in a national prospective online database. Forty-two variables were analysed as potential independent risk factors for anastomotic leakage, postoperative morbidity and mortality. Variables were selected using the 'least absolute shrinkage and selection operator' (LASSO) method. Results We analysed 1111 patients. Eight per cent of patients had a leakage and in 80% of them reoperation or surgical drainage was needed. A quarter of patients (24.9%) experienced at least one minor complication. Perioperative mortality was 2%, leakage being responsible for 47.6% of deaths. Obesity (OR 2.8, 95% CI 1.00-7.05, P = 0.04) and total parenteral nutrition (TPN) (OR 3.7, 95% CI 1.58-8.51, P = 0.002) were associated with increased risk of leakage, whereas female patients had a lower risk (OR 0.36, 95% CI 0.18-0.67, P = 0.002). Corticosteroids (P = 0.03) and oral anticoagulants (P = 0.01) doubled the risk of complications, which was lower with hyperlipidaemia (OR 0.3, P = 0.02). Patients on TPN had more complications (OR 4.02, 95% CI 2.03-8.07, P = 0.04) and higher mortality (OR 8.7, 95% CI 1.8-40.9, P = 0.006). Liver disease and advanced age impaired survival, corticosteroids being the strongest predictor of mortality (OR 21.5, P = 0.001). Conclusion Requirement for TPN was associated with more leaks, complications and mortality. Leakage was presumably responsible for almost half of deaths. Hyperlipidaemia and female gender were associated with lower rates of complications. These findings warrant a better understanding of metabolic status on perioperative outcome after left colectomy.
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- 2018
15. Safety of primary anastomosis following emergency left sided colorectal resection: an international, multi-centre prospective audit
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Sánchez-Guillén, L, Nepogodiev, D, Sivrikoz, E, van Elst, T, Minaya, A, Pata, F, Glasbey, J, Pinkney, T, Bhangu, A, El-Hussuna, A, Buchs, N, Buskens, C, Chaudri, S, Frasson, M, Gallo, G, Morton, D, Negoi, I, Singh, B, Zmora, O, Perry, R, Magill, L, Altomare, D, Bemelman, W, Brown, S, Denost, Q, Knowles, C, Laurberg, S, Lefèvre, J, Möeslein, G, Vaizey, C, Bilali, S, Bilali, V, Salomon, M, Cillo, M, Estefania, D, Patron Uriburu, J, Ruiz, H, Farina, P, Carballo, F, Guckenheimer, S, Proud, D, Brouwer, R, Bui, A, Nguyen, B, Smart, P, Warwick, A, Theodore, J, Herbst, F, Birsan, T, Dauser, B, Ghaffari, S, Hartig, N, Stift, A, Argeny, S, Unger, L, Strouhal, R, Heuberger, A, Varabei, A, Lahodzich, N, Makhmudov, A, Selniahina, L, Feryn, T, Leupe, T, Maes, L, Reynvoet, E, Van Langenhove, K, Nachtergaele, M, Monami, B, Francart, D, Jehaes, C, Markiewicz, S, Weerts, J, Van Belle, K, Bomans, B, Cavenaile, V, Nijs, Y, Vertruyen, M, Pletinckx, P, Claeys, D, Defoort, B, Muysoms, F, Van Cleven, S, Lange, C, Vindevoghel, K, Wolthuis, A, Todorovic, M, Dabic, S, Kenjic, B, Lovric, S, Vidovic, J, Delibegovic, S, Mehmedovic, Z, Christiano, A, Lombardi, B, Marchiori, M Jr, Tercioti, V Jr, Dardanov, D, Petkov, P, Simonova, L, Yonkov, A, Zhivkov, E, Maslyankov, S, Pavlov, V, Sokolov, M, Todorov, G, Stoyanov, V, Batashki, I, Iarumov, N, Lozev, I, Moshev, B, Slavchev, M, Atanasov, B, Belev, N, Krstev, P, Penkov, R, Šantak, G, Ćosić, J, Previšić, A, Vukušić, L, Zukanović, G, Zelić, M, Kršul, D, Lekić Vitlov, V, Mendrila, D, Orhalmi, J, Dusek, T, Maly, O, Paral, J, Sotona, O, Skrovina, M, Bencurik, V, Machackova, M, Kala, Z, Farkašová, M, Grolich, T, Procházka, V, Hoch, J, Kocian, P, Martinek, L, Antos, F, Pruchova, V, Ceccotti, A, Madsbøll, T, Straarup, D, Uth Ovesen, A, Christensen, P, Bondeven, P, Edling, P, Elfeki, H, Alexandrovich Gameza, V, Michelsen Bach, S, Zheltiakova, I, Krarup, Pm, Krogh, A, Rolff, Hc, Lykke, J, Juvik, Af, Lóven, Hhk, Marckman, M, Osterkamp, Jtf, Madsen, Ah, Worsøe, J, Ugianskis, A, Kjaer, Md, Youn Cho Lee, B, Khalid, A, Kristensen, Mh, El Sorogy, M, Elgeidie, A, Elhemaly, M, Elnakeeb, A, Elrefai, M, Shalaby, M, Emile, S, Omar, W, Sakr, A, Thabet, W, Awny, S, Metwally, I, Refky, B, Shams, N, Zuhdy, M, Lepistö, A, Keränen, I, Kivelä, A, Lehtonen, T, Siironen, P, Rautio, T, Ahonen-Siirtola, M, Klintrup, K, Paarnio, K, Takala, H, Hyöty, M, Haukijärvi, E, Kotaluoto, Sm, Lehto, K, Tomminen, T, Huhtinen, H, Carpelan, A, Karvonen, J, Rantala, A, Varpe, P, Cotte, E, Francois, Y, Glehen, O, Passot, G, D'Alessandro, A, Chouillard, E, Etienne, Jc, Ghilles, E, Vinson-Bonnet, B, Germain, A, Ayav, A, Bresler, L, Chevalier, R, Didailler, R, Rullier, E, Tiret, E, Chafai, N, Lefevre, J, Parc, Y, Sielezneff, I, Mege, D, Lakkis, Z, Barussaud, M, Krones, C, Bock, B, Webler, R, Baral, J, Lang, T, Münch, S, Pullig, F, Schön, M, Hinz, S, Becker, T, Möller, T, Richter, F, Schafmayer, C, Hardt, J, Kienle, P, Crescenti, F, Ahmad, M, Soleiman, Y, Papaconstantinou, I, Gklavas, A, Nastos, K, Theodosopoulos, T, Vezakis, A, Stamou, K, Saridaki, A, Xynos, E, Paraskakis, S, Zervakis, N, Skroubis, G, Amanatidis, T, Germanos, S, Maroulis, I, Papadopoulos, G, Dimitriou, N, Alexandrou, A, Felekouras, E, Griniatsos, J, Karavokyros, I, Papadopoulos, A, Chouliaras, C, Ioannidis, P, Katsounis, D, Kefalou, E, Katsoulis, I, Balalis, D, Manatakis, D, Tzovaras, G, Baloyiannis, I, Mamaloudis, I, Lázár, G, Ábraham, S, Paszt, A, Simonka, Z, Zaránd, A, Baranyai, Z, Ferreira, G, Harsányi, L, Ónody, P, Banky, B, Burány, Á, Lakatos, M, Marton, J, Solymosi, A, Besznyák, I, Bursics, A, Papp, G, Saftics, G, Svastics, I, Valsdottir, E, Atladottir, J, Jonsson, T, Moller, P, Sigurdsson, H, Gupta, Sk, Gupta, S, Kaul, N, Mohan, S, Sharma, G, Wani, R, Chowdri, N, Khan, M, Mehraj, A, Parray, F, Coveney, A, Burke, J, Deasy, J, El-Masry, S, Mcnamara, D, Khan, Mf, Cahill, R, Faul, E, Mulsow, J, Shields, C, Kelly, Me, Bass, G, Martin, St, O'Connell, R, Ryan, E, Connelly, T, Ahmad, G, Bukhari, W, Cooke, F, Gold Deutch, R, Haim, N, Lavy, R, Moscovici, A, Shussman, N, Gefen, R, Marom, G, Pikarsky, A, Weiss, D, Avital, S, Hermann, N, Raguan, B, Slavin, M, White, I, Wasserberg, N, Arieli, H, Gurevich, N, Freund, Mr, Dorot, S, Halfteck, G, Reissman, P, Yair, E, Eden, Y, Pery, R, Tulchinsky, H, Weizman, A, Agresta, F, Curinga, R, Finotti, E, Savino, G, Verza, La, Asteria, Cr, Boccia, L, Pascariello, A, Tamini, N, Bugatti, A, Gianotti, L, Totis, M, Vincenti, L, Andriola, V, Giannini, I, Travaglio, E, Balestri, R, Buccianti, P, Roffi, N, Rossi, E, Urbani, L, Mellano, A, Cinquegrana, A, Lauretta, A, Belluco, C, Mistrangelo, M, Allaix, Me, Arolfo, S, Morino, M, Testa, V, Delrio, P, Pace, U, Rega, D, Scala, D, Clerico, G, Cornaglia, S, Realis Luc, A, Trompetto, M, Ugolini, G, Antonacci, N, Fabbri, S, Montroni, I, Zattoni, D, D'Urbano, C, Cornelli, A, Viti, M, Inama, M, Bacchion, M, Casaril, A, Impellizzeri, H, Moretto, G, Spinelli, A, Carvello, M, David, G, Di Candido, F, 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Gallego, E, Elia Guedea, M, Escola, D, Martinez, S, Primo Romaguera, V, Parreno, R, Pastor, L, Rosell, E, Lozoya Trujillo, R, Alos Company, R, Ruiz Carmona, M, Solana Bueno, A, Salvans Ruiz, S, Alonso Goncalves, S, Jimenez-Toscano, M, Pascual Damieta, M, Pera Roman, M, Pellicer-Franco, E, Garcia-Marin, J, Mengual-Ballester, M, Soria-Aledo, V, Valero-Navarro, G, Vicente-Ruiz, M, Garcia-Zamora, C, Gonzalez-Gil, A, Montoya-Tabares, M, Paredes-Quiles, M, Die Trill, J, Abadia, P, Moreno, I, Pina, J, Ramos Rubio, D, Escartin, J, Blas, J, Fernando, J, Ferrer, R, Garcia Egea, J, Pros, I, Martinez, W, Rius, J, Socias, M, Sabia, D, Castellvi Valls, J, Gonzalez Santin, V, Mompart Garcia, S, Viso Pons, L, Julia, D, Codina-Cazador, A, Farres, R, Gomez, N, Planellas, P, Cuadrado, M, Camps, I, Rufas, M, Escoll, J, Ferminan, A, Muriel, P, Sierra, E, Alvarez-Laso, C, Lora, P, Padin, H, Garcia-Septiem, J, Bustamante, C, Jimenez, V, Jimenez-Miramon, J, Ramos, J, Gallardo, A, Benito, P, Colao, L, Galindo, P, Garcia, C, Forero-Torres, A, Alonso Poza, A, Dieguez Fernandez, B, Gilsanz Martin, C, Hernandez Garcia, M, Rojo Lopez, J, Gil Lopez, J, Gonzalez Zunzarren, M, Martinez Alegre, J, Zorrilla Matilla, J, Navarro-Sanchez, A, Alcala Serrano, F, Lopez-Fernandez, J, Montesdeoca Cabrera, D, Alvarez-Gallego, M, Guevara, J, Pascual Miguelanez, I, Rubio-Perez, I, Gomez Ruiz, M, Alonso Martin, J, Cagigas Fernandez, C, Castillo Diego, J, Pando, J, Maristany, C, Munoz-Duyos, A, Rada-Palomino, A, Vargas-Pierola, H, Pena Ros, E, Benavides Buleje, J, Munoz Camarena, J, Parra Banos, P, Ramirez Faraco, M, Arenal, J, Citores, M, Marcos, J, Sanchez, J, Tinoco, C, Garcia Florez, L, Arias Pacheco, R, Minguez Ruiz, G, Rodriguez Corral, N, Rodriguez Infante, A, Carrillo Lopez, M, Carrasco Prats, M, Lage Laredo, A, Martinez Manzano, A, Rodriguez Garcia, P, Segura-Sampedro, J, Alonso-Hernandez, N, Fernandez Isart, M, Gamundi Cuesta, M, Ochogavia Segui, A, Ibanez, N, Abrisqueta, J, Lujan, J, Gomez Perez, R, 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J, Chabok, A, Smedh, K, Tiselius, C, Haapaniemi, S, Benckert, A, Adamina, M, Freil-Lanter, C, Gingert, C, Muller, P, Schafli, J, Regusci, L, Brenna, M, Fasolini, F, Misteli, H, Kirchhoff, P, Oertli, D, Hahnloser, D, Clerc, D, Hubner, M, Ris, F, Chevallay, M, Morel, P, Schiltz, B, Wang, J, Su, W, Huang, C, Ma, C, Tsai, H, Ozbalci, G, Ozkan, B, Karabacak, U, Bugra, D, Agalar, F, Baloglu, H, Basoglu, I, Okkabaz, N, Binboga, E, Biricik, A, Celik, A, Yavuz, E, Canda, A, Agalar, C, Fuzun, M, Sokmen, S, Terzi, C, Isik, A, Karip, B, Bilgili, A, Leventoglu, S, Aytac, B, Yildiz, A, Yuksel, O, Sinan, H, Hancerliogullari, O, Kaymak, S, Kozak, O, Ozer, M, Sarici, I, Akca, O, Kalayci, M, Kara, Y, Agcaoglu, O, Balik, E, Bayram, O, Sungurtekin, U, Ozgen, U, Demirbas, S, Ozturk, E, Isik, O, Yilmazlar, T, Colak, E, Karagul, S, Kinas, V, Fearnhead, N, Lord, I, Stewart, P, Zammit, M, Arnold, S, Battersby, N, Broadhurst, J, Mehta, A, Seretis, F, Shabbir, J, Jones, C, Kynaston, J, Vimalachandran, D, Blower, 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J, Richardson, J, Tzivanakis, A, Gregori, M, Ashraf, M, Atif, M, Santos, J, Saffaf, N, Canning, L, Chandratreya, N, Bowen, M, Graham, B, Hamad, Y, Kaubrys, M, Chaudhry, Z, Bhan, C, Mukhtar, H, Oshowo, A, Wilson, J, Gouvas, N, Nicol, D, Pandey, S, Zilvetti, M, Sharma, A, Fatayer, T, Mothe, S, Rahman, M, Curtis, N, Allison, A, Dalton, R, Francis, N, Ockrim, J, Psaras, G, Dudarovaska, H, Marharint, T, Mostovoy, E, Voloshin, S, Kolesnik, O, Makhmudov, D, Altinel, Y, Iqbal, A, Cunningham, L, Go, K, Tan, S, Surgery, R. Tutino, G. Salamone, L. Licari, G. Cocorullo, G. Gulotta, European Society of Coloproctology (ESCP) Cohort Studie, and Tonini V, Cervellera M, Vaccari S
- Subjects
Male ,Medical audit ,Treatment outcome ,anastomotic leak ,030230 surgery ,0302 clinical medicine ,Postoperative Complications ,Prospective Studies ,Multi centre ,emergency surgery ,Prospective cohort study ,Colectomy ,Medical Audit ,Proctectomy ,Proctectomy/adverse effects ,Prospective audit ,Primary anastomosis ,Anastomosis, Surgical ,Gastroenterology ,Middle Aged ,surgical complications ,Europe ,Treatment Outcome ,colon cancer ,gastrointestinal surgery ,rectal cancer ,Surgery ,surgical outcomes ,030220 oncology & carcinogenesis ,Postoperative Complications/etiology ,Female ,Colectomy/adverse effects ,Emergency Treatment/adverse effects ,Adult ,medicine.medical_specialty ,Adolescent ,surgical outcome ,Left sided ,NO ,03 medical and health sciences ,Young Adult ,surgical complication ,medicine ,Humans ,Emergency Treatment ,Colorectal resection ,Aged ,ta3126 ,Anastomosis, Surgical/methods ,business.industry ,General surgery ,Surgical Stomas ,Surgical Stomas/statistics & numerical data ,Settore MED/18 - Chirurgia Generale ,Multivariate Analysis ,business - Abstract
Introduction: Some evidence suggests that primary anastomosis following left sided colorectal resection in the emergency setting may be safe in selected patients, and confer favourable outcomes to permanent enterostomy. The aim of this study was to compare the major postoperative complication rate in patients undergoing end stoma vs primary anastomosis following emergency left sided colorectal resection. Methods: A pre-planned analysis of the European Society of Coloproctology 2017 audit. Adult patients (>16years) who underwent emergency (unplanned, within 24h of hospital admission) left sided colonic or rectal resection were included. The primary endpoint was the 30-day major complication rate (Clavien-Dindo grade 3 to 5). Results: From 591 patients, 455 (77%) received an end stoma, 103 a primary anastomosis (17%) and 33 primary anastomosis with defunctioning stoma (6%). In multivariable models, anastomosis was associated with a similar major complication rate to end stoma (adjusted odds ratio for end stoma 1.52, 95%CI 0.83–2.79, P=0.173). Although a defunctioning stoma was not associated with reduced anastomotic leak (12% defunctioned [4/33] vs 13% not defunctioned [13/97], adjusted odds ratio 2.19, 95%CI 0.43–11.02, P=0.343), it was associated with less severe complications (75% [3/4] with defunctioning stoma, 86.7% anastomosis only [13/15]), a lower mortality rate (0% [0/4] vs 20% [3/15]), and fewer reoperations (50% [2/4] vs 73% [11/15]) when a leak did occur. Conclusions: Primary anastomosis in selected patients appears safe after left sided emergency colorectal resection. A defunctioning stoma might mitigate against risk of subsequent complications.
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- 2018
16. An individualised versus a conventional pneumoperitoneum pressure strategy during colorectal laparoscopic surgery: Rationale and study protocol for a multicentre randomised clinical study
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Diaz-Cambronero, O, Mazzinari, G, Errando, C L, Schultz, M J, Flor Lorente, B, García-Gregorio, N, Vila Montañés, M, Robles-Hernández, Daniel, Olmedilla Arnal, L E, Martín-De-Pablos, A, Marqués Marí, A, Argente Navarro, M P, IPPCollapse-II study group, Intensive Care Medicine, ACS - Diabetes & metabolism, ACS - Pulmonary hypertension & thrombosis, and ACS - Microcirculation
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Laparoscopic surgery ,medicine.medical_specialty ,Pneumoperitoneum pressure ,Time Factors ,Colon ,medicine.medical_treatment ,MEDLINE ,Medicine (miscellaneous) ,Outcome (game theory) ,Clinical study ,Study Protocol ,03 medical and health sciences ,Postoperative complications ,0302 clinical medicine ,Statistical Analysis Plan ,Pneumoperitoneum ,030202 anesthesiology ,Colorectal surgery ,medicine ,Pressure ,Humans ,Multicenter Studies as Topic ,Pharmacology (medical) ,Single-Blind Method ,030212 general & internal medicine ,Digestive System Surgical Procedures ,Outcome ,Randomized Controlled Trials as Topic ,Protocol (science) ,lcsh:R5-920 ,business.industry ,General surgery ,Rectum ,Recovery of Function ,Length of Stay ,medicine.disease ,3. Good health ,Treatment Outcome ,Spain ,Abdominal laparoscopy ,Laparoscopy ,Post-operative Quality of Recovery Scale (PQRS) ,Safety ,lcsh:Medicine (General) ,business ,Pneumoperitoneum, Artificial - Abstract
Background A recent study shows that a multifaceted strategy using an individualised intra-abdominal pressure titration strategy during colorectal laparoscopic surgery results in an acceptable workspace at low intra-abdominal pressure in most patients. The multifaceted strategy, focused on lower to individualised intra-abdominal pressures, includes prestretching the abdominal wall during initial insufflation, deep neuromuscular blockade, low tidal volume ventilation settings and a modified lithotomy position. The study presented here tests the hypothesis that this strategy improves outcomes of patients scheduled for colorectal laparoscopic surgery. Methods The Individualized Pneumoperitoneum Pressure in Colorectal Laparoscopic Surgery versus Standard Therapy (IPPCollapse-II) study is a multicentre, two-arm, parallel-group, single-blinded randomised 1:1 clinical study that runs in four academic hospitals in Spain. Patients scheduled for colorectal laparoscopic surgery with American Society of Anesthesiologists classification I to III who are aged > 18 years and are without cognitive deficits are randomised to an individualised pneumoperitoneum pressure strategy (the intervention group) or to a conventional pneumoperitoneum pressure strategy (the control group). The primary outcome is recovery assessed with the Post-operative Quality of Recovery Scale (PQRS) at postoperative day 1. Secondary outcomes include PQRS score in the post anaesthesia care unit and at postoperative day 3, postoperative complications until postoperative day 28, hospital length of stay and process-related outcomes. Discussion The IPPCollapse-II study will be the first randomised clinical study that assesses the impact of an individualised pneumoperitoneum pressure strategy focused on working with the lowest intra-abdominal pressure during colorectal laparoscopic surgery on relevant patient-centred outcomes. The results of this large study, to be disseminated through conference presentations and publications in international peer-reviewed journals, are of ultimate importance for optimising the care and safety of laparoscopic abdominal surgery. Selection of patient-reported outcomes as the primary outcome of this study facilitates the translation into clinical practice. Access to source data will be made available through anonymised datasets upon request and after agreement of the Steering Committee of the IPPCollapse-II study. Trial registration ClinicalTrials.gov, NCT02773173. Registered on 16 May 2016. EudraCT, 2016-001693-15. Registered on 8 August 2016. Electronic supplementary material The online version of this article (10.1186/s13063-019-3255-1) contains supplementary material, which is available to authorized users.
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- 2019
17. Management of intersphincteric abscesses
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Millan, M., García-Granero, E., Esclápez, P., Flor-Lorente, B., Espí, A., and Lledó, S.
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- 2006
18. What is the Real Benefit of Preoperative Chemoradiotherapy after Adequate Mesorectal Excision for Cancer of the Distal Rectum?: F035
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Flor-Lorente, B, Garcia-Granero, E, Muñoz, E, Garcia-Botello, S, Cervantes, A, Esclapez, P, Espi, A, Navarro, S, Campos, S, and Lledo, S
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- 2006
19. Use of Photoplethysmography to Determine Gastrointestinal Perfusion Pressure: An Experimental Canine Model
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Garcia-Granero, E., Garcia, S. A., Alos, R., Calvete, J., Flor-Lorente, B., Willatt, J., and Lledo, S.
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- 2003
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20. Effect of an individualized versus standard pneumoperitoneum pressure strategy on postoperative recovery: a randomized clinical trial in laparoscopic colorectal surgery.
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Díaz‐Cambronero, O., Mazzinari, G., Flor Lorente, B., García Gregorio, N., Robles‐Hernandez, D., Olmedilla Arnal, L. E., Martin de Pablos, A., Schultz, M. J., Errando, C. L., and Argente Navarro, M. P.
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LAPAROSCOPIC surgery ,PROCTOLOGY ,CLINICAL trials ,SURGICAL complications ,PATIENT positioning - Abstract
Copyright of British Journal of Surgery is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2020
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21. Risk factors for leak, complications and mortality after ileocolic anastomosis: comparison of two anastomotic techniques.
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Sánchez-Guillén, L, Frasson, M, García-Granero, Á, Pellino, G, Flor-Lorente, B, Álvarez-Sarrado, E, and García-Granero, E
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- 2019
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22. Anastomotic leakage after colon cancer resection: does the individual surgeon matter?
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Marinello, F. G., Baguena, G., Lucas, E., Frasson, M., Hervás, D., Flor‐Lorente, B., Esclapez, P., Espí, A., and García‐Granero, E.
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SURGICAL anastomosis ,COLON cancer treatment ,COLON surgery ,SURGICAL excision ,SURGICAL complications - Abstract
Aim Anastomotic leakage is one of the most feared complications after colonic resection. Many risk factors for anastomotic leakage have been reported, but the impact of an individual surgeon as a risk factor has scarcely been reported. The aim of this study was to assess if the individual surgeon is an independent risk factor for anastomotic leakage in colonic cancer surgery. Method This was a retrospective analysis of prospectively collected data from patients who underwent elective resection for colon cancer with anastomosis at a specialized colorectal unit from January 1993 to December 2010. Anastomotic leaks were diagnosed according to standardized criteria. Patient and tumour characteristics, surgical procedure and operating surgeons were analysed. A logistic regression model was used to discriminate statistical variation and identify risk factors for anastomotic leakage. Results A total of 1045 patients underwent elective colon cancer resection with primary anastomosis. Anastomotic leakage occurred in 6.4% of patients. Ileocolic anastomosis had an anastomotic leakage rate of 7.2%, colo-colonic/colorectal anastomosis 5.2% and ileorectal anastomosis 12.7%, with intersurgeon variability. The independent risk factors associated with anastomotic leakage were the use of perioperative blood transfusion ( OR 2.83, CI 1.59-5.06, P < 0.0001) and the individual surgeon performing the procedure ( OR up to 8.44, P < 0.0001). Conclusion In addition to perioperative blood transfusion, the individual surgeon was identified as an important risk factor for anastomotic leakage. Efforts should be made to reduce performance variability amongst surgeons. [ABSTRACT FROM AUTHOR]
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- 2016
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23. A video demonstration of three‐dimensional imaging to assess the circumferential resection margin in locally advanced rectal cancer and recurrent rectal cancer – a video vignette.
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Garcia‐Granero, A., Pellino, G., Giner, F., Frasson, M., Fletcher‐Sanfeliu, D., Primo Romeguera, V., Flor Lorente, B., Gamundi, M., Brogi, L., Garcia‐Calderón, D., González‐Argente, F. X., and Garcia‐Granero, E.
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THREE-dimensional imaging ,RECTAL cancer ,RECTUM ,VIGNETTES - Abstract
A video demonstration of three-dimensional imaging to assess the circumferential resection margin in locally advanced rectal cancer and recurrent rectal cancer - a video vignette I Dear Editor, i Surgical treatment of locally advanced primary rectal cancer and locally recurrent rectal cancer often requires extensive approaches to achieve a tumour-free resection margin (R0). After chemoradiotherapy, the presence of tumour cells, signs of fibrosis or mucin pools are considered to be associated with previous invasion by the tumour. [Extracted from the article]
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- 2020
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24. An individualised versus a conventional pneumoperitoneum pressure strategy during colorectal laparoscopic surgery: rationale and study protocol for a multicentre randomised clinical study.
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IPPCollapse-II study group, García-Gregorio, N., Vila Montañés, M., Argente Navarro, M. P., Diaz-Cambronero, O., Olmedilla Arnal, L. E., Martín-De-Pablos, A., Marqués Marí, A., Mazzinari, G., Errando, C. L., Schultz, M. J., Flor Lorente, B., and Robles-Hernández, Daniel
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INTRA-abdominal pressure ,VOLUMETRIC analysis ,LAPAROSCOPIC surgery ,PATIENTS ,LITHOTOMY position ,PNEUMOPERITONEUM ,ANESTHESIOLOGISTS - Abstract
Background: A recent study shows that a multifaceted strategy using an individualised intra-abdominal pressure titration strategy during colorectal laparoscopic surgery results in an acceptable workspace at low intra-abdominal pressure in most patients. The multifaceted strategy, focused on lower to individualised intra-abdominal pressures, includes prestretching the abdominal wall during initial insufflation, deep neuromuscular blockade, low tidal volume ventilation settings and a modified lithotomy position. The study presented here tests the hypothesis that this strategy improves outcomes of patients scheduled for colorectal laparoscopic surgery.Methods: The Individualized Pneumoperitoneum Pressure in Colorectal Laparoscopic Surgery versus Standard Therapy (IPPCollapse-II) study is a multicentre, two-arm, parallel-group, single-blinded randomised 1:1 clinical study that runs in four academic hospitals in Spain. Patients scheduled for colorectal laparoscopic surgery with American Society of Anesthesiologists classification I to III who are aged > 18 years and are without cognitive deficits are randomised to an individualised pneumoperitoneum pressure strategy (the intervention group) or to a conventional pneumoperitoneum pressure strategy (the control group). The primary outcome is recovery assessed with the Post-operative Quality of Recovery Scale (PQRS) at postoperative day 1. Secondary outcomes include PQRS score in the post anaesthesia care unit and at postoperative day 3, postoperative complications until postoperative day 28, hospital length of stay and process-related outcomes.Discussion: The IPPCollapse-II study will be the first randomised clinical study that assesses the impact of an individualised pneumoperitoneum pressure strategy focused on working with the lowest intra-abdominal pressure during colorectal laparoscopic surgery on relevant patient-centred outcomes. The results of this large study, to be disseminated through conference presentations and publications in international peer-reviewed journals, are of ultimate importance for optimising the care and safety of laparoscopic abdominal surgery. Selection of patient-reported outcomes as the primary outcome of this study facilitates the translation into clinical practice. Access to source data will be made available through anonymised datasets upon request and after agreement of the Steering Committee of the IPPCollapse-II study.Trial Registration: ClinicalTrials.gov, NCT02773173 . Registered on 16 May 2016. EudraCT, 2016-001693-15. Registered on 8 August 2016. [ABSTRACT FROM AUTHOR]- Published
- 2019
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25. Inferior mesenteric vein as initial landmark for laparoscopic medial to lateral dissection of descending colon - a video vignette.
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Garcia‐Granero, A., Wagner Tustanowski, G., Sánchez‐Guillén, L., Fletcher Sanfeliu, D., Frasson, M., Flor Lorente, B., and Martinez‐Soriano, F.
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MESENTERIC veins ,RETROPERITONEUM - Published
- 2017
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26. Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection: an international, multi-centre, prospective audit
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The 2017 European Society of Coloproctology (ESCP) collaborating group, Blanco-Colino, Kelly, Singh, Bhangu, Pinkney, Poskus, El-Hussuna, Battersby, N. J., Buchs, N. C., Buskens, Chaudri, Frasson, Gallo, Minaya-Bravo, A. M., Morton, Negoi, Nepogodiev, Pata, Sánchez-Guillén, Zmora, Perry, Magill, Altomare, Bemelman, Brown, Denost, Knowles, Laurberg, Lefevre, J. H., Möeslein, Vaizey, Bilali, Salomon, Cillo, Estefania, Patron, Uriburu, Ruiz, Farina, Carballo, Guckenheimer, Proud, Brouwer, Bui, Nguyen, Smart, Warwick, Theodore, J. E., Herbst, Birsan, Dauser, Ghaffari, Hartig, Stift, Argeny, Unger, Strouhal, Heuberger, Varabei, Lahodzich, Makhmudov, Selniahina, Feryn, Leupe, Maes, Reynvoet, Van, Langenhove, Nachtergaele, Monami, Francart, Jehaes, Markiewicz, Weerts, Van, Belle, Bomans, Cavenaile, Nijs, Vertruyen, Pletinckx, Claeys, Defoort, Muysoms, Van, Cleven, Lange, Vindevoghel, Wolthuis, Todorovic, Dabic, Kenjic, Lovric, Vidovic, Delibegovic, Mehmedovic, Christiano, Lombardi, Marchiori, J, R., Tercioti, Dardanov, Petkov, Simonova, Yonkov, Zhivkov, Maslyankov, Pavlov, Sokolov, Todorov, Stoyanov, Batashki, Iarumov, Lozev, Moshev, Slavchev, Atanasov, Belev, Krstev, Penkov, Šantak, Ćosić, Previšić, Vukušić, Zukanović, Zelić, Kršul, Lekić, Vitlov, Mendrila, Orhalmi, Dusek, Maly, Paral, Sotona, Skrovina, Bencurik, Machackova, Kala, Farkašová, Grolich, Procházka, Hoch, Kocian, Martinek, Antos, Pruchova, Ceccotti, Madsbøll, Straarup, Uth, Ovesen, Christensen, Bondeven, Edling, Elfeki, Alexandrovich, Gameza, Michelsen, Bach, Zheltiakova, Krarup, P. M., Krogh, Rolff, H. -C., Lykke, Juvik, A. F., Lóven, H. H. K., Marckmann, Osterkamp, J. T. F., Madsen, A. H., Worsøe, Ugianskis, Kjær, M. D., Youn Cho Lee, Khalid, Kristensen, M. H., Sorogy, El, Elgeidie, Elhemaly, Nakeeb, El, Elrefai, Shalaby, Emile, Omar, Sakr, Thabet, Awny, Metwally, Refky, Shams, Zuhdy, Lepistö, Keränen, Kivelä, Lehtonen, Siironen, Rautio, Ahonen-Siirtola, Klintrup, Paarnio, Takala, Hyöty, Haukijärvi, Kotaluoto, S. -M., Lehto, Tomminen, Huhtinen, Carpelan, Karvonen, Rantala, Varpe, Cotte, Francois, Glehen, Passot, D'Alessandro, Chouillard, Etienne, J. C., Ghilles, Vinson-Bonnet, Germain, Ayav, Bresler, Chevalier, Didailler, Rullier, Tiret, Chafai, Parc, Sielezneff, Mege, Lakkis, Barussaud, Krones, Bock, Webler, Baral, Lang, Münch, Pullig, Schön, Hinz, Becker, Möller, Richter, Schafmayer, Hardt, Kienle, Crescenti, Ahmad, Soleiman, Papaconstantinou, Gklavas, Nastos, Theodosopoulos, Vezakis, Stamou, Saridaki, Xynos, Paraskakis, Zervakis, Skroubis, Amanatidis, Germanos, Maroulis, Papadopoulos, Dimitriou, Alexandrou, Felekouras, Griniatsos, Karavokyros, Chouliaras, Ioannidis, Katsounis, Kefalou, Katsoulis, I. E., Balalis, Korkolis, D. P., Manatakis, Tzovaras, Baloyiannis, Mamaloudis, Lázár, Ábraham, Paszt, Simonka, Tóth, Zaránd, Baranyai, Ferreira, Harsányi, Ónody, Banky, Burány, Lakatos, Marton, Solymosi, Besznyák, Bursics, Papp, Saftics, Svastics, Valsdottir, Atladottir, Jonsson, Moller, Sigurdsson, Gupta, S. K., Kaul, Mohan, Sharma, Wani, Chowdri, Khan, Mehraj, Parray, F. Q., Coveney, Burke, Deasy, El-Masry, Mcnamara, Cahill, Faul, Mulsow, Shields, Bass, Martin, S. T., O'Connell, Ryan, Connelly, Bukhari, Cooke, Gold, Deutch, Haim, Lavy, Moscovici, Shussman, Gefen, Marom, Pikarsky, Weiss, Avital, Hermann, Raguan, Slavin, White, Wasserberg, Arieli, Gurevich, Freund, M. R., Dorot, Edden, Halfteck, Reissman, Pery, Tulchinsky, Weizman, Agresta, Curinga, Finotti, Savino, Verza, L. A., Asteria, C. R., Boccia, Pascariello, Tamini, Bugatti, Gianotti, Totis, Vincenti, Andriola, Giannini, Travaglio, Balestri, Buccianti, Roffi, Rossi, Urbani, Mellano, Cinquegrana, Lauretta, Belluco, Mistrangelo, Allaix, M. E., Arolfo, Morino, Testa, Delrio, Pace, Rega, Scala, Clerico, Cornaglia, Realis, Luc, Trompetto, Ugolini, Antonacci, Fabbri, Montroni, Zattoni, D'Urbano, Cornelli, Viti, Inama, Bacchion, Casaril, Impellizzeri, Moretto, Spinelli, Carvello, David, Candido, Di, Sacchi, Frontali, Ceriani, Molteni, Rosati, Aleotti, Elmore, Lemma, Vignali, Scabini, Casoni, Pattacini, Luzzi, Romairone, Marino, Lorusso, Pezzolla, Colombo, Baldi, Foschi, Sampietro, Sorrentino, Saverio, Di, Birindelli, Segalini, Spacca, Romano, G. M., Belli, Bianco, Franciscis, De, Falato, Muratore, Marsanic, Grimaldi, Castaldo, Ciolli, M. G., Picarella, Porfidia, Tugnoli, Bondurri, Cavallo, Maffioli, Pertusati, Pulighe, Balestra, Nisco, De, Podda, Opocher, Longhi, Mariani, N. M., Maroni, Pisani, Ceretti, Galleano, Aonzo, Curletti, Reggiani, Marconi, Del, Prete, Oldani, Pappalardo, Zaccone, L, Scatizzi, Baraghini, Cantafio, Feroci, Giani, Tutino, Cocorullo, Gulotta, Licari, Salamone, Sileri, Saraceno, Torre, La, Chirletti, Coletta, Toma, De, Mingoli, Papandrea, Luca, De, Sacco, Sammarco, Vescio, Tonini, Bianchini, Cervellera, Vaccari, Cracco, Barugola, Bertocchi, Rossini, Ruffo, Sartori, Clemente, Scaffidi, Lorenzon, Balducci, Bocchetti, Ferri, Mercantini, Bauce, Benevento, Bottini, Crapa, P. R., Rubbini, Michele, Anania, Gabriele, Carcoforo, Paolo, Cavallesco, Narciso Giorgio, Feo, Carlo, Yamamoto, Sivins, Ancans, Gerkis, Lunis, Pcolkins, Venskutonis, Bradulskis, Dainius, Subocius, Vencius, Zeromskas, Eismontas, Nutautiene, Simcikas, Tamosiunas, Svagzdys, Latkauskas, Lizdenis, Saladzinskas, Tamelis, Dulskas, Kuliavas, Samalavicius, N. E., Jotautas, Mikalauskas, Strupas, Zakaria, A. D., Lah, N. N., Wong, Zain, W. Z., Mazlan, Mohd, Azman, Z. A., Sagap, Psaila, Andrejevic, Cini, Ellul, Ahallat, Hamid, Hrora, Majbar, M. A., Raiss, Westerduin, Tanis, van der Sluis, P. C., Davids, P. H., Pronk, Schiphorst, A. H. W., Smakman, Zimmerman, Koeter, Stijns, Van, Loon, Y. -T., Vermaas, Graaf, De, Doornebosch, Van, Hagen, Van, Ruler, Toorenvliet, Nonner, van den Berg, Van, Steensel, Vles, Melenhorst, Orsini, Visschers, Hoff, Blom, Marsman, Mulder, Cense, Castro, De, Demirkiran, Hunfeld, Van, Geloven, Groof, De, Hendriks, Leeuwenburg, Van, Oorschot, Wit, Rupert, Veldman, Keijzers, Konsten, Den, Boer, Corver, Boerma, E. G., Koolen, Martens, Van, Wijck, Ignjatovic, Breuer, Gurpreet, Oresland, Tetens, Moe, Nesbakken, Flaaten, Backe, Wik, T. -A., Radiya, Dehli, Gjessing, Norderval, Woll, Anwer, Qureshi, M. S., A. U., Billah, Jawad, M. Y., Raza, Urooj, Wang, Jajtner, Gasinski, Kabiesz, Walega, Romaniszyn, Zawadzki, Czarnecki, Obuszko, Rzaca, Sitarska, Silva, Duarte, Gonçalves, Morais, Rama, Nobre, Sales, Costa, Pereira, Costa, Insua, Romero, Figueiredo, Cunha, Domingos, Vieira, Americano, Amorim, Rachadell, Carvas, J. M., Armas, Fernandes, Pires, Reis, Martins, Dos, Santos, Henriques, Oliveira, Miranda, Vilela, Corte, Real, Carlos, Frois, Borges, Moniz, Pereira, Simões, Silva-vaz, Bettencourt, Gouveia, Perez, Rainho, Bintintan, Ciuce, Dindelegan, Scurtu, Seicean, Cristian, Burcos, Grama, Mandi, D. M., Richiteanu, Miron, Calu, Enciu, Nadragea, Parvuletu, Mogoanta, S. S., Crafciuc, Paitici, Beuran, Ciubotaru, Prodan, Vartic, Tomulescu, Copaescu, Yanishev, Abelevich, Kokobelyan, Lebedeva, Luzan, Pozdnyakov, Cherdancev, Mahotin, Nesytykh, Samsonyuk, Pravosudov, Ivlev, Karachun, Lebedev, Samsonov, Aiupov, Feoktistov, Garipov, Suleymanov, Tarasov, Rasulov, Dzhumabaev, Mamedli, Bedzhanyan, Popov, Sednev, Klimenko, Semenov, Vasilyev, Khazov, Khanevich, Khrykov, Katorkin, Andreev, Chernov, Davidova, Zhuravlev, Achkasov, Shakhmatov, Shelygin, Sushkov, Vardanyan, Ilkanich, Barbashinov, Darvin, Onishchenko, Voronin, Krivokapić, Barišić, Dimitrijević, Marković, Sekulić, Stanojevic, Brankovic, Nestorovic, Pecic, Petrovic, Kostic, Aleksic, Maric, Perunicic, Radovanovic, Djuric, Lukic, Cuk, Juloski, Kenic, Krdzic, Ngu, Y. Y., Teo, Korcek, Lazorisak, Rems, Ramovš, Trampuš, Tomazic, Grosek, Kosir, Norcic, Vigorita, Caceres, Casal, Ruano, Trostchansky, Golda, Galvez, Saldaña, Kreisler, Moreno, Lopez, Dominguez, Vila, Tura, Labarga, Galvez, Maderuelo, Suero, Bargallo, Cayetano, Lamas, M. C., Bernal-Sprekelsen, Gómez, Jareño, Ríos, Vercher, García-González, J. -M., Cervera-Aldama, Ramos-Prada, Santamaría-Olabarrieta, Borda, Enrriquez-Navascués, Saralegui, Calero-Lillo, Aznar-Puig, López-Lara, Muñoz-Collado, Valverde-Sintas, Menendez, Leon, Truan, Baldonedo, Fernández-Martínez, Otero, Solar-García, Turrado-Rodriguez, de Lacy Oliver, Lacy, Fortuny, Martin, Perez, Otero, Piñeiro, Paredes, Fernandez, Ladra, M. J., Paulos, Prieto, Beltrán de Heredia, J. P., Blanco, Antona, de Andrés Asenjo, Ferreras, García, Romero de Diego, Cordoba Diaz de Laspra, Echazarreta, Gallego, Elia, Guedea, Escola, Martinez, Primo, Romaguera, Parreño, Pastor, Rosell, Lozoya, Trujillo, Alós, Company, Ruiz, Carmona, Solana, Bueno, Salvans, Ruiz, Alonso, Gonçalves, Jiménez-Toscano, Pascual, Damieta, Pera, Roman, Pellicer-Franco, E. M., Garcia-Marin, J. A., Mengual-Ballester, Soria-Aledo, Valero-Navarro, Vicente-Ruiz, Garcia-Zamora, Gonzalez-Gil, Montoya-Tabares, Paredes-Quiles, Die, Trill, Abadia, Moreno, Pina, J. D., Ramos, Rubio, Escartin, Blas, J. L., Fernando, Ferrer, Garcia, Egea, Pros, Rius, Socías, Sabia, Castellvi, Valls, Gonzalez, Santin, Mompart, Garcia, Viso, Pons, Julià, Codina-Cazador, Farrés, Planellas, Cuadrado, Camps, Rufas, Escoll, Fermiñán, Muriel, Sierra, Alvarez-Laso, Lora, Padin, Garcia-Septiem, Bustamante, Jimenez, Jimenez-Miramon, Ramos, Gallardo, A. 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Y., Raza, A., Urooj, N., Wang, X., Li, L., Jajtner, D., Gasinski, B., Kabiesz, W., Walega, P., Romaniszyn, M., Zawadzki, M., Czarnecki, R., Obuszko, Z., Rzaca, M., Sitarska, M., Silva, P., Duarte, A., Gonçalves, D., Morais, M., Rama, N., Nobre, J., Sales, I., Costa Pereira, J., Costa, S., Costa Pereira, C., Insua, C., Romero, I., Figueiredo, N., Cunha, J., Domingos, H., Vieira, P., Cunha, M., Americano, M., Amorim, E., Rachadell, J., Carvas, J. M., Armas, I., Fernandes, P., Pires, C., Reis, R., Martins, R., Dos Santos, M., Henriques, P., Oliveira, O., Duarte, M., Ferreira, L., Miranda, J., Vilela, N., Corte Real, J., Carlos, S., Frois Borges, M., Moniz Pereira, P., Simões, J., Silva-vaz, P., Bettencourt, V., Gouveia, A., Perez, H., Rainho, R., Bintintan, V., Ciuce, C., Dindelegan, G., Scurtu, R., Seicean, R., Cristian, D., Burcos, T., Grama, F., Mandi, D. M., Richiteanu, G., Miron, A., Calu, V., Enciu, O., Nadragea, M., Parvuletu, R., Mogoanta, S. S., Crafciuc, A., Paitici, S., Negoi, I., Beuran, M., Ciubotaru, C., Prodan, A., Vartic, M., Tomulescu, V., Copaescu, C., Yanishev, A., Abelevich, A., Kokobelyan, A., Lebedeva, M., Luzan, R., Pozdnyakov, A., Cherdancev, D., Mahotin, D., Nesytykh, A., Samsonyuk, V., Pravosudov, I., Ivlev, D., Karachun, A., Lebedev, K., Samsonov, D., Aiupov, R., Feoktistov, D., Garipov, M., Suleymanov, N., Tarasov, N., Rasulov, A., Dzhumabaev, H., Mamedli, Z., Bedzhanyan, A., Popov, D., Sednev, A., Klimenko, A., Semenov, A., Vasilyev, S., Khazov, A., Khanevich, M., Khrykov, G., Katorkin, S., Andreev, P., Chernov, A., Davidova, O., Zhuravlev, A., Achkasov, S., Shakhmatov, D., Shelygin, Y., Sushkov, O., Vardanyan, A., Ilkanich, A., Barbashinov, N., Darvin, V., Onishchenko, S., Voronin, Y., Krivokapić, Z., Barišić, G., Dimitrijević, I., Marković, V., Sekulić, A., Stanojevic, G., Brankovic, B., Nestorovic, M., Pecic, V., Petrovic, D., Kostic, I., Aleksic, A., Dabic, D., Maric, B., Perunicic, V., Radovanovic, Z., Djuric, M., Lukic, D., Radovanovic, D., Cuk, V., Juloski, J., Kenic, M., Krdzic, I., Ngu, J. C., Ng, Y. Y., Teo, N., Korcek, J., Lazorisak, A., Rems, M., Ramovš Trampuš, Å , Tomazic, A., Grosek, J., Kosir, J., Norcic, G., Vigorita, V., Caceres, N., Casal, E., Ruano, A., Trostchansky, I., Golda, T., Galvez Saldaña, A., Kreisler Moreno, E., Lopez Dominguez, J., Vila Tura, M., Labarga, F., Galvez, P., Maderuelo, V., Suero, C., Bargallo, J., Cayetano, L., Lamas, S., Silva, M. C., Bernal-Sprekelsen, J. C., Gómez, R., Jareño, S., Ríos, A., Vercher, D., García-González, J. -M., Cervera-Aldama, J., Ramos-Prada, J., Santamaría-Olabarrieta, M., Borda, N., Enrriquez-Navascués, J. M., Saralegui, Y., Calero-Lillo, A., Aznar-Puig, S., López-Lara, M. A., Muñoz-Collado, S., Valverde-Sintas, J., Menendez, P., Leon, C., Truan, N., Baldonedo, R., Fernández-Martínez, D., Otero, J., Solar-García, L., Turrado-Rodriguez, V., de Lacy Oliver, F., Lacy Fortuny, A. M., Martin Perez, B., Otero Piñeiro, A. M., Paredes, J., Fernandez, F., Ladra, M. J., Paulos, A., Prieto, D., Beltrán de Heredia, J. P., Blanco Antona, F., de Andrés Asenjo, B., Ferreras García, C., Romero de Diego, A., Cordoba Diaz de Laspra, E., Echazarreta Gallego, E., Elia Guedea, M., Escola, D., Martinez, S., Primo Romaguera, V., Parreño, R., Pastor, L., Rosell, E., Lozoya Trujillo, R., Alós Company, R., Ruiz Carmona, M. D., Solana Bueno, A., Salvans Ruiz, S., Alonso Gonçalves, S., Jiménez-Toscano, M., Pascual Damieta, M., Pera Roman, M., Pellicer-Franco, E. M., Garcia-Marin, J. A., Mengual-Ballester, M., Soria-Aledo, V., Valero-Navarro, G., Vicente-Ruiz, M., Garcia-Zamora, C., Gonzalez-Gil, A., Montoya-Tabares, M. J., Paredes-Quiles, M., Die Trill, J., Abadia, P., Moreno, I., Pina, J. D., Ramos Rubio, D., Escartin, J., Blas, J. L., Fernando, J., Ferrer, R., Garcia Egea, J., Pros, I., Martinez, W., Rius, J., Socías, M., Sabia, D., Castellvi Valls, J., Gonzalez Santin, V., Mompart Garcia, S., Viso Pons, L., Julià, D., Codina-Cazador, A., Farrés, R., Gómez, N., Planellas, P., Cuadrado, M., Camps, I., Rufas, M., Escoll, J., Fermiñán, A., Muriel, P., Sierra, E., Alvarez-Laso, C., Lora, P., Padin, H., Garcia-Septiem, J., Bustamante, C., Jimenez, V., Jimenez-Miramon, J., Ramos, J. L., Gallardo, A. B., Benito, P., Colao, L., Galindo, P., Garcia, C., Forero-Torres, A., Alonso Poza, A., Dieguez Fernandez, B., Gilsanz Martin, C., Hernandez Garcia, M., Rojo López, J. A., Gil López, J. M., González Zunzárren, M., Martínez Alegre, J., Zorrilla Matilla, L. P., Navarro-Sánchez, A., Alcalá Serrano, F. J., López-Fernández, J., Montesdeoca Cabrera, D., Alvarez-Gallego, M., Guevara, J., Pascual Miguelañez, I., Rubio-Perez, I., Gomez Ruiz, M., Alonso Martín, J., Cagigas Fernández, C., Castillo Diego, J., Pando, J. A., Maristany, C., Muñoz-Duyos, A., Rada-Palomino, A., Vargas-Pierola, H., Peña Ros, E., Benavides Buleje, J. A., Muñoz Camarena, J. M., Parra Baños, P. A., Ramirez Faraco, M., Arenal, J. J., Citores, M. A., Marcos, J. L., Sánchez, J., Tinoco, C., García Flórez, L. J., Arias Pacheco, R. D., Mínguez Ruiz, G., Gutiérrez Corral, N., Rodríguez Infante, A., Carrillo López, M. J., Carrasco Prats, M. M., Lage Laredo, A., Martínez Manzano, Ã ., Rodríguez García, P., Segura-Sampedro, J. J., Alonso-Hernández, N., Fernandez Isart, M., Gamundi Cuesta, M., Ochogavia Segui, A., Ibañez, N., Abrisqueta, J., Lujan, J., Gómez Pérez, R., Corrales Valero, E., Monje Salazar, C., Sanchiz Cardenas, E., Soler Humanes, R., Jimenez-Rodriguez, R. M., De la Portilla, F., Diaz Pavon, J. M., Garcia Cabrera, A. M., Reyes Diaz, M. L., Espin, E., Marinello, F., Martí, M., Sanchez, J. L., Vallribera, F., Orts Mico, F. J., Ortin Navarro, M., Perez Climent, M., Serra Diaz, C., Millan, M., Caro, A., Escuder, J., Espina, B., Feliu, F., Climent Aira, A., Estévez Diz, A., Moreno Asencio, M. T., Varela Mato, A., Vázquez Bouzán, R., Minaya-Bravo, A. M., Diez-Alonso, M. M., Villeta-Plaza, R., Guadalajara, H., Alías, D., García Olmo, D., Pastor, C., Valverde, I., Sanchez Romero, A., Gardea, A., Gil Santos, M., Nimmersgern, T., Serrano Paz, P., Romero-Simó, M., Blasco-Segura, T., Caravaca-García, I., Costa-Navarro, D., Zarco-Pleguezuelos, A., Sánchez-Guillén, L., Flor-Lorente, B., Frasson, M., García-Granero, Ã ., García-Granero, E., Arencibia, B., Alonso, J., Febles, G., Nogués, E. M., Roque, C., Segelman, J., Nygren, J., Nestler, G., Abraham-Nordling, M., Egenvall, M., Myrelid, P., Jung, B., Loftås, P., Lydrup, M. -L., Azahr, N., Buchwald, P., Mangell, P., Syk, I., Nikberg, M., Carlander, J., Chabok, A., Smedh, K., Tiselius, C., Haapaniemi, S., Benckert, A., Adamina, M., Freil-Lanter, C., Gingert, C., Müller, P., Schäfli, J., Regusci, L., Brenna, M., Fasolini, F., Misteli, H., Kirchhoff, P., Oertli, D., Hahnloser, D., Clerc, D., Hübner, M., Ris, F., Buchs, N. C., Chevallay, M., Morel, P., Schiltz, B., Wang, J. Y., Su, W. -C., Huang, C. -W., Ma, C. -J., Tsai, H. -L., Bugra, D., Agalar, F., Baloglu, H., Basoglu, I., Okkabaz, N., Binboga, E., Biricik, A., Celik, A., Yavuz, E., Canda, A. E., Agalar, C., Fuzun, M., Sokmen, S., Terzi, C., Isik, A., Karip, B., Bilgili, A. C., Leventoğlu, S., Aytac, B., Küçükdiler, E., Yıldız, A., Yuksel, O., Sinan, H., Hancerliogullari, O., Kaymak, S., Kozak, O., Ozer, M. T., Sarici, I. S., Akca, O., Kalayci, M. U., Kara, Y., Agcaoglu, O., Balik, E., Bayram, O., Özbalcı, G. S., Özkan, B. B., Karabacak, U., Sungurtekin, U., Ozgen, U., Demirbas, S., Öztürk, E., Isik, O., Yilmazlar, T., Colak, E., Karagul, S., Kinas, V., Fearnhead, N., Lord, I., Stewart, P., Zammit, M., Arnold, S., Battersby, N. J., Broadhurst, J., Moran, S., Seretis, F., Shabbir, J., Jones, C., Kynaston, J., Vimalachandran, D., Blower, E., Mcfaul, C., Mcwhirter, D., Pilkington, J., Wilson, T., Chowdhary, M., Stubbs, B., Abdalkoddus, M., Lai, C., Thavanesan, N., Yao, C., Agarwal, T., Dindyal, S., Hill, R. M. C., Reade, S., Slesser, A., Paterson, H., Balfour, A., Boland, M., Geraghty, A., O'Kelly, J., Patel, P., Tezas, S., Yahia, S., Jadhav, V., Marimuthu, K., Narayanan, A., Piramanayagam, B., Bradley, N., Buchanan, F., Paul, K., Singh, J., Thomson, K., Korsgen, S., Bedford, M., Lee, K., Leong, K., Mcarthur, D., Bhangu, A., Malik, S., Mohamed, I., Cunha, P., Pilavas, A., Reddy, A., Ahmed, S., Ahmed, A., Voll, J., Velchuru, V., Lal, R., Mirshekar-Syahkal, B., Kassai, M., Aleem, M., Keogh-Bootland, S., Sarmah, P., Brown, S., Keegan, R., Kelkar, A., Sen, P., Oliveira-Cunha, M., Chaudhri, S., Fares, R., Singh, B., Thomas, W. M., Aslam, M. I., Boyle, K., Hemingway, D., Miller, A., Norwood, M., Gurjar, S., Al-Saeedi, M., Anandan, L., Sudlow, A., Zampitis, N., Malik, K., Bogdan, M., Smart, C., Iqbal, M. R., Bailey, S., Lawes, D., Omar, G., Tamhane, R., Evans, M., Ather, S., Lim, J., Nageswaran, H., Taylor, G., Hunt, L., Nicholls, J., Shaikh, I., Muscara, F., O'Brien, J., Photi, E., Stearns, A., Meylemans, D., Cunningham, C., Hompes, R., Tennakoon, A., Kumarasinghe, N., Rao, M., Upanishad, I., Khan, J., Ahmad, N., Shweejawee, Z., Stefan, S., Smart, N., Daniels, I., Gregoir, T., Longstaff, L., Mcdermott, F., Varcada, M., Drami, I., Gala, T., Moggia, E., Ratnatunga, K., Harries, R., Hayes, J., Williams, G., Raymond, T., Bronder, C., Davies, E., Hawkin, P., Ryska, O., Ayral, K., Beveridge, A., Bhowmik, A., Gill, M., Simpson, R., Schofield, A., Mcardle, K., Parmar, M., Williamson, M., Burton, H., Courtney, E., Grant, C., Saracino, A., Newton, K., Epstein, J., Branagan, G., Bignell, M., Symankewicz, M., Zaman, S., Mankotia, R., Siddiqui, Z., Torrance, A., Artioukh, D., Eggleston, M., Gokul, K., Selwyn, D., Warusavitarne, J., Chandrasinghe, P., Grainger, J., Leo, C. A., Vaizey, C. J., Harris, G., Levy, B., Skull, A., Thaha, M., Garg, A., Patel, H., Ramsanahie, A., Mondragon-Pritchard, M., Cuinas Leon, K., Shukla, A., Brewer, H., Fitzgerald, J., Kho, H., Torkington, J., Tate, S., Wheat, J., Smolarek, S., Platt, E., Rossi, B., Tham, J. C., Knight, J., Richardson, J., Tzivanakis, A., Gregori, M., Ashraf, M. A., Atif, M., Santos, J., Saffaf, N., Canning, L., Chandratreya, N., Bowen, M., Graham, B., Hamad, Y., Kaubrys, M., Chaudhry, Z. U., Bhan, C., Mukhtar, H., Oshowo, A., Wilson, J., Gouvas, N., Nicol, D., Pandey, S., Zilvetti, M., Sharma, A., Fatayer, T., Mothe, S., Rahman, M., Curtis, N., Allison, A., Dalton, R., Francis, N., Ockrim, J., Psaras, G., Dudarovaska, H., Marharint, T., Mostovoy, E., Voloshin, S., Kolesnik, O., Makhmudov, D., Altinel, Y., Iqbal, A., Cunningham, L., Go, K., and Tan, S.
- Subjects
Laparoscopic surgery ,Male ,Leak ,medicine.medical_specialty ,Cathartics/administration & dosage ,medicine.drug_class ,medicine.medical_treatment ,Antibiotics ,anastomotic leak ,bowel preparation ,colonic cancer ,Colorectal surgery ,laparoscopic surgery ,Gastroenterology ,030230 surgery ,Anastomosis ,Preoperative Care/methods ,NO ,03 medical and health sciences ,0302 clinical medicine ,Anti-Bacterial Agents/administration & dosage ,Preoperative Care ,Medicine ,Humans ,risk factors ,Prospective Studies ,Multi centre ,Prospective cohort study ,Colectomy ,Aged ,ta3126 ,Medical Audit ,business.industry ,Cathartics ,digestive, oral, and skin physiology ,Middle Aged ,digestive system diseases ,Surgery ,Anti-Bacterial Agents ,030220 oncology & carcinogenesis ,Bowel preparation ,Drug Therapy, Combination ,Female ,Colectomy/adverse effects ,business ,Anastomotic Leak/etiology - Abstract
INTRODUCTION: The optimal bowel preparation strategy to minimise the risk of anastomotic leak is yet to be determined. This study aimed to determine whether oral antibiotics combined with mechanical bowel preparation (MBP+Abx) was associated with a reduced risk of anastomotic leak when compared to mechanical bowel preparation alone (MBP) or no bowel preparation (NBP).METHODS: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 Left Sided Colorectal Resection audit was performed. Patients undergoing elective left sided colonic or rectal resection with primary anastomosis between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak.RESULTS: Of 3676 patients across 343 centres in 47 countries, 618 (16.8%) received MBP+ABx, 1945 MBP (52.9%) and 1099 patients NBP (29.9%). Patients undergoing MBP+ABx had the lowest overall rate of anastomotic leak (6.1%, 9.2%, 8.7% respectively) in unadjusted analysis. After case-mix adjustment using a mixed-effects multivariable regression model, MBP+Abx was associated with a lower risk of anastomotic leak (OR 0.52, 0.30-0.92, P = 0.02) but MBP was not (OR 0.92, 0.63-1.36, P = 0.69) compared to NBP.CONCLUSION: This non-randomised study adds 'real-world', contemporaneous, and prospective evidence of the beneficial effects of combined mechanical bowel preparation and oral antibiotics in the prevention of anastomotic leak following left sided colorectal resection across diverse settings. We have also demonstrated limited uptake of this strategy in current international colorectal practice.
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- 2018
27. Application of three-dimensional printing in laparoscopic dissection to facilitate D3-lymphadenectomy for right colon cancer
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E. García-Granero, Matteo Frasson, J Sancho Muriel, Delfina Fletcher-Sanfeliu, Gianluca Pellino, M J Roca Estelles, Luis Sánchez-Guillén, E Alvarez Serrado, P Esclapez Valero, Blas Flor-Lorente, Álvaro García-Granero, I Grifo Albalat, Francisco Giner, Garcia-Granero, A., Sánchez-Guillén, L., Fletcher-Sanfeliu, D., Flor-Lorente, B., Frasson, M., Sancho Muriel, J., Alvarez Serrado, E., Pellino, G., Grifo Albalat, I., Giner, F., Roca Estelles, M. J., Esclapez Valero, P., and Garcia-Granero, E.
- Subjects
Male ,medicine.medical_specialty ,Colorectal cancer ,MEDLINE ,Dissection (medical) ,03 medical and health sciences ,0302 clinical medicine ,medicine ,D3 lymphadenectomy ,Humans ,Colonic Neoplasm ,business.industry ,General surgery ,Dissection ,Gastroenterology ,medicine.disease ,Colorectal surgery ,030220 oncology & carcinogenesis ,Three dimensional printing ,Colonic Neoplasms ,Printing, Three-Dimensional ,Lymph Node Excision ,030211 gastroenterology & hepatology ,Laparoscopy ,Surgery ,business ,Abdominal surgery ,Human - Published
- 2018
28. Standardization of the definition of the types of oncological colectomy. Delphi method for consensus of experts of the Spanish Association of Surgeons.
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Garcia-Granero A, Martín-Martín GP, Dujovne-Lindenbaum P, Alvarez Laso CJ, Cerdán-Santacruz C, Flor-Lorente B, and Biondo S
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- Humans, Spain, Consensus, Lymph Node Excision methods, Lymph Node Excision standards, Societies, Medical, Colectomy methods, Colectomy standards, Delphi Technique, Colonic Neoplasms surgery, Colonic Neoplasms pathology
- Abstract
There is no international consensus on the definition of the type of oncological resection that corresponds to each of the colectomies existing in the current literature. The objective is to define for each colectomy described in the literature: embryological dissection plane, vascular pedicles in which to perform central ligation, the extent of the colectomy, and the need for resection of the greater momentum. A consensus of experts is carried out through the Delphi methodology through two rounds from the Coloproctology Section of the Spanish Association of Surgeons. Study period: November 2021-January 2023. 120 experts were surveyed. Degrees of consensus: Very strong: >90%, Strong: 80%-90%, Moderate: 50%-80%, No consensus: <50%. The definition for each oncological colectomy was established by very strong, and strong recommendations. Each oncological colectomy was established as Right hemicolectomy (RHC), RHC with D3 lymphadenectomy, Extended-RHC, transverse colon segmental colectomy, splenic flexure segmental colectomy, subtotal colectomy, total colectomy, left hemicolectomy (LHC), extended-LHC, sigmoidectomy., (Copyright © 2024 AEC. Published by Elsevier España, S.L.U. All rights reserved.)
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- 2024
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29. Local Excision for organ preservation in early REctal cancer with No Adjuvant treatment (LORENA Trial): prospective observational study protocol.
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Tovar Pérez R, Cerdán Santacruz C, Cano-Valderrama Ó, Jiménez Escovar F, Flor Lorente B, Perez RO, and García Septiem J
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- Humans, Prospective Studies, Organ Sparing Treatments methods, Neoplasm Staging, Digestive System Surgical Procedures methods, Margins of Excision, Rectal Neoplasms surgery, Rectal Neoplasms pathology, Rectal Neoplasms therapy
- Abstract
Introduction: Local resection (LR) is an alternative to total mesorectal excision (TME) that avoids its associated morbidity to the detriment of oncological radicality in early stages of rectal cancer. There are several conditioning factors for the success of this strategy, such as poor prognosis histological factors (PPHF), involvement of resection margins, clinical under staging, or complications that may lead to the indication for radical surgery with TME., Patients and Method: An international multicenter prospective observational open-label study has been designed. Consecutive patients diagnosed with early rectal cancer (cT1N0 on MRI +/- endorectal ultrasound) whose lower limit is a maximum of 2 cm proximal to the ano-rectal junction will be included. The primary objective of the study is to determine the overall prevalence of PPHF after LR and requiring TME or postoperative radio-chemotherapy., Discussion: The prevalence of PPHF conditioning the success of LR in early distal rectal cancer has been scarcely studied in the literature, and there are very few prospective data. Considering the increasing interest in the watch and wait strategy in rectal cancer and its possible application in early-stage tumors, it seems necessary to know this information. The results of this study will help guide clinical practice in patients with early distal rectal cancer. It will also provide quality information for the design of future comparative studies to improve organ preservation success in these patients., Trial Registration Number: NCT05927584., (Copyright © 2024 AEC. Published by Elsevier España, S.L.U. All rights reserved.)
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- 2024
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30. A comparison of whole-mount and conventional sections for pathological mesorectal extension and circumferential resection margin assessment after total mesorectal excision.
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Giner F, Frasson M, Cholewa H, Sancho-Muriel J, García-Gómez E, Hernández JA, Flor-Lorente B, and García-Granero E
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- Humans, Prospective Studies, Male, Female, Aged, Middle Aged, Proctectomy methods, Rectum pathology, Rectum surgery, Aged, 80 and over, Rectal Neoplasms surgery, Rectal Neoplasms pathology, Margins of Excision, Neoplasm Invasiveness
- Abstract
Introduction: The objective of the study is to compare 2 techniques for histological handling of rectal cancer specimens, namely whole-mount in a large block vs conventional sampling using small blocks, for mesorectal pathological assessment of circumferential resection margin status and depth of tumor invasion into the mesorectal fat., Methods: This is a prospective study including 27 total mesorectal excision specimens of rectal cancer from patients treated for primary rectal carcinoma between 2020 and 2022 in a specialized multidisciplinary Colorectal Unit. For each total mesorectal excision specimen, 2 contiguous representative tumoral slices were selected and comparatively analyzed with whole-mount and small blocks macroscopic dissection techniques, enabling comparison between them in the same surgical specimen. The agreement between the 2 techniques to assess the distance of the tumor from the circumferential resection margin as well as the depth of tumor invasion was evaluated with the Student's t-test for paired samples, Pearson's correlation coefficient, and the Bland-Altman method comparison analysis., Results: Complete mesorectal excision was observed in 8% of cases. Circumferential resection margin involvement was observed in only one case (4 %). The whole-mount and small block techniques obtained similar results when we assessed the distance to the circumferential resection margin (t-test P = 0.8, r = 0.92) and the depth of mesorectal infiltration (t-test P = 0.6, r = 0.95)., Conclusions: Both gross dissection techniques (whole-mount vs multiple small cassettes) are equivalent and reliable to assess the distance to circumferential resection margin and the depth of mesorectal infiltration in the mesorectal fat in rectal cancer staging., (Copyright © 2024 The Authors. Published by Elsevier España, S.L.U. All rights reserved.)
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- 2024
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31. Total pelvic exenteration extended to pelvic bones with subsequent VRAM flap reconstruction in patient with recurrent anal squamous cell carcinoma following chemoradiotherapy.
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Sancho-Muriel J, Guerrero-Antolino P, Cholewa H, and Flor Lorente B
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- Humans, Male, Middle Aged, Pelvic Exenteration, Anus Neoplasms therapy, Anus Neoplasms surgery, Carcinoma, Squamous Cell therapy, Carcinoma, Squamous Cell surgery, Neoplasm Recurrence, Local surgery, Chemoradiotherapy methods, Pelvic Bones surgery, Plastic Surgery Procedures methods, Surgical Flaps
- Abstract
Anal squamous cell carcinoma, typically associated with human papillomavirus infection, remains a rare malignancy. This article outlines a case of local recurrence in a male patient with a history of HIV and hepatitis C virus infection, previously treated with chemoradiotherapy. Extensive tumour involvement called for total pelvic exenteration extended to anterior osteomuscular compartment and genitalia. The surgical approach involved multidisciplinary collaboration and detailed preoperative planning using three-dimensional reconstruction. Key surgical considerations comprised the following: achieving tumour-free margins (R0 resection), extensive osteotomies and intricate pelvic floor reconstruction with prosthetic mesh and flap reconstruction. The procedure successfully yielded an R0 resection, maintaining adequate lower limb functionality. Our case report underscores the benefits of pelvic exenteration in locally advanced or recurrent pelvic tumours, invariably following careful patient selection and exhaustive preoperative studies., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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32. Perianal extramammary Paget disease: our experience of two cases - a video vignette.
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Filotico M, Sancho-Muriel J, Cholewa H, Frasson M, Castro RA, and Flor-Lorente B
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- Humans, Anus Neoplasms pathology, Anus Neoplasms surgery, Paget Disease, Extramammary surgery, Paget Disease, Extramammary pathology
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- 2024
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33. Double-Barreled Wet Colostomy After Pelvic Exenteration.
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Cholewa H, Sancho-Muriel J, and Flor-Lorente B
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- Humans, Colostomy, Pelvic Exenteration, Urinary Diversion
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- 2024
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34. Diagnostic Accuracy of Abdominal CT for Locally Advanced Colon Tumors: Can We Really Entrust Certain Decisions to the Reliability of CT?
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García Del Álamo Hernández Y, Cano-Valderrama Ó, Cerdán-Santacruz C, Pereira Pérez F, Aldrey Cao I, Núñez Fernández S, Álvarez Sarrado E, Obregón Reina R, Dujovne Lindenbaum P, Taboada Ameneiro M, Ambrona Zafra D, Pérez Farré S, Pascual Damieta M, Frago Montanuy R, Flor Lorente B, Biondo S, and Collaborative Group For The Study Of Metachronous Peritoneal Metastases Of pT Colon Cancer
- Abstract
Many different options of neoadjuvant treatments for advanced colon cancer are emerging. An accurate preoperative staging is crucial to select the most appropriate treatment option. A retrospective study was carried out on a national series of operated patients with T4 tumors. Considering the anatomo-pathological analysis of the surgical specimen as the gold standard, a diagnostic accuracy study was carried out on the variables T and N staging and the presence of peritoneal metastases (M1c). The parameters calculated were sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios, as well as the overall accuracy. A total of 50 centers participated in the study in which 1950 patients were analyzed. The sensitivity of CT for correct staging of T4 colon tumors was 57%. Regarding N staging, the overall accuracy was 63%, with a sensitivity of 64% and a specificity of 62%; however, the positive and negative likelihood ratios were 1.7 and 0.58, respectively. For the diagnosis of peritoneal metastases, the accuracy was 94.8%, with a sensitivity of 40% and specificity of 98%; in the case of peritoneal metastases, the positive and negative likelihood ratios were 24.4 and 0.61, respectively. The diagnostic accuracy of CT in the setting of advanced colon cancer still has some shortcomings for accurate diagnosis of stage T4, correct classification of lymph nodes, and preoperative detection of peritoneal metastases.
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- 2023
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35. "Long-term oncologic outcomes and risk factors for distant recurrence after pathologic complete response following neoadjuvant treatment for locally advanced rectal cancer. A nationwide, multicentre study".
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Cerdán-Santacruz C, Cano-Valderrama Ó, Santos Rancaño R, Terés LB, Vigorita V, Pérez TP, Rosciano Paganelli JG, Paredes Cotoré JP, Carre MK, Flor-Lorente B, Antona FB, Martín EY, Tebar JC, Cao IA, Coltell ZB, Alonso MG, Paredes Cotoré JP, Prada López BL, Riesco AB, Cánovas NI, Sánchez CM, Serrat DR, Conde GA, Toscano MJ, Aira AC, Pérez MR, Petit NM, Espín Basany E, Carré MK, Pellino G, Retuerta JM, Saldaña AG, Laso CÁ, Allende IA, Álvarez DH, Cazador AC, Sánchez Bautista WM, Torres Sánchez MT, Bonito AC, Velázquez MC, Díaz OM, Fuentes NS, Olías MDCV, Pérez TP, Rosciano Paganelli JG, Lorente BF, Valderrama ÓC, Santos Rancaño R, Terés LB, and Santacruz CC
- Abstract
Background: Pathologic complete response (pCR) after multimodal treatment for locally advanced rectal cancer (LARC) is used as surrogate marker of success as it is assumed to correlate with improved oncologic outcome. However, long-term oncologic data are scarce., Methods: This retrospective, multicentre study updated the oncologic follow-up of prospectively collected data from the Spanish Rectal Cancer Project database. pCR was described as no evidence of tumour cells in the specimen. Endpoints were distant metastases-free survival (DMFS) and overall survival (OS). Multivariate regression analyses were run to identify factors associated with survival., Results: Overall, 32 different hospitals were involved, providing data on 815 patients with pCR. At a median follow-up of 73.4 (IQR 57.7-99.5) months, distant metastases occurred in 6.4% of patients. Abdominoperineal excision (APE) (HR 2.2, 95%CI 1.2-4.1, p = 0.008) and elevated CEA levels (HR = 1.9, 95% CI 1.0-3.7, p = 0.049) were independent risk factors for distant recurrence. Age (years) (HR 1.1; 95%-CI 1.05-41.09; p < 0.001) and ASA III-IV (HR = 2.0; 95%-CI 1.4-2.9; p < 0.001), were the only factors associated with OS. The estimated 12, 36 and 60-months DMFS rates were 96.9%, 91.3%, and 86.8%. The estimated 12, 36 and 60-months OS rates were 99.1%, 94.9% and 89.3%., Conclusions: The incidence of metachronous distant metastases is low after pCR, with high rates of both DMFS and OS. The oncologic prognosis in LARC patients that achieve pCR after neoadjuvant chemo-radiotherapy is excellent in the long term., Competing Interests: Declaration of competing interest The authors of the article do not have any commercial association that might pose a conflict of interest in relation to this article., (Copyright © 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
- Published
- 2023
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36. The percentage of mesorectal infiltration as a prognostic factor after curative surgery for pT3 rectal cancer.
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Sancho-Muriel J, Giner F, Cholewa H, Garcia-Granero Á, Roselló S, Flor-Lorente B, Cervantes A, Garcia-Granero E, and Frasson M
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- Humans, Prognosis, Margins of Excision, Neoplasm Recurrence, Local pathology, Rectum surgery, Rectal Neoplasms pathology
- Abstract
Aim: The aim of this study is to evaluate the prognostic value of a novel variable - the percentage of mesorectal infiltration (PMI) - in pT3 rectal cancer., Method: A cohort of 241 patients with pT3 rectal adenocarcinoma, operated on between February 2002 and May 2019, was selected for the analysis. Data concerning patient, treatment and tumour characteristics were collected. The depth of mesorectal infiltration (DMI) and the distance between the deepest invasion and the circumferential resection margin (CRM) were measured. The PMI was calculated using a formula combining these parameters., Results: Neoadjuvant therapy was administered in 33.2% of cases. A complete mesorectal excision was achieved in 74% of patients. The CRM was affected in 24 patients (9.9%). The 5-year actuarial local recurrence (LR), overall recurrence (OR) and overall survival (OS) rates were 7.5%, 22.9% and 72.4%, respectively. The PMI was significantly associated with worse oncological outcomes regarding LR (p = 0.009), OR (p = 0.001) and OS (p = 0.016) rates. A cut-off value of PMI >60% had the highest specificity (80%) for LR (p = 0.026), OR (p = 0.04) and OS (p = 0.07)., Conclusion: The PMI has an adverse prognostic impact on the oncological results following surgery for pT3 rectal cancer. It allows prediction of the risk of both LR and distant recurrence with higher accuracy than the DMI or the distance to the CRM. A PMI >60% may be used as a cut off value while subclassifying pT3 rectal tumours. It may influence decision-making while establishing adjuvant treatment and the follow-up schedule., (© 2023 Association of Coloproctology of Great Britain and Ireland.)
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- 2023
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37. Fluorescence-guided lymphadenectomy in colon cancer. The tool called to adjust the radicality of surgery?
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Martín-Martín GP, Chand M, and Flor-Lorente B
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- Humans, Fluorescence, Lymph Nodes surgery, Lymph Node Excision, Colonic Neoplasms surgery
- Published
- 2023
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38. Protective ileostomy creation after anterior resection of the rectum: Shared decision-making or still subjective?
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Balla A, Saraceno F, Rullo M, Morales-Conde S, Targarona Soler EM, Di Saverio S, Guerrieri M, Lepiane P, Di Lorenzo N, Adamina M, Alarcón I, Arezzo A, Bollo Rodriguez J, Boni L, Biondo S, Carrano FM, Chand M, Jenkins JT, Davies J, Delgado Rivilla S, Delrio P, Elmore U, Espin-Basany E, Fichera A, Flor Lorente B, Francis N, Gómez Ruiz M, Hahnloser D, Licardie E, Martinez C, Ortenzi M, Panis Y, Pastor Idoate C, Paganini AM, Pera M, Perinotti R, Popowich DA, Rockall T, Rosati R, Sartori A, Scoglio D, Shalaby M, Simó Fernández V, Smart NJ, Spinelli A, Sylla P, Tanis PJ, Valdes-Hernandez J, Wexner SD, and Sileri P
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- Humans, Ileostomy adverse effects, Anastomotic Leak etiology, Anastomosis, Surgical adverse effects, Retrospective Studies, Rectum surgery, Rectum pathology, Rectal Neoplasms pathology
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Aim: The choice of whether to perform protective ileostomy (PI) after anterior resection (AR) is mainly guided by risk factors (RFs) responsible for the development of anastomotic leakage (AL). However, clear guidelines about PI creation are still lacking in the literature and this is often decided according to the surgeon's preferences, experiences or feelings. This qualitative study aims to investigate, by an open-ended question survey, the individual surgeon's decision-making process regarding PI creation after elective AR., Method: Fifty four colorectal surgeons took part in an electronic survey to answer the questions and describe what usually led their decision to perform PI. A content analysis was used to code the answers. To classify answers, five dichotomous categories (In favour/Against PI, Listed/Unlisted RFs, Typical/Atypical, Emotions/Non-emotions, Personal experience/No personal experience) have been developed., Results: Overall, 76% of surgeons were in favour of PI creation and 88% considered listed RFs in the question of whether to perform PI. Atypical answers were reported in 10% of cases. Emotions and personal experience influenced surgeons' decision-making process in 22% and 49% of cases, respectively. The most frequently considered RFs were the distance of the anastomosis from the anal verge (96%), neoadjuvant chemoradiotherapy (88%), a positive intraoperative leak test (65%), blood loss (37%) and immunosuppression therapy (35%)., Conclusion: The indications to perform PI following rectal cancer surgery lack standardization and evidence-based guidelines are required to inform practice. Until then, expert opinion can be helpful to assist the decision-making process in patients who have undergone AR for adenocarcinoma., (© 2022 Association of Coloproctology of Great Britain and Ireland.)
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- 2023
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39. The economic impact of anastomotic leak after colorectal cancer surgery.
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Flor-Lorente B, Noguera-Aguilar JF, Delgado-Rivilla S, García-González JM, Rodriguez-Martín M, Salinas-Ortega L, Casado MÁ, and Álvarez M
- Abstract
Objective: To determine the economic impact of the incremental consumption of resources for the diagnosis and treatment of anastomotic leak (AL) in patients after resection with anastomosis for colorectal cancer compared to patients without AL on the Spanish health system., Method: This study included a literature review with parameters validated by experts and the development of a cost analysis model to estimate the incremental resource consumption of patients with AL versus those without. The patients were divided into three groups: 1) colon cancer (CC) with resection, anastomosis and AL; 2) rectal cancer (RC) with resection, anastomosis without protective stoma and AL; and 3) RC with resection, anastomosis with protective stoma and AL., Results: The average total incremental cost per patient was €38,819 and €32,599 for CC and RC, respectively. The cost of AL diagnosis per patient was €1018 (CC) and €1030 (RC). The cost of AL treatment per patient in Group 1 ranged from €13,753 (type B) to €44,985 (type C + stoma), that in Group 2 ranged from €7348 (type A) to €44,398 (type C + stoma), and that in Group 3 ranged from €6197 (type A) to €34,414 (type C). Hospital stays represented the highest cost for all groups. In RC, protective stoma was found to minimize the economic consequences of AL., Conclusions: The appearance of AL generates a considerable increase in the consumption of health resources, mainly due to an increase in hospital stays. The more complex the AL, the higher the cost associated with its treatment. INTEREST OF THE STUDY: it is the first cost-analysis study of AL after CR surgery based on prospective, observational and multicenter studies, with a clear, accepted and uniform definition of AL and estimated over a period of 30 days., (© 2023. The Author(s).)
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- 2023
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40. Rectal cancer at the peritoneal reflection. Preoperative MRI accuracy and histophatologic correlation. Prospective study.
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Álvarez Sarrado E, Giner Segura F, Batista Domenech A, Garcia-Granero García-Fuster Á, Frasson M, Rudenko P, Flor Lorente B, and Garcia-Granero Ximénez E
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- Fascia, Humans, Magnetic Resonance Imaging methods, Peritoneum diagnostic imaging, Prospective Studies, Rectal Neoplasms diagnostic imaging, Rectal Neoplasms pathology, Rectal Neoplasms surgery
- Abstract
Introduction: To investigate magnetic resonance imaging (MRI) accuracy for determining the location of rectal tumors with respect to the peritoneal reflection (PR) and its potential involvement., Methods: Prospective study of 161 patients ongoing surgery for rectal cancer. A double-ink method has been aplied to examine surgical specimen, orange ink for the serosal surface and indian ink for the mesorrectal margin, and assess preoperative MRI accuracy., Results: Twenty-two tumors were located above, 65 at and 74 below PR. MRI accuracy was 90.6% for determining tumor's location with respect to the PR and 80.5% for defining peritoneal involvement. For classifying tumors according to their intra or extraperitoneal location an accuracy of 92.5% was set for MRI. Histophatologic peritoneal involvement was found in 28.7% of tumors located above or at the PR., Conclusions: Magnetic resonance imaging accurately predicts the location of rectal tumors with respect to the PR and its potential involvement. The double-ink method is useful to assess serosal involvement (pT4a) and to distinguish mesorrectal fascia from the peritonealized surface., (Copyright © 2021 AEC. Published by Elsevier España, S.L.U. All rights reserved.)
- Published
- 2022
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41. Gender dysphoria: laparoscopic sigmoid vaginoplasty. Another utility of indocyanine green.
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Flor-Lorente B, Rosciano JG, Pérez-Pérez T, Sancho-Muriel J, García-Granero Á, Nohales-Alfonso FJ, Primo-Romaguera V, and Simón-Sanz EA
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- Colon, Sigmoid surgery, Female, Humans, Indocyanine Green, Vagina surgery, Gender Dysphoria, Laparoscopy
- Abstract
Aim: Gender dysphoria is the disagreement between the gender of birth and the one with which the patient identifies. For its management it is mandatory to have a multidisciplinary team. Gender confirmation surgery with penoscrotal skin flap is the procedure of choice, and a sigmoid vaginoplasty is a feasible alternative. The new technologies and the help of indocyanine green (ICG) fluorescence can help to guarantee a correct neovagina vascularization. The objective of this paper is to present the surgical technique of laparoscopic sigmoid vaginoplasty assisted by ICG., Methods: We present two patients with gender dysphoria and a history of stricture of the penoscrotal skin flap vaginoplasty. We performed sigmoid vaginoplasty by the laparoscopic approach. We began the procedure with the mobilization and section of 30 cm of sigmoid colon, selective ligation of the vessels assisted by ICG, 180° sigmoid rotation, externalized on antiperistaltic position, construction of colovestibular anastomosis and promontory fixation. We finished the procedure with virtual ileostomy construction and drain placement., Results: Patients recovered satisfactorily and were discharged on the seventh day after surgery without complications., Conclusion: Sigmoid vaginoplasty is a safe and feasible procedure. ICG has great value, contributing to the selective ligation of the vessels, allowing 180° sigmoid rotation and guaranteeing the irrigation of the neovagina., (© 2021 Association of Coloproctology of Great Britain and Ireland.)
- Published
- 2021
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42. Extended right hemicolectomy with central ligation of the middle colic vessels - a video vignette.
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Cholewa H, Perez-Girbes A, Avelino González L, Flor Lorente B, García-Granero E, and Sancho-Muriel J
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- Colectomy, Humans, Ligation, Lymph Node Excision, Colic, Colonic Neoplasms surgery, Laparoscopy, Mesocolon surgery
- Published
- 2021
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43. Rectal cancer at the peritoneal reflection. Preoperative MRI accuracy and histophatologic correlation. Prospective study.
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Álvarez Sarrado E, Giner Segura F, Batista Domenech A, Garcia-Granero García-Fuster Á, Frasson M, Rudenko P, Flor Lorente B, and Garcia-Granero Ximénez E
- Abstract
Introduction: To investigate magnetic resonance imaging (MRI) accuracy for determining the location of rectal tumors with respect to the peritoneal reflection (PR) and its potential involvement., Methods: Prospective study of 161 patients ongoing surgery for rectal cancer. A double-ink method has been aplied to examine surgical specimen, orange ink for the serosal surface and indian ink for the mesorrectal margin, and assess preoperative MRI accuracy., Results: Twenty-two tumors were located above, 65 at and 74 below PR. MRI accuracy was 90.6% for determining tumor's location with respect to the PR and 80.5% for defining peritoneal involvement. For classifying tumors according to their intra or extraperitoneal location an accuracy of 92.5% was set for MRI. Histophatologic peritoneal involvement was found in 28.7% of tumors located above or at the PR., Conclusions: Magnetic resonance imaging accurately predicts the location of rectal tumors with respect to the PR and its potential involvement. The double-ink method is useful to assess serosal involvement (pT4a) and to distinguish mesorrectal fascia from the peritonealized surface., (Copyright © 2021 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)
- Published
- 2021
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44. Nomograms for morbidity and mortality after oncologic colon resection in the enhanced recovery era: results from a multicentric prospective national study.
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Sánchez-Guillén L, Frasson M, Pellino G, Fornés-Ferrer V, Ramos JL, Flor-Lorente B, García-Granero Á, Sierra IB, Jiménez-Gómez LM, Moya-Martínez A, and García-Granero E
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- Colon, Humans, Male, Morbidity, Postoperative Complications etiology, Prospective Studies, Risk Factors, Colectomy, Nomograms
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Purpose: Predicting postoperative complications and mortality is important to plan the surgical strategy. Different scores have been proposed before to predict them but none of them have been yet implemented into the routine clinical practice because their difficulties and low accuracy with new surgical strategies and enhanced recovery. The main aim of this study is to identify risk factors for postoperative morbidity and mortality after colonic resection (CR) without protective stomas, in order to develop a comprehensive, up-to-date, simple, reliable, and applicable model for the preoperative assessment of patients with colon cancer., Methods: Multivariable analysis was performed to identify risk factors for 60-day morbidity and mortality. Coefficients derived from the regression model were used in the nomograms to predict morbidity and mortality., Results: Three thousand one hundred ninety-three patients from 52 hospitals were included into the analysis. Sixty-day postoperative complications rate was 28.3% and the mortality rate was 3%. In multivariable analysis the independent risk factors for postoperative complications were age, male gender, liver and pulmonary diseases, obesity, preoperative albumin, anticoagulant treatment, open surgery, intraoperative complications, and urgent surgery. Independent risk factors for mortality were age, preoperative albumin anticoagulant treatment, and intraoperative complications., Conclusions: Risk factors for morbidity and mortality after CR for cancer were identified and two easy predictive tools were developed. Both of them could provide important information for preoperative consultation and surgical planning in the time of enhance recovery.
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- 2020
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45. A video guide of five access methods to the splenic flexure: the concept of the splenic flexure box.
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Garcia-Granero A, Primo Romaguera V, Millan M, Pellino G, Fletcher-Sanfeliu D, Frasson M, Flor-Lorente B, Ibañez-Canovas N, Carreño Saenz O, Sánchez-Guillén L, Sancho-Muriel J, Alvarez-Sarrado E, and Valverde-Navarro AA
- Subjects
- Cadaver, Colectomy education, Dissection, Female, Humans, Laparoscopy education, Male, Mesocolon surgery, Colectomy methods, Colon, Transverse anatomy & histology, Colon, Transverse surgery, Colorectal Neoplasms surgery, Laparoscopy methods
- Abstract
Aim: The aim of this study was to describe all the possible approaches for laparoscopic splenic flexure mobilization (SFM), each suitable for specific situations, and create an illustrated system to show SFM approaches in an easy and practical way to make it easy to learn and teach., Methods: Two different phases. First part: Cadaver-based study of the colonic splenic flexure anatomy. In order to demonstrate the different approaches, a balloon was placed through the colonic hepatic flexure in the lesser sac without sectioning any of the fixing ligaments of the splenic flexure. Second part: A real case series of laparoscopic SFM., Results: First part: 11 cadavers were dissected. Five potential approaches to SFM were found: anterior, trans-omentum, lateral, medial infra-mesocolic, and medial trans-mesocolic. The illustrative system developed was named: Splenic Flexure "Box"(SFBox). Second part: One of the types of SFM described in first part was used in five patients with colorectal cancer. Each laparoscopic approach to the splenic flexure was illustrated in a video accompanied by illustration aids delineating the access., Conclusion: With the cadaver dissection and subsequent demonstration in real-life laparoscopic surgery, we have shown five types of laparoscopic splenic flexure mobilization. The Splenic Flexure "Box" is a useful way to learn and teach this surgical maneuver.
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- 2020
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46. "Virtual ileostomy" combined with early endoscopy to avoid a diversion ileostomy in low or ultralow colorectal anastomoses. A preliminary report.
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Flor-Lorente B, Sánchez-Guillén L, Pellino G, Frasson M, García-Granero Á, Ponce M, Domingo S, Paya V, and García-Granero E
- Subjects
- Adult, Aged, Aged, 80 and over, Anastomosis, Surgical, Anastomotic Leak surgery, Female, Humans, Male, Middle Aged, Pilot Projects, Retrospective Studies, Colorectal Neoplasms surgery, Endoscopy, Gastrointestinal, Ileostomy methods
- Abstract
Purpose: Despite the benefits of a loop ileostomy after total mesorectal excision (TME), it carries a significant associated morbidity. A "virtual ileostomy" (VI) has been proposed to avoid ileostomies in low-risk patients, which could then be converted into a real ileostomy (RI) in the event of anastomotic leak (AL). The aim of the present study is to evaluate safety and efficacy of VI associated with early endoscopy in patients undergoing rectal surgery with anastomosis to detect subclinical AL prior to the onset of clinical symptoms for sepsis., Methods: This is a single-center, retrospective study of a consecutive series of patients undergoing elective or emergent colorectal surgery with low or ultralow colorectal or ileorectal anastomosis between September 2015 and September 2016., Results: We included 44 consecutive, unselected patients. Eight patients (18.2%) required conversion into RI and one required terminal colostomy because of AL, of whom 44.4% were asymptomatic and AL was detected with early endoscopy. Fashioning of RI was not associated with further morbidity. All patients with AL converted into RI (n = 8/9) (88.9%), had adequate healed anastomosis, and later underwent stoma closure with no complications. A stoma was avoided in 79.6% of VI. Endoscopy was associated with 55% sensitivity and 100% specificity, with a global accuracy of 88%., Conclusions: The combination of VI with early postoperative endoscopy could avoid unnecessary ileostomies in patients with low or ultralow anastomoses and reveal AL before the onset of symptoms, thus reducing associated morbidity.
- Published
- 2019
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47. An individualised versus a conventional pneumoperitoneum pressure strategy during colorectal laparoscopic surgery: rationale and study protocol for a multicentre randomised clinical study.
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Diaz-Cambronero O, Mazzinari G, Errando CL, Schultz MJ, Flor Lorente B, García-Gregorio N, Vila Montañés M, Robles-Hernández D, Olmedilla Arnal LE, Martín-De-Pablos A, Marqués Marí A, and Argente Navarro MP
- Subjects
- Colon physiopathology, Digestive System Surgical Procedures adverse effects, Humans, Length of Stay, Multicenter Studies as Topic, Pneumoperitoneum, Artificial adverse effects, Postoperative Complications etiology, Pressure, Randomized Controlled Trials as Topic, Recovery of Function, Rectum physiopathology, Single-Blind Method, Spain, Time Factors, Treatment Outcome, Colon surgery, Digestive System Surgical Procedures methods, Laparoscopy adverse effects, Pneumoperitoneum, Artificial methods, Rectum surgery
- Abstract
Background: A recent study shows that a multifaceted strategy using an individualised intra-abdominal pressure titration strategy during colorectal laparoscopic surgery results in an acceptable workspace at low intra-abdominal pressure in most patients. The multifaceted strategy, focused on lower to individualised intra-abdominal pressures, includes prestretching the abdominal wall during initial insufflation, deep neuromuscular blockade, low tidal volume ventilation settings and a modified lithotomy position. The study presented here tests the hypothesis that this strategy improves outcomes of patients scheduled for colorectal laparoscopic surgery., Methods: The Individualized Pneumoperitoneum Pressure in Colorectal Laparoscopic Surgery versus Standard Therapy (IPPCollapse-II) study is a multicentre, two-arm, parallel-group, single-blinded randomised 1:1 clinical study that runs in four academic hospitals in Spain. Patients scheduled for colorectal laparoscopic surgery with American Society of Anesthesiologists classification I to III who are aged > 18 years and are without cognitive deficits are randomised to an individualised pneumoperitoneum pressure strategy (the intervention group) or to a conventional pneumoperitoneum pressure strategy (the control group). The primary outcome is recovery assessed with the Post-operative Quality of Recovery Scale (PQRS) at postoperative day 1. Secondary outcomes include PQRS score in the post anaesthesia care unit and at postoperative day 3, postoperative complications until postoperative day 28, hospital length of stay and process-related outcomes., Discussion: The IPPCollapse-II study will be the first randomised clinical study that assesses the impact of an individualised pneumoperitoneum pressure strategy focused on working with the lowest intra-abdominal pressure during colorectal laparoscopic surgery on relevant patient-centred outcomes. The results of this large study, to be disseminated through conference presentations and publications in international peer-reviewed journals, are of ultimate importance for optimising the care and safety of laparoscopic abdominal surgery. Selection of patient-reported outcomes as the primary outcome of this study facilitates the translation into clinical practice. Access to source data will be made available through anonymised datasets upon request and after agreement of the Steering Committee of the IPPCollapse-II study., Trial Registration: ClinicalTrials.gov, NCT02773173 . Registered on 16 May 2016. EudraCT, 2016-001693-15. Registered on 8 August 2016.
- Published
- 2019
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48. A multifaceted individualized pneumoperitoneum strategy for laparoscopic colorectal surgery: a multicenter observational feasibility study.
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Diaz-Cambronero O, Flor Lorente B, Mazzinari G, Vila Montañes M, García Gregorio N, Robles Hernandez D, Olmedilla Arnal LE, Argente Navarro MP, Schultz MJ, and Errando CL
- Subjects
- Abdominal Cavity physiopathology, Feasibility Studies, Female, Humans, Male, Middle Aged, Pressure, Prospective Studies, Colectomy methods, Colonic Diseases surgery, Laparoscopy methods, Pneumoperitoneum, Artificial methods
- Abstract
Background: While guidelines for laparoscopic abdominal surgery advise using the lowest possible intra-abdominal pressure, commonly a standard pressure is used. We evaluated the feasibility of a predefined multifaceted individualized pneumoperitoneum strategy aiming at the lowest possible intra-abdominal pressure during laparoscopic colorectal surgery., Methods: Multicenter prospective study in patients scheduled for laparoscopic colorectal surgery. The strategy consisted of ventilation with low tidal volume, a modified lithotomy position, deep neuromuscular blockade, pre-stretching of the abdominal wall, and individualized intra-abdominal pressure titration; the effect was blindly evaluated by the surgeon. The primary endpoint was the proportion of surgical procedures completed at each individualized intra-abdominal pressure level. Secondary endpoints were the respiratory system driving pressure, and the estimated volume of insufflated CO
2 gas needed to perform the surgical procedure., Results: Ninety-two patients were enrolled in the study. Fourteen cases were converted to open surgery for reasons not related to the strategy. The intervention was feasible in all patients and well-accepted by all surgeons. In 61 out of 78 patients (78%), surgery was performed and completed at the lowest possible IAP, 8 mmHg. In 17 patients, IAP was raised up to 12 mmHg. The relationship between IAP and driving pressure was almost linear. The mean estimated intra-abdominal CO2 volume at which surgery was performed was 3.2 L., Conclusion: A multifaceted individualized pneumoperitoneum strategy during laparoscopic colorectal surgery was feasible and resulted in an adequate working space in most patients at lower intra-abdominal pressure and lower respiratory driving pressure. ClinicalTrials.gov (Trial Identifier: NCT03000465).- Published
- 2019
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49. Predictors of complications and mortality following left colectomy with primary stapled anastomosis for cancer: results of a multicentric study with 1111 patients.
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Pellino G, Frasson M, García-Granero A, Granero-Castro P, Ramos Rodríguez JL, Flor-Lorente B, Bargallo Berzosa J, Alonso Hernández N, Labrador Vallverdú FJ, Parra Baños PA, Ais Conde G, and Garcia-Granero E
- Subjects
- Aged, Anastomosis, Surgical methods, Anastomosis, Surgical mortality, Anastomotic Leak etiology, Colectomy methods, Colonic Neoplasms mortality, Databases, Factual, Female, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Surgical Stapling methods, Treatment Outcome, Anastomotic Leak mortality, Colectomy mortality, Colon surgery, Colonic Neoplasms surgery, Surgical Stapling mortality
- Abstract
Aim: Reports detailing the morbidity-mortality after left colectomy are sparse and do not allow definitive conclusions to be drawn. We aimed to identify risk factors for anastomotic leakage, perioperative mortality and complications following left colectomy for colonic malignancies., Method: We undertook a STROBE-compliant analysis of left colectomies included in a national prospective online database. Forty-two variables were analysed as potential independent risk factors for anastomotic leakage, postoperative morbidity and mortality. Variables were selected using the 'least absolute shrinkage and selection operator' (LASSO) method., Results: We analysed 1111 patients. Eight per cent of patients had a leakage and in 80% of them reoperation or surgical drainage was needed. A quarter of patients (24.9%) experienced at least one minor complication. Perioperative mortality was 2%, leakage being responsible for 47.6% of deaths. Obesity (OR 2.8, 95% CI 1.00-7.05, P = 0.04) and total parenteral nutrition (TPN) (OR 3.7, 95% CI 1.58-8.51, P = 0.002) were associated with increased risk of leakage, whereas female patients had a lower risk (OR 0.36, 95% CI 0.18-0.67, P = 0.002). Corticosteroids (P = 0.03) and oral anticoagulants (P = 0.01) doubled the risk of complications, which was lower with hyperlipidaemia (OR 0.3, P = 0.02). Patients on TPN had more complications (OR 4.02, 95% CI 2.03-8.07, P = 0.04) and higher mortality (OR 8.7, 95% CI 1.8-40.9, P = 0.006). Liver disease and advanced age impaired survival, corticosteroids being the strongest predictor of mortality (OR 21.5, P = 0.001)., Conclusion: Requirement for TPN was associated with more leaks, complications and mortality. Leakage was presumably responsible for almost half of deaths. Hyperlipidaemia and female gender were associated with lower rates of complications. These findings warrant a better understanding of metabolic status on perioperative outcome after left colectomy., (Colorectal Disease © 2018 The Association of Coloproctology of Great Britain and Ireland.)
- Published
- 2018
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50. How to reduce the superior mesenteric vein bleeding risk during laparoscopic right hemicolectomy.
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Garcia-Granero A, Sánchez-Guillén L, Frasson M, Sancho Muriel J, Alvarez Sarrado E, Fletcher-Sanfeliu D, Flor Lorente B, Pamies J, Corral Rubio J, Valverde Navarro AA, Martinez Soriano F, and Garcia-Granero E
- Subjects
- Dissection, Female, Humans, Male, Middle Aged, Risk Factors, Colectomy adverse effects, Hemorrhage etiology, Hemorrhage prevention & control, Laparoscopy adverse effects, Mesenteric Veins pathology, Mesenteric Veins surgery
- Abstract
Purpose: The superior right colic vein (SRCV) has been proposed as the main cause of superior mesenteric vein bleeding by avulsion during laparoscopic right hemicolectomy. Our objective is to identify the main vessel causing transverse mesocolic tension during the extraction of the surgical specimen or extracorporeal anastomosis and to perform an anatomical description of the SRCV., Methods: In this cadaveric study, we performed a simulation of right hemicolectomy and anatomical description of the surgical area of the gastrocolic trunk of Henle (SAGCTH), the gastrocolic trunk of Henle (GCTH), and SRCV. The length of the exteriorization of the anastomotic transverse colon (ATC) was measured before and after sectioning the vascular vessel causing the exteriorization tension., Results: Five fresh cadavers and 12 formalin were dissected. In 100% of the specimens, the SRCV was present and drained in 95% into the GCTH and in 5% directly into the superior mesenteric vein (SMV). In 100% of the specimens, the SRCV caused the tension when extracting the ATC. The mean length of exteriorization of the ATC before and after SRCV section was 7.2 and 10.4 cm in formalin cadavers, meaning a 44% of increment in the length of exteriorization. In fresh cadavers, the mean length of exteriorization increased to 2.7 cm, meaning a 28% of the initial length of exteriorization., Conclusions: The SRCV is the main cause of tension in the extraction of the surgical specimen after right hemicolectomy. Its high tie increases the length of the ATC exteriorization, in about 3 cm, and could reduce the risk of SMV bleeding during laparoscopic right hemicolectomy and facilitate an extracorporeal anastomosis free of tension.
- Published
- 2018
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