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1. Prospective observational non-randomized trial protocol for surgical planner 3D image processing & reconstruction for locally advanced colon cancer

Author

Sebastián Jerí-McFarlane, Álvaro García-Granero, Gianluca Pellino, Noemi Torres-Marí, Aina Ochogavía-Seguí, Miguel Rodríguez-Velázquez, Margarita Gamundí-Cuesta, and Francisco Xavier González-Argenté

Subjects
Innovation, Colon neoplasm, 3D Reconstruction, Colorectal surgery, Surgery, RD1-811
Abstract

Abstract Introduction Colon cancer presents significant surgical challenges that necessitate the development of precise strategies. Standardization with complete mesocolic excision (CME) is common, but some cases require extended resections. This study investigates the use of 3D Image Processing and Reconstruction (3D-IPR) to improve diagnostic accuracy in locally advanced colon cancer (LACC) with suspected infiltration and achieve R0 surgery. Methods Single-center, prospective, observational, comparative, non-randomized study. •Participants: Patients aged > 18 years undergoing LACC surgery, as indicated by CT scans, confirmed via colonoscopy. Exclusion criteria include neoadjuvant therapy, suspected carcinomatosis on CT, and unresectable tumors. •Interventions: 3D-IPR models are used for surgical planning, providing detailed tumor and surrounding structure metrics. Surgical procedures are guided by CT scans and intraoperative findings, categorized by surgical margins as R0, R1, or R2. •Objective: The primary goal is to evaluate 3D-IPR’s utility in achieving R0 resection in LACC with suspected infiltration. Secondary objectives include assessing preoperative surgical strategy, comparing CT reports, detecting adenopathy, and identifying vascularization and anatomical variants. • Outcome: The main outcome is the diagnostic accuracy of 3D-IPR in determining tumor infiltration of neighboring structures compared to conventional CT scans, using definitive pathological reports as the gold standard. Results •Recruitment and Number Analyzed: The study aims to recruit about 20 patients annually over two years, focusing on preoperative 3D-IPR analysis and subsequent surgical procedures. •Outcome Parameters: These include loco-regional and distant recurrence rates, peritoneal carcinomatosis, disease-free and overall survival, and mortality due to oncologic progression. •Harms: No additional risks from CT scans, as they are mandatory for staging colon tumors. 3D-IPR is derived from these CT scans. Discussion If successful, this study could provide an objective tool for precise tumor extension delimitation, aiding decision-making for radiologists, surgeons, and multidisciplinary teams. Enhanced staging through 3D-IPR may influence therapeutic strategies, reduce postsurgical complications, and improve the quality of life of patients with LACC. Trial registration Trial is registered at ISRCTN registry as ISRCTN81005215. Protocol version I (Date 29/06/2023).

Published
2024
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2. Definition and reporting of lymphadenectomy and complete mesocolic excision for radical right colectomy: a systematic review

Author

Giuseppe S. Sica, Danilo Vinci, Leandro Siragusa, Bruno Sensi, Andrea M. Guida, Vittoria Bellato, Álvaro García-Granero, Gianluca Pellino, Sica, Giuseppe S, Vinci, Danilo, Siragusa, Leandro, Sensi, Bruno, Guida, Andrea M, Bellato, Vittoria, García-Granero, Álvaro, Pellino, Gianluca, Institut Català de la Salut, [Sica GS, Siragusa L, Sensi B] Minimally Invasive Unit, Department of Surgical Science, University Tor Vergata, Rome, Italy. Department of Surgical Science, Policlinico Tor Vergata – University Tor Vergata, Rome, Italy. [Vinci D, Guida AM] Department of Surgical Science, Policlinico Tor Vergata – University Tor Vergata, Rome, Italy. [Bellato V] Department of Surgical Science, Policlinico Tor Vergata – University Tor Vergata, Rome, Italy. Ospedale IRCCS San Rafaele, Milan, Italy. [García-Granero Á] Colorectal Unit, Hospital Universitario Son Espases, Palma, Spain. Applied Surgical Anatomy Unit, Human Embryology and Anatomy Department, University of Valencia, Valencia, Spain. Human Embryology and Anatomy Department, University of Islas Baleares, Palma, Spain. [Pellino G] Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania 'Luigi Vanvitelli', Naples, Italy. Unitat de Cirurgia de Còlon i Recte, Vall d’Hebron Hospital Universitari, Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus

Subjects
Colorectal cancer, Colorectal surgery, Complete mesocolic excision, D3 lymphadenectomy, Right colectomy, intervenciones quirúrgicas::procedimientos quirúrgicos del sistema digestivo::colectomía [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS], Neoplasms::Neoplasms by Site::Digestive System Neoplasms::Gastrointestinal Neoplasms::Intestinal Neoplasms::Colorectal Neoplasms::Colonic Neoplasms [DISEASES], Otros calificadores::Otros calificadores::/cirugía [Otros calificadores], Other subheadings::Other subheadings::/surgery [Other subheadings], Settore MED/18, neoplasias::neoplasias por localización::neoplasias del sistema digestivo::neoplasias gastrointestinales::neoplasias intestinales::neoplasias colorrectales::neoplasias del colon [ENFERMEDADES], Surgical Procedures, Operative::Digestive System Surgical Procedures::Colectomy [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT], Surgery, Còlon - Càncer - Cirurgia
Abstract

Background Several procedures have been proposed to reduce the rates of recurrence in patients with right-sided colon cancer. Different procedures for a radical right colectomy (RRC), including extended D3 lymphadenectomy, complete mesocolic excision and central vascular ligation have been associated with survival benefits by some authors, but results are inconsistent. The aim of this study was to assess the variability in definition and reporting of RRC, which might be responsible for significant differences in outcome evaluation. Methods PRISMA-compliant systematic literature review to identify the definitions of RRC. Primary aims were to identify surgical steps and different nomenclature for RRC. Secondary aims were description of heterogeneity and overlap among different RRC techniques. Results Ninety-nine articles satisfied inclusion criteria. Eight surgical steps were identified and recorded as specific to RRC: Central arterial ligation was described in 100% of the included studies; preservation of mesocolic integrity in 73% and dissection along the SMV plane in 67%. Other surgical steps were inconstantly reported. Six differently named techniques for RRC have been identified. There were 35 definitions for the 6 techniques and 40% of these were used to identify more than one technique. Conclusions The only universally adopted surgical step for RRC is central arterial ligation. There is great heterogeneity and consistent overlap among definitions of all RRC techniques. This is likely to jeopardise the interpretation of the outcomes of studies on the topic. Consistent use of definitions and reporting of procedures are needed to obtain reliable conclusions in future trials. PROSPERO CRD42021241650.

Published
2022
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3. Three‐dimensional modelling as a novel interactive tool for preoperative planning for complex perianal fistulas in Crohn's disease

Author

Sebastián Jeri‐McFarlane, Álvaro García‐Granero, Aina Ochogavía‐Seguí, Gianluca Pellino, Anaí Oseira‐Reigosa, Alejandro Gil‐Catalan, Leandro Brogi, Daniel Ginard‐Vicens, Margarita Gamundi‐Cuesta, Francisco Xavier Gonzalez‐Argente, Institut Català de la Salut, [Jeri-McFarlane S, Ochogavía-Seguí A, Oseira-Reigosa A, Gil-Catalan A] Colorectal Unit, General and Digestive Surgery Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain. [García-Granero Á] Colorectal Unit, General and Digestive Surgery Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain. Human Embryology and Anatomy Department, University of Islas Baleares, Mallorca, Spain. [Pellino G] Unitat de Cirurgia de Còlon i Recte, Vall d'Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy, and Vall d'Hebron Barcelona Hospital Campus

Subjects
Crohn, Malaltia de - Tractament, Imatgeria tridimensional en medicina, Diagnosis::Diagnostic Techniques and Procedures::Diagnostic Imaging::Tomography::Magnetic Resonance Imaging [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT], Gastroenterology, Digestive System Diseases::Gastrointestinal Diseases::Gastroenteritis::Inflammatory Bowel Diseases::Crohn Disease [DISEASES], Fístules, diagnóstico::técnicas y procedimientos diagnósticos::diagnóstico por imagen::tomografía::imagen por resonancia magnética [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS], Other subheadings::/therapy [Other subheadings], afecciones patológicas, signos y síntomas::afecciones patológicas anatómicas::fístula::fístula del sistema digestivo::fístula intestinal::fístula rectal [ENFERMEDADES], Pathological Conditions, Signs and Symptoms::Pathological Conditions, Anatomical::Fistula::Digestive System Fistula::Intestinal Fistula::Rectal Fistula [DISEASES], Otros calificadores::/terapia [Otros calificadores], enfermedades del sistema digestivo::enfermedades gastrointestinales::gastroenteritis::enfermedad inflamatoria intestinal::enfermedad de Crohn [ENFERMEDADES]
Abstract

Crohn disease; Artificial intelligence; Three-dimensional imaging Enfermedad de Crohn; Inteligencia artificial; Imagen tridimensional Malaltia de Crohn; Intel·ligència artificial; Imatge tridimensional Aim The aim of this study is to demonstrate the added value of three-dimensional (3D) reconstruction models and artificial intelligence for preoperative planning in complex perianal Crohn's disease. MRI is the gold standard for diagnosis of complex perianal fistulas and abscess due to its high sensitivity, but it lacks high specificity values. This creates the need for better diagnostic models such as 3D image processing and reconstruction (3D-IPR) with artificial intelligence (AI) algorithms. Method This is a prospective study evaluating the utility of 3D reconstruction models from MRI in four patients with perineal Crohn's disease (pCD). Results Four pCD patients had 3D reconstruction models made from pelvic MRI. This provided a more visual representation of perianal disease and made possible location of the internal fistula orifice, seton placement in fistula tracts and abscess drainage. Conclusion Three-dimensional reconstruction in CD-associated complex perianal fistulas can facilitate disease interpretation, anatomy and surgical strategy, potentially improving preoperative planning as well as intraoperative assistance. This could probably result in better surgical outcomes to control perianal sepsis and reduce the number of surgical procedures required in these patients.

Published
2023
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4. Management of acute diverticulitis with pericolic free gas (ADIFAS). an international multicenter observational study

Author

Tejedor, Patricia, Pastor, Carlos, Pellino, Gianluca, Di Saverio, Salomone, Gorter-Stam, Marguerite, Sylla, Patricia, Francis, Nader, Javier Tomas Morales-Bernaldo de Quiros, Pablo Hernández Sanz, Carlos, Pastor, Alicia Alvarellos Pérez, Lucía Granero Peiró, Jorge Lucía Granero, Vicente, Simó, Patricia, Tejedor, Luis Miguel Jiménez, Maria Luz Fernández, Vincenzo, Vigorita, Laura Rodríguez Fernández, Marta Paniagua García-Señoráns, Alejandro, Forero, Isabel, Prieto, Beatriz Díaz San Andrés, Luis Asensio Gómez, Fernando, Prieto, Víctor, Turrado, Xavier Morales Sevillano, Felipe García Sánchez, Esther María Cano Pecharromán, Tamara Llamero Sanz, Mercedes Estaire Gómez, Pilar Olivenza Palomar, Manuel Losada Ruiz, Beatriz Diéguez Fernández, Miguel Hernández García, Alfredo Alonso Poza, Ariel Jullien Petrelli, María Labalde Martínez, Ana, Rodríguez, Pablo, Mendendez, Antonio, Navarro-Sánchez, Iván, Soto-Darias, Luis, Sánchez-Guillén, Marina, Bosch-Ramírez, Marta Castro Suárez, Marta Tasende Presedo, Dennis César Lévano-Linares, Silvia, Salvans, Gianluca, Pellino, Eloy, Espín-Basany, Rodrigo, Mata, Carlos, Petrola, Carmen, Cagigas, Rubén Caiña Ruiz, Natalia, Suárez, Tatiana Gómez Sánchez, Eva María Sancho Maraver, Carmen Sánchez de la Orden, Rosalía Velasco López, María, Pelloni, Aida, Rahy-Martin, Juan, Ocaña, Laura Fernández Vega, Álvaro, García-Granero, Natalia Alonso Hernández, Jeancarlos, Trujillo-Díaz, Eduardo de San Pío Carvajal, Elena Sagarra Cebolla, Zahira Gómez Carmona, Cristina Gras Gómez, Núria Mestres Petit, Ruiz de la Hermosa, María Luisa de Fuenmayor Valera, Jesús Bollo Rodríguez, Sabrina, Garbarino, Roberta, Tutino, Marco, Massani, Ugo, Grossi, Nicola, Passuello, Giacomo, Zanus, Gallo, Gaetano, Gilda de Paola, Alice, Frontali, Isabella, Pezzoli, Nicola, Cillara, Antonello, Deserra, Francesca, D’Agostino, Nigri, Giuseppe, Zerunian, Marta, Laghi, Andrea, Emmanuele, Abate, Letizia, Laface, Francesco, Roscio, CLERICI BAGOZZI, Federico, Marco Vito Marino, Martina de Leonardis, Lodovico, Sartarelli, Mauro, Montuori, Enrico, Pinotti, Gian Marco Palini, Caterina, Marietta, Pietro, Schettino, Giovanni, Romano, Alan, Biloslavo, Giada, Aizza, Nicolò, Tamini, Mauro, Podda, Giuseppe, Esposito, Grande, Michele, Michela, Campanelli, Leandro, Siragusa, Lapolla, Pierfrancesco, Mingoli, Andrea, Brachini, Gioia, Paola De Nardi, Giaime Gonario Arru, Chiarugi, Massimo, Dario, Tartaglia, Enrico, Cicuttin, Federico, Coccolini, Mauro, Zago, Morena, Burati, Ludovica, Gibelli, Matteo, Runfola, Matteo, Palmeri, Matteo, Bianchini, Alfredo, Annicchiarico, Mario, Giuffrida, Fausto, Catena, Gennaro, Perrone, Mansoor, Khan, Qurrat Al Ain Atif, George, Davis, Hamid, Joseph, Garvin, Sharjeel, H Paul, Hamid, Mustafa, James, Byrne, Ata, Khan, Nicolas, Avellaneda, Augusto, Carrie, German, Espil, Elgun, Samadov, Arturan, Ibrahimli, Semra Demirli Atici, Sinue, Cázarez-Huazano, Oscar, Santes, Noel, Salgado-Nesme, Jorge Luis Aguilar Frasco, Zoe, Garoufalia, Nikolaos, Nikiteas, Jurij Aleš Košir, and Jan, Grosek

Subjects
surgery, diverticulitis, nonoperative management, diverticular disease, complication, diverticulosis
Published
2023

5. A Proposal for Novel Standards of Histopathology Reporting for D3 Lymphadenectomy in Right Colon Cancer: The Mesocolic Sail and Superior Right Colic Vein Landmarks

Author

Matteo Frasson, Luis Sánchez-Guillén, Francisco Giner, Isabel Grifo Albalat, Alfonso A. Valverde-Navarro, Álvaro García-Granero, Eduardo García-Granero, Gianluca Pellino, Garcia-Granero, A., Pellino, G., Giner, F., Frasson, M., Albalat, I. G., Sanchez-Guillen, L., Valverde-Navarro, A. A., and Garcia-Granero, E.

Subjects
Male, medicine.medical_specialty, Surgical specimen, 03 medical and health sciences, Mesenteric Veins, 0302 clinical medicine, D3 lymphadenectomy, Cadaver, Humans, Medicine, Prospective Studies, Colectomy, Aged, Neoplasm Staging, Aged, 80 and over, New quality standards, business.industry, Right colic vein, Gastroenterology, Outcome measures, General Medicine, Middle Aged, Colon cancer, medicine.anatomical_structure, Specimen Quality, Lymphatic Metastasis, 030220 oncology & carcinogenesis, Quality standard, Colonic Neoplasms, Right Colectomy, Lymph Node Excision, Female, Laparoscopy, 030211 gastroenterology & hepatology, Histopathology, Lymph Nodes, Anatomic Landmarks, business, Nuclear medicine, Follow-Up Studies
Abstract

Background Strong agreement exists concerning the standards of pathologic reporting for total mesorectal excision and complete mesocolic excision. It represents a quality standard that correlates with survival. However, no agreed standards of reporting are available to define D3 lymphadenectomy for right colectomy. Objective The purpose of this study was to define anatomopathological standards of specimen quality obtained from the surgical specimen when an oncologic right hemicolectomy with D3 lymphadenectomy has been correctly performed. Design This study was conducted in 2 different phases. The first part consisted of a cadaver-based study of right colon anatomy, and the second part consisted of a prospective assessment of a series of surgical specimens obtained after right hemicolectomy for cancer. Settings The anatomic phase of the study was performed in collaboration with the University of Valencia Department of Anatomy and Embryology. The second part was performed at a colorectal unit of a tertiary hospital. Patients Seventeen cadavers were used for the first phase, and 65 surgical specimens were examined for the second part of the study. Main outcome measures In each specimen, the pathologists looked for anatomic structures defined as markers of quality standards of the D3 lymphadenectomy during the first phase. Specimens were classified as complete, partial, and incomplete D3 lymphadenectomy. Results Twenty percent of specimens were classified as incomplete D3 lymphadenectomy, 31% as partial, and 49% as complete. A median number of 14 (6-64), 22 (11-47), and 29 (14-55) lymph nodes were isolated (p = 0.01). Similarly, the median numbers of lymph nodes isolated in the area of D3 lymphadenectomy were 0 in incomplete, 1 (0-5) in Partial, and 3 (0-8) in Complete D3 lymphadenectomy specimens (p = 0.0001). Limitations A large multicenter study with adequate power is needed. Conclusions We propose the right mesocolic sail and trunk of superior right colic vein as new and reproducible anatomopathologic standards of D3 lymphadenectomy in oncologic right hemicolectomy. See Video Abstract at http://links.lww.com/DCR/B149. PROPUESTA PARA NUEVOS ESTANDARES HISTOPATOLOGICOS EN LA LINFADENECTOMIA D3 EN EL CANCER DE COLON DERECHO: LA VELA MESOCOLICA Y LA VENA COLICA DERECHA SUPERIOR: Existe un claro acuerdo sobre los estandares de calidad patologicos para la escision total del mesorrecto y la escision completa del mesocolon. Son considerados "estandar de calidad" que se correlaciona con la supervivencia. Sin embargo, no se dispone de estandares de calidad para definir la linfadenectomia D3, en la colectomia derecha.Definir los estandares anatomopatologicos de calidad obtenidos de una muestra quirurgica, cuando se ha realizado correctamente una hemicolectomia derecha oncologica, con linfadenectomia D3.Dos fases diferentes. La primera parte consistio en un estudio basado en la anatomia del colon derecho, realizado en cadaveres, y la segunda parte consistio en una evaluacion prospectiva de una serie de muestras quirurgicas obtenidas despues de la hemicolectomia derecha para cancer.La fase anatomica del estudio se realizo en colaboracion con el Departamento de Anatomia y Embriologia de la Universidad de Valencia. La segunda parte se realizo en la Unidad Colorrectal de un hospital terciario.Se utilizaron diecisiete cadaveres para la primera fase y se examinaron 65 muestras quirurgicas para la segunda parte del estudio.En cada muestra, los patologos buscaron estructuras anatomicas definidas, como marcadores de los estandares de calidad de la linfadenectomia D3, durante la primera fase. Las muestras se clasificaron como linfadenectomia D3 completa, parcial e incompleta.El veinte por ciento de las muestras se clasificaron como "Linfadenectomia D3 Incompleta", el 31% como "Parcial" y el 49% como "Completa." Se aislo una media de 14 (6-64), 22 (11-47) y 29 (14-55) ganglios linfaticos respectivamente (p = 0,01). Del mismo modo, el numero medio de ganglios linfaticos aislados en el area de la linfadenectomia D3 fue 0 en "Incompleta", 1 (0-5) en "Parcial" y 3 (0-8) en muestras de "Linfadenectomia D3 Completa" (p = 0,0001).Se necesita un estudio multicentrico con potencia adecuada.Proponemos la vela mesocolica derecha y el tronco de la vena colica derecha superior, como estandares anatomopatologicos nuevos y reproducibles de linfadenectomia D3, en hemicolectomia derecha oncologica. Consulte Video Resumen en http://links.lww.com/DCR/B149.

Published
2020
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6. A video guide of five access methods to the splenic flexure: the concept of the splenic flexure box

Author

M. Millan, Matteo Frasson, Gianluca Pellino, Eduardo Alvarez-Sarrado, Omar Carreño Saenz, Blas Flor-Lorente, Delfina Fletcher-Sanfeliu, Noelia Ibañez-Canovas, Vicent Primo Romaguera, Jorge Sancho-Muriel, Luis Sánchez-Guillén, Alfonso A. Valverde-Navarro, Álvaro García-Granero, Garcia-Granero, A., Primo Romaguera, V., Millan, M., Pellino, G., Fletcher-Sanfeliu, D., Frasson, M., Flor-Lorente, B., Ibanez-Canovas, N., Carreno Saenz, O., Sanchez-Guillen, L., Sancho-Muriel, J., Alvarez-Sarrado, E., and Valverde-Navarro, A. A.

Subjects
Male, Laparoscopic surgery, Colon, medicine.medical_treatment, Lesser sac, Surgical anatomic, Hepatic Flexure, Splenic flexure, Colon, Colorectal cancer, Human anatomy, Laparoscopy, Splenic flexure, Surgical anatomic, 03 medical and health sciences, 0302 clinical medicine, Cadaver, Humans, Medicine, Cadaver dissection, Splenic flexure mobilization, Colectomy, business.industry, Dissection, Anatomy, Colorectal cancer, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Human anatomy, Female, Laparoscopy, 030211 gastroenterology & hepatology, Surgery, Colorectal Neoplasms, business, Colon, Transverse, Mesocolon
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.

Published
2020
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7. Impact of perioperative transfusions and sepsis on long-term oncologic outcomes after curative colon cancer resection. A retrospective analysis of a prospective database

Author

Javier Escrig, Alejandro Espí, Susana Roselló, Eduardo García-Granero, Álvaro García-Granero, Gloria Baguena, Gianluca Pellino, Matteo Frasson, Franco G. Marinello, Andrés Cervantes, Baguena, G., Pellino, G., Frasson, M., Escrig, J., Marinello, F., Espi, A., Garcia-Granero, A., Rosello, S., Cervantes, A., and Garcia-Granero, E.

Subjects
Male, medicine.medical_specialty, Time Factors, Databases, Factual, Survival, Sepsi, Colorectal cancer, 030230 surgery, computer.software_genre, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Septic complication, Sepsis, Local recurrence, medicine, Humans, Anastomotic leak, Perioperative Period, Aged, Retrospective Studies, Aged, 80 and over, Hepatology, Database, Proportional hazards model, business.industry, Mortality rate, Blood transfusion, Hazard ratio, Gastroenterology, Perioperative, Middle Aged, medicine.disease, Colorectal surgery, Colon cancer, Survival Rate, Bowel obstruction, Treatment Outcome, Anastomotic leak, Blood transfusion, Colon cancer, Complicaciones sépticas, Complicación, Complication, Cáncer de colon, Fuga anastomótica, Local recurrence, Recurrencia local, Sepsis, Septic complications, Supervivencia, Survival, Transfusión de sangre, 030220 oncology & carcinogenesis, Colonic Neoplasms, Female, Complication, business, computer, Septic complications
Abstract

Objective: Intra-abdominal septic complications (IASC) affect short-term outcomes after surgery for colon cancer. Blood transfusions have been associated with worse short-term results.The role of IASC and blood transfusions on long-term oncologic results is still debated. This study aims to assess the impact of these two variables on survival after curative colon cancer resection. Patients and methods: Retrospective analysis of a prospectively maintained database of patients who underwent curative surgery for colon cancer at a university hospital, between 1993 and 2010. Cox regression was used to identify the role of IASC and transfusions (alone and combined) on local recurrence (LR), disease-free survival (DES), and cancer-specific survival (CSS). Results: Out of the 1686 patients analyzed, 1277 fit in the inclusion criteria. Colorectal surgeons performed the procedure in 82.2% of the patients. Blood transfusions were administered to 25.8% of the patients. Thirty-day complication and mortality rates were 34.5% and 6.1%. IASC occurred in 9.9%. The mean follow-up was 66 months. The 5-year rates of LR, DES, and CSS were 7%, 79.8%, and 85.1%. The year of surgery and pT (Hazard ratio 9.35, 95% CI 1.23-70.9, for T4) and pN (Hazard ratio 2.57, 95% CI 1.39-4.72, for N2) stages were independent risk factors for LR. The same variables, bowel obstruction and surgeries performed by surgeons not specialized in colorectal surgery, were also associated with worse DES and CSS. IASC and blood transfusions were not associated with LR, DFS, and CSS, whether alone or combined. Conclusions: IASC and transfusions were not associated with worse oncological outcomes after curative colon cancer surgery per se. Other factors were more important predictors of survival. (C) 2019 Published by Elsevier Espana, S.L.U.

Published
2020
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8. Comparison of vertical and extended vertical rectus abdominis myocutaneous flaps. An anatomical study

Author

Alberto Pérez-García, Elena García-Vilariño, Álvaro García-Granero, Miriam Alonso-Carpio, Alberto Sánchez-García, Alfonso Valverde-Navarro, and Eduardo García-Granero

Subjects
Perineal reconstruction, Surgery, rectus abdominis myocutaneous flap, flaps
Abstract

The extended vertical rectus abdominis myocutaneous (eVRAM) flap has been proposed for reconstruction of large pelviperineal defects where traditional VRAM flap could be insufficient. To compare the dimensions of VRAM and eVRAM flaps an anatomical study was performed. Ten VRAM and ten eVRAM flaps were dissected in ten fresh adult cadavers. Length, width and volume of all the flaps were measured. Length and volume were significantly larger in eVRAM flap compared to VRAM flap (36.55 cm vs. 30.15, p=.005; and 315.5 vs. 244 mL, p=.012, respectively). No differences were observed in flap width. The eVRAM flap could be a better option than traditional VRAM for reconstruction of big pelviperineal defects when bulkier tissue, larger skin paddle and/or longer arch of rotation are needed for reconstruction.

Published
2022

10. Risk factors for leak, complications and mortality after ileocolic anastomosis: comparison of two anastomotic techniques

Author

Blas Flor-Lorente, Matteo Frasson, Álvaro García-Granero, Luis Sánchez-Guillén, Eduardo Alvarez-Sarrado, E. García-Granero, Gianluca Pellino, Sánchez-Guillén, L, Frasson, M, García-Granero, Á, Pellino, G, Flor-Lorente, B, Álvarez-Sarrado, E, and García-Granero, E

Subjects
Male, medicine.medical_specialty, Leak, Colon, Stapled, Anastomotic Leak, 030230 surgery, Anastomosis, 03 medical and health sciences, Postoperative Complications, Sex Factors, 0302 clinical medicine, Ileum, Risk Factors, Surgical Stapling, medicine, Humans, Anastomotic leak, Aged, Retrospective Studies, Anastomotic leak, Handsewn, Ileocolic anastomosis, Risk factors, Stapled, Ileocolic anastomosis, Ideal (set theory), business.industry, Anastomosis, Surgical, Suture Techniques, General Medicine, Perioperative, Middle Aged, Handsewn, Surgery, Risk factors, 030220 oncology & carcinogenesis, Ileocolic anastomosi, Hypertension, Female, Risk factor, business, Colorectal Surgery
Abstract

Introduction There are no definitive data concerning the ideal configuration of ileocolic anastomosis. Aim of this study was to identify perioperative risk factors for anastomotic leak and for 60-day morbidity and mortality after ileocolic anastomoses (stapled vs handsewn). Materials and methods This is a STROBE-compliant study. Demographic and surgical data were gathered from patients with an ileocolic anastomosis performed between November 2010 and September 2016 at a tertiary hospital. Anastomoses were performed using standardised techniques. Independent risk factors for anastomotic leak, complications and mortality were assessed. Results We included 477 patients: 53.7% of the anastomoses were hand sewn and 46.3% stapled. Laterolateral anastomosis was the most common configuration (93.3%). Anastomotic leak was diagnosed in 8.8% of patients and 36 were classified as major anastomotic leak (7.5%). In the multivariate analysis, male sex (P = 0.014, odds ratio, OR, 2.9), arterial hypertension (P = 0.048, OR 2.29) and perioperative transfusions (P < 0.001, OR 2.4 per litre) were independent risk factors for major anastomotic leak. The overall 60-day complication rate was 27.3%. Male sex (31.3% vs female 22.3%, P = 0.02, OR 1.7), diabetes (P = 0.03 OR 2.0), smoking habit (P = 0.04, OR 1.8) and perioperative transfusions (P < 0.001, OR 3.3 per litre) were independent risk factors for postoperative morbidity. The 60-day-mortality rate was 3.1% and no significant risk factors were identified. Conclusion Anastomotic leak after ileocolic anastomosis is a relevant problem. Male sex, arterial hypertension and perioperative transfusions were associated with major anastomotic leak. Conversion to open surgery was more frequently associated with perioperative death.

Published
2019
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11. How to Know if a D3 Lymphadenectomy Has Been Actually Performed in a Right Hemicolectomy: Focus on the Pathology Report

Author

Vicent Primo-Romaguera, Álvaro García-Granero, Francisco Giner, Alfonso A. Valverde-Navarro, María Alfonso-García, Eduardo García-Granero, Gianluca Pellino, Xavier González-Argente, Alfonso-Garcia, Maria, Garcia-Granero, Alvaro, Pellino, Gianluca, Giner, Francisco, Valverde-Navarro, Alfonso A, Primo-Romaguera, Vicent, Gonzalez-Argente, Xavier, and Garcia-Granero, Eduardo

Subjects
Focus (computing), medicine.medical_specialty, business.industry, General surgery, Gastroenterology, D3 lymphadenectomy, Medicine, General Medicine, Pathology Report, business, Right hemicolectomy
Published
2021

12. Surgical anatomy applied to transperitoneal approaches of the abdominal aorta and visceral trunks. Dynamic article

Author

Delfina Fletcher-Sanfeliu, Francisco Orbis, Álvaro García-Granero, Gianluca Pellino, Luis Sabater Ortí, Alfonso A. Valverde-Navarro, Antonio Arroyo, Alberto Domenech Dolz, Iván Martín-González, Fletcher-Sanfeliu, Delfina, García-Granero, Álvaro, Doménech Dolz, Alberto, Pellino, Gianluca, Orbis, Francisco, Arroyo, Antonio, Valverde-Navarro, Alfonso A, Sabater Ortí, Lui, and Martín-González, Iván

Subjects
medicine.medical_specialty, Abdominal aorta, Abordaje, Acceso quirúrgico, Anatomía quirúrgica, Aorta abdominal, Approaches, Surgical access, Surgical anatomy, Surgical acce, Surgical anatomy, Celiac Artery, Mesenteric Artery, Superior, Cadaver, medicine.artery, Approache, medicine, Humans, Aorta, Abdominal, Superior mesenteric artery, Abdominal aorta, Aorta, business.industry, Dissection, Digestive surgery, General Engineering, Trunk, Surgery, Aorta abdominal, Acceso quirúrgico, Anatomía quirúrgica, Abordaje, business, Human
Abstract

Access to the abdominal aorta and its visceral trunks is possible through several approaches. Dissections of five cadavers performed during three National Surgical Anatomy courses applied to Aorta, Hepatobiliopancreatic and Digestive Surgery. Videos and pictures were taken throughout the dissections and showed different abdominal aorta approaches. Abdominal aorta and visceral trunks approaches: longitudinal inframesocolic access, supraceliac clamping, celiac trunk dissection, superior mesenteric artery approaches (retroperitoneal after Kocher menoeuvre, supramesocolic or inframesocolic), Cattell-Braasch manoeuvre and mattox manoeuvre: retrorenal and prerenal. Correct knowledge of the intraabdominal anatomy is necessary to perform all the abdominal aorta surgical approaches. Cadaveric dissection could help to achieve this objective. Cardiovascular and digestive surgeons need to know the possible strategies in order to choose the one which is best suited for each patient.

Published
2021

13. Surgical management of complex ileocolonic Crohn's disease: a survey of IBD colorectal surgeons to assess variability in operative strategy

Author

Francesco Selvaggi, Álvaro García-Granero, Janindra Warusavitarne, E. Espin, E Garofalo, Mark Coleman, Gianluca Pellino, Michele Carvello, Mick Harper, K Flashman, Valerio Celentano, Matteo Frasson, Nicola de’Angelis, Antonino Spinelli, Garofalo, E, Selvaggi, F, Spinelli, A, Pellino, G, Flashman, K, Frasson, M, Carvello, M, De'Angelis, N, Garcia-Granero, A, Harper, M, Warusavitarne, J, Coleman, M, Espin, E, Celentano, V, Institut Català de la Salut, [Garofalo E] Department of General Surgery, Sant’Andrea Hospital, La Sapienza University, Rome, Italy. [Selvaggi F, Pellino G] Department of Advanced Medical and Surgical Sciences, Universitádella Campania 'Luigi Vanvitelli', Naples, Italy. [Spinelli A] Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy. IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy. [Flashman K] Colorectal Unit, Queen Alexandra Hospital – Portsmouth Hospitals NHS Trust, Portsmouth, UK. [Frasson M] Department of General Surgery, Colorectal Unit, La Fe University and Polytechnic Hospital, University of Valencia, Valencia, Spain. [Espin E] Servei de Cirurgia General, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain, and Vall d'Hebron Barcelona Hospital Campus

Subjects
Laparoscopic surgery, Investigative Techniques::Epidemiologic Methods::Data Collection::Surveys and Questionnaires [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT], Crohn’s disease, medicine.medical_specialty, Crohn, Malaltia de - Cirurgia, Short Communication, medicine.medical_treatment, Ileocaecal resection, Digestive System Diseases::Gastrointestinal Diseases::Gastroenteritis::Inflammatory Bowel Diseases::Crohn Disease [DISEASES], Qüestionaris, Colorectal Neoplasm, Anastomosis, Subspecialty, Inflammatory bowel disease, 03 medical and health sciences, Ileostomy, Colorectal surgery, Crohn’s disease, Ileocaecal resection, Inflammatory bowel disease, Laparoscopic surgery, 0302 clinical medicine, Crohn Disease, Colorectal surgery, Surveys and Questionnaires, medicine, Humans, Surveys and Questionnaire, Surgeons, Crohn's disease, business.industry, General surgery, Inflammatory Bowel Disease, Gastroenterology, Correction, Otros calificadores::Otros calificadores::/cirugía [Otros calificadores], técnicas de investigación::métodos epidemiológicos::recopilación de datos::encuestas y cuestionarios [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS], Inflammatory Bowel Diseases, medicine.disease, digestive system diseases, Other subheadings::Other subheadings::/surgery [Other subheadings], enfermedades del sistema digestivo::enfermedades gastrointestinales::gastroenteritis::enfermedad inflamatoria intestinal::enfermedad de Crohn [ENFERMEDADES], Dissection, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Terapèutica - Presa de decisions, Colorectal Neoplasms, business, Human
Abstract

Introduction To explore the reported variability in the surgical management of ileocolonic Crohn’ s disease and identify areas of standard practice, we present this study which aims to assess how different colorectal surgeons with a subspecialty interest in inflammatory bowel disease (IBD) surgery may act in different clinical scenarios of ileocolonic Crohn’s disease. Methods Anonymous videos demonstrating the small bowel walkthrough and anonymised patients’ clinical data, imaging and pathological findings were distributed to the surgeons using an electronic tool. Surgeons answered on operative strategy, bowel resections, management of small bowel mesentery, type of anastomosis and use of stomas. Results Eight small bowel walkthrough videos were registered and 12 assessors completed the survey with a questionnaire completion rate of 87.5%. There was 87.7% agreement in the need to perform an ileocolonic resection. However, the agreement for the need to perform associated surgical procedures such as strictureplasties or further bowel resections was only 57.4%. When an anastomosis was fashioned, the side to side configuration was the most commonly used. The preferred management of the mesentery was dissection close to the bowel. Conclusions The decision on the main procedure to be performed had a high agreement amongst the different assessors, but the treatment of multifocal disease was highly controversial, with low agreement on the need for associated procedures to treat internal fistulae and the use of strictureplasties. At the same time, there was significant heterogeneity in the decision on when to anastomose and when to fashion an ileostomy.

Published
2021

14. D3-lymphadenectomy enhances oncological clearance in patients with right colon cancer. Results of a meta-analysis

Author

E. García-Granero, Izaskun Balciscueta, Álvaro García-Granero, Gianluca Pellino, Zutoia Balciscueta, Natalia Uribe, Matteo Frasson, Balciscueta, Zutoia, Balciscueta, Izaskun, Uribe, Natalia, Pellino, Gianluca, Frasson, Matteo, García-Granero, Eduardo, and García-Granero, Álvaro

Subjects
medicine.medical_specialty, Colorectal cancer, education, Disease, 03 medical and health sciences, 0302 clinical medicine, D3 lymphadenectomy, medicine, Humans, In patient, Neoplasm Metastasis, Hemicolectomy, Mesentery, Colectomy, Central vascular ligation, Central vessel ligation, Colon cancer, Complete mesocolic excision, D3 lymphadenectomy, Right hemicolectomy, Colonic Neoplasm, business.industry, Right hemicolectomy, General Medicine, Central vessel ligation, medicine.disease, Surgery, Central vascular ligation, Colon cancer, medicine.anatomical_structure, Lymphatic system, Oncology, 030220 oncology & carcinogenesis, Meta-analysis, Colonic Neoplasms, Lymph Node Excision, 030211 gastroenterology & hepatology, Lymph, business, Complete mesocolic excision, Human
Abstract

Background D3-Lymphadenectomy, together with complete mesocolic excision (CME), were introduced to provide oncological results after right colon cancer. The aim of this systematic review with meta-analysis was to assess the short and long-term outcomes of right-sided hemicolectomy with CME + D3 as compared with classic right hemicolectomy. Secondary aims included the prevalence of D3-metastasis and skip metastasis when performing CME + D3. Material and methods A systematic review with meta-analysis was conducted, according to PRISMA methodology. Results 29 studies were enrolled (2592 patients). No differences were accounted in morbidity variables associated with the measured techniques. CME + D3 was significantly associated with a greater distance between the tumour and the closest vascular tie, a longer colonic resection, a wider resection of mesentery and an increased number of harvested lymph nodes. Regarding to long-terms outcomes, we found a significant decrease in local recurrence in patients undergoing CME + D3 (HR:0.17) and a significant improvement in 3-year and 5-year overall survival rates (HR:0.53 vs. HR:0.57, respectively), as well as an improving survival in patients with stage II and III disease. Overall prevalence of patients with lymphatic metastases in D3-territory was of 8.6% and 2.2% of skip metastases. Conclusions CME + D3 is a feasible surgical procedure that allows to obtain specimens with higher quality oncological resection, without greater associated morbidity, thus improving survival in patients with stage II and III right colon cancer.

Published
2020

15. Surgical steps for right laparoscopic D3 lymphadenectomy in a patient with a giant duodenal diverticulum

Author

Francesc Xavier González-Argente, A. Ochogavia-Segui, A. Gil-Catalan, Álvaro García-Granero, Vicent Primo-Romaguera, Gianluca Pellino, S. Jeri-McFarlane, M. Gamundi-Cuesta, A. Blasco-Cerda, Jeri-McFarlane, S, García-Granero, Á, Gil-Catalan, A, Primo-Romaguera, V, Pellino, G, Ochogavia-Segui, A, Blasco-Cerda, A, Gamundi-Cuesta, M, and Gonzalez-Argente, F X

Subjects
medicine.medical_specialty, business.industry, General surgery, Gastroenterology, Duodenal diverticulum, Colorectal surgery, Diverticulum, D3 lymphadenectomy, Medicine, Humans, Lymph Node Excision, Surgery, Laparoscopy, business, Abdominal surgery, Human
Published
2020

16. 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

Author

Matteo Frasson, V. Primo Romeguera, Delfina Fletcher-Sanfeliu, E. García-Granero, L. Brogi, D. Garcia‐Calderón, Gianluca Pellino, Francisco Giner, Álvaro García-Granero, Francesc Xavier González-Argente, B. Flor Lorente, M. Gamundi, Garcia-Granero, A., Pellino, G., Giner, F., Frasson, M., Fletcher-Sanfeliu, D., Primo Romeguera, V., Flor Lorente, B., Gamundi, M., Brogi, L., Garcia-Calderon, D., Gonzalez-Argente, F. X., and Garcia-Granero, E.

Subjects
medicine.medical_specialty, business.industry, Colorectal cancer, Rectal Neoplasms, Gastroenterology, Locally advanced, Rectum, Margins of Excision, medicine.disease, Three dimensional imaging, Imaging, Three-Dimensional, Treatment Outcome, Vignette, Medicine, Humans, Circumferential resection margin, Radiology, Neoplasm Recurrence, Local, business, Recurrent Rectal Cancer, Neoplasm Staging
Published
2020

17. Indications and practice of diverting ileostomy after colorectal resection and anastomosis in ovarian cancer cytoreduction

Author

Víctor Lago, Vito Chiantera, Santiago Domingo, A. Tejerizo, Álvaro García-Granero, Christina Fotopoulou, P.A. Cascales-Campos, Antonio Gil-Moreno, Tiermes Marina, M. Jurado, Luis Matute, Luis Chiva, MC Di Donna, Jose Luis Sánchez-Iglesias, Pablo Padilla-Iserte, José Miguel Cárdenas-Rebollo, A. Olloqui, M.E. Malune, L Minig, Lago V., Fotopoulou C., Chiantera V., Minig L., Gil-Moreno A., Cascales-Campos P.A., Jurado M., Tejerizo A., Padilla-Iserte P., Malune M.E., Di Donna M.C., Marina T., Sanchez-Iglesias J.L., Chiva L., Olloqui A., Matute L., Garcia-Granero A., Cardenas-Rebollo J.M., and Domingo S.

Subjects
0301 basic medicine, medicine.medical_specialty, Bevacizumab, Anastomotic Leak, Gynecologic oncology, Anastomosis, Stoma, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Diverting ileostomy, Ovarian cancer, Anastomotic leak, Medicine, Humans, Practice Patterns, Physicians', Aged, Neoplasm Staging, Retrospective Studies, Ovarian Neoplasms, business.industry, Ileostomy, Anastomosis, Surgical, Obstetrics and Gynecology, Retrospective cohort study, Perioperative, Cytoreduction Surgical Procedures, medicine.disease, Neoadjuvant Therapy, Surgery, 030104 developmental biology, Risk factors, Oncology, 030220 oncology & carcinogenesis, Cohort, Female, Risk factor, business, Colorectal Neoplasms, medicine.drug
Abstract

Objective. To determine the factors related with diverting ileostomy performance after colorectal resection and anastomosis, in advanced ovarian cancer cytoreductive surgery. Methods. We have previously demonstrated the risk factors associated with anastomotic leak after colorectal anastomosis: Advanced age at surgery, low serum albumin level, additional bowel resections, manual anastomosis and distance of the anastomosis from the anal verge. However, use of diverting ileostomy is strongly variable and depends on individual surgeon preferences and training. Eight hospitals participated in this retrospective study. Data of 695 patients operated for ovarian cancer with primary colorectal anastomosis were included (January 2010-June 2018). Fourteen pre-/intraoperatively defined variables were identified and analysed as justification factors for use of diverting ileostomy. Results. The rate of diverting ileostomy in the entire cohort was 19.13% (133/695; range within individual centers 4.6-24.32%). Previous treatment with bevacizumab [OR 2.8 (1.3-6.1); p=0.01]; additional bowel resections [OR 3.0 (1.8-5.1); p

Published
2020

18. Preoperative surgical planning based on cadaver simulation and 3D imaging for a retrorectal tumour: description and video demonstration

Author

Matteo Frasson, D. Garcia‐Calderón, Juan García-Armengol, José Vicente Roig-Vila, E. García-Granero, Álvaro García-Granero, Gianluca Pellino, Delfina Fletcher-Sanfeliu, Alfonso A. Valverde-Navarro, M. Garcia‐Gausi, M Navasquillo-Tamarit, Pellino, G., García-Granero, A., Fletcher-Sanfeliu, D., Navasquillo-Tamarit, M., Frasson, M., García-Calderon, D., García-Gausi, M., Valverde-Navarro, A. A., Garcia-Armengol, J., Roig-Vila, J. V., and García-Granero, E.

Subjects
medicine.medical_specialty, Epidermal Cyst, MEDLINE, 030230 surgery, Surgical planning, Patient Care Planning, Pelvis, 03 medical and health sciences, Imaging, Three-Dimensional, 0302 clinical medicine, Cadaver, medicine, Humans, medicine.diagnostic_test, business.industry, Gastroenterology, Magnetic resonance imaging, Magnetic Resonance Imaging, Colorectal surgery, medicine.anatomical_structure, Preoperative Period, Female, 030211 gastroenterology & hepatology, Surgery, Radiology, Tomography, Tomography, X-Ray Computed, business, Abdominal surgery
Published
2018
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19. Surgical strategy for supralevator abscess in Perianal Crohn’s disease: emergency surgery and residual complex fistula

Author

M. Coll-Sastre, S. Jeri-McFarlane, D. Ginard-Vincens, M. Gamundi-Cuesta, A. Gil-Catalan, Álvaro García-Granero, Francesc Xavier González-Argente, and Andrea Craus-Miguel

Subjects
Perianal Crohn's disease, medicine.medical_specialty, Surgical strategy, business.industry, Fistula, Supralevator abscess, Gastroenterology, medicine.disease, Colorectal surgery, Surgery, Emergency surgery, medicine, business, Abdominal surgery
Published
2021
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20. Self-Expanding Metallic Stent as a Bridge to Surgery in the Treatment of Left Colon Cancer Obstruction: Cost–Benefit Analysis and Oncologic Results

Author

Andrés Peña, Vicente Sanchiz, Matteo Frasson, Andrés Cervantes, E. García-Granero, Álvaro García-Granero, Pedro Esclapez, Blas Flor-Lorente, Alejandro Espí, and Gloria Báguena

Subjects
Male, medicine.medical_specialty, Survival, Colorectal cancer, Cost-Benefit Analysis, medicine.medical_treatment, Perforation (oil well), Self Expandable Metallic Stents, Cost-benefit, 030230 surgery, Stoma, 03 medical and health sciences, 0302 clinical medicine, Stomas avoided, Colonic obstruction, Recurrence, Self-expandable metallic stent, medicine, Humans, Prospective Studies, Bridge to surgery, Colonic stenting, Aged, Cost–benefit analysis, business.industry, General Engineering, Stent, Cancer, Middle Aged, medicine.disease, Colon cancer, Surgery, Treatment Outcome, 030220 oncology & carcinogenesis, Colonic Neoplasms, Female, business, Intestinal Obstruction
Abstract

Introduction: The use of a self-expanding metallic stent as a bridge to surgery in acute malignant left colonic obstruction has been suggested as an alternative treatment to emergency surgery. The aim of the present study was to compare the morbi-mortality, cost-benefit and long-term oncological outcomes of both therapeutic options. Methods: This is a prospective, comparative, controlled, non-randomized study (2005-2010) performed in a specialized unit. The study included 82 patients with left colon cancer obstruction treated by stent as a bridge to surgery (n = 27) or emergency surgery (n = 55) operated with local curative intention. The main outcome measures (postoperative morbimortaliy, cost-benefit, stoma rate and long-term oncological outcomes) were compared based on an "intention-to-treat'' analysis. Results: There were no significant statistical differences between the two groups in terms of preoperative data and tumor characteristics. The technically successful stenting rate was 88.9% (11.1% perforation during stent placement) and clinical success was 81.4%. No difference was observed in postoperative morbi-mortality rates. The primary anastomosis rate was higher in the bridge to surgery group compared to the emergency surgery group (77.8% vs. 56.4%; P =.05). The mean costs in the emergency surgery group resulted to be (Sic)1,391.9 more expensive per patient than in the bridge to surgery group. There was no significant statistical difference in oncological long-term outcomes. Conclusions: The use of self-expanding metalllic stents as a bridge to surgery is a safe option in the urgent treatment of obstructive left colon cancer, with similar short and long-term results compared to direct surgery, inferior mean costs and a higher rate of primary anastomosis. (C) 2017 AEC. Published by Elsevier Espanna, S.L.U. All rights reserved.

Published
2017
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21. How to manage smoke evacuation and filter pneumoperitoneum during laparoscopy to minimize potential viral spread: different methods from SoMe ‐ a video vignette

Author

Felipe García Sanchez, Juan Luis Blas Laina, Francesc Xavier González-Argente, Alberto Vaquero Rodriguez, Elías Palma-Zamora, Nuria Martínez Sanz, Daniel Costa Henere, Carlos Yánez Benítez, Beatriz Fernández, Mariana García Virosta, Emilio Ros, Francesco Pata, Natalia Pujol Cano, Jose Miguel Morón Canis, Pedro López Morales, M. Alvarez-Gallego, Antonino Spinelli, Álvaro García-Granero, Miguel Hernández García, Pedro A. Parra Baños, Jorge Alejandro Benavides Buleje, Francesco Maria Carrano, Enrique Moncada Iribarren, Alberto San Ildefonso Pereira, Teresa Calderon Duque, Raquel Sánchez Santos, Vincenzo Vigorita, Alfredo Alonso Poza, Daniel Sánchez López, Eric Herrero Fonollosa, Gianluca Pellino, Isabel Pascual‐Miguelañez, Ana NoguEs Pedival, Julià Diez Izquierdo, Francesc Xavier Molina-Romero, M. Ruiz, Esther María Cano Pecharromán, and Beatriz Cros Montalban

Subjects
Smoke, medicine.diagnostic_test, business.industry, Gastroenterology, Insufflation, medicine.disease, Pneumoperitoneum, Control theory, Filter (video), medicine, Humans, Laparoscopy, Viral spread, business, Pneumoperitoneum, Artificial
Published
2020
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22. A mathematical 3D-method applied to MRI to evaluate prostatic infiltration in advanced rectal cancer

Author

Matteo Frasson, Blas Flor-Lorente, Francisco Giner, L. Brogi, Álvaro García-Granero, Vicent Primo Romaguera, D. Garcia‐Calderón, E. García-Granero, Delfina Fletcher-Sanfeliu, F X Gonzalez-Argente, Gianluca Pellino, M. Gamundi, Garcia-Granero, A., Pellino, G., Giner, F., Frasson, M., Fletcher-Sanfeliu, D., Romaguera, V. P., Flor-Lorente, B., Gamundi, M., Brogi, L., Garcia-Calderon, D., Gonzalez-Argente, F. X., and Garcia-Granero, E.

Subjects
Male, medicine.medical_specialty, Colorectal cancer, business.industry, Rectal Neoplasms, Gastroenterology, MEDLINE, Prostate, Rectum, Prostatic Neoplasms, medicine.disease, Magnetic Resonance Imaging, Colorectal surgery, medicine, Humans, Surgery, Radiology, business, Infiltration (medical), Abdominal surgery, Neoplasm Staging
Published
2020

23. Martius flap and sphincteroplasty as treatment for recurrent anovaginal fistula associated with anal incontinence: a video vignette

Author

A. Valverde Navarro, M. Millan, Jorge Sancho-Muriel, Santiago Domingo, E. García-Granero, Álvaro García-Granero, Matteo Frasson, V. Primo, and Hanna Cholewa

Subjects
medicine.medical_specialty, Fistula, business.industry, Gastroenterology, MEDLINE, Anal Canal, medicine.disease, Surgical Flaps, Surgery, Treatment Outcome, Vignette, medicine, Humans, business, Digestive System Surgical Procedures, Fecal Incontinence
Published
2020

24. Risk factors for anastomotic leakage after colorectal resection in ovarian cancer surgery: A multi-centre study

Author

MC Di Donna, A. Olloqui, M.E. Malune, Pablo Padilla-Iserte, L Minig, Álvaro García-Granero, P.A. Cascales-Campos, J.L. Sánchez-Iglesias, M. Jurado, Tiermes Marina, Vito Chiantera, V. Fornes, Luis Matute, Santiago Domingo, A. Tejerizo, Víctor Lago, Christina Fotopoulou, Antonio Gil-Moreno, Lago V., Fotopoulou C., Chiantera V., Minig L., Gil-Moreno A., Cascales-Campos P.A., Jurado M., Tejerizo A., Padilla-Iserte P., Malune M.E., Di Donna M.C., Marina T., Sanchez-Iglesias J.L., Olloqui A., Garcia-Granero A., Matute L., Fornes V., and Domingo S.

Subjects
0301 basic medicine, Leak, medicine.medical_specialty, Multivariate analysis, Anastomotic Leak, Anastomosis, Stoma, 03 medical and health sciences, 0302 clinical medicine, Ovarian cancer, Retrospective Studie, Risk Factors, Intestine, Small, medicine, Anastomotic leak, Humans, Age Factor, Colectomy, Serum Albumin, Aged, Retrospective Studies, Ovarian Neoplasms, Proctectomy, business.industry, Incidence (epidemiology), Ovarian Neoplasm, Risk Factor, Anastomosis, Surgical, Suture Techniques, Age Factors, Obstetrics and Gynecology, Retrospective cohort study, Middle Aged, medicine.disease, Posterior Pelvic Exenteration, Surgery, Pelvic Exenteration, 030104 developmental biology, Risk factors, Oncology, 030220 oncology & carcinogenesis, Female, Neoplasm Recurrence, Local, business, Human
Abstract

Objective. To determine pre-/intraoperative risk factors for anastomotic leak after modified posterior pelvic exenteration (MPE) or colorectal resection in ovarian cancer and to create a practical instrument for predicting anastomotic leak risk. Background. In advanced ovarian cancer surgery, there is rather limited published evidence, drawn from a small sample, providing information about risk factors for anastomotic leak. Methods. Eight hospitals participated in this retrospective study. Data on 695 patients operated for ovarian cancer with primary anastomosis were included (January 2010-June 2018). Twelve pre-/intraoperative variables were analysed as potential independent risk factors for anastomotic leak. A predictive model was created to stablish the risk of anastomotic leak for a given patient. Results. The anastomotic leak rate was 6.6% (46/695; range 1.7%-12.5%). A total of 457 patients were included in the final multivariate analysis. The following variables were found to be independently associated with anastomotic leakage: age at surgery (OR 1.046, 95% CI 1.013-1.080, p = 0.005), serum albumin level (OR 0.621, 95% CI 0.407-0.948, p = 0.027), one or more additional small bowel resections (OR 3.544, 95% CI 1.228-10.23, p = 0.019), manual anastomosis (OR 8.356, 95% CI 1.777-39.301, p = 0.007) and distance of the anastomosis from the anal verge (OR 0.839, 95% CI 0.726-0.971, p = 0.018). Conclusions. Due to the low incidence of AL in ovarian cancer patients, a restrictive stoma policy based on the presence of risk factors should be the actual recommendation. Hand-sewn anastomosis should be avoided. Crown Copyright (C) 2019 Published by Elsevier Inc. All rights reserved.

Published
2019

25. The fusion fascia of Fredet: an important embryological landmark for complete mesocolic excision and D3-lymphadenectomy in right colon cancer

Author

F Martinez-Soriano, Alberto Domenech Dolz, Gianluca Pellino, Álvaro García-Granero, Delfina Fletcher-Sanfeliu, E. García-Granero, Matteo Frasson, Luis Sabater Ortí, Fernando Bonilla, Luis Sánchez-Guillén, Alfonso A. Valverde-Navarro, Vicent Primo Romaguera, Garcia-Granero, A., Pellino, G., Frasson, M., Fletcher-Sanfeliu, D., Bonilla, F., Sanchez-Guillen, L., Domenech Dolz, A., Primo Romaguera, V., Sabater Orti, L., Martinez-Soriano, F., Garcia-Granero, E., and Valverde-Navarro, A. A.

Subjects
musculoskeletal diseases, Male, medicine.medical_specialty, Fredet, Lymphovascular invasion, Colorectal cancer, Adenocarcinoma, 03 medical and health sciences, 0302 clinical medicine, Colorectal surgery, Cadaver, Training, Medicine, Humans, Colorectal surgery, Fascia, Fredet, Laparoscopy, Surgical anatomy, Training, Prospective Studies, Superior mesenteric vein, Fascia, Colectomy, business.industry, Dissection, Surgical anatomy, Middle Aged, musculoskeletal system, medicine.disease, Trunk, Surgery, body regions, medicine.anatomical_structure, Outcome and Process Assessment, Health Care, 030220 oncology & carcinogenesis, Colonic Neoplasms, T-stage, Lymph Node Excision, 030211 gastroenterology & hepatology, Female, Laparoscopy, Peritoneum, business, Mesocolon
Abstract

Background: The fusion fascia of Toldt is a well-known landmark used by colorectal surgeons. On the contrary, the fusion fascia of Fredet (the plane between the ascending mesocolon and the visceral duodenal-pancreatic peritoneum) still remains a neglected embryological structure. Aim of this study was to provide an anatomic description of this fascia and its application to minimally invasive D3-lymphadenectomy (D3-L) and complete mesocolic excision (CME) for right colon cancer. Methods: First phase: Cadaveric dissection and anatomic description of the fascia of Fredet. Second phase: prospective evaluation of its surgical application ina consecutive series of laparoscopic right hemicolectomies with CME and D3-L at a tertiary hospital. Results: The fascia of Fredet was identified and dissected in one fresh and two formalin-fixed cadavers. The trunk of Henle and the medial border of the superior mesenteric vein defined the medial limit of this embryologic plane. Seventeen patients were operated on. Laparoscopic dissection of the fascia of Fredet was possible in every patient. Median operative time was 210 (120–380) min. There were no major postoperative complications. All cases were adenocarcinomas, except one adenomatous polyp. T stage was Tis in three, T2 in two, T3 in seven, and T4 in five patients. Median number of harvested lymph nodes was 24 (9–39). Lymphatic invasion was found in six patients. All resections were classified as satisfactory mesocolic excision and R0. Median postoperative length of stay was 6 (4–20) days. Median follow-up time was 28 (16–41) months. Local and distal recurrence rate was 0. Conclusion: The fusion fascia of Fredet is useful to achieve CME and D3-L in right colon cancers with reduced risk of intraoperative complications. This structure is particularly suitable for minimally invasive surgery; therefore, we encourage awareness of the fascia of Fredet by colorectal surgeons.

Published
2019

26. Prognostic Impact of pT Stage and Peritoneal Invasion in Locally Advanced Colon Cancer

Author

Susana Roselló, Andrés Cervantes, Eduardo García-Granero, Francisco Giner, Álvaro García-Granero, Gloria Baguena, Matteo Frasson, Gianluca Pellino, Baguena, Gloria, Pellino, Gianluca, Frasson, Matteo, Roselló, Susana, Cervantes, Andre, García-Granero, Alvaro, Giner, Francisco, and García-Granero, Eduardo

Subjects
Oncology, Male, medicine.medical_specialty, Survival, Colorectal cancer, medicine.medical_treatment, Locally advanced, T stage, Locally advanced colon cancer, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Colon cancer resection, Humans, Neoplasm Invasiveness, Risk factor, Stage (cooking), Survival rate, Colectomy, Peritoneal Neoplasms, Aged, Neoplasm Staging, Retrospective Studies, Carcinomatosis, Tumor-node-metastasis, business.industry, Gastroenterology, Retrospective cohort study, General Medicine, Middle Aged, medicine.disease, Prognosis, Colon cancer, Survival Rate, Treatment Outcome, 030220 oncology & carcinogenesis, Colonic Neoplasms, 030211 gastroenterology & hepatology, Female, Neoplasm Recurrence, Local, business
Abstract

BACKGROUND: TNM stage has been identified as an independent variable for local recurrence and survival after colon cancer resection. It is still unclear whether peritoneal invasion (pT4a) is a risk factor for adverse oncologic outcome or whether these patients have better results compared with contiguous organs infiltration (pT4b), independent from nodal status (pN). OBJECTIVE: The purpose of this study was to analyze whether peritoneal invasion is an independent risk factor for worse oncologic outcome after curative colon cancer resection. DESIGN: This was a retrospective analysis with multivariate regression of a prospective database, according to Strengthening the Reporting of Observational Studies in Epidemiology Statement. SETTINGS: The study was conducted in a specialized colorectal unit of a tertiary hospital. PATIENTS: A consecutive series of pT3-pT4a-pT4b patients with colon cancer who underwent curative surgery (1993-2010) were included, and patients with metastasis were excluded. MAIN OUTCOME MEASURES: A multivariate Cox regression analysis was performed to assess independent risk factors for 5-year local recurrence, peritoneal carcinomatosis-like recurrence, disease-free survival, and cancer-specific survival. RESULTS: A total of 1010 patients were analyzed (79.3% pT3, 9.9% pT4a, and 10.8% pT4b). At diagnosis, 22.0% had obstructive symptoms, and 10.5% had bowel perforation. A total of 72.2% of the surgeries were elective, and in 15.6% en bloc resection of contiguous organs was performed. Median follow-up was 62 months (38-100 mo). For the whole group, 5-year actuarial rates were 8.8% for local recurrence, 2.5% for peritoneal carcinomatosis, 75.5% for disease-free survival, and 81.8% for cancer-specific survival. At multivariate analysis, pT4a stage was an independent risk factor for local recurrence (p = 0.002; HR = 3.1), peritoneal carcinomatosis (p = 0.02; HR = 4.9), worse diseasefree survival (p = 0.002; HR = 1.9), and cancer-specific survival (p = 0.001; HR = 2.2). When considering only the 566 patients with >= 12 nodes identified, T stage was still associated with higher local recurrence (p = 0.04) and carcinomatosis rate (p = 0.04), as well as worse diseasefree (p = 0.009) and cancer-specific survival (p = 0.014). LIMITATIONS: This was a retrospective, single-center study. CONCLUSIONS: pT4a stage is an independent risk factor for worse oncologic outcome after curative colon cancer resection compared with pT3 and pT4b stages. The current pT4a-pT4b classification should be reconsidered. Of note, even in pT4a patients, 5-year carcinomatosis rate does not exceed 6%. See Video Abstract at http://links.lww.com/DCR/A926.

Published
2019

27. Pelvic exenteration in gynecologic cancer: complications and oncological outcome

Author

Luis Matute, Eduardo Simón-Sanz, Ines Poveda, Álvaro García-Granero, Pablo Padilla-Iserte, Víctor Lago, Santiago Domingo, and Jose Luis Pontones

Subjects
medicine.medical_specialty, Complications, Survival, medicine.medical_treatment, Reproductive medicine, lcsh:Surgery, 030230 surgery, VRAM, lcsh:Gynecology and obstetrics, 03 medical and health sciences, 0302 clinical medicine, Surgical oncology, Gynecologic cancer, medicine, lcsh:RG1-991, Relapsed cancer, Pelvic exenteration, medicine.diagnostic_test, business.industry, Obstetrics and Gynecology, Pelvic cancer, Interventional radiology, lcsh:RD1-811, Surgery, 030220 oncology & carcinogenesis, Palliative intent, Complication, business
Abstract

Introduction Pelvic exenteration (PE) is indicated in cases of unresponsive, recurrent pelvic cancer or for palliative intent. Despite the fact that the surgery is associated with a high rate of morbidity, it is currently the only real option that can effect a cure. Material and methods Patients who underwent PE between January 2011 and July 2017 in our centre were retrospectively reviewed. Data related to surgery, complications and outcomes were recorded. Results Twenty-three patients were included. PE was performed due to recurrent gynaecological cancer, persistence of disease and after first diagnosis in 19 (82%), 2 (9%) and 2 patients (9%), respectively. Total PE was performed in 15 cases (65%), followed by anterior PE in 5 cases (22%) and posterior PE in 3 cases (13%). Early grade II, III and IV complications occurred in 15 (65%), 5 (22%) and 2 patients (9%), respectively. No mortality was observed within 30 days. Medium-late grade II, III, IV and V complications occurred in 15 (65%), 11 (48%), 3 (13%) and 2 cases (9%), respectively. Two patients died after > 30-day period from surgery-related complications. The overall survival (OS) and disease-free survival (DFS) at 48 months after PE was 41.6% and 30.8% respectively. Conclusions PE provides about a 40% 4-year survival chance in a selected group of patients. The early-complications rate and 30-day mortality were acceptable. Nevertheless, the medium-late complication grades II–V were 65, 48, 18 and 9%, respectively. We must focus on identifying those patients who could potentially benefit most from PE.

Published
2019

28. An 'easy' method to understand perianal sepsis - a video vignette

Author

Delfina Fletcher-Sanfeliu, V. Primo Romaguera, Arantxa Blasco-Serra, Alfonso A. Valverde-Navarro, Matteo Frasson, Álvaro García-Granero, Juan García-Armengol, M. Garcia‐Gausi, José Vicente Roig-Vila, Víctor Lago, Gianluca Pellino, Primo Romaguera, V., Garcia-Granero, A., Fletcher-Sanfeliu, D., Pellino, G., Garcia-Gausi, M., Frasson, M., Lago, V., Blasco-Serra, A., Garcia-Armengol, J., Roig-Vila, J. V., and Valverde-Navarro, A. A.

Subjects
medicine.medical_specialty, Anus Diseases, Perianal sepsis, business.industry, Gastroenterology, MEDLINE, Anal Canal, Perineum, Abscess, Vignette, Sepsis, medicine, Cadaver, Humans, Female, Anatomic Landmarks, Intensive care medicine, business
Published
2019

29. 'Virtual ileostomy' combined with early endoscopy to avoid a diversion ileostomy in low or ultralow colorectal anastomoses. A preliminary report

Author

Eduardo García-Granero, Luis Sánchez-Guillén, Marta Ponce, Álvaro García-Granero, Matteo Frasson, Blas Flor-Lorente, Santiago Domingo, Gianluca Pellino, Vicente Paya, Flor-Lorente, Bla, Sánchez-Guillén, Lui, Pellino, Gianluca, Frasson, Matteo, García-Granero, Álvaro, Ponce, Marta, Domingo, Santiago, Paya, Vicente, and García-Granero, Eduardo

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Colorectal anastomosis, Pilot Projects, 030230 surgery, Anastomosis, Asymptomatic, Endoscopy, Gastrointestinal, Stoma, 03 medical and health sciences, Ileostomy, 0302 clinical medicine, Humans, Medicine, Anastomotic leak, Colorectal anastomosi, Aged, Retrospective Studies, Aged, 80 and over, medicine.diagnostic_test, business.industry, Anastomosis, Surgical, Middle Aged, Total mesorectal excision, Colorectal surgery, Endoscopy, Surgery, Virtual ileostomy, 030220 oncology & carcinogenesis, Ghost ileostomy, Female, Early postoperative endoscopy, medicine.symptom, Colorectal Neoplasms, business, Complication, Abdominal surgery
Abstract

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

30. Short article: Outcome of medical and surgical management for perforated jejunal diverticulitis

Author

Omar Carreño, Álvaro García-Granero, Matteo Frasson, Carmen Muniesa Gallardo, Francisco Giner, Gianluca Pellino, Brenda Geraldine Argüelles, Garcia-Granero, Alvaro, Argüelles, Brenda G., Gallardo, Carmen Muniesa, Carreño, Omar, Giner, Francisco, Pellino, Gianluca, and Frasson, Matteo

Subjects
Male, Reoperation, medicine.medical_specialty, Percutaneous, Time Factors, complications, medicine.medical_treatment, complication, Anastomosis, Conservative Treatment, diverticula, jejunoileal, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Risk Factors, small bowel, Laparotomy, medicine, perforation, Humans, Evisceration (ophthalmology), Digestive System Surgical Procedures, Diverticulitis, diverticuliti, Aged, Retrospective Studies, Hepatology, business.industry, Gastroenterology, Bowel resection, Perioperative, Jejunal Diseases, Surgical procedures, Length of Stay, medicine.disease, Surgery, diverticulitis, Treatment Outcome, Intestinal Perforation, 030220 oncology & carcinogenesis, Drainage, 030211 gastroenterology & hepatology, Female, Emergencies, business, Tomography, X-Ray Computed
Abstract

Objectives Perforated jejunal diverticulitis (PJD) is rare, but it has high mortality rates. The role of nonsurgical management is debated. The aim of this study is to assess the outcomes of medical and surgical management of PJD. Patients and methods A single-centre study on a series of emergency patients diagnosed with PJD between 2010 and 2016 was conducted. Results Eleven patients with PJD were treated (seven women). Nine out of 11 were diagnosed by a computed tomography scan, and two were diagnosed at laparotomy. The initial approach was medical treatment in five patients, based on clinical and imaging findings. Four (80%) of these five patients were discharged without the need for surgical intervention. The median hospital stay was 7.5 days. Seven patients required surgery overall with a median length of hospital stay of 10.8 days. Surgical procedures consisted of segmental bowel resection and primary anastomosis in six patients and simple closure in one. There was no perioperative deaths. One patient required percutaneous drainage because of anastomotic leak, and one required reoperation owing to evisceration. Discussion Selected patients with PJD can be successfully managed with conservative approach, based on clinical and computed tomography findings. Copyright (c) 2018 Wolters Kluwer Health, Inc. All rights reserved.

Published
2018

31. Ghost Ileostomy in Advanced Ovarian Cancer: A Reliable Option

Author

Luis Matute, Santiago Domingo, Álvaro García-Granero, Pablo Padilla-Iserte, Blas Flor, Marco Bustamante, and Víctor Lago

Subjects
Adult, medicine.medical_specialty, Colorectal cancer, medicine.medical_treatment, Rectum, Anastomotic Leak, Pilot Projects, Anastomosis, 03 medical and health sciences, Ileostomy, 0302 clinical medicine, Ovarian cancer, Diverting ileostomy, medicine, Humans, Prospective Studies, Prospective cohort study, Aged, Ovarian Neoplasms, business.industry, Obstetrics and Gynecology, Bowel resection, Middle Aged, medicine.disease, Surgery, medicine.anatomical_structure, Oncology, 030220 oncology & carcinogenesis, Colorectal resection, Ghost ileostomy, 030211 gastroenterology & hepatology, Female, business, Complication, Leakage
Abstract

ObjectiveDiverting ileostomy (DI) has been proposed to reduce the incidence and consequences anastomotic leakage after bowel resection. In colorectal cancer treatment, ghost ileostomy (GI) has been proposed as an alternative to DI. Our objective was to report the results of GI associated with colorectal resection in the treatment of ovarian cancer.Materials and MethodsThis is an observational pilot study performed in a single institution. The main objective sought was to report the results of GI associated with colorectal resection in the treatment of ovarian cancer: 26 patients were included.ResultsModified posterior exenteration was performed in 24 cases (92.3%) and rectum resection in the 2 cases of relapse (7.7%). After the main procedure GI was created, to check up the anastomosis status, a sequential postoperative rectoscopy was performed on postoperative day 5 ± 1 (range, 4–7). Serum levels were monitored in first and third postoperative days just with a descriptive intention to establish its relationship with the rectoscopy findings. In 2 cases, rectoscopy demonstrated a leakage. During postoperative course, no other complication related with the GI or DI was observed. No case of clinical anastomotic leakage was found.ConclusionsTo the extent of our knowledge, this is the first study in which GI has been performed for the treatment of patients with ovarian cancer. Ghost ileostomy represents a real option that may reduce the number of ileostomies performed in ovarian cancer without increasing the morbimortality. Ghost ileostomy presents the advantages of DI while avoiding its drawbacks. It also seems to be a safe, feasible, and reproducible technique that does not add significant costs to the surgery.

Published
2018

32. Anatomical strategy for complete laparoscopic mesocolic excision for splenic flexure colonic cancer - a video vignette

Author

Gianluca Pellino, Matteo Frasson, Luis Sánchez-Guillén, E Alvarez-Sarrado, Jose Pamies, Jorge Sancho-Muriel, Delfina Fletcher-Sanfeliu, F Martinez-Soriano, C. García-Amador, Álvaro García-Granero, Omar Carreño, Alfonso A. Valverde-Navarro, Garcia-Granero, A., Carreño, O., Sancho-Muriel, J., Alvarez-Sarrado, E., Fletcher-Sanfeliu, D., Sánchez-Guillén, L., Pellino, G., García-Amador, C., Pamies, J., Valverde-Navarro, A. A., Martinez-Soriano, F., and Frasson, M.

Subjects
Splenic flexure, medicine.medical_specialty, business.industry, Gastroenterology, 030230 surgery, Mesenteric Vein, Surgery, 03 medical and health sciences, 0302 clinical medicine, Colonic cancer, Vignette, Cadaver, medicine, Operative time, 030211 gastroenterology & hepatology, business
Published
2018

33. Simulation of Supralevator Abscesses and Complex Fistulas in Cadavers: Pelvic Dissemination and Drainage Routes

Author

Francisco Martinez Soriano, Álvaro García-Granero, Matteo Frasson, Jorge Sancho-Muriel, Delfina Fletcher-Sanfeliu, Alfonso A. Valverde-Navarro, Luis Sánchez-Guillén, and Eduardo Alvarez Sarrado

Subjects
Male, medicine.medical_specialty, Anal Canal, 030230 surgery, Pelvis, 03 medical and health sciences, 0302 clinical medicine, Cadaver, medicine, Humans, Rectal Fistula, Simulation Training, Supralevator abscesses, business.industry, General surgery, Complex fistula, Gastroenterology, Surgical anatomy, General Medicine, bacterial infections and mycoses, Abscess, Pelvis surgery, 030220 oncology & carcinogenesis, Drainage, Female, business
Abstract

BACKGROUND: Most perianal abscesses have a cryptoglandular origin, following the pathogenesis described by Parks in 1961. Supralevator abscesses have the most uncommon location. Nevertheless, such pathology results in a high morbidity because of their difficult diagnosis and treatment. OBJECTIVE: This study aimed to deepen the knowledge of the pathogenesis and management of supralevator abscesses, as well as the complications derived from incorrect treatment, by using simulation in cadavers. DESIGN: This study is an anatomosurgical description of pelvic and perianal zone and simulation of the different types of supralevator abscesses, their correct drainage routes, and secondary complex fistulas due to incorrect drainage. SETTINGS: This dynamic article is based on cadaveric simulation. PATIENTS: Three cadaveric pelvises (2 male and 1 female) were prepared in formalin and sagittally sectioned, and one perineal dissection was performed of a fresh male pelvis. This is an iconographic description of 3 patients treated for supralevator abscesses in our colorectal surgical unit. MAIN OUTCOME MEASURES: The virtual anatomical spaces map out a correct treatment. RESULTS: We reproduced the origin of the different types of supralevator abscesses, as well as their locations and possible drainage pathways, and we determined the definitive treatment of secondary fistulas and their morbidity due to their incorrect drainage. LIMITATIONS: The limitations of this study are inherent to anatomical studies without real case intervention. CONCLUSIONS: A proper anatomical knowledge of the supralevator abscesses and surgical training by using cadaveric simulations could improve the diagnostic criteria, facilitate the correct decision on surgical drainage pathways, and, thus, decrease postoperative morbidity in patients with this disease.

Published
2018

34. Application of three-dimensional printing in laparoscopic dissection to facilitate D3-lymphadenectomy for right colon cancer

Author

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

35. Surgical anatomy of D3 lymphadenectomy in right colon cancer, gastrocolic trunk of Henle and surgical trunk of Gillot - a video vignette

Author

Delfina Fletcher-Sanfeliu, Matteo Frasson, Álvaro García-Granero, J J Delgado-Moraleda, Alfonso A. Valverde-Navarro, Jorge Sancho-Muriel, Gianluca Pellino, E Alvarez-Sarrado, L Sabater Ortí, Luis Sánchez-Guillén, García-Granero, Ã ., Sánchez-Guillén, L., Fletcher-Sanfeliu, D., Sancho-Muriel, J., Alvarez-Sarrado, E., Pellino, G., Delgado-Moraleda, J. J., Sabater Ortí, L., Valverde-Navarro, A. A., and Frasson, M.

Subjects
medicine.medical_specialty, Colon, Colorectal cancer, medicine.medical_treatment, 03 medical and health sciences, 0302 clinical medicine, Surgical anatomy, Colon surgery, Cadaver, medicine, Humans, Colectomy, business.industry, Gastroenterology, medicine.disease, Trunk, Surgery, Vignette, 030220 oncology & carcinogenesis, Gastrocolic trunk, Colonic Neoplasms, Lymph Node Excision, 030211 gastroenterology & hepatology, Anatomic Landmarks, business, Mesocolon
Published
2018

36. How to reduce the superior mesenteric vein bleeding risk during laparoscopic right hemicolectomy

Author

Alfonso Navarro, Delfina Fletcher-Sanfeliu, Javier Corral Rubio, Matteo Frasson, Jose Pamies, Álvaro García-Granero, Jorge Sancho Muriel, Eduardo Alvarez Sarrado, Blas Flor Lorente, Luis Sánchez-Guillén, E. García-Granero, and Francisco Martinez Soriano

Subjects
Male, medicine.medical_specialty, Hemorrhage, Anastomosis, Extracorporeal, 03 medical and health sciences, 0302 clinical medicine, Mesenteric Veins, Cadaver, Risk Factors, medicine, Humans, Superior mesenteric vein, Colectomy, business.industry, Right colic vein, Dissection, Gastroenterology, Transverse colon, Exteriorization, Middle Aged, Surgery, medicine.anatomical_structure, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Female, Laparoscopy, Cadaveric spasm, business
Abstract

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. 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. 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. 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
2017

37. Importance of the Moskowitz artery in the laparoscopic medial approach to splenic flexure mobilization: a cadaveric study

Author

Matteo Frasson, Omar Carreño, J Sancho Muriel, D. Fletcher Sanfeliu, Luis Sánchez-Guillén, F Martinez Soriano, E. García-Granero, B. Flor Lorente, E Alvarez Sarrado, and Álvaro García-Granero

Subjects
Left colic artery, Male, medicine.medical_specialty, Moskowitz, Anastomosis, Lesser sac, Splenic flexure, 03 medical and health sciences, 0302 clinical medicine, Cadaver, Mesenteric Artery, Superior, medicine.artery, medicine, Humans, Pancreas, business.industry, Gastroenterology, Mesenteric Artery, Inferior, Anatomy, Middle Aged, Surgery, Middle colic artery, medicine.anatomical_structure, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Female, Laparoscopy, Cadaveric spasm, business, Laparoscopic medial approach, Artery, Colon, Transverse, Mesocolon
Abstract

Background The medial approach in laparoscopic splenic flexure mobilization is based on the entrance to the lesser sac just above the ventral edge of the pancreas (VEOP). The artery of Moskowitz runs through the base of the mesocolon, just above the VEOP. The aim of this study was to assess the incidence of the artery of Moskowitz, its route and its distance from the VEOP. Methods We performed a cadaveric study on 27 human cadavers. The vascular arcades of the splenic flexure were dissected, the number of vascular arches, and the origin and localization of its terminal anastomosis were recorded. The splenic flexure avascular space (SFAS) was defined as the avascular zone in the mesocolon delimited by the VEOP, middle colic artery, ascending branch of the left colic artery and the vascular arch of the splenic flexure nearest to the VEOP and was quantified as the distance between the VEOP and the most proximal arch. Results The artery of Drummond was identified in 100% of the cadavers. In 5 of 27 (18%) Riolan's arch was present, and in 3 of 27 (11%) the Moskowitz artery was found. The mean distance from the VEOP to the artery of Moskowitz was 0.3 cm (SD 0.04). This vascular arch travelled from the origin of the middle colic artery to the distal third of the ascending branch of the left colic artery. The SFAS was greater (p = 0.001) in cadavers that only presented the artery of Drummond (mean 6.8 cm; SD 1.25) than in those with Riolan's arch (mean 4.5 cm; SD 0.5). Conclusions In the medial approach for laparoscopic mobilization of the splenic flexure, when only one of the arches is present, the avascular area is an extensive and secure territory. If the artery of Moskowitz is present, the area is nonexistent and this would contraindicate the approach due to risk of iatrogenic bleeding. A radiological preoperatory study could be essential for accurate and safe surgery in this area.

Published
2017

38. Management of cryptoglandular supralevator abscesses in the magnetic resonance imaging era: a case series

Author

Eduardo García-Granero, Alejandro Espí, Itziar Puchades, Omar Carreño, Álvaro García-Granero, Blas Flor-Lorente, Pablo Granero-Castro, and Matteo Frasson

Subjects
Adult, Male, Reoperation, Anal fistula, medicine.medical_specialty, Fistula, Supralevator abscess, Lumen (anatomy), Surgical Flaps, Recurrence, medicine, Humans, Rectal Fistula, Aged, Retrospective Studies, Anus Diseases, medicine.diagnostic_test, business.industry, Gastroenterology, Magnetic resonance imaging, Retrospective cohort study, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Abscess, Surgery, Catheter, Referral center, Female, Radiology, business
Abstract

The aim of this study is to describe the diagnostic performance of magnetic resonance imaging in the management of supralevator abscess, regarding its origin, location, drainage route, subsequent treatment of the fistula, and long-term results. A retrospective case series including thirteen consecutive patients with cryptoglandular supralevator abscess treated between 2001 and 2011 at a colorectal unit of a tertiary referral center. A magnetic resonance imaging was performed in all patients before surgical drainage, and its usefulness in assessing supralevator abscess origin was analyzed. Short- and long-term results after drainage were also evaluated. The final diagnosis of supralevator abscess and the location described in the magnetic resonance were confirmed intraoperatively in all patients. An ischiorectal origin was identified in nine patients, and perineal translevator drainage was performed placing a mushroom catheter through the ischiorectal or the postanal space. Four patients underwent secondary treatment of anal fistula: two rectal advancement flap and two non-cutting seton. In the other four patients, an intersphincteric origin was identified and transanal surgical drainage was performed placing a long-term mushroom catheter. Several weeks later, transanal unroofing of the residual cavity was performed and the fistula lay open to the anorectal lumen. In the long-term follow-up (median 61 months), only patients with supralevator abscess of ischiorectal origin in whom fistula was not subsequently treated presented a recurrence of the anal sepsis. Magnetic resonance imaging seems essential to clarify the location of supralevator abscess, its origin, and choice of the right drainage route. Subsequent treatment of the fistula is necessary to avoid recurrence.

Published
2014
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39. Type I thoracoabdominal aortic aneurysm: Intercostal reimplantation by the 'snake' technique

Author

Ivan Martín-González, Álvaro García-Granero, Delfina Fletcher-Sanfeliu, and Cristina Rueda Muñoz

Subjects
Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Aortic Aneurysm, Thoracic, business.industry, Aorta, Thoracic, 030204 cardiovascular system & hematology, medicine.disease, Surgery, Blood Vessel Prosthesis Implantation, 03 medical and health sciences, Aortic aneurysm, Thoracic Arteries, Treatment Outcome, 0302 clinical medicine, Text mining, 030228 respiratory system, Replantation, medicine, Humans, Cardiology and Cardiovascular Medicine, business
Published
2018
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40. Inferior mesenteric vein as initial landmark for laparoscopic medial to lateral dissection of descending colon - a video vignette

Author

Matteo Frasson, F Martinez-Soriano, Álvaro García-Granero, Luis Sánchez-Guillén, D. Fletcher Sanfeliu, B. Flor Lorente, and G. Wagner Tustanowski

Subjects
medicine.medical_specialty, business.industry, Gastroenterology, Anatomy, Dissection (medical), medicine.disease, Inferior mesenteric artery, Surgery, Descending colon, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, 030220 oncology & carcinogenesis, medicine.artery, Cadaveric dissection, Medicine, Inferior mesenteric vein, 030211 gastroenterology & hepatology, business, Video based, Lateral approach
Abstract

The root of the inferior mesenteric artery is an important area where autonomic nerves are close by, the dissection can be hard and laborious in order to avoid nerve damage; and the separation of mesocolon and retroperitoneum in this area can sometimes be difficult. The inferior mesenteric vein dissection is an alternative option as the first step during medial to lateral approach of laparoscopic left mesocolon mobilisation, as we have shown in this video based on two real cases and two anatomical cadaveric dissection. This article is protected by copyright. All rights reserved.

Published
2017

41. Individual surgeon is an independent risk factor for leak after double-stapled colorectal anastomosis: An institutional analysis of 800 patients

Author

Eduardo García-Granero, Franco G. Marinello, Alejandro Espí, Carlos Cerdán Santacruz, Matteo Frasson, Álvaro García-Granero, Francisco Navarro, and Blas Flor-Lorente

Subjects
Male, medicine.medical_specialty, Leak, Colon, Colorectal cancer, Anastomotic Leak, 030230 surgery, Anastomosis, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Colon surgery, Surgical Stapling, Humans, Medicine, Colectomy, Aged, Retrospective Studies, Surgeons, Rectal Neoplasms, business.industry, Mortality rate, Anastomosis, Surgical, Hollow viscera, Rectum, Retrospective cohort study, Colorectal anastomosis, Middle Aged, medicine.disease, Surgery, Elective Surgical Procedures, 030220 oncology & carcinogenesis, Colonic Neoplasms, Female, Clinical Competence, Radiology, business
Abstract

Background. Our aim was to assess whether the individual surgeon is an independent risk factor for anastomotic leak in double-stapled colorectal anastomosis after left colon and rectal cancer resection. Methods. This retrospective analysis of a prospectively collected database consists of a consecutive series of 800 patients who underwent an elective left colon and rectal resection with a colorectal, double-stapled anastomosis between 1993 and 2009 in a specialized colorectal unit of a tertiary hospital with 7 participating surgeons. The main outcome variable was anastomotic leak, defined as leak of luminal contents from a colorectal anastomosis between 2 hollow viscera diagnosed radiologically, clinically, endoscopically, or intraoperatively. Pelvic abscesses were also considered to be an anastomotic leak. Radiologic examination was performed when there was clinical suspicion of leak. Results. Anastomotic leak occurred in 6.1 % of patients, of which 33 (67%) were treated operatively, 6 (12%) with radiologic drains, and 10 (21 %) by medical treatment. Postoperative mortality rate was 2.9% for the whole group of 800 patients. In patients with anastomotic leak, mortality rate increased up to 16% vs 2.0% in patients without anastomotic leak (P

Published
2017

42. The use of an endostapler in the treatment of supralevator abscess of intersphincteric origin

Author

Matteo Frasson, Pablo Granero-Castro, Omar Carreño, Álvaro García-Granero, Eduardo García-Granero, and Blas Flor-Lorente

Subjects
medicine.medical_specialty, Supralevator abscess, Fistula, Endoscopy, Gastrointestinal, Anal abscess, Surgical Staplers, Surgical Stapling, medicine, Humans, Stage (cooking), Abscess, Crohn's disease, Anus Diseases, business.industry, General surgery, Gastroenterology, Technical note, endostapler, medicine.disease, Surgery, supralevator abscess, Catheter, Treatment Outcome, Drainage, business, Follow-Up Studies
Abstract

Aim This technical note describes the use of an endostapler for the definitive treatment of supralevator abscess upward from an intersphincteric origin. Method A two-stage treatment was performed. First an endoanal drainage was performed by inserting a mushroom catheter in the supralevator abscess cavity. In the second stage transanal unroofing of the fistula was performed with an endostapler. Results Since 2011, three patients have been treated in this way. After 2 years of follow up, none of the patients had recurrence of the abscess or been referred for anal incontinence. Conclusion The use of an endostapler in the treatment of supralevator abscess of intersphincteric origin may be an alternative to decrease the risk of recurrence and incontinence.

Published
2013

43. Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Author

Stephen R Knight, Catherine A Shaw, Riinu Pius, Thomas M Drake, Lisa Norman, Adesoji O Ademuyiwa, Adewale O Adisa, Maria Lorena Aguilera, Sara W Al-Saqqa, Ibrahim Al-Slaibi, Aneel Bhangu, Bruce M Biccard, Peter Brocklehurst, Ainhoa Costas-Chavarri, Kathryn Chu, Anna Dare, Muhammed Elhadi, Cameron J Fairfield, J Edward Fitzgerald, Dhruv Ghosh, James Glasbey, Mark I. van Berge Henegouwen, J.C. Allen Ingabire, T Peter Kingham, Marie Carmela Lapitan, Ismaïl Lawani, Bettina Lieske, Richard Lilford, Janet Martin, Kenneth A McLean, Rachel Moore, Dion Morton, Dmitri Nepogodiev, Faustin Ntirenganya, Francesco Pata, Thomas Pinkney, Ahmad Uzair Qureshi, Antonio Ramos-De la Medina, Aya Riad, Hosni Khairy Salem, Joana Simões, Richard Spence, Neil Smart, Stephen Tabiri, Hannah Thomas, Thomas G Weiser, Malcolm West, John Whitaker, Ewen M Harrison, Arben Gjata, Maria Marta Modolo, Sebastian King, Erick Chan, Sayeda Nazmun Nahar, Ade Waterman, Dominique Vervoort, Alemayehu Ginbo Bedada, Bernardo De Azevedo, Ana Gabriela Figueiredo, Manol Sokolov, Venerand Barendegere, Gerald Ekwen, Arnav Agarwal, Qinyang Liu, Juan Camilo Correa, Kalisya Luc Malemo, Jacques Bake, Jakov Mihanovic, Kamila Kunčarová, Julius Orhalmi, Hosni Salem, Jyri Teras, Aristotelis Kechagias, Alexis P Arnaud, Judith Lindert, Vasileios Kalles, Maria-Lorena Aguilera-Arevalo, Gustavo Recinos, Zsolt Baranyai, Basant Kumar, Harish Neelamraju Lakshmi, Sanoop Koshy Zachariah, Philip Alexander, Sunil Kumar Venkatappa, C Pramesh, Radhian Amandito, Christina Fleming, Luca Ansaloni, Gianluca Pellino, Ahmed M. Altibi, Ibrahim Nour, Intisar Hamdun, Ali M. Ghellai, Donatas Venskutonis, Tomas Poskus, Justas Zilinskas, Precious Malemia, Yong Yong Tew, Elaine Borg, Sarah Ellul, fatima Zahraa Wafqui, David W Borowski, Anne Sophie van Dalen, Cameron Wells, Harissou Adamou, Adesoji Ademuyiwa, Adewale Adisa, Kjetil Søreide, Sara Al Saqqa, Osaid Alser, Haya Tahboub, Helmut Alfredo Segovia Lohse, Sebastian Shu Yip, Piotr Major, António Sampaio Soares, Matei Razvan Bratu, Andrey Litvin, Armen Vardanyan, JC Allen Ingabire, Ahmad Gudal, Naif Albati, Jovan Juloski, Miran Rems, Sarah Rayne, Stephanie Van Straten, Yoshan Moodley, Irene Ortega Vázquez, Jaime Ruiz-Tovar, Kithsiri Janakantha Senanayake, Sujeewa Priyantha Bandara Thalgaspitiya, Omer Abdelbagi Omer, Anmar Homeida, Yucel Cengiz, Daniel Clerc, Muhammad Alshaar, Hanen Bouaziz, Yuksel Altinel, Matthew Doe, Maryna Freigofer, Ella Teasdale, Rakan Kabariti, Joshua Michael Clements, Stephen Richard Knight, Ahsan Ashfaq, Ijeoma Azodo, Gabriela Wagner, Ivan Trostchansky, Mayaba Maimbo, David Linyama, Helidon Nina, Amanda Zeko, Claudio Gabriel Fermani, Santiago Villalobos, Federico Carballo, Pablo Farina, Sebastian Guckenheimer, Marilla Dickfos, Ankit Ajmera, Chester Chong, Ralph Gourlay, Sikandar Hussaini, Yi Jia Lee, Adeeb Majid, Peter Martin, Rebecca Miles, Owen James Morris, Jamie Phua, William Ridley, Tarunpreet Saluja, Ryan Renxin Tan, Jen Teh, Anna Wells, Bharti Arora, Qaasim Dollie, Debbie Ho, Yanru Ma, Omattage Mahasha Perera, Anthony Truong, Amanda Caroline Dawson, Bryan Lim, Upuli Pahalawatta, Jacqueline Phan, Xiao-Ming Sarah Woon-Shoo-Tong, Andrea Yeoh, Lillian Charman, Andrew Drane, Sharon Laura, Charmaine Chu Wen Lo, Amy Mozes, Rita Poon, Hao Han Tan, Ellen Wall, Prakshi Chopra, Jasmine De Giovanni, Bal Dhital, Brian Draganic, Alexander Duller, Jonathan Gani, Yao Kuan Goh, Jun Young Jeong, Brendan McManus, Prakash Nagappan, Peter Pockney, Anya Rugendyke, Mahsa Sarrami, Stephen Smith, Vanessa Wills, Hsu Ven Wong, Geoffrey Ye, Geoffrey Zhang, Ethan Brooker, Daniel Feng, Bonnie Lau, Carlin Ngai, Sarah Birks, David Gyorki, Jaime Otero de Pablos, Ali Abbosh, Chris Gillespie, Ahmed Mahmoud, Bianca Kwan, Joshua Lawson, Andrea Warwick, Janne Bingham, Andrew J Cockbain, Nagendra Naidu Dudi-Venkata, Jordan Ellaby-Hall, Ben Finlay, Emily Humphries, Jade Pisaniello, Monique Pisaniello, Salma Salih, Tarik Sammour, Haidar Hadri Abd Wahab, April De Silva, Nicola Hayward, Kartik Iyer, Guy Maddern, Gian Andrea Prevost, Naga Annapureddy, Krishna Pranathi Settipalli, Jeremy Yeo, Lucy Hempenstall, Lily Pham, Shaun Purcell, Cherry Talavera, Ashish I Vaska, Gurpreet Chaggar, Phillip Chrapko, Annelise Cocco, Sarah Michelle Crystal Jade Coulter-Nile, Grahame Ctercteko, James French, Houchen Gong, Martijn Gosselink, Thuvarahan Jegathees, Ivan Jin, Michelle Kalachov, Kathryn Kiefhaber, Katherine Lee, Jason Luong, Steven Phan, Henry Pleass, Kelly Veale, Zhi Zeng, Angela Au, Ashe DeBiasio, Idy Deng, Jananee Myooran, Amrita Nair, Peter Stewart, Anton Stift, Lukas Walter Unger, Kerstin Wimmer, Nabila Ahmed, Syed Hasan, Saber Rahman, Margaret O'Shea, Greg Padmore, Adrian Peters, Pietro Perduca, Guenda Pulcina, Nicolas Tinton, Frederic Buxant, Elsa Dabin, Giulia Garofalo, Francis Dossou, Freddy Houehanou Rodrigue Gnangnon, Yacoubou Imorou Souaibou, Pako Motlaleselelo, Omphile Tlhomelang, Igor Lima Buarque, Gustavo Mendonça Ataíde Gomes, Aldo Vieira Barros, Ilia Batashki, Nikolai Damianov, Vladislav Stoyanov, Dragomir Dardanov, Svilen Maslyankov, Plamen Petkov, George Todorov, Evgeni Zhivkov, Aygulya Akisheva, Miguel Angel Castilla Moreno, Geno Genov, Ivelina Ilieva, Tsvetomir Ivanov, Martin Karamanliev, Azhar Khan, Emil Mitkov, Tsanko Yotsov, Boyko Atanasov, Nikolay Belev, Mihail Slavchev, Carlos Nsengiyumva, Elgan Jones, Simon Stock, Steve Kyota, James Brown, Tresor Mabanza K., Lemery Nigo Samuel, Chidi Otuneme, Ngwang Prosper, Franklin Umenze, Marylise Boutros, Natasha Caminsky, Sinziana Dumitra, Richard Garfinkle, Dominique Morency, Ebram Salama, Alexander Banks, Lorenzo Ferri, Haitian He, Amit Katz, Alexander Sender Liberman, Sarkis Meterissian, Allison Pang, Elena Parvez, Usmaan Hameed, Fahima Osman, Sangita Sequeira, Natalie Coburn, Alisha Jaffer, Paul Karanicolas, Matthew Mosseler, Reilly Musselman, Xinyuan Liu, Ching Wan Yip, Juan Sebastian Garces-Otero, Carolina Guzman, Sebastian Sierra, Andres Uribe Valencia, Paulo Andrés Cabrera Rivera, Saul Camelo, Andrea Gonzalez, Alejandro González-Orozco, Manuel Santiago Mosquera Paz, Carlos J- Perez Rivera, Felipe Gonzalez, Andres Isaza-Restrepo, Laura Nino- Torres, Natalia Arias Madrid, Maria Clara Mendoza Arango, Justin Tsandiraki, Damir Jemendžić, Branislav Kocman, Oliver Šuman, Renata Canic, Darko Jurišić, Ivana Karakas, Ana Krizanovic Rupcic, Vlatka Pitlovic, Josip Samardžić, Mario Kopljar, Ivan Bacic, Edgar Domini, Robert Karlo, Danijela Miljanić, Andrea Simic, Mariam Ahmed, Majdi Al Nassrallah, Rabiya Altaf, Talal Amjad, Ruba Eltoum, Heba Haidar, Alhassan Hassan, Omar Khalil, Marwan Qasem, Rommel Ramesh, Gautham Sajith, Maham Wisal, Jan Žatecký, Michele Bujda, Katerina Jirankova, Ales Paclik, Aya Abdallah, Mariam Abdulgawad Almogy, Esraa Ayman El-sawy, Ahmed Moustafa ElFayoumy, Nourhan Elghareeb, Nourhan Ahmed Esmat, Ahmed Fadel, Abdullah Habater, Heba Hamdy, Amr Hefni, Marwa Kamal, Norhan Mohamed Abobakr, Ahmed Sayed, Nancy Shaker, Ehab Taha, Hoda Tharwat, Omar Zakaria, Ibrahem Abdelmotaleb, Ali Al-Dhufri, Hamza S. Al-Himyari, Enas El sheikh, Asmaa Eldmaty, Aya Elkhalawy, Ahmed M.Elkhashen, Kithara Magdy, Safa Mostafa, Habib Doutoum Sadia, Mohamed mahmoud Saleh, Dina Samir, Mohamed Yahia Mohamed Ali, Mahmoud A. Nassar, Samar Abdelhady, Aly Abdelrazek, Israa Abdelsalam, Aya El-Sawy, Eman Essam, Mohamed Gadelkarim, Khaled Ghaly, Mohamed Hassabalnaby, Rana Masarani, Nourhan Mohamed Shaaban, Ahmed Sabry, Menatalla Salem, Nourhan Akram Soliman, Diaaaldin Zahran, Moustafa Ramadan Abou El.soud, Esraa Tarek Badr, Hala Borham, Nehal Elmeslemany, Mohammad Elsayed, Fawzia Elsherif, Sara Eslam, Gehad Gaber, Sondos Ibrahim, Yara Kamh, Abdelrahman Mahmoud, Shimaa gamal Mohamed, Eman Morshedy, Cinderella Omar, Fatima Salem Soliman, Shaza Abdelkawy, Naglaa Abdelmohsen, Mahmoud Abdelshakour, Ahmed Dahy, Norhan Gamal, Mohammed Gamal, Ahmad Hasan, Helal Hetta, Nehad Mousa, Mohamed Omar, Somia Rabie, Mahmoud Saad, Bakeer Saleh, Marwa Sayed Mohamed, Muhammad Shawqi, Heba Abdelhady Mousa, Mostafa Alnoury, Mohamed Elbealawy, Ahmed Elshafey, Muhammad Essam Ibrahim El Desouki Muhammad Ahmed, Mennatullah Ghonaim, Fawzy Hgag, Mohamed Ibrahim, Mahmoud Morsy, Mohamed Reda Loaloa, Ahmed Refaat, Hadeer Samir, Fatma Shahien, Mohamed Sobhy, Fathy Sroor, Esraa Abdellatif, Marina Adel, Amr Abdelghani Afifi, Eman Afifi, Marco Antaky, Amr Dawoud, Naira El Zoghby, Amira El-remaily, Ali Abdelazez Elzanfaly, Ahmed Gadallah, Fatma Alzahraa Gamal, Omar Hashem, Shrouk Medhat Youssef, Aliaa Muhammad Attyah, Malak Munir, Omar Shazly, Esraa Taha, Karim Wilson, Sawsan Adel, Asmaa Ali, Esraa Eid, Esraa Elhelow, Marwa Elmahdy, Bassant Elshatby, Amany Hossam el-din Zakaria, Ahmad Hossny, Eman Ibrahim, Ahmed M.Yonis, Maram Metwalli, Basant Yousry, Esraa Zid, Mina A Yacoub, Ahmed Abdelhakim, Nervana Abouelsoad, Mo'min Alkhatib, Ahmed Ashraf, Alaa Ashraf, Yasmin Elazab, Mahmoud Elfanty, Osama Elkabir, Mai Elsayed, Ahmed Elshimy, Hager Elsobky, John Eskander, Ahmed Gad, Ward Hamsho, Noura Khaled Abdelwahed, Menna Magdy, Dalia Moharam, Abeer Osama, Shereen Ramadan, Radwa Roum, Taqwa Sayed, Tarneem Shehada, Ahmed Mohy Zidan, Khalid Abbas, Amr Ali, Mohamed Attia, Mohamed Balata, Ayman El Nakeeb, Mohamed Ibrahim Elsayed Elewaily, Ahmed Elfallal, Hossam Elfeki, Ahmed Elkhadragy, Sameh Emile, Helmy Ezzat, Hasnaa Hosni, Islam Mansour, Waleed Omar, Gehad Othman, Kareem Sadek, Mostafa Shalaby, Noura Shehab-Eldeen, Rawda Anas khalifa, Helmy Badr, Mostafa Eldeep, Ahmed Eldeep, Amany Eldoseuky mohammed, Salwa Khallaf, Eman Magdy Hegazy, Rokia Mahmoud, Pola Mikhail, Mahmoud Morsi, Sara Mowafy, Dina Raafat, Amina Safy, Marwa Sera, Ahmed shible Sera, Mostafa Salim Mohamed AbdAllah, Muhammad Abdelkader, Abdulrahman Osama Abdou, Ahmedgaber Ahmed, Shireen Gaafar, Fatma Ibrahim negm, Mina Lapic, Ahmed Maher, Hagar Mahmoud, Ahmed Mostafa, Mohamed Samir, Fatma Samy, Nourhan Semeda, Hind I. Shalaby, Alaa El-taweel, Ahmed Galal Elnagar, Ahmed Gamal Hemidan, Mohamed Hussein, Ahmed.A. Kandil, Mf Moawad, Ayat Allah Nasser Hamamah, Mostafa Soliman, Mohamed Abdelkhalek, Noura Abdelmaksoud Tawakel, Ahmed Mohamed Abdelwahed, Alrawy Abdou, Khalid Atallah, Mohammed Yasser Elsherbeny, Eman Emara, Mohamed Hamdy, Omar Hamdy, Amira Haron, Salma Ismail, Islam Hany Metwally, Nihal Mohamed Hamed Elgaml, Ahmed Nassar, Basel Refky, Mirna Sadek, Mahmoud Saleh, Asmaa Yunes, Mai Zakaria, Mohammed Zuhdy, Notila Fayed, Mohammed Mustafa Hassan Mohammed, Sander Kütner, Priit Melnik, Indrek Seire, Toomas Ümarik, Eppu Ainoa, Verner Eerola, Hanna Koppatz, Laura Koskenvuo, Ville Sallinen, Sini Takala, Jevgeni Katunin, Arto Turunen, Niki Christou, Muriel Mathonnet, Vincent Lavoue, Krystel Nyangoh Timoh, Lucie Soulabaille, Romain Lesourd, Aude Merdrignac, Laurent Sulpice, Benoît André, Elodie Chantalat, Charlotte Vaysse, Bertrand Dousset, Sebastien Gaujoux, Gregory Martin, Octavian Clonda, Domantas Juodis, Klaus Kienle, Andras Mravik, Samuel Palmer, Gabor Szabadhegyi, Anita Eseenam Agbeko, Solomon Gyabaah, Frank Enoch Gyamfi, Nuhu Naabo, Atta Owusu senior, Joseph Yorke, Frank Owusu, Francis Abantanga, Theophilus Teddy Kojo Anyomih, Abdul-Jalilu Mohammed Muntaka, Emmanuel Owusu Abem, Mohammed Sheriff, Paul M. Wondoh, Dimitrios Balalis, Dimitrios Korkolis, Georgios Gkiokas, Eirini Pantiora, Theodosios Theodosopoulos, Argyrios Ioannidis, Konstantinos Konstantinidis, Sofia Konstantinidou, Nikolaos Machairas, Anna Paspala, Anastasia Prodromidou, Christos Chouliaras, Konstantinos Papadopoulos, Ioannis Baloyiannis, Ioannis Mamaloudis, George Tzovaras, Ioanna Akrida, Maria-Ioanna Argentou, Stylianos Germanos, Evangelos Iliopoulos, Ioannis Maroulis, George Skroubis, George Theofanis, Christos Chatzakis, Orestis Ioannidis, Lydia Loutzidou, Panagiotis Karathanasis, Nikolaos Michalopoulos, Charalampos Theodoropoulos, Dimitrios Theodorou, Tania Triantafyllou, Zoe Garoufalia, Natasha Hasemaki, Michalis Kontos, Gregory Kouraklis, Stylianos Kykalos, Theodore Liakakos, Eustratia Mpaili, Alexandros Papalampros, Dimitrios Schizas, Athanasios Syllaios, Ekaterini Christina Tampaki, Antonios Tsimpoukelis, Maria Ioanna Antonopoulou, Eirini Deskou, Dimitrios K. Manatakis, Dimitrios Papageorgiou, Menelaos Zoulamoglou, Christos Anthoulakis, Michalis Margaritis, Nikolaos Nikoloudis, Veronica Campo, André Ceballos, Mario-Andrés Flores, Waleska Giron, Donghyun Ko, Gabriel Martinez, Verónica Rivera Lara, Nataly Rueda, Andres Sanchez, Jorge Carlos Guillermo Tejeda Garrido, Alvaro Eduardo Alvarez Rivera, Elvis Benjamin Bamaca Ixcajoc, Lilian Elizabeth Barreda Zelaya, Patricia Chacòn-Herrera, Ligia Margarita Corea Ruiz, Guillermo Echeverria-Davila, Mario Garcia, Danilo García, Edgar Fernando Gutiérrez Mayen, Noriega José, Nery Mazariegos, Diego Méndez, Michael Paniagua Espinoza, David Bardos, Marton Benke, Kristof Illes, Balint András Kokas, Réka Szabó, Akhila Appukuttan, Anjitha Asok, Vijaykumar D.k, Kapil Malik, Praveen Ravishankaran, Ritesh Tapkire, Guru Moorthy, Joyner Abraham, Ramesh Muthuvel, John Alapatt, Abhay Kattepur, Nizamudheen Pareekutty, Mebanshanbor Garod, Caleb Harris, Cliff Wanniang, Ashish Gupta, Deepak Nehra, Sanjeev Parshad, Rajgopal Acharya, Rajendra Badwe, Manish Bhandare, Urvashi Jain, Karishma Kirti, Nita Nair, Shailesh Shrikhande, Purvi Thakkar, Premkumar Anandan, Archana C S, Arun Holenarasipur Narasannaiah, Tejaswi Jagarlamudi, Rashmi M R, Mallikarjuna Manangi, Abhishek Raghavendra, K. Seshagiri Rao, Vinay S, Vinay Sajjan, Aneesh Shenoy, Santhosh Shivashankar Chikkanayakanahalli, Kavya Tharanath, Sushmita V, Peter Adidharma, Raksheeth Agarwal, Phebe Anggita Gultom, Ghafur Rasyid Arifin, Matthew Billy, Zatira Elfizri, Alessa Fahira, Devi Felicia, Triana Hardianti Gunardi, Nadya Johanna, Nadia Rahmadiani Nugrahadi, Sonar Soni Panigoro, Siti Rahmayanti, Retta Catherina Sihotang, Santi Yuanita Brata, Hadi Winoto, Nastaran Barati, Manoochehr Karami, Hamidreza Khorshidi, Homa Naderifar, Mazin A. Abdulla, Maggie Coleman, Ronan J Doherty, Rob Hannon, Brenda Murphy, Aine Stakelum, Des Winter, Lylas Aljohmani, Richard Farnan, Yeshey Seldon, Tanna Tan, Shriya Varghese, Mohammad Alherz, Muaaz Ather, Mohammad Bajilan, Vivien Graziadei, Isobel Pilkington, Omar Quidwai, Paul Ridgway, Haaris Shiwani, Abd al-Rahman Tahir, Eimear Blunnie, Daniel Burke, Niall Kennedy, Kate Macdonagh, Maeve O'Neill, Siobhan Rooney, Giuseppe Falco, Guglielmo Ferrari, Simone Mele, Gabriela Elisa Nita, Lara Ugoletti, Maurizio Zizzo, Gianmaria Confalonieri, Giovanni Pesenti, Fulvio Tagliabue, Gianluca Baronio, Deborah Ongaro, Giacomo Pata, Bruno Compagnoni, Renato Salvadori, Lucio Taglietti, Nicola D'Alessandro, Pierpaolo Di Lascio, Giovanni Pascale, Luca Bortolasi, Tommaso Campagnaro, Massimo Carlini, Giorgio Lisi, Davide Lombardi, Corrado Pedrazzani, Domenico Spoletini, Giulia Turri, Paola Violi, Donato Francesco Altomare, Fabrizio Aquilino, Nicola Musa, Vincenzo Papagni, Arcangelo Picciariello, Leonardo Vincenti, Dario Andreotti, Savino Occhionorelli, Matteo Tondo, Stefano Maria Massimiliano. Basso, Paolo Ubiali, Riccardo Cirelli, Marco Enrico Mario Maino, Guglielmo Niccolò Piozzi, Emanuele Picone, Rosa Scaramuzzo, Giovanni Sinibaldi, Alfonso Amendola, Lorenzo Anastasio, Luigi Bucci, Emanuele Caruso, Antonio Castaldi, Sara Di Maso, Vincenza Paola Dinuzzi, Giovanni Esposito, Maria Gaudiello, Mariano Cesare Giglio, Paola Antonella Greco, Gaetano Luglio, Andrea Manfreda, Ester Marra, Federica Mastella, Gianluca Pagano, Roberto Peltrini, Vincenzo Pepe, Michele Sacco, Viviana Sollazzo, Giovanni Spiezio, Ettore Cianchetti, Nunzia Menduni, Michele Maria Carvello, Francesca Di Candido, Antonino Spinelli, Fabio Corsi, Luca Sorrentino, Fabio Marino, Emanuele Luigi Giuseppe Asti, Luigi Bonavina, Emanuele Rausa, Martina Asta, Andrea Belli, Francesco Bianco, Carmela Cervone, Paolo Delrio, Armando Falato, Andrea Fares Bucci, Rita Guarino, Ugo Pace, Daniela Rega, Emilia De Luca, Gaetano Gallo, Giuseppe Sammarco, Giuseppe Sena, Giuseppina Vescio, Letizia Santandrea, Giampaolo Ugolini, Davide Zattoni, Nicola Chetta, Gaetano Logrieco, Serafino Vanella, Gianluca Garulli, Nicola Zanini, Andrea Bondurri, Francesco Cammarata, Francesco Colombo, Diego Foschi, Giulia Maria Beatrice Lamperti, Anna Maffioli, Gianluca Matteo Sampietro, Al'ona Yakushkina, Gloria Zaffaroni, Enrico Cicuttin, Maria Grazia Sibilla, Harmony Impellizzeri, Marco Inama, Gianluigi Moretto, Sylvie Mochet, Elisa Ponte, Antonella Usai, Stefano Mancini, Andrea Sagnotta, Luigi Solinas, Elisa Bolzonaro, Nicolò Tamini, Gianluca Curletti, Raffaele Galleano, Michele Malerba, Sofia Campanella, Gianfranco Cocorullo, Francesco Colli, Paolino De Marco, Nicolò Falco, Tommaso Fontana, Leonel jospin Kamdem Mambou, Antonella La Brocca, Leo Licari, Brenda Randisi, Giovanna Rizzo, Giulia Rotolo, Giuseppe Salamone, Roberta Tutino, Paolina Venturelli, Stefano Malabarba, Alessandro Sgrò, Ivan Vella, Bruno Cirillo, Daniele Crocetti, Giorgio De Toma, Pierfrancesco Lapolla, Andrea Mingoli, Paolo Sapienza, Angela Belvedere, Stefania Bianchini, Margherita Binetti, Arianna Birindelli, Valeria Tonini, Mauro Podda, Fabio Pulighe, Michele De Rosa, Lorenzo Bono, Felice Borghi, Paolo Geretto, Maria Carmela Giuffrida, Corrado Lauro, Alessandra Marano, Luca Pellegrino, Paola Salusso, Diego Sasia, Michela Campanelli, Alberto Realis Luc, Mario Trompetto, Roberto Cardia, Nicola Cillara, Antonio Nicola Giordano, Antonio Costanzo, Mario Alessandro Giovilli, Luca Turati, Silvestro Canonico, Guido Sciaudone, Francesco Selvaggi, Lucio Selvaggi, Nader Albsoul, Ahmad AlBsoul, Ala'a Aldeen Alkhatib, Osama Alsallaq, Justin Z. Amarin, Rami Ayoub, Isam Bsisu, M S El Muhtaseb, Mohammad Jabaiti, Jamal Melhem, Yasmeen Z. Qwaider, Mohammad Hasan Salameh, Ahmad Suleihat, Haya H. Suradi, Mohammad Alammarin, Almoutuz Aljaafreh, Mohammad Bani hani, Zeina Bani hani, Farah Bani Hani, Toqa Fahmawee, Shadi Hamouri, Cyrine Katanani, Ra'fat Tawalbeh, Tamara Tawalbeh, Hassan Zawahrah, Mohamad K. Abou Chaar, Lana Abusalem, Mahmoud Al-Masri, Hani Al-Najjar, Lutfi Barghuthi, Zahra Ahmed, Adnan Maulana, Omar Ngotho, Charbel Kamau, Aruyaru Stanley Mwenda, Fridah Bosire, Elizabeth Mwachiro, Robert Parker, Ian Simel, Kimutai Sylvester, Abdulmunem Ahmed Mustafa Althini, Sofian Elbarouni, Aya Elseed Elbeshina, Ahmed Gwea, Ans Malek, Wedad Albashir Masoud Farag, Abdulwahab Abdalei, Abu Baker Abdel Malik, Areej Abo-khammash, Ma'aly Abuhlaiga, Nour Adnan, Marwa Albaggar, Asma Alfitory, Asma Aljanfi, Fakhruddin Almuzghi, Zohoor Altumei, Fatima Alzabti, Hana Ashoushan, Mohamed Assalhi, Joma Azzubia, Sondos Bnhameida, Malik Delhen, Houssein Elshafei, Hana Elteir, Fatima Esbaga, Abdel Aziz Gobbi, Fatma Hamouda, Hamdan Hilan, Rania Ismail, Fieruz Jebran, Muataz Kasbour, Galia Maderi, Saja Mohammad, Burooj Mohammed, Habib Murtadi, Hamassat Mustafa, Mohamed Rajab, Sarah Trenba, Mariam Wafaa, Eman Al Sagheir, Alabas Almigheerbi, Ahmed Alzahaf, Sumayyah Ghayth Bahroun, Najah Ben Dallah, Mahmoud Elshaibani, Haitem Eswaye, Maha Karar, Samah Omar, Eman Younes, Maha Younes, Dafer Zreeg, Saleh Abujamra, Firas Ashour, Mala Elgammudi, Wesal Omar F. Aljadidi, Enas Saddouh, Randa Sharif, Aya Alabuzidi, AbdulMawlay Alwerfally, Sarra Aribi, Fatma Bibas, Taha Elfaituri, Yasmine Elhajjaji, Ala Khaled, Wegdan Khalil, Tesneem Layas, Enas Soula, Ahmed Tarek, Muad fathi khalleefah Abu hallalah, Hazem Abdelkarem Ahmed, Tagwa Alsharef, Abdulsalam Ali Ben Saoud, Tasnim El Gharmoul, Ahmed Elhadi, Safa Elrais, Abdulhalim Shebani, Heba Zarti, Asaid Zeiton, Marijus Ambrazevicius, Nerijus Kaselis, Migle Stakyte, Oleg Aliosin, Agne Cizauskaite, Sarunas Dailidenas, Vitalijus Eismontas, Migle Kybransiene, Vitalija Nutautiene, Narimantas Samalavicius, Dainius Simcikas, Algirdas Slepavicius, Albinas Tamosiunas, Nerijus Ubartas, Paulius Zeromskas, Saulius Bradulskis, Edvinas Dainius, Juozas Juočas, Egle Kubiliute, Juozas Kutkevičius, Aurimas Opolskis, Audrius Parseliunas, Andrejus Subocius, Egle Virbickaite, Diana Zuikyte, Algirdas Bogusevicius, Kristina Buzaite, Daiva Čepuliené, Ieva Cesleviciene, Vaidotas Cesna, Jolanta Gribauskaite, Povilas Ignatavicius, Mantas Jokubauskas, Monika Liugailaitè, Ernest Margelis, Ruta Mazelyte, Lina Pankratjevaitè, Matas Pažusis, Agne Rackeviciute, Justina Saladyte, Monika Škimelytè, Vygintas Šlenfuktas, Monika Sudeikyte, Algimantas Tamelis, Tomas Vanagas, Žygimantas Žumbakys, Aivaras Atkociunas, Audrius Dulskas, Justas Kuliavas, Justas Birutis, Sigitas Paškevičius, Mindaugas Šatkauskas, Donatas Danys, Matas Jakubauskas, Lina Jakubauskiene, Marius Kryzauskas, Vytautas Lipnickas, Gabija Makūnaitè, Fanjandrainy Rasoaherinomenjanahary, Herizo Rasolofonarivo, Luc Hervé Samison, Bitiel Banda, Vanessa Msosa, Ahmad Imran Ahmad Izzuddin, Andre Das, Ying Yee Gan, Tan Shong Sheng, Jia yng Siaw, Mohd Fadliyazid Ab Rahim, Dyg Zahratul Hamrak Abang Jamari, Nurfariza Che Husin, Muhd Yusairi Kamarulzaman, Yi Ping Lim, Nil Amri Mohamed Kamil, Mohd Razeen Mohd Hassan, Saidah Mohd Sahid, Johari Mustafa, Elaine Hui Been Ng, Wan Khamizar Wan Khazim, Ng Chang Ern, P.g. Lingeshan, Syariz Ezuan Sulaiman, Sue Ean Ang, Muhammad Navid Bin Mohamad Sithik, Yih Jeng Cheong, Mahadevan Deva Tata, Law Jia Xian, Aravinthan Kadravello, I-Ern Koh, Li-Yen Ng, Yuki Julius Ng We Yong, Kandasami Palayan, Chi Xuan Sam, Phuah Siow Jin, Jeremy Tan Ern Hwei, Yita Tang, Alvin Zubin Ter, Michael Pak-Kai Wong, Andee Dzulkarnaen Zakaria, Zaidi Zakaria, Fitjerald Henry, Thyivya Kalaiselvan, Muhammad Fairuz Shah Abd Karim, Mohamed Rezal Abdul Aziz, Nora Abdul Aziz, Tak Loon Khong, Peng Choong Lau, Hiong Chin Lim, April Camilla Roslani, Jonathan Chen Ken Seak, Sui-Weng Wong, Lai Fen Wong, Leow Yeen Chin, Mercy Chinemerem Anyanwu, Zachary Busuttil, Thomas Calleja, Kurt Lee Chircop, Ruth Cutajar, Andrew Michael Dimech, Joseph Galea, Kiara Gascon Perai, Ruth Gatt, Lisa Kelman, Elizabeth Micallef, Favour Nwolu, Kim Sammut, Joanna Thompson, Sean Warwicker, Matthew Zammit, Fernando Cordera, Efraín Cruz González, Jorge Sánchez-García, Francisco José Barbosa Camacho, Francisco Javier Barrera López, Carlos Jose Zuloaga Fernandez del Valle, Eric Acosta, Iván Romarico González Espinoza, Perla Moreno, Ana Olivia Cortes-Flores, Clotilde Fuentes Orozco, Alejandro Gonzalez Ojeda, Samantha Corro Díaz González, Laura Martinez, Bonifacio Mosqueda Amador, Armando Novoa, Dennet Arturo Olazo Espejo, Alejandro Jimenez, Federico Lopez Rosales, Elva Gabriela Vanoye, Luis Alberto Garcia Gonzalez, Roberto Carlos Miranda-Ackerman, Manuel Solano-Genesta, Alethia Alvarez-Cano, Hector Hugo Romero-Garza, Heriberto Medina-Franco, Lorelí Mejía-Fernández, Noel Salgado-Nesme, Omar Vergara-Fernandez, Guadalupe Montserrat Gutiérrez-Mota, Francisco Xavier Hernandez Vera, Anabella Llantada Lopez, Gilberto Morgan Villela, Felipe de Jesus Ramirez Padilla, Walezka Tapia Marin, Mónica Martínez Maldonado, Ramses Sánchez Suárez, José Manuel Troche, Chaymae Benyaiche, Oumaima Outani, Souadka Amine, Amine Benkabbou, Anass Mohammed Majbar, Raouf Mohsine, Ali Rafik, Thida Oung, Moe Moe Tin, Philipp Plarre, Anna Alberga, Nina Sluiter, Jurriaan Tuynman, Robin Blok, Didem Cömert, Roel Hompes, Marianne Kalff, Merel Elisabeth Stellingwerf, Pieter Tanis, Mark van Berge Henegouwen, Elise Maria van Praag, Daan Wisselink, Michael Gerhards, Josephine Lopes Cardozo, Emma Westerduin, Joske de Jonge, Aaw van Geloven, Kaz van Schilt, Frank den Boer, Simone Stoots, Stijn Vlek, Jamie Adams, Ibrahim S. Al-Busaidi, Gabrielle Budd, Seung il Choi, Michael Jen Jie Chu, Anurag Ganugapati, Lucy McKinstry, Rebecca Pascoe, Simon Richards, Kenrick Rosser, Annie Stevenson, Rebecca White, Shebani Farik, Jin Kwun, Ahmed Murad, Sarah Cowan, Timothy Hall, Michael Hayton, Laminou Malam Sani, Souleymane Oumarou Garba, Ibrahim Amadou Magagi, Oumarou Habou, Halima Aliyu, Muhammad Daniyan, Tunde T. Sholadoye, Lawal Abdullahi, Lofty-John Anyanwu, Aminu Mohammad Mohammad, Abubakar Bala Muhammad, Abdurrahman Abba Sheshe, Ibrahim Suleiman, Alaba Adesina, Ajibola Awolowo, Clement Onuoha, Omotayo Salami, Ogechukwu Taiwo, Agboola Taiwo, Stephen Kache, Jerry Godfrey Makama, Danjuma Sale, Olajide Abiola, Akinlabi Ajao, Anthony Ajiboye, Amarachukwu Etonyeaku, Julius Olaogun, Ademola Adebanjo, Opeoluwa Adesanya, Michael Olatunji Afolayan, Olanrewaju Balogun, Ayomide Makanjuola, Samuel Nwokocha, Rufus Wale Ojewola, Thomas Olagboyega Olajide, Adewale Aderounmu, Abdul-Rashid Adesunkanmi, Augustine Agbakwuru, Adeleke Akeem Aderogba, Olusegun Isaac Alatise, Olukayode Arowolo, Oladejo Lawal, Tajudeen Mohammed, Chinedu Ndegbu, Olalekan Olasehinde, Funmilola Wuraola, Akinbolaji Akinkuolie, Arinzechukwu Mosanya, Omobolaji Ayandipo, Peter Elemile, Taiwo Akeem Lawal, Samuel Ali SANI, Stephen Garba, Rebecca Hauwa SANI, Samson Olori, Henry Onyebuashi, Ifeanyi Umoke, Adedire Adenuga, Ademola Adeyeye, Olufemi Habeeb, Bashir Lawal, Abdulrasheed Nasir, Eirik Kjus Aahlin, Didrik Kjønås, Elisabeth Myrseth, Jibran Abbasy, Abdul Alvi, Omair Saleem, Asma Afzal, Anam Nazir, Muhammad Farooq, Ayesha Liaqat, Syed Asghar Naqi, Ali Raza, Muzna Sarfraz, Muhammad Sarwar, Muntaha Banglani, Ambreen Munir, Rahmat Sehrish, Bushra Ayub, Raza Sayyed, Amna Altaf, Saima Ayub, Komal Saeed, Bilal Syed, Sana Amir Akbar, Abdul Wahid Anwer, Ruqayya Naheed Khan, Amina Iqbal Khan, Shahid Khattak, Sameen Mohtasham, Muhammad Asad Parvaiz, Aamir Ali Syed, Abdul Basit Ansari, Noman Shahzad, Tanwir Khaliq, Isbah Rashid, Shahzad Hussain Waqar, Hasan Abu Al-saleem, Amjad Abu Alqumboz, Mohammad Alqadi, Adham Amro, Rawan Assa, Eman Awesat, Rawan Ayyad, Mohammed Hammad, Ayat Haymony, Bassel Hijazi, Bara Hmeidat, Rowaa Lahaseh, Aseel Qawasmi, Alaa Rajabi, Mohammed Shehada, Sundus Shkokani, Yasmine Yaghi, Nadine Yaghi, Mohammad AlZohour, Mohammad Farid, Yousef Mahmoud Habes, Wesam Juba, Yanal Nubani, Abdelrahman Rabee, Mohammad Sa'deh, Saeed Abed, Iyad Al basos, Mohammad Alswerki, Dina Ashour, Israa Awad, Samar Diab, Alaa El Jamassi, Sahar El-Kahlout, Somaya Elhout, Ahmed N K Hajjaj, Doaa Hasanain, Baraa Nabil hajjaj, Mohammed Obaid, Eman Saikaly, Ahmed Salhi, Hiba Al-Tammam, Murad Almasri, Muath Baniowda, Doha Beshtawi, Ali Horoub, Rami Misk, Bayan Mohammad, Rami Qasrawi, Tasnim Sholi, Samar Abu-Nimeh, Abrar Abu-srour, Sadi A. Abukhalaf, Samer Adawi, Barah Alsalameh, Kholoud Ayesh, Muawiyah Elqadi, Ahmad Hammouri, Fatima Karim Mustafa, Natalie Marzouqa, Shatha Melhem, Dima Miqdad, Balqees Mohamad, Mhammed Rawhi, Ayman B. Abu Ahammala, Ahmed Abu Ataya, Israa Abu Jayyab, Samar Al-Shwaikh, Othman Alagha, Mohammed Alasttal, Haneen Awadallah, Mahmood Elblbessy, Jehad Fares, Akram Jarbou, Ibtisam Mahfouz, Moath A. Albahnasawi, Asmaa' Abo mahadi, Hasan Abuelhatal, Ayham Abuelqomboz, Abdelrahman Almoqayyad, Abdallah Alwali, Reem Balaawi, Mahmoud Hamouda, Mohammed Humeid, Abdullah Jedyan, Tasneem Mahmoud Abu hamam, Ghadeer Matar, Ali Salem, Tahani Samra, Nureddin Shaheen, Karam Shihada, Ayoob A.Nemer, Mahmoud Abu Al Amrain, Abdulwhhab Abu Alamrain, Najlaa Abu Jamie, Mohammed R. Abu-Rous, Nada Alfarra, Mohammed AlTaweel, Noor Alwhaidi, Ramadan Hamed, Bader Saqqa, Ahmad Shaheen, Dana Aljaber, Loay Aljaberi, Malak Alwaheidi, Assef Jawaada, Hani Khaldi, Rami Qahoush, Jalil Qari, Rana Saadeh, Ahlam Salim, Aseel Yacoub, Abbas Abbas, Rana Abu shua'ib, Baraa Abu Zainah, Mahmoud AbuSirrees, Basheer Babaa, Ola Barhoush, Asef Belal qadomi, Laith Daraghmeh, Reema Haji, Alaa Khatatbeh, Lana Khatib, Salsabeel Qarariah, Yara Quzmar, Khalil Safadi, Roqaya Salameh, Mohammad Hassan, Shifaa Herzallah, Loai Massad, Ahmed Nazzal, Ranin Nazzal, Dennis Escobar, Gustavo Miguel Machain V, Agustin Rodriguez Gonzalez, Jorge Emerson Chachaima Mar, Nathaly Olga Chinchihualpa Paredes, Vicente Cuba, Walter Lopez, Maria Milagros Niquen Jimenez, Nestor Alberto Sanchez Bartra, Olenka Sapallanay Ojeda, Diego Sequeiros, Andrea Toscano Pacheco, María Vergara, Sol Abarca, Rodrigo Alcorta, Giuliano Borda-Luque, Ivan Edward Eusebio Zegarra, Claudia Luján López, Mirella Marrufo, Cinthya Mogrovejo, Andrea Nomura, Yamile Rodríguez Angeles, Maitza Rosario Vidal Meza, Gabriela Zavala, José Neiser Castillo Arrascue, Jomara Caroline Hidrogo Cabrera, José Julio Mariano Larrea vera, Miguel Osorio, Edgar Alcides Ylatoma Díaz, Mark Anthony Fontanilla, Joseph Roy Fuentes, Anna Leah Salazar, Genieve Dominguez, Marc Paul Lopez, Shiela Macalindong, Mark Augustine Onglao, Arjel Ramirez, Marie Dione Sacdalan, Mayou Martin Tampo, Gemma Leonora Uy, Jeremiah Mangahas, Kenneth Yabut, Joannes Paul Cañete, Bernalynn Eris Cansana, Ernes John Castro, Maria Kaiserin Lipana, Manuel Francisco Roxas, Vlu Jean Zara, Maciej Chroł, Paula Franczak, Michał Orłowski, Piotr Budzyński, Andrzej Budzyński, Pawel Bury, Agata Czerwińska, Jadwiga Dworak, Jacek Dziedzic, Michał Kisielewski, Jan Kulawik, Anna Lasek, Piotr Małczak, Marcin Migaczewski, Michał Pędziwiatr, Magdalena Pisarska, Dorota Radkowiak, Mateusz Rubinkiewicz, Anna Rzepa, Tomasz Skoczylas, Maciej Stanek, Katarzyna Truszkiewicz, Mateusz Wierdak, Marek Winiarski, Piotr Zarzycki, Anna Zub-Pokrowiecka, Piotr Kowalewski, Rafał Roszkowski, Maciej Walędziak, Miguel Tomé, Sara Patrocinio, Ines Guerreiro, Filipe Almeida, Xavier de Sousa, Nuno Monteiro, Maria Teresa Costa Santos, Daniela de Oliveira, Marta Lopes Serra, Daniela Morgado, Christian Neves, Ana Carolina Oliveira, Alice Pimentel, Sofia Silva, Márcia Carvalho, Lúcia Carvalho, Joana Magalhães, Leonor Matos, Tânia Monteiro, Carlota Ramos, Vanessa Santos, José Barbosa, Jose Costa-Maia, Vítor Devezas, Ana Fareleira, Cristina Fernandes, Diana Gonçalves, Henrique Mora, Marina Morais, Fabiana Silva de Sousa, Sara Catarino Santos, Ana Logrado, André Tojal, Edgar Amorim, Miguel F. Cunha, Ana Fazenda, João Pedro Melo Neves, Inês Isabel Sampaio da Nóvoa Gomes Miguel, Diogo Veiga, José Azevedo, Hugo Cardoso Louro, Mariana Leite, Maria Bairos Menezes, Bárbara Gama, Diana Brito, Marta Cristina Cruz Martins, André Graça e Magalhães, Ana Catarina Longras, Rita Lourenço, Diana Matos, Luis Castro, Filipa Policarpo, Joana Romano, Cristina Monteiro, Diogo Pinto, Marina Duarte, Sónia Fortuna Martins, Mariline Oliveira, Diogo Galvão, Lisandra Martins, Anaisa Silva, Viorel Taranu, Bárbara Vieira, Jessica Neves, Simone Oliveira, Hugo Ribeiro, Margarida Cinza, Rosa Felix, Arnaldo Machado, Joana Oliveira, Joana Patrício, Rita Pedroso de Lima, Mário Pereira, Miguel Rocha Melo, Cristina Velez, Alberto Abreu da Silva, Mariana Claro, Daniel Costa Santos, Andreia Ferreira, Hugo Capote, Daniela Rosado, Filipa Taré, Oriana Nogueira, Miguel Ângelo, José Miguel Baiao, Andreia Guimarães, João Marques, Miguel Nico Albano, Marta Silva, Ana Valente da Costa, Teresa Vieira Caroço, Sara Almeida Braga, Ines Capunge, Marta Fragoso, João Guimarães, Bruno Pinto, João Ribeiro, Miguel Angel, Guilherme Fialho, Monica Guerrero, Filipa Campos Costa, Diogo Cardoso, Vasco Cardoso, Magda Alves, Inês Estalagem, Tiago Louro, Cláudia Marques, Rita Martelo, Miguel Morgado, Rita Canotilho, Ana Margarida Correia, Pedro Martins, Mariana Peyroteo, João Gomes, Rita Monteiro, Manuela Romano, Daniela Macedo Alves, Rita Peixoto, Catarina Quintela, Maria João Jervis, Débora Melo, André Pacheco, Valter Paixão, Vera Pedro, Joana Pimenta, João Pimenta de Castro, Ana Rocha, Mircea Beuran, Cezar Ciubotaru, Bogdan Diaconescu, Sorin Hostiuc, Ionut Negoi, Bogdan Stoica, Evgeny Anokhin, Georgy Kuznetsov, Giorgi Oganezov, Fedor Paramzin, Ekaterina Romanova, Valeryan Rutkovskii, Vasilii Rutkovskii, Mikhail Shushval, Mikhail Zabiyaka, Khasan Dzhumabaev, Valerii Ivanov, Zaman Mamedli, Sergey Achkasov, Artem Balkarov, Elnur Nabiev, Marat Nagudov, Evgeny Rybakov, Karina Saifutdinova, Oleg Sushkov, Lule Joseph, Isaac Ndayishimiye, Ntirenganya Faustin, Alphonse Zeta Mutabazi, Jean Paul Mvukiyehe, Vizir J.P Nsengimana, Carine Uwakunda, Mohammad Monir Abbas, Nouf Akeel, Murad Aljiffry, Kholoud Awaji, Ali Farsi, Ghader Jamjoum, Ahmad Khoja, Ashraf Maghrabi, Nadim Malibary, Mohammed Nassif, Abdulaziz Saleem, Abdullah Sultan, Wail Tashkandi, Hanaa Tashkandi, Nora Trabulsi, Mouhamadou Bachir Ba, Adja Coumba Diallo, Abdourahmane Ndong, Vladica Cuk, Uroš Janković, Sharon Zhiling Koh, Frederick Koh, Kuok Chung Lee, Kai Yin Lee, Sean Lee, Wei Qi Leong, Su Ann Lui, Prajwala Prakash, Jan Grosek, Gregor Norcic, Ales Tomazic, Nicolas Fitchat, Robert Jaich, Devorah Wineberg, Modise Zacharia Koto, Daniella Baiocchi, Damian Clarke, Christina Johanna Steenkamp, Sharon Bannister, Adam Boutall, Galya Chinnery, Anna Coccia, Angela Dell, Parveen Karjiker, Christo Kloppers, Nicholas Loxton, Tumi Mabogoane, Francois Malherbe, Eugenio Panieri, Shreya Rayamajhi, Tirsa van Wyngaard, Claire Warden, T E Madiba, Nivashen Pillay, Savannah Brooks, Charlise Kruger, Lisa Hannah Van Der Merwe, Ferhana Gool, Maahir Kariem, Heather Bougard, Nazmie Kariem, Fazlin Noor, Reantha Pillay, Leandi Steynfaardt, Lucía González González, José Miguel Marín Santos, Paula Martín-Borregón, Javier Martínez Caballero, Cristina Nevado García, Pastora Rodriguez Fraga, Gonzalo De Castro Parga, Maria Pilar Fernández Veiga, Lucía Garrido López, Hugo Infante Pino, Irene Lages Cal, Marta López Otero, Manuel Nogueira Sixto, Marta Paniagua García Señorans, Laura Rodríguez Fernández, Alejandro Ruano Poblador, Erika Rufo Crespo, Raquel Sanchez-Santos, Vincenzo Vigorita, Ester Alonso Batanero, Dorisme Asnel, Isabel Cifrian Canales, Elisa Contreras Saiz, Irene De Santiago Alvarez, Tamara Díaz Vico, Sebastian Fernandez Arias, Daniel Fernández Martínez, Carmen García Bernardo, Luis Joaquín García Flórez, Carmen Garcia Gutierrez, Manuel García Munar, Carlos Alberto Márquez Zorrilla Molina, Marta Merayo, José Luis Michi Campos, Maria Moreno Gijon, Jorge L. Otero-Diez, Jose Luis Rodicio Miravalles, Lorena Solar-Garcia, Aida Suárez Sánchez, Nuria Truan, Cristina Alejandre Villalobos, Yurena Caballero Díaz, Marta Jimenez, Dacil Montesdeoca, Antonio Navarro-Sánchez, Victor Vega, Juan Beltrán de Heredia, Zahira Gómez, Carlos Jezieniecki, Ana Patricia Legido Morán, Mario Montes-Manrique, Mario Rodriguez-Lopez, María Ruiz Soriano, Jeancarlos Trujillo Díaz, Andrea Vazquez Fernandez, Nuria Argudo, Miguel Pera, Laia Torrent Jansà, Melody García Domínguez, Ignacio Goded, Marta Roldón Golet, Issa Talal El-Abur, Alejandra Utrilla Fornals, Vanesa Zambrana Campos, Maria Del Mar Aguilar Martinez, Marina Bosch, Luis García-Catalá, Luis Sánchez-Guillén, Eva Artigau, Nuria Gomez Romeu, David Julià Bergkvist, Beatriz Espina Perez, Olga Morató, Carles Olona, Beatriz Diéguez, Alexander Forero-Torres, Manuel Losada, Segundo Gomez-Abril, Paula Gonzálvez, Rosario Martinez, Sergio Navarro Martínez, Carmen Payá-Llorente, Álvaro Pérez Rubio, Sandra Santarrufina Martinez, Juan Carlos Sebastián Tomás, Ramon Trullenque Juan, Alberto Gegúndez Simón, Paloma Maté, Maria Isabel Prieto-Nieto, Ines Rubio-Perez, Aitor Urbieta, Marina Vicario Bravo, David Abelló, Matteo Frasson, Alvaro Garcia-Granero, Alfredo Abad Gurumeta, Ane Abad-Motos, Elena Lucena-de Pablo, Beatriz Nozal, Javier Ripollés-Melchor, Rut Salvachúa, Esther Ferrero, Luis Garcia-Sancho Tellez, Antonio L. Picardo, Jose Alberto Rojo López, Laura Patricia Zorrilla Matilla, Carmen Cagigas Fernandez, Sonia Castanedo Bezanilla, José Estevez Tesouro, Maria Jose Fernandez-Diaz, Juan García Cardo, Marcos Gomez Ruiz, Erik Gonzalez-Tolaretxipi, Jaime Jimeno Fraile, Cristobal Poch, Montserrat Rodriguez-Aguirre, Noemí Troche Pesqueira, Maria Soledad Trugeda-Carrera, Javier de la Torre, Ruth Blanco-Colino, Eloy Espin-Basany, Martin Espinosa-Bravo, Clara Morales Comas, Eduardo Reyes Afonso, Joaquín Rivero Déniz, Christian Siso Raber, Mireia Verdaguer Tremolosa, Pramodh Chandrasinghe, Sumudu Kumarage, Nimeshi Wijekoon Arachchilage, Ahmed Abdalla Ahmed Elkamel, Mohammed A. Adam, Nina Blomme, Anders Thorell, Fredrik Wogensen, Andreas Älgå, Dhirar Ansarei, Fuat Celebioglu, Göran Heinius, Linda Nigard, Emil Pieniowski, Sandra Ahlqvist, Ida Björklund, Andreas Frånberg, Martina Håkansson, Karin Adamo, Oskar Franklin, Malin Sund, Rebecca Wiberg, Yvette Andersson, Abbas Chabok, Maziar Nikberg, Alexander Kugelberg, Claudia Canonica, Dimitrios Christoforidis, Fabrizio Fasolini, Paolo Gaffuri, Mauro Giuliani, Francesco Meani, Sotirios Georgios Popeskou, Silvia Pozza, Wiebke Wandschneider, Lorenz Peterer, Lukas Werner Widmer, Bernd Zimmermann, Panagiotis Bakoleas, Iris Chanousi, Lydia Charalampidou, Lukasz Filip Grochola, Franziska Heid, Sotirios Ntaoulas, Michail Outos, Georgios Peros, Hanna Podolska-Skoczek, Katharina Beate Reinisch, Christian Zielasek, Nicolas Demartines, Jérôme Gilgien, Amaniel Kefleyesus, Pénélope St-Amour, Arnaud Toussaint, Maryam Alhimyar, Bayan Alsaid, Amr Alyafi, Ahmad Alkhaledi, Basel Kouz, Ahmad Omarain, Yusra Al-Sabbagh, Haya Alkhatib, Samer Sara, Ahmad Alhaj, Aghyad Danial, Lama Kadoura, Sarah Maa Albared, Yamen Monawar, Louei Nahas, Barook Abd, Ahmad Saad, Habib Wakkaf, Hatem Bouzaiene, Montassar Ghalleb, Elif Akaydin, Ata Cem Akbaba, Onur Atakul, Ege Baltaci, Sevval Besli, Gökçen Burgu, Ulukan Cenal, Cansu de Muijnck, Hasan Can Demirkaya, Alper Dogruoz, Zeynep Ipek Gezer, Yasemin Gündoğdu, Merve Kara, Hasan Kürşad Korkmaz, Gökalp Kağan Kurtoğlu, Volkan Ozben, Berk Baris Ozmen, Ahmet Murat Pektaş, Eda Kübra Sel, Nilüfer Yenidünya, Fuat Baris Bengur, Berke Mustafa Oral, Tahir Koray Yozgatli, Seymur Abdullayev, Mehmet Emin Gunes, Nuri Alper Sahbaz, Tuba Banaz, Kübra Kargici, Omer Faruk Kuyumcu, Erkan Yanikoğlu, Merve Yeşilsancak, Duygu Yilmaz, Melik Kagan Aktas, Ahmet Rencuzogullari, Arda Isik, Sezai Leventoğlu, Ali Yalçinkaya, Osman Yüksel, Mustafa U Kalayci, Yasin Kara, Inanc Samil Sarici, Alp Akin, Gökçe nur Alemdağ, Ekin Arslan, Bahadir Emre Baki, Muhammed Selim Bodur, Adnan Calik, Bahar Candas Altinbas, Irem 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Henderson, Bilal Ibrahim, Thummini Jayasinghe, Jennifer Livie, Keir Mailley, Gopikrishnan Nair, Daniel Tan, Caitlin Baggaley, Aleksander Dawidziuk, Bartosz Szyszka, Charlotte Barter, Nirav Gandhi, Karen Hassell, Samantha Hitchin, Jennett Kelsall, Eva Nagy, Ashrafun Nessa, Lisa Whisker, Fady Yanni, Mahmoud Ali, Deeksha Arora, Sunanda Hediwattege, Navam Kumarasinghe, Munir Rathore, Athula Tennakoon, Syed Mustafa Ali Ahmad, Oreoluwa Bajomo, Fahema Nadira, Valerio Celentano, Ewen Griffiths, Rama Santhosh Karri, Jason Kei Chak Mak, Michelle Pipe, Muhammad Iqbal Bhatti, Mohamed Rabie, Connor Boyle, David Hamilton, Aishath Mihuna, James Chean Khun Ng, Gary Nicholson, Agata Oliwa, Robert Pearson, Anna Rose, Shun Qi Yong, Catherine Boereboom, Michael Hanna, Catherine Walter, Thomas Samuel Greensmith, Rachel Mitchell, Eimear Monaghan, James Crawford, Susan Moug, James Blackwell, Hannah Boyd-Carson, Philip Herrod, Omar Al-Allaf, Miriam Beattie, Cameron Bullock, Shivang Burman, Gemma Clark, Nicolas Flamey, Oliver Flannery, Alexander Harding, Ben Kodiatt, Samuel Lawday, Shivani Mahapatra, Navin Mukundu Nagesh, Michael Ng, Dupinderjit Rye, Andrel Yoong, Laura Clark, Chris Deans, Monisha Edirisooriya, Emma Victoria Carrington, Tsz Lun Ernest Wong, Baasil Yusuf, Carla Chamberlain, Kathryn Duke, Elizabeth Kmiotek, Azel Botes, Natalie Condie, Timothy Schrire, Reena Shah, Iolo Thomas-Jones, Charlotte Yates, Natasha Anthony, Edward Matthews, Kapil Sahnan, James Tankel, Sally Tucker, Jasmine Winter Beatty, Paul Ziprin, William Duggan, Anastasia Kantartzi, Shruthi Sridhar, Rachel Alys Khaw, Prakhar Srivastava, Charlotte Underwood, Homero Alves do Canto Brum, Sharat Chopra, Laura Davis, Rebecca Hughes, Joshua Tulley, Justin Alberts, Thomas Athisayaraj, Mojolaoluwa Olugbemi, Kasim Ahmad, Claudia Chan, Gavin Chapman, Hannah Fleming, Benjamin Fox, Julia Grewar, Kate Hulse, Duncan Rutherford, Mackay Sinead, Scott Smith, Doug Speake, Peter G Vaughan-Shaw, Natasha Christodoulides, Simrit Kudhail, Matthew Welch, Syed Muhibullah Husaini, Simon Lambracos, Chikamuche Anyanwu, Rishi Suresh, Jimmy Scott Thomas, Elizabeth Gleeson, Rebecca Platoff, Areeba Saif, Zachary Enumah, Eric Etchill, Alodia Gabre-Kidan, Mitchell Bernstein, Francesco Maria Carrano, Joseph Connors, Patricio Lynn, Marcovalerio Melis, Elliot Newman, Deshka S Foster, Kenneth Perrone, Ashley Titan, Sarwat Ahmad, Andrea Chao M.D. Bafford, Marco Dal Molin, Nader Hanna, Syed Nabeel Zafar, Mark Hemmila, Lena Napolitano, Jane J Wong, Julia Chandler, Lauren Wood, Sherry Wren, Taylor Ottesen, Lucia You, Kristin Yu, María del pilar Arciénega Yañez, Martin Ferreira Fernandes, Daniel González, Santiago Cubas, María Catalina González, Vanessa Zubiaurre, Rodrigo Demolin, Nicolas Giroff, Pablo Sciuto, Maite Campos, Gabriela Rodríguez Cantera, Garg Deepika, Elliot Simuchimba, Anadi Bulaya, Chali Chibuye, Bright Chirengendure, Mary-Rose Kabale, Kizito Kabongo, James Munthali, Oliver Mweso, Francis Pikiti, James Otieno, Log Tung Lai, Brighid Blackman, Sophie Richards, Suren Subramaniam, Rafid Karim, Nathan Kok, Yanni Dion Lee, Shabina Ali, Aanjaneya Sinha, Robert Corrigan, Nicole Barnes, Florence Wong, Grace Dennis, Julia Jedamzik, Emil Phillips, Wivine Piette, Marie Van hentenryck, Houenoukpo Koco, Souliath Lawani, Mamo Woldu Kassa, Tainá Santos Bezerra, Petar Gribnev, Dobromir Dimitrov, Panche Krastev, Sovannarith Oum, Divine Tim Bonghaseh, Maryam Al Farsi, Nourah Alsharqawi, Veronica Acevedo, Andrea Carolina Castillo Barbosa, Felipe Giron, Jimmy Paul Leon Rodriguez, Darko Kučan, Damir Rosko, Neven Barsic, Domagoj Župan, Amgad Hegazi, Vendula Trunčíková, Vladimir Fryba, Mostafa Mohamed, Ahmed Sultan, Ahmed Nagi, Abdallah Rashad Temerik, Mohamed Elemam Elshawy, Moustafa Ibrahim Mahmoud, Shrouk Omar, Mohamed Anwar, Tarek Rageh, Aya Elmokadem, Khaled Gaballa, Sandra Teppo, Antti Turunen, Pasi Pengermä, Quentin Ballouhey, Damien Bergeat, Ariane Weyl, Elisabeth Hain, Adam Gyedu, Edwin Yenli, Dorcas Osei-Poku, Vaia-Aliki Rompou, Athanasios Zoikas, Apostolos Gaitanidis, Georgios Koukis, Konstantinos Perivoliotis, Panagiotis Tavlas, Konstantinos Galanos-Demiris, George Zografos, Ioannis Karavokyros, Georgia Xanthopoulou, Eirini Iordanidou, Fernanda Ayau, Allan Garcia, Pekli Damján, Deepender Wason, Ashika B L, Ervandy Rangganata, Prerna Kamath, Donal B O'Connor, Margherita Pinto, Fabrizio Perrone, Francesca Paola Tropeano, Francesca Troilo, Daniela Bossi, Dario Scala, Lucrezia Pulitanò, Marcella Carella, Andrea Pietrabissa, Alice Gori, Giorgio Giraudo, Veronica De Simone, Alfio Alessandro Russo, Bartolomeo Braccio, Raed Al-Taher, Sarah Athamneh, Andrea Parker, Adnan Sawiee, Amina Kattia, Malik Salem, Osama Tababa, Zuhour Shaeeb, Vilius Syminas, Jonas Jurgaitis, Gytè Damulevičienè, Saulius Svagzdys, Narindra Njarasoa Mihaja Razafimanjato, Ling Chieng Loo, Ing Ching Tiong, Wan Farahiyah Wan Muhmad, Harinthiran Vijeyan, Teoh Li Ying, Gabriella Grech, Rodrigo Arrangoiz, Vania Brickelia Jimenez Ley, Daniel Arizpe, Elizabeth Lagunes Lara, Elizabeth Victoria Castro López, Jose Eaazim, Marije Gordinou de Gouberville, Vivian Bastiaenen, Simone Rottier, Fouad Nahab, Maria Yeonhee Ji, Mohammed Seyoji, Callistus Nwachukwu, Okechukwu Emeghara, Sayyid Egbunu Muhammed, Ayodeji Idowu, Olamiposi Sowemimo, Olakayode Ogundoyin, Oluwatosin Akande, Alexander Lott, Maliha Nadeem, Ahsan Ali Laghari, Asif Loya, Hassan Mushtaq, Muhammad Tariq Abdullah, Baseel Abuhilal, Mohammad Atawneh, Hamdan Hamdan, Belal Alhabil, Abedelrahman Srour, Ibrahim Mousa, Luis Da Silva Medina, Katarzyna Bartosiak, Pedro Ferreira, Vítor Francisco, Ricardo Lemos, Luísa Frutuoso, Sara Fernandes, Telma Fonseca, Jorge Pereira, Juan Rachadell, Ana Torre, Filipe Madeira Martins, Ana Cristina Carvalho, Joana Rodrigues Ferreira, Bruno Ribeiro da Silva, Helena Devesa, Ana Vieira, Inês Mónica, Margarida Amaro, Diogo Sousa, Marta Reia, João Louro, Ana Martins, Joaquina Dominguez, Inês Santos, Nuno Miguel Freitas Oliveira, José Carlos Pereira, Pedro Silva-Vaz, Ligia Freire, Ricardo Escrevente, Valentina Madalina Negoita, Dmitry Shakhmatov, Yves Nezerwa, Radosav Radulovic, Gareth Obery, Francois Viljoen, Tome Mendes, Antonio Suarez, Enrique Moncada, Maria Fernandez-Hevia, Carolina Curtis Martínez, Julia Maria Gil Garcia, Mariana González Zunzarren, Tarig Idris, Karolina Eklöv, Oskar Grahn, Leila Amin, Malin Blomqvist, Costanza Ajani, Rebecca Kraus, Nico Seeger, Melissa Willemin, Fadi Rayya, Mohammad Ayash, Raneem Msouti, Israa Kannas, Eias Abazid, Asil Esper, Skander Slim, Akil Serdar Kavcar, Erman Aytac, Ahmet Cem Dural, Ayse Ilker, Ismail Cem Eray, Eray Kurnaz, Saygin Altiner, Mustafa Deniz Tepe, Can Şahin, Evrim Savli, Aryon Innocent, Lilian Babirye, Andrii Diachenko, Vladislav Hordoskiy, Heather Curry, Charlene Yat Che Chau, Harry Robertson, Arin Mahmoud, Hannah Lennon, Lynette Loi, Emily Kirkham, Cameron McCann, Daniel Watts, Binay Gurung, Michael Wilson, Thomas Tribedi, Eleonora Garofalo, Baryab Zahra, Scott MacDonald, Ian Daniels, Nathan Ng, Shivun Khosla, James Olivier, Sum Yu Pansy Yue, Gayathri Suresh, Jack Wellington, Emmanuel Lorejo, Mafdi Mossaad, Madison Crutcher, Marjan Alimi, Ioana Baiu, Hossam Abdou, Alison Conway, Connor Peck, Mauro Andres Perdomo Perez, Stanley Zulu, Mildred Nakazwe, Sule Burger, Justine Davies, Rachel Donaldson, Chikwendu Ede, O James Garden, Chiapo Lesetedi, Charles Mabedi, Laura Magill, Felix Makinde Alakaloko, Alex Makupe, Mark Monahan, Soloman Mulira, Elmi Muller, Jospeh Musowoyo, Jean Léon Olory-Togbe, Tracey Roberts, Martin Smith, Viki Tayler, John Windsor, Raul Yepez, Sudha Sundar, Emmy Runigamugabo, Azmina Verjee, José Chen, Leonid Daya, Nouhaila El Aroussi, Valeria Farina, Tchianze Gnintedeme Olivier, Mauricio Gonzales Nacarino, Aamr Hammani, Sarah Honjo, Rebecca Jacobs, Hitomi Kimura, Mugisha Nkoronko, Jasson Javier Oscullo Yepez, Wei Pin Hung, Ankit Raj, Alina Romani Pozo, Muna Rommaneh, Samuel Chimbioputo Sassamela Fabiano, Camila Milagros Shiroma Gago, Abhishekh Srinivas, Chia-Yen Sung, Aswan Tai, Yener Cristyell Valle Aranda, Sara Venturini, and Jean Wilguens Lartigue

Subjects
Public aspects of medicine, RA1-1270
Abstract

Summary: Background: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p

Published
2022
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