358 results on '"Denost Q."'
Search Results
102. Local recurrence after local excision of early rectal cancer: a meta‐analysis of completion TME, adjuvant (chemo)radiation, or no additional treatment.
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Oostendorp, S. E., Smits, L. J. H., Vroom, Y., Detering, R., Heymans, M. W., Moons, L. M. G., Tanis, P. J., Graaf, E. J. R., Cunningham, C., Denost, Q., Kusters, M., and Tuynman, J. B.
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RECTAL cancer ,DISEASE relapse ,RADIATION - Abstract
Copyright of British Journal of Surgery is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2020
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103. La formation en chirurgie colorectale en 2018 et plus tard�
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Denost, Q., primary
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- 2018
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104. P661 Endoscopy-based therapeutic management in postoperative recurrent Crohn’s disease: Results of a multi-centre retrospective study
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Rivière, P, primary, Vermeire, S, additional, Irles-Depe, M, additional, Van Assche, G, additional, Rutgeerts, P, additional, de Buck van Overstraeten, A, additional, Denost, Q, additional, Wolthuis, A, additional, D'Hoore, A, additional, Laharie, D, additional, and Ferrante, M, additional
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- 2018
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105. Préservation d’organe dans les cancers du rectum : résultats de l’essai randomisé de phase 3 Greccar 2
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Vendrely, V., primary, Rouanet, P., additional, Tuech, J.-J., additional, Valverde, A., additional, Lelong, B., additional, Rivoire, M., additional, Faucheron, J.-L., additional, Jafari, M., additional, Portier, G., additional, Meunier, B., additional, Rullier, A., additional, Denost, Q., additional, Asselineau, J., additional, Doussau, A., additional, and Rullier, E., additional
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- 2017
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106. Is diverting loop ileostomy necessary for completion proctectomy with ileal pouch-anal anastomosis? A multicenter randomized trial of the GETAID Chirurgie group (IDEAL trial): rationale and design (NCT03872271).
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Beyer-Berjot, Laura, Baumstarck, Karine, Loubière, Sandrine, Vicaut, Eric, Berdah, Stéphane V., Benoist, Stéphane, Lefèvre, Jérémie H., GETAID Chirurgie group, Panis, Y., Maggiori, L., Rullier, E., Denost, Q., Zerbib, P., Cotte, E., Germain, A., Lakkis, Z., Bridoux, V., Tuech, J. J., Ouaissi, M., and Meurette, G.
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RESTORATIVE proctocolectomy ,ILEOSTOMY ,CROHN'S disease ,INFLAMMATORY bowel diseases ,ULCERATIVE colitis ,SURGICAL complications ,COST effectiveness - Abstract
Background: There is no quality evidence of the benefit of defunctioning ileostomy (DI) in ileal pouch-anal anastomoses (IPAAs) performed for inflammatory bowel disease (IBD), but most surgical teams currently resort to DI. In the case of a staged procedure with subtotal colectomy first, completion proctectomy with IPAA is performed for healthy patients, namely, after nutritional support, inflammation reduction and immunosuppressive agent weaning. Therefore, the aim of this trial is to assess the need for systematic DI after completion proctectomy and IPAA for IBD.Methods/design: This is a multicenter randomized open trial comparing completion proctectomy and IPAA without (experimental) or with (control) DI in patients presenting with ulcerative colitis or indeterminate colitis. Crohn's disease patients will not be included. The design is a superiority trial. The main objective is to compare the 6-month global postoperative morbidity, encompassing both surgical and medical complications, between the two groups. The morbidity of DI closure will be included, as appropriate. The sample size calculation is based on the hypothesis that the overall 6-month morbidity rate is 30% in the case of no stoma creation (i.e., experimental group) vs. 55% otherwise (control group). With the alpha risk and power are fixed to 0.05 and 0.80, respectively, and considering a dropout rate of 10%, the objective is set to 194 patients. The secondary objectives are to compare both strategies in terms of morbi-mortality at 6 months and functional results as well as quality of life at 12 months, namely, the 6-month major morbidity and unplanned reoperation rates, 6-month anastomotic leakage rate, 6-month mortality, length of hospital stay, 6-month unplanned readmission rate, quality of life assessed 3 and 12 months from continuity restoration (i.e., either IPAA or stoma closure), functional results assessed 3 and 12 months from continuity restoration, 12-month pouch results, 12-month cost-utility analysis, and 12-month global morbidity.Discussion: The IDEAL trial is a nationwide multicenter study that will help choose the optimal strategy between DI and no ileostomy in completion proctectomy with IPAA for IBD.Trial Registration: ClinicalTrial.gov: NCT03872271, date of registration March 13th, 2019. [ABSTRACT FROM AUTHOR]- Published
- 2019
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107. Individualizing surgical treatment based on tumour response following neoadjuvant therapy in T4 primary rectal cancer
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Denost, Q., primary, Kontovounisios, C., additional, Rasheed, S., additional, Chevalier, R., additional, Brasio, R., additional, Capdepont, M., additional, Rullier, E., additional, and Tekkis, P.P., additional
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- 2017
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108. Randomized clinical trial of sacral nerve stimulation for refractory constipation
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Zerbib, F, primary, Siproudhis, L, additional, Lehur, P-A, additional, Germain, C, additional, Mion, F, additional, Leroi, A-M, additional, Coffin, B, additional, Le Sidaner, A, additional, Vitton, V, additional, Bouyssou-Cellier, C, additional, Chene, G, additional, Zerbib, F, additional, Simon, M, additional, Denost, Q, additional, Lepicard, P, additional, Meurette, G, additional, Wyart, V, additional, Kubis, C, additional, Roman, S, additional, Damon, H, additional, Barth, X, additional, Bridoux, V, additional, Gourcerol, G, additional, Castel, B, additional, Gorbatchef, C, additional, Le Sidaner, Anne, additional, Mathonnet, M, additional, Lesavre, N, additional, Orsoni, P, additional, Brochard, C, additional, and Desfourneaux, V, additional
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- 2016
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109. Cancer colorectal associé à une maladie inflammatoire chronique de l’intestin, quel pronostic ?
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Thicoïpé, A., primary, Laharie, D., additional, Smith, D., additional, Pontallier, A., additional, Didailler, R., additional, Rullier, E., additional, and Denost, Q., additional
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- 2016
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110. Hereditary intraductal papillary mucinous neoplasm of the pancreas
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Denost, Q., Chafai, N., Arrive, L., Mourra, N., and Paye, F.
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- 2012
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111. Recommandations pour la pratique clinique Cancer du rectum
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Maggiori, L., primary, Denost, Q., additional, Neuzillet, C., additional, Palazzo, M., additional, and Zappa, M., additional
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- 2015
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112. Cancers du bas rectum localement évolués : peut-on changer le type de chirurgie après le traitement néoadjuvant ?
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Célérier, B., primary, Vendrely, V., additional, Denost, Q., additional, Frulio, N., additional, Rullier, A., additional, and Rullier, E., additional
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- 2015
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113. Intersphincteric resection for low rectal cancer: laparoscopic vs open surgery approach
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Laurent, C., primary, Paumet, T., additional, Leblanc, F., additional, Denost, Q., additional, and Rullier, E., additional
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- 2011
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114. French current management and oncological results of locally recurrent rectal cancer.
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Denost, Q., Faucheron, J.L., Lefevre, J.H., Panis, Y., Cotte, E., Rouanet, P., Jafari, M., Capdepont, M., and Rullier, E.
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RECTAL cancer treatment ,CANCER relapse ,DISEASE management ,SURGICAL excision ,POSTOPERATIVE care - Abstract
Background There is a significant worldwide variation in practice regarding the criteria for operative intervention and overall management in patients with locally recurrent rectal cancer (LRRC). A survival benefit has been described for patients with clear resection margins in patients undergoing surgery for LRRC which is seen as an important surgical quality indicator. Methods A prospective French national database was established in 2008 which recorded procedures undertaken for locally recurrent rectal cancer (LRRC). Overall and Disease-Free Survival (OS, DFS) were assessed retrospectively. We report the variability and the heterogeneity of LRRC management in France as well as 5-year oncological outcomes. Results In this national report, 104 questionnaires were completed at 29 French surgical centres with a high variability of cases-loaded. Patients had preoperative treatment in 86% of cases. Surgical procedures included APER (36%), LAR (25%), Hartmann's procedure (21%) and pelvic exenterations (15.5%). Four patients had a low sacrectomy (S4/S5). There were no postoperative deaths and overall morbidity was 41%. R0 was achieved in 60%, R1 and R2 in 29% and 11%, respectively. R0 resection resulted in a 5-year OS of 35% compared to 12% and 0% for respectively R1 and R2 (OR = 2.04; 95% CI: 1.4–2.98; p < 0.001). OS was similar between R2 and non-resected patients (OR = 1.47; 95% CI: 0.58–3.76; p = 0.418). Conclusions Our data is in accordance with the literature except the rate of extended resection procedures. This underlines the selective character of operative indications for LRRC in France as well as the care variability and the absence of optimal clinical pathway regarding these patients. [ABSTRACT FROM AUTHOR]
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- 2015
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115. Stratégie de Watch-and-Waitpour cancer du rectum : résultats préliminaires
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Boubaddi, M., Cauvin, T., Vendrely, V., Frulio, N., Denost, Q., and Rullier, E.
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Évaluer la faisabilité d’une stratégie de préservation d’organe par simple surveillance après traitement néoadjuvant d’un adénocarcinome rectal.
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- 2021
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116. Functional Outcomes from a Randomized Trial of Early Closure of Temporary Ileostomy after Rectal Excision for Cancer.
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Denost, Q.
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Background: Low anterior resection syndrome (LARS) has a significant impact on postoperative quality of life. Although early closure of an ileostomy is safe in selected patients, functional outcomes have not been investigated. The aim was to compare bowel function and the prevalence of LARS in patients who underwent early or late closure of an ileostomy after rectal resection for cancer. Methods: Early closure (8–13 days) was compared with late closure (after 12 weeks) of the ileostomy following rectal cancer surgery in a multicentre RCT. Exclusion criteria were: signs of anastomotic leakage, diabetes mellitus, steroid treatment and postoperative complications. Bowel function was evaluated using the LARS score and the Memorial Sloan Kettering Cancer Center Bowel Function Instrument (BFI). Results: Following index surgery, 112 participants were randomized (55 early closures, 57 late closures). Bowel function was evaluated at a median of 49 months after stoma closure. Eighty‑two of 93 eligible participants responded (12 had died and 7 had a permanent stoma). Rates of bowel dysfunction were higher in the late closure group, but this did not reach statistical significance (major LARS in 29 of 40 participants in late group and 25 of 42 in early group, P = 0.250; median BFI score 63 versus 71 respectively, P = 0.207). Participants in the late closure group had worse scores on the urgency/soiling subscale of the BFI (14 versus 17; P = 0.017). One participant in the early group and six in the late group had a permanent stoma (P = 0.054). Conclusion: Patients undergoing early stoma closure had fewer problems with soiling and fewer had a permanent stoma, although reduced LARS was not demonstrated in this cohort. Dedicated prospective studies are required to evaluate definitively the association between temporary ileostomy, LARS and timing of closure. [ABSTRACT FROM AUTHOR]
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- 2019
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117. Normative data for the Low Anterior Resection Sybdrome Score (LARS Score).
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Denost, Q.
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- 2018
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118. Palliative pelvic exenteration: A systematic review of patient-centered outcomes
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Hidde M. Kroon, N.N. Dudi-Venkata, S. Bedrikovetski, M.L. Thomas, M.E. Kelly, A.G.J. Aalbers, N. Abdul Aziz, M. Abraham-Nordling, T. Akiyoshi, W. Alberda, M. Andric, A. Antoniou, K.K. Austin, R.P. Baker, M. Bali, G. Baseckas, B.K. Bednarski, G.L. Beets, P.L. Berg, J. Beynon, S. Biondo, L. Bordeianou, M. Brunner, P. Buchwald, J.W.A. Burger, D. Burling, N. Campain, K.K.L. Chan, G.J. Chang, M.H. Chew, P. C Chong, H.K. Christensen, M. Codd, A.J. Colquhoun, A. Corr, M. Coscia, P.E. Coyne, B. Creavin, L. Damjanovic, I.R. Daniels, M. Davies, R.J. Davies, J.H.W. de Wilt, Q. Denost, D. Dietz, E.J. Dozois, M. Duff, T. Eglinton, J.M. Enriquez-Navascues, M.D. Evans, N.S. Fearnhead, F.A. Frizelle, E. Garcia-Granero, J.L. Garcia-Sabrido, L. Gentilini, M.L. George, R. Glynn, T. Golda, B. Griffiths, D.A. Harris, M. Evans, J.A.W. Hagemans, D.P. Harji, A.G. Heriot, W. Hohenberger, T. Holm, J.T. Jenkins, S. Kapur, Y. Kanemitsu, S.R. Kelley, D.S. Keller, H. Kim, C.E. Koh, N.F.M. Kok, R. Kokelaar, C. Kontovounisios, M. Kusters, D.W. Larson, W.L. Law, S. Laurberg, P. Lee, M.L. Lydrup, A.C. Lynch, C. Mantyh, K.L. Mathis, A. Martling, W.J.H.J. Meijerink, S. Merkel, A.M. Mehta, F.D. McDermott, J.S. McGrath, A. Mirnezami, J.R. Morton, T.G. Mullaney, J.W. Mesquita-Neto, M.B. Nielsen, G.A.P. Nieuwenhuijzen, P.J. Nilsson, P.R. O'Connell, G. Palmer, D. Patsouras, G. Pellino, G. Poggioli, M. Quinn, A. Quyn, R.W. Radwan, S. Rasheed, P.C. Rasmussen, S.E. Regenbogen, R. Rocha, J. Rothbarth, C. Roxburgh, H.J.T. Rutten, É. Ryan, P.M. Sagar, A. Saklani, A.M.P. Schizas, E. Schwarzkopf, V. Scripcariu, I. Shaikh, D. Shida, A. Simpson, N.J. Smart, J.J. Smith, M.J. Solomon, M.M. Sørensen, S.R. Steele, D. Steffens, L. Stocchi, N.A. Stylianides, P.P. Tekkis, C. Taylor, P. Tsarkov, S. Tsukamoto, W.H. Turner, J.B. Tuynman, G.H. van Ramshorst, D. van Zoggel, W. Vasquez-Jimenez, C. Verhoef, M. Verstegen, C. Wakeman, S. Warrier, H.H. Wasmuth, M.R. Weiser, J.M.D. Wheeler, J. Wild, J. Yip, D.C. Winter, T. Sammour, Kroon H.M., Dudi-Venkata N.N., Bedrikovetski S., Thomas M.L., Kelly M.E., Aalbers A.G.J., Abdul Aziz N., Abraham-Nordling M., Akiyoshi T., Alberda W., Andric M., Antoniou A., Austin K.K., Baker R.P., Bali M., Baseckas G., Bednarski B.K., Beets G.L., Berg P.L., Beynon J., Biondo S., Bordeianou L., Brunner M., Buchwald P., Burger J.W.A., Burling D., Campain N., Chan K.K.L., Chang G.J., Chew M.H., C Chong P., Christensen H.K., Codd M., Colquhoun A.J., Corr A., Coscia M., Coyne P.E., Creavin B., Damjanovic L., Daniels I.R., Davies M., Davies R.J., de Wilt J.H.W., Denost Q., Dietz D., Dozois E.J., Duff M., Eglinton T., Enriquez-Navascues J.M., Evans M.D., Fearnhead N.S., Frizelle F.A., Garcia-Granero E., Garcia-Sabrido J.L., Gentilini L., George M.L., Glynn R., Golda T., Griffiths B., Harris D.A., Evans M., Hagemans J.A.W., Harji D.P., Heriot A.G., Hohenberger W., Holm T., Jenkins J.T., Kapur S., Kanemitsu Y., Kelley S.R., Keller D.S., Kim H., Koh C.E., Kok N.F.M., Kokelaar R., Kontovounisios C., Kusters M., Larson D.W., Law W.L., Laurberg S., Lee P., Lydrup M.L., Lynch A.C., Mantyh C., Mathis K.L., Martling A., Meijerink W.J.H.J., Merkel S., Mehta A.M., McDermott F.D., McGrath J.S., Mirnezami A., Morton J.R., Mullaney T.G., Mesquita-Neto J.W., Nielsen M.B., Nieuwenhuijzen G.A.P., Nilsson P.J., O'Connell P.R., Palmer G., Patsouras D., Pellino G., Poggioli G., Quinn M., Quyn A., Radwan R.W., Rasheed S., Rasmussen P.C., Regenbogen S.E., Rocha R., Rothbarth J., Roxburgh C., Rutten H.J.T., Ryan E., Sagar P.M., Saklani A., Schizas A.M.P., Schwarzkopf E., Scripcariu V., Shaikh I., Shida D., Simpson A., Smart N.J., Smith J.J., Solomon M.J., Sorensen M.M., Steele S.R., Steffens D., Stocchi L., Stylianides N.A., Tekkis P.P., Taylor C., Tsarkov P., Tsukamoto S., Turner W.H., Tuynman J.B., van Ramshorst G.H., van Zoggel D., Vasquez-Jimenez W., Verhoef C., Verstegen M., Wakeman C., Warrier S., Wasmuth H.H., Weiser M.R., Wheeler J.M.D., Wild J., Yip J., Winter D.C., Sammour T., Kroon, Hm, Dudi-Venkata, Nn, Bedrikovetski, S, Thomas, Ml, Kelly, Me, Aalbers, Agj, Abdul Aziz, N, Abraham-Nordling, M, Akiyoshi, T, Alberda, W, Andric, M, Antoniou, A, Austin, Kk, Baker, Rp, Bali, M, Baseckas, G, Bednarski, Bk, Beets, Gl, Berg, Pl, Beynon, J, Biondo, S, Bordeianou, L, Brunner, M, Buchwald, P, Burger, Jwa, Burling, D, Campain, N, Chan, Kkl, Chang, Gj, Chew, Mh, C Chong, P, Christensen, Hk, Codd, M, Colquhoun, Aj, Corr, A, Coscia, M, Coyne, Pe, Creavin, B, Damjanovic, L, Daniels, Ir, Davies, M, Davies, Rj, de Wilt, Jhw, Denost, Q, Dietz, D, Dozois, Ej, Duff, M, Eglinton, T, Enriquez-Navascues, Jm, Evans, Md, Fearnhead, N, Frizelle, Fa, Garcia-Granero, E, Garcia- Sabrido, Jl, Gentilini, L, George, Ml, Glynn, R, Golda, T, Griffiths, B, Harris, Da, Evans, M, Hagemans, Jaw, Harji, Dp, Heriot, Ag, Hohenberger, W, Holm, T, Jenkins, Jt, Kapur, S, Kanemitsu, Y, Kelley, Sr, Keller, D, Kim, H, Koh, Ce, Kok, Nfm, Kokelaar, R, Kontovounisios, C, Kusters, M, Larson, Dw, Law, Wl, Laurberg, S, Lee, P, Lydrup, Ml, Lynch, Ac, Mantyh, C, Mathis, Kl, Martling, A, Meijerink, Wjhj, Merkel, S, Mehta, Am, Mcdermott, Fd, Mcgrath, J, Mirnezami, A, Morton, Jr, Mullaney, Tg, Mesquita-Neto, Jw, Nielsen, Mb, Nieuwenhuijzen, Gap, Nilsson, Pj, O’Connell, Pr, Palmer, G, Patsouras, D, Pellino, G, Poggioli, G, Quinn, M, Quyn, A, Radwan, Rw, Rasheed, S, Rasmussen, Pc, Regenbogen, Se, Rocha, R, Rothbarth, J, Roxburgh, C, Rutten, Hjt, Ryan, E, Sagar, Pm, Saklani, A, Schizas, Amp, Schwarzkopf, E, Scripcariu, V, Shaikh, I, Shida, D, Simpson, A, Smart, Nj, Smith, Jj, Solomon, Mj, Sørensen, Mm, Steele, Sr, Steffens, D, Stocchi, L, Stylianides, Na, Tekkis, Pp, Taylor, C, Tsarkov, P, Tsukamoto, S, Turner, Wh, Tuynman, Jb, van Ramshorst, Gh, van Zoggel, D, Vasquez- Jimenez, W, Verhoef, C, Verstegen, M, Wakeman, C, Warrier, S, Wasmuth, Hh, Weiser, Mr, Wheeler, Jmd, Wild, J, Yip, J, Winter, Dc, and Sammour, T.
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medicine.medical_specialty ,Pelvic Neoplasm ,Palliative care ,Fistula ,medicine.medical_treatment ,Disease ,Locally advanced pelvic cancer ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,03 medical and health sciences ,0302 clinical medicine ,SDG 3 - Good Health and Well-being ,Quality of life ,Internal medicine ,Patient-Centered Care ,Outcome Assessment, Health Care ,medicine ,Palliative surgery ,Humans ,Pelvic Neoplasms ,Pelvic exenteration ,business.industry ,Mortality rate ,Patient-centered outcomes ,Palliative Care ,General Medicine ,medicine.disease ,Pelvic Exenteration ,Oncology ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Surgery ,business ,Human - Abstract
Item does not contain fulltext OBJECTIVE: Palliative pelvic exenteration (PPE) is a technically complex operation with high morbidity and mortality rates, considered in patients with limited life expectancy. There is little evidence to guide practice. We performed a systematic review to evaluate the impact of PPE on symptom relief and quality of life (QoL). METHODS: A systematic review was conducted according to the PRISMA guidelines using Ovid MEDLINE, EMBASe, and PubMed databases for studies reporting on outcomes of PPE for symptom relief or QoL. Descriptive statistics were used on pooled patient cohorts. RESULTS: Twenty-three historical cohorts and case series were included, comprising 509 patients. No comparative studies were found. Most malignancies were of colorectal, gynaecological and urological origin. Common indications for PPE were pain, symptomatic fistula, bleeding, malodour, obstruction and pelvic sepsis. The pooled median postoperative morbidity rate was 53.6% (13-100%), the median in-hospital mortality was 6.3% (0-66.7%), and median OS was 14 months (4-40 months). Some symptom relief was reported in a median of 79% (50-100%) of the patients, although the magnitude of effect was poorly measured. Data for QoL measures were inconclusive. Five studies discouraged performing PPE in any patient, while 18 studies concluded that the procedure can be considered in highly selected patients. CONCLUSION: Available evidence on PPE is of low-quality. Morbidity and mortality rates are high with a short median OS interval. While some symptom relief may be afforded by this procedure, evidence for improvement in QoL is limited. A highly selective individualised approach is required to optimise the risk:benefit equation.
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- 2019
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119. Segmental colectomy for ulcerative colitis: is there a place in selected patients without active colitis ? An international multicentric retrospective study in 72 patients
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Xavier Treton, Edouard Louis, Silvio Danese, Q Denost, Fabrizio Michelassi, V Bridoux, Gianluca M. Sampietro, D. Laharie, Pär Myrelid, Gilberto Poggioli, E Espin, Philippe Zerbib, Stéphane Nancey, Romain Altwegg, Giuseppe S. Sica, L Cohen, L Beyer-Berjot, Yves Panis, Matteo Frasson, Antonino Spinelli, Mathurin Fumery, A. Frontali, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de chirurgie digestive [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Nutrition, inflammation et dysfonctionnement de l'axe intestin-cerveau (ADEN), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institute for Research and Innovation in Biomedicine (IRIB), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), UNIROUEN - UFR Santé (UNIROUEN UFR Santé), Normandie Université (NU)-Normandie Université (NU), Linköping University (LIU), PoliclinicoTor Vergata - Fondatione PTV, Policlinico S. Orsola-malpighi, Alma Mater Studiorum Università di Bologna [Bologna] (UNIBO)-Servizio sanitario regionale Emilia-Romagna, Vall d'Hebron University Hospital [Barcelona], Assistance Publique - Hôpitaux de Marseille (APHM), CHU Bordeaux [Bordeaux], Department of Colorectal Surgery, Humanitas Research Hospital, Milano, Italy., Hôpital Claude Huriez [Lille], CHU Lille, Department of Surgery, IBD Unit, Luigi Sacco University Hospital, Milano, Italy., University Hospital La Fe, Digestive Surgery, Valencia, Spain., Centre Hospitalier Universitaire de Liège (CHU-Liège), Department of Gastroenterology, Humanitas Research Hospital, Milano, Italy., Registre EPIMAD, Normandie Université (NU)-Normandie Université (NU)-CHU Amiens-Picardie-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service d'Hépato Gastroenterologie [CHU Amiens-Picardie], CHU Amiens-Picardie, CHU Pessac, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Agogo Presbyterian Hospital [GHANA], Frontali, A, Cohen, L, Bridoux, V, Myrelid, P, Sica, G, Poggioli, G, Espin, E, Beyer-Berjot, L, Laharie, D, Spinelli, A, Zerbib, P, Sampietro, G, Frasson, M, Louis, E, Danese, S, Fumery, M, Denost, Q, Altwegg, R, Nancey, S, Michelassi, F, Treton, X, Panis, Y, Frontali A., Cohen L., Bridoux V., Myrelid P., Sica G., Poggioli G., Espin E., Beyer-Berjot L., Laharie D., Spinelli A., Zerbib P., Sampietro G., Frasson M., Louis E., Danese S., Fumery M., Denost Q., Altwegg R., Nancey S., Michelassi F., Treton X., and Panis Y.
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,segmental colectomy ,postoperative flare ,Anastomosis ,Gastroenterology ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Sigmoidectomy ,Internal medicine ,Humans ,Medicine ,Colitis ,Child ,Colectomy ,ulcerative colitis ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,postoperative flare, segmental colectomy, ulcerative colitis ,Segmental colectomy ,[SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology ,Retrospective cohort study ,General Medicine ,Middle Aged ,Diverticulitis ,medicine.disease ,Ulcerative colitis ,Settore MED/18 ,3. Good health ,Dysplasia ,030220 oncology & carcinogenesis ,Right Colectomy ,Colitis, Ulcerative ,Female ,030211 gastroenterology & hepatology ,business - Abstract
Background and Aims The aim of this study was to report a multicentric experience of segmental colectomy [SC] in ulcerative colitis [UC] patients without active colitis, in order to assess if SC can or cannot represent an alternative to ileal pouch-anal anastomosis [IPAA]. Methods All UC patients undergoing SC were included. Postoperative complications according to ClavienDindo’s classification, long term results, and risk factors for postoperative colitis and reoperation for colitis on the remnant colon, were assessed. Results: A total of 72 UC patients underwent: sigmoidectomy [n = 28], right colectomy [n = 24], proctectomy [n = 11], or left colectomy [n = 9] for colonic cancer [n = 27], ‘diverticulitis’ [n = 17], colonic stenosis [n = 5], dysplasia or polyps [n = 8], and miscellaneous [n = 15]. Three patients died postoperatively and 5/69 patients [7%] developed early flare of UC within 3 months after SC. After a median followup of 40 months, 24/69 patients [35%] were reoperated after a median delay after SC of 19 months [range, 2–158 months]: 22/24 [92%] underwent total colectomy and ileorectal anastomosis [n = 9] or total coloproctectomy [TCP] [n = 13] and 2/24 [8%] an additional SC. Reasons for reoperation were: colitis [n = 14; 20%], cancer [n = 3] or dysplasia [n = 3], colonic stenosis [n = 1], and unknown reasons [n = 3]. Endoscopic score of colitis before SC was Mayo 23 in 5/5 [100%] patients with early flare vs 15/42 without early flare [36%; p = 0.0101] and in 9/12 [75%] patients with reoperation for colitis vs 11/35 without reoperation [31%; p = 0.016]. Conclusions After segmental colectomy in UC patients, postoperative early colitis is rare [7%]. Segmental colectomy could possibly represent an alternative to IPAA in selected UC patients without active colitis.
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- 2020
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120. Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection: an international, multi-centre, prospective audit
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The 2017 European Society of Coloproctology (ESCP) collaborating group, Blanco-Colino, Kelly, Singh, Bhangu, Pinkney, Poskus, El-Hussuna, Battersby, N. J., Buchs, N. C., Buskens, Chaudri, Frasson, Gallo, Minaya-Bravo, A. M., Morton, Negoi, Nepogodiev, Pata, Sánchez-Guillén, Zmora, Perry, Magill, Altomare, Bemelman, Brown, Denost, Knowles, Laurberg, Lefevre, J. H., Möeslein, Vaizey, Bilali, Salomon, Cillo, Estefania, Patron, Uriburu, Ruiz, Farina, Carballo, Guckenheimer, Proud, Brouwer, Bui, Nguyen, Smart, Warwick, Theodore, J. E., Herbst, Birsan, Dauser, Ghaffari, Hartig, Stift, Argeny, Unger, Strouhal, Heuberger, Varabei, Lahodzich, Makhmudov, Selniahina, Feryn, Leupe, Maes, Reynvoet, Van, Langenhove, Nachtergaele, Monami, Francart, Jehaes, Markiewicz, Weerts, Van, Belle, Bomans, Cavenaile, Nijs, Vertruyen, Pletinckx, Claeys, Defoort, Muysoms, Van, Cleven, Lange, Vindevoghel, Wolthuis, Todorovic, Dabic, Kenjic, Lovric, Vidovic, Delibegovic, Mehmedovic, Christiano, Lombardi, Marchiori, J, R., Tercioti, Dardanov, Petkov, Simonova, Yonkov, Zhivkov, Maslyankov, Pavlov, Sokolov, Todorov, Stoyanov, Batashki, Iarumov, Lozev, Moshev, Slavchev, Atanasov, Belev, Krstev, Penkov, Šantak, Ćosić, Previšić, Vukušić, Zukanović, Zelić, Kršul, Lekić, Vitlov, Mendrila, Orhalmi, Dusek, Maly, Paral, Sotona, Skrovina, Bencurik, Machackova, Kala, Farkašová, Grolich, Procházka, Hoch, Kocian, Martinek, Antos, Pruchova, Ceccotti, Madsbøll, Straarup, Uth, Ovesen, Christensen, Bondeven, Edling, Elfeki, Alexandrovich, Gameza, Michelsen, Bach, Zheltiakova, Krarup, P. M., Krogh, Rolff, H. -C., Lykke, Juvik, A. F., Lóven, H. H. K., Marckmann, Osterkamp, J. T. F., Madsen, A. H., Worsøe, Ugianskis, Kjær, M. D., Youn Cho Lee, Khalid, Kristensen, M. H., Sorogy, El, Elgeidie, Elhemaly, Nakeeb, El, Elrefai, Shalaby, Emile, Omar, Sakr, Thabet, Awny, Metwally, Refky, Shams, Zuhdy, Lepistö, Keränen, Kivelä, Lehtonen, Siironen, Rautio, Ahonen-Siirtola, Klintrup, Paarnio, Takala, Hyöty, Haukijärvi, Kotaluoto, S. -M., Lehto, Tomminen, Huhtinen, Carpelan, Karvonen, Rantala, Varpe, Cotte, Francois, Glehen, Passot, D'Alessandro, Chouillard, Etienne, J. C., Ghilles, Vinson-Bonnet, Germain, Ayav, Bresler, Chevalier, Didailler, Rullier, Tiret, Chafai, Parc, Sielezneff, Mege, Lakkis, Barussaud, Krones, Bock, Webler, Baral, Lang, Münch, Pullig, Schön, Hinz, Becker, Möller, Richter, Schafmayer, Hardt, Kienle, Crescenti, Ahmad, Soleiman, Papaconstantinou, Gklavas, Nastos, Theodosopoulos, Vezakis, Stamou, Saridaki, Xynos, Paraskakis, Zervakis, Skroubis, Amanatidis, Germanos, Maroulis, Papadopoulos, Dimitriou, Alexandrou, Felekouras, Griniatsos, Karavokyros, Chouliaras, Ioannidis, Katsounis, Kefalou, Katsoulis, I. E., Balalis, Korkolis, D. P., Manatakis, Tzovaras, Baloyiannis, Mamaloudis, Lázár, Ábraham, Paszt, Simonka, Tóth, Zaránd, Baranyai, Ferreira, Harsányi, Ónody, Banky, Burány, Lakatos, Marton, Solymosi, Besznyák, Bursics, Papp, Saftics, Svastics, Valsdottir, Atladottir, Jonsson, Moller, Sigurdsson, Gupta, S. K., Kaul, Mohan, Sharma, Wani, Chowdri, Khan, Mehraj, Parray, F. 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S., Crafciuc, Paitici, Beuran, Ciubotaru, Prodan, Vartic, Tomulescu, Copaescu, Yanishev, Abelevich, Kokobelyan, Lebedeva, Luzan, Pozdnyakov, Cherdancev, Mahotin, Nesytykh, Samsonyuk, Pravosudov, Ivlev, Karachun, Lebedev, Samsonov, Aiupov, Feoktistov, Garipov, Suleymanov, Tarasov, Rasulov, Dzhumabaev, Mamedli, Bedzhanyan, Popov, Sednev, Klimenko, Semenov, Vasilyev, Khazov, Khanevich, Khrykov, Katorkin, Andreev, Chernov, Davidova, Zhuravlev, Achkasov, Shakhmatov, Shelygin, Sushkov, Vardanyan, Ilkanich, Barbashinov, Darvin, Onishchenko, Voronin, Krivokapić, Barišić, Dimitrijević, Marković, Sekulić, Stanojevic, Brankovic, Nestorovic, Pecic, Petrovic, Kostic, Aleksic, Maric, Perunicic, Radovanovic, Djuric, Lukic, Cuk, Juloski, Kenic, Krdzic, Ngu, Y. 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M., Roque, C., Segelman, J., Nygren, J., Nestler, G., Abraham-Nordling, M., Egenvall, M., Myrelid, P., Jung, B., Loftås, P., Lydrup, M. -L., Azahr, N., Buchwald, P., Mangell, P., Syk, I., Nikberg, M., Carlander, J., Chabok, A., Smedh, K., Tiselius, C., Haapaniemi, S., Benckert, A., Adamina, M., Freil-Lanter, C., Gingert, C., Müller, P., Schäfli, J., Regusci, L., Brenna, M., Fasolini, F., Misteli, H., Kirchhoff, P., Oertli, D., Hahnloser, D., Clerc, D., Hübner, M., Ris, F., Buchs, N. C., Chevallay, M., Morel, P., Schiltz, B., Wang, J. Y., Su, W. -C., Huang, C. -W., Ma, C. -J., Tsai, H. -L., Bugra, D., Agalar, F., Baloglu, H., Basoglu, I., Okkabaz, N., Binboga, E., Biricik, A., Celik, A., Yavuz, E., Canda, A. E., Agalar, C., Fuzun, M., Sokmen, S., Terzi, C., Isik, A., Karip, B., Bilgili, A. C., Leventoğlu, S., Aytac, B., Küçükdiler, E., Yıldız, A., Yuksel, O., Sinan, H., Hancerliogullari, O., Kaymak, S., Kozak, O., Ozer, M. T., Sarici, I. S., Akca, O., Kalayci, M. U., Kara, Y., Agcaoglu, O., Balik, E., Bayram, O., Özbalcı, G. S., Özkan, B. B., Karabacak, U., Sungurtekin, U., Ozgen, U., Demirbas, S., Öztürk, E., Isik, O., Yilmazlar, T., Colak, E., Karagul, S., Kinas, V., Fearnhead, N., Lord, I., Stewart, P., Zammit, M., Arnold, S., Battersby, N. J., Broadhurst, J., Moran, S., Seretis, F., Shabbir, J., Jones, C., Kynaston, J., Vimalachandran, D., Blower, E., Mcfaul, C., Mcwhirter, D., Pilkington, J., Wilson, T., Chowdhary, M., Stubbs, B., Abdalkoddus, M., Lai, C., Thavanesan, N., Yao, C., Agarwal, T., Dindyal, S., Hill, R. M. C., Reade, S., Slesser, A., Paterson, H., Balfour, A., Boland, M., Geraghty, A., O'Kelly, J., Patel, P., Tezas, S., Yahia, S., Jadhav, V., Marimuthu, K., Narayanan, A., Piramanayagam, B., Bradley, N., Buchanan, F., Paul, K., Singh, J., Thomson, K., Korsgen, S., Bedford, M., Lee, K., Leong, K., Mcarthur, D., Bhangu, A., Malik, S., Mohamed, I., Cunha, P., Pilavas, A., Reddy, A., Ahmed, S., Ahmed, A., Voll, J., Velchuru, V., Lal, R., Mirshekar-Syahkal, B., Kassai, M., Aleem, M., Keogh-Bootland, S., Sarmah, P., Brown, S., Keegan, R., Kelkar, A., Sen, P., Oliveira-Cunha, M., Chaudhri, S., Fares, R., Singh, B., Thomas, W. M., Aslam, M. I., Boyle, K., Hemingway, D., Miller, A., Norwood, M., Gurjar, S., Al-Saeedi, M., Anandan, L., Sudlow, A., Zampitis, N., Malik, K., Bogdan, M., Smart, C., Iqbal, M. R., Bailey, S., Lawes, D., Omar, G., Tamhane, R., Evans, M., Ather, S., Lim, J., Nageswaran, H., Taylor, G., Hunt, L., Nicholls, J., Shaikh, I., Muscara, F., O'Brien, J., Photi, E., Stearns, A., Meylemans, D., Cunningham, C., Hompes, R., Tennakoon, A., Kumarasinghe, N., Rao, M., Upanishad, I., Khan, J., Ahmad, N., Shweejawee, Z., Stefan, S., Smart, N., Daniels, I., Gregoir, T., Longstaff, L., Mcdermott, F., Varcada, M., Drami, I., Gala, T., Moggia, E., Ratnatunga, K., Harries, R., Hayes, J., Williams, G., Raymond, T., Bronder, C., Davies, E., Hawkin, P., Ryska, O., Ayral, K., Beveridge, A., Bhowmik, A., Gill, M., Simpson, R., Schofield, A., Mcardle, K., Parmar, M., Williamson, M., Burton, H., Courtney, E., Grant, C., Saracino, A., Newton, K., Epstein, J., Branagan, G., Bignell, M., Symankewicz, M., Zaman, S., Mankotia, R., Siddiqui, Z., Torrance, A., Artioukh, D., Eggleston, M., Gokul, K., Selwyn, D., Warusavitarne, J., Chandrasinghe, P., Grainger, J., Leo, C. A., Vaizey, C. J., Harris, G., Levy, B., Skull, A., Thaha, M., Garg, A., Patel, H., Ramsanahie, A., Mondragon-Pritchard, M., Cuinas Leon, K., Shukla, A., Brewer, H., Fitzgerald, J., Kho, H., Torkington, J., Tate, S., Wheat, J., Smolarek, S., Platt, E., Rossi, B., Tham, J. C., Knight, J., Richardson, J., Tzivanakis, A., Gregori, M., Ashraf, M. A., Atif, M., Santos, J., Saffaf, N., Canning, L., Chandratreya, N., Bowen, M., Graham, B., Hamad, Y., Kaubrys, M., Chaudhry, Z. U., Bhan, C., Mukhtar, H., Oshowo, A., Wilson, J., Gouvas, N., Nicol, D., Pandey, S., Zilvetti, M., Sharma, A., Fatayer, T., Mothe, S., Rahman, M., Curtis, N., Allison, A., Dalton, R., Francis, N., Ockrim, J., Psaras, G., Dudarovaska, H., Marharint, T., Mostovoy, E., Voloshin, S., Kolesnik, O., Makhmudov, D., Altinel, Y., Iqbal, A., Cunningham, L., Go, K., and Tan, S.
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Laparoscopic surgery ,Male ,Leak ,medicine.medical_specialty ,Cathartics/administration & dosage ,medicine.drug_class ,medicine.medical_treatment ,Antibiotics ,anastomotic leak ,bowel preparation ,colonic cancer ,Colorectal surgery ,laparoscopic surgery ,Gastroenterology ,030230 surgery ,Anastomosis ,Preoperative Care/methods ,NO ,03 medical and health sciences ,0302 clinical medicine ,Anti-Bacterial Agents/administration & dosage ,Preoperative Care ,Medicine ,Humans ,risk factors ,Prospective Studies ,Multi centre ,Prospective cohort study ,Colectomy ,Aged ,ta3126 ,Medical Audit ,business.industry ,Cathartics ,digestive, oral, and skin physiology ,Middle Aged ,digestive system diseases ,Surgery ,Anti-Bacterial Agents ,030220 oncology & carcinogenesis ,Bowel preparation ,Drug Therapy, Combination ,Female ,Colectomy/adverse effects ,business ,Anastomotic Leak/etiology - Abstract
INTRODUCTION: The optimal bowel preparation strategy to minimise the risk of anastomotic leak is yet to be determined. This study aimed to determine whether oral antibiotics combined with mechanical bowel preparation (MBP+Abx) was associated with a reduced risk of anastomotic leak when compared to mechanical bowel preparation alone (MBP) or no bowel preparation (NBP).METHODS: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 Left Sided Colorectal Resection audit was performed. Patients undergoing elective left sided colonic or rectal resection with primary anastomosis between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak.RESULTS: Of 3676 patients across 343 centres in 47 countries, 618 (16.8%) received MBP+ABx, 1945 MBP (52.9%) and 1099 patients NBP (29.9%). Patients undergoing MBP+ABx had the lowest overall rate of anastomotic leak (6.1%, 9.2%, 8.7% respectively) in unadjusted analysis. After case-mix adjustment using a mixed-effects multivariable regression model, MBP+Abx was associated with a lower risk of anastomotic leak (OR 0.52, 0.30-0.92, P = 0.02) but MBP was not (OR 0.92, 0.63-1.36, P = 0.69) compared to NBP.CONCLUSION: This non-randomised study adds 'real-world', contemporaneous, and prospective evidence of the beneficial effects of combined mechanical bowel preparation and oral antibiotics in the prevention of anastomotic leak following left sided colorectal resection across diverse settings. We have also demonstrated limited uptake of this strategy in current international colorectal practice.
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- 2018
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121. Colectomie droite par abord robotique. Recommandations formalisées d’experts sous l’égide de l’Association française de chirurgie (AFC)
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N. de’Angelis, R. Micelli Lupinacci, S. Abdalla, P. Genova, A. Beliard, E. Cotte, Q. Denost, N. Goasguen, Z. Lakkis, B. Lelong, G. Manceau, G. Meurette, C. Perrenot, D. Pezet, P. Rouanet, A. Valverde, P. Pessaux, S. Azagra, D. Mege, S. Di Saverio, C. de Chaisemartin, E. Espin-Basany, S. Gaujoux, M. Gómez-Ruiz, C. Gronnier, M. Karoui, G. Spinoglio, de’Angelis, N., Micelli Lupinacci, R., Abdalla, S., Genova, P., Beliard, A., Cotte, E., Denost, Q., Goasguen, N., Lakkis, Z., Lelong, B., Manceau, G., Meurette, G., Perrenot, C., Pezet, D., Rouanet, P., Valverde, A., Pessaux, P., Azagra, S., Mege, D., Di Saverio, S., de Chaisemartin, C., Espin-Basany, E., Gaujoux, S., Gómez-Ruiz, M., Gronnier, C., Karoui, M., and Spinoglio, G.
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Right colon cancer ,Minimally invasive surgery ,Right colectomy ,Robotic surgery ,Surgery ,Recommendations - Abstract
Twenty-seven experts under the aegis of the French Association of Surgery (AFC) offer this reference system with formalized recommendations concerning the performance of right colectomy by robotic approach (RRC). For RRC, experts suggest patient installation in the so-called “classic” or “suprapubic” setup. For patients undergoing right colectomy for a benign pathology or cancer, RRC provides no significant benefit in terms of intra-operative blood loss, intra-operative complications or conversion rate to open laparotomy compared to laparoscopy. At the same time, RRC is associated with significantly longer operating times. Data from the literature are insufficient to define whether the robot facilitates the performance of an intra-abdominal anastomosis, but the robotic approach is more frequently associated with an intra-abdominal anastomosis than the laparoscopic approach. Experts also suggest that RRC offers a benefit in terms of post-operative morbidity compared to right colectomy by laparotomy. No benefit is retained in terms of mortality, duration of hospital stay, histological results, overall survival or recurrence-free survival in RRC performed for cancer. In addition, RRC should not be performed based on the cost/benefit ratio, since RRC is associated with significantly higher costs than laparoscopy and laparotomy. Future research in the field of RRC should consider the evaluation of patient-targeted parameters such as pain or quality of life and the technical advantages of the robot for complex procedural steps, as well as surgical and oncological results.
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- 2022
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122. The effect of adjuvant chemotherapy on survival and recurrence after curative rectal cancer surgery in patients who are histologically node negative after neoadjuvant chemoradiotherapy
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Gianluca Pellino, S. Rasheed, Daniel L H Baird, Christos Kontovounisios, Constantinos Simillis, Eric Rullier, Quentin Denost, Paris P. Tekkis, Baird, Dlh, Denost, Q, Simillis, C, Pellino, Gianluca, Rasheed, S, Kontovounisios, C, Tekkis, P. P, and Rullier, E.
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Adult ,Male ,medicine.medical_specialty ,Colorectal cancer ,medicine.medical_treatment ,Pathological staging ,Adenocarcinoma ,Disease-Free Survival ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Adjuvant therapy ,Rectal Adenocarcinoma ,Humans ,Lymph node ,Aged ,Neoplasm Staging ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Rectal Neoplasms ,Gastroenterology ,Rectum ,1103 Clinical Sciences ,Chemoradiotherapy, Adjuvant ,Middle Aged ,medicine.disease ,Combined Modality Therapy ,Neoadjuvant Therapy ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Propensity score matching ,030211 gastroenterology & hepatology ,Female ,Lymph Nodes ,Neoplasm Recurrence, Local ,business ,Adjuvant - Abstract
Aim The aim of this study is to evaluate whether adjuvant chemotherapy will affect recurrence rates, disease free and overall survival in patients with rectal adenocarcinoma who were staged with MRI node positive disease (mrN+) preoperatively and underwent neoadjuvant chemoradiotherapy with curative rectal cancer surgery and their pathological staging was negative for nodal disease (ypN0). There is no consensus on the role of adjuvant chemotherapy in these patients. Method Patients who received neoadjuvant chemoradiotherapy and underwent curative rectal cancer surgery for rectal adenocarcinoma staged as [mrTxN+M0] on MRI staging and on pathological staging were found to be [ypTxN0M0] were retrospectively identified from 01/2008-12/2012 from two tertiary referral centers (Royal Marsden Hospital and Saint-Andre Hospital). Results 163 patients were recruited and after propensity matching at a ratio of 2:1 n=80 patients were divided into adjuvant (n=28) and no adjuvant treatment (n=52) respectively. A comparison of adjuvant chemotherapy vs no adjuvant therapy showed that the mean overall survival was 2.67 vs 3.60 years (p=0.42), disease free survival was 2.27 vs 3.32 years (p=0.14). Conclusion This study found no significant difference in survival or disease recurrence between patients who received adjuvant chemotherapy and patients who did not. There is no clear evidence to support or dismiss the use of adjuvant chemotherapy for patients who have been node positive on pre-operative MRI and node negative on histopathological staging. Further multicenter prospective randomised trials are needed to identify the appropriate treatment regime for this group of patients. This article is protected by copyright. All rights reserved.
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- 2017
123. Do We Really Know That a "Substantial" Proportion of Near-Complete Pathological Responses Become Complete Over Time?
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São Julião GP, Fernandez LM, Vailati BB, Corbi LE, Denost Q, and Perez RO
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- 2025
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124. Final Results of the GRECCAR-6 Trial on Waiting Period Following Neoadjuvant Radiochemotherapy for Locally Advanced Rectal Cancer: 5 Years of Follow-up.
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Collard MK, Mineur L, Nekrouf C, Denost Q, Rouanet P, de Chaisemartin C, Merdrignac A, Jafari M, Cotte E, Desrame J, Manceau G, Benoist S, Buscail E, Karoui M, Panis Y, Piessen G, Saudemont A, Prudhomme M, Peschaud F, Dubois A, Loriau J, Tuech JJ, Duchalais E, Lupinacci RM, Goasguen N, Simon T, Parc Y, and Lefevre JH
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- Humans, Male, Female, Middle Aged, Aged, Follow-Up Studies, Disease-Free Survival, Chemoradiotherapy methods, Proctectomy, Prognosis, Adult, Survival Rate, Chemoradiotherapy, Adjuvant methods, Rectal Neoplasms therapy, Rectal Neoplasms pathology, Rectal Neoplasms mortality, Neoadjuvant Therapy methods, Adenocarcinoma therapy, Adenocarcinoma pathology, Adenocarcinoma mortality, Fluorouracil therapeutic use, Fluorouracil administration & dosage, Capecitabine administration & dosage, Capecitabine therapeutic use, Neoplasm Staging
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Background: The potential oncological benefit of extending the waiting period between neoadjuvant radiochemotherapy and surgical resection for rectal cancer is debated., Objective: To evaluate the impact of prolonging this waiting period on the 5-year oncological prognosis and 2-year functional result of locally advanced rectal adenocarcinoma., Design: Phase III, multicenter, randomized, open-label, parallel-group, controlled trial., Settings: Patients were enrolled from 24 colorectal centers., Patients: Patients with nonmetastatic mid or lower cT3/T4Nx or cTxN+ rectal adenocarcinoma who had received radiochemotherapy (45-50 Gy radiation dose with fluorouracil or capecitabine)., Intervention: Patients were randomly assigned to undergo total mesorectal excision either 7 weeks or 11 weeks after radiochemotherapy., Main Outcomes Measures: Overall survival and disease-free survival at 5-year follow-up and low anterior resection syndrome score assessed after 2 years of follow-up., Results: Among 265 patients enrolled, 133 were randomized in the 7-week group and 132 in the 11-week group. Twelve patients were excluded because they did not undergo resection. Among 253 patients analyzed, 5-year overall survival was not different between the 2 groups (81.6% in the 7-week group vs 82.6% in the 11-week group, p = 0.827), and neither was the 5-year disease-free survival (70.4% in the 7-week group vs 69.5% in the 11-week group, p = 0.856). No difference was observed between the 2 groups for distant recurrence (27.4% in the 7-week group vs 25.7% in the 11-week group, p = 0.777) or local recurrence (8.4% in the 7-week group vs 10.2% in the 11-week group, p = 0.543). The low anterior resection syndrome score was similar between the 7-week (25.0; interquartile range, 15.0-34.0) and 11-week groups (23.0; interquartile range, 14.2-32.0; p = 0.743)., Limitations: The response rate to the low anterior resection syndrome questionnaire was only 52%., Conclusions: Extending the waiting period between radiochemotherapy and resection from 7 to 11 weeks does not change the 5-year oncological prognosis in rectal cancer or the 2-year low anterior resection occurrence. See Video Abstract., Resultados Finales Del Ensayo Greccar Sobre El Perodo De Espera Tras La Radioquimioterapia Neoadyuvante Para El Cncer De Recto Localmente Avanzado Aos De Seguimiento: ANTECEDENTES:Se debate el posible beneficio oncológico de prolongar el periodo de espera entre la radioquimioterapia neoadyuvante y la resección quirúrgica del cáncer de recto.OBJETIVO:Evaluar el impacto de la prolongación de este periodo de espera sobre el pronóstico oncológico a 5 años y el resultado funcional a 2 años del adenocarcinoma rectal localmente avanzado.DISEÑO:Ensayo controlado de fase III, multicéntrico, aleatorizado, abierto, de grupos paralelos.LUGAR:Se reclutaron pacientes de 24 centros colorrectales.PACIENTES:Pacientes con adenocarcinoma rectal de tercio medio o inferior, no metastásico cT3-4 o TxN+ que habían recibido radioquimioterapia (45 a 50 Gy con fluorouracilo o capecitabina).INTERVENCIÓN:Se asignaron aleatoriamente a los pacientes para ser sometidos a una escisión mesorrectal total 7 semanas (W7) u 11 semanas (W11) después de la radioquimioterapia.MEDIDAS DE RESULTADOS PRINCIPALES:Supervivencia global y supervivencia libre de enfermedad a los 5 años de seguimiento y puntuación del síndrome de resección anterior baja evaluada a los 2 años de seguimiento.RESULTADOS:De los 265 pacientes reclutados, 133 fueron asignados aleatoriamente al grupo de 7 semanas y 132 al grupo de 11 semanas. Doce pacientes fueron excluidos porque no fueron sometidos a resección. Entre los 253 pacientes analizados, la supervivencia global a 5 años no fue diferente entre los dos grupos (81,6% en el grupo de 7 semanas frente a 82,6% en el grupo de 11 semanas, p = 0,827), así como para la supervivencia libre de enfermedad a 5 años (70,4% en el grupo de 7 semanas frente a 69,5% en el grupo de 11 semanas, p = 0,856). No se observaron diferencias entre los dos grupos en cuanto a la recidiva a distancia (27,4% en el grupo de 7 semanas frente a 25,7% en el grupo de 11 semanas, p = 0,777) o la recidiva local (8,4% en el grupo de 7 semanas frente a 10,2% en el grupo de 11 semanas, p = 0,543). La puntuación del síndrome de resección anterior baja fue similar entre los grupos de 7 semanas (25,0 IQR [15,0-34,0]) y 11 semanas (23,0 IQR [14,2-32,0], p = 0,743).LIMITACIONES:La tasa de respuesta al cuestionario LARS fue sólo del 52%.CONCLUSIONES:Ampliar el periodo de espera entre radioquimioterapia y resección de 7 a 11 semanas no modifica el pronóstico oncológico a 5 años en cáncer de recto ni la baja incidencia de resección anterior a 2 años. (Traducción-Dr Osvaldo Gauto )., (Copyright © The ASCRS 2024.)
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- 2025
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125. Durable remission after ileocolic resection for Crohn's disease is achievable in selected patients. Long-term results of a prospective multicentric cohort study of the GETAID Chirurgie.
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Abdalla S, Benoist S, Maggiori L, Lefèvre JH, Denost Q, Cotte E, Germain A, Beyer-Berjot L, Desfourneaux V, Rahili A, Duffas JP, Pautrat K, Denet C, Bridoux V, Meurette G, Faucheron JL, Loriau J, Souche FR, Corte H, Vicaut É, Zerbib P, Panis Y, and Brouquet A
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- Humans, Female, Male, Adult, Retrospective Studies, Colectomy methods, Prospective Studies, Colon surgery, Colon pathology, Middle Aged, Follow-Up Studies, Treatment Outcome, Young Adult, Reoperation statistics & numerical data, Crohn Disease surgery, Remission Induction methods, Ileum surgery, Recurrence
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Background and Aims: Postoperative recurrence requiring medical treatment intensification or redo surgery is common after ileocolic resection (ICR) for Crohn's disease (CD). This study aimed to identify a subgroup of CD patients for whom ICR could achieve durable remission., Methods: This retrospective follow-up study analyzed 592 CD patients who underwent ICR (2013-2015) in a nationwide prospective cohort. Patients with >36 months follow-up were included. Primary outcome was durable remission, defined as the absence of endoscopic recurrence and/or medical treatment intensification. Uni- and multivariate analyses identified predictive factors for durable remission., Results: Among 268 included patients, 59% had B2 phenotype, 70% had a first ICR, and 66% had postoperative medical treatment. After a median follow-up of 85 (36-104) months, 52 patients (19%) experienced durable remission, of whom 24 (46%) didn't require medical treatment and 28 (54%) maintained the same postoperative treatment, including anti-tumor necrosis factor in 15/28 patients (54%). Surgery could stabilize the disease course in 112 patients (41.7%), including 22.4% endoscopic recurrence that didn't require CD treatment initiation or intensification. Durable remission rate was significantly increased in B1 phenotype vs B2/B3 (n = 7/18;39% vs n = 45/250;18%, P = .030) and in first ICR vs redo ICR (n = 43/184;23% vs n = 9/80;11%, P = .023). In multivariate analysis, B1 phenotype was the only independent predictive factor for durable remission (odds ratio = 3.59, IC 95%, 1.13-11.37, P = .030)., Conclusions: Surgery for CD achieved durable remission in 20%, rising to 40% in those with a B1 phenotype. These results support surgery as a viable alternative to medical treatment, offering treatment-free durable remission and preserving medical treatment options., (© The Author(s) 2025. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
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- 2025
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126. MRI of the Rectum: A Decade into DISTANCE, Moving to DISTANCED.
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Nougaret S, Gormly K, Lambregts DMJ, Reinhold C, Goh V, Korngold E, Denost Q, and Brown G
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- Humans, Neoadjuvant Therapy methods, Neoplasm Staging, Rectal Neoplasms diagnostic imaging, Rectal Neoplasms therapy, Magnetic Resonance Imaging methods, Rectum diagnostic imaging, Rectum pathology
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Over the past decade, advancements in rectal cancer research have reshaped treatment paradigms. Historically, treatment for locally advanced rectal cancer has focused on neoadjuvant long-course chemoradiotherapy, followed by total mesorectal excision. Interest in organ preservation strategies has been strengthened by the introduction of total neoadjuvant therapy with improved rates of complete clinical response. The administration of systemic induction chemotherapy and consolidation chemoradiotherapy in the neoadjuvant setting has introduced a new dimension to the treatment landscape and patients now face a more intricate decision-making process, given the expanded therapeutic options. This complexity underlines the importance of shared decision-making and brings to light the crucial role of radiologists. MRI, especially high-spatial-resolution T2-weighted imaging, is heralded as the reference standard for rectal cancer management because of its exceptional ability to provide staging and prognostic insights. A key evolution in MRI interpretation for rectal cancer is the transition from the DISTANCE mnemonic to the more encompassing DISTANCED-DIS, distal tumor boundary; T, T stage; A, anal sphincter complex; N, nodal status; C, circumferential resection margin; E, extramural venous invasion; D, tumor deposits. This nuanced shift in the mnemonic captures a wider range of diagnostic indicators. It also emphasizes the escalating role of radiologists in steering well-informed decisions in the realm of rectal cancer care., (© RSNA, 2025.)
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- 2025
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127. Robotic ventral mesh placement for external prolabation of ileoanal pouch-A video vignette.
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Denost Q, Karlsen M, Assenat V, and Francois MO
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- 2025
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128. Local excision for organ preservation in low rectal cancer: Video technique and case report applying GRECCAR 2 and GRECCAR 12 trial principles-A video vignette.
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Sánchez-Rodríguez M, Koo CH, Assenat V, François MO, Tejedor P, and Denost Q
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- 2025
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129. Robotic approach for removal of a presacral lesion-a video vignette.
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Denost Q, Karlsen M, Assenat V, and Francois MO
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- 2024
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130. Low rectal resection for low rectal endometriosis and rectal adenocarcinoma: Are we discussing the same risks?
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Volodarsky-Perel A, Roman H, Francois MO, Jehaes C, Dennis T, Kade S, Forestier D, Assenat V, Merlot B, and Denost Q
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- Humans, Female, Adult, Retrospective Studies, Middle Aged, Risk Factors, Aged, Proctectomy methods, Proctectomy adverse effects, Logistic Models, Endometriosis surgery, Rectal Neoplasms surgery, Adenocarcinoma surgery, Anastomotic Leak epidemiology, Anastomotic Leak etiology, Anastomosis, Surgical adverse effects, Anastomosis, Surgical methods, Rectal Diseases surgery
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Objective: To evaluate the rate and risk factors for anastomosis leakage in patients undergoing colorectal resection with low anastomosis for rectal endometriosis and rectal adenocarcinoma., Methods: A retrospective cohort study evaluating prospectively collected data was conducted. Patients undergoing colorectal resection for rectal endometriosis and rectal adenocarcinoma with low anastomosis (<7 cm from the anal verge [AV]) from September 2018 to January 2023 were included in the analysis. The main outcome was the rate of anastomosis leakage. A multivariate logistic regression was conducted to evaluate risk factors for anastomosis leakage in both groups., Results: A total of 159 patients underwent colorectal resection with low anastomosis due to rectal endometriosis (n = 99) and rectal adenocarcinoma (n = 60). Patients with endometriosis were significantly younger than those with adenocarcinoma (35.7 ± 5.1 vs 63.7 ± 12.6; P = 0.001). The leakage rate was similar between the endometriosis (n = 12, 12.1%) and adenocarcinoma (n = 9, 15.0%) patients (P = 0.621). The anastomosis height less than 5 cm from the AV (adjusted odds ratio [aOR] 12.12, 95% confidence interval [CI] 2.24-23.54) was significantly associated with the anastomosis leakage. Protective stoma was associated with the decrease of the leakage risk (aOR 0.12, 95% CI 0.01-0.72). The type of disease (rectal endometriosis or adenocarcinoma) was not associated with the anastomosis leakage (aOR 2.87, 95% CI 0.34-21.23)., Conclusions: Despite the different pathogenesis, the risk of anastomotic leakage was found to be similar between patients with low rectal endometriosis and those with rectal adenocarcinoma. These results must be considered by the gynecologist and colorectal surgeon to deliver proper information before rectal surgery for endometriosis., (© 2024 International Federation of Gynecology and Obstetrics.)
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- 2024
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131. Laparoscopic and robotic total mesorectal excision in overweight and obese patients: multinational cohort study.
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Smalbroek BP, Geitenbeek RTJ, Dijksman LM, Khan J, Denost Q, Rouanet P, Hompes R, Consten ECJ, and Smits AB
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- 2024
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132. Tumor response rates based on initial TNM stage and tumor size in locally advanced rectal cancer: a useful tool for shared decision-making.
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Boubaddi M, Fleming C, Assenat V, François MO, Rullier E, and Denost Q
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- Humans, Male, Female, Middle Aged, Aged, Treatment Outcome, Adult, Retrospective Studies, Chemoradiotherapy, Adjuvant, Organ Sparing Treatments methods, Proctectomy methods, Aged, 80 and over, Rectal Neoplasms pathology, Rectal Neoplasms therapy, Rectal Neoplasms diagnostic imaging, Neoplasm Staging, Neoadjuvant Therapy methods, Tumor Burden, Magnetic Resonance Imaging, Decision Making, Shared
- Abstract
Background: It is accepted that tumor stage and size can influence response to neoadjuvant therapy in locally advanced rectal cancer (LARC). Studies on organ preservation to date have included a wide variety of size and TNM stage tumors. The aim of this study was to report tumor response based on each relevant TNM stage and tumor size., Methods: Patients treated with LARC from 2014 to 2021 with cT2-3NxM0 tumors who received neoadjuvant chemoradiotherapy with or without induction chemotherapy were included. Tumors were staged and tumor size calculated on pelvic MRI at the time of diagnosis (cTNM). Tumor size was based on the largest dimension taken on the longest axis of each tumor. Clinical response was defined on the basis of post-treatment pelvic MRI and pathological response following surgery, when performed. Statistical analysis was performed using IBM SPSS Statistics™, version 20. Data from 432 patients were analyzed as follows: cT2N0 (n = 51), cT2N+ (n = 36), cT3N0 (n = 76), cT3N+ (n = 270)., Results: The rate of complete or near-complete response (cCR or nCR) varied from 77% in cT2N0 ≤ 3 cm to 20% in cT3N+ > 4 cm. Organ preservation without recurrence at 2 years was achieved in 86% of patients with cT2N0, 50% in cT2N+, 39% in cT3N0, and 12% in cT3N+., Conclusion: There is significant variation in tumor response according to tumor stage and size. Tumor response appears inversely proportional to increasing TNM stage and tumor size. This data can support both refinement of selective patient recruitment to organ preservation programs and shared decision-making., (© 2024. Springer Nature Switzerland AG.)
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- 2024
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133. Impact of radiotherapy on quality of life in patients with rectal cancer.
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Tejedor P and Denost Q
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- Humans, Male, Female, Aged, Middle Aged, Surveys and Questionnaires, Rectal Neoplasms radiotherapy, Rectal Neoplasms psychology, Quality of Life
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- 2024
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134. TAilored SToma policY after TME for rectal cancer: The TASTY approach.
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Boissieras L, Harji D, Celerier B, Rullier E, and Denost Q
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- Humans, Male, Female, Middle Aged, Aged, Prospective Studies, Risk Assessment methods, Pilot Projects, C-Reactive Protein analysis, Adult, Rectal Neoplasms surgery, Anastomotic Leak etiology, Anastomotic Leak epidemiology, Anastomotic Leak prevention & control, Surgical Stomas adverse effects
- Abstract
Aim: Diverting stomas are routinely used in restorative surgery following total mesorectal exicision (TME) for rectal cancer to mitigate the clinical risks of anastomotic leakage (AL). However, routine diverting stomas are associated with their own complication profile and may not be required in all patients. A tailored approach based on personalized risk of AL and selective use of diverting stoma may be more appropriate. The aim of the TAilored SToma policY (TASTY) project was to design and pilot a standardized, tailored approach to diverting stoma in low rectal cancer., Method: A mixed-methods approach was employed. Phase I externally validated the anastomotic failure observed risk score (AFORS). We compared the observed rate of AL in our cohort to the theoretical, predicted risk of the AFORS score. To identify the subset of patients who would benefit from early closure of the diverting stoma using C-reactive protein (CRP) we calculated the Youden index. Phase II designed the TASTY approach based on the results of Phase I. This was evaluated within a second prospective cohort study in patients undergoing TME for rectal cancer between April 2018 and April 2020., Results: A total of 80 patients undergoing TME surgery for rectal cancer between 2016 and 2018 participated in the external validation of the AFORS score. The overall observed AL rate in this cohort of patients was 17.5% (n = 14). There was a positive correlation between the predicted and observed rates of AL using the AFORS score. Using ROC curves, we calculated a CRP cutoff value of 115 mg/L on postoperative day 2 for AL with a sensitivity of 86% and a negative predictive value of 96%. The TASTY approach was designed to allocate patients with a low risk AFORS score to primary anastomosis with no diverting stoma and high risk AFORS score patients to a diverting stoma, with early closure at 8-14 days, if CRP values and postoperative CT were satisfactory. The TASTY approach was piloted in 122 patients, 48 (39%) were identified as low risk (AFORS score 0-1) and 74 (61%) were considered as high risk (AFORS score 2-6). The AL rate was 10% in the low-risk cohort of patient compared to 23% in the high-risk cohort of patients, p = 0.078 The grade of Clavien-Dindo morbidity was equivalent. The incidence of major LARS was lowest in the no stoma cohort at 3 months (p = 0.014)., Conclusion: This study demonstrates the feasibility and safety of employing a selective approach to diverting stoma in patients with a low anastomosis following TME surgery for rectal cancer., (© 2024 Association of Coloproctology of Great Britain and Ireland.)
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- 2024
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135. Imaging in pelvic exenteration-a multidisciplinary practice guide from the ESGAR-SAR-ESUR-PelvEx collaborative group.
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Nougaret S, Lambregts DMJ, Beets GL, Beets-Tan RGH, Blomqvist L, Burling D, Denost Q, Gambacorta MA, Gui B, Klopp A, Lakhman Y, Maturen KE, Manfredi R, Petkovska I, Russo L, Shinagare AB, Stephenson JA, Tolan D, Venkatesan AM, Quyn AJ, and Forstner R
- Abstract
Pelvic exenteration (PE) is a radical surgical approach designed for the curative treatment of advanced pelvic malignancies, requiring en-bloc resection of multiple pelvic organs. While the procedure is radical, it has shown promise in enhancing long-term survival and is now comparable in surgical mortality to elective resections for primary pelvic cancers. Imaging plays a crucial role in preoperative planning, with MRI, CT, and PET/CT being pivotal in assessing the extent of cancer and formulating a surgical roadmap. This paper presents clinical practice guidelines for imaging in the context of PE, developed jointly by ESGAR, SAR, ESUR, and the PelvEx Collaborative. These guidelines aim to standardize imaging protocols and reporting to improve the preoperative assessment and facilitate decision-making in the multidisciplinary treatment of pelvic cancers. Our recommendations underscore the importance of a multidisciplinary approach and the need for clear and precise imaging reports to optimize patient care. CLINICAL RELEVANCE STATEMENT: Our recommendations underscore the importance of a multidisciplinary approach and the need for clear and precise imaging reports to optimize patient care. KEY POINTS: MRI is mandatory for local staging in pelvic exenteration. Structured reporting (using the template provided in this guide) is recommended. Multidisciplinary review of imaging is critical for surgical planning., (© 2024. The Author(s), under exclusive licence to European Society of Radiology.)
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- 2024
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136. Rectovaginal Fistula: What Is the Role of Martius Flap and Gracilis Muscle Interposition in the Therapeutic Strategy?
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Pastier C, Loriau J, Denost Q, O'Connell LV, Challine A, Collard MK, Debove C, Chafai N, Parc Y, and Lefevre JH
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- Humans, Female, Retrospective Studies, Middle Aged, Adult, Superficial Back Muscles transplantation, Treatment Outcome, Aged, Length of Stay statistics & numerical data, Plastic Surgery Procedures methods, Surgical Stomas adverse effects, Gracilis Muscle transplantation, Surgical Flaps, Rectovaginal Fistula surgery
- Abstract
Background: Although numerous treatments exist for the management of rectovaginal fistula, none has demonstrated its superiority. The role of diverting stoma remains controversial. A few series include Martius flap in the armamentarium., Objective: Determine the role of gracilis muscle interposition and Martius flap in the surgical management of rectovaginal fistula., Design: Retrospective cohort study of a pooled prospectively maintained database from 3 centers., Patients: All consecutive eligible patients with rectovaginal fistula undergoing Martius flap and gracilis muscle interposition were included from 2001 to 2022., Main Outcome Measures: Success was defined by the absence of stoma and rectovaginal fistula., Results: Sixty-two patients were included with 55 Martius flap and 24 gracilis muscle interposition performed after failures of 164 initial procedures. Total length of stay was longer for gracilis muscle interposition by 2 days ( p = 0.01) without a significant difference in severe morbidity (20% vs 12%, p = 0.53). Twenty-seven percent of the Martius flap interpositions were performed without a stoma, which did not have an impact on overall morbidity ( p = 0.763). Per patient immediate success rates were not significantly different between groups (35% vs 31%, p > 0.99). The success of gracilis muscle interposition after the failure of the Martius flap was not significantly different from an initial gracilis muscle interposition ( p > 0.99). After simple perineal procedures, the immediate success rate rose to 49.4% (49% vs 50%, p > 0.99). After a median follow-up of 23 months, no significant difference was detected in success rate between the 2 procedures (69% vs 69%, p > 0.99). Smoking was the only negative predictive factor ( p = 0.02)., Limitations: By its retrospective nature, this study is limited in its comparison., Conclusions: This novel comparison between Martius flap and gracilis muscle interposition suggests that Martius flap presents several advantages, including shorter length of stay, similar morbidity, and similar success rate. Proximal diversion via a stoma for Martius flap does not appear mandatory. Gracilis muscle interposition could be reserved as a salvage procedure after Martius flap failure. See Video Abstract ., Fstula Rectovaginal Cul Es El Rol Del Colgajo De Martius Y La Interposicin Del Msculo Gracilis En La Estrategia Teraputica: ANTECEDENTES:Si bien existen numerosos tratamientos para el manejo de la fistula rectovaginal, ninguno ha demostrado su superioridad. El papel del estoma de derivación sigue siendo controvertido. Pocas series incluyen colgajo de Martius en el armamento.OBJETIVO:Determinar el rol de la interposición del músculo gracilis y del colgajo de Martius, en el manejo quirúrgico de la fístula rectovaginal.DISEÑO:Estudio de cohorte retrospectivo de una base de datos mantenida prospectivamente en 3 centros.AJUSTES/PACIENTES:Se incluyeron todos los pacientes elegibles consecutivos con fistula rectovaginal sometidos a colgajo de Martius y la interposición del músculo gracilis desde 2001 hasta 2022.RESULTADOS PRINCIPALES:El éxito se definió por la ausencia de estoma y fistula rectovaginal.RESULTADOS:Se incluyeron 62 pacientes con 55 colgajo de Martius y 24 con interposición del músculo gracilis realizados después de fracasos de 164 procedimientos iniciales. La duración total de la estancia hospitalaria fue dos días más larga para la interposición del músculo gracilis ( p = 0,01) sin una diferencia significativa en la morbilidad grave (20% frente a 12%, p = 0,53). El 27% de los colgajos de Martius se realizaron sin estoma, sin impacto en la morbilidad global ( p = 0,763). Las tasas de éxito inmediato por paciente no fueron significativamente diferentes entre los grupos (35% vs. 31%, p = 1,0). El éxito de la interposición del músculo gracilis después del fracaso del colgajo de Martius no fue significativamente diferente de una interposición del músculo gracilis inicial (p = 1,0). La tasa de éxito inmediato aumentó al 49,4% (49% frente a 50%, p = 1,0) después de procedimientos perineales simples. Después de una mediana de seguimiento de 23 meses, no se detectaron diferencias significativas en la tasa de éxito entre los dos procedimientos (69 % frente a 69 %, p = 1,0). El tabaquismo fue el único factor predictivo negativo ( p = 0,02).LIMITACIONES:Por su naturaleza retrospectiva, este estudio tiene limitaciones en su comparación.CONCLUSIÓN:Esta novedosa comparación entre colgajo de Martius y la interposición del músculo gracilis sugiere que el colgajo de Martius presenta varias ventajas, incluida una estancia prolongada más corta, una morbilidad similar y un éxito. La derivación proximal a través de un estoma para el colgajo de Martius no parece obligatoria. La interposición del músculo gracilis podría reservarse como procedimiento de rescate después de una falla de colgajo de Martius. (Traducción-Dr. Aurian Garcia Gonzalez )., (Copyright © The ASCRS 2024.)
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- 2024
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137. Feasibility of a tailored operative strategy from organ preservation to pelvic exenteration for cT4 rectal cancer depending on neoadjuvant response.
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Fleming C, Harji D, Fernandez B, François MO, Assenat V, Gilles P, Clément M, Robert G, and Denost Q
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- Humans, Female, Male, Middle Aged, Aged, Neoplasm Staging, Organ Sparing Treatments, Treatment Outcome, Neoplasm Recurrence, Local pathology, Adult, Pelvic Exenteration, Rectal Neoplasms surgery, Rectal Neoplasms pathology, Neoadjuvant Therapy, Feasibility Studies
- Abstract
Purpose: Improvements in neoadjuvant therapy for locally advanced cT4 rectal cancer have led to improved tumour response and thus a variety of suitable management strategies. The aim of this study was to report management and outcomes of patients with cT4 rectal cancer undergoing a spectrum of treatment strategies from organ preservation (OP) to pelvic exenteration (PE)., Methods: Patients who underwent elective treatment for cT4 rectal cancer between 2016 and 2021 were included. All patients were treated with curative intent. Surgical management was adapted to tumour response. Kaplan-Meier curves were generated to compare 3-year overall survival (3y-OS), local recurrence (3y-LR) and distant metastases (3y-DM) between different strategies., Results: Among 152 patients included, 13 (8%) underwent OP, 71 (47%) TME and 68 (45%) APR/PE. The median follow-up was 31.3 months. Patients undergoing OP had a lower tumour pretreatment (p < 0.001). Compared to patients with TME, those with APR/PE had a higher rate of ypT4 (p = 0.001) with a lower R0 rate (p = 0.044). The 3y-OS and 3y-DM were 78% and 15.1%, respectively, without significant differences. The 3y-LR was 6.6%, and patients with OP had a significantly worse 3y-local regrowth compared to 3y-LR in patients with TME and APR/PE (30.2% vs. 5.4% vs. 2%, p = 0.008)., Conclusion: cT4 tumours may be suitable for the full spectrum of rectal cancer management from organ preservation to pelvic exenteration depending on tumour response to neoadjuvant therapy. However, careful attention is required in OP as local regrowth in up to 30% of cases reinforces the need for sustained active surveillance in Watch&Wait programmes., (© 2024. The Author(s).)
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- 2024
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138. Tips and tricks: robotic low anterior resection - A video vignette.
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Sánchez-Rodríguez M, Khan J, Denost Q, and Tejedor P
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- Humans, Robotic Surgical Procedures methods, Rectal Neoplasms surgery, Proctectomy methods
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- 2024
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139. Treatment techniques for rectovaginal fistulas after low rectal resection for deep endometriosis.
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Potolicchio A, Jehaes C, Merlot B, Assenat V, Dennis T, Roman H, Francois MO, and Denost Q
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- Humans, Female, Postoperative Complications etiology, Postoperative Complications surgery, Proctectomy adverse effects, Proctectomy methods, Rectum surgery, Anastomosis, Surgical adverse effects, Anastomosis, Surgical methods, Surgical Flaps, Perineum surgery, Adult, Rectovaginal Fistula surgery, Rectovaginal Fistula etiology, Endometriosis surgery, Laparoscopy methods, Laparoscopy adverse effects
- Abstract
Endometriosis is a benign gynecologic affection that may lead to major surgeries, such as colorectal resections. Rectovaginal fistulas (RVF) are among the possible complications. When they occur, it is necessary to adapt the repair surgery as best as possible to limit their functional consequences. This video shows three different techniques for correcting RVF after rectal resection for endometriosis, with a combination of perineal surgery and laparoscopy: a mucosal flap, a transanal transection and single stapled anastomosis (TTSS) and a pull through. Supplementary file1 (MP4 469658 KB)., (© 2024. Springer Nature Switzerland AG.)
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- 2024
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140. Combined Robotic Transanal Transection Single-Stapled Technique in Ultralow Rectal Endometriosis Involvement Associated With Parametrial and Vaginal Infiltration.
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D'Ancona G, Merlot B, Denost Q, Angioni S, Dennis T, and Roman H
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- Female, Humans, Adult, Rectum surgery, Anastomosis, Surgical methods, Vagina surgery, Endometriosis surgery, Endometriosis complications, Robotic Surgical Procedures, Rectal Diseases surgery, Rectal Diseases complications, Laparoscopy methods, Rectal Neoplasms surgery
- Abstract
Objective: To describe a combined robotic and transanal technique used to treat ultralow rectal endometriosis in a 36-year-old patient with multiple pelvic compartments, which was responsible for infertility, dyspareunia, left sciatic pain, and severe dyschezia., Design: Surgical video article., Setting: The achievement of a perfect bowel anastomosis in patients with low rectal endometriosis could be challenging owing to technical and anatomic limitations [1]. By allowing a right angle rectotomy with a single-stapled anastomosis, the transanal transection single-stapled technique overcomes these technical difficulties ensuring a good-quality anastomosis with an easier correction of postoperative anastomotic leakage when it occurs [2,3]., Interventions: The surgery starts by splitting the nodule in 3 components according to different anatomic structures involved (parametrium, vagina, and rectum). Parametrial and vaginal fragments are excised as previously described (Supplemental Videos 1) [4]. The rectal involvement is approached following several steps: isolation and cut of inferior mesenteric vessels (inferior mesenteric artery and inferior mesenteric vein) and left colic artery to obtain a proper colon mobilization; transanal rectotomy immediately below the lower limit of the nodule; extraction of the specimen through the anus (Supplemental Videos 2); proximal bowel segment transection 1 cm above the upper limit of the nodule; introduction of circular stapler anvil into the sigmoid colon; placement of 2 purse string to secure the anvil and at distal rectal cuff, respectively; connection of the anvil to the shoulder of circular stapler; stapler closing and firing with coloanal anastomosis formation; stapled line reinforcement by stitching; and integrity anastomosis test (Supplemental Videos 3). No preventive diverting stoma was performed in accordance with our policy [5]., Conclusions: Although no data are yet available in patients with endometriosis, the use of transanal transection single-stapled technique may be an interesting approach in patients with very low rectal endometriosis involvement., (Copyright © 2024. Published by Elsevier Inc.)
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- 2024
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141. Multicentre cohort study evaluating clinical, oncological and functional outcomes following robotic rectal cancer surgery-the EUREKA collaborative: trial protocol.
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Fleming CA, Duhoky R, Geitenbeek RTJ, Moussion A, Bouazza N, Khan J, Cotte E, Dubois A, Rullier E, Hompes R, Denost Q, Rouanet P, and Consten ECJ
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- Humans, Cohort Studies, Multicenter Studies as Topic, Rectum, Rectal Neoplasms surgery, Robotic Surgical Procedures methods
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- 2024
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142. Can shared medical decision-making help to solve the complex equation involved in the choice of optimal treatment for low rectal cancer?
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Brouquet A and Denost Q
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- Humans, Clinical Decision-Making, Decision Making, Shared, Patient Participation, Decision Making, Rectal Neoplasms surgery
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- 2024
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143. Local Regrowth and the Risk of Distant Metastases Among Patients Undergoing Watch-and-Wait for Rectal Cancer: What Is the Best Control Group? Multicenter Retrospective Study.
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São Julião GP, Fernández LM, Vailati BB, Habr-Gama A, Azevedo JM, Santiago IA, Parés O, Parvaiz A, Vendrely V, Rullier A, Rullier E, Denost Q, and Perez RO
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- Humans, Retrospective Studies, Cohort Studies, Control Groups, Neoplasm Staging, Rectal Neoplasms pathology
- Abstract
Background: A proportion of rectal cancer patients who achieve a clinical complete response may develop local regrowth. Although salvage appears to provide appropriate local control, the risk of distant metastases is less known., Objective: To compare the risk of distant metastases between patients who achieve a clinical complete response (watch-and-wait strategy) and subsequent local regrowth and patients managed by surgery after chemoradiation., Design: Retrospective multicenter cohort study., Settings: This study used data of patients from 3 institutions who were treated between 1993 and 2019., Patients: Patients with initial clinical complete response (after neoadjuvant therapy) followed by local regrowth and patients with near-complete pathological response (≤10%) after straightforward surgery after chemoradiation were included., Main Outcome Measures: Univariate and multivariate analyses were performed to identify risk factors for distant metastases. Kaplan-Meier curves were created (log-rank test) to compare survival outcomes. Analyses were performed using time zero as last day of radiation therapy or as date of salvage resection in the local regrowth group., Results: Twenty-one of 79 patients with local regrowth developed distant metastases, whereas only 10 of 74 after upfront total mesorectal excision following neoadjuvant chemoradiation therapy ( p = 0.04). Local regrowth and final pathology (ypT3-4) were the only independent risk factors associated with distant metastases. When using date of salvage resection as time zero, distant metastases-free survival rates were significantly inferior for patients with local regrowth (70% vs 86%; p = 0.01)., Limitations: Small number of patients, many neoadjuvant therapies, and selection bias., Conclusions: Patients undergoing watch-and-wait strategy who develop local regrowth are at higher risk for development of distant metastases compared to patients with near-complete pathological response managed by upfront surgery after chemoradiation. See Video Abstract., Nuevo Crecimiento Local Y El Riesgo De Metstasis a Distancia Entre Pacientes Sometidos a Observacin Y Espera Por Cncer De Recto Cul Es El Mejor Grupo De Control Estudio Retrospectivo Muticntrico: ANTECEDENTES:Una proporción de pacientes que logran una respuesta clínica completa pueden desarrollar un nuevo crecimiento local. Si bien el rescate parece proporcionar un control local apropiado, el riesgo de metástasis a distancia es menos conocido.OBJETIVO:Comparar el riesgo de metástasis a distancia entre los pacientes que logran una respuesta clínica completa (estrategia de observación y espera) y el nuevo crecimiento local posterior con los pacientes tratados con cirugía después de la quimiorradiación.DISEÑO:Estudio de cohorte multicéntrico retrospectivo.CONFIGURACIÓN:Este estudio utilizó datos de pacientes de 3 instituciones que fueron tratados entre 1993 y 2019.PACIENTES:Pacientes con respuesta clínica completa inicial (después de la terapia neoadyuvante) seguida de crecimiento local nuevo y pacientes con respuesta patológica casi completa (≤10 %) después de cirugía directa después de quimiorradiación.PRINCIPALES MEDIDAS DE RESULTADO:Se realizó un análisis univariante/multivariante para identificar los factores de riesgo de metástasis a distancia. Se crearon curvas de Kaplan-Meier (prueba de rango logarítmico) para comparar los resultados de supervivencia. El análisis se realizó utilizando el tiempo cero como último día de radioterapia (1) o como fecha de resección de rescate (2) en el grupo de recrecimiento local.RESULTADOS:Veintiuno de 79 pacientes con recrecimiento local desarrollaron metástasis a distancia, mientras que solo 10 de 74 después de una cirugía sencilla (p = 0,04). El recrecimiento local y la patología final (ypT3-4) fueron los únicos factores de riesgo independientes asociados con las metástasis a distancia. Cuando se utilizó la fecha de la resección de rescate como tiempo cero, las tasas de supervivencia sin metástasis a distancia fueron significativamente inferiores para los pacientes con recrecimiento local (70 frente a 86 %; p = 0,01).LIMITACIONES:Pequeño número de pacientes, muchas terapias neoadyuvantes, sesgo de selección.CONCLUSIONES:Los pacientes sometidos a observación y espera que desarrollan un nuevo crecimiento local tienen un mayor riesgo de desarrollar metástasis a distancia en comparación con los pacientes con una respuesta patológica casi completa manejados con cirugía por adelantado después de la quimiorradiación. (Traducción-Dr. Xavier Delgadillo )., (Copyright © The ASCRS 2023.)
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- 2024
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144. Low-impact laparoscopy in colorectal resection-A multicentric randomised trial comparing low-pressure pneumoperitoneum plus microsurgery versus low-pressure pneumoperitoneum alone: The PAROS II trial.
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Marichez A, Eude A, Martenot M, Celerier B, Capdepont M, Rullier E, Denost Q, and Fernandez B
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- Humans, Prospective Studies, Microsurgery, Pain, Postoperative drug therapy, Pain, Postoperative etiology, Analgesics, Opioid, Pneumoperitoneum etiology, Pneumoperitoneum surgery, Laparoscopy methods, Colorectal Neoplasms surgery
- Abstract
Introduction: Low-pressure pneumoperitoneum (LLP) in laparoscopy colorectal surgery (CS) has resulted in reduced hospital stay and lower analgesic consumption. Microsurgery (MS) in CS is a technique that has a significant impact with respect to postoperative pain. The combination of MS plus LLP, known as low-impact laparoscopy (LIL), has never been applied in CS. Therefore, this trial will assess the efficacy of LLP plus MS versus LLP alone in terms of decreasing postoperative pain 24 h after surgery, without taking opioids., Method: PAROS II will be a prospective, multicentre, outcome assessor-blinded, randomised controlled phase III clinical trial that compares LLP plus MS versus LLP alone in patients undergoing laparoscopic surgery for colonic or upper rectal cancer or benign pathology. The primary outcome will be the number of patients with postoperative pain 24 h after the surgery, as defined by a visual analogue scale rating ≤3 and without taking opioids. Overall, PAROS II aims to recruit 148 patients for 50% of patients to reach the primary outcome in the LLP plus MS arm, with 80% power and an 5% alpha risk., Conclusion: The PAROS II trial will be the first phase III trial to investigate the impact of LIL, including LLP plus MS, in laparoscopic CS. The results may improve the postoperative recovery experience and decrease opioid consumption after laparoscopic CS., (© 2023 Association of Coloproctology of Great Britain and Ireland.)
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- 2023
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145. IDEAL Stage 2a/b prospective cohort study of transanal transection and single-stapled anastomosis for rectal cancer.
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Harji D, Fernandez B, Boissieras L, Celerier B, Rullier E, and Denost Q
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- Humans, Anastomotic Leak etiology, Postoperative Complications epidemiology, Postoperative Complications etiology, Prospective Studies, Treatment Outcome, Syndrome, Anastomosis, Surgical methods, Rectum surgery, Rectum pathology, Retrospective Studies, Rectal Neoplasms surgery, Rectal Neoplasms pathology
- Abstract
Aim: There are several anastomotic techniques available to facilitate restorative rectal cancer surgery after total mesorectal excision (TME), including double-stapled anastomosis (DST) and handsewn coloanal anastomosis (CAA). However, to date no one technique is superior with regard to anastomotic leakage (AL) or functional outcomes. Transanal transection single-stapled anastomosis (TTSS) aims to overcome some of the technical challenges and offer comparable clinical and functional outcomes to traditional anastomotic techniques. The aim of this study was to explore the role of TTSS in modern rectal cancer surgery and to provide comparative clinical and functional outcome data with DST and CAA., Method: A prospective cohort study was undertaken to assess the safety and clinical and patient-reported outcomes associated with the TTSS procedure. All patients undergoing sphincter-preserving surgery for rectal cancer with an anastomosis performed within 6 cm of the anal verge between January 2016 and April 2021 were prospectively enrolled into this study. Clinical and patient-reported outcome data, including low anterior resection syndrome (LARS) assessment, were collected. The primary endpoint was anastomotic leakage within 30 days., Results: A total of 275 patients participated in this study, with 70 (25%) patients undergoing a TTSS, 110 (40%) undergoing a DST and 95 (35%) undergoing a CAA. Patients undergoing a CAA had more distal tumours than those having a TTSS or DST, with a median tumour height of 5, 7 and 9 cm (p < 0.001), respectively. We observed a statistically significant reduction in AL in the TTSS group compared with the DST group, with rates of 8.6% versus 20.9% (p = 0.028). There was no difference in LARS scores between patients undergoing TTSS and DST (p = 0.228), while patients with a CAA had worse LARS scores than TTSS patients (p = 0.002)., Conclusion: TTSS is a technically safe and feasible anastomotic technique in rectal cancer surgery as an alternative to DST and CAA. Its advantages over DST are a reduced AL rate and, over CAA, improved function. It should therefore be considered as an alternative technique to improve clinical and patient-reported outcomes in restorative rectal cancer surgery., (© 2023 Association of Coloproctology of Great Britain and Ireland.)
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- 2023
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146. Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patients.
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Greijdanus NG, Wienholts K, Ubels S, Talboom K, Hannink G, Wolthuis A, de Lacy FB, Lefevre JH, Solomon M, Frasson M, Rotholtz N, Denost Q, Perez RO, Konishi T, Panis Y, Rutegård M, Hompes R, Rosman C, van Workum F, Tanis PJ, and de Wilt JHW
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- Humans, Cohort Studies, Anastomosis, Surgical methods, Rectum surgery, Retrospective Studies, Anastomotic Leak etiology, Anastomotic Leak surgery, Rectal Neoplasms surgery, Rectal Neoplasms complications
- Abstract
Background: The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied., Methods: Patients from 216 centres and 45 countries with anastomotic leak after rectal cancer resection between 2014 and 2018 were included. Treatment was categorized as salvage surgery, faecal diversion with passive or active (vacuum) drainage, and no primary/secondary faecal diversion. The primary outcome was 1-year stoma-free survival. In addition, passive and active drainage were compared using propensity score matching (2 : 1)., Results: Of 2470 evaluable patients, 388 (16.0 per cent) underwent salvage surgery, 1524 (62.0 per cent) passive drainage, 278 (11.0 per cent) active drainage, and 280 (11.0 per cent) had no faecal diversion. One-year stoma-free survival rates were 13.7, 48.3, 48.2, and 65.4 per cent respectively. Propensity score matching resulted in 556 patients with passive and 278 with active drainage. There was no statistically significant difference between these groups in 1-year stoma-free survival (OR 0.95, 95 per cent c.i. 0.66 to 1.33), with a risk difference of -1.1 (95 per cent c.i. -9.0 to 7.0) per cent. After active drainage, more patients required secondary salvage surgery (OR 2.32, 1.49 to 3.59), prolonged hospital admission (an additional 6 (95 per cent c.i. 2 to 10) days), and ICU admission (OR 1.41, 1.02 to 1.94). Mean duration of leak healing did not differ significantly (an additional 12 (-28 to 52) days)., Conclusion: Primary salvage surgery or omission of faecal diversion likely correspond to the most severe and least severe leaks respectively. In patients with diverted leaks, stoma-free survival did not differ statistically between passive and active drainage, although the increased risk of secondary salvage surgery and ICU admission suggests residual confounding., (© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.)
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- 2023
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147. Is Delaying a Coloanal Anastomosis the Ideal Solution for Rectal Surgery?: Analysis of a Multicentric Cohort of 564 Patients From the GRECCAR.
- Author
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Collard MK, Rullier E, Tuech JJ, Sabbagh C, Souadka A, Loriau J, Faucheron JL, Benoist S, Dubois A, Dumont F, Germain A, Manceau G, Marchal F, Sourrouille I, Lakkis Z, Lelong B, Derieux S, Piessen G, Laforest A, Venara A, Prudhomme M, Brigand C, Duchalais E, Ouaissi M, Lebreton G, Rouanet P, Mège D, Pautrat K, Reynolds IS, Pocard M, Parc Y, Denost Q, and Lefevre JH
- Abstract
Objectives: To assess the specific results of delayed coloanal anastomosis (DCAA) in light of its 2 main indications., Background: DCAA can be proposed either immediately after a low anterior resection (primary DCAA) or after the failure of a primary pelvic surgery as a salvage procedure (salvage DCAA)., Methods: All patients who underwent DCAA intervention at 30 GRECCAR-affiliated hospitals between 2010 and 2021 were retrospectively included., Results: Five hundred sixty-four patients (male: 63%; median age: 62 years; interquartile range: 53-69) underwent a DCAA: 66% for primary DCAA and 34% for salvage DCAA. Overall morbidity, major morbidity, and mortality were 57%, 30%, and 1.1%, respectively, without any significant differences between primary DCAA and salvage DCAA ( P = 0.933; P = 0.238, and P = 0.410, respectively). Anastomotic leakage was more frequent after salvage DCAA (23%) than after primary DCAA (15%), ( P = 0.016).Fifty-five patients (10%) developed necrosis of the intra-abdominal colon. In multivariate analysis, intra-abdominal colon necrosis was significantly associated with male sex [odds ratio (OR) = 2.67 95% CI: 1.22-6.49; P = 0.020], body mass index >25 (OR = 2.78 95% CI: 1.37-6.00; P = 0.006), and peripheral artery disease (OR = 4.68 95% CI: 1.12-19.1; P = 0.030). The occurrence of this complication was similar between primary DCAA (11%) and salvage DCAA (8%), ( P = 0.289).Preservation of bowel continuity was reached 3 years after DCAA in 74% of the cohort (primary DCAA: 77% vs salvage DCAA: 68%, P = 0.031). Among patients with a DCAA mannered without diverting stoma, 75% (301/403) have never required a stoma at the last follow-up., Conclusions: DCAA makes it possible to definitively avoid a stoma in 75% of patients when mannered initially without a stoma and to save bowel continuity in 68% of the patients in the setting of failure of primary pelvic surgery., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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148. Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage: Development and Validation of a Prediction Model in a Large International Cohort.
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Greijdanus NG, Wienholts K, Ubels S, Talboom K, Hannink G, Wolthuis A, de Lacy FB, Lefevre JH, Solomon M, Frasson M, Rotholtz N, Denost Q, Perez RO, Konishi T, Panis Y, Rutegård M, Hompes R, Rosman C, van Workum F, Tanis PJ, and de Wilt JHW
- Subjects
- Humans, Rectum surgery, Retrospective Studies, Anastomosis, Surgical methods, Risk Factors, Anastomotic Leak etiology, Anastomotic Leak surgery, Rectal Neoplasms surgery
- Abstract
Objective: To develop and validate a prediction model (STOMA score) for 1-year stoma-free survival in patients with rectal cancer (RC) with anastomotic leakage (AL)., Background: AL after RC resection often results in a permanent stoma., Methods: This international retrospective cohort study (TENTACLE-Rectum) encompassed 216 participating centres and included patients who developed AL after RC surgery between 2014 and 2018. Clinically relevant predictors for 1-year stoma-free survival were included in uni and multivariable logistic regression models. The STOMA score was developed and internally validated in a cohort of patients operated between 2014 and 2017, with subsequent temporal validation in a 2018 cohort. The discriminative power and calibration of the models' performance were evaluated., Results: This study included 2499 patients with AL, 1954 in the development cohort and 545 in the validation cohort. Baseline characteristics were comparable. One-year stoma-free survival was 45.0% in the development cohort and 43.7% in the validation cohort. The following predictors were included in the STOMA score: sex, age, American Society of Anestesiologist classification, body mass index, clinical M-disease, neoadjuvant therapy, abdominal and transanal approach, primary defunctioning stoma, multivisceral resection, clinical setting in which AL was diagnosed, postoperative day of AL diagnosis, abdominal contamination, anastomotic defect circumference, bowel wall ischemia, anastomotic fistula, retraction, and reactivation leakage. The STOMA score showed good discrimination and calibration (c-index: 0.71, 95% CI: 0.66-0.76)., Conclusions: The STOMA score consists of 18 clinically relevant factors and estimates the individual risk for 1-year stoma-free survival in patients with AL after RC surgery, which may improve patient counseling and give guidance when analyzing the efficacy of different treatment strategies in future studies., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2023
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149. The Crying Need for a Better Response Assessment in Rectal Cancer.
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Amintas S, Giraud N, Fernandez B, Dupin C, Denost Q, Garant A, Frulio N, Smith D, Rullier A, Rullier E, Vuong T, Dabernat S, and Vendrely V
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- Humans, Treatment Outcome, Crying, Chemoradiotherapy methods, Neoadjuvant Therapy methods, Watchful Waiting methods, Biomarkers, Retrospective Studies, Positron Emission Tomography Computed Tomography, Rectal Neoplasms diagnostic imaging, Rectal Neoplasms therapy
- Abstract
Opinion Statement: Since total neoadjuvant treatment achieves almost 30% pathologic complete response, organ preservation has been increasingly debated for good responders after neoadjuvant treatment for patients diagnosed with rectal cancer. Two organ preservation strategies are available: a watch and wait strategy and a local excision strategy including patients with a near clinical complete response. A major issue is the selection of patients according to the initial tumor staging or the response assessment. Despite modern imaging improvement, identifying complete response remains challenging. A better selection could be possible by radiomics analyses, exploiting numerous image features to feed data characterization algorithms. The subsequent step is to include baseline and/or pre-therapeutic MRI, PET-CT, and CT radiomics added to the patients' clinicopathological data, inside machine learning (ML) prediction models, with predictive or prognostic purposes. These models could be further improved by the addition of new biomarkers such as circulating tumor biomarkers, molecular profiling, or pathological immune biomarkers., (© 2023. The Author(s).)
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- 2023
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150. Robotic-assisted versus conventional laparoscopic approach in patients with large rectal endometriotic nodule: the evaluation of safety and complications.
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Volodarsky-Perel A, Merlot B, Denost Q, Dennis T, Chanavaz-Lacheray I, and Roman H
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- Humans, Female, Retrospective Studies, Postoperative Complications epidemiology, Postoperative Complications etiology, Postoperative Complications surgery, Anastomotic Leak epidemiology, Anastomotic Leak etiology, Anastomotic Leak surgery, Treatment Outcome, Digestive System Surgical Procedures adverse effects, Endometriosis surgery, Robotic Surgical Procedures adverse effects, Rectal Diseases complications, Laparoscopy adverse effects, Fistula complications, Fistula surgery
- Abstract
Aim: The aim was to compare postoperative complications in patients undergoing the excision of a rectal endometriotic nodule over 3 cm by a robotic-assisted versus a conventional laparoscopic approach., Methods: We conducted a retrospective cohort study evaluating prospectively collected data. The main interventions included rectal shaving, disc excision or colorectal resection. All the surgeries were performed in one endometriosis reference institute. To evaluate factors significantly associated with the risk of anastomosis leakage or fistula and bladder atony, we conducted a multivariate logistic regression model., Results: A total of 548 patients with rectal endometriotic nodule over 3 cm in diameter (#ENZIAN C3) were included in the final analysis. The demography and clinical characteristics of women managed by the robotic-assisted (n = 97) approach were similar to those of patients who underwent conventional laparoscopy (n = 451). The multivariate logistic regression demonstrated that the surgical approach (robotic-assisted vs. laparoscopic) was not associated with the rate of anastomosis leakage or fistula (adjusted odds ratio [aOR] 1.2, 95% confidence interval [CI] 0.3-4.0) and bladder dysfunction (aOR 0.5, 95% CI 0.1-1.8). A rectal nodule located lower than 6 cm from the anal verge was significantly associated with anastomosis leakage (aOR 4.1, 95% CI 1.4-10.8) and bladder atony (aOR 4.3, 95% CI 1.5-12.3). Anastomosis leakage was also associated with smoking (aOR 3.2, 95% CI 1.4-7.4), significant vaginal infiltration (aOR 2.7, 95% CI 1.2-6.7) and excision of nodules involving sacral roots (aOR 5.6, 95% CI 1.7-15.5)., Conclusion: The robotic-assisted approach was not associated with increased risk of main postoperative complications compared to conventional laparoscopy for the treatment of large rectal endometriotic nodules., (© 2023 Association of Coloproctology of Great Britain and Ireland.)
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- 2023
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