92 results on '"Dourado J"'
Search Results
2. Gracilis muscle interposition for pouch-vaginal fistulas: a single-centre cohort study and literature review
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Rogers, P., Emile, S. H., Garoufalia, Z., Strassmann, V., Dourado, J., Ray-Offor, E., Horesh, N., and Wexner, S. D.
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- 2024
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3. Chemical Composition and Larvicidal Activity of Essential Oil from Leaves Eugenia catharinae
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Romano, C. A., Dourado, J. S. A., Ramos-Filho, R., Cabral, R. O., Santos, A. H., Oliveira-Neto, J. R., Cunha, L. C., and Paula, J. R.
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- 2023
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4. Gracilis muscle interposition for pouch-vaginal fistulas: a single-centre cohort study and literature review
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Rogers, P., primary, Emile, S. H., additional, Garoufalia, Z., additional, Strassmann, V., additional, Dourado, J., additional, Ray-Offor, E., additional, Horesh, N., additional, and Wexner, S. D., additional
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- 2023
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5. Coliform accumulation in Amphibalanus amphitrite (Darwin, 1854) (Cirripedia) and its use as an organic pollution bioindicator in the estuarine area of Recife, Pernambuco, Brazil/Acumulacao de coliformes em Amphibalanus amphitrite (Darwin, 1854) (Cirripedia) e seu uso como bioindicador de poluicao organica na area estuarina do Recife, Pernambuco, Brazil
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Farrapeira, C.M.R., Mendes, E.S., Dourado, J., and Guimaraes, J.
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- 2010
6. Inflammatory and genetic signatures for recurrent oropharynx cancer
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Garg, R., primary, Yang, C., additional, Fredenburg, K., additional, Kresak, J., additional, Dziegielewski, P.T., additional, Dourado, J., additional, Amdur, R.J., additional, Mendenhall, W.M., additional, Hitchcock, K.E., additional, Kaye, F., additional, Mitchell, D., additional, Sayour, E., additional, and Silver, N., additional
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- 2020
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7. ENTRE A FORMA E O PRODUTOR DO EDIFÍCIO: O PROCESSO DE VERTICALIZAÇÃO URBANA EM VALPARAÍSO DE GOIÁS, BRASIL
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Dourado, J., primary and Araújo Sobrinho, F.L., additional
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- 2020
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8. Speciation of inorganic and organic arsenic in marine sediments from La Coruña estuary
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Soto, E. González, Lojo, M. C. Villa, Rodríguez, E. Alonso, Dourado, J. Neira, Rodríguez, D. Prada, and Fernández-Fernández, E.
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- 1996
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9. Proceedings of CAMUSS, the International Symposium on Cellular Automata Modeling for Urban and Spatial Systems
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Pinto, Nuno, N., N., Dourado, J., and Natálio, A.
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- 2012
10. The São Vicente earthquake of 2008 April and seismicity in the continental shelf off SE Brazil: further evidence for flexural stresses
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Assumpção, M., primary, Dourado, J. C., additional, Ribotta, L. C., additional, Mohriak, W. U., additional, Dias, Fábio L., additional, and Barbosa, J. R., additional
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- 2011
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11. Upper-mantle seismic anisotropy from SKS splitting in the South American stable platform: A test of asthenospheric flow models beneath the lithosphere
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Assumpcao, M., primary, Guarido, M., additional, van der Lee, S., additional, and Dourado, J. C., additional
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- 2011
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12. Energy Deviation Values of Gabor Filters in Texture Classification
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Dourado, J., primary, Rouco, J., additional, Penedo, M.G., additional, Ortega, M., additional, and Mosquera, A., additional
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- 2010
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13. The São Vicente Earthquake of April 2008 in the SE Continental Shelf, Brazil
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Assumpção, Marcelo, primary, Fernandes, C. M., additional, Barbosa, J. R., additional, Dourado, J. C., additional, and Ribotta, L. C., additional
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- 2009
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14. Speciation of inorganic and organic arsenic in marine sediments from La Coru�a estuary
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Soto, E. Gonz�lez, primary, Lojo, M. C. Villa, additional, Rodr�guez, E. Alonso, additional, Dourado, J. Neira, additional, Rodr�guez, D. Prada, additional, and Fern�ndez-Fern�ndez, E., additional
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- 1996
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15. AVALIAÇÃO DE FRATURA DE COLUNA E LESÃO DE LOMBO EM CARCAÇA DE SUÍNOS RELACIONADA COM ALTURA DO TERCEIRO PONTO DA ELETROCUSSÃO.
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OLIVEIRA, L. A., COSSI, M. V. C., TREZZI, L. C., and DOURADO, J. M.
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Copyright of Archives of Veterinary Science is the property of Archives of Veterinary Science 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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- 2016
16. The complex relationship between driving behaviour and personality traits - a mediation analysis.
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Dourado, J., Pereira, A. T., Bastos Silva, A. M. C., Seco, Á. J. M., and Macedo, A.
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PERSONALITY , *SENSATION seeking , *MOTOR vehicle driving , *TRAFFIC safety , *AGGRESSIVE driving , *OPENNESS to experience - Abstract
Introduction: Personality is an internal factor, that is always present, independently of the particularly circumstances of the driver and the road context. Exploring the relationships between personality traits and the different driver behaviour dimensions is important to better understand who is more prone to risky driving behaviours. Objectives: The aim of this study is to explore the role of gender and personality traits on driver behaviour in a vast sample of Portuguese drivers, focusing on the mediation effects of certain variables. Methods: Participants answered an online survey including sociodemographic questions and the Portuguese validated version of the following questionnaires: Driver Behaviour Questionnaire (evaluates Infractions and aggressive driving/IAD, Non intentional errors/NIE, and Lapses), Impulsive Sensation Seeking Scale and NEO-FFI-20. The sample is composed of 747 participants [417 (55.8%) women; mean age=42.13±12.349 years; mean years of regular driving=20.33±11.328]. Hayes' PROCESS Macro for SPSS was used. Results: IAD significantly correlated with age (-.239), gender (.254), Agreeableness (-.142), Extraversion (.138), Impulsivity (.259) and Sensation seeking (.301); NIE with Neuroticism (.188), Consciousness (-.188) and Impulsivity (.212); Lapses with age (-.092), gender (-.133), Neuroticism (.166), Openness to experience (.113), Conscientiousness (-.157) and Impulsivity (.227) (p<.05). Sensation seeking was a mediator between gender and IAD; Impulsivity was a mediator between Consciousness/Neuroticism and NIE; even controlling the effect of gender and age, Impulsivity mediates the relationship between Neuroticism/Openness to experience/Conscientiousness and Lapses. Conclusions: Results emphasise that personality traits should be considered when developing profiles and models of driver behaviour to better understand and prevent risky behaviours on the road. [ABSTRACT FROM AUTHOR]
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- 2020
17. Sífilis do sistema nervoso: Aluizio Marques
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Dourado, J. Victor
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- 1945
18. Neurosyphilis: H. H. Merritt. R. D. Adams E H. C. Solomon
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Dourado, J. V.
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- 1946
19. Penicillin in neurology: A. E. Walker e H. C. Johnson. Um volume com 200 páginas e 71 figuras. Ch. C. Thomas, Springfield, 1946
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Dourado, J. V.
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- 1947
20. Parallelism strategies for neurophysiological delayed transfer entropy data processing: Towards causal inference in big data
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Dourado, J. R., José Roberto Boffino de Almeida Monteiro, Lima, D. R., Bessani, M., and Maciel, C. D.
21. Shallow geoelectric methods and techniques to define AN area affected by roof failure of AN urban tunnel | Métodos e técnicas geoelétricas rasas na delimitação de area afetada POR ruptura EM teto de túnel urbano
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Gallas, J. D. F., Fabio Taioli, Malagutti Filho, W., Prado, R. L., and Dourado, J. C.
22. Sífilis do sistema nervoso: Aluizio Marques
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Dourado, J. Victor, primary
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- 1945
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23. [NO TITLE AVAILABLE]
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Dourado, J. V., primary
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- 1947
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24. [NO TITLE AVAILABLE]
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Dourado, J. V., primary
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- 1946
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25. Factors Associated With Prolonged Operative Times in Laparoscopic Right Hemicolectomy and Its Association With Short-Term Outcomes.
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Emile SH, Horesh N, Garoufalia Z, Gefen R, Dourado J, Dasilva G, and Wexner SD
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Background: This study aimed to investigate factors associated with prolonged operative time in laparoscopic right hemicolectomy for colon cancer., Methods: This was a retrospective review of patients with colon cancer who underwent laparoscopic right hemicolectomy between 2011 and 2021. Linear and binary logistic regression analyses were performed to determine factors associated with prolonged operative time. The association between longer operative times and complications and hospital stay was assessed., Results: One hundred and ninety-seven patients (52.3% female; mean age: 68.8 ± 14.1 years) were included. Factors independently associated with operative time were male sex (β = 17.3, 95% CI: 2, 32.5; p = 0.026) and extended hemicolectomy (β = 67.7, 95% CI: 27.6, 107.9; p = 0.001). American Society of Anesthesiologists (ASA) IV classification had a borderline significant association with operative time (β = 100.4, 95% CI: -2.05, 202.9; p = 0.055). Male sex (r = 0.158; p = 0.026), body mass index (r = 0.205; p = 0.004), ASA classification (r = 0.232; p = 0.001), extended hemicolectomy (r = 0.256; p < 0.001), and intracorporeal vessel control (r = 0.161; p = 0.025) had significant positive correlation with operative times. Patients with operative times ≥ 160 min had significantly longer hospital stays (5 vs. 4 days; p = 0.043) and similar complication rates to patients with shorter operative times., Conclusions: Male sex, advanced ASA classification, and extended hemicolectomy were independently and significantly associated with longer operative times in laparoscopic right hemicolectomy. Longer operative times were associated with longer hospital stays and similar complication rates., (© 2024 The Author(s). Journal of Surgical Oncology published by Wiley Periodicals LLC.)
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- 2024
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26. Laparoscopic versus robotic-assisted primary bariatric-metabolic surgery. Are we still expecting to overcome the learning curve? A propensity score-matched analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database.
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Aeschbacher P, Garoufalia Z, Rogers P, Dourado J, Liang H, Pena A, Szomstein S, Lo Menzo E, and Rosenthal RJ
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- Humans, Female, Male, Adult, Middle Aged, Learning Curve, Postoperative Complications epidemiology, Postoperative Complications etiology, Retrospective Studies, Databases, Factual, Laparoscopy education, Laparoscopy statistics & numerical data, Robotic Surgical Procedures statistics & numerical data, Bariatric Surgery statistics & numerical data, Bariatric Surgery methods, Bariatric Surgery standards, Propensity Score, Quality Improvement, Patient Readmission statistics & numerical data, Obesity, Morbid surgery, Reoperation statistics & numerical data
- Abstract
Background: Robotic surgery is becoming increasingly popular in bariatric-metabolic surgery. However, its superiority regarding postoperative outcomes compared with conventional laparoscopy has not been clearly proven. With growing adoption of robotic surgery and improved technologies, benefits should become more evident., Objectives: Evaluate readmission and reoperation rates after bariatric-metabolic surgery performed by conventional laparoscopy versus robotic-assisted from 2015 to 2021., Setting: Academic institution., Methods: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) was reviewed for primary bariatric operations performed with conventional laparoscopy versus robotic-assisted. Postoperative outcomes were compared in a propensity score-matched sample., Results: Of 1,059,348 cases meeting inclusion criteria, 921,322 (87%) were conventional laparoscopic bariatric-metabolic surgeries, which were matched 1:1 with robotic-assisted cases (138,026). Reoperation (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.00-1.15, P = .0463), postoperative morbidity (OR 1.07; 95% CI 1.01-1.12, P = .0193), readmission (OR 1.14; 95% CI 1.09-1.18, P < .0001), and emergency department visits (OR 1.06; 95% CI 1.03-1.09, P = .0003) at 30 days postoperatively were significantly greater for robotic-assisted cases. Robotic-assisted cases had a similar mortality rate at 30 days postoperatively and length of stay >3 days when compared with conventional laparoscopic cases. Similar results were observed in cases from 2020 to 2021, except for reoperation and emergency department visits, which showed no difference between groups and length of stay >3 days, which was greater in robotic-assisted cases., Conclusions: Our results show a greater readmission and reoperation rate and greater morbidity at 30 days postoperatively in robotic-assisted bariatric-metabolic surgery compared with conventional laparoscopy. Analyzing only cases performed between 2020 and 2021, robotic surgery also does not show superiority over conventional laparoscopy., (Copyright © 2024 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)
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- 2024
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27. Predictors of nodal positivity in clinically under-staged patients with colon cancer: A National Cancer Database study and proposal of a predictive scoring system.
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Dourado J, Rogers P, Emile S, Wignakumar A, Weiss B, Horesh N, Garoufalia Z, Aeschbacher P, and Wexner S
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- Humans, Female, Male, Middle Aged, Aged, Risk Factors, United States epidemiology, Lymphatic Metastasis, Adult, Aged, 80 and over, Lymph Nodes pathology, Colonic Neoplasms pathology, Neoplasm Staging, Databases, Factual
- Abstract
Background: Colon cancer pathological and clinical staging may be disoncordant. This study assessed patients with colon cancer in whom the nodal status was clinically understaged., Methods: Patients with stage I-III clinical node-negative colon cancer from the National Cancer Database were included. Regression analyses were conducted to elucidate risk factors for clinical nodal understaging and a scoring system was developed to identify high-risk patients., Results: The study included 94,945 patients with 78.4 % of patients correctly staged and 21.6 % clinically understaged. The predictors of nodal positivity in clinically understaged patients were age <65 (OR 1.43), left-sided tumors (OR 1.41), elevated CEA (OR 2.03), moderately (OR 1.81) or poorly/undifferentiated tumors (OR 3.76), T1 tumors (OR 1.29), signet-ring cell histology (OR 2.26), and microsatellite-stable tumors (OR 1.4)., Conclusion: Patients with colon cancer and the above factors are more likely to have their nodal status clinically understaged. A scoring system has been developed to identify high-risk patients., Competing Interests: Declaration of competing interest None of the authors has any relevant financial disclosures. Dr. Wexner is a consultant for Baxter, Becton, Dickinson and Co, Glaxo Smith Kline, Intuitive Surgical, Livsmed, Medtronic, OstomyCure, Stryker, Takeda, Virtual Ports, is a member of the Data Safety Monitoring Board of JSR/WCG/ACI (chair), Polypoid (chair), and Boomerang and receives royalties from Intuitive Surgical, Karl Storz Endoscopy America Inc., and Unique Surgical Solutions, LLC., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2024
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28. Comparative anatomical analysis between lateral supraorbital and minipterional approaches.
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Marques Lopes de Araujo R, Zimelewicz Oberman D, Christiaan Welling L, Chaurasia B, Evins AI, Bernardo A, Isolan GR, Paulo Dourado J, Rabelo NN, and Figueiredo EG
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Background: The pterional craniotomy, described by Yasargil and Fox in 1975, constitutes the most traditional and important surgical access in vascular neurosurgery. Minimally invasive alternatives include the minipterional (MP) and lateral supraorbital (LSO) craniotomies, which avoid complications such as injury to the frontal branch of the facial nerve, temporal muscle dysfunction, depression of the craniotomy site, frontal sinus opening, and cosmetically unacceptable outcomes. We evaluated and compared the exposures provided by MP and LSO craniotomies through quantitative measurements of the surgical exposure area around the circle of Willis and parasellar regions, as well as angular and linear exposures of the internal carotid artery (ICA) bifurcation, middle cerebral artery (MCA), midpoint of the anterior communicating artery, and tip of the basilar artery (BA)., Methods: Seven fresh cadavers were dissected at the São Paulo Medical Examiner's Office, SP, and three at the skull base laboratory of Weill Cornell Medical College, New York, USA. The craniotomies were performed sequentially, initially with the LSO craniotomy followed by the MP. After the craniotomy, the surgical exposure area, craniotomy area, and angular exposures in the horizontal and vertical axes were determined., Results: The MP craniotomy provided better angular exposure for the ipsilateral MCA, while the LSO craniotomy and BA provided better vertical axis exposures. The LSO craniotomy provided better angular exposure in the vertical axis for the midpoint of the anterior communicating artery and contralateral ICA bifurcation. Regarding surgical exposure and craniotomy area, there were no statistically significant differences., Conclusion: The MP craniotomy offers a significantly larger surgical exposure compared to the LSO craniotomy, with specific advantages regarding angular exposure to important neurovascular structures. This study provides important quantitative data to guide the choice between these minimally invasive access techniques in vascular neurosurgery., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Surgical Neurology International.)
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- 2024
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29. Predictors and outcomes of delays between diagnosis and definitive surgery for rectal cancer.
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Emile SH, Garoufalia Z, Dourado J, Salama E, and Wexner SD
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Background: The National Accreditation Program for Rectal Cancer (NAPRC) recommends definitive treatment of rectal cancer commence within 60 days from diagnosis. This study aimed to assess predictors of >60 days delay between diagnosis and definitive surgery of rectal cancer and the impact on survival and short-term outcomes., Methods: Retrospective cohort analysis of patients with stage I-III rectal adenocarcinoma who underwent proctectomy without preoperative neoadjuvant treatment from the National Cancer Database (2015-2019). Based on the time interval between diagnosis and definitive surgery, patients were divided into timely non-adherent (>60 days) and timely-adherent (≤60 days) groups. Multivariate analysis determined predictors of delayed definitive surgery., Results: 9479 patients (57.5 % males; mean age: 63.7 years) had a 41-day median time between diagnosis and definitive surgery. Non-adherence was noted in 27.9 % of patients. Independent predictors of non-adherence were male sex (Odds ratio [OR]: 1.25; p < 0.001), Black (OR: 1.65; p < 0.001) or Asian (OR: 1.33; p = 0.014) race, Charlson score 2 (OR: 1.33; p = 0.005) or 3 (OR: 1.55; p < 0.001), urban residence (OR: 1.21; p = 0.003), abdominoperineal resection (OR: 1.69; p < 0.001), pelvic exenteration (OR: 1.7; p = 0.002), and robotic-assisted surgery (OR: 1.22; p = 0.001). Medicare (OR: 0.725; p = 0.003) and private insurance (OR: 0.711; p < 0.001) were associated with better adherence. 30-day and 90-day mortality, unplanned readmission, and overall survival were similar., Conclusions: Male Black or Asian patients with high Charlson scores, and undergoing abdominoperineal resection, pelvic exenteration, and robotic-assisted surgery were more likely non-adherent with NAPRC standards with >60 days delay before definitive surgery for rectal cancer. Hopefully, recognition for these reasons for delay of definitive surgery will lead to an improvement in adherence to the standards., Competing Interests: Declaration of competing interest Dr. Wexner is a consultant for Baxter, Becton, Dickinson and Co, Glaxo Smith Kline, Intuitive Surgical, Livsmed, Medtronic, OstomyCure, Stryker, Takeda, Virtual Ports, is a member of the Data Safety Monitoring Board of JSR/WCG/ACI (chair), Polypoid (chair), and Boomerang and receives royalties from Intuitive Surgical, Karl Storz Endoscopy America Inc., and Unique Surgical Solutions, LLC. None of the rest of the authors reported any financial disclosures. Dr. Emile is a consultant for Becton, Dickinson & Co., (Copyright © 2024 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
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- 2024
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30. Umbrella review of systematic reviews on the efficacy and safety of using mesh in the prevention of parastomal hernias.
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Emile SH, Dourado J, Rogers P, Wignakumar A, Horesh N, Garoufalia Z, Gefen R, and Wexner SD
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Background: This umbrella review aimed to summarize the findings and conclusions of published systematic reviews on the prophylactic role of mesh against parastomal hernias in colorectal surgery., Methods: PRISMA-compliant umbrella overview of systematic reviews on the role of mesh in prevention of parastomal hernias was conducted. PubMed and Scopus were searched through November 2023. Main outcomes were efficacy and safety of mesh. Efficacy was assessed by the rates of clinically and radiologically detected hernias and the need for surgical repair, while safety was assessed by the rates of overall complications., Results: 19 systematic reviews were assessed; 7 included only patients with end colostomy and 12 included patients with either ileostomy or colostomy. The use of mesh significantly reduced the risk of clinically detected parastomal hernias in all reviews except one. Seven reviews reported a significantly lower risk of radiologically detected parastomal hernias with the use of mesh. The pooled hazards ratio of clinically detected and radiologically detected parastomal hernias was 0.33 (95%CI: 0.26-0.41) and 0.55 (95%CI: 0.45-0.68), respectively. Six reviews reported a significant reduction in the need for surgical repair when a mesh was used whereas six reviews found a similar need for hernia repair. The pooled hazards ratio for surgical hernia repair was 0.46 (95%CI: 0.35-0.62). Eight reviews reported similar complications in the two groups. The pooled hazard ratio of complications was 0.81 (95%CI: 0.66-1)., Conclusions: The use of surgical mesh is likely effective and safe in the prevention of parastomal hernias without an increased risk of overall complications., (© 2024. The Author(s).)
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- 2024
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31. Outcome of gastric electrical stimulator with and without pyloromyotomy for refractory gastroparesis.
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Aeschbacher P, Garcia A, Dourado J, Rogers P, Zoe G, Pena A, Szomstein S, Menzo EL, and Rosenthal R
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Background: Surgical treatments of refractory gastroparesis include pyloromyotomy and gastric electrical stimulator (GES). It is unclear if patients may benefit from a combined approach with concomitant GES and pyloromyotomy., Methods: Retrospective cohort analysis of all patients with refractory gastroparesis treated with GES implantation with and without concomitant pyloromyotomy at Cleveland Clinic Florida from January 2003 to January 2023. Primary endpoint was efficacy (clinical response duration and success rate) and secondary endpoints included safety (postoperative morbidity) and length of stay. Success rate was defined as the absence of one of the following reinterventions during follow-up: Roux-en-Y gastric bypass (RYGB), pyloromyotomy, GES removal., Results: During a period of 20 years, 134 patients were treated with GES implantation. Three patients with history of previous surgical pyloromyotomy or RYGB were excluded from the analysis. Median follow-up was 31 months (IQR 10, 72). Forty patients (30.5%) had GES with pyloromyotomy, whereas 91 (69.5%) did not have pyloromyotomy. Most of the patients had idiopathic (n = 68, 51.9%) or diabetic (n = 58, 43.3%) gastroparesis. Except for preoperative use of opioids (47.5 vs 14.3%; p < 0.001), patient's characteristics were similar in both groups. There were no significant differences between the two groups in terms of overall postoperative complications (17.5% vs 14.3%; p = 0.610), major postoperative complications (0% vs 2.2%; p = 1), and length of stay (2(IQR 1, 2) vs 2(IQR 1, 3) days; p = 0.068). At 5 years, success rate was higher in patients with than without pyloromyotomy however not statistically significant (82% versus 62%, p = 0.066). Especially patients with diabetic gastroparesis seemed to benefit from pyloromyotomy during GES (100% versus 67%, p = 0.053). In an adjusted Cox regression, GES implantation without pyloromyotomy was associated with a 2.66 times higher risk of treatment failure compared to GES implantation with pyloromyotomy (HR 2.66, 95% CI 1.03-6.94, p = 0.044)., Conclusion: Pyloromyotomy during GES implantation for gastroparesis seems to be associated with a longer clinical response with similar postoperative morbidity and length of hospital stay than GES without pyloromyotomy. Patient with diabetic gastroparesis might benefit from a combination of GES implantation and pyloromyotomy., (© 2024. The Author(s).)
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- 2024
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32. Resection versus resection with ablation: Analysis from the colorectal liver operative metastasis international collaborative.
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Mainali BB, Valenzuela CD, Moaven O, Stauffer JA, Del Piccolo NR, Cheung T, Corvera CU, Wisneski AD, Cha CH, Zarandi NP, Dourado J, Russell G, and Shen P
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Background: Thermal ablation has recently become a key therapy for the treatment of colorectal liver metastasis (CLM). However, the role of ablation in combination with resection has not yet been firmly established. We hypothesize that in patients with CLM, those who undergo liver resection with ablation (RA) have similar outcomes compared with those who undergo liver resection only., Methods: We reviewed a multicenter international database of 906 surgical procedures for CLM from 5 high volume hepatobiliary surgical units. Patients undergoing RA (n = 63) were matched based on the number of lesions and tumor size using a 1:1 balanced propensity score analysis with those having resection only (n = 63). Our primary outcomes were overall survival (OS) and disease-free survival (DFS)., Results: The mean age of our cohort was 58 ± 11 years, with 43% females. With a median follow-up of 70.8 months, patients in the resection and RA group had a median OS of 45.1 and 54.8 months (p = 0.71), respectively. The median DFS was 22.7 and 14.2 months (p = 0.045), respectively. Using a multivariate Cox proportional hazards regression model, the treatment approach was not associated with OS (p = 0.94) or DFS (p = 0.059). A higher number of lesions is independently associated with worse DFS (hazard ratio: 1.12, p < 0.01). When there was disease recurrence, the region of recurrence was similar between the RA versus resection only groups (p = 0.27), but there was a shorter time to recurrence in the RA group (p = 0.002)., Conclusion: For CLM, the treatment approach was not significantly associated with OS or DFS, while tumor biology likely played an important role. Prospective research on the quality and effectiveness of thermal ablation combined with hepatic resection is warranted., (© 2024 Wiley Periodicals LLC.)
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- 2024
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33. Local vs radical resection of stage I-III rectal cancer in very elderly patients: an exact matched analysis of the National Cancer Database.
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Gefen R, Emile SH, Garoufalia Z, Horesh N, Dourado J, and Wexner SD
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- Humans, Male, Female, Retrospective Studies, Aged, 80 and over, Patient Readmission statistics & numerical data, Proctectomy methods, Survival Rate, Neoadjuvant Therapy statistics & numerical data, Rectal Neoplasms surgery, Rectal Neoplasms mortality, Rectal Neoplasms pathology, Neoplasm Staging, Databases, Factual, Length of Stay statistics & numerical data
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Background: Treatment of elderly patients with cancer is challenging as they can be overtreated with respect to frailty or undertreated because of advanced age. Maintaining a good quality of life is essential for this population. This study aimed to assess the difference in overall survival and short-term outcomes according to the extent of rectal cancer resection in patients aged ≥80 years., Methods: In this retrospective cohort study, very elderly patients with stage I-III rectal cancer aged ≥80 years were identified from the National Cancer Database (2004-2019). Patients were divided into 2 groups: radical resection and local excision. The groups were matched using exact matched analysis for clinical T and N stage, tumor size, and neoadjuvant treatment. The main outcome measures were overall survival, hospital stay, 30-day unplanned readmissions, and short-term mortality., Results: A total of 9634 patients were included (local excision = 2710; radical resection = 6924). After matching, 1106 patients were included in each group with a median follow-up of 49.9 and 51.7 months, respectively. The radical resection group had statistically significantly longer overall survival than did the local excision group (60 vs 57.2 months, P = .026). Local excision was associated with shorter length of stay (1 vs 7 days. P < .001), lower 30-day mortality (odds ratio: 0.43; 95% CI: 0.25-0.75, P = .003), lower 90-day mortality (odds ratio: 0.47, 95% CI: 0.32-0.68, P < .001), and lower 30-day readmission (odds ratio: 0.49, 95% CI: 0.33-0.74, P < .001). A subgroup analysis of matched patients with cTis-T2 and N0 tumors who underwent curative surgery revealed similar results., Conclusion: Radical resection of rectal cancer in very elderly patients has a modest survival benefit, whereas local excision has lower odds of readmission and short-term mortality., (Copyright © 2024 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights reserved.)
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- 2024
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34. Obesity and overweight are associated with worse survival in early-onset colorectal cancer.
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Aeschbacher P, Garoufalia Z, Dourado J, Rogers P, Emile SH, Matamoros E, Nagarajan A, Rosenthal RJ, and Wexner SD
- Subjects
- Humans, Male, Retrospective Studies, Female, Middle Aged, Adult, Adenocarcinoma mortality, Adenocarcinoma surgery, Adenocarcinoma complications, Adenocarcinoma pathology, Risk Factors, Age of Onset, Survival Rate, Prognosis, Obesity complications, Overweight complications, Colorectal Neoplasms mortality, Colorectal Neoplasms surgery, Colorectal Neoplasms complications, Colorectal Neoplasms pathology, Body Mass Index
- Abstract
Background: Obesity and its associated lifestyle are known risk factors for early-onset colorectal cancer and are associated with poor postoperative and survival outcomes in older patients. We aimed to investigate the impact of obesity on the outcomes of early-onset colorectal cancers., Methods: Retrospective review of all patients undergoing primary resection of colon or rectal adenocarcinoma at our institution between 2015-2022. Patients who had palliative resections, resections performed at another institution, appendiceal tumors, and were underweight were excluded. The primary endpoint was survival according to the patient's body mass index: normal weight (18-24.9 kg/m
2 ), overweight (25-29.9 kg/m2 ), and obesity (≥30 kg/m2 ). Patient and tumor characteristics and survival were compared between the three groups., Results: A total of 279 patients aged <50 years with colorectal cancer were treated at our hospital; 120 were excluded from the analysis for the following reasons: main treatment or primary resection performed at another hospital (n = 97), no resection/palliative resection (n = 23), or body mass index <18 kg/m2 (n = 2). Of these, 157 patients were included in the analysis; 61 (38.9%) were overweight and 45 (28.7%) had obesity. Except for a higher frequency of hypertension in the overweight (P = .062) and obese (P = .001) groups, no differences in patient or tumor characteristics were observed. Mean overall survival was 89 months with normal weight, 92 months with overweight, and 65 months with obesity (P = .032). Mean cancer-specific survival was 95 months with normal weight, 94 months with overweight, and 68 months with obesity (P = .018). No statistically significant difference in disease-free survival (75 vs 70 vs 59 months, P = .844) was seen., Conclusion: Individuals with early-onset colorectal cancer who are overweight or obese present with similar tumor characteristics and postoperative morbidity to patients with normal weight. However, obesity may have a detrimental impact on their survival. Addressing obesity as a modifiable risk factor might improve early-onset colorectal cancer prognosis., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)- Published
- 2024
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35. Robotic ventral mesh rectopexy: Troubleshooting in redo surgery - A video vignette.
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Rogers P, Dourado J, Delgado Z, Strassmann V, Vogler S, and DaSilva G
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- Humans, Female, Rectum surgery, Robotic Surgical Procedures methods, Surgical Mesh adverse effects, Reoperation methods, Rectal Prolapse surgery
- Published
- 2024
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36. Laparoscopic and transanal redo of J-pouch - A video vignette.
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Dourado J, DeTrolio V, Salama E, De Stefano F, Wignakumar A, and Wexner SD
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- Humans, Colonic Pouches adverse effects, Proctocolectomy, Restorative methods, Proctocolectomy, Restorative adverse effects, Female, Male, Colitis, Ulcerative surgery, Laparoscopy methods, Reoperation methods, Transanal Endoscopic Surgery methods
- Published
- 2024
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37. Trans‑anal minimally invasive surgery (TAMIS) versus rigid platforms for local excision of early rectal cancer: a systematic review and meta-analysis of the literature.
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Garoufalia Z, Rogers P, Meknarit S, Mavrantonis S, Aeschbacher P, Ray-Offor E, Emile SH, Gefen R, Dourado J, Horesh N, and Wexner SD
- Subjects
- Humans, Postoperative Complications epidemiology, Postoperative Complications etiology, Operative Time, Minimally Invasive Surgical Procedures methods, Margins of Excision, Rectal Neoplasms surgery, Rectal Neoplasms pathology, Transanal Endoscopic Surgery methods, Transanal Endoscopic Surgery instrumentation
- Abstract
Background: Available platforms for local excision (LE) of early rectal cancer are rigid or flexible [trans‑anal minimally invasive surgery (TAMIS)]. We systematically searched the literature to compare outcomes between platforms., Methods: PRISMA-compliant search of PubMed and Scopus databases until September 2022 was undertaken in this random-effect meta-analysis. Statistical heterogeneity was assessed using I
2 statistic. Studies comparing TAMIS versus rigid platforms for LE for early rectal cancer were included. Main outcome measures were intraoperative and short-term postoperative outcomes and specimen quality., Results: 7 studies were published between 2015 and 2022, including 931 patients (423 females); 402 underwent TAMIS and 529 underwent LE with rigid platforms. Techniques were similar for operative time (WMD 11.1, 95%CI - 2.6 to 25, p = 0.11), percentage of defect closure (OR 0.7, 95%CI 0.06-8.22, p = 0.78), and peritoneal violation (OR 0.41, 95%CI 0.12-1.43, p = 0.16). Rigid platforms had higher rates of short-term complications (19.1% vs 14.2, OR 1.6, 95%CI 1.07-2.4, p = 0.02), although no significant differences were seen for major complications (OR 1.41, 95%CI 0.61-3.23, p = 0.41). Patients in the rigid platforms group were 3-times more likely to be re-admitted within 30 days compared to the TAMIS group (OR 3.1, 95%CI 1.07-9.4, p = 0.03). Rates of positive resection margins (rigid platforms: 7.6% vs TAMIS: 9.34%, OR 0.81, 95%CI 0.42-1.55, p = 0.53) and specimen fragmentation (rigid platforms: 3.3% vs TAMIS: 4.4%, OR 0.74, 95%CI 0.33-1.64, p = 0.46) were similar between the groups. Salvage surgery was required in 5.5% of rigid platform patients and 6.2% of TAMIS patients (OR 0.8, 95%CI 0.4-1.8, p = 0.7)., Conclusion: TAMIS or rigid platforms for LE seem to have similar operative outcomes and specimen quality. The TAMIS group demonstrated lower readmission and overall complication rates but did not significantly differ for major complications. The choice of platform should be based on availability, cost, and surgeon's preference., (© 2024. The Author(s).)- Published
- 2024
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38. Accuracy of Clinical Staging of Localized Colon Cancer: A National Cancer Database Cohort Analysis.
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Emile SH, Horesh N, Garoufalia Z, Dourado J, Rogers P, Salama E, and Wexner SD
- Abstract
Background: This study aimed to assess concordance between clinical and pathologic assessment of colon cancer., Patients and Methods: A retrospective cohort analysis of patients with stage I-III colon cancer in the National Cancer Database (2010-2019) was conducted. Concordance between clinical and pathologic assessment of colon cancer was calculated using Kappa coefficients and 95% confidence intervals (CIs)., Results: A total of 125,473 patients (51.2% female; mean age 68.2 years) were included. There was moderate concordance between clinical and pathologic T stage (Kappa = 0.606, 95%CI: 0.602-0.609) and between clinical and pathologic N stage (Kappa = 0.506, 95%CI: 0.501-0.511). For right-sided colon cancer, there was moderate agreement between clinical and pathologic T stage (Kappa = 0.594, 95%CI: 0.589-0.599) and N stage (Kappa = 0.530, 95%CI: 0.523-0.537). For left-sided colon cancer, there was substantial agreement between clinical and pathologic T stage (Kappa = 0.624, 95%CI: 0.619-0.630) and moderate agreement between N stage (Kappa 0.472, 95%CI: 0.463-0.480). Sensitivity of clinical assessment of T and N stage ranged from 64.3% to 77.2% and 41.6% to 54.5%, respectively. Specificity ranged from 96.7% to 97.7% for T stage and 95.7% to 97.3% for N stage., Conclusions: Clinical assessment of T and N stages of colon cancer had good diagnostic accuracy with moderate concordance with the final pathologic stage. While clinical assessment was highly specific with < 3% of patients being over-staged, it had modest sensitivity, especially for detection of nodal involvement. Diagnostic accuracy of clinical assessment of right and left colon cancers was similar, except for higher sensitivity and accuracy of assessment of nodal involvement in right than left colon cancers., (© 2024. The Author(s).)
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- 2024
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39. Endoscopic surgery for craniosynostosis: a bibliometric analysis of primary studies.
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Porto Junior S, Fontes JHM, Pustilnik H, Meira D, da Cunha B, da Paz M, Alcântara T, Dourado J, and de Avellar L
- Abstract
Introduction: Bibliometrics, a statistical method assessing the influence of scholarly works, was employed to analyze the evolution of endoscopic surgery for craniosynostosis., Methods: This comprehensive review followed PRISMA guidelines, sourcing data from PubMed, Embase, and Web of Science, focusing on clinical and surgical outcomes up to December 2023. We identified 1409 records, with 83 papers meeting inclusion criteria., Results: The majority of studies originated from the Americas (79%), predominantly from the United States (75.9%). The typical study design was retrospective cohort studies (62%), involving a total of 8,175 patients with median research duration of 8 years. Citation metrics indicated an average count of 38.9 per paper, with notable contributions from several key authors. A distinct increase in research was observed in recent years, particularly from 2011 onwards, peaking in 2022 and 2023. The top 10 most cited papers, largely emanating from the U.S., had a higher median patient number (103) compared to the overall median (53), suggesting their significant impact. These papers were primarily published in journals with higher impact factors and citation indicators. The most cited research was notably published in the Journal of Neurosurgery-Pediatrics., Conclusion: This analysis provides a comprehensive view of the field, highlighting the growing trend and clinical importance of endoscopic approaches in craniosynostosis, offering a valuable resource for future research and clinical practice., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2024
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40. Low-pressure versus standard-pressure pneumoperitoneum in minimally invasive colorectal surgery: a systematic review, meta-analysis, and meta-regression analysis.
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Dourado J, Rogers P, Horesh N, Emile SH, Aeschbacher P, and Wexner SD
- Abstract
Background: We aimed to assess the efficacy and safety of low-pressure pneumoperitoneum (LPP) in minimally invasive colorectal surgery., Methods: A PRISMA-compliant systematic review/meta-analysis was conducted, searching PubMed, Scopus, Google Scholar, and clinicaltrials.gov for randomized-controlled trials assessing outcomes of LPP vs standard-pressure pneumoperitoneum (SPP) in colorectal surgery. Efficacy outcomes [pain score in post-anesthesia care unit (PACU), pain score postoperative day 1 (POD1), operative time, and hospital stay] and safety outcomes (blood loss and postoperative complications) were analyzed. Risk of bias2 tool assessed bias risk. The certainty of evidence was graded using GRADE., Results: Four studies included 537 patients (male 59.8%). LPP was undertaken in 280 (52.1%) patients and associated with lower pain scores in PACU [weighted mean difference: -1.06, 95% confidence interval (CI): -1.65 to -0.47, P = 0.004, I
2 = 0%] and POD1 (weighted mean difference: -0.49, 95% CI: -0.91 to -0.07, P = 0.024, I2 = 0%). Meta-regression showed that age [standard error (SE): 0.036, P < 0.001], male sex (SE: 0.006, P < 0.001), and operative time (SE: 0.002, P = 0.027) were significantly associated with increased complications with LPP. In addition, 5.9%-14.5% of surgeons using LLP requested pressure increases to equal the SPP group. The grade of evidence was high for pain score in PACU and on POD1 postoperative complications and major complications, and blood loss, moderate for operative time, low for intraoperative complications, and very low for length of stay., Conclusions: LPP was associated with lower pain scores in PACU and on POD1 with similar operative times, length of stay, and safety profile compared with SPP in colorectal surgery. Although LPP was not associated with increased complications, older patients, males, patients undergoing laparoscopic surgery, and those with longer operative times may be at risk of increased complications., Competing Interests: S.D.W. reports receiving consulting fees from Baxter, Becton, Dickinson and Co, Glaxo Smith Kline, Intuitive Surgical, Livsmed, Medtronic, OstomyCure, Stryker, Takeda, Virtual Ports, is a member of the Data Safety Monitoring Board of JSR/WCG/ACI (chair), Polypoid (chair), and Boomerang and receives royalties from Intuitive Surgical, Karl Storz Endoscopy America Inc., and Unique Surgical Solutions, LLC., (© The Author(s) 2024. Published by Oxford University Press and Sixth Affiliated Hospital of Sun Yat-sen University.)- Published
- 2024
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41. Effect of neoadjuvant therapy regimens on lymph nodes yield in rectal cancer.
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Ray-Offor E, Nagarajan A, Horesh N, Emile SH, Gefen R, Garoufalia Z, Dourado J, Parlade A, Da Silva G, and Wexner S
- Subjects
- Humans, Male, Female, Middle Aged, Retrospective Studies, Lymph Node Excision, Aged, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Lymphatic Metastasis, Follow-Up Studies, Prognosis, Neoplasm Staging, Rectal Neoplasms pathology, Rectal Neoplasms therapy, Rectal Neoplasms mortality, Rectal Neoplasms surgery, Neoadjuvant Therapy, Lymph Nodes pathology, Lymph Nodes surgery
- Abstract
Background and Objectives: Pathological nodal staging is relevant to postoperative decision-making and a prognostic marker of cancer survival. This study aimed to assess the effect of different total neoadjuvant therapy (TNT) regimens on lymph node status following total mesorectal excision (TME) for locally advanced rectal cancer (LARC)., Methods: A retrospective cohort study of patients treated for node-positive clinical stage 3 LARC with TNT between January 2015 and August 2022. Patients were stratified into induction therapy and consolidation therapy groups. Variables collated included patient demographics, clinical and radiological characteristics of the tumor, and pathology of the resected specimen. Primary outcome was total harvested lymph nodes., Results: Ninety-seven patients were included (57 [58.8%] males; mean age of 58.5 ± 11.4 years). The induction therapy group included 85 (87.6%) patients while 12 (12.4%) patients received consolidation therapy. A median interquartile range value of 22.00 (5.00-72.00) harvested lymph nodes was recorded for the induction therapy group in comparison to 16.00 (16.00-47.00) in the consolidation therapy arm (p = 0.487). Overall pathological complete response rate was 34%., Conclusion: Total harvested nodes from resected specimens were marginally lower in the consolidation therapy group. Induction therapy may be preferrable to optimize postoperative specimen staging., (© 2024 The Author(s). Journal of Surgical Oncology published by Wiley Periodicals LLC.)
- Published
- 2024
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42. Endoscopic repair of ileorectal anastomotic sinus-A video vignette.
- Author
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Dourado J, Rogers P, Delgado Z, Aeschbacher P, Salama E, and DaSilva G
- Subjects
- Humans, Male, Rectum surgery, Anastomosis, Surgical methods, Ileum surgery
- Published
- 2024
- Full Text
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43. Splenic flexure mobilization in left-sided colonic and rectal resections: A meta-analysis and meta-regression of factors associated with anastomotic leak and complications.
- Author
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Emile SH, Dourado J, Rogers P, Horesh N, Garoufalia Z, Gefen R, and Wexner SD
- Subjects
- Humans, Risk Factors, Female, Male, Proctectomy adverse effects, Proctectomy methods, Rectum surgery, Middle Aged, Anastomosis, Surgical adverse effects, Anastomosis, Surgical methods, Aged, Rectal Neoplasms surgery, Postoperative Complications etiology, Postoperative Complications epidemiology, Anastomotic Leak etiology, Anastomotic Leak epidemiology, Colon, Transverse surgery, Colectomy adverse effects, Colectomy methods, Length of Stay statistics & numerical data, Operative Time
- Abstract
Aim: Splenic flexure mobilization (SFM) is commonly performed during left-sided colon and rectal resections. The aim of the present systematic review was to assess the outcomes of SFM in left-sided colon and rectal resections and the risk factors for complications and anastomotic leak (AL)., Method: This study was a PRISMA-compliant systematic review. PubMed, Scopus and Web of Science were searched for studies that assessed the outcomes of sigmoid and rectal resections with or without SFM. The primary outcomes were AL and total complications, and the secondary outcomes were individual complications, operating time, conversion to open surgery, length of hospital stay (LOS) and pathological and oncological outcomes., Results: Nineteen studies including data on 81 116 patients (49.1% male) were reviewed. SFM was undertaken in 40.7% of patients. SFM was associated with a longer operating time (weighted mean difference 24.50, 95% CI 14.47-34.52, p < 0.0001) and higher odds of AL (OR 1.19, 95% CI 1.06-1.33, p = 0.002). Both groups had similar odds of total complications, splenic injury, anastomotic stricture, conversion to open surgery, (LOS), local recurrence, and overall survival. A secondary analysis of rectal cancer cases only showed similar outcomes for SFM and the control group., Conclusions: SFM was associated with a longer operating time and higher odds of AL, yet a similar likelihood of total complications, splenic injury, anastomotic stricture, conversion to open surgery, LOS, local recurrence, and overall survival. These conclusions must be cautiously interpreted considering the numerous study limitations. SFM may have only been selectively undertaken in cases in which anastomotic tension was suspected. Therefore, the suboptimal anastomoses may have been the reason for SFM rather than the SFM being causative of the anastomotic insufficiencies., (© 2024 The Author(s). Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.)
- Published
- 2024
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44. A national database analysis of the evolution of outcomes of surgery for anal melanoma.
- Author
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Emile SH, Horesh N, Garoufalia Z, Gefen R, Dourado J, and Wexner SD
- Subjects
- Humans, Female, Male, Aged, Middle Aged, Survival Rate, Follow-Up Studies, Retrospective Studies, Prognosis, Aged, 80 and over, Melanoma surgery, Melanoma mortality, Melanoma pathology, Anus Neoplasms surgery, Anus Neoplasms mortality, Anus Neoplasms pathology, Databases, Factual
- Abstract
Background: This study assessed trends in treatment and outcomes of anal melanomas over a 17-year period., Methods: NCDB was searched for patients with anal melanoma (2004-2020). Receiver-operating characteristic curve analysis was used to determine cutoff year marking increased overall survival (OS) of anal melanoma. Characteristics, treatments, and outcomes in consecutive time periods were compared., Results: A total of 815 patients (mean age: 67.2 years; 59.4% female) were included: 354 in Period 1 (2004-2012) and 461 in Period 2 (2013-2020). Period 2 included fewer abdominoperineal resections (18% vs. 28%, p = 0.002), more local tumor excisions (61.1% vs. 55%, p = 0.002), more often immunotherapy (odds ratio [OR]: 3.41, 95% confidence interval [CI]: 2.22-5.22, p < 0.001) and less often chemotherapy (OR: 0.516, 95% CI: 0.352-0.755, p < 0.001) administered and longer median OS (25.2 vs. 19.8 months, p = 0.006). Independent predictors of worse OS were older age (hazard ratio [HR]: 1.02, p = 0.012), higher Charlson score (HR: 2.32, p = 0.02), and greater number of positive lymph nodes (HR: 1.15, p < 0.001); conversely private insurance (HR: 0.385, p = 0.008) was predictive of increased OS., Conclusions: Anal melanoma patients diagnosed between 2013 and 2020 underwent fewer abdominoperineal resections and more local excisions than patients diagnosed between 2004 and 2013. Increased immunotherapy and longer median OS were noted in period two. Age and private insurance were significant predictors of OS, remaining constant across time periods., (© 2024 Wiley Periodicals LLC.)
- Published
- 2024
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45. Perforated jejunal diverticulitis in the setting of biologic therapy presenting as transverse Colon diverticulitis: A case report.
- Author
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Dourado J, Jassir FF, Pavlovsky A, and Blumofe K
- Abstract
Introduction: Small bowel diverticula are a rare entity and are mostly found in the duodenum on diagnosis. Some common complications of this pathology include bleeding, obstruction, diverticulitis, and perforation. Furthermore, there is growing evidence supporting an association between biologic therapies and spontaneous intestinal perforation., Presentation of Case: We present a case of a 79-year-old female on prednisone, hydroxychloroquine, and tofacitinib for rheumatoid arthritis who was misdiagnosed with transverse colonic diverticulitis and eventually found to have perforated jejunal diverticulitis on laparotomy., Discussion: While tofacitinib has been associated with spontaneous intestinal perforation, it has not been documented as an aggravating factor in small bowel diverticular disease., Conclusion: It is imperative to maintain a high index of suspicion for this pathology in immunosuppressed patients with an atypical presentation of diverticular disease., Competing Interests: Declaration of competing interest All authors report no conflicts of interest or financial disclosures related to this case report., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2024
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46. Ostomy continence devices: a systematic review of the literature and meta-analysis.
- Author
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Dourado J, Garoufalia Z, Emile SH, Wignakumar A, Aeschbacher P, Rogers P, Delgado Z, Greer M, and Wexner SD
- Subjects
- Humans, Colostomy instrumentation, Colostomy adverse effects, Postoperative Complications etiology, Postoperative Complications prevention & control, Male, Female, Quality of Life, Fecal Incontinence etiology
- Abstract
Aim: Colostomy complication rates range widely from 10% to 70%. The psychological burden on patients, leading to lifestyle changes and decreased quality of life (QoL), is one of the largest factors. The aim of this work was to assess the history and efficacy of ostomy continence devices in improving continence and QoL., Method: In this PRISMA-compliant systematic review and meta-analysis, we searched PubMed, Scopus, Google Scholar and clinicaltrials.gov for studies on continence devices for all ostomies up to April 2023. Primary outcomes were continence and improvement in QoL. Secondary outcomes were leakage, patient's device preference and complications. Risk of Bias 2 and the revised tool to assess risk of bias in non-randomized studies of interventions (ROBINS-1) were used to assess risk of bias. Certainty of evidence was graded using GRADE., Results: Twenty-two studies assessed devices from 1978 to 2022. The two main types identified were ball-valve devices and plug systems. Conseal and Vitala were the two main devices with significant evidence allowing for pooled analyses. Conseal, the only currently marketed device, had a pooled rate of continence of 67.4%, QoL improvement was 74.9%, patient preference over a traditional appliance was 69.1%, leakage was 10.1% and complications was 13.7%. Since 2011, five studies have investigated experimental devices on both human and animal models., Conclusion: Ostomy continence has been a long-standing goal without a consistently reliable solution. We propose that selective and short-term usage of continence devices may lead to improved continence and QoL in ostomy patients. Further research is needed to develop a reliable daily device for ostomy continence. Future investigation should include the needs of ileostomates., (© 2024 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.)
- Published
- 2024
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47. "Primary Correction of the Cleft Nasal Septum: A Systematic Review".
- Author
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Bins GP, Dourado J, Tang J, Kogan S, and Runyan CM
- Subjects
- Humans, Esthetics, Cleft Lip surgery, Cleft Palate surgery, Nasal Septum surgery, Nasal Septum abnormalities, Rhinoplasty methods
- Abstract
Patients affected by cleft lip and palate have a characteristic nasal deformity; however, the treatment timeline varies amongst providers. There has been a shift from a more conservative approach to earlier intervention in order to allow for more normal development of the nose. Form, function, and future development all must be considered. For this reason, this investigation was undertaken to present the current literature available on the effects to all aspects of primary septoplasty in the cleft nasal deformity., An initial list of 222 papers was identified, and it was determined that 16 papers fit the inclusion criteria. Studies were included in which the initial age of operation for the majority of patients was between 3 and 12 months and in which patients underwent septal repositioning at the time of cleft lip repair. These papers were all reviewed by a single author initially, and the results recorded. All results were then verified by a second author for accuracy and completeness., Symmetry was found to be improved by primary septoplasty. Growth was not found to be impaired in any study; data was insufficient to indicate that growth was improved. Obstruction was improved as determined both by imaging, endoscopy, and patient survey. Finally, reoperation rates occurred at an acceptable rate not exceeding that of primary rhinoplasty without septoplasty., Primary septoplasty leads to better aesthetic symmetry and function of the cleft nose without impairing growth. This change is maintained into adulthood often without the need for revisionary surgery., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- Published
- 2024
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48. Perineal rectosigmoidectomy (Altemeier) with colonic J pouch and levatorplasty: a technical demonstration - a video vignette.
- Author
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Rogers P, Dourado J, Delgado Z, De Stefano Hernandez F, Aeschbacher P, and Wexner SD
- Subjects
- Humans, Rectum surgery, Colon, Treatment Outcome, Colonic Pouches, Rectal Prolapse surgery
- Published
- 2024
- Full Text
- View/download PDF
49. Laparoscopic completion proctectomy and J-pouch formation: How we do it - A Video Vignette.
- Author
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Rogers P, Garoufalia Z, Delgado Z, Dourado J, Horesh N, and Wexner SD
- Subjects
- Humans, Rectum surgery, Colonic Pouches, Proctocolectomy, Restorative, Laparoscopy, Rectal Neoplasms surgery
- Published
- 2023
- Full Text
- View/download PDF
50. Survival Outcomes of Optimally Treated Colorectal Metastases: The Importance of R0 Status in Surgical Treatment of Hepatic and Peritoneal Surface Disease.
- Author
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Solsky I, Moaven O, Valenzuela CD, Lundy M, Stauffer JA, Del Piccolo NR, Cheung T, Corvera CU, Wisneski AD, Cha C, Zarandi NP, Dourado J, Russell G, Levine EA, Votanopoulos KI, and Shen P
- Subjects
- Humans, Female, Combined Modality Therapy, Retrospective Studies, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Cytoreduction Surgical Procedures, Survival Rate, Peritoneal Neoplasms surgery, Peritoneal Neoplasms drug therapy, Hyperthermia, Induced, Liver Neoplasms surgery, Liver Neoplasms drug therapy, Colorectal Neoplasms pathology
- Abstract
Background: Although colorectal hepatic metastases (HM) and peritoneal surface disease (PSD) are distinct biologic diseases, they may have similar long-term survival when optimally treated with surgery., Methods: This study retrospectively reviewed prospectively managed databases. Patients undergoing R0 or R1 resections were analyzed with descriptive statistics, the Kaplan-Meier method, and Cox regression. Survival was compared over time for the following periods: 1993-2006, 2007-2012, and 2013-2020., Results: The study enrolled 783 HM patients undergoing liver resection and 204 PSD patients undergoing cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC). Compared with PSD patients, HM patients more often had R0 resections (90.3% vs. 32.4%), less often had pre-procedure chemotherapy (52.4% vs. 92.1%), and less often were functionally independent (79.7% vs. 95.6%). The 5-year overall survival for HM was 40.9%, with a median survival period of 45.8 months versus 25.8% and 33.4 months, respectively, for PSD (p < 0.05). When stratified by resection status, R0 HM and R0 PSD did not differ significantly in median survival (49.0 vs. 45.4 months; p = 0.83). The median survival after R1 resection also was similar between HM and PSD (32.6 vs. 26.9 months; p = 0.59). Survival between the two groups again was similar over time when stratified by resection status. The predictors of survival for HM patients were R0 resection, number of lesions, intraoperative transfusion, age, and adjuvant chemotherapy. For the PSD patients, the predictors were peritoneal cancer index (PCI) score, estimated blood loss (EBL), and female gender., Conclusion: The study showed that R0 resections are associated with improved outcomes and that median survival is similar between HM and PSD patients when it is achieved. Surveillance and treatment strategies that facilitate R0 resections are needed to improve results, particularly for PSD., (© 2023. Society of Surgical Oncology.)
- Published
- 2023
- Full Text
- View/download PDF
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