164 results on '"Flor Lorente B"'
Search Results
2. A mathematical 3D-method applied to MRI to evaluate prostatic infiltration in advanced rectal cancer
- Author
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Garcia-Granero, A., Pellino, G., Giner, F., Frasson, M., Fletcher-Sanfeliu, D., Romaguera, V. P., Flor-Lorente, B., Gamundi, M., Brogi, L., Garcia-Calderón, D., Gonzalez-Argente, F. X., and Garcia-Granero, E.
- Published
- 2020
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3. An international assessment of the adoption of enhanced recovery after surgery (ERAS®) principles across colorectal units in 2019–2020
- Author
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Pinkney T., Taylor H., Tong C., Schmitz N. -D., Morton D. G., Pinkney T. D., Bhangu A., Blackwell S., Dardanov D., Dulskas A., Gallo G., Glasbey J., Keatley J., Knowles C., Li Y. E., McCourt V., Minaya-Bravo A., Neary P., Nepogodiev D., Pata F., Pellino G., Sivrikoz E., van Ramshorst G., Zmora O., Perry R., Magill E. L., Abdalkoddus M., Abelevich A., Abraham S., Abraham-Nordling M., Adamina M., Agalar C., Agresta F., Ahallat M., Ahmad N., Aiupov R., Akca O., Aleksic A., Aleotti F., Alias D., Alonso J., Alonso Goncalves S., Alonso Martin J., Alonso Poza A., Alonso-Hernandez N., Alos Company R., Al-Saeedi M., Alvarez-Laso C., Alvarez-Gallego M., Amanatidis T., Americano M., Amorim E., Anandan L., Anania G., Ancans G., Andreev P., Andrejevic P., Antonacci N., Anwer M., Aonzo P., Arencibia B., Argeny S., Arieli H., Arnold S., Ashraf M., Aslam M., Atanasov B., Atif M., Atladottir J., Avital S., Awny S., Aytac B., Azahr N., Aznar-Puig S., Bailey S., Balalis D., Baldi C., Baldonedo R., Balducci G., Balestra F., Balestri R., Balfour A., Baloyiannis I., Banky B., Baral J., Baranyai Z., Barbashinov N., Bargallo J., Barisic G., Barugola G., Batashki I., Battersby N., Belev N., Belli A., Beltran de Heredia J., Bemelman W., Benavides Buleje J., Benckert A., Bernal-Sprekelsen J., Bertocchi E., Beuran M., Bhan C., Bianco F., Bilali S., Bilali V., Bintintan V., Birindelli A., Birsan T., Blanco Antona F., Blas J., Blasco-Segura T., Blom R., Bocchetti T., Boerma E., Bogdan M., Boland M., Bomans B., Borda N., Bowen M., Bradulskis S., Branagan G., Brankovic B., Brenna M., Brewer H., Broadhurst J., Bronder C., Brouwer R., Buccianti P., Buchs N., Buchwald P., Bugatti A., Bui A., Burcos T., Buskens C., Bustamante C., Caceres N., Cagigas Fernandez C., Calero-Lillo A., Camps I., Canda A., Caravaca-Garcia I., Carballo F., Carcoforo P., Carlander J., Carlos S., Caro A., Carpelan A., Carrasco Prats M., Carrillo Lopez M., Carvello M., Casal E., Casoni Pattacini G., Castellvi Valls J., Castillo Diego J., Cavallesco G., Cavenaile V., Cayetano L., Ceccotti A., Cervera-Aldama J., Chabok A., Chafai N., Chandrasinghe P., Chandratreya N., Chaudhri S., Chaudhry Z., Cherdancev D., Chernov A., Chevallay M., Chirletti P., Chouillard E., Chouliaras C., Chowdri N., Cillo M., Cini C., Ciubotaru C., Ciuce C., Claeys D., Cocorullo G., Codina-Cazador A., Colak E., Coletta D., Colombo F., Copaescu C., Corte Real J., Corver M., Cosic J., Costa S., Costa Pereira J., Costa Pereira C., Costa-Navarro D., Cotte E., Cracco N., Cristian D., Cuadrado M., Cuk V., Cunha M., Cunha J., Curinga R., Curletti G., Curtis N., Dabic D., Dainius E., d'Alessandro A., Daniels I., Darvin V., Dauser B., David G., Davidova O., Davies E., de Andres Asenjo B., De franciscis S., de Graaf E., De la Portilla F., De Luca E., De Nisco C., De Toma G., Defoort B., Den Boer F., Di Candido F., Di Saverio S., Diaz Pavon J., Dieguez Fernandez B., Diez-Alonso M., Dimitrijevic I., Dindelegan G., Djuric M., Domingos H., Doornebosch P., Dos Santos M., Drami I., Dudarovaska H., Dusek T., Dzhumabaev H., Eden Y., Egenvall M., Eismiontas V., El Sorogy M., Elgeidie A., Elhemaly M., El-Hussuna A., Ellul S., Elmore U., ElNakeeb A., Elrefai M., Emile S., Enrriquez-Navascues J., Epstein J., Escartin J., Escola D., Escuder J., Espin E., Espina B., Estefania D., Etienne J., Fabbri S., Falato A., Fares R., Farina P., Farkasova M., Farres R., Fasolini F., Fatayer T., Febles G., Feliu F., Feo C., Feoktistov D., Fernandez F., Fernandez Isart M., Fernando J., Ferreira G., Ferrer R., Ferreras Garcia C., Ferri M., Figueiredo N., Finotti E., Fitzgerald J., Flateh Backe I., Flor-Lorente B., Forero-Torres A., Foschi D., Francart D., Francois Y., Frasson M., Freil-Lanter C., Frois Borges M., Fuzun M., Gala T., Galleano R., Galvez P., Galvez Saldana A., Gamundi Cuesta M., Garcia Cabrera A., Garcia Egea J., Garcia Olmo D., Garcia-Gonzalez J., Garcia-Granero A., Garcia-Granero E., Garcia-Septiem J., Gardea A., Garipov M., Gefen R., Geraghty A., Gerkis S., Germanos S., Ghaffari S., Ghilles E., Gianotti L., Gil Santos M., Gilsanz Martin C., Gingert C., Gklavas A., Glehen O., Golda T., Gomez N., Gomez R., Gomez Ruiz M., Gonzalez Santin V., Graham B., Grainger J., Grama F., Gregoir T., Gregori M., Grolich T., Grosek J., Guadalajara H., Guckenheimer S., Guevara J., Gulotta G., Gupta S., Gurevich N., Gurjar S., Haapaniemi S., Hahnloser D., Hamad Y., Hamid M., Hanly A., Harris G., Harsanyi L., Hartig N., Hawkin P., Henriques P., Herbst F., Hermann N., Hernandez Garcia M., Hoch J., Hrora A., Huhtinen H., Iarumov N., Ilkanich A., Insua C., Ioannidis P., Iqbal M., Iqbal A., Isik A., Ismaiel M., Ivlev D., Jadhav V., Jareno S., Jehaes C., Jimenez V., Jimenez-Toscano M., Jimenez-Miramon J., Jimenez-Rodriguez R., Jonsson T., Jotautas V., Julia D., Juloski J., Jung B., Kala Z., Kalayci M., Kara Y., Karachun A., Karagul S., Karvonen J., Katorkin S., Katsoulis I., Katsounis D., Kaubrys M., Kaul N., Kefalou E., Keijzers M., Kelly M., Kenic M., Kennelly R., Khan J., Khan M., Kho H., Kinas V., Knight J., Kocian P., Koeter T., Kokobelyan A., Konsten J., Koolen L., Kosir J., Kostic I., Krdzic I., Kreisler Moreno E., Krivokapic Z., Krstev P., Krsul D., Kumarasinghe N., La Torre F., Labarga F., Ladra M., Lage Laredo A., Lahodzich N., Lai C., Lakkis Z., Lal R., Lamas S., Lang T., Latkauskas T., Lawes D., Lazar G., Lebedev K., Lebedeva M., Lefevre J., Lekic Vitlov V., Lemma M., Leo C., Leon C., Leventoglu S., Levy B., Li L., Licari L., Lizdenis P., Loftas P., Longhi M., Longstaff L., Lopez Dominguez J., Lopez-Lara M., Lora P., Lorenzon L., Lorusso D., Lozev I., Lozoya Trujillo R., Lukic D., Lunins R., Luzan R., Luzzi A., Maderuelo V., Madsboll T., Mahotin D., Majbar M., Makhmudov A., Malik K., Maly O., Mamaloudis I., Mamedli Z., Manatakis D., Mandi D., Mangell P., Marharint T., Mariani N., Maric B., Marimuthu K., Marinello F., Marino F., Markiewicz S., Markovic V., Marom G., Maroni N., Maroulis I., Marsanic P., Marsman H., Martens M., Marti M., Martinek L., Martinez S., Martinez D., Martinez Manzano A., Martins R., Maslyankov S., McArdle K., McDermott F., Mege D., Mehraj A., Mehta A., Mendrila D., Menendez P., Mercantini P., Metwally I., Mikalauskas S., Millan M., Mingoli A., Mirshekar-Syahkal B., Moggia E., Mohan S., Moller P., Mompart Garcia S., Monami B., Moniz Pereira P., Montroni I., Morel P., Moshev B., Mostovoy E., Mothe S., Mukhtar H., Muller P., Munch S., Munoz Camarena J., Munoz-Collado S., Muratore A., Muscara F., Muysoms F., Myrelid P., N. Lah N., Nail S., Narayanan A., Nastos K., Negoi I., Nesbakken A., Nestler G., Nestorovic M., Nesytykh A., Newton K., Ng Y., Ngu J., Nguyen B., Nijs Y., Nikberg M., Nimmersgern T., Nogues E., Norcic G., Nutautiene V., Nygren J., O'Brien J., Ochogavia Segui A., O'Kelly J., Oliveira-Cunha M., Omar W., Omar G., Onishchenko S., Onody P., Opocher E., Orhalmi J., Oshowo A., Otero J., Ozgen U., Pace K., Padin H., Papaconstantinou I., Papadopoulos A., Papadopoulos G., Papandrea M., Paral J., Parc Y., Paredes J., Parmar M., Parra Banos P., Parray F., Pascual Damieta M., Pascual Miguelanez I., Passot G., Pastor C., Paszt A., Patel P., Paterson H., Patron Uriburu J., Paulos A., Pavlov V., Pcolkins A., Pecic V., Pena Ros E., Penkov R., Pera Roman M., Perunicic V., Pery R., Petrovic D., Pezzolla F., Photi E., Pikarsky A., Piramanayagam B., Pisani Ceretti A., Planellas P., Platt E., Pletinckx P., Podda M., Poskus T., Poskus E., Pozdnyakov A., Pravosudov I., Previsic A., Prieto D., Prochazka V., Prodan A., Proud D., Psaila J., Psaras G., Pulighe F., Pullig F., Qureshi M., Rachadell J., Radovanovic Z., Radovanovic D., Raguan B., Rahman M., Raiss M., Ramirez Faraco M., Ramos J., Ramos-Prada J., Rantala A., Rao M., Rasulov A., Ratnatunga K., Raymond T., Refky B., Reggiani L., Regusci L., Reyes Diaz M., Richardson J., Richiteanu G., Rios A., Ris F., Rodriguez Garcia P., Roffi N., Romairone E., Romano G., Romero I., Romero de Diego A., Romero-Simo M., Roque C., Rosati R., Rossi B., Rossi E., Rossini R., Ruano A., Rubbini M., Rubio-Perez I., Ruffo G., Ruiz H., Ruiz Carmona M., Ryska O., Sabia D., Sacchi M., Sacco R., Sakr A., Saladzinskas Z., Salamone G., Salomon M., Salvans Ruiz S., Sammarco G., Sampietro G., Samsonov D., Samsonyuk V., Sanchez J., Sanchez Romero A., Sanchez-Guillen L., Santak G., Santamaria-Olabarrieta M., Santos J., Saraceno F., Saralegui Y., Sarici I., Savino G., Scabini S., Schafli J., Schiltz B., Schofield A., Schon M., Scurtu R., Segalini E., Segelman J., Segura-Sampedro J., Seicean R., Sekulic A., Selniahina L., Seretis F., Serrano Paz P., Shaikh I., Shalaby M., Shams N., Sharma A., Sharma G., Shukla A., Shussman N., Shweejawee Z., Sielezneff I., Sigurdsson H., Sileri P., Silva M., Simcikas D., Simoes J., Simonka Z., Singh B., Sivins A., Skroubis G., Skull A., Slavchev M., Slavin M., Smart N., Smart C., Smart P., Smedh K., Smolarek S., Sokmen S., Sokolov M., Solana Bueno A., Solar L., Sorrentino L., Sotona O., Spacca D., Spinelli A., Stanojevic G., Stearns A., Stefan S., Stift A., Stijns J., Stoyanov V., Straarup D., Strupas K., Stubbs B., Subocius A., Sudlow A., Suero C., Sungurtekin U., Svagzdys S., Syk I., Tamelis A., Tamhane R., Tamini N., Tamosiunas A., Tanis P., Tarasov N., Tate S., Tennakoon A., Teo N., Terzi C., Tezas S., Thabet W., Tham J., Thavanesan N., Theodosopoulos T., Thomas W., Tiret E., Tiselius C., Todorov G., Tomazic A., Tomulescu V., Torkington J., Totis M., Trostchansky I., Truan N., Tulchinsky H., Tutino R., Tzivanakis A., Tzovaras G., Ugolini G., Unger L., Upanishad I., Urbani L., Uth Ovesen A., Vaizey C., Vallribera F., Valsdottir E., Valverde I., Valverde-Sintas J., Van Belle K., Van Cleven S., van Hagen P., van Loon Y., van Ruler O., Van Wijck K., Varabei A., Varcada M., Varpe P., Vartic M., Velchuru V., Vencius J., Venskutonis D., Vercher D., Vermaas M., Vertruyen M., Verza L., Vescio G., Vezakis A., Vieira P., Vignali A., Vigorita V., Vila Tura M., Vinson-Bonnet B., Viso Pons L., Voloshin S., Voronin Y., Vukusic L., Wang X., Wang J., Wani R., Warusavitarne J., Wasserberg N., Weerts J., Weiss D., Weizman A., Westerduin E., Wheat J., White I., Wik T., Wilson J., Winter D., Wolthuis A., Wong M., Yahia S., Yamamoto T., Yanishev A., Yao C., Yildiz A., Yuksel O., Zain Z., Zakaria A., Zakaria Z., Zampitis N., Zarand A., Zarco-Pleguezuelos A., Zattoni D., Zelic M., Zeromskas P., Zhuravlev A., Zimmerman D., Zuhdy M., Zukanovic G., Surgery, CCA - Cancer Treatment and Quality of Life, Amsterdam Gastroenterology Endocrinology Metabolism, Graduate School, Amsterdam Neuroscience - Cellular & Molecular Mechanisms, Amsterdam Neuroscience - Neuroinfection & -inflammation, APH - Methodology, APH - Personalized Medicine, Pinkney, T, Taylor, H, Tong, C, Schmitz, N, Morton, D, Bhangu, A, Blackwell, S, Dardanov, D, Dulskas, A, Gallo, G, Glasbey, J, Keatley, J, Knowles, C, Li, Y, Mccourt, V, Minaya-Bravo, A, Neary, P, Nepogodiev, D, Pata, F, Pellino, G, Sivrikoz, E, van Ramshorst, G, Zmora, O, Perry, R, Magill, E, Abdalkoddus, M, Abelevich, A, Abraham, S, Abraham-Nordling, M, Adamina, M, Agalar, C, Agresta, F, Ahallat, M, Ahmad, N, Aiupov, R, Akca, O, Aleksic, A, Aleotti, F, Alias, D, Alonso, J, Alonso Goncalves, S, Alonso Martin, J, Alonso Poza, A, Alonso-Hernandez, N, Alos Company, R, Al-Saeedi, M, Alvarez-Laso, C, Alvarez-Gallego, M, Amanatidis, T, Americano, M, Amorim, E, Anandan, L, Anania, G, Ancans, G, Andreev, P, Andrejevic, P, Antonacci, N, Anwer, M, Aonzo, P, Arencibia, B, Argeny, S, Arieli, H, Arnold, S, Ashraf, M, Aslam, M, Atanasov, B, Atif, M, Atladottir, J, Avital, S, Awny, S, Aytac, B, Azahr, N, Aznar-Puig, S, Bailey, S, Balalis, D, Baldi, C, Baldonedo, R, Balducci, G, Balestra, F, Balestri, R, Balfour, A, Baloyiannis, I, Banky, B, Baral, J, Baranyai, Z, Barbashinov, N, Bargallo, J, Barisic, G, Barugola, G, Batashki, I, Battersby, N, Belev, N, Belli, A, Beltran de Heredia, J, Bemelman, W, Benavides Buleje, J, Benckert, A, Bernal-Sprekelsen, J, Bertocchi, E, Beuran, M, Bhan, C, Bianco, F, Bilali, S, Bilali, V, Bintintan, V, Birindelli, A, Birsan, T, Blanco Antona, F, Blas, J, Blasco-Segura, T, Blom, R, Bocchetti, T, Boerma, E, Bogdan, M, Boland, M, Bomans, B, Borda, N, Bowen, M, Bradulskis, S, Branagan, G, Brankovic, B, Brenna, M, Brewer, H, Broadhurst, J, Bronder, C, Brouwer, R, Buccianti, P, Buchs, N, Buchwald, P, Bugatti, A, Bui, A, Burcos, T, Buskens, C, Bustamante, C, Caceres, N, Cagigas Fernandez, C, Calero-Lillo, A, Camps, I, Canda, A, Caravaca-Garcia, I, Carballo, F, Carcoforo, P, Carlander, J, Carlos, S, Caro, A, Carpelan, A, Carrasco Prats, M, Carrillo Lopez, M, Carvello, M, Casal, E, Casoni Pattacini, G, Castellvi Valls, J, Castillo Diego, J, Cavallesco, G, Cavenaile, V, Cayetano, L, Ceccotti, A, Cervera-Aldama, J, Chabok, A, Chafai, N, Chandrasinghe, P, Chandratreya, N, Chaudhri, S, Chaudhry, Z, Cherdancev, D, Chernov, A, Chevallay, M, Chirletti, P, Chouillard, E, Chouliaras, C, Chowdri, N, Cillo, M, Cini, C, Ciubotaru, C, Ciuce, C, Claeys, D, Cocorullo, G, Codina-Cazador, A, Colak, E, Coletta, D, Colombo, F, Copaescu, C, Corte Real, J, Corver, M, Cosic, J, Costa, S, Costa Pereira, J, Costa Pereira, C, Costa-Navarro, D, Cotte, E, Cracco, N, Cristian, D, Cuadrado, M, Cuk, V, Cunha, M, Cunha, J, Curinga, R, Curletti, G, Curtis, N, Dabic, D, Dainius, E, D'Alessandro, A, Daniels, I, Darvin, V, Dauser, B, David, G, Davidova, O, Davies, E, de Andres Asenjo, B, De franciscis, S, de Graaf, E, De la Portilla, F, De Luca, E, De Nisco, C, De Toma, G, Defoort, B, Den Boer, F, Di Candido, F, Di Saverio, S, Diaz Pavon, J, Dieguez Fernandez, B, Diez-Alonso, M, Dimitrijevic, I, Dindelegan, G, Djuric, M, Domingos, H, Doornebosch, P, Dos Santos, M, Drami, I, Dudarovaska, H, Dusek, T, Dzhumabaev, H, Eden, Y, Egenvall, M, Eismiontas, V, El Sorogy, M, Elgeidie, A, Elhemaly, M, El-Hussuna, A, Ellul, S, Elmore, U, Elnakeeb, A, Elrefai, M, Emile, S, Enrriquez-Navascues, J, Epstein, J, Escartin, J, Escola, D, Escuder, J, Espin, E, Espina, B, Estefania, D, Etienne, J, Fabbri, S, Falato, A, Fares, R, Farina, P, Farkasova, M, Farres, R, Fasolini, F, Fatayer, T, Febles, G, Feliu, F, Feo, C, Feoktistov, D, Fernandez, F, Fernandez Isart, M, Fernando, J, Ferreira, G, Ferrer, R, Ferreras Garcia, C, Ferri, M, Figueiredo, N, Finotti, E, Fitzgerald, J, Flateh Backe, I, Flor-Lorente, B, Forero-Torres, A, Foschi, D, Francart, D, Francois, Y, Frasson, M, Freil-Lanter, C, Frois Borges, M, Fuzun, M, Gala, T, Galleano, R, Galvez, P, Galvez Saldana, A, Gamundi Cuesta, M, Garcia Cabrera, A, Garcia Egea, J, Garcia Olmo, D, Garcia-Gonzalez, J, Garcia-Granero, A, Garcia-Granero, E, Garcia-Septiem, J, Gardea, A, Garipov, M, Gefen, R, Geraghty, A, Gerkis, S, Germanos, S, Ghaffari, S, Ghilles, E, Gianotti, L, Gil Santos, M, Gilsanz Martin, C, Gingert, C, Gklavas, A, Glehen, O, Golda, T, Gomez, N, Gomez, R, Gomez Ruiz, M, Gonzalez Santin, V, Graham, B, Grainger, J, Grama, F, Gregoir, T, Gregori, M, Grolich, T, Grosek, J, Guadalajara, H, Guckenheimer, S, Guevara, J, Gulotta, G, Gupta, S, Gurevich, N, Gurjar, S, Haapaniemi, S, Hahnloser, D, Hamad, Y, Hamid, M, Hanly, A, Harris, G, Harsanyi, L, Hartig, N, Hawkin, P, Henriques, P, Herbst, F, Hermann, N, Hernandez Garcia, M, Hoch, J, Hrora, A, Huhtinen, H, Iarumov, N, Ilkanich, A, Insua, C, Ioannidis, P, Iqbal, M, Iqbal, A, Isik, A, Ismaiel, M, Ivlev, D, Jadhav, V, Jareno, S, Jehaes, C, Jimenez, V, Jimenez-Toscano, M, Jimenez-Miramon, J, Jimenez-Rodriguez, R, Jonsson, T, Jotautas, V, Julia, D, Juloski, J, Jung, B, Kala, Z, Kalayci, M, Kara, Y, Karachun, A, Karagul, S, Karvonen, J, Katorkin, S, Katsoulis, I, Katsounis, D, Kaubrys, M, Kaul, N, Kefalou, E, Keijzers, M, Kelly, M, Kenic, M, Kennelly, R, Khan, J, Khan, M, Kho, H, Kinas, V, Knight, J, Kocian, P, Koeter, T, Kokobelyan, A, Konsten, J, Koolen, L, Kosir, J, Kostic, I, Krdzic, I, Kreisler Moreno, E, Krivokapic, Z, Krstev, P, Krsul, D, Kumarasinghe, N, La Torre, F, Labarga, F, Ladra, M, Lage Laredo, A, Lahodzich, N, Lai, C, Lakkis, Z, Lal, R, Lamas, S, Lang, T, Latkauskas, T, Lawes, D, Lazar, G, Lebedev, K, Lebedeva, M, Lefevre, J, Lekic Vitlov, V, Lemma, M, Leo, C, Leon, C, Leventoglu, S, Levy, B, Li, L, Licari, L, Lizdenis, P, Loftas, P, Longhi, M, Longstaff, L, Lopez Dominguez, J, Lopez-Lara, M, Lora, P, Lorenzon, L, Lorusso, D, Lozev, I, Lozoya Trujillo, R, Lukic, D, Lunins, R, Luzan, R, Luzzi, A, Maderuelo, V, Madsboll, T, Mahotin, D, Majbar, M, Makhmudov, A, Malik, K, Maly, O, Mamaloudis, I, 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D., Chernov, A., Chevallay, M., Chirletti, P., Chouillard, E., Chouliaras, C., Chowdri, N., Cillo, M., Cini, C., Ciubotaru, C., Ciuce, C., Claeys, D., Cocorullo, G., Codina-Cazador, A., Colak, E., Coletta, D., Colombo, F., Copaescu, C., Corte Real, J., Corver, M., Cosic, J., Costa, S., Costa Pereira, J., Costa Pereira, C., Costa-Navarro, D., Cotte, E., Cracco, N., Cristian, D., Cuadrado, M., Cuk, V., Cunha, M., Cunha, J., Curinga, R., Curletti, G., Curtis, N., Dabic, D., Dainius, E., D'Alessandro, A., Daniels, I., Darvin, V., Dauser, B., David, G., Davidova, O., Davies, E., de Andres Asenjo, B., De franciscis, S., de Graaf, E., De la Portilla, F., De Luca, E., De Nisco, C., De Toma, G., Defoort, B., Den Boer, F., Di Candido, F., Di Saverio, S., Diaz Pavon, J., Dieguez Fernandez, B., Diez-Alonso, M., Dimitrijevic, I., Dindelegan, G., Djuric, M., Domingos, H., Doornebosch, P., Dos Santos, M., Drami, I., Dudarovaska, H., Dusek, T., Dzhumabaev, H., Eden, Y., Egenvall, M., Eismiontas, V., El Sorogy, M., Elgeidie, A., Elhemaly, M., El-Hussuna, A., Ellul, S., Elmore, U., Elnakeeb, A., Elrefai, M., Emile, S., Enrriquez-Navascues, J., Epstein, J., Escartin, J., Escola, D., Escuder, J., Espin, E., Espina, B., Estefania, D., Etienne, J., Fabbri, S., Falato, A., Fares, R., Farina, P., Farkasova, M., Farres, R., Fasolini, F., Fatayer, T., Febles, G., Feliu, F., Feo, C., Feoktistov, D., Fernandez, F., Fernandez Isart, M., Fernando, J., Ferreira, G., Ferrer, R., Ferreras Garcia, C., Ferri, M., Figueiredo, N., Finotti, E., Fitzgerald, J., Flateh Backe, I., Flor-Lorente, B., Forero-Torres, A., Foschi, D., Francart, D., Francois, Y., Frasson, M., Freil-Lanter, C., Frois Borges, M., Fuzun, M., Gala, T., Galleano, R., Galvez, P., Galvez Saldana, A., Gamundi Cuesta, M., Garcia Cabrera, A., Garcia Egea, J., Garcia Olmo, D., Garcia-Gonzalez, J., Garcia-Granero, A., Garcia-Granero, E., Garcia-Septiem, J., Gardea, A., Garipov, M., Gefen, R., Geraghty, A., Gerkis, S., Germanos, S., Ghaffari, S., Ghilles, E., Gianotti, L., Gil Santos, M., Gilsanz Martin, C., Gingert, C., Gklavas, A., Glehen, O., Golda, T., Gomez, N., Gomez, R., Gomez Ruiz, M., Gonzalez Santin, V., Graham, B., Grainger, J., Grama, F., Gregoir, T., Gregori, M., Grolich, T., Grosek, J., Guadalajara, H., Guckenheimer, S., Guevara, J., Gulotta, G., Gupta, S., Gurevich, N., Gurjar, S., Haapaniemi, S., Hahnloser, D., Hamad, Y., Hamid, M., Hanly, A., Harris, G., Harsanyi, L., Hartig, N., Hawkin, P., Henriques, P., Herbst, F., Hermann, N., Hernandez Garcia, M., Hoch, J., Hrora, A., Huhtinen, H., Iarumov, N., Ilkanich, A., Insua, C., Ioannidis, P., Iqbal, M., Iqbal, A., Isik, A., Ismaiel, M., Ivlev, D., Jadhav, V., Jareno, S., Jehaes, C., Jimenez, V., Jimenez-Toscano, M., Jimenez-Miramon, J., Jimenez-Rodriguez, R., Jonsson, T., Jotautas, V., Julia, D., Juloski, J., Jung, B., Kala, Z., Kalayci, M., Kara, Y., Karachun, A., Karagul, S., Karvonen, J., Katorkin, S., Katsoulis, I., Katsounis, D., Kaubrys, M., Kaul, N., Kefalou, E., Keijzers, M., Kelly, M., Kenic, M., Kennelly, R., Khan, J., Khan, M., Kho, H., Kinas, V., Knight, J., Kocian, P., Koeter, T., Kokobelyan, A., Konsten, J., Koolen, L., Kosir, J., Kostic, I., Krdzic, I., Kreisler Moreno, E., Krivokapic, Z., Krstev, P., Krsul, D., Kumarasinghe, N., La Torre, F., Labarga, F., Ladra, M., Lage Laredo, A., Lahodzich, N., Lai, C., Lakkis, Z., Lal, R., Lamas, S., Lang, T., Latkauskas, T., Lawes, D., Lazar, G., Lebedev, K., Lebedeva, M., Lefevre, J., Lekic Vitlov, V., Lemma, M., Leo, C., Leon, C., Leventoglu, S., Levy, B., Li, L., Licari, L., Lizdenis, P., Loftas, P., Longhi, M., Longstaff, L., Lopez Dominguez, J., Lopez-Lara, M., Lora, P., Lorenzon, L., Lorusso, D., Lozev, I., Lozoya Trujillo, R., Lukic, D., Lunins, R., Luzan, R., Luzzi, A., Maderuelo, V., Madsboll, T., Mahotin, D., Majbar, M., Makhmudov, A., Malik, K., Maly, O., Mamaloudis, I., Mamedli, Z., Manatakis, D., Mandi, D., Mangell, P., Marharint, T., Mariani, N., Maric, B., Marimuthu, K., Marinello, F., Marino, F., Markiewicz, S., Markovic, V., Marom, G., Maroni, N., Maroulis, I., Marsanic, P., Marsman, H., Martens, M., Marti, M., Martinek, L., Martinez, S., Martinez, D., Martinez Manzano, A., Martins, R., Maslyankov, S., Mcardle, K., Mcdermott, F., Mege, D., Mehraj, A., Mehta, A., Mendrila, D., Menendez, P., Mercantini, P., Metwally, I., Mikalauskas, S., Millan, M., Mingoli, A., Mirshekar-Syahkal, B., Moggia, E., Mohan, S., Moller, P., Mompart Garcia, S., Monami, B., Moniz Pereira, P., Montroni, I., Morel, P., Moshev, B., Mostovoy, E., Mothe, S., Mukhtar, H., Muller, P., Munch, S., Munoz Camarena, J., Munoz-Collado, S., Muratore, A., Muscara, F., Muysoms, F., Myrelid, P., N. Lah, N., Nail, S., Narayanan, A., Nastos, K., Negoi, I., Nesbakken, A., Nestler, G., Nestorovic, M., Nesytykh, A., Newton, K., Ng, Y., Ngu, J., Nguyen, B., Nijs, Y., Nikberg, M., Nimmersgern, T., Nogues, E., Norcic, G., Nutautiene, V., Nygren, J., O'Brien, J., Ochogavia Segui, A., O'Kelly, J., Oliveira-Cunha, M., Omar, W., Omar, G., Onishchenko, S., Onody, P., Opocher, E., Orhalmi, J., Oshowo, A., Otero, J., Ozgen, U., Pace, K., Padin, H., Papaconstantinou, I., Papadopoulos, A., Papadopoulos, G., Papandrea, M., Paral, J., Parc, Y., Paredes, J., Parmar, M., Parra Banos, P., Parray, F., Pascual Damieta, M., Pascual Miguelanez, I., Passot, G., Pastor, C., Paszt, A., Patel, P., Paterson, H., Patron Uriburu, J., Paulos, A., Pavlov, V., Pcolkins, A., Pecic, V., Pena Ros, E., Penkov, R., Pera Roman, M., Perunicic, V., Pery, R., Petrovic, D., Pezzolla, F., Photi, E., Pikarsky, A., Piramanayagam, B., Pisani Ceretti, A., Planellas, P., Platt, E., Pletinckx, P., Podda, M., Poskus, T., Poskus, E., Pozdnyakov, A., Pravosudov, I., Previsic, A., Prieto, D., Prochazka, V., Prodan, A., Proud, D., Psaila, J., Psaras, G., Pulighe, F., Pullig, F., Qureshi, M., Rachadell, J., Radovanovic, Z., Radovanovic, D., Raguan, B., Rahman, M., Raiss, M., Ramirez Faraco, M., Ramos, J., Ramos-Prada, J., Rantala, A., Rao, M., Rasulov, A., Ratnatunga, K., Raymond, T., Refky, B., Reggiani, L., Regusci, L., Reyes Diaz, M., Richardson, J., Richiteanu, G., Rios, A., Ris, F., Rodriguez Garcia, P., Roffi, N., Romairone, E., Romano, G., Romero, I., Romero de Diego, A., Romero-Simo, M., Roque, C., Rosati, R., Rossi, B., Rossi, E., Rossini, R., Ruano, A., Rubbini, M., Rubio-Perez, I., Ruffo, G., Ruiz, H., Ruiz Carmona, M., Ryska, O., Sabia, D., Sacchi, M., Sacco, R., Sakr, A., Saladzinskas, Z., Salamone, G., Salomon, M., Salvans Ruiz, S., Sammarco, G., Sampietro, G., Samsonov, D., Samsonyuk, V., Sanchez, J., Sanchez Romero, A., Sanchez-Guillen, L., Santak, G., Santamaria-Olabarrieta, M., Santos, J., Saraceno, F., Saralegui, Y., Sarici, I., Savino, G., Scabini, S., Schafli, J., Schiltz, B., Schofield, A., Schon, M., Scurtu, R., Segalini, E., Segelman, J., Segura-Sampedro, J., Seicean, R., Sekulic, A., Selniahina, L., Seretis, F., Serrano Paz, P., Shaikh, I., Shalaby, M., Shams, N., Sharma, A., Sharma, G., Shukla, A., Shussman, N., Shweejawee, Z., Sielezneff, I., Sigurdsson, H., Sileri, P., Silva, M., Simcikas, D., Simoes, J., Simonka, Z., Singh, B., Sivins, A., Skroubis, G., Skull, A., Slavchev, M., Slavin, M., Smart, N., Smart, C., Smart, P., Smedh, K., Smolarek, S., Sokmen, S., Sokolov, M., Solana Bueno, A., Solar, L., Sorrentino, L., Sotona, O., Spacca, D., Spinelli, A., Stanojevic, G., Stearns, A., Stefan, S., Stift, A., Stijns, J., Stoyanov, V., Straarup, D., Strupas, K., Stubbs, B., Subocius, A., Sudlow, A., Suero, C., Sungurtekin, U., Svagzdys, S., Syk, I., Tamelis, A., Tamhane, R., Tamini, N., Tamosiunas, A., Tanis, P., Tarasov, N., Tate, S., Tennakoon, A., Teo, N., Terzi, C., Tezas, S., Thabet, W., Tham, J., Thavanesan, N., Theodosopoulos, T., Thomas, W., Tiret, E., Tiselius, C., Todorov, G., Tomazic, A., Tomulescu, V., Torkington, J., Totis, M., Trostchansky, I., Truan, N., Tulchinsky, H., Tutino, R., Tzivanakis, A., Tzovaras, G., Ugolini, G., Unger, L., Upanishad, I., Urbani, L., Uth Ovesen, A., Vaizey, C., Vallribera, F., Valsdottir, E., Valverde, I., Valverde-Sintas, J., Van Belle, K., Van Cleven, S., van Hagen, P., van Loon, Y., van Ruler, O., Van Wijck, K., Varabei, A., Varcada, M., Varpe, P., Vartic, M., Velchuru, V., Vencius, J., Venskutonis, D., Vercher, D., Vermaas, M., Vertruyen, M., Verza, L., Vescio, G., Vezakis, A., Vieira, P., Vignali, A., Vigorita, V., Vila Tura, M., Vinson-Bonnet, B., Viso Pons, L., Voloshin, S., Voronin, Y., Vukusic, L., Wang, X., Wang, J., Wani, R., Warusavitarne, J., Wasserberg, N., Weerts, J., Weiss, D., Weizman, A., Westerduin, E., Wheat, J., White, I., Wik, T., Wilson, J., Winter, D., Wolthuis, A., Wong, M., Yahia, S., Yamamoto, T., Yanishev, A., Yao, C., Yildiz, A., Yuksel, O., Zain, Z., Zakaria, A., Zakaria, Z., Zampitis, N., Zarand, A., Zarco-Pleguezuelos, A., Zattoni, D., Zelic, M., Zeromskas, P., Zhuravlev, A., Zimmerman, D., Zuhdy, M., and Zukanovic, G.
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medicine.medical_specialty ,Prehabilitation ,medicine.medical_treatment ,MEDLINE ,Colorectal Neoplasm ,Perioperative Care ,NO ,medicine ,Humans ,03.02. Klinikai orvostan ,Perioperative Optimisation ,Enhanced recovery after surgery ,Digestive System Surgical Procedures ,LS7_4 ,Enhanced Recovery After Surgery (ERAS) ,business.industry ,Gastroenterology ,Digestive System Surgical Procedure ,Guideline ,Colorectal surgery ,Surgery ,Family medicine ,Perioperative care ,Nasogastric intubation ,Preoperative fasting ,Colorectal Neoplasms ,Enhanced Recovery After Surgery ,business ,Colorectal Surgery ,Human - Abstract
Aim The Enhanced Recovery After Surgery (ERAS® ) Society guidelines aim to standardise perioperative care in colorectal surgery via 25 principles. We aimed to assess the variation in uptake of these principles across an international network of colorectal units. Method An online survey was circulated amongst European Society of Coloproctology members in 2019/20. For each ERAS® principle, respondents were asked to score how frequently the principle was implemented in their hospital, from 1 ('rarely') to 4 ('always'). Respondents were also asked to recall whether practice had changed since 2017. Subgroup analyses based on hospital characteristics were conducted. Results Of hospitals approached, 58% responded to the survey (195/335), with 296 individual responses (multiple responses were received from some hospitals). The majority were European (163/195 [83.6%]). Overall, respondents indicated they 'most often' or 'always' adhered to most individual ERAS® principles (18/25 [72%]). Variability in uptake of principles was reported, with universal uptake of some principles (e.g., prophylactic antibiotics; early mobilisation) and inconsistency from 'rarely' to 'always' in others (e.g., no nasogastric intubation; no preoperative fasting and carbohydrate drinks). In alignment with 2018 ERAS® guideline updates, adherence to principles for prehabilitation, managing anaemia, and postoperative nutrition appears to have increased since 2017. Conclusions Uptake of ERAS® principles varied across hospitals, and not all 25 principles were equally adhered to. Whilst some principles exhibited a high level of acceptance, others had a wide variability in uptake indicative of controversy or barriers to uptake. Further research into specific principles is required to improve ERAS® implementation.
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- 2021
4. Application of three-dimensional printing in laparoscopic dissection to facilitate D3-lymphadenectomy for right colon cancer
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Garcia-Granero, A., Sánchez-Guillén, L., Fletcher-Sanfeliu, D., Flor-Lorente, B., Frasson, M., Sancho Muriel, J., Alvarez Serrado, E., Pellino, G., Grifo Albalat, I., Giner, F., Roca Estelles, M. J., Esclapez Valero, P., and Garcia-Granero, E.
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- 2018
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5. The percentage of mesorectal infiltration as a prognostic factor after curative surgery for pT3 rectal cancer
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Sancho‐Muriel, J., primary, Giner, F., additional, Cholewa, H., additional, Garcia‐Granero, A., additional, Roselló, S., additional, Flor‐Lorente, B., additional, Cervantes, A., additional, Garcia‐Granero, E., additional, and Frasson, M., additional
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- 2023
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6. Importance of the Moskowitz artery in the laparoscopic medial approach to splenic flexure mobilization: a cadaveric study
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Garcia-Granero, A., Sánchez-Guillén, L., Carreño, O., Sancho Muriel, J., Alvarez Sarrado, E., Fletcher Sanfeliu, D., Flor Lorente, B., Frasson, M., Martinez Soriano, F., and Garcia-Granero, E.
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- 2017
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7. Observational cross-sectional study of compliance with the fast track protocol in elective surgery for colon cancer in Spain
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Alcántara-Moral, Manuel, Serra-Aracil, X., Gil-Egea, M. J., Frasson, M., Flor-Lorente, B., Garcia-Granero, E., and E.B.S.Q.-C on behalf of the collaborative Group of Coloproctology Section of The Spanish Association of Surgeons
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- 2014
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8. Nomograms for morbidity and mortality after oncologic colon resection in the enhanced recovery era: results from a multicentric prospective national study
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Sanchez-Guillen L., Frasson M., Pellino G., Fornes-Ferrer V., Ramos J. L., Flor-Lorente B., Garcia-Granero A., Sierra I. B., Jimenez-Gomez L. M., Moya-Martinez A., Garcia-Granero E., Alvarez R. M. A., Garcia B. M. J., Gonzalez J. M. S., Braithwaite M. M., Martinez E. M., Perez J. A. A., Espi A., Anoro M. T., Scheiding M. M., Diaz O. M., Lindenbaum P. D., Abad A. M., Simo M. R., Rufino J. E., Olabarrieta M. S., Martinez J. V., Banaeres M. L., Villaro F. F., Lucia J. A., Berzosa J. B., Hernandez N. A., Vallverdu F. J. L., Banos P. A. P., Farres R., Villalba J. H., Laso C. A., Alcaide S. M., Alvarado M. N. C., Simo I. R., Garcia J. M., Fadrique A. G., Diago V. A., Septiem J. G., Garcia J. G., Ponchietti L., Navarro M. S. C., Fernandez M. R., Muino R. C., Alvarez D. H., Sanchez P. M., Bienert C. M., Martinez M. T. G., Muzas C. M., Idoate C. P., Andicoechea A., Casado A. P. A., Vila J. V. R., Broto I. G., Collera P., Sebastian A. A., Sanchez-Guillen, L., Frasson, M., Pellino, G., Fornes-Ferrer, V., Ramos, J. L., Flor-Lorente, B., Garcia-Granero, A., Sierra, I. B., Jimenez-Gomez, L. M., Moya-Martinez, A., Garcia-Granero, E., Alvarez, R. M. A., Garcia, B. M. J., Gonzalez, J. M. S., Braithwaite, M. M., Martinez, E. M., Perez, J. A. A., Espi, A., Anoro, M. T., Scheiding, M. M., Diaz, O. M., Lindenbaum, P. D., Abad, A. M., Simo, M. R., Rufino, J. E., Olabarrieta, M. S., Martinez, J. V., Banaeres, M. L., Villaro, F. F., Lucia, J. A., Berzosa, J. B., Hernandez, N. A., Vallverdu, F. J. L., Banos, P. A. P., Farres, R., Villalba, J. H., Laso, C. A., Alcaide, S. M., Alvarado, M. N. C., Simo, I. R., Garcia, J. M., Fadrique, A. G., Diago, V. A., Septiem, J. G., Garcia, J. G., Ponchietti, L., Navarro, M. S. C., Fernandez, M. R., Muino, R. C., Alvarez, D. H., Sanchez, P. M., Bienert, C. M., Martinez, M. T. G., Muzas, C. M., Idoate, C. P., Andicoechea, A., Casado, A. P. A., Vila, J. V. R., Broto, I. G., Collera, P., and Sebastian, A. A.
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Male ,medicine.medical_specialty ,Colon ,Colorectal cancer ,Surgical planning ,Nomogram ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Enhanced recovery ,Risk Factors ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Mortality ,Colectomy ,business.industry ,Mortality rate ,Gastroenterology ,Cancer ,Hepatology ,medicine.disease ,Surgery ,Colon cancer ,Short-term outcome ,Nomograms ,030220 oncology & carcinogenesis ,National study ,030211 gastroenterology & hepatology ,Morbidity ,business ,Length-of-stay - Abstract
Purpose: Predicting postoperative complications and mortality is important to plan the surgical strategy. Different scores have been proposed before to predict them but none of them have been yet implemented into the routine clinical practice because their difficulties and low accuracy with new surgical strategies and enhanced recovery. The main aim of this study is to identify risk factors for postoperative morbidity and mortality after colonic resection (CR) without protective stomas, in order to develop a comprehensive, up-to-date, simple, reliable, and applicable model for the preoperative assessment of patients with colon cancer. Methods: Multivariable analysis was performed to identify risk factors for 60-day morbidity and mortality. Coefficients derived from the regression model were used in the nomograms to predict morbidity and mortality. Results: Three thousand one hundred ninety-three patients from 52 hospitals were included into the analysis. Sixty-day postoperative complications rate was 28.3% and the mortality rate was 3%. In multivariable analysis the independent risk factors for postoperative complications were age, male gender, liver and pulmonary diseases, obesity, preoperative albumin, anticoagulant treatment, open surgery, intraoperative complications, and urgent surgery. Independent risk factors for mortality were age, preoperative albumin anticoagulant treatment, and intraoperative complications. Conclusions: Risk factors for morbidity and mortality after CR for cancer were identified and two easy predictive tools were developed. Both of them could provide important information for preoperative consultation and surgical planning in the time of enhance recovery.
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- 2020
9. Extended right hemicolectomy with central ligation of the middle colic vessels - video vignette
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Cholewa H, Perez-Girbes A, Avelino González L, Flor Lorente B, García-Granero E, and Sancho-Muriel J
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COMPLETE MESOCOLIC EXCISION - Abstract
We explain the anatomy and the technique of a laparoscopic extended right hemicolectomy with central ligation of the middle colic vessels. There is a rising tendency to perform a complete mesocolic excision with D3 lymphadenectomy in order to achieve maximum lymph node harvest and therefore lower local recurrence (1).
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- 2021
10. An international multicentre prospective audit of elective rectal cancer surgery; operative approach versus outcome, including transanal total mesorectal excision (TaTME)
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Bhangu, Aneel, Minaya-Bravo, Ana María, Gallo, Gaetano, Glasbey, James C., Kamarajah, Sivesh, Pinkney, Thomas, El-Hussuna, Alaa, Battersby, Nick J., Buchs, Nicolas C., Buskens, Christianne, Chaudri, Sanjay, Frasson, Matteo, Glasbey, James, Morton, Dion, Negoi, Ionut, Nepogodiev, Dmitri, Pata, Francesco, Sánchez-Guillén, Luis, Singh, Baljit, Zmora, Oded, Perry, Rita, Magill, Laura, Altomare, Donato, Bemelman, Willem, Brown, Steven, Denost, Quentin, Knowles, Charles, Laurberg, Søren, Lefevre, Jérémie H., Möeslein, Gabriela, Pinkney, Tom, Vaizey, Carolynne, Bilali, S., Bilali, V., Salomon, M., Cillo, M., Estefania, D., Patron Uriburu, J., Ruiz, H., Farina, P., Carballo, F., Guckenheimer, S., Proud, D., Brouwer, R., Bui, A., Nguyen, B., Smart, P., Warwick, A., Theodore, J. E., Herbst, F., Birsan, T., Dauser, B., Ghaffari, S., Hartig, N., Stift, A., Argeny, S., Unger, L., Strouhal, R., Heuberger, A., Varabei, A., Lahodzich, N., Makhmudov, A., Selniahina, L., Feryn, T., Leupe, T., Maes, L., Reynvoet, E., Van Langenhove, K., Nachtergaele, M., Monami, B., Francart, D., Jehaes, C., Markiewicz, S., Weerts, J., Van Belle, K., Bomans, B., Cavenaile, V., Nijs, Y., Vertruyen, M., Pletinckx, P., Claeys, D., Defoort, B., Muysoms, F., Van Cleven, S., Lange, C., Vindevoghel, K., Wolthuis, A., Todorovic, M., Dabic, S., Kenjic, B., Lovric, S., Vidovic, J., Delibegovic, S., Mehmedovic, Z., Christiano, A., Lombardi, B., Marchiori, M., Tercioti, V., Dardanov, D., Petkov, P., Simonova, L., Yonkov, A., Zhivkov, E., Maslyankov, S., Pavlov, V., Sokolov, M., Todorov, G., Stoyanov, V., Batashki, I., Iarumov, N., Lozev, I., Moshev, B., Slavchev, M., Atanasov, B., Belev, N., Krstev, P., Penkov, R., Šantak, G., Ćosić, J., Previšić, A., Vukušić, L., Zukanović, G., Zelić, M., Kršul, D., Lekić Vitlov, V., Mendrila, D., Orhalmi, J., Dusek, T., Maly, O., Paral, J., Sotona, O., Skrovina, M., Bencurik, V., Machackova, M., Kala, Z., Farkašová, M., Grolich, T., Procházka, V., Hoch, J., Kocian, P., Martinek, L., Antos, F., Pruchova, V., Ceccotti, A., Madsbøll, T., Straarup, D., Uth Ovesen, A., Christensen, P., Bondeven, P., Edling, P., Elfeki, H., Alexandrovich Gameza, V., Michelsen Bach, S., Zheltiakova, I., Krarup, P. M., Krogh, A., Rolff, H. -C., Lykke, J., Juvik, A. F., Lóven, H. H. K., Marckmann, M., Osterkamp, J. T. F., Madsen, A. H., Worsøe, J., Ugianskis, A., Kjær, M. D., Youn Cho Lee, B., Khalid, A., Kristensen, M. H., El Sorogy, M., Elgeidie, A., Elhemaly, M., El Nakeeb, A., Elrefai, M., Shalaby, M., Emile, S., Omar, W., Sakr, A., Thabet, W., Awny, S., Metwally, I., Refky, B., Shams, N., Zuhdy, M., Lepistö, A., Keränen, I., Kivelä, A., Lehtonen, T., Siironen, P., Rautio, T., Ahonen-Siirtola, M., Klintrup, K., Paarnio, K., Takala, H., Hyöty, M., Haukijärvi, E., Kotaluoto, S. -M., Lehto, K., Tomminen, T., Huhtinen, H., Carpelan, A., Karvonen, J., Rantala, A., Varpe, P., Cotte, E., Francois, Y., Glehen, O., Passot, G., D'Alessandro, A., Chouillard, E., Etienne, J. C., Ghilles, E., Vinson-Bonnet, B., Germain, A., Ayav, A., Bresler, L., Chevalier, R., Denost, Q., Didailler, R., Rullier, E., Tiret, E., Chafai, N., Lefevre, J. H., Parc, Y., Sielezneff, I., Mege, D., Lakkis, Z., Barussaud, M., Krones, C., Bock, B., Webler, R., Baral, J., Lang, T., Münch, S., Pullig, F., Schön, M., Hinz, S., Becker, T., Möller, T., Richter, F., Schafmayer, C., Hardt, J., Kienle, P., Crescenti, F., Ahmad, M., Soleiman, Y., Papaconstantinou, I., Gklavas, A., Nastos, K., Theodosopoulos, T., Vezakis, A., Stamou, K., Saridaki, A., Xynos, E., Paraskakis, S., Zervakis, N., Skroubis, G., Amanatidis, T., Germanos, S., Maroulis, I., Papadopoulos, G., Dimitriou, N., Alexandrou, A., Felekouras, E., Griniatsos, J., Karavokyros, I., Papadopoulos, A., Chouliaras, C., Ioannidis, P., Katsounis, D., Kefalou, E., Katsoulis, I. E., Balalis, D., Korkolis, D. 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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., Tan, S., R. Tutino, G. salamone, L. Licari, G. Cocorullo, G. Gulotta, AGEM - Digestive immunity, AGEM - Re-generation and cancer of the digestive system, and CCA - Cancer Treatment and Quality of Life
- Subjects
Male ,Laparoscopic surgery ,medicine.medical_specialty ,Colorectal cancer ,medicine.medical_treatment ,Operative Time ,Anastomosis ,Malignancy ,rectal cancer ,laparoscopic surgery ,TME ,transanal TME ,TaTME ,robotic surgery ,randomized clinical-trial ,short-term outcomes ,laparoscopic-assisted resection ,pathological outcomes ,anastomotic leakage ,initial-experience ,risk ,NO ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Robotic Surgical Procedures ,Humans ,Medicine ,Robotic surgery ,Prospective Studies ,Rectal cancer ,Gastroenterology ,Aged ,Transanal Endoscopic Surgery ,ta3126 ,Medical Audit ,Univariate analysis ,Proctectomy ,Rectal Neoplasms ,business.industry ,Rectum ,Margins of Excision ,Middle Aged ,medicine.disease ,Total mesorectal excision ,Surgery ,Treatment Outcome ,Elective Surgical Procedures ,030220 oncology & carcinogenesis ,Rectal cancer surgery ,Female ,Laparoscopy ,030211 gastroenterology & hepatology ,business - Abstract
Introduction: Transanal total mesorectal excision (TaTME) has rapidly emerged as a novel approach for rectal cancer surgery. Safety profiles are still emerging and more comparative data is urgently needed. This study aimed to compare indications and short-term outcomes of TaTME, open, laparoscopic, and robotic TME internationally. Methods: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients undergoing elective total mesorectal excision (TME) for malignancy between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak. Results: Of 2579 included patients, 76.2% (1966/2579) underwent TME with restorative anastomosis of which 19.9% (312/1966) had a minimally invasive approach (laparoscopic or robotic) which included a transanal component (TaTME). Overall, 9.0% (175/1951, 15 missing outcome data) of patients suffered an anastomotic leak. On univariate analysis both laparoscopic TaTME (OR 1.61, 1.02–2.48, P=0.04) and robotic TaTME (OR 3.05, 1.10–7.34, P=0.02) were associated with a higher risk of anastomotic leak than non-transanal laparoscopic TME. However this association was lost in the mixed-effects model controlling for patient and disease factors (OR 1.23, 0.77–1.97, P=0.39 and OR 2.11, 0.79–5.62, P=0.14 respectively), whilst low rectal anastomosis (OR 2.72, 1.55–4.77, P 
- Published
- 2018
11. Evaluating the incidence of pathological complete response in current international rectal cancer practice: the barriers to widespread safe deferral of surgery
- Author
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Battersby, Nick, Glasbey, James C., Neary, Peter, Negoi, Ionut, Kamarajah, Sivesh, Sgro, Alessandro, Bhangu, Aneel, Pinkney, Thomas, Frasson, Matteo, El-Hussuna, Alaa, Battersby, Nick J., Buchs, Nicolas C., Buskens, Christianne, Chaudri, Sanjay, Gallo, Gaetano, Glasbey, James, Minaya-Bravo, Ana María, Morton, Dion, Nepogodiev, Dmitri, Pata, Francesco, Sánchez-Guillén, Luis, Singh, Baljit, Zmora, Oded, Perry, Rita, Magill, Laura, Altomare, Donato, Bemelman, Willem, Brown, Steven, Denost, Quentin, Knowles, Charles, Laurberg, Søren, Lefevre, Jérémie H., Möeslein, Gabriela, Pinkney, Tom, Vaizey, Carolynne, Bilali, S., Bilali, V., Salomon, M., Cillo, M., Estefania, D., Patron Uriburu, J., Ruiz, H., Farina, P., Carballo, F., Guckenheimer, S., Proud, D., Brouwer, R., Bui, A., Nguyen, B., Smart, P., Warwick, A., Theodore, J. 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C, Romero de Diego, A, Cordoba Diaz de Laspra, E, Echazarreta Gallego, E, Elia Guedea, M, Escola, D, Martinez, S, Primo Romaguera, V, Parreno, R, Pastor, L, Rosell, E, Lozoya Trujillo, R, Alos Company, R, Ruiz Carmona, M, Solana Bueno, A, Salvans Ruiz, S, Alonso Goncalves, S, Jimenez- Toscano, M, Pascual Damieta, M, Pera Roman, M, Pellicer-Franco, E, Garcia-Marin, J, Mengual-Ballester, M, Soria-Aledo, V, Valero-Navarro, G, Vicente-Ruiz, M, Garcia-Zamora, C, Gonzalez-Gil, A, Montoya-Tabares, M, Paredes-Quiles, M, Die Trill, J, Abadia, P, Moreno, I, Pina, J, Ramos Rubio, D, Escartin, J, Blas, J, Fernando, J, Ferrer, R, Garcia Egea, J, Pros, I, Martinez, W, Rius, J, Socias, M, Sabia, D, Castellvi Valls, J, Gonzalez Santin, V, Mompart Garcia, S, Viso Pons, L, Julia, D, Codina-Cazador, A, Farres, R, Gomez, N, Planellas, P, Cuadrado, M, Camps, I, Rufas, M, Escoll, J, Ferminan, A, Muriel, P, Sierra, E, Alvarez-Laso, C, Lora, P, Padin, H, Garcia-Septiem, J, Bustamante, C, Jimenez, V, Jimenez-Miramon, J, Ramos, J, Gallardo, A, Benito, P, Colao, L, Galindo, P, Garcia, C, Forero-Torres, A, Alonso Poza, A, Dieguez Fernandez, B, Gilsanz Martin, C, Hernandez Garcia, M, Rojo Lopez, J, Gil Lopez, J, Gonzalez Zunzarren, M, Martinez Alegre, J, Zorrilla Matilla, L, Navarro-Sanchez, A, Alcala Serrano, F, Lopez-Fernandez, J, Montesdeoca Cabrera, D, Alvarez-Gallego, M, Guevara, J, Pascual Miguelanez, I, Rubio-Perez, I, Gomez Ruiz, M, Alonso Martin, J, Cagigas Fernandez, C, Castillo Diego, J, Pando, J, Maristany, C, Munoz-Duyos, A, Rada-Palomino, A, Vargas-Pierola, H, Pena Ros, E, Benavides Buleje, J, Munoz Camarena, J, Parra Banos, P, Ramirez Faraco, M, Arenal, J, Citores, M, Marcos, J, Sanchez, J, Tinoco, C, Garcia Florez, L, Arias Pacheco, R, Minguez Ruiz, G, Gutierrez Corral, N, Rodriguez Infante, A, Carrillo Lopez, M, Carrasco Prats, M, Lage Laredo, A, Martinez Manzano, A, Rodriguez Garcia, P, Segura-Sampedro, J, Alonso-Hernandez, N, Fernandez Isart, M, Gamundi Cuesta, M, Ochogavia Segui, A, Ibanez, N, Abrisqueta, J, Lujan, J, Gomez Perez, R, Corrales Valero, E, Monje Salazar, C, Sanchiz Cardenas, E, Soler Humanes, R, Jimenez-Rodriguez, R, De la Portilla, F, Diaz Pavon, J, Garcia Cabrera, A, Reyes Diaz, M, Espin, E, Marinello, F, Marti, M, Vallribera, F, Orts Mico, F, Ortin Navarro, M, Perez Climent, M, Serra Diaz, C, Millan, M, Caro, A, Escuder, J, Espina, B, Feliu, F, Climent Aira, A, Estevez Diz, A, Moreno Asencio, M, Varela Mato, A, Vazquez Bouzan, R, Diez-Alonso, M, Villeta-Plaza, R, Guadalajara, H, Alias, D, Garcia Olmo, D, Pastor, C, Valverde, I, Sanchez Romero, A, Gardea, A, Gil Santos, M, Nimmersgern, T, Serrano Paz, P, Romero-Simo, M, Blasco-Segura, T, Caravaca-Garcia, I, Costa-Navarro, D, Zarco-Pleguezuelos, A, Flor-Lorente, B, Garcia-Granero, A, Garcia-Granero, E, Arencibia, B, Alonso, J, Febles, G, Nogues, E, Roque, C, Segelman, J, Nygren, J, Nestler, G, Abraham-Nordling, M, Egenvall, M, Myrelid, P, Jung, B, Loftas, P, Lydrup, M, Azahr, N, Buchwald, P, Mangell, P, Syk, I, Nikberg, M, Carlander, J, Chabok, A, Smedh, K, Tiselius, C, Haapaniemi, S, Benckert, A, Adamina, M, Freil-Lanter, C, Gingert, C, Muller, P, Schafli, J, Regusci, L, Brenna, M, Fasolini, F, Misteli, H, Kirchhoff, P, Oertli, D, Hahnloser, D, Clerc, D, Hubner, M, Ris, F, Chevallay, M, Morel, P, Schiltz, B, Wang, J, Su, W, Huang, C, Ma, C, Tsai, H, Bugra, D, Agalar, F, Baloglu, H, Basoglu, I, Okkabaz, N, Binboga, E, Biricik, A, Celik, A, Yavuz, E, Canda, A, Agalar, C, Fuzun, M, Sokmen, S, Terzi, C, Isik, A, Karip, B, Bilgili, A, Leventoglu, S, Aytac, B, Kucukdiler, E, Yildiz, A, Yuksel, O, Sinan, H, Hancerliogullari, O, Kaymak, S, Kozak, O, Ozer, M, Sarici, I, Akca, O, Kalayci, M, Kara, Y, Agcaoglu, O, Balik, E, Bayram, O, Ozbalci, G, Ozkan, B, Karabacak, U, Sungurtekin, U, Ozgen, U, Demirbas, S, Ozturk, E, Isik, O, Yilmazlar, T, Colak, E, Karagul, S, Kinas, V, Fearnhead, N, Lord, I, Stewart, P, Zammit, M, Arnold, S, Broadhurst, J, Moran, S, Seretis, F, Shabbir, J, Jones, C, Kynaston, J, Vimalachandran, D, Blower, E, Mcfaul, C, Mcwhirter, D, Pilkington, J, Wilson, T, Chowdhary, M, Stubbs, B, Abdalkoddus, M, Lai, C, Thavanesan, N, Yao, C, Agarwal, T, Dindyal, S, Hill, R, Reade, S, Slesser, A, Paterson, H, Balfour, A, Boland, M, Geraghty, A, O'Kelly, J, Patel, P, Tezas, S, Yahia, S, Jadhav, V, Marimuthu, K, Narayanan, A, Piramanayagam, B, Bradley, N, Buchanan, F, Paul, K, Singh, J, Thomson, K, Korsgen, S, Bedford, M, Lee, K, Leong, K, Mcarthur, D, Malik, S, Mohamed, I, Cunha, P, Pilavas, A, Reddy, A, Ahmed, S, Ahmed, A, Voll, J, Velchuru, V, Lal, R, Mirshekar-Syahkal, B, Kassai, M, Aleem, M, Keogh-Bootland, S, Sarmah, P, Keegan, R, Kelkar, A, Sen, P, Oliveira-Cunha, M, Chaudhri, S, Fares, R, Thomas, W, Aslam, M, Boyle, K, Hemingway, D, Miller, A, Norwood, M, Gurjar, S, Al-Saeedi, M, Anandan, L, Sudlow, A, Zampitis, N, Malik, K, Bogdan, M, Smart, C, Iqbal, M, Bailey, S, Lawes, D, Omar, G, Tamhane, R, Evans, M, Ather, S, Lim, J, Nageswaran, H, Taylor, G, Hunt, L, Nicholls, J, Shaikh, I, Muscara, F, O'Brien, J, Photi, E, Stearns, A, Meylemans, D, Cunningham, C, Hompes, R, Tennakoon, A, Kumarasinghe, N, Rao, M, Upanishad, I, Khan, J, Ahmad, N, Shweejawee, Z, Stefan, S, Smart, N, Daniels, I, Gregoir, T, Longstaff, L, Mcdermott, F, Varcada, M, Drami, I, Gala, T, Moggia, E, Ratnatunga, K, Harries, R, Hayes, J, Williams, G, Raymond, T, Bronder, C, Davies, E, Hawkin, P, Ryska, O, Ayral, K, Beveridge, A, Bhowmik, A, Gill, M, Simpson, R, Schofield, A, Mcardle, K, Parmar, M, Williamson, M, Burton, H, Courtney, E, Grant, C, Saracino, A, Newton, K, Epstein, J, Branagan, G, Bignell, M, Symankewicz, M, Zaman, S, Mankotia, R, Siddiqui, Z, Torrance, A, Artioukh, D, Eggleston, M, Gokul, K, Selwyn, D, Warusavitarne, J, Chandrasinghe, P, Grainger, J, Leo, C, Harris, G, Levy, B, Skull, A, Thaha, M, Garg, A, Patel, H, Ramsanahie, A, Mondragon-Pritchard, M, Cuinas Leon, K, Shukla, A, Brewer, H, Fitzgerald, J, Kho, H, Torkington, J, 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Tutino, G. Salamone, L. Licari, G. Cocorullo, and G. Gulotta
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Male ,Colorectal cancer ,deferral of surgery ,neoadjuvant therapy ,pathology ,radiology ,rectal cancer ,Rectal surgery ,surgical oncology ,Gastroenterology ,0302 clinical medicine ,Prospective Studies ,Prospective cohort study ,Complete response ,Medical Audit ,integumentary system ,Incidence (epidemiology) ,Incidence ,Remission Induction ,Middle Aged ,Magnetic Resonance Imaging ,Europe ,Treatment Outcome ,Response Evaluation Criteria in Solid Tumors ,030220 oncology & carcinogenesis ,Preoperative Period ,030211 gastroenterology & hepatology ,Female ,Adult ,medicine.medical_specialty ,NO ,03 medical and health sciences ,medicine ,Humans ,Intensive care medicine ,Deferral ,Pathological ,Aged ,Neoplasm Staging ,ta3126 ,business.industry ,Rectal Neoplasms ,Reproducibility of Results ,Chemoradiotherapy, Adjuvant ,medicine.disease ,Rectal Neoplasms/diagnostic imaging ,Neoplasm Staging/methods ,business - Abstract
INTRODUCTION: The mainstay of management for locally advanced rectal cancer is chemoradiotherapy followed by surgical resection. Following chemoradiotherapy, a complete response may be detected clinically and radiologically (cCR) prior to surgery or pathologically after surgery (pCR). We aim to report the overall complete pathological response (pCR) rate and the reliability of detecting a cCR by conventional pre-operative imaging.METHODS: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients treated by elective rectal resection were included. A pCR was defined as a ypT0 N0 EMVI negative primary tumour; a partial response represented any regression from baseline staging following chemoradiotherapy. The primary endpoint was the pCR rate. The secondary endpoint was agreement between post-treatment MRI restaging (yMRI) and final pathological staging.RESULTS: Of 2572 patients undergoing rectal cancer surgery in 277 participating centres across 44 countries, 673 (26.2%) underwent chemoradiotherapy and surgery. The pCR rate was 10.3% (67/649), with a partial response in 35.9% (233/649) patients. Comparison of AJCC stage determined by post-treatment yMRI with final pathology showed understaging in 13% (55/429) and overstaging in 34% (148/429). Agreement between yMRI and final pathology for T-stage, N-stage, or AJCC status were each graded as 'fair' only (n = 429, Kappa 0.25, 0.26 and 0.35 respectively).CONCLUSION: The reported pCR rate of 10% highlights the potential for non-operative management in selected cases. The limited strength of agreement between basic conventional post-chemoradiotherapy imaging assessment techniques and pathology suggest alternative markers of response should be considered, in the context of controlled clinical trials.
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- 2018
12. The use of an endostapler in the treatment of supralevator abscess of intersphincteric origin
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García-Granero, A., Granero-Castro, P., Frasson, M., Flor-Lorente, B., Carreño, O., and Garcia-Granero, E.
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- 2014
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13. Nomograms for morbidity and mortality after oncologic colon resection in the enhanced recovery era: results from a multicentric prospective national study
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Sanchez-Guillen L, Frasson M, Pellino G, Fornes-Ferrer V, Ramos J, Flor-Lorente B, Garcia-Granero A, Sierra I, Jimenez-Gomez L, Moya-Martinez A, Garcia-Granero E, and Anaco Study Grp
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Short-term outcome ,Morbidity ,Mortality ,Length-of-stay ,Nomogram ,Colon cancer - Abstract
Purpose Predicting postoperative complications and mortality is important to plan the surgical strategy. Different scores have been proposed before to predict them but none of them have been yet implemented into the routine clinical practice because their difficulties and low accuracy with new surgical strategies and enhanced recovery. The main aim of this study is to identify risk factors for postoperative morbidity and mortality after colonic resection (CR) without protective stomas, in order to develop a comprehensive, up-to-date, simple, reliable, and applicable model for the preoperative assessment of patients with colon cancer. Methods Multivariable analysis was performed to identify risk factors for 60-day morbidity and mortality. Coefficients derived from the regression model were used in the nomograms to predict morbidity and mortality. Results Three thousand one hundred ninety-three patients from 52 hospitals were included into the analysis. Sixty-day postoperative complications rate was 28.3% and the mortality rate was 3%. In multivariable analysis the independent risk factors for postoperative complications were age, male gender, liver and pulmonary diseases, obesity, preoperative albumin, anticoagulant treatment, open surgery, intraoperative complications, and urgent surgery. Independent risk factors for mortality were age, preoperative albumin anticoagulant treatment, and intraoperative complications. Conclusions Risk factors for morbidity and mortality after CR for cancer were identified and two easy predictive tools were developed. Both of them could provide important information for preoperative consultation and surgical planning in the time of enhance recovery.
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- 2020
14. Effect of an individualized versus standard pneumoperitoneum pressure strategy on postoperative recovery: a randomized clinical trial in laparoscopic colorectal surgery
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Díaz-Cambronero O, Mazzinari G, Flor Lorente B, García Gregorio N, Robles-Hernandez D, Olmedilla Arnal LE, Martin de Pablos A, Schultz MJ, Errando CL, Argente Navarro MP, and on behalf of the IPPColLapSe II study investigators
- Abstract
Background It remains uncertain whether individualization of pneumoperitoneum pressures during laparoscopic surgery improves postoperative recovery. This study compared an individualized pneumoperitoneum pressure (IPP) strategy with a standard pneumoperitoneum pressure (SPP) strategy with respect to postoperative recovery after laparoscopic colorectal surgery. Methods This was a multicentre RCT. The IPP strategy comprised modified patient positioning, deep neuromuscular blockade, and abdominal wall prestretching targeting the lowest intra-abdominal pressure (IAP) that maintained acceptable workspace. The SPP strategy comprised patient positioning according to the surgeon's preference, moderate neuromuscular blockade and a fixed IAP of 12 mmHg. The primary endpoint was physiological postoperative recovery, assessed by means of the Postoperative Quality of Recovery Scale. Secondary endpoints included recovery in other domains and overall recovery, the occurrence of intraoperative and postoperative complications, duration of hospital stay, and plasma markers of inflammation up to postoperative day 3. Results Of 166 patients, 85 received an IPP strategy and 81 an SPP strategy. The IPP strategy was associated with a higher probability of physiological recovery (odds ratio (OR) 2 center dot 77, 95 per cent c.i. 1 center dot 19 to 6 center dot 40, P = 0 center dot 017; risk ratio (RR) 1 center dot 82, 1 center dot 79 to 1 center dot 87, P = 0 center dot 049). The IPP strategy was also associated with a higher probability of emotional (P = 0 center dot 013) and overall (P = 0 center dot 011) recovery. Intraoperative adverse events were less frequent with the IPP strategy (P < 0 center dot 001) and the plasma neutrophil-lymphocyte ratio was lower (P = 0 center dot 029). Other endpoints were not affected. Conclusion In this cohort of patients undergoing laparoscopic colorectal surgery, an IPP strategy was associated with faster recovery, fewer intraoperative complications and less inflammation than an SPP strategy. Registration number: NCT02773173 ( ).
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- 2020
15. Prospective evaluation of intraoperative peripheral nerve injury in colorectal surgery
- Author
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Navarro-Vicente, F., García-Granero, A., Frasson, M., Blanco, F., Flor-Lorente, B., García-Botello, S., and García-Granero, E.
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- 2012
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16. Is always necessary preoperative chemo-radiotherapy in uT3 rectal cancer? Preoperative tumour thickness assessment with endorectal ultrasound is a prognostic factor: 137
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Flor-Lorente, B., Frasson, M., Esclapez, P., Espi, A., Garcia-Botello, S., Roda, D., Cervantes, A., Navarro, S., Garcia-Fuster, M., Puga, R., and Garcia-Granero, E.
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- 2011
17. Wongʼs classification for improved staging of rectal cancer with rectal ultrasound and pelvic magnetic resonance imaging: 045
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Muñoz, E., Garcia-Granero, E., Frasson, M., Esclapez, P., Campos, S., Flor-Lorente, B., Navarro, S., Garcia-Botello, S., Puga, R., Garcia-Fuster, M., and Cervantes, A.
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- 2011
18. Prognostic implications of circumferential location of distal rectal cancer
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García-Granero, E., Faiz, O., Flor-Lorente, B., García-Botello, S., Esclápez, P., and Cervantes, A.
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- 2011
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19. A video demonstration of three‐dimensional imaging to assess the circumferential resection margin in locally advanced rectal cancer and recurrent rectal cancer – a video vignette
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Garcia‐Granero, A., primary, Pellino, G., additional, Giner, F., additional, Frasson, M., additional, Fletcher‐Sanfeliu, D., additional, Primo Romeguera, V., additional, Flor Lorente, B., additional, Gamundi, M., additional, Brogi, L., additional, Garcia‐Calderón, D., additional, González‐Argente, F. X., additional, and Garcia‐Granero, E., additional
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- 2020
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20. Risk factors for leak, complications and mortality after ileocolic anastomosis: comparison of two anastomotic techniques
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Sánchez-Guillén, L, primary, Frasson, M, additional, García-Granero, Á, additional, Pellino, G, additional, Flor-Lorente, B, additional, Álvarez-Sarrado, E, additional, and García-Granero, E, additional
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- 2019
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21. The impact of conversion on the risk of major complication following laparoscopic colonic surgery: an international, multicentre prospective audit
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van der Pool, Anne, Rawlings, Alexandra, Sánchez-Guillén, Luis, Kuiper, Sara, Negoi, Ionut, Buchs, Nicolas, El-Hussuna, Alaa, Battersby, Nick J., Buchs, Nicolas C., Buskens, Christianne, Chaudri, Sanjay, Frasson, Matteo, Gallo, Gaetano, Minaya-Bravo, Ana María, Morton, Dion, Nepogodiev, Dmitri, Pata, Francesco, Singh, Baljit, Zmora, Oded, Perry, Rita, Magill, Laura, Altomare, Donato, Bemelman, Willem, Brown, Steven, Denost, Christianne Buskens Quentin, Knowles, Charles, Laurberg, Søren, Lefevre, Jérémie H., Möeslein, Gabriela, Pinkney, Tom, Vaizey, Carolynne, Bilali, S., Bilali, V., Salomon, M., Cillo, M., Estefania, D., Patron Uriburu, J., Ruiz, H., Farina, P., Carballo, F., Guckenheimer, S., Proud, D., Brouwer, R., Bui, A., Nguyen, B., Smart, P., Warwick, A., Theodore, J. E., Herbst, F., Birsan, T., Dauser, B., Ghaffari, S., Hartig, N., Stift, A., Argeny, S., Unger, L., Strouhal, R., Heuberger, A., Varabei, A., Lahodzich, N., Makhmudov, A., Selniahina, L., Feryn, T., Leupe, T., Maes, L., Reynvoet, E., Van Langenhove, K., Nachtergaele, M., Monami, B., Francart, D., Jehaes, C., Markiewicz, S., Weerts, J., Van Belle, K., Bomans, B., Cavenaile, V., Nijs, Y., Vertruyen, M., Pletinckx, P., Claeys, D., Defoort, B., Muysoms, F., Van Cleven, S., Lange, C., Vindevoghel, K., Wolthuis, A., Todorovic, M., Dabic, S., Kenjic, B., Lovric, S., Vidovic, J., Delibegovic, S., Mehmedovic, Z., Christiano, A., Lombardi, B., Marchiori, M., Tercioti, V., Dardanov, D., Petkov, P., Simonova, L., Yonkov, A., Zhivkov, E., Maslyankov, S., Pavlov, V., Sokolov, M., Todorov, G., Stoyanov, V., Batashki, I., Iarumov, N., Lozev, I., Moshev, B., Slavchev, M., Atanasov, B., Belev, N., Krstev, P., Penkov, R., Šantak, G., Ćosić, J., Previšić, A., Vukušić, L., Zukanović, G., Zelić, M., Kršul, D., Lekić Vitlov, V., Mendrila, D., Orhalmi, J., Dusek, T., Maly, O., Paral, J., Sotona, O., Skrovina, M., Bencurik, V., Machackova, M., Kala, Z., Farkašová, M., Grolich, T., Procházka, V., Hoch, J., Kocian, P., Martinek, L., Antos, F., Pruchova, V., El-Hussuna, A., Ceccotti, A., Madsbøll, T., Straarup, D., Uth Ovesen, A., Christensen, P., Bondeven, P., Edling, P., Elfeki, H., Alexandrovich Gameza, V., Michelsen Bach, S., Zheltiakova, I., Krarup, P. M., Krogh, A., Rolff, H. -C., Lykke, J., Juvik, A. F., Lóven, H. H. K., Marckmann, M., Osterkamp, J. T. F., Madsen, A. H., Worsøe, J., Ugianskis, A., Kjær, M. D., Youn Cho Lee, B., Khalid, A., Kristensen, M. H., El Sorogy, M., Elgeidie, A., Elhemaly, M., El Nakeeb, A., Elrefai, M., Shalaby, M., Emile, S., Omar, W., Sakr, A., Thabet, W., Awny, S., Metwally, I., Refky, B., Shams, N., Zuhdy, M., Lepistö, A., Keränen, I., Kivelä, A., Lehtonen, T., Siironen, P., Rautio, T., Ahonen-Siirtola, M., Klintrup, K., Paarnio, K., Takala, H., Hyöty, M., Haukijärvi, E., Kotaluoto, S. -M., Lehto, K., Tomminen, T., Huhtinen, H., Carpelan, A., Karvonen, J., Rantala, A., Varpe, P., Cotte, E., Francois, Y., Glehen, O., Passot, G., D'Alessandro, A., Chouillard, E., Etienne, J. C., Ghilles, E., Vinson-Bonnet, B., Germain, A., Ayav, A., Bresler, L., Chevalier, R., Denost, Q., Didailler, R., Rullier, E., Tiret, E., Chafai, N., Lefevre, J. 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R., Dorot, S., Edden, Y., Halfteck, G., Reissman, P., Pery, R., Tulchinsky, H., Weizman, A., Agresta, F., Curinga, R., Finotti, E., Savino, G., Verza, L. A., Asteria, C. R., Boccia, L., Pascariello, A., Tamini, N., Bugatti, A., Gianotti, L., Totis, M., Vincenti, L., Andriola, V., Giannini, I., Travaglio, E., Balestri, R., Buccianti, P., Roffi, N., Rossi, E., Urbani, L., Mellano, A., Cinquegrana, A., Lauretta, A., Belluco, C., Mistrangelo, M., Allaix, M. E., Arolfo, S., Morino, M., Testa, V., Delrio, P., Pace, U., Rega, D., Scala, D., Gallo, G., Clerico, G., Cornaglia, S., Realis Luc, A., Trompetto, M., Ugolini, G., Antonacci, N., Fabbri, S., Montroni, I., Zattoni, D., D'Urbano, C., Cornelli, A., Viti, M., Inama, M., Bacchion, M., Casaril, A., Impellizzeri, H., Moretto, G., Spinelli, A., Carvello, M., David, G., Di Candido, F., Sacchi, M., Frontali, A., Ceriani, V., Molteni, M., Rosati, R., Aleotti, F., Elmore, U., Lemma, M., Vignali, A., Scabini, S., Casoni Pattacini, G., Luzzi, A., Romairone, E., Marino, F., Lorusso, D., Pezzolla, F., Colombo, F., Baldi, C., Foschi, D., Sampietro, G., Sorrentino, L., Di Saverio, S., Birindelli, A., Segalini, E., Spacca, D., Romano, G. M., Belli, A., Bianco, F., De franciscis, S., Falato, A., Muratore, A., Marsanic, P., Grimaldi, S., Castaldo, N., Ciolli, M. G., Picarella, P., Porfidia, R., Tugnoli, G., Bondurri, A., Cavallo, D., Maffioli, A., Pertusati, A., Pulighe, F., Balestra, F., De Nisco, C., Podda, M., Opocher, E., Longhi, M., Mariani, N. M., Maroni, N., Pisani Ceretti, A., Galleano, R., Aonzo, P., Curletti, G., Reggiani, L., Marconi, M., Del Prete, L., Oldani, M., Pappalardo, R., Zaccone l, S., Scatizzi, M., Baraghini, M., Cantafio, S., Feroci, F., Giani, I., Tutino, R., Cocorullo, G., Gulotta, G., Licari, L., Salamone, G., Sileri, P., Saraceno, F., La Torre, F., Chirletti, P., Coletta, D., De Toma, G., Mingoli, A., Papandrea, M., De Luca, E., Sacco, R., Sammarco, G., Vescio, G., Tonini, V., Bianchini, S., Cervellera, M., Vaccari, S., Cracco, N., Barugola, G., Bertocchi, E., Rossini, R., Ruffo, G., Sartori, A., Clemente, N., De Luca, M., De Luca, A., Scaffidi, G., Lorenzon, L., Balducci, G., Bocchetti, T., Ferri, M., Mercantini, P., Pata, F., Bauce, S., Benevento, A., Bottini, C., Crapa, P. R., Rubbini, M., Anania, G., Carcoforo, P., Cavallesco, G., Feo, C., Yamamoto, T., Sivins, A., Ancans, G., Gerkis, S., Lunis, R., Pcolkins, A., Venskutonis, D., Bradulskis, S., Dainius, E., Subocius, A., Vencius, J., Zeromskas, P., Eismontas, V., Nutautiene, V., Simcikas, D., Tamosiunas, A., Svagzdys, S., Latkauskas, T., Lizdenis, P., Saladzinskas, Z., Tamelis, A., Dulskas, A., Kuliavas, J., Samalavicius, N. E., Poskus, T., Jotautas, V., Mikalauskas, S., Poskus, E., Strupas, K., Zakaria, A. D., Lah, N. N., Wong, M., Zain, W. Z., Zakaria, Z., Mazlan, L., Mohd Azman, Z. A., Sagap, I., Psaila, J., Andrejevic, P., Cini, C., Ellul, S., Pace, K., Ahallat, M., Hamid, M., Hrora, A., Majbar, M. A., Raiss, M., Westerduin, E., Bemelman, W., Buskens, C., Tanis, P., van der Sluis, P. C., Davids, P. H., Pronk, A., Schiphorst, A. H. 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Garcia-Septiem, J, Bustamante, C, Jimenez, V, Jimenez-Miramon, J, Ramos, J, Gallardo, A, Benito, P, Colao, L, Galindo, P, Garcia, C, Forero-Torres, A, Alonso Poza, A, Dieguez Fernandez, B, Gilsanz Martin, C, Hernandez Garcia, M, Rojo Lopez, J, Gil Lopez, J, Gonzalez Zunzarren, M, Martinez Alegre, J, Zorrilla Matilla, L, Navarro-Sanchez, A, Alcala Serrano, F, Lopez-Fernandez, J, Montesdeoca Cabrera, D, Alvarez-Gallego, M, Guevara, J, Pascual Miguelanez, I, Rubio-Perez, I, Gomez Ruiz, M, Alonso Martin, J, Cagigas Fernandez, C, Castillo Diego, J, Pando, J, Maristany, C, Munoz-Duyos, A, Rada-Palomino, A, Vargas-Pierola, H, Pena Ros, E, Benavides Buleje, J, Munoz Camarena, J, Parra Banos, P, Ramirez Faraco, M, Arenal, J, Citores, M, Marcos, J, Sanchez, J, Tinoco, C, Garcia Florez, L, Arias Pacheco, R, Minguez Ruiz, G, Gutierrez Corral, N, Rodriguez Infante, A, Carrillo Lopez, M, Carrasco Prats, M, Lage Laredo, A, Martinez Manzano, A, Rodriguez Garcia, P, Segura-Sampedro, J, Alonso-Hernandez, N, Fernandez Isart, M, Gamundi Cuesta, M, Ochogavia Segui, A, Ibanez, N, Abrisqueta, J, Lujan, J, Gomez Perez, R, Corrales Valero, E, Monje Salazar, C, Sanchiz Cardenas, E, Soler Humanes, R, Jimenez-Rodriguez, R, De la Portilla, F, Diaz Pavon, J, Garcia Cabrera, A, Reyes Diaz, M, Espin, E, Marinello, F, Marti, M, Vallribera, F, Orts Mico, F, Ortin Navarro, M, Perez Climent, M, Serra Diaz, C, Millan, M, Caro, A, Escuder, J, Espina, B, Feliu, F, Climent Aira, A, Estevez Diz, A, Moreno Asencio, M, Varela Mato, A, Vazquez Bouzan, R, Diez-Alonso, M, Villeta-Plaza, R, Guadalajara, H, Alias, D, Garcia Olmo, D, Pastor, C, Valverde, I, Sanchez Romero, A, Gardea, A, Gil Santos, M, Nimmersgern, T, Serrano Paz, P, Romero-Simo, M, Blasco-Segura, T, Caravaca-Garcia, I, Costa-Navarro, D, Zarco-Pleguezuelos, A, Flor-Lorente, B, Garcia-Granero, A, Garcia-Granero, E, Arencibia, B, Alonso, J, Febles, G, Nogues, E, Roque, C, Segelman, J, Nygren, J, Nestler, G, Abraham-Nordling, M, Egenvall, M, Myrelid, P, Jung, B, Loftas, P, Lydrup, M, Azahr, N, Buchwald, P, Mangell, P, Syk, I, Nikberg, M, Carlander, J, Chabok, A, Smedh, K, Tiselius, C, Haapaniemi, S, Benckert, A, Adamina, M, Freil-Lanter, C, Gingert, C, Muller, P, Schafli, J, Regusci, L, Brenna, M, Fasolini, F, Misteli, H, Kirchhoff, P, Oertli, D, Hahnloser, D, Clerc, D, Hubner, M, Ris, F, Chevallay, M, Morel, P, Schiltz, B, Wang, J, Su, W, Huang, C, Ma, C, Tsai, H, Bugra, D, Agalar, F, Baloglu, H, Basoglu, I, Okkabaz, N, Binboga, E, Biricik, A, Celik, A, Yavuz, E, Canda, A, Agalar, C, Fuzun, M, Sokmen, S, Terzi, C, Isik, A, Karip, B, Bilgili, A, Leventoglu, S, Aytac, B, Kucukdiler, E, Yildiz, A, Yuksel, O, Sinan, H, Hancerliogullari, O, Kaymak, S, Kozak, O, Ozer, M, Sarici, I, Akca, O, Kalayci, M, Kara, Y, Agcaoglu, O, Balik, E, Bayram, O, Ozbalci, G, Ozkan, B, Karabacak, U, Sungurtekin, U, Ozgen, U, Demirbas, S, Ozturk, E, Isik, O, Yilmazlar, T, Colak, E, Karagul, S, Kinas, V, Fearnhead, N, Lord, I, Stewart, P, Zammit, M, Arnold, S, Broadhurst, J, Moran, S, Seretis, F, Shabbir, J, Jones, C, Kynaston, J, Vimalachandran, D, Blower, E, Mcfaul, C, Mcwhirter, D, Pilkington, J, Wilson, T, Chowdhary, M, Stubbs, B, Abdalkoddus, M, Lai, C, Thavanesan, N, Yao, C, Agarwal, T, Dindyal, S, Hill, R, Reade, S, Slesser, A, Paterson, H, Balfour, A, Boland, M, Geraghty, A, O'Kelly, J, Patel, P, Tezas, S, Yahia, S, Jadhav, V, Marimuthu, K, Narayanan, A, Piramanayagam, B, Bradley, N, Buchanan, F, Paul, K, Singh, J, Thomson, K, Korsgen, S, Bedford, M, Lee, K, Leong, K, Mcarthur, D, Malik, S, Mohamed, I, Cunha, P, Pilavas, A, Reddy, A, Ahmed, S, Ahmed, A, Voll, J, Velchuru, V, Lal, R, Mirshekar-Syahkal, B, Kassai, M, Aleem, M, Keogh-Bootland, S, Sarmah, P, Keegan, R, Kelkar, A, Sen, P, Oliveira-Cunha, M, Chaudhri, S, Fares, R, Thomas, W, Aslam, M, Boyle, K, Hemingway, D, Miller, A, Norwood, M, Gurjar, S, Al-Saeedi, M, Anandan, L, Sudlow, A, Zampitis, N, Malik, K, Bogdan, M, Smart, C, Iqbal, M, Bailey, S, Lawes, D, Omar, G, Tamhane, R, Evans, M, Ather, S, Lim, J, Nageswaran, H, Taylor, G, Hunt, L, Nicholls, J, Shaikh, I, Muscara, F, O'Brien, J, Photi, E, Stearns, A, Meylemans, D, Cunningham, C, Hompes, R, Tennakoon, A, Kumarasinghe, N, Rao, M, Upanishad, I, Khan, J, Ahmad, N, Shweejawee, Z, Stefan, S, Smart, N, Daniels, I, Gregoir, T, Longstaff, L, Mcdermott, F, Varcada, M, Drami, I, Gala, T, Moggia, E, Ratnatunga, K, Harries, R, Hayes, J, Williams, G, Raymond, T, Bronder, C, Davies, E, Hawkin, P, Ryska, O, Ayral, K, Beveridge, A, Bhowmik, A, Gill, M, Simpson, R, Schofield, A, Mcardle, K, Parmar, M, Williamson, M, Burton, H, Courtney, E, Grant, C, Saracino, A, Newton, K, Epstein, J, Branagan, G, Bignell, M, Symankewicz, M, Zaman, S, Mankotia, R, Siddiqui, Z, Torrance, A, Artioukh, D, Eggleston, M, Gokul, K, Selwyn, D, Warusavitarne, J, Chandrasinghe, P, Grainger, J, Leo, C, Harris, G, Levy, B, Skull, A, Thaha, M, Garg, A, Patel, H, Ramsanahie, A, Mondragon-Pritchard, M, Cuinas Leon, K, Shukla, A, Brewer, H, Fitzgerald, J, Kho, H, Torkington, J, Tate, S, Wheat, J, Smolarek, S, Platt, E, Rossi, B, Tham, J, Knight, J, Richardson, J, Tzivanakis, A, Gregori, M, Ashraf, M, Atif, M, Santos, J, Saffaf, N, Canning, L, Chandratreya, N, Bowen, M, Graham, B, Hamad, Y, Kaubrys, M, Chaudhry, Z, Bhan, C, Mukhtar, H, Oshowo, A, Wilson, J, Gouvas, N, Nicol, D, Pandey, S, Zilvetti, M, Sharma, A, Fatayer, T, Mothe, S, Rahman, M, Curtis, N, Allison, A, Dalton, R, Francis, N, Ockrim, J, Psaras, G, Dudarovaska, H, Marharint, T, Mostovoy, E, Voloshin, S, Kolesnik, O, Makhmudov, D, Altinel, Y, Iqbal, A, Cunningham, L, Go, K, Tan, S, R. Tutino, G. Salamone, L. Licari, G. Cocorullo, G. Gulotta, AGEM - Digestive immunity, Surgery, AGEM - Re-generation and cancer of the digestive system, CCA - Cancer Treatment and Quality of Life, RS: NUTRIM - R2 - Liver and digestive health, and 2017 and 2015 European Society of Coloproctology (ESCP) collaborating, Group
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Laparoscopic surgery ,Male ,Colorectal cancer ,medicine.medical_treatment ,surgery ,0302 clinical medicine ,Postoperative Complications ,Medicine ,Major complication ,Prospective Studies ,Laparoscopy ,SHORT-TERM OUTCOMES ,Colectomy ,Medical Audit ,medicine.diagnostic_test ,Prospective audit ,Gastroenterology ,Middle Aged ,laparoscopic surgery ,Conversion to Open Surgery ,Colon cancer ,Treatment Outcome ,Elective Surgical Procedures ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Female ,Colonic surgery ,Adult ,medicine.medical_specialty ,CLINICAL-TRIAL ,NO ,OPEN COLECTOMY ,03 medical and health sciences ,COLORECTAL SURGERY ,Case mix index ,gastrointestinal surgery ,Humans ,rectal cancer ,RECTAL-CANCER ,Aged ,ta3126 ,business.industry ,Elective resection ,medicine.disease ,RANDOMIZED-TRIAL ,OPEN RESECTION ,Surgery ,business - Abstract
BACKGROUND: Laparoscopy has now been implemented as a standard of care for elective colonic resection around the world. During the adoption period, studies showed that conversion may be detrimental to patients, with poorer outcomes than both laparoscopic completed or planned open surgery. The primary aim of this study was to determine whether laparoscopic conversion was associated with a higher major complication rate than planned open surgery in contemporary, international practice.METHODS: Combined analysis of the European Society of Coloproctology 2017 and 2015 audits. Patients were included if they underwent elective resection of a colonic segment from the caecum to the rectosigmoid junction with primary anastomosis. The primary outcome measure was the 30-day major complication rate, defined as Clavien-Dindo grade III-V.RESULTS: Of 3980 patients, 64% (2561/3980) underwent laparoscopic surgery and a laparoscopic conversion rate of 14% (359/2561). The major complication rate was highest after open surgery (laparoscopic 7.4%, converted 9.7%, open 11.6%, P < 0.001). After case mix adjustment in a multilevel model, only planned open (and not laparoscopic converted) surgery was associated with increased major complications in comparison to laparoscopic surgery (OR 1.64, 1.27-2.11, P < 0.001).CONCLUSIONS: Appropriate laparoscopic conversion should not be considered a treatment failure in modern practice. Conversion does not appear to place patients at increased risk of complications vs planned open surgery, supporting broadening of selection criteria for attempted laparoscopy in elective colonic resection.
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- 2018
22. Predictors of complications and mortality following left colectomy with primary stapled anastomosis for cancer: results of a multicentric study with 1111 patients
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Pellino, G., Frasson, M., García-Granero, A., Granero-Castro, P., Ramos Rodríguez, J. L., Flor-Lorente, B., Bargallo Berzosa, J., Alonso Hernández, N., Labrador Vallverdú, F. J., Parra Baños, P. A., Ais Conde, G., Garcia-Granero, E., Alvarez Rico, Miguel Angel, García Brao, Maria Jesus, Sanchez Gonzalez, Juan Manuel, Braithwaite, Mariela, Martí Martínez, Eva, Álvarez Pérez, Jose Antonio, Espí, Alejandro, Trallero, A., Millán Scheiding, Mónica, Maseda Díaz, Olga, Dujovne Lindenbaum, Paula, Monzón Abad, Andrés, Romero Simó, Manuel, Escoll Rufino, Jordi, Santamaría Olabarrieta, Marta, Viñas Martínez, José, López Bañeres, Manolo, Blesa Sierra, Isabel, Feliú Villaró, Francesc, Lucía, Javier Aguiló, Codina Cazador, Antonio, Villalba, Juan Hernandis, Álvarez Laso, Carlos, Alcaide, Sonia Martínez, Cáceres Alvarado, Maria Nieves, Simó, Ignacio Rey, Montero García, Josep, García Fadrique, Alfonso, Aguilella Diago, Vicente, García Septiem, Javier, García, Jacinto García, Ponchietti, Luca, Carceller Navarro, Maria Soledad, Ramos Fernández, María, Conde Muiño, Raquel, Huerga Álvarez, Daniel, Sánchez, Pablo Menéndez, Maristany Bienert, Carlos, García Martínez, Maria Teresa, Muzas, Celia Moreno, Pastor Idoate, Carlos, Alonso Casado, Adolfo Pedro, Roig Vila, Jose Vicente, Goded Broto, Ignacio, Collera, Pablo, Sebastián, Antonio Arroyo, Pellino, G., Frasson, M., García-Granero, A., Granero-Castro, P., Ramos Rodríguez, J. L., Flor-Lorente, B., Bargallo Berzosa, J., Alonso Hernández, N., Labrador Vallverdú, F. J., Parra Baños, P. A., Ais Conde, G., Garcia-Granero, E., Alvarez Rico, Miguel Angel, García Brao, Maria Jesu, Sanchez Gonzalez, Juan Manuel, Braithwaite, Mariela, Martí Martínez, Eva, Álvarez Pérez, Jose Antonio, Espí, Alejandro, Trallero, A., Millán Scheiding, Mónica, Maseda Díaz, Olga, Dujovne Lindenbaum, Paula, Monzón Abad, André, Romero Simó, Manuel, Escoll Rufino, Jordi, Santamaría Olabarrieta, Marta, Viñas Martínez, José, López Bañeres, Manolo, Blesa Sierra, Isabel, Feliú Villaró, Francesc, Lucía, Javier Aguiló, Codina Cazador, Antonio, Villalba, Juan Hernandi, Álvarez Laso, Carlo, Alcaide, Sonia Martínez, Cáceres Alvarado, Maria Nieve, Simó, Ignacio Rey, Montero García, Josep, García Fadrique, Alfonso, Aguilella Diago, Vicente, García Septiem, Javier, García, Jacinto García, Ponchietti, Luca, Carceller Navarro, Maria Soledad, Ramos Fernández, María, Conde Muiño, Raquel, Huerga Álvarez, Daniel, Sánchez, Pablo Menéndez, Maristany Bienert, Carlo, García Martínez, Maria Teresa, Muzas, Celia Moreno, Pastor Idoate, Carlo, Alonso Casado, Adolfo Pedro, Roig Vila, Jose Vicente, Goded Broto, Ignacio, Collera, Pablo, and Sebastián, Antonio Arroyo
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Male ,medicine.medical_specialty ,Colectomies ,Databases, Factual ,Colorectal cancer ,Colon ,anastomotic leak ,030230 surgery ,Lower risk ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Risk Factors ,Surgical Stapling ,medicine ,Humans ,stapled anastomosi ,postoperative complication ,Prospective Studies ,left colectomy ,Colectomy ,Aged ,business.industry ,Anastomosis, Surgical ,Gastroenterology ,Postoperative complication ,Perioperative ,Middle Aged ,medicine.disease ,Surgery ,Colon cancer ,Parenteral nutrition ,Treatment Outcome ,030220 oncology & carcinogenesis ,Colonic Neoplasms ,Female ,business ,Complication - Abstract
Aim Reports detailing the morbidity-mortality after left colectomy are sparse and do not allow definitive conclusions to be drawn. We aimed to identify risk factors for anastomotic leakage, perioperative mortality and complications following left colectomy for colonic malignancies. Method We undertook a STROBE-compliant analysis of left colectomies included in a national prospective online database. Forty-two variables were analysed as potential independent risk factors for anastomotic leakage, postoperative morbidity and mortality. Variables were selected using the 'least absolute shrinkage and selection operator' (LASSO) method. Results We analysed 1111 patients. Eight per cent of patients had a leakage and in 80% of them reoperation or surgical drainage was needed. A quarter of patients (24.9%) experienced at least one minor complication. Perioperative mortality was 2%, leakage being responsible for 47.6% of deaths. Obesity (OR 2.8, 95% CI 1.00-7.05, P = 0.04) and total parenteral nutrition (TPN) (OR 3.7, 95% CI 1.58-8.51, P = 0.002) were associated with increased risk of leakage, whereas female patients had a lower risk (OR 0.36, 95% CI 0.18-0.67, P = 0.002). Corticosteroids (P = 0.03) and oral anticoagulants (P = 0.01) doubled the risk of complications, which was lower with hyperlipidaemia (OR 0.3, P = 0.02). Patients on TPN had more complications (OR 4.02, 95% CI 2.03-8.07, P = 0.04) and higher mortality (OR 8.7, 95% CI 1.8-40.9, P = 0.006). Liver disease and advanced age impaired survival, corticosteroids being the strongest predictor of mortality (OR 21.5, P = 0.001). Conclusion Requirement for TPN was associated with more leaks, complications and mortality. Leakage was presumably responsible for almost half of deaths. Hyperlipidaemia and female gender were associated with lower rates of complications. These findings warrant a better understanding of metabolic status on perioperative outcome after left colectomy.
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- 2018
23. Safety of primary anastomosis following emergency left sided colorectal resection: an international, multi-centre prospective audit
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Sánchez-Guillén, L, Nepogodiev, D, Sivrikoz, E, van Elst, T, Minaya, A, Pata, F, Glasbey, J, Pinkney, T, Bhangu, A, El-Hussuna, A, Buchs, N, Buskens, C, Chaudri, S, Frasson, M, Gallo, G, Morton, D, Negoi, I, Singh, B, Zmora, O, Perry, R, Magill, L, Altomare, D, Bemelman, W, Brown, S, Denost, Q, Knowles, C, Laurberg, S, Lefèvre, J, Möeslein, G, Vaizey, C, Bilali, S, Bilali, V, Salomon, M, Cillo, M, Estefania, D, Patron Uriburu, J, Ruiz, H, Farina, P, Carballo, F, Guckenheimer, S, Proud, D, Brouwer, R, Bui, A, Nguyen, B, Smart, P, Warwick, A, Theodore, J, Herbst, F, Birsan, T, Dauser, B, Ghaffari, S, Hartig, N, Stift, A, Argeny, S, Unger, L, Strouhal, R, Heuberger, A, Varabei, A, Lahodzich, N, Makhmudov, A, Selniahina, L, Feryn, T, Leupe, T, Maes, L, Reynvoet, E, Van Langenhove, K, Nachtergaele, M, Monami, B, Francart, D, Jehaes, C, Markiewicz, S, Weerts, J, Van Belle, K, Bomans, B, Cavenaile, V, Nijs, Y, Vertruyen, M, Pletinckx, P, Claeys, D, Defoort, B, Muysoms, F, Van Cleven, S, Lange, C, Vindevoghel, K, Wolthuis, A, Todorovic, M, Dabic, S, Kenjic, B, Lovric, S, Vidovic, J, Delibegovic, S, Mehmedovic, Z, Christiano, A, Lombardi, B, Marchiori, M Jr, Tercioti, V Jr, Dardanov, D, Petkov, P, Simonova, L, Yonkov, A, Zhivkov, E, Maslyankov, S, Pavlov, V, Sokolov, M, Todorov, G, Stoyanov, V, Batashki, I, Iarumov, N, Lozev, I, Moshev, B, Slavchev, M, Atanasov, B, Belev, N, Krstev, P, Penkov, R, Šantak, G, Ćosić, J, Previšić, A, Vukušić, L, Zukanović, G, Zelić, M, Kršul, D, Lekić Vitlov, V, Mendrila, D, Orhalmi, J, Dusek, T, Maly, O, Paral, J, Sotona, O, Skrovina, M, Bencurik, V, Machackova, M, Kala, Z, Farkašová, M, Grolich, T, Procházka, V, Hoch, J, Kocian, P, Martinek, L, Antos, F, Pruchova, V, Ceccotti, A, Madsbøll, T, Straarup, D, Uth Ovesen, A, Christensen, P, Bondeven, P, Edling, P, Elfeki, H, Alexandrovich Gameza, V, Michelsen Bach, S, Zheltiakova, I, Krarup, Pm, Krogh, A, Rolff, Hc, Lykke, J, Juvik, Af, Lóven, Hhk, Marckman, M, Osterkamp, Jtf, Madsen, Ah, Worsøe, J, Ugianskis, A, Kjaer, Md, Youn Cho Lee, B, Khalid, A, Kristensen, Mh, El Sorogy, M, Elgeidie, A, Elhemaly, M, Elnakeeb, A, Elrefai, M, Shalaby, M, Emile, S, Omar, W, Sakr, A, Thabet, W, Awny, S, Metwally, I, Refky, B, Shams, N, Zuhdy, M, Lepistö, A, Keränen, I, Kivelä, A, Lehtonen, T, Siironen, P, Rautio, T, Ahonen-Siirtola, M, Klintrup, K, Paarnio, K, Takala, H, Hyöty, M, Haukijärvi, E, Kotaluoto, Sm, Lehto, K, Tomminen, T, Huhtinen, H, Carpelan, A, Karvonen, J, Rantala, A, Varpe, P, Cotte, E, Francois, Y, Glehen, O, Passot, G, D'Alessandro, A, Chouillard, E, Etienne, Jc, Ghilles, E, Vinson-Bonnet, B, Germain, A, Ayav, A, Bresler, L, Chevalier, R, Didailler, R, Rullier, E, Tiret, E, Chafai, N, Lefevre, J, Parc, Y, Sielezneff, I, Mege, D, Lakkis, Z, Barussaud, M, Krones, C, Bock, B, Webler, R, Baral, J, Lang, T, Münch, S, Pullig, F, Schön, M, Hinz, S, Becker, T, Möller, T, Richter, F, Schafmayer, C, Hardt, J, Kienle, P, Crescenti, F, Ahmad, M, Soleiman, Y, Papaconstantinou, I, Gklavas, A, Nastos, K, Theodosopoulos, T, Vezakis, A, Stamou, K, Saridaki, A, Xynos, E, Paraskakis, S, Zervakis, N, Skroubis, G, Amanatidis, T, Germanos, S, Maroulis, I, Papadopoulos, G, Dimitriou, N, Alexandrou, A, Felekouras, E, Griniatsos, J, Karavokyros, I, Papadopoulos, A, Chouliaras, C, Ioannidis, P, Katsounis, D, Kefalou, E, Katsoulis, I, Balalis, D, Manatakis, D, Tzovaras, G, Baloyiannis, I, Mamaloudis, I, Lázár, G, Ábraham, S, Paszt, A, Simonka, Z, Zaránd, A, Baranyai, Z, Ferreira, G, Harsányi, L, Ónody, P, Banky, B, Burány, Á, Lakatos, M, Marton, J, Solymosi, A, Besznyák, I, Bursics, A, Papp, G, Saftics, G, Svastics, I, Valsdottir, E, Atladottir, J, Jonsson, T, Moller, P, Sigurdsson, H, Gupta, Sk, Gupta, S, Kaul, N, Mohan, S, Sharma, G, Wani, R, Chowdri, N, Khan, M, Mehraj, A, Parray, F, Coveney, A, Burke, J, Deasy, J, El-Masry, S, Mcnamara, D, Khan, Mf, Cahill, R, Faul, E, Mulsow, J, Shields, C, Kelly, Me, Bass, G, Martin, St, O'Connell, R, Ryan, E, Connelly, T, Ahmad, G, 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Tutino, G. Salamone, L. Licari, G. Cocorullo, G. Gulotta, European Society of Coloproctology (ESCP) Cohort Studie, and Tonini V, Cervellera M, Vaccari S
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Male ,Medical audit ,Treatment outcome ,anastomotic leak ,030230 surgery ,0302 clinical medicine ,Postoperative Complications ,Prospective Studies ,Multi centre ,emergency surgery ,Prospective cohort study ,Colectomy ,Medical Audit ,Proctectomy ,Proctectomy/adverse effects ,Prospective audit ,Primary anastomosis ,Anastomosis, Surgical ,Gastroenterology ,Middle Aged ,surgical complications ,Europe ,Treatment Outcome ,colon cancer ,gastrointestinal surgery ,rectal cancer ,Surgery ,surgical outcomes ,030220 oncology & carcinogenesis ,Postoperative Complications/etiology ,Female ,Colectomy/adverse effects ,Emergency Treatment/adverse effects ,Adult ,medicine.medical_specialty ,Adolescent ,surgical outcome ,Left sided ,NO ,03 medical and health sciences ,Young Adult ,surgical complication ,medicine ,Humans ,Emergency Treatment ,Colorectal resection ,Aged ,ta3126 ,Anastomosis, Surgical/methods ,business.industry ,General surgery ,Surgical Stomas ,Surgical Stomas/statistics & numerical data ,Settore MED/18 - Chirurgia Generale ,Multivariate Analysis ,business - Abstract
Introduction: Some evidence suggests that primary anastomosis following left sided colorectal resection in the emergency setting may be safe in selected patients, and confer favourable outcomes to permanent enterostomy. The aim of this study was to compare the major postoperative complication rate in patients undergoing end stoma vs primary anastomosis following emergency left sided colorectal resection. Methods: A pre-planned analysis of the European Society of Coloproctology 2017 audit. Adult patients (>16years) who underwent emergency (unplanned, within 24h of hospital admission) left sided colonic or rectal resection were included. The primary endpoint was the 30-day major complication rate (Clavien-Dindo grade 3 to 5). Results: From 591 patients, 455 (77%) received an end stoma, 103 a primary anastomosis (17%) and 33 primary anastomosis with defunctioning stoma (6%). In multivariable models, anastomosis was associated with a similar major complication rate to end stoma (adjusted odds ratio for end stoma 1.52, 95%CI 0.83–2.79, P=0.173). Although a defunctioning stoma was not associated with reduced anastomotic leak (12% defunctioned [4/33] vs 13% not defunctioned [13/97], adjusted odds ratio 2.19, 95%CI 0.43–11.02, P=0.343), it was associated with less severe complications (75% [3/4] with defunctioning stoma, 86.7% anastomosis only [13/15]), a lower mortality rate (0% [0/4] vs 20% [3/15]), and fewer reoperations (50% [2/4] vs 73% [11/15]) when a leak did occur. Conclusions: Primary anastomosis in selected patients appears safe after left sided emergency colorectal resection. A defunctioning stoma might mitigate against risk of subsequent complications.
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- 2018
24. A multifaceted individualized pneumoperitoneum strategy for laparoscopic colorectal surgery: a multicenter observational feasibility study
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Diaz-Cambronero O, Flor Lorente B, Mazzinari G, Vila Montañes M, García Gregorio N, Robles Hernandez D, Olmedilla Arnal LE, Argente Navarro MP, Schultz MJ, Errando CL, and IPPColLapSe study group
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Colorectal surgery ,Colorectal surgery, Laparoscopy, Neuromuscular blockade ,Laparoscopy ,Neuromuscular blockade - Abstract
BackgroundWhile guidelines for laparoscopic abdominal surgery advise using the lowest possible intra-abdominal pressure, commonly a standard pressure is used. We evaluated the feasibility of a predefined multifaceted individualized pneumoperitoneum strategy aiming at the lowest possible intra-abdominal pressure during laparoscopic colorectal surgery.MethodsMulticenter prospective study in patients scheduled for laparoscopic colorectal surgery. The strategy consisted of ventilation with low tidal volume, a modified lithotomy position, deep neuromuscular blockade, pre-stretching of the abdominal wall, and individualized intra-abdominal pressure titration; the effect was blindly evaluated by the surgeon. The primary endpoint was the proportion of surgical procedures completed at each individualized intra-abdominal pressure level. Secondary endpoints were the respiratory system driving pressure, and the estimated volume of insufflated CO2 gas needed to perform the surgical procedure.ResultsNinety-two patients were enrolled in the study. Fourteen cases were converted to open surgery for reasons not related to the strategy. The intervention was feasible in all patients and well-accepted by all surgeons. In 61 out of 78 patients (78%), surgery was performed and completed at the lowest possible IAP, 8mmHg. In 17 patients, IAP was raised up to 12mmHg. The relationship between IAP and driving pressure was almost linear. The mean estimated intra-abdominal CO2 volume at which surgery was performed was 3.2L.ConclusionA multifaceted individualized pneumoperitoneum strategy during laparoscopic colorectal surgery was feasible and resulted in an adequate working space in most patients at lower intra-abdominal pressure and lower respiratory driving pressure.ClinicalTrials.gov (Trial Identifier: NCT03000465).
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- 2019
25. An individualised versus a conventional pneumoperitoneum pressure strategy during colorectal laparoscopic surgery: Rationale and study protocol for a multicentre randomised clinical study
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Diaz-Cambronero, O, Mazzinari, G, Errando, C L, Schultz, M J, Flor Lorente, B, García-Gregorio, N, Vila Montañés, M, Robles-Hernández, Daniel, Olmedilla Arnal, L E, Martín-De-Pablos, A, Marqués Marí, A, Argente Navarro, M P, IPPCollapse-II study group, Intensive Care Medicine, ACS - Diabetes & metabolism, ACS - Pulmonary hypertension & thrombosis, and ACS - Microcirculation
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Laparoscopic surgery ,medicine.medical_specialty ,Pneumoperitoneum pressure ,Time Factors ,Colon ,medicine.medical_treatment ,MEDLINE ,Medicine (miscellaneous) ,Outcome (game theory) ,Clinical study ,Study Protocol ,03 medical and health sciences ,Postoperative complications ,0302 clinical medicine ,Statistical Analysis Plan ,Pneumoperitoneum ,030202 anesthesiology ,Colorectal surgery ,medicine ,Pressure ,Humans ,Multicenter Studies as Topic ,Pharmacology (medical) ,Single-Blind Method ,030212 general & internal medicine ,Digestive System Surgical Procedures ,Outcome ,Randomized Controlled Trials as Topic ,Protocol (science) ,lcsh:R5-920 ,business.industry ,General surgery ,Rectum ,Recovery of Function ,Length of Stay ,medicine.disease ,3. Good health ,Treatment Outcome ,Spain ,Abdominal laparoscopy ,Laparoscopy ,Post-operative Quality of Recovery Scale (PQRS) ,Safety ,lcsh:Medicine (General) ,business ,Pneumoperitoneum, Artificial - Abstract
Background A recent study shows that a multifaceted strategy using an individualised intra-abdominal pressure titration strategy during colorectal laparoscopic surgery results in an acceptable workspace at low intra-abdominal pressure in most patients. The multifaceted strategy, focused on lower to individualised intra-abdominal pressures, includes prestretching the abdominal wall during initial insufflation, deep neuromuscular blockade, low tidal volume ventilation settings and a modified lithotomy position. The study presented here tests the hypothesis that this strategy improves outcomes of patients scheduled for colorectal laparoscopic surgery. Methods The Individualized Pneumoperitoneum Pressure in Colorectal Laparoscopic Surgery versus Standard Therapy (IPPCollapse-II) study is a multicentre, two-arm, parallel-group, single-blinded randomised 1:1 clinical study that runs in four academic hospitals in Spain. Patients scheduled for colorectal laparoscopic surgery with American Society of Anesthesiologists classification I to III who are aged > 18 years and are without cognitive deficits are randomised to an individualised pneumoperitoneum pressure strategy (the intervention group) or to a conventional pneumoperitoneum pressure strategy (the control group). The primary outcome is recovery assessed with the Post-operative Quality of Recovery Scale (PQRS) at postoperative day 1. Secondary outcomes include PQRS score in the post anaesthesia care unit and at postoperative day 3, postoperative complications until postoperative day 28, hospital length of stay and process-related outcomes. Discussion The IPPCollapse-II study will be the first randomised clinical study that assesses the impact of an individualised pneumoperitoneum pressure strategy focused on working with the lowest intra-abdominal pressure during colorectal laparoscopic surgery on relevant patient-centred outcomes. The results of this large study, to be disseminated through conference presentations and publications in international peer-reviewed journals, are of ultimate importance for optimising the care and safety of laparoscopic abdominal surgery. Selection of patient-reported outcomes as the primary outcome of this study facilitates the translation into clinical practice. Access to source data will be made available through anonymised datasets upon request and after agreement of the Steering Committee of the IPPCollapse-II study. Trial registration ClinicalTrials.gov, NCT02773173. Registered on 16 May 2016. EudraCT, 2016-001693-15. Registered on 8 August 2016. Electronic supplementary material The online version of this article (10.1186/s13063-019-3255-1) contains supplementary material, which is available to authorized users.
- Published
- 2019
26. Management of intersphincteric abscesses
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Millan, M., García-Granero, E., Esclápez, P., Flor-Lorente, B., Espí, A., and Lledó, S.
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- 2006
27. What is the Real Benefit of Preoperative Chemoradiotherapy after Adequate Mesorectal Excision for Cancer of the Distal Rectum?: F035
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Flor-Lorente, B, Garcia-Granero, E, Muñoz, E, Garcia-Botello, S, Cervantes, A, Esclapez, P, Espi, A, Navarro, S, Campos, S, and Lledo, S
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- 2006
28. Use of Photoplethysmography to Determine Gastrointestinal Perfusion Pressure: An Experimental Canine Model
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Garcia-Granero, E., Garcia, S. A., Alos, R., Calvete, J., Flor-Lorente, B., Willatt, J., and Lledo, S.
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- 2003
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29. How to reduce the superior mesenteric vein bleeding risk during laparoscopic right hemicolectomy
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Garcia-Granero A, Sanchez-Guillen L, Frasson M, Sancho Muriel J, Alvarez Sarrado E, Fletcher-Sanfeliu D, Flor Lorente B, Pamies J, Corral Rubio J, Valverde Navarro AA, Martinez Soriano F, and Garcia-Granero E
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Intraoperative bleeding ,Laparoscopic right hemicolectomy ,Superior right colic vein ,Gastrocolic trunk - Abstract
The superior right colic vein (SRCV) has been proposed as the main cause of superior mesenteric vein bleeding by avulsion during laparoscopic right hemicolectomy. Our objective is to identify the main vessel causing transverse mesocolic tension during the extraction of the surgical specimen or extracorporeal anastomosis and to perform an anatomical description of the SRCV. In this cadaveric study, we performed a simulation of right hemicolectomy and anatomical description of the surgical area of the gastrocolic trunk of Henle (SAGCTH), the gastrocolic trunk of Henle (GCTH), and SRCV. The length of the exteriorization of the anastomotic transverse colon (ATC) was measured before and after sectioning the vascular vessel causing the exteriorization tension. Five fresh cadavers and 12 formalin were dissected. In 100% of the specimens, the SRCV was present and drained in 95% into the GCTH and in 5% directly into the superior mesenteric vein (SMV). In 100% of the specimens, the SRCV caused the tension when extracting the ATC. The mean length of exteriorization of the ATC before and after SRCV section was 7.2 and 10.4 cm in formalin cadavers, meaning a 44% of increment in the length of exteriorization. In fresh cadavers, the mean length of exteriorization increased to 2.7 cm, meaning a 28% of the initial length of exteriorization. The SRCV is the main cause of tension in the extraction of the surgical specimen after right hemicolectomy. Its high tie increases the length of the ATC exteriorization, in about 3 cm, and could reduce the risk of SMV bleeding during laparoscopic right hemicolectomy and facilitate an extracorporeal anastomosis free of tension.
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- 2018
30. Predictors of complications and mortality following left colectomy with primary stapled anastomosis for cancer: results of a multicentric study with 1111 patients
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Pellino, G, Frasson, M, Garcia-Granero, A, Granero-Castro, P, Rodriguez, JLR, Flor-Lorente, B, Berzosa, JB, Hernandez, NA, Vallverdu, FJL, Banos, PAP, Conde, GA, Garcia-Granero, E, and ANACO Study Grp
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stapled anastomosis ,anastomotic leak ,postoperative complication ,left colectomy ,Colon cancer - Abstract
Aim Reports detailing the morbidity-mortality after left colectomy are sparse and do not allow definitive conclusions to be drawn. We aimed to identify risk factors for anastomotic leakage, perioperative mortality and complications following left colectomy for colonic malignancies. Method Results We undertook a STROBE-compliant analysis of left colectomies included in a national prospective online database. Forty-two variables were analysed as potential independent risk factors for anastomotic leakage, postoperative morbidity and mortality. Variables were selected using the 'least absolute shrinkage and selection operator' (LASSO) method. We analysed 1111 patients. Eight per cent of patients had a leakage and in 80% of them reoperation or surgical drainage was needed. A quarter of patients (24.9%) experienced at least one minor complication. Perioperative mortality was 2%, leakage being responsible for 47.6% of deaths. Obesity (OR 2.8, 95% CI 1.00-7.05, P = 0.04) and total parenteral nutrition (TPN) (OR 3.7, 95% CI 1.58-8.51, P = 0.002) were associated with increased risk of leakage, whereas female patients had a lower risk (OR 0.36, 95% CI 0.18-0.67, P = 0.002). Corticosteroids (P = 0.03) and oral anticoagulants (P = 0.01) doubled the risk of complications, which was lower with hyperlipidaemia (OR 0.3, P = 0.02). Patients on TPN had more complications (OR 4.02, 95% CI 2.03-8.07, P = 0.04) and higher mortality (OR 8.7, 95% CI 1.8-40.9, P = 0.006). Liver disease and advanced age impaired survival, corticosteroids being the strongest predictor of mortality (OR 21.5, P = 0.001). Conclusion Requirement for TPN was associated with more leaks, complications and mortality. Leakage was presumably responsible for almost half of deaths. Hyperlipidaemia and female gender were associated with lower rates of complications. These findings warrant a better understanding of metabolic status on perioperative outcome after left colectomy.
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- 2018
31. Standard outcome indicators after colon cancer resection. Creation of a nomogram for autoevaluation
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Sancho-Muriel J, Frasson M, Hervas D, Flor-Lorente B, Ramos Rodriguez J, Romero Simo M, Escoll Rufino J, Santamaria Olabarrieta M, Vinas Martinez J, Lopez Baneres M, and Garcia-Granero E
- Abstract
Introduction: Lately there has been an increasing interest in identifying quality standards in different pathologies, among them colon cancer due to its great prevalence. The main goal of this study is to define the quality standards of colon cancer surgery based on a large prospective national study dataset. Methods: Data from the prospective national study ANACO were used. This study included a consecutive series of patients operated on for colon cancer in 52 Spanish hospitals (20112012). Centers with less than 30 patients were excluded. The present analysis finally included 42 centers (2975 patients). Based on the results obtained in 4 main indicators from each hospital (anastomotic leak, lymph-nodes found in the specimen, mortality and length of stay), a nomogram that allows the evaluation of the performance of each center was designed. Standard results for further 5 intraoperative and 5 postoperative quality indicators were also reported. Results: Median of anastomotic leak and mortality rate was 8.5% (25th-75th percentiles 6.1%12.4%) and 2.5% (25th-75th percentiles 0.6%-4.7%), respectively. Median number of nodes found in the surgical specimen was 15,1 (25th-75th percentiles 18-14 nodes). Median length of postoperative stay was 7.7 days (25th-75th percentiles 6.9-9.2 days). Based on these data, a nomogram for hospital audit was created. Conclusions: Standard surgical results after colon cancer surgery were defined, creating a tool for auto-evaluation and allowing each center to identify areas for improvement in the surgical treatment of colon cancer. (C)2016 AEC. Published by Elsevier Espana, S.L.U. All rights reserved.
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- 2017
32. Laparoscopy may decrease morbidity and length of stay after elective colon cancer resection, especially in frail patients: results from an observational real-life study
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Cerdán Santacruz C, Frasson M, Flor-Lorente B, Ramos Rodríguez JL, Trallero Anoro M, Millán Scheiding M, Maseda Díaz O, Dujovne Lindenbaum P, Monzón Abad A, García-Granero Ximenez E, and ANACO Study Group
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Short-term outcome ,Laparoscopic surgery ,Morbidity ,Mortality ,Observational multicenter study ,Length-of-stay ,Colon cancer - Abstract
Advantages of laparoscopic approach in colon cancer surgery have been previously demonstrated in controlled, randomized trials and in retrospective analysis of large administrative databases. Nevertheless, evidence of these advantages in prospective, observational studies from real-life settings is scarce. This is a prospective, observational study, including a consecutive series of patients that underwent elective colonic resection for cancer in 52 Spanish hospitals. Pre-/intraoperative data, related to patient, tumor, surgical procedure, and hospital, were recorded as well as 60-day post-operative outcomes, including wound infection, complications, anastomotic leak, length of stay, and mortality. A univariate and multivariate analysis was performed to determine the influence of laparoscopy on short-term post-operative outcome. A sub-analysis of the effect of laparoscopy according to patients' pre-operative risk (ASA Score I-II vs. III-IV) was also performed. 2968 patients were included: 44.2% were initially operated by laparoscopy, with a 13.9% conversion rate to laparotomy. At univariate analysis, laparoscopy was associated with a decreased mortality (p = 0.015), morbidity (p < 0.0001), wound infection (p < 0.0001), and post-operative length of stay (p < 0.0001). At multivariate analysis, laparoscopy resulted as an independent protective factor for morbidity (OR 0.7; p = 0.004), wound infection (OR 0.6; p < 0.0001), and length of post-operative stay (Effect-2 days; p < 0.0001), compared to open approach. These advantages were more relevant in high-risk patients (ASA III-IV), even if the majority of them were operated by open approach (67.1%). In a real-life setting, laparoscopy decreases wound infection rate, post-operative complications, and length of stay, especially in ASA III-IV patients.
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- 2017
33. Risk factors for anastomotic leak and postoperative morbidity and mortality after elective right colectomy for cancer: results from a prospective, multicentric study of 1102 patients
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Frasson M, Granero-Castro P, Rodriguez J, Flor-Lorente B, Braithwaite M, Martinez E, Perez J, Cazador A, Espi A, Garcia-Granero E, and ANACO Study Grp
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Postoperative mortality ,Colorectal surgery ,Wound infection ,Right colectomy ,Anastomotic leak ,Primary anastomosis ,Ileocolic anastomosis ,Colon cancer ,Postoperative complication ,Colon resection - Abstract
Studies focused on postoperative outcome after oncologic right colectomy are lacking. The main objective was to determine pre-/intraoperative risk factors for anastomotic leak after elective right colon resection for cancer. Secondary objectives were to determine risk factors for postoperative morbidity and mortality. Fifty-two hospitals participated in this prospective, observational study (September 2011-September 2012), including 1102 patients that underwent elective right colectomy. Forty-two pre-/intraoperative variables, related to patient, tumor, surgical procedure, and hospital, were analyzed as potential independent risk factors for anastomotic leak and postoperative morbidity and mortality. Anastomotic leak was diagnosed in 93 patients (8.4 %), and 72 (6.5 %) of them needed radiological or surgical intervention. Morbidity, mortality, and wound infection rates were 29.0, 2.6, and 13.4 %, respectively. Preoperative serum protein concentration was the only independent risk factor for anastomotic leak (p < 0.0001, OR 0.6 per g/dL). When considering only clinically relevant anastomotic leaks, stapled technique (p = 0.03, OR 2.1) and preoperative serum protein concentration (p = 0.004, OR 0.6 g/dL) were identified as the only two independent risk factors. Age and preoperative serum albumin concentration resulted to be risk factors for postoperative mortality. Male gender, pulmonary or hepatic disease, and open surgical approach were identified as risk factors for postoperative morbidity, while male gender, obesity, intraoperative complication, and end-to-end anastomosis were risk factors for wound infection. Preoperative nutritional status and the stapled anastomotic technique were the only independent risk factors for clinically relevant anastomotic leak after elective right colectomy for cancer. Age and preoperative nutritional status determined the mortality risk, while laparoscopic approach reduced postoperative morbidity.
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- 2016
34. Inferior mesenteric vein as initial landmark for laparoscopic medial to lateral dissection of descending colon – a video vignette
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Garcia‐Granero, A., primary, Wagner Tustanowski, G., additional, Sánchez‐Guillén, L., additional, Fletcher Sanfeliu, D., additional, Frasson, M., additional, Flor Lorente, B., additional, and Martinez‐Soriano, F., additional
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- 2017
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35. Selective Approach for Upper Rectal Cancer Treatment: Total Mesorectal Excision and Preoperative Chemoradiation Are Seldom Necessary
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Marinello FG, Frasson M, Baguena G, Flor-Lorente B, Cervantes A, Roselló S, Espí A, and García-Granero E
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Neoadjuvant therapy ,Circumferential resection margin ,Oncological results ,Upper rectal cancer ,Mesorectal excision - Abstract
BACKGROUND: The implementation of preoperative chemoradiation combined with total mesorectal excision has reduced local recurrence rates in rectal cancer. However, the use of both types of treatment in upper rectal cancer is controversial. OBJECTIVE: The purpose of this work was to assess oncological results after radical resection of upper rectal cancers compared with sigmoid, middle, and lower rectal cancers and to determine risk factors for local recurrence in upper rectal cancer. DESIGN: This was a retrospective analysis of prospectively collected data. SETTINGS: This study was conducted in a tertiary care referral hospital in Valencia, Spain. PATIENTS: Analysis included 1145 patients who underwent colorectal resection with primary curative intent for primary sigmoid (n = 450), rectosigmoid (n = 70), upper rectal (n = 178), middle rectal (n = 186), or lower rectal (n = 261) cancer. MAIN OUTCOME MEASURES: Oncological results, including local recurrence, disease-free survival, and cancer-specific survival, were compared between the different tumor locations. Univariate and multivariate analyses were performed to identify risk factors for local recurrence in upper rectal cancer. RESULTS: A total of 147 patients (82.6%) with upper rectal tumors underwent partial mesorectal excision, and only 10 patients (5.6%) of that group received preoperative chemoradiation. The 5-year actuarial local recurrence, disease-free survival, and cancer-specific survival rates for upper rectal tumors were 4.9%, 82.0%, and 91.6%. Local recurrence rates showed no differences when compared among all of the locations (p = 0.20), whereas disease-free survival and cancer-specific survival were shorter for lower rectal tumors (p = 0.006; p = 0.003). The only independent risk factor for local recurrence in upper rectal cancer was an involved circumferential resection margin at pathologic analysis (HR, 14.23 (95% CI, 2.75-73.71); p = 0.002). LIMITATIONS: This was a single-institution, retrospective study. CONCLUSIONS: Most upper rectal tumors can be treated with partial mesorectal excision without the systematic use of preoperative chemoradiation. Involvement of the mesorectal fascia was the only independent risk factor for local recurrence in these tumors.
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- 2015
36. Anastomotic leaks after colon cancer resections: Does the individual surgeon matter?
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Marinello FG, Baguena G, Lucas E, Frasson M, Hervás D, Flor-Lorente B, Esclapez P, Espí A, and García-Granero E
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- 2015
37. Risk Factors for Anastomotic Leak After Colon Resection for Cancer Multivariate Analysis and Nomogram From a Multicentric, Prospective, National Study With 3193 Patients
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Frasson M, Flor-Lorente B, Jl, Rodríguez, Granero-Castro P, Hervás D, Ma, Alvarez Rico, Mj, Brao, Jm, Sánchez González, and Garcia-Granero E
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nomogram ,colon cancer ,risk factor ,anastomotic leak ,colon resection - Abstract
Objective: To determine pre-/intraoperative risk factors for anastomotic leak after colon resection for cancer and to create a practical instrument for predicting anastomotic leak risk. Background: Anastomotic leak is still the most dreaded complication in colorectal surgery. Many risk factors have been identified to date, but multicentric prospective studies on anastomotic leak after colon resection are lacking. Methods: Fifty-two hospitals participated in this prospective, observational study. Data of 3193 patients, operated for colon cancer with primary anastomosis without stoma, were included in a prospective online database (September 2011-September 2012). Forty-two pre-/intraoperative variables, related to patient, tumor, surgical procedure, and hospital, were analyzed as potential independent risk factors for anastomotic leak (60-day follow-up). A nomogram was created to easily predict the risk of anastomotic leak for a given patient. Results: The anastomotic leak rate was 8.7%, and widely varied between hospitals (variance of 0.24 on the logit scale). Anastomotic leak significantly increased mortality (15.2% vs 1.9% in patients without anastomotic leak, P < 0.0001) and length of hospitalization (median 23 vs 7 days in uncomplicated patients, P < 0.0001). In the multivariate analysis, the following variables were independent risk factors for anastomotic leak: obesity [P = 0.003, odds ratio (OR) = 2.7], preoperative serum total proteins (P = 0.03, OR = 0.7 per g/dL), male sex (P = 0.03, OR = 1.6), ongoing anticoagulant treatment (P = 0.05, OR = 1.8), intraoperative complication (P = 0.03, OR = 2.2), and number of hospital beds (P = 0.04, OR = 0.95 per 100 beds). Conclusions: Anastomotic leak after colon resection for cancer is a frequent, relevant complication. Patients, surgical technique, and hospital are all important determining factors of anastomotic leak risk.
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- 2015
38. Evaluation of Mesorectal Fascia in Mid and Low Anterior Rectal Cancer Using Endorectal Ultrasound Is Feasible and Reliable: A Comparison With MRI Findings
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Granero-Castro P, Muñoz E, Frasson M, García-Granero A, Esclapez P, Campos S, Flor-Lorente B, and Garcia-Granero E
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Mesorectal fascia ,Circumferential resection margin ,Endorectal ultrasound ,Rectal cancer ,Cancer staging ,MRI - Abstract
BACKGROUND: Accuracy of MRI in assessing mesorectal fascia and predicting circumferential resection margin decreases in low anterior rectal tumors. OBJECTIVE: The purpose of this work was to evaluate the accuracy of endorectal ultrasound in predicting the pathologic circumferential resection margin in low rectal anterior tumors and to compare it with MRI findings. DESIGN: This was a prospective series comparing the preoperative circumferential resection margin assessed by endorectal ultrasound and MRI with pathologic examination. SETTINGS: The study was conducted by a specialized colorectal multidisciplinary team at a tertiary teaching hospital. PATIENTS: Between 2002 and 2008, 76 patients with mid to low rectal cancer were preoperatively evaluated by endorectal ultrasound and MRI and underwent total mesorectal excision without neoadjuvant radiochemotherapy. Twenty-seven patients with posterior or postero-lateral tumors were excluded, leaving 49 patients with anterior or antero-lateral tumors for the present subanalysis. We compared preoperative circumferential resection margin status using endorectal ultrasound and MRI with pathologic examination. INTERVENTIONS: We conducted a comparison between preoperative circumferential resection margin status and pathologic examination after total mesorectal excision surgery. MAIN OUTCOME MEASURES: Accuracy in predicting pathologic circumferential resection margin status was measured. RESULTS: Overall accuracy of endorectal ultrasound and MRI in assessing circumferential resection margin status was 83.7% and 91.8%, with negative predictive values of 97.2% and 97.5%. When focusing on low rectal tumors, the overall accuracy of endorectal ultrasound increased to 87.5%, whereas the accuracy of MRI decreased to 87.5%, with a negative predictive value of 95.6% for both diagnostic tests. LIMITATIONS: The sample size is small, and interobserver variability in radiologic assessment was not evaluated. CONCLUSIONS: Endorectal ultrasound can help MRI in predicting circumferential resection margin involvement in mid to low anterior rectal cancer, especially at the low third of the rectum, with a high negative predictive value.
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- 2014
39. Management of cryptoglandular supralevator abscesses in the magnetic resonance imaging era: a case series
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Garcia-Granero A, Granero-Castro P, Frasson M, Flor-Lorente B, Carreño O, Espí A, Puchades I, and Garcia-Granero E
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Anal abscess ,Magnetic resonance imaging ,Supralevator abscess - Abstract
The aim of this study is to describe the diagnostic performance of magnetic resonance imaging in the management of supralevator abscess, regarding its origin, location, drainage route, subsequent treatment of the fistula, and long-term results. A retrospective case series including thirteen consecutive patients with cryptoglandular supralevator abscess treated between 2001 and 2011 at a colorectal unit of a tertiary referral center. A magnetic resonance imaging was performed in all patients before surgical drainage, and its usefulness in assessing supralevator abscess origin was analyzed. Short- and long-term results after drainage were also evaluated. The final diagnosis of supralevator abscess and the location described in the magnetic resonance were confirmed intraoperatively in all patients. An ischiorectal origin was identified in nine patients, and perineal translevator drainage was performed placing a mushroom catheter through the ischiorectal or the postanal space. Four patients underwent secondary treatment of anal fistula: two rectal advancement flap and two non-cutting seton. In the other four patients, an intersphincteric origin was identified and transanal surgical drainage was performed placing a long-term mushroom catheter. Several weeks later, transanal unroofing of the residual cavity was performed and the fistula lay open to the anorectal lumen. In the long-term follow-up (median 61 months), only patients with supralevator abscess of ischiorectal origin in whom fistula was not subsequently treated presented a recurrence of the anal sepsis. Magnetic resonance imaging seems essential to clarify the location of supralevator abscess, its origin, and choice of the right drainage route. Subsequent treatment of the fistula is necessary to avoid recurrence.
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- 2014
40. Extralevator abdominoperineal resection in the prone position
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Flor-Lorente B, Frasson M, and Montilla E
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Extralevator abdominoperineal resection ,Recidiva local ,Supine ,Circumferential resection margin ,Miles ,Perforacion tumoral iatrogena ,Prono ,Morbimortalidad ,Prone ,Margen circunferencial de reseccion ,Iatrogenic tumor perforation ,Local recurrence ,Amputacion abdominoperineal extraelevadora ,Morbidity ,Mortality ,Rectal cancer ,Supino ,Cancer de recto - Abstract
The Miles operation is every day more in the limelight. The abdominoperineal resection compared to anterior resection results in increased rate of circumferential resection margin (CRM) infiltration, increased iatrogenic tumor perforation rate and poorer quality of the mesorectum. These worse results may be caused by excessive dissection between the distal mesorectum and the plane of the levator ani and the consequent "resection waist" or "cone" effect in the specimen. A wider excision of the pelvic floor muscles, known as extraelevator abdominoperineal resection (ELAPE), would provide a "cylindrical" specimen which would hypothetically reduce the risk of tumor perforation and CRM infiltration and local recurrence rate. However, there is insufficient evidence to conclude that the ELAPE is oncologically superior compared to standard abdominoperineal resection. Independently from the surgical technique adopted, another actual point of discussion is the position of the patient during the perineal part of the operation. The position on "prone" provides excellent pelvic exposure, a top-down dissection under direct vision and is very comfortable for the operating surgeons. However, there is no clear scientific evidence of the superiority of prone ELAPE over supine ELAPE in terms of oncologic results, morbidity and mortality. The laparoscopy seems to be the best surgical approach for the abdominal part of the operation, although it has not been validated so far by large prospective studies. Prospective, controlled and randomized trials are necessary to resolve all these issues. The current interest in a more accurate and standardized perineal surgery to obtain a cylindrical specimen, undoubtedly, will improve results.
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- 2014
41. Reconstruction techniques after extralevator abdominoperineal rectal excision or pelvic exenteration: meshes, plasties and flaps
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Frasson M, Flor-Lorente B, and Carreño O
- Subjects
Cierre directo ,Herida perineal ,recto ,Epiploplastia ,Abdomino-perineal rectal resection ,Amputacion abdominoperineal del ,Cierre con malla ,Colgajo miocutaneo ,Primary closure ,Perineal wound ,Hernia perineal ,Colgajo musculo recto ,Low rectal cancer ,Myocutaneous flap ,Perineal hernia ,Cancer del recto bajo - Abstract
Perineal wound complications after abdomino-perineal rectal resection are frequent and clinically relevant for their impact on the length of hospitalization, costs, patients' quality of life and oncologic results. With the diffusion of the preoperative radiotherapy and the gradual shift to the extra-elevator technique, the perineal morbidity rate has increased. Many series describing different techniques of primary closure of the perineal defect have been published, but high-quality clinical studies, indicating which is the best option, are missing. A biologic mesh, associated if possible to an omentoplasty, seems to be sufficient to close the perineal defect after extra-elevator abdomino-perineal rectal resection. However, when the proctectomy is associated to the resection of other organs, as for example vagina or sacrum, resulting in an ample perineal defect, the vertical rectus abdominis flap seems to be the best option. If the perineal defect is smaller, the gracilis or gluteus flaps could be other valid alternatives.
- Published
- 2014
42. Anastomotic leakage after colon cancer resection: does the individual surgeon matter?
- Author
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Marinello, F. G., primary, Baguena, G., additional, Lucas, E., additional, Frasson, M., additional, Hervás, D., additional, Flor-Lorente, B., additional, Esclapez, P., additional, Espí, A., additional, and García-Granero, E., additional
- Published
- 2016
- Full Text
- View/download PDF
43. Procalcitonin and C-reactive protein as early predictors of anastomotic leak in colorectal surgery: a prospective observational study
- Author
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Garcia-Granero A, Frasson M, Flor-Lorente B, Blanco F, Puga R, Carratalá A, and Garcia-Granero E
- Abstract
Although the early diagnosis of anastomotic leak is a key point in reducing its clinical consequences, in daily practice, anastomotic leak diagnosis is often late.
- Published
- 2013
44. Modified Wong's classification improves the accuracy of rectal cancer staging by endorectal ultrasound and MRI
- Author
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Muñoz E, Granero-Castro P, Frasson M, Escartin J, Esclapez P, Campos S, Flor-Lorente B, and Garcia-Granero E
- Abstract
Douglas Wong proposed a new classification of tumor penetration in the rectal wall (T stage) in an attempt to incorporate the prognostic heterogeneity of T3 rectal cancers into the preoperative staging.
- Published
- 2013
45. Pathological evaluation of mesocolic resection quality and ex vivo methylene blue injection: what is the impact on lymph node harvest after colon resection for cancer?
- Author
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Frasson M, Faus C, Garcia-Granero A, Puga R, Flor-Lorente B, Cervantes A, Navarro S, and Garcia-Granero E
- Subjects
Lymph node excision ,Methylene blue ,Staging ,Pathological methodology ,Colon cancer - Abstract
Although the National Quality Forum has endorsed the harvest of =12 lymph nodes as a standard quality indicator for colon cancer surgery, this minimum quantity is not reached in many centers.
- Published
- 2012
46. El uso precoz de la tomografía computarizada en el manejo de la diverticulitis aguda
- Author
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Martín Arévalo, J., García-Granero, E., García Botello, S., Muñoz, E., Cervera, V., Flor Lorente, B., and Lledó, S.
- Subjects
Tomografía computarizada ,Sigmoid diverticulitis ,Computerized tomography ,Diverticulitis colónica ,Diverticulitis sigmoidea ,Colonic diverticulitis - Abstract
Objetivo: valorar el uso precoz de la tomografía computarizada (TC) para el diagnóstico, estadificación y manejo de la diverticulitis aguda. Material y métodos: realizamos un estudio prospectivo de 102 pacientes con el diagnóstico clínico de diverticulitis aguda de colon izquierdo. La diverticulitis aguda fue inicialmente dividida en tres estadios. Los pacientes fueron reestadiados en los estadios I, IIa, IIb y III de acuerdo a los hallazgos encontrados en la TC. El diagnóstico se confirmó después intraoperatoriamente, por colonoscopia o estudio con bario. Resultados: fueron incluidos 102 pacientes (52 mujeres y 50 hombres) con una edad media de 59,4 (DS ± 14,96). En 84 (82,35%) pacientes con el diagnóstico clínico de diverticulitis aguda se confirmó este diagnóstico con un error diagnóstico del 17,65% (n = 18). La diverticulitis aguda se diagnosticó con la TC en el 84,3% (n = 86). La TC tuvo una sensibilidad del 100% y especificidad del 88,9%. La TC cambió la estadificación clínica en un 38% debido a una infraestadificación del 13% y una sobreestadificación del 25%, que llega al 60 y al 50% en los estadios clínicos II y III, respectivamente. La reclasificación o reestadificación de los pacientes de acuerdo con los hallazgos en la TC tiene una consecuencia importante en la indicación quirúrgica. Conclusiones: la estadificación clínica precoz de la diverticulitis con la TC evita errores de diagnóstico clínico en el 17,65%. La TC modifica la estadificación clínica de severidad en el 38% evitando la cirugía innecesaria y el retraso en el tratamiento quirúrgico. Objectives: to assess the early use of CT for the diagnosis, staging, and management of acute diverticulitis. Materials and methods: a prospective study of 102 patients with a clinical diagnosis of acute diverticulitis of the left colon. Acute diverticulitis was initially divided into 3 clinical stages. Patients were restaged according to CT findings into stages I, IIa, IIb, and III. Diagnosis was subsequently confirmed intraoperatively or by colonoscopy or barium studies. Results: 102 patients (52 females and 50 males, mean age of 59.4 (SD + 14.96 years)) were included; 84 (82.35%) patients with a clinical diagnosis of acute diverticulitis were confirmed to suffer this disease for a diagnostic error of 17.65% (n=18). Acute diverticulitis was diagnosed by CT in 84.3% (n=86). CT had a sensitivity of 100% and a specificity of 88.9%. CT changed clinical stage for 38% of patients - because of understaging in 13% and of overstaging in 25%. When stages II and III were analyzed separately, 60 and 50% were overstaged, respectively. The reclassification of patients according to CT results had a significant impact on treatment. Conclusions: Early clinical staging with CT avoids diagnostic clinical errors in 17.65% of patients. CT changes the initial clinical staging of acute episodes in 38% of cases, thus avoiding unnecessary delays in surgery for severe cases, and unnecessary surgeries for mild cases.
- Published
- 2007
47. Prognostic implications of circumferential location of distal rectal cancer
- Author
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García-Granero, E., primary, Faiz, O., additional, Flor-Lorente, B., additional, García-Botello, S., additional, Esclápez, P., additional, and Cervantes, A., additional
- Published
- 2010
- Full Text
- View/download PDF
48. El uso precoz de la tomografía computarizada en el manejo de la diverticulitis aguda
- Author
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Martín Arévalo, J., primary, García-Granero, E., additional, García Botello, S., additional, Muñoz, E., additional, Cervera, V., additional, Flor Lorente, B., additional, and Lledó, S., additional
- Published
- 2007
- Full Text
- View/download PDF
49. La imagen del mes
- Author
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García-Botello, Stephanie, primary, Calvete-Chornet, Julio, additional, Sabater-Ortí, Luis, additional, Flor-Lorente, B., additional, Cassinello-Fernández, Norberto, additional, March-Villalba, José Antonio, additional, and Lledó-Matoses, Salvador, additional
- Published
- 2005
- Full Text
- View/download PDF
50. An individualised versus a conventional pneumoperitoneum pressure strategy during colorectal laparoscopic surgery: rationale and study protocol for a multicentre randomised clinical study.
- Author
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IPPCollapse-II study group, García-Gregorio, N., Vila Montañés, M., Argente Navarro, M. P., Diaz-Cambronero, O., Olmedilla Arnal, L. E., Martín-De-Pablos, A., Marqués Marí, A., Mazzinari, G., Errando, C. L., Schultz, M. J., Flor Lorente, B., and Robles-Hernández, Daniel
- Subjects
INTRA-abdominal pressure ,VOLUMETRIC analysis ,LAPAROSCOPIC surgery ,PATIENTS ,LITHOTOMY position ,PNEUMOPERITONEUM ,ANESTHESIOLOGISTS - Abstract
Background: A recent study shows that a multifaceted strategy using an individualised intra-abdominal pressure titration strategy during colorectal laparoscopic surgery results in an acceptable workspace at low intra-abdominal pressure in most patients. The multifaceted strategy, focused on lower to individualised intra-abdominal pressures, includes prestretching the abdominal wall during initial insufflation, deep neuromuscular blockade, low tidal volume ventilation settings and a modified lithotomy position. The study presented here tests the hypothesis that this strategy improves outcomes of patients scheduled for colorectal laparoscopic surgery.Methods: The Individualized Pneumoperitoneum Pressure in Colorectal Laparoscopic Surgery versus Standard Therapy (IPPCollapse-II) study is a multicentre, two-arm, parallel-group, single-blinded randomised 1:1 clinical study that runs in four academic hospitals in Spain. Patients scheduled for colorectal laparoscopic surgery with American Society of Anesthesiologists classification I to III who are aged > 18 years and are without cognitive deficits are randomised to an individualised pneumoperitoneum pressure strategy (the intervention group) or to a conventional pneumoperitoneum pressure strategy (the control group). The primary outcome is recovery assessed with the Post-operative Quality of Recovery Scale (PQRS) at postoperative day 1. Secondary outcomes include PQRS score in the post anaesthesia care unit and at postoperative day 3, postoperative complications until postoperative day 28, hospital length of stay and process-related outcomes.Discussion: The IPPCollapse-II study will be the first randomised clinical study that assesses the impact of an individualised pneumoperitoneum pressure strategy focused on working with the lowest intra-abdominal pressure during colorectal laparoscopic surgery on relevant patient-centred outcomes. The results of this large study, to be disseminated through conference presentations and publications in international peer-reviewed journals, are of ultimate importance for optimising the care and safety of laparoscopic abdominal surgery. Selection of patient-reported outcomes as the primary outcome of this study facilitates the translation into clinical practice. Access to source data will be made available through anonymised datasets upon request and after agreement of the Steering Committee of the IPPCollapse-II study.Trial Registration: ClinicalTrials.gov, NCT02773173 . Registered on 16 May 2016. EudraCT, 2016-001693-15. Registered on 8 August 2016. [ABSTRACT FROM AUTHOR]- Published
- 2019
- Full Text
- View/download PDF
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