Search

Your search keyword '"Tekkis, P."' showing total 1,256 results
Start Over Author "Tekkis, P."
1,256 results on '"Tekkis, P."'

2. Beating the empty pelvis syndrome: the PelvEx Collaborative core outcome set study protocol

Author

G Palmer, T Smith, A Ghosh, K Brown, C Harris, B Griffiths, H Kim, A Martinez, J Park, S Kumar, D Collins, M Ito, M Davies, A Wolthuis, A Lyons, J Rintala, M Quinn, K Boyle, T Skeie-Jensen, S Domingo, A Gil-Moreno, M Wilson, V Lago, F Köse, A Saklani, KKL Chan, G Vizzielli, PJ Nilsson, B Flor, H Yano, A Antoniou, M Valente, M Angeles, B Eyjolfsdottir, P Chong, V George, A Simpson, D Proud, J Wild, A Oliver, C Taylor, E Burns, C Rao, RJ Davies, P Georgiou, M Brunner, D Taylor, K Weber, C Mann, HJ Kim, S Rasheed, A Denys, M Bedford, J Tiernan, G Turner, D Steffens, E Egger, A Burgess, P Tejedor, B Nguyen, B Yip, M Fahy, W Hohenberger, T Glover, R Thurairaja, W Ceelen, S Laurberg, L Castro, O Aziz, M Gargiulo, Y Tsukada, A Sahai, S Warrier, T Glyn, M Rochester, B Lampe, R Sayyed, M Duff, D Burling, G Poggioli, T Akiyoshi, C Deutsch, A Renehan, IR Daniels, NJ Smart, JT Jenkins, ST O’Dwyer, O Peacock, R Kiran, NS Fearnhead, PA Sutton, D Patsouras, ML George, FD Mcdermott, DC Winter, J Beynon, R Hompes, NA Stylianides, N Rajendran, AG Heriot, DA Harris, JMD Wheeler, C Selvasekar, M Kaufman, J Armitage, S Kapur, E Hyun, F Fleming, N Campain, K Uehara, M Kraft, MS Khan, M Albert, D Shida, J Yip, JJ Smith, S Baransi, C Bergzoll, G Pellino, I Shaikh, JS McGrath, C Cotsoglou, JHW de Wilt, Y Kanemitsu, M Shaban, CT West, MA West, I Drami, C Behrenbruch, G Guerra, PS Waters, N Woodward, S Applin, SJ Charles, SA Rose, E Pape, GH van Ramshorst, AH Mirnezami, AGJ Aalbers, N Abdul Aziz, N Abecasis, M Abraham-Nordling, R Alahmadi, W Alberda, M Andric, E Angenete, R Auer, KK Austin, E Aytac, N Bacalbasa, RP Baker, M Bali, G Baseckas, B Bebington, BK Bednarski, GL Beets, PL Berg, S Biondo, L Bordeianou, E Brecelj, AB Bremers, P Buchwald, A Bui, JWA Burger, S Carvalhal, A Caycedo-Marulanda, GJ Chang, MH Chew, AK Chok, HK Christensen, H Clouston, AJ Colquhoun, J Constantinides, A Corr, M Coscia, M Cosimelli, PE Coyne, RS Croner, L Damjanovic, CP Delaney, QD Denost, D Dietz, EJ Dozois, E Drozdov, T Eglinton, JM Enrique-Navascues, E Espín-Basany, MD Evans, S Fichtner-Feigl, K Flatmark, J Folkesson, K Foskett, FA Frizelle, J Funder, MA Gallego, E García-Granero, JL García-Sabrido, VG Gava, L Gentilini, L Ghouti, F Giner, N Ginther, P Goffredo, T Golda, CM Gomez, F Gwenaël, JAW Hagemans, V Hanchanale, DP Harji, C Helbren, RM Helewa, G Hellawell, D Hochman, T Holm, A Holmström, B Hornung, S Hurton, LH Iversen, K Jourand, S Kaffenberger, GV Kandaswamy, M Kazi, SR Kelley, DS Keller, ME Kelly, S Kersting, SHJ Ketelaers, J Khaw, CE Koh, Kok NFM, R Kokelaar, C Kontovounisios, M Koutra, Kristensen HØ, M Kusters, Z Lakkis, MC Langheinrich, T Larach, SG Larsen, DW Larson, WL Law, PJ Lee, M Limbert, A Loria, ML Lydrup, AC Lynch, M Mackintosh, C Mantyh, KL Mathis, CFS Margues, A Martling, Meijerink WJHJ, A Merchea, S Merkel, AM Mehta, DR McArthur, JJ McCormick, A McPhee, J Maciel, S Malde, S Manfredelli, S Mikalauskas, D Modest, JRT Monson, JR Morton, TG Mullaney, AS Navarro, H Neeff, I Negoi, JWM Neto, MB Nielsen, GAP Nieuwenhuijzen, S Nordkamp, K Paarnio, E Pappou, AC Peterson, F Pfeffer, F Piqeur, J Pinson, A Quyn, RW Radwan, PC Rasmussen, E Rausa, SE Regenbogen, HM Reims, R Rocha, J Rohila, J Rothbarth, M Rottoli, C Roxburgh, HJT Rutten, B Safar, PM Sagar, T Sammour, AMP Schizas, E Schwarzkopf, D Scripcariu, V Scripcariu, G Seifert, P Smart, AM Solbakken, MJ Solomon, MM Sørensen, M Spasojevic, SR Steele, K Stitzenberg, L Stocchi, T Swartling, H Sumrien, T Swartking, H Takala, EJ Tan, A Tekin, PP Tekkis, J Teras, MR Thanapal, HV Thaysen, E Thorgersen, EL Toh, P Tsarkov, J Tolenaar, S Tsukamoto, JJ Tuech, WH Turner, JB Tuynman, J van Rees, D van Zoggel, W Vásquez-Jiménez, C Verhoef, M Vierimaa, ELK Voogt, C Wakeman, HH Wasmuth, MR Weiser, OL Westney, RN Yoo, MA Zappa, and L Sorrentino

Subjects
Medicine
Abstract

Introduction The empty pelvis syndrome is a significant source of morbidity following pelvic exenteration surgery. It remains poorly defined with research in this field being heterogeneous and of low quality. Furthermore, there has been minimal engagement with patient representatives following pelvic exenteration with respect to the empty pelvic syndrome. ‘PelvEx—Beating the empty pelvis syndrome’ aims to engage both patient representatives and healthcare professionals to achieve an international consensus on a core outcome set, pathophysiology and mitigation of the empty pelvis syndrome.Methods and analysis A modified-Delphi approach will be followed with a three-stage study design. First, statements will be longlisted using a recent systematic review, healthcare professional event, patient and public engagement, and Delphi piloting. Second, statements will be shortlisted using up to three rounds of online modified Delphi. Third, statements will be confirmed and instruments for measurable statements selected using a virtual patient-representative consensus meeting, and finally a face-to-face healthcare professional consensus meeting.Ethics and dissemination The University of Southampton Faculty of Medicine ethics committee has approved this protocol, which is registered as a study with the Core Outcome Measures in Effectiveness Trials Initiative. Publication of this study will increase the potential for comparative research to further understanding and prevent the empty pelvis syndrome.Trial registration number NCT05683795.

Published
2024
Full Text
View/download PDF

3. Risk of Bowel Obstruction in Patients Undergoing Neoadjuvant Chemotherapy for High-risk Colon Cancer: A Nested Case-control Matched Analysis of an International, Multi-centre, Randomised Controlled Trial (FOxTROT)

Author

Glasbey, James, Glasbey, James, Beggs, Andrew, Glimelius, Bengt, Gray, Richard, Handley, Kelly, Laurberg, Søren, Magill, Laura, Murakami, Keigo, Palmer, Andy, Quirke, Philip, Seligman, Jenny, Seymour, Matt, Sinha, Yash, West, Nick, Morton, Dion, Glasbey, James, Handley, Kelly, Palmer, Andy, Morton, Dion, Crosby, T., Olliff, J., Peto (Chair), R., Brown, Gina, Ferry, David, Glimelius, Bengt, Gray, Richard, Handley, Kelly, Ismail, Tariq, Laurberg, Søren, Magill, Laura, Morton, Dion, Oliver, Alf, Quirke, Phil, Seymour, Matt, Scott, Nigel, Seligman, Jenny, Swift, Ian, Warren, Bryan, West, Nick, Northover, J., Parmar (Chair), M., Slevin, M., Magill, Laura, Gray, Richard, Handley, Kelly, Wilcockson, Adrian, Gray, Zoe, Lancaster, Dominic, Brown, James, Palmer, Andrew, Adie, Ladan, Kennedy, Georgia, Eld, M., Holt, G., Yilmaz, M., Spendler, K. Garm, Hansen, F., Laurberg, S., Rosenkilde, M., Ahlstrom, H., Glimelius, B., Abgamu, D., Day, N., Walsh, C., Bannister, J., Furniss, D., Morgan, S., Walkington, L., Yates, S., Branagan, G., Mustajab, A., O’Neil, H., Rees, C., Geh, I., Hendrickse, C., Langman, G., Pallan, A., Conn, A., Lowe, A., Ostrowski, J., Steward, M., Callaway, M., Falk, S., Thomas, M., Wong, N., Cast, J., Hartley, J., Roy, R., Tiam, R., Blunt, D., Cleator, S., Dawson, P., Goldin, R., Gujral, D., Lowdell, C., Ziprin, P., Clenton, S., Dewdney, A., Euinton, H., Furniss, D., Gupta, R., Tarapowewalla, D., Wilshaw, V., Braun, M., Chakrabarty, B., Hill, J., Laasch, H., Saunders, M., Cruickshank, N., Davies, M., Muzaffar, S., Orme, A., Punia, P., Rea, D., Campbell, F., Hughes, M., Palmer, D., Rooney, P., Abbott, G., Hamid, B., Vimalachandran, D., Berry, J., Hinson, F., Maarouf, Z., Nicoll, J., Adams, C., Denson, J., Jackson, S., Sherriff, D., Kweka, E., McAdam, G., Peters, M., Roy, R., Khaira, M., Kurien, G., Robinson, J., Wadsley, J., White, D., Young, R., Dega, R., Lamparelli, M., Orbell, J., Osborne, R., Taylor, P., Thomas, T., Gopalakrishnan, K., Jadhav, V., Scott-Brown, M., Baijal, S., Chapman, M., Glaholm, J., Nelson, C., Singh, R., Harrison, J., Last, K., Scott, D., Scullion, D., Lind, P., Milosavljevic, Z., Dent, J., Ilsley, D., Littleford, S., Roberts, C., Crabtree, M., Orrell, J., Sherwin, E., Smith, S., Soomal, R., Braun, M., De, A., Khan, A., Khan, U., Lavin, V., McBain, C., Radharkrishna, G., Sil, R., Weerasinghe, S., Hill, J., Lee, S., Wright, P., Church, R., Holland, C., Kunene, V., Thompson, A., Glynne-Jones, R., Goh, V., Livingstone, J., Richman, P., Barlow, C., Burn, P., Geraghty, J., Walther, J., Grumett, S., Mangalika, S., Qaiyum, M., Williams, G., Borgstein, R., Bridgewater, J., Melville, D., Rees, J., Coxon, F., Hainsworth, P., Needham, S., Scott, J., Asmussen, J., Hansen, T., Jensen, K., Pfeiffer, P., Alkhaldi, A., Brittenden, J., Jackson, A., Kamposioras, K., Kumaran, G., Macklin, C., Alexander, J., Harle, A., Hickish, T., Talbot, R., Tarver, D., Bridgewater, J., Partridge, W., Sundaresan, V., Vivekanandan, S., Agrawal, N., Higginson, A., Muthuramalingam, S., O’Leary, D., Devarajan, G., Gulati, M., Kerwat, R., Maisey, N., Mikhaeel, G., Ismail, T., Middleton, G., Page, A., Steven, N., Taniere, P., Gutmann, J., Huang, J., Raouf, S., Dunn, W., Escola, C. Lopez, Potter, V., Scholefield, J., Walker, G., Zaitoun, A., Eason, D., McPhail, N., Mmeka, W., Stenhouse, G., Watson, A., Fozard, B., Hickish, T., Snape, S., Ellis, R., Faux, W., Jenkins, R., Maskell, G., Kulkarni, R., Lund, J., Menon, S., Singh, R., Chandler, I., Daniels, I., Harries, S., Osborne, M., Bell, J., Krell, D., Mayer, A., Ogunbiyi, O., Watkins, J., Bronder, C., Eaton, D., Taylor, A., Brown, G., Cunningham, D., Tekkis, P., Wotherspoon, A., Dobson, M., Mitchell, P., Pitt, M., Scott, N., Susnerwala, S., Adab, F., Britton, I., Ghiridaran, S., Howitt, C., Kirby, R., Biddlestone, L., Dalton, S., De Winton, E., Phillips, A., Ferry, D., Grumett, S., Kawesha, A., Maleki, K., Momtahan, N., Burnett, H., Hayes, S., Soop, M., Branagan, G., Cook, I., Cook, S., Iveson, T., Shablak, A., Coup, A., Hamid, A., Moore, P., O’Toole, L., Pai, D., Bateman, A., Bateman, A., Blaquiere, R., Nichols, P., Chappell, M., Dworkin, M., Jain, S., Tsang, D., Hopkins, K., Loveday, E., Lyons, A., Rooney, N., Ali, N., Chatterjee, M., Chiphang, A., Dundas, S., Myint, A. Sun, Zeiderman, M., Beharry, N., Chong, H., Lofts, F., Melville, D., Finan, P., Seymour, M., Tolan, D., West, N., Anyamene, N., Burling, D., Kennedy, R., Moorghen, M., Agrawal, S., Hasan, J., Mehta, S., Saeed, M., Burgess, P., John, L., Lowndes, S., Planner, A., Campbell, F., Hughes, M., Rooney, P., Smith, D., Hochhauser, D., Obichere, A., Rodriguez-Justo, M., Shiu, K., Taylor, S., Correa, P., James, S., Shatwell, W., Williams, N., Brady, J., Lanaspre, E., Mikhaeel, G., Ahmad, M., Gill, T., Wilson, D., Adams, R., Beehen, R., Morgan, M., Lindh, B., Adams, R., Morgan, M., Ford, A., Gopal, K., Pranesh, N., Shareef, D., Tighe, M., Busby, K., Correa, P., Sanders, S., Sinha, R., Ahmad, R., Desai, S., Ramesh, S., Hilman, S., Lott, M., O’Brien, J., Radstone, D., West, D., Amin, S., Hampton, J., Hornbuckle, J., Kitsanta, P., Ali, M., Desai, A., Hadaki, M., Hall, M., Arul, D., Hochhauser, D., Leonard, P., Mukhtar, H., Murray, D., Baxter, A., Churn, M., Farrugia, D., Lake, S., Smith, G., Bansal, A., Chandran, P., Corr, C., Gollins, S., Davenport, A., Saunders, M., Sukumar, S., Bathurst, N., Beaumont, E., Cooper, E., Francis, N., Sephton, M., Sparrow, G., Clarke, A., Haselden, J., Last, K., Woodcock, N., Atkinson, M., Gollins, S., Gupta, M., Maw, A., Abdullah, N., Bale, C., and Lord, M.

Published
2023
Full Text
View/download PDF

9. Post-Operative Functional Outcomes in Early Age Onset Rectal Cancer

Author

REACCT Collaborative, Lauren V. O’Connell, Alexandra M. Zaborowski, Ahmed Abdile, Michel Adamina, Felix Aigner, Laura d’Allens, Caterina Allmer, Andrea Álvarez, Rocio Anula, Mihailo Andric, Sam Atallah Simon Bach, Miklosh Bala, Marie Barussaud, Augustinas Bausys, Andrew Beggs, Felipe Bellolio, Melissa-Rose Bennett, Vicki Bevan, Sebastiano Biondo, Gabriele Bislenghi, Marc Bludau, Carl Brown, Christiane Bruns, Daniel D. Buchanan, Pamela Buchwald, Jacobus W.A. Burger, Nikita Burlov, Michela Campanelli, Maylis Capdepont, Michele Carvello, Hwee-Hoon Chew, Dimitri Christoforidis, David Clark, Marta Climent, Rowan Collinson, Kyle G. Cologne, Tomas Contreras, Roland Croner, Ian R. Daniels, Giovanni Dapri, Justin Davies, Paolo Delrio, Quentin Denost, Michael Deutsch, Andre Dias, André D’Hoore, Evgeniy Drozdov, Daniel Duek, Malcolm Dunlop, Adam Dziki, Aleksandra Edmundson, Sergey Efetov, Alaa El-Hussuna, Brodie Elliott, Sameh Emile, Eloy Espin-Basany, Martyn Evans, Seraina Faes, Omar Faiz, Nuno Figueiredo, Fergal Fleming, Caterina Foppa, George Fowler, Matteo Frasson, Tim Forgan, Frank Frizelle, Shamil Gadaev, Jose Gellona, Tamara Glyn, Barisic Goran, Emma Greenwood, Marianne G. Guren, Stephanie Guillon, Ida Gutlic, Dieter Hahnloser, Heather Hampel, Ann Hanly, Hirotoshi Hasegawa, Lene Hjerrild Iversen, Andrew Hill, James Hill, Jiri Hoch, Roel Hompes, Luis Hurtado, Fabiano Iaquinandi, Ugne Imbrasaite, Rumana Islam, Mehrenah D Jafari, Andrea Jiménez Salido, Marta Jiménez-Toscano, Yukihide Kanemitsu, Aleksei Karachun, Ahmer A. Karimuddin, Deborah S. Keller, Justin Kelly, Rory Kennelly, Gleb Khrykov, Petr Kocian, Cherry Koh, Neils Kok, Katrina A. Knight, Joep Knol, Christos Kontovounisios, Hartwig Korner, Zoran Krivokapic, Irmgard Kronberger, Hidde Maarten Kroon, Marius Kryzauskas, Said Kural, Miranda Kusters, Zaher Lakkis, Timur Lankov, David Larson, György Lázár, Kai-Yin Lee, Suk Hwan Lee, Jérémie H. Lefèvre, Anna Lepisto, Christopher Lieu, Lynette Loi, Craig Lynch, Helene Maillou-Martinaud, Annalisa Maroli, Sean T. Martin, Anna Martling, Klaus E. Matzel, Julio Mayol, Frank McDermott, Guillaume Meurette, Monica Millan, Martin Mitteregger, Andrei Moiseenko, John RT. Monson, Stefan Morarasu, Konosuke Moritani, Gabriela Möslein, Martino Munini, Caio Nahas, Sergio Nahas, Ionut Negoi, Anastasia Novikova, Misael Ocares, Koji Okabayashi, Alexandra Olkina, Luis Oñate-Ocaña, Jaime Otero, Cihan Ozen, Ugo Pace, Guilherme Pagin São Julião, Lidiia Panaiotti, Yves Panis, Demetris Papamichael, Swati Patel, Juan Carlos Patrón Uriburu, Sze-Lin Peng, Miguel Pera, Rodrigo O. Perez, Alexei Petrov, Frank Pfeffer, Terry P. Phang, Tomas Poskus, Heather Pringle, David Proud, Ivana Raguz, Nuno Rama, Shahnawaz Rasheed, Manoj J. Raval, Daniela Rega, Christoph Reissfelder, Juan Carlos Reyes Meneses, Frederic Ris, Stefan Riss, Homero Rodriguez-Zentner, Campbell S Roxburgh, Avanish Saklani, Tarik Sammour, Deborah Saraste, Martin Schneider, Ryo Seishima, Aleksandar Sekulic, Toni Seppala, Kieran Sheahan, Alexandra Shlomina, Guiseppe Sica, Tongplaew Singnomklao, Leandro Siragusa, Neil Smart, Alejandro Solis-Peña, Antonino Spinelli, Roxane D. Staiger, Michael J. Stamos, Scott Steele, Ker-Kan Tan, Pieter J Tanis, Paris Tekkis, Biniam Teklay, Sabrina Tengku, Petr Tsarkov, Matthias Turina, Alexis Ulrich, Bruna B. Vailati, Meike van Harten, Cornelis Verhoef, Satish Warrier, Steven Wexner, Benjamin A. Weinberg, Cameron Wells, Albert Wolthuis, Evangelos Xynos, Nancy You, Alexander Zakharenko, Justino Zeballos, Youzhi Zhou, and Des C. Winter

Subjects
functional outcome, young rectal cancer, patient reported outcome (PROM), rectal cancer, early onset rectal cancer, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

BackgroundImpairment of bowel, urogenital and fertility-related function in patients treated for rectal cancer is common. While the rate of rectal cancer in the young (

Published
2022
Full Text
View/download PDF

11. The role of Neurotensin and its receptors in non-gastrointestinal cancers: a review

Author

Stella Nikolaou, Shengyang Qiu, Francesca Fiorentino, Constantinos Simillis, Shahnawaz Rasheed, Paris Tekkis, and Christos Kontovounisios

Subjects
Neurotensin, Neurotensin receptors, Cancer, Medicine, Cytology, QH573-671
Abstract

Abstract Background Neurotensin, originally isolated in 1973 has both endocrine and neuromodulator activity and acts through its three main receptors. Their role in promoting tumour cell proliferation, migration, DNA synthesis has been studied in a wide range of cancers. Expression of Neurotensin and its receptors has also been correlated to prognosis and prediction to treatment. Main body The effects of NT are mediated through mitogen-activated protein kinases, epidermal growth factor receptors and phosphatidylinositol-3 kinases amongst others. This review is a comprehensive summary of the molecular pathways by which Neurotensin and its receptors act in cancer cells. Conclusion Identifying the role of Neurotensin in the underlying molecular mechanisms in various cancers can give way to developing new agnostic drugs and personalizing treatment according to the genomic structure of various cancers. Video abstract

Published
2020
Full Text
View/download PDF

12. Facilitating the Adoption and Evolution of Digital Technologies Through Re-conceptualization

Author

Nicholas Pari Tekkis, Rebecca Richmond-Smith, Gianluca Pellino, and Christos Kontovounisios

Subjects
3D printing, imaging, innovation, healthcare system, layered modular architecture, Surgery, RD1-811
Abstract

BackgroundThe NHS has been making steps toward greater efficiency and cutting costs to maintain quality of care despite constraints, but without innovation the NHS will not be able to meet its increasing financial demands. The purpose of this article is to analyse a single potentially transformative technology's path of adoption in the NHS [3D printing (3DP)].MethodsAnalysis of 3DP and its current value propositions. Re-conceptualization of the technology to gain insights into these value propositions and identify the capabilities it may provide. Analysis of previous business models to identify where this value is not fully captured and development of a new business model, followed by exploration of benefits and potential limitations of this new model.Results3D printing applications can be broadly categorized into anatomical modeling, implants, and tools. Conceptualizing 3D imaging using the layered architecture model suggests the potential of 3DP to evolve the current imaging and modeling infrastructure of the NHS, and as such should be adopted to facilitate this potential.Conclusion3D printing is an innovation with large potential for generativity, and it is important that it is integrated at a level that could both stimulate and communicate its benefits. Re-conceptualization identified a backbone within the NHS that could facilitate it as a point of entry, and the most successful installations have been through this channel. However, progress on the frontier is currently limited by both physical and organizational boundaries, the resolution of which is paramount for the current and future success of this technology.

Published
2022
Full Text
View/download PDF

15. Anorectal Manometry Versus Patient-Reported Outcome Measures as a Predictor of Maximal Treatment for Fecal Incontinence

Author

Lisa Ramage, Shengyang Qiu, Zhu Yeap, Constantinos Simillis, Christos Kontovounisios, Paris Tekkis, and Emile Tan

Subjects
anorectal physiology, anorectal manometry, patient-reported outcome measures, fecal incontinence, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Purpose This study aims to establish the ability of patient-reported outcome measures (PROMs) and anorectal manometry (ARM) in predicting the need for surgery in patients with fecal incontinence (FI). Methods Between 2008 and 2015, PROMs data, including the Birmingham Bowel and Urinary Symptoms Questionnaire (BBUSQ), Short Form 36 (SF-36), Wexner Incontinence Score and ARM results, were prospectively collected from 276 patients presenting with FI. Spearman rank was used to assess correlations between specific PROMs questions and ARM assessments of sphincter motor function. Binomial regression analyses were performed to identify factors predictive of the need for surgery. Finally, receiver operating characteristic (ROC) curve analyses were performed to establish the utility of individual ARM and PROMs variables in predicting the need for surgical intervention in patients with FI. Results Two hundred twenty-eight patients (82.60%) were treated conservatively while 48 (17.39%) underwent surgery. On univariate analyses, all 4 domains of the BBUSQ, all 8 domains of the SF-36, and the Wexner Incontinence Score were significant predictors of surgery. Additionally, maximum resting pressure, 5-second squeeze endurance, threshold volume, and urge volume were significant. On ROC curve analyses, the only significant ARM measurement was the 5-second squeeze endurance. PROMs, such as the incontinence domain of the BBUSQ and five of the SF-36 domains, were identified as fair discriminators of the need for surgery. Conclusion PROMs are reliable predictors of maximal treatment in patients with FI and can be readily used in primary care to aid surgical referrals and can be applied in hospital settings as an aid to guide surgical treatment decisions.

Published
2019
Full Text
View/download PDF

16. An unusual rectal duplication cyst

Author

Sofia Anastasiadou, Paris Tekkis, and Christos Kontovounisios

Subjects
Rectal duplication cyst, Gastrointestinal congenital cyst, Retrorectal development cyst, Rectal mass, Surgery, RD1-811
Abstract

Abstract Background Rectal duplication cysts are rare gastrointestinal congenital duplicate cysts with various clinical presentations that require different management. Case presentation We present a case of a lady with a double rectal duplicate cyst which was found incidentally on a follow-up CT abdomen and pelvis scan. The patient initially had a mucocele excision, and following that, she had a non-contrast CT abdomen and pelvis to investigate post-operative pain. The CT scan revealed a single rectal duplicate cyst. She had a posterior approach excision to have it removed, and only intra-operatively, she was found to have a double rectal duplicate cyst. She had them both removed via a midline incision running from the perineal pigmentation and extending until the coccyx. She had another follow-up CT which showed complete excision of the cysts. Conclusions After a thorough review of the literature regarding rectal cysts, there was no mention of a double rectal duplicate cyst. The purpose of this paper is to point out the various potential presentations of a rectal cyst as well as the idea that a double cyst is managed effectively in a similar way as the single one.

Published
2019
Full Text
View/download PDF

17. Correction to: Inflammatory bowel disease patients requiring surgery can be treated in referral centres regardless of the COVID-19 status of the hospital: results of a multicentric European study during the first COVID-19 outbreak (COVIBD-Surg)

Author

Rottoli, Matteo, Pellino, Gianluca, Tanzanu, Marta, Baldi, Caterina, Frontali, Alice, Carvello, Michele, Foppa, Caterina, Kontovounisios, Christos, Tekkis, Paris, Colombo, Francesco, Sancho-Muriel, Jorge, Frasson, Matteo, Danelli, Piergiorgio, Celentano, Valerio, Spinelli, Antonino, Panis, Yves, Sampietro, Gianluca M., and Poggioli, Gilberto

Published
2022
Full Text
View/download PDF

33. A rectal cancer feasibility study with an embedded phase III trial design assessing magnetic resonance tumour regression grade (mrTRG) as a novel biomarker to stratify management by good and poor response to chemoradiotherapy (TRIGGER): study protocol for a randomised controlled trial

Author

Nick J. Battersby, Mit Dattani, Sheela Rao, David Cunningham, Diana Tait, Richard Adams, Brendan J. Moran, Shelize Khakoo, Paris Tekkis, Shahnawaz Rasheed, Alex Mirnezami, Philip Quirke, Nicholas P. West, Iris Nagtegaal, Irene Chong, Anguraj Sadanandam, Nicola Valeri, Karen Thomas, Michelle Frost, and Gina Brown

Subjects
Randomised control trial, Chemoradiotherapy, Rectal cancer, mrTRG, Complete response, Tumour regression, Medicine (General), R5-920
Abstract

Abstract Background Pre-operative chemoradiotherapy (CRT) for MRI-defined, locally advanced rectal cancer is primarily intended to reduce local recurrence rates by downstaging tumours, enabling an improved likelihood of curative resection. However, in a subset of patients complete tumour regression occurs implying that no viable tumour is present within the surgical specimen. This raises the possibility that surgery may have been avoided. It is also recognised that response to CRT is a key determinant of prognosis. Recent radiological advances enable this response to be assessed pre-operatively using the MRI tumour regression grade (mrTRG). Potentially, this allows modification of the baseline MRI-derived treatment strategy. Hence, in a ‘good’ mrTRG responder, with little or no evidence of tumour, surgery may be deferred. Conversely, a ‘poor response’ identifies an adverse prognostic group which may benefit from additional pre-operative therapy. Methods/design TRIGGER is a multicentre, open, interventional, randomised control feasibility study with an embedded phase III design. Patients with MRI-defined, locally advanced rectal adenocarcinoma deemed to require CRT will be eligible for recruitment. During CRT, patients will be randomised (1:2) between conventional management, according to baseline MRI, versus mrTRG-directed management. The primary endpoint of the feasibility phase is to assess the rate of patient recruitment and randomisation. Secondary endpoints include the rate of unit recruitment, acute drug toxicity, reproducibility of mrTRG reporting, surgical morbidity, pathological circumferential resection margin involvement, pathology regression grade, residual tumour cell density and surgical/specimen quality rates. The phase III trial will focus on long-term safety, regrowth rates, oncological survival analysis, quality of life and health economics analysis. Discussion The TRIGGER trial aims to determine whether patients with locally advanced rectal cancer can be recruited and subsequently randomised into a control trial that offers MRI-directed patient management according to radiological response to CRT (mrTRG). The feasibility study will inform a phase III trial design investigating stratified treatment of good and poor responders according to 3-year disease-free survival, colostomy-free survival as well as an increase in cases managed without a major resection. Trial registration ClinicalTrials.gov, ID: NCT02704520 . Registered on 5 February 2016.

Published
2017
Full Text
View/download PDF

34. Squamous Cell Carcinoma of the Anal Transitional Zone after Ileal Pouch Surgery for Ulcerative Colitis: Systematic Review and Treatment Perspectives

Author

Gianluca Pellino, Christos Kontovounisios, Diana Tait, John Nicholls, and Paris P. Tekkis

Subjects
Squamous cell carcinoma, Pouch, Ulcerative colitis, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Background: Few cases of pouch-related cancers have been reported in ulcerative colitis (UC), and squamous cell carcinoma (SCC) is very rare. Method: A systematic review of the literature was performed to identify all unequivocal cases of pouch-related SCC in UC patients. Results: Eight cases of SCC developing after ileal pouch-anal anastomosis (IPAA) have been observed since 1978. Two arose from the pouch mucosa and 6 from below. The pooled cumulative incidence of SCC is below 0.06% after IPAA. Many patients had neoplasia on the preoperative specimen, but squamous metaplasia of the pouch or anorectal mucosa may have an important role in SCC. These patients are rarely offered chemoradiation therapy and the outcome is poor. Selected patients with SCC located close to the pouch outlet can be treated with chemoradiation prior to consideration of surgery and salvage their pouch. A chemoradiation regimen is suggested to avoid pouch excision in these patients. Conclusions: SCC is rare after pouch surgery but associated with extremely poor survival. Very low SCC can be managed with chemoradiation treatment, preserving the pouch and avoiding surgery, even in older patients. The role of pouch metaplasia, surveillance frequency, and treatment modalities after IPAA need further studying.

Published
2017
Full Text
View/download PDF

36. Is Rectal Washout Effective for Preventing Localized Recurrence After Anterior Resection for Rectal Cancer?

Author

Constantinides, Vasilis, Cheetham, Dorstan, Nicholls, R., and Tekkis, Paris

Abstract

Abstract: PURPOSE: The present study evaluated the effect of rectal washout in reducing local recurrence after resection for rectal cancer. METHODS: A literature search was performed on studies published since 1989 that compared rectal washout to no washout for rectal cancer resection. Primary end point was local cancer recurrence. Random-effect meta-analysis was used and subgroup analysis was performed. RESULTS: Five studies matched the selection criteria, and reported on 176 patients who underwent rectal washout and 256 who did not undergo washout. Different washout solutions were used in every study, and total mesorectal excision was not universally applied. Overall local recurrence rate was 8 percent (33/432). Local recurrence rate for rectal washout patients was 4.8 percent compared with 10.2 percent for patients who did not undergo rectal washout, a difference that was not statistically significant (odds ratio = 0.64; 95 percent confidence interval = 0.2–2.04). When only studies using total mesorectal excision were considered, there was no significant difference between the two groups (odds ratio = 1.21; 95 percent confidence interval = 0.37–3.92). CONCLUSIONS: Although no definitive conclusions may be drawn because of the nonrandomized nature of the included studies, rectal washout is relatively risk-free and adds little to the operative time. This may be performed until a randomized, controlled trial is undertaken to resolve this contentious issue.

Published
2024
Full Text
View/download PDF

38. St.Gallen consensus on safe implementation of transanal total mesorectal excision

Author

Adamina, Michel, Buchs, Nicolas C., Penna, Marta, Hompes, Roel, Adamina, Michel, Aigner, Felix, Albert, Matthew, Bell, Stephen, Bemelman, Willem, Boni, Luigi, Brown, Carl J., Brown, Gina, Buchs, Nicolas C., Grieder, Felix, Güller, Ulrich, Hompes, Roel, d’Hoore, André, Huscher, Cristiano, Ito, Masaaki, Kneist, Werner, Knol, Joep, Lacy, Antonio, Maykel, Justin, Merrie, Arend, Oh, Jae Hwan, Panis, Yves, Penna, Marta, Perez, Rodrigo Oliva, Pfeffer, Frank, Quirke, Philip, Rouanet, Philippe, Rullier, Eric, Seitinger, Gerald, Sietses, Colin, Spinelli, Antonino, Stevenson, Andrew R. L., Sylla, Patricia, Tekkis, Paris, Tuech, Jean-Jacques, Tuynman, Jurriaan, Warusavitarne, Janindra, Whiteford, Mark, Winter, Des, Wolthuis, Albert, and on behalf of the St.Gallen Colorectal Consensus Expert Group

Published
2017
Full Text
View/download PDF

46. A novel methodology for in vivo endoscopic phenotyping of colorectal cancer based on real-time analysis of the mucosal lipidome: a prospective observational study of the iKnife

Author

Alexander, James, Gildea, Louise, Balog, Julia, Speller, Abigail, McKenzie, James, Muirhead, Laura, Scott, Alasdair, Kontovounisios, Christos, Rasheed, Shanawaz, Teare, Julian, Hoare, Jonathan, Veselkov, Kirill, Goldin, Robert, Tekkis, Paris, Darzi, Ara, Nicholson, Jeremy, Kinross, James, and Takats, Zoltan

Published
2017
Full Text
View/download PDF

47. Characterisation of the Expression of Neurotensin and Its Receptors in Human Colorectal Cancer and Its Clinical Implications

Author

Shengyang Qiu, Stella Nikolaou, Jie Zhu, Peter Jeffery, Robert Goldin, James Kinross, James L. Alexander, Shahnawaz Rasheed, Paris Tekkis, and Christos Kontovounisios

Subjects
colorectal cancer, biomarker, neurotensin, Microbiology, QR1-502
Abstract

Introduction: Colorectal Cancer (CRC) accounts for 9% of cancer deaths globally. Hormonal pathways play important roles in some cancers. This study investigated the association of CRC expression of neurotensin (NTS), NTS receptors 1 and 3 (NTSR1 and NTSR3) and clinical outcomes. Methods: A prospective cohort study which quantifies the protein expression of NTS, NTSR1 and NTSR3 in human CRCs using immunohistochemistry. Expression levels were then compared with clinico-pathological outcome including histological grade, overall survival (OS) and disease-free survival (DFS). Results: Sixty-four patients were enrolled with median follow-up of 44.0 months. There was significantly higher expression of NTS in cancer tissue in CRC with higher T stages (p < 0.01), N stages (p = 0.03), and AJCC clinical stages (p = 0.04). There was significantly higher expression of NTS, NTSR1 and NTSR3 in cancer tissue compared to surrounding normal epithelium (median H-score 163.5 vs 97.3, p < 0.01). There was significantly shorter DFS in individuals with CRC with high levels of NTS compared to lower levels of NTS (35.8 months 95% CI 28.7–42.8 months vs 46.4 months 95% CI 42.2–50.5 months, respectively, p = 0.02). Above median NTS expression in cancer tissue was a significant risk factor for disease recurrence (HR 4.10, 95% CI 1.14–14.7, p = 0.03). Discussion: The expression of NTS and its receptors has the potential to be utilised as a predictive and prognostic marker in colorectal cancer for postoperative selection for adjuvant therapy and identify individuals for novel therapies targeting the neurotensinergic pathways. Conclusions: High NTS expression appears to be associated with more advanced CRC and worse DFS.

Published
2020
Full Text
View/download PDF

49. Simultaneous pelvic exenteration and liver resection for primary rectal cancer with synchronous liver metastases: results from the PelvEx Collaborative

Author

Kelly, M. E., Aalbers, A. G. J., Abdul Aziz, N., Abecasis, N., Abraham‐Nordling, M., Akiyoshi, T., Alberda, W., Albert, M., Andric, M., Angenete, E., Antoniou, A., Auer, R., Austin, K. K., Aziz, O., Baker, R. P., Bali, M., Baseckas, G., Bebington, B., Bednarski, B. K., Beets, G. L., Berg, P. L., Beynon, J., Biondo, S., Boyle, K., Bordeianou, L., Bremers, A. B., Brunner, M., Buchwald, P., Bui, A., Burgess, A., Burger, J. W. A., Burling, D., Burns, E., Campain, N., Carvalhal, S., Castro, L., Caycedo‐Marulanda, A., Chan, K. K. L., Chang, G. J., Chew, M. H., Chong, P. C., Christensen, H. K., Clouston, H., Codd, M., Collins, D., Colquhoun, A. J., Corr, A., Coscia, M., Coyne, P. E., Creavin, B., Croner, R. S., Damjanovic, L., Daniels, I. R., Davies, M., Davies, R. J., Delaney, C. P., Denost, Q., Deutsch, C., Dietz, D., Domingo, S., Dozois, E. J., Duff, M., Eglinton, T., Enrique‐Navascues, J. M., Espin‐Basany, E., Evans, M. D., Fearnhead, N. S., Flatmark, K., Fleming, F., Frizelle, F. A., Gallego, M. A., Garcia‐Granero, E., Garcia‐Sabrido, J. L., Gentilini, L., George, M. L., Ghouti, L., Giner, F., Ginther, N., Glynn, R., Golda, T., Griffiths, B., Harris, D. A., Hagemans, J. A. W., Hanchanale, V., Harji, D. P., Helewa, R. M., Heriot, A. G., Hochman, D., Hohenberger, W., Holm, T., Hompes, R., Jenkins, J. T., Kaffenberger, S., Kandaswamy, G. V., Kapur, S., Kanemitsu, Y., Kelley, S. R., Keller, D. S., Khan, M. S., Kiran, R. P., Kim, H., Kim, H. J., Koh, C. E., Kok, N. F. M., Kokelaar, R., Kontovounisios, C., Kristensen, H. Ø., Kroon, H. M., Kusters, M., Lago, V., Larsen, S. G., Larson, D. W., Law, W. L., Laurberg, S., Lee, P. J., Limbert, M., Lydrup, M. L., Lyons, A., Lynch, A. C., Mantyh, C., Mathis, K. L., Margues, C. F. S., Martling, A., Meijerink, W. J. H. J., Merkel, S., Mehta, A. M., McArthur, D. R., McDermott, F. D., McGrath, J. S., Malde, S., Mirnezami, A., Monson, J. R. T., Morton, J. R., Mullaney, T. G., Negoi, I., Neto, J. W. M., Nguyen, B., Nielsen, M. B., Nieuwenhuijzen, G. A. P., Nilsson, P. J., O’Connell, P. R., O’Dwyer, S. T., Palmer, G., Pappou, E., Park, J., Patsouras, D., Pellino, G., Peterson, A. C., Poggioli, G., Proud, D., Quinn, M., Quyn, A., Radwan, R. W., van Ramshorst, G. H., Rasheed, S., Rasmussen, P. C., Regenbogen, S. E., Renehan, A., Rocha, R., Rochester, M., Rohila, J., Rothbarth, J., Rottoli, M., Roxburgh, C., Rutten, H. J. T., Ryan, É. J., Safar, B., Sagar, P. M., Sahai, A., Saklani, A., Sammour, T., Sayyed, R., Schizas, A. M. P., Schwarzkopf, E., Scripcariu, V., Selvasekar, C., Shaikh, I., Hellawell, G., Shida, D., Simpson, A., Smart, N. J., Smart, P., Smith, J. J., Solbakken, A. M., Solomon, M. J., Sørensen, M. M., Steele, S. R., Steffens, D., Stitzenberg, K., Stocchi, L., Stylianides, N. A., Sumrien, H., Sutton, P. A., Swartking, T., Taylor, C., Tekkis, P. P., Teras, J., Thurairaja, R., Toh, E. L., Tsarkov, P., Tsukada, Y., Tsukamoto, S., Tuech, J. J., Turner, W. H., Tuynman, J. B., Vasquez‐Jimenez, W., Verhoef, C., Vizzielli, G., Voogt, E. L. K., Uehara, K., Wakeman, C., Warrier, S., Wasmuth, H. H., Weber, K., Weiser, M. R., Wheeler, J. M. D., Wild, J., Wilson, M., de Wilt, J. H. W., Wolthuis, A., Yano, H., Yip, B., Yip, J., Yoo, R. N., van Zoggel, D., Winter, D. C., Kelly, M. E., Aalbers, A. G. J., Abdul Aziz, N., Abecasis, N., Abraham‐nordling, M., Akiyoshi, T., Alberda, W., Albert, M., Andric, M., Angenete, E., Antoniou, A., Auer, R., Austin, K. K., Aziz, O., Baker, R. P., Bali, M., Baseckas, G., Bebington, B., Bednarski, B. K., Beets, G. L., Berg, P. L., Beynon, J., Biondo, S., Boyle, K., Bordeianou, L., Bremers, A. B., Brunner, M., Buchwald, P., Bui, A., Burgess, A., Burger, J. W. A., Burling, D., Burns, E., Campain, N., Carvalhal, S., Castro, L., Caycedo‐marulanda, A., Chan, K. K. L., Chang, G. J., Chew, M. H., Chong, P. C., Christensen, H. K., Clouston, H., Codd, M., Collins, D., Colquhoun, A. J., Corr, A., Coscia, M., Coyne, P. E., Creavin, B., Croner, R. S., Damjanovic, L., Daniels, I. R., Davies, M., Davies, R. J., Delaney, C. P., Denost, Q., Deutsch, C., Dietz, D., Domingo, S., Dozois, E. J., Duff, M., Eglinton, T., Enrique‐navascues, J. M., Espin‐basany, E., Evans, M. D., Fearnhead, N. S., Flatmark, K., Fleming, F., Frizelle, F. A., Gallego, M. A., Garcia‐granero, E., Garcia‐sabrido, J. L., Gentilini, L., George, M. L., Ghouti, L., Giner, F., Ginther, N., Glynn, R., Golda, T., Griffiths, B., Harris, D. A., Hagemans, J. A. W., Hanchanale, V., Harji, D. P., Helewa, R. M., Heriot, A. G., Hochman, D., Hohenberger, W., Holm, T., Hompes, R., Jenkins, J. T., Kaffenberger, S., Kandaswamy, G. V., Kapur, S., Kanemitsu, Y., Kelley, S. R., Keller, D. S., Khan, M. S., Kiran, R. P., Kim, H., Kim, H. J., Koh, C. E., Kok, N. F. M., Kokelaar, R., Kontovounisios, C., Kristensen, H. Ø., Kroon, H. M., Kusters, M., Lago, V., Larsen, S. G., Larson, D. W., Law, W. L., Laurberg, S., Lee, P. J., Limbert, M., Lydrup, M. L., Lyons, A., Lynch, A. C., Mantyh, C., Mathis, K. L., Margues, C. F. S., Martling, A., Meijerink, W. J. H. J., Merkel, S., Mehta, A. M., Mcarthur, D. R., Mcdermott, F. D., Mcgrath, J. S., Malde, S., Mirnezami, A., Monson, J. R. T., Morton, J. R., Mullaney, T. G., Negoi, I., Neto, J. W. M., Nguyen, B., Nielsen, M. B., Nieuwenhuijzen, G. A. P., Nilsson, P. J., O’Connell, P. R., O’Dwyer, S. T., Palmer, G., Pappou, E., Park, J., Patsouras, D., Pellino, G., Peterson, A. C., Poggioli, G., Proud, D., Quinn, M., Quyn, A., Radwan, R. W., van Ramshorst, G. H., Rasheed, S., Rasmussen, P. C., Regenbogen, S. E., Renehan, A., Rocha, R., Rochester, M., Rohila, J., Rothbarth, J., Rottoli, M., Roxburgh, C., Rutten, H. J. T., Ryan, É. J., Safar, B., Sagar, P. M., Sahai, A., Saklani, A., Sammour, T., Sayyed, R., Schizas, A. M. P., Schwarzkopf, E., Scripcariu, V., Selvasekar, C., Shaikh, I., Hellawell, G., Shida, D., Simpson, A., Smart, N. J., Smart, P., Smith, J. J., Solbakken, A. M., Solomon, M. J., Sørensen, M. M., Steele, S. R., Steffens, D., Stitzenberg, K., Stocchi, L., Stylianides, N. A., Sumrien, H., Sutton, P. A., Swartking, T., Taylor, C., Tekkis, P. P., Teras, J., Thurairaja, R., Toh, E. L., Tsarkov, P., Tsukada, Y., Tsukamoto, S., Tuech, J. J., Turner, W. H., Tuynman, J. B., Vasquez‐jimenez, W., Verhoef, C., Vizzielli, G., Voogt, E. L. K., Uehara, K., Wakeman, C., Warrier, S., Wasmuth, H. H., Weber, K., Weiser, M. R., Wheeler, J. M. D., Wild, J., Wilson, M., de Wilt, J. H. W., Wolthuis, A., Yano, H., Yip, B., Yip, J., Yoo, R. N., van Zoggel, D., Winter, D. C., Kelly, ME, Aalbers, AGJ, Aziz, NA, Abecasis, N, Abraham-Nordling, M, Akiyoshi, T, Alberda, W, Albert, M, Andric, M, Angenete, E, Antoniou, A, Auer, R, Austin, KK, Aziz, O, Baker, RP, Bali, M, Baseckas, G, Bebington, B, Bednarski, BK, Beets, GL, Berg, PL, Beynon, J, Biondo, S, Boyle, K, Bordeianou, L, Bremers, AB, Brunner, M, Buchwald, P, Bui, A, Burgess, A, Burger, JWA, Burling, D, Burns, E, Campain, N, Carvalhal, S, Castro, L, Caycedo-Marulanda, A, Chan, KKL, Chew, GJH, Chong, PC, Christensen, HK, Clouston, H, Codd, M, Coffins, D, Colquhoun, AJ, Corr, A, Coscia, M, Coyne, PE, Creavin, B, Croner, RS, Damjanovic, L, Daniels, R, Davies, M, Davies, RJ, Delaney, CP, Denost, Q, Deutsch, C, Dietz, D, Domingo, S, Dozois, EJ, Duff, M, Eglinton, T, Enrique-Navascues, JM, Espin-Basany, E, Evans, MD, Fearnhead, NS, Flatmark, K, Fleming, F, Frizelle, FA, Gallego, MA, Garcia-Granero, E, Garcia-Sabrido, JL, Gentilini, L, George, ML, Ghouti, L, Giner, F, Ginther, N, Glynn, R, Golda, T, Griffiths, B, Harris, DA, Hagemans, JAW, Hanchanale, V, Harji, DP, Helewa, RM, Heriot, AG, Hochman, D, Hohenberger, W, Holm, T, Hompes, R, Jenkins, JT, Kaffenberger, S, Kandaswamy, GV, Kapur, S, Kanemitsu, Y, Kelley, SR, Keller, DS, Khan, MS, Kiran, RP, Kim, H, Kim, HJ, Koh, CE, Kok, NFM, Kokelaar, R, Kontovounisios, C, Kristensen, HO, Kroon, HM, Kusters, M, Lago, V, Larsen, SG, Larson, DW, Law, WL, Laurberg, S, Lee, PJ, Limbert, M, Lydrup, ML, Lyons, A, Lynch, AC, Mantyh, C, Mathis, KL, Margues, CFS, Martling, A, Meijerink, WJHJ, Merkel, S, Mehta, AM, McArthur, DR, McDermott, FD, McGrath, JS, Malde, S, Mimezami, A, Monson, JRT, Morton, JR, Mullaney, TG, Negoi, I, Neto, JWM, Nguyen, B, Nielsen, MB, Nieuwenhuijzen, GAP, Nilsson, PJ, O'Connell, PR, O'Dwyer, ST, Palmer, G, Pappou, E, Park, J, Patsouras, D, Pellino, G, Peterson, AC, Poggioli, G, Proud, D, Quinn, M, Quyn, A, Radwan, RW, van Ramshorst, GH, Rasheed, S, Rasmussen, PC, Regenbogen, SE, Renehan, A, Rocha, R, Rochester, M, Rohila, J, Rothbarth, J, Rottoli, M, Roxburgh, C, Rutten, HJT, Ryan, EJ, Safar, B, Sagar, PM, Sahai, A, Saklani, A, Sammour, T, Sayyed, R, Schizas, AMP, Schwarzkopf, E, Scripcariu, V, Selvasekar, C, Shaikh, I, Hellawell, G, Shida, D, Simpson, A, Smart, NJ, Smart, P, Smith, JJ, Solbakken, AM, Solomon, MJ, Sorensen, MM, Steele, SR, Steffens, D, Stitzenberg, K, Stocchi, L, Stylianides, NA, Sumrien, H, Sutton, PA, Swanking, T, Taylor, C, Tekkis, PP, Teras, J, Thurairaja, R, Toh, EL, Tsarkov, P, Tsukada, Y, Tsukamoto, S, Tuech, JJ, Turner, WH, Tuynman, JB, Vasquez-Jimenez, W, Verhoef, C, Vizzielli, G, Voogt, ELK, Uehara, K, Wakeman, C, Warner, S, Wasmuth, HH, Weber, K, Weiser, MR, Wheeler, JMD, Wild, J, Wilson, M, de Wilt, JHW, Wolthuis, A, Yano, H, Yip, B, Yip, J, Yoo, RN, van Zoggel, D, Winter, DC, Surgery, CCA - Cancer Treatment and quality of life, and Amsterdam Gastroenterology Endocrinology Metabolism

Subjects
Male, medicine.medical_specialty, Adolescent, Colorectal cancer, survival outcomes, medicine.medical_treatment, surgical outcome, surgical outcomes, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], 03 medical and health sciences, 0302 clinical medicine, SDG 3 - Good Health and Well-being, Interquartile range, medicine, Humans, liver metastasi, Rectal cancer, Retrospective Studies, Pelvic exenteration, business.industry, Rectal Neoplasms, Mortality rate, Liver Neoplasms, Gastroenterology, Postoperative complication, Perioperative, medicine.disease, Surgery, Pelvic Exenteration, liver metastasis, Treatment Outcome, 030220 oncology & carcinogenesis, international collaboration, Resection margin, 030211 gastroenterology & hepatology, Hepatectomy, Neoplasm Recurrence, Local, business
Abstract

Aim: At presentation, 15–20% of patients with rectal cancer already have synchronous liver metastases. The aim of this study was to determine the surgical and survival outcomes in patients with advanced rectal cancer who underwent combined pelvic exenteration and liver (oligometastatic) resection. Method: Data from 20 international institutions that performed simultaneous pelvic exenteration and liver resection between 2007 and 2017 were accumulated. Primarily, we examined perioperative outcomes, morbidity and mortality. We also assessed the impact that margin status had on survival. Results: Of 128 patients, 72 (56.2%) were men with a median age of 60 years [interquartile range (IQR) 15 years]. The median size of the liver oligometastatic deposits was 2 cm (IQR 1.8 cm). The median duration of surgery was 406 min (IQR 240 min), with a median blood loss of 1090 ml (IQR 2010 ml). A negative resection margin (R0 resection) was achieved in 73.5% of pelvic exenterations and 66.4% of liver resections. The 30-day mortality rate was 1.6%, and 32% of patients had a major postoperative complication. The 5-year overall survival for patients in whom an R0 resection of both primary and metastatic disease was achieved was 54.6% compared with 20% for those with an R1/R2 resection (P = 0.006). Conclusion: Simultaneous pelvic exenteration and liver resection is feasible, with acceptable morbidity and mortality. Simultaneous resection should only be performed where an R0 resection of both pelvic and hepatic disease is anticipated.

Published
2020
Full Text
View/download PDF

50. Management strategies for patients with advanced rectal cancer and liver metastases using modified Delphi methodology: results from the PelvEx Collaborative

Author

Kelly M. E., Agj A., Abdul Aziz N., Abecasis N., Abraham-Nordling M., Akiyoshi T., Alberda W., Albert M., Andric M., Angenete E., Antoniou A., Auer R., Austin K. K., Aziz O., Baker R. P., Bali M., Baseckas G., Bebington B., Bednarski B. K., Beets G. L., Berg P. L., Beynon J., Biondo S., Boyle K., Bordeianou L., Bremers A. B., Brunner M., Buchwald P., Bui A., Burgess A., Jwa B., Burling D., Campain N., Carvalhal S., Castro L., Caycedo-Marulanda A., Kkl C., Chang G. J., Chew M. H., Chong P., Christensen H. K., Clouston H., Codd M., Collins D., Colquhoun A. J., Corr A., Coscia M., Coyne P. E., Creavin B., Croner R. S., Damjanovic L., Daniels I. R., Davies M., Davies R. J., Delaney C. P., de Wilt J., Denost Q., Deutsch C., Dietz D., Domingo S., Dozois E. J., Duff M., Eglinton T., Enrique-Navascues J. M., Espin-Basany E., Evans M. D., Fearnhead N. S., Flatmark K., Fleming F., Frizelle F. A., Gallego M. A., Garcia-Granero E., Garcia-Sabrido J. L., Gentilini L., George M. L., Ghouti L., Giner F., Ginther N., Glynn R., Golda T., Griffiths B., Harris D. A., Jaw H., Hanchanale V., Harji D. P., Helewa R. M., Heriot A. G., Hochman D., Hohenberger W., Holm T., Hompes R., Jenkins J. T., Kaffenberger S., Kandaswamy G. V., Kapur S., Kanemitsu Y., Kelley S. R., Keller D. S., Khan M. S., Kiran R. P., Kim H., Kim H. J., Koh C. E., Nfm K., Kokelaar R., Kontovounisios C., Kristensen H. O., Kroon H. M., Kusters M., Lago V., Larsen S. G., Larson D. W., Law W. L., Laurberg S., Lee P. J., Limbert M., Lydrup M. L., Lyons A., Lynch A. C., Mantyh C., Mathis K. L., Cfs M., Martling A., Wjhj M., Merkel S., Mehta A. M., McArthur D. R., McDermott F. D., McGrath J. S., Malde S., Mirnezami A., Jrt M., Morton J. R., Mullaney T. G., Negoi I., Jwm N., Nguyen B., Nielsen M. B., Gap N., Nilsson P. J., O'Connell P. R., O'Dwyer S. T., Palmer G., Pappou E., Park J., Patsouras D., Pellino G., Peterson A. C., Poggioli G., Proud D., Quinn M., Quyn A., Radwan R. W., Rasheed S., Rasmussen P. C., Regenbogen S. E., Renehan A., Rocha R., Rochester M., Rohila J., Rothbarth J., Rottoli M., Roxburgh C., Hjt R., Ryan E. J., Safar B., Sagar P. M., Sahai A., Saklani A., Sammour T., Sayyed R., Amp S., Schwarzkopf E., Scripcariu V., Selvasekar C., Shaikh I., Shellawell G., Shida D., Simpson A., Smart N. J., Smart P., Smith J. J., Solbakken A. M., Solomon M. J., Sorensen M. M., Steele S. R., Steffens D., Stitzenberg K., Stocchi L., Stylianides N. A., Sumrien H., Sutton P. A., Swartking T., Taylor C., Tekkis P. P., Teras J., Thurairaja R., Toh E. L., Tsarkov P., Tsukada Y., Tsukamoto S., Tuech J. J., Turner W. H., Tuynman J. B., van Ramshorst G., van Zoggel D., Vasquez-Jimenez W., Verhoef C., Vizzielli G., Elk V., Uehara K., Wakeman C., Warrier S., Wasmuth H. H., Weber K., Weiser M. R., Jmd W., Wild J., Wilson M., Wolthuis A., Yano H., Yip B., Yip J., Yoo R. N., Winter D. C., Rottoli M, Poggioli G, Kelly, M. E., Agj, A., Abdul Aziz, N., Abecasis, N., Abraham-Nordling, M., Akiyoshi, T., Alberda, W., Albert, M., Andric, M., Angenete, E., Antoniou, A., Auer, R., Austin, K. K., Aziz, O., Baker, R. P., Bali, M., Baseckas, G., Bebington, B., Bednarski, B. K., Beets, G. L., Berg, P. L., Beynon, J., Biondo, S., Boyle, K., Bordeianou, L., Bremers, A. B., Brunner, M., Buchwald, P., Bui, A., Burgess, A., Jwa, B., Burling, D., Campain, N., Carvalhal, S., Castro, L., Caycedo-Marulanda, A., Kkl, C., Chang, G. J., Chew, M. H., Chong, P., Christensen, H. K., Clouston, H., Codd, M., Collins, D., Colquhoun, A. J., Corr, A., Coscia, M., Coyne, P. E., Creavin, B., Croner, R. S., Damjanovic, L., Daniels, I. R., Davies, M., Davies, R. J., Delaney, C. P., de Wilt, J., Denost, Q., Deutsch, C., Dietz, D., Domingo, S., Dozois, E. J., Duff, M., Eglinton, T., Enrique-Navascues, J. M., Espin-Basany, E., Evans, M. D., Fearnhead, N. S., Flatmark, K., Fleming, F., Frizelle, F. A., Gallego, M. A., Garcia-Granero, E., Garcia-Sabrido, J. L., Gentilini, L., George, M. L., Ghouti, L., Giner, F., Ginther, N., Glynn, R., Golda, T., Griffiths, B., Harris, D. A., Jaw, H., Hanchanale, V., Harji, D. P., Helewa, R. M., Heriot, A. G., Hochman, D., Hohenberger, W., Holm, T., Hompes, R., Jenkins, J. T., Kaffenberger, S., Kandaswamy, G. V., Kapur, S., Kanemitsu, Y., Kelley, S. R., Keller, D. S., Khan, M. S., Kiran, R. P., Kim, H., Kim, H. J., Koh, C. E., Nfm, K., Kokelaar, R., Kontovounisios, C., Kristensen, H. O., Kroon, H. M., Kusters, M., Lago, V., Larsen, S. G., Larson, D. W., Law, W. L., Laurberg, S., Lee, P. J., Limbert, M., Lydrup, M. L., Lyons, A., Lynch, A. C., Mantyh, C., Mathis, K. L., Cfs, M., Martling, A., Wjhj, M., Merkel, S., Mehta, A. M., Mcarthur, D. R., Mcdermott, F. D., Mcgrath, J. S., Malde, S., Mirnezami, A., Jrt, M., Morton, J. R., Mullaney, T. G., Negoi, I., Jwm, N., Nguyen, B., Nielsen, M. B., Gap, N., Nilsson, P. J., O'Connell, P. R., O'Dwyer, S. T., Palmer, G., Pappou, E., Park, J., Patsouras, D., Pellino, G., Peterson, A. C., Poggioli, G., Proud, D., Quinn, M., Quyn, A., Radwan, R. W., Rasheed, S., Rasmussen, P. C., Regenbogen, S. E., Renehan, A., Rocha, R., Rochester, M., Rohila, J., Rothbarth, J., Rottoli, M., Roxburgh, C., Hjt, R., Ryan, E. J., Safar, B., Sagar, P. M., Sahai, A., Saklani, A., Sammour, T., Sayyed, R., Amp, S., Schwarzkopf, E., Scripcariu, V., Selvasekar, C., Shaikh, I., Shellawell, G., Shida, D., Simpson, A., Smart, N. J., Smart, P., Smith, J. J., Solbakken, A. M., Solomon, M. J., Sorensen, M. M., Steele, S. R., Steffens, D., Stitzenberg, K., Stocchi, L., Stylianides, N. A., Sumrien, H., Sutton, P. A., Swartking, T., Taylor, C., Tekkis, P. P., Teras, J., Thurairaja, R., Toh, E. L., Tsarkov, P., Tsukada, Y., Tsukamoto, S., Tuech, J. J., Turner, W. H., Tuynman, J. B., van Ramshorst, G., van Zoggel, D., Vasquez-Jimenez, W., Verhoef, C., Vizzielli, G., Elk, V., Uehara, K., Wakeman, C., Warrier, S., Wasmuth, H. H., Weber, K., Weiser, M. R., Jmd, W., Wild, J., Wilson, M., Wolthuis, A., Yano, H., Yip, B., Yip, J., Yoo, R. N., Winter, D. C., and Academic Medical Center

Subjects
Liver metastasisSurvival Outcome, medicine.medical_specialty, survival outcomes, Colorectal cancer, surgical outcome, medicine.medical_treatment, Delphi method, Rectum, Disease, surgical outcomes, 03 medical and health sciences, Liver disease, 0302 clinical medicine, SDG 3 - Good Health and Well-being, Hepatectomy, Humans, Medicine, liver metastasi, Rectal cancer, Neoplasm Staging, Pelvic exenteration, Rectal Neoplasms, business.industry, General surgery, Liver Neoplasms, Gastroenterology, Induction chemotherapy, medicine.disease, liver metastasis, medicine.anatomical_structure, 030220 oncology & carcinogenesis, international collaboration, 030211 gastroenterology & hepatology, business
Abstract

Aim: A total of 15–20% of patients with rectal cancer have liver metastases on presentation. The management of these patients is controversial. Heterogeneity in management strategies is considerable, with management often being dependent on local resources and available expertise. Method: Members of the PelvEx Collaborative were invited to participate in the generation of a consensus statement on the optimal management of patients with advanced rectal cancer with liver involvement. Fifteen statements were created for topical discussion on diagnostic and management issues. Panellists were asked to vote on statements and anonymous feedback was given. A collaborative meeting was used to discuss any nuances and clarify any obscurity. Consensus was considered when > 85% agreement on a statement was achieved. Results: A total of 135 participants were involved in the final round of the Delphi questionnaire. Nine of the 15 statements reached consensus regarding the management of patients with advanced rectal cancer and oligometastatic liver disease. Routine use of liver MRI was not recommended for patients with locally advanced rectal cancer, unless there was concern for metastatic disease on initial computed tomography staging scan. Induction chemotherapy was advocated as first-line treatment in those with synchronous liver metastases in locally advanced rectal cancer. In the presence of symptomatic primary disease, a diverting stoma may be required to facilitate induction chemotherapy. Overall, only one-quarter of the panellists would consider simultaneous pelvic exenteration and liver resection. Conclusion: This Delphi process highlights the diverse treatment of advanced rectal cancer with liver metastases and provides recommendations from an experienced international group regarding the multidisciplinary management approach.

Published
2020
Full Text
View/download PDF

Catalog

Books, media, physical & digital resources
See catalog results