18 research outputs found
How to do a laparoscopic high left colectomy with complete mesocolic excision and central vascular ligation for splenic flexure cancer
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Evaluation of the Immunohistochemical Scoring System of CDX2 Expression as a Prognostic Biomarker in Colon Cancer
No full textEncoded by the CDX2 homeobox gene, the CDX2 protein assumes the role of a pivotal transcription factor localized within the nucleus of intestinal epithelial cells, orchestrating the delicate equilibrium of intestinal physiology while intricately guiding the precise development and differentiation of epithelial tissue. Emerging research has unveiled that positive immunohistochemical expression of this protein shows that the CDX2 gene exerts a potent suppressive impact on tumor advancement in colorectal cancer, impeding the proliferation and distant dissemination of tumor cells, while the inhibition or suppression of CDX2 frequently correlates with aggressive behavior in colorectal cancer. In this study, we conducted an immunohistochemical assessment of CDX2 expression on a cohort of 43 intraoperatively obtained tumor specimens from patients diagnosed with colon cancer at Colțea Clinical Hospital in Bucharest, between April 2019 and December 2023. Additionally, we shed light on the morphological diversity within colon tumors, uncovering varying differentiation grades within the same tumor, reflecting the variations in CDX2 expression as well as the genetic complexity underlying these tumors. Based on the findings, we developed an innovative immunohistochemical scoring system that addresses the heterogeneous nature of colon tumors. Comprehensive statistical analysis of CDX2 immunohistochemical expression unveiled significant correlations with known histopathological parameters such as tumor differentiation grades (p-value = 0.011) and tumor budding score (p-value = 0.002), providing intriguing insights into the complex involvement of the CDX2 gene in orchestrating tumor progression through modulation of differentiation processes, and highlighting its role in metastatic predisposition. The compelling correlation identified between CDX2 expression and conventional histopathological parameters emphasizes the prognostic significance of the CDX2 biomarker in colon cancer. Moreover, our novel immunohistochemical scoring system reveals a distinct subset of colon tumors exhibiting reserved prognostic outcomes, distinguished by their “mosaic” CDX2 expression pattern
Evaluation of a Quality Improvement Intervention To Reduce Anastomotic Leak Following Right Colectomy (eagle): Pragmatic, Batched Stepped-Wedge, Cluster-Randomized Trial in 64 Countries
No full textMagill, Laura/0000-0003-2498-8407; Chitul, Andrei/0000-0001-5991-3443; Taha, Mohamed Hassan Ali Ahmed/0000-0001-6503-2239; Soria Aledo, Victoriano/0000-0003-0159-4034; Fiume, Diego/0000-0001-9483-4783; Yonekura, Hiroshi/0000-0003-0523-2997; yadev, IP/0000-0002-5086-6246; ALVAREZ PADILLA, FRANCISCO EMILIANO/0009-0000-8197-3274; Maurya, Ajeet/0000-0002-5845-7236; Mutlu, Arda Ulas/0000-0001-7499-7155; Marino, Fabio/0000-0002-7535-436X; Fernandez-Hevia, Maria/0000-0002-2147-1317; Espin-Basany, Eloy/0000-0002-9139-4548; Rashed, Amier Mohamed/0009-0003-3671-2042; Atanasov, Boyko/0000-0003-3000-681X; Ibrahimli, Arturan/0000-0002-5527-4434; Alvarez-Bautista, Francisco Emmanuel/0000-0003-2645-832X; Elshami, Mohamedraed/0000-0002-9977-0923; Theodoropoulos, Charalampos/0000-0002-7393-1987; Abdou, Khaled/0000-0001-9777-080X; SANLI, AHMET NECATI/0000-0002-1483-8176; Ferrario, Luca/0000-0002-3652-3255; Garcia Botello, Stephanie Anne/0000-0001-6921-4902; Lule, Herman/0000-0002-0647-9716; Colak, Elif/0000-0002-1893-6427; Rey Valcarcel, Cristina/0000-0001-9762-9742; Pantoja Pachajoa, Diana Alejandra/0000-0002-3968-4206; Balaban, Vladimir/0000-0002-7226-4641; Tidjane, Anisse/0000-0002-3264-2441; Duzgun, Ozgul/0000-0001-7214-2276; JIMENEZ-GOMEZ, LUIS MIGUEL/0000-0003-1390-0473; Mastriale, Francesco/0000-0003-3586-2826; Fleres, Francesco/0000-0002-1092-8975; Garzali, Ibrahim Umar/0000-0002-9797-851X; Isik, Ozgen/0000-0002-9541-5035; Paniagua Garcia-Senorans, Marta/0000-0003-2402-4106; Marson, Fernando Augusto Lima/0000-0003-4955-4234; Stijns, Jasper/0000-0002-5256-6167; Mourad, Mohamed/0000-0003-4714-7192; Zayakov, Georgi/0000-0002-8796-8350; Glasbey, James/0000-0001-7688-5018; Arabadzhiev, Angel/0000-0003-2186-3799; KOSTEK, MEHMET/0000-0001-7259-2461; Blanca, Ana/0000-0002-4360-4352; Bozbiyik, Osman/0000-0002-1827-2720; Pizanias, Michail/0000-0002-5270-3555; Waqar, Usama/0000-0002-9447-5810; Karamanliev, Martin/0000-0001-5166-0752; Mariani, Nicolo Maria/0000-0003-4360-187X; Burlov, Nikita/0000-0003-3407-4406; Shudrak, Anatolii/0000-0003-2760-8780; Quintanilha, Rui/0000-0002-5367-4872; KARA, YASIN/0000-0002-9723-1774; , Mikael/0000-0002-5189-2251; Biswas, Jyotirmoy/0000-0001-9357-0448; Garcia Florez, Luis Joaquin/0000-0003-1231-9126; Waledziak, Maciej/0000-0003-4311-9995; Bayhan, Zulfu/0000-0002-7587-7267; Manatakis, Dimitrios K./0000-0002-1263-8488; Sulen, Nina/0000-0002-2012-8090; Sena, Giuseppe/0000-0001-9793-3250; Isaacs Beron, Reinaldo/0000-0002-3539-9985; Minaya Bravo, Ana Maria/0000-0002-7982-5499; Baili, Efstratia/0000-0001-8745-2269; Garcia Urena, Miguel Angel/0000-0002-7356-6211; Gallo, Gaetano/0000-0003-1066-4671; Chowdhury, Sharfuddin/0000-0002-3794-4158; Gribnev, Petar/0000-0001-9459-7095; Palomba, Giuseppe/0000-0003-3954-5166; Bedzhanyan, Arkady/0000-0002-4377-0035; Litvin, Andrey/0000-0002-9330-6513; Baelum, Jens Kristian/0000-0003-0135-2430; fakhradiyev, ildar/0000-0003-0528-3874; Azhar, Najia/0000-0001-6709-4441; Shahu, Juliana/0000-0003-1908-6601; Resendiz Aguilar, Hogla Aridai/0000-0002-3416-2775; Douba, Zain/0000-0001-9662-9492; CHISTHI, MEER/0000-0003-2794-0062; Bisgin, Tayfun/0000-0001-7040-4228; FENNER LYRA JUNIOR, HUMBERTO/0000-0001-8649-802X; Valdes-Hernandez, Javier/0000-0002-0837-8986; Zimmerman, David/0000-0002-0393-9350; Kulimbet, Mukhtar/0000-0003-4399-700X; Triantafyllou, Alexandra/0000-0001-8232-2203; Mantoglu, Baris/0000-0002-2161-3629; Romano, Francesco Maria/0000-0002-9491-748X; Castaldi, Antonio/0000-0003-3084-7942; Bhangu, Aneel/0000-0001-5999-4618; Slavchev, Mihail/0000-0003-4412-7604; Dhar, Puneet/0000-0003-3141-5447; Hamdan, Fatma/0000-0002-0276-1343; Biondo, Santino Antonio/0000-0002-4720-3345; GONULLU, Emre/0000-0001-6391-4414; Perivoliotis, Konstantinos/0000-0002-6622-5734; Tokidis, Evripidis/0000-0001-8594-0007; Negoi, Ionut/0000-0002-6950-9599; Pellino, Gianluca/0000-0002-8322-6421; Elmore, Ugo/0000-0001-9652-1502; Kashchenko, Victor/0000-0002-4958-5850; El Sorogy, Mohamed/0000-0002-5922-3917; Kovacevic, Bojan/0000-0001-6595-337X; Sokolov, Manol/0000-0002-2608-333X; Ulasi, Ikechukwu/0000-0001-7387-2713; Manigrasso, Michele/0000-0001-8204-7942; Metwally, Islam Hany/0000-0002-5981-9614; Bains, Lovenish/0000-0002-8627-0452; Mazzeo, Carmelo/0000-0001-9893-7480; Drozdov, Evgeniy/0000-0003-4157-9744; Perra, Teresa/0000-0001-7032-1289; Akin, Emrah/0000-0003-0224-3834; Ekwesianya, Andrew Chiagozie/0000-0001-5064-681X; Akay, Omer/0000-0002-0824-2077; Jakhar, Subham/0000-0002-1980-3175; Li, Elizabeth/0000-0001-5961-2894; Bintintan, Vasile/0000-0002-1435-6791; BALALIS, DIMITRIOS/0000-0001-8879-2804; Abd-erRazik, Mohammad/0000-0002-8498-9957; Poskus, Tomas/0000-0002-6931-6041; Selvaggi, Lucio/0000-0001-6920-3103; MANDI, DRAGA-MARIA/0000-0002-5070-217X; Curro, Giuseppe/0000-0001-9566-1378; Beznosenko, Andriy/0000-0003-2293-3488; De Deken, Julie/0000-0002-7788-0881; Sarakatsianou, Chamaidi/0000-0002-9509-581X; Ciftci, Ahmet Burak/0000-0002-1814-4008; Egwuonwu, Ochonma Amobi/0000-0001-5978-6392; ozgen, utku/0000-0002-6481-1473; /0000-0003-4645-6655; Dushimova, Zaure/0000-0003-0791-4246; Hamza, Amr/0000-0001-6520-3595; Altintoprak, Fatih/0000-0002-3939-8293; Shehta, Ahmed/0000-0002-9184-8597; Belev, Nikolay/0000-0001-9248-8194; Ballah, Abubakar/0000-0002-7988-5993; Munoz, Jose/0000-0001-9529-6980Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov).ESCP; National Institutes of Health Research (NIHR) [NIHR133364] Funding Source: National Institutes of Health Research (NIHR)The EAGLE study was funded by the ESCP. Ethicon provided an unrestricted educational grant to the ESCP which was used in supporting the development of the online education materials. The NIHR Global Health Research Unit on Global Surgery (NIHR133364) provided support, notably in accessing and supporting collaborating teams in low-and middle-income countries. The funders had no role in the design, set-up, running or analysis of this study, or writing of this report. The views expressed are those of the authors and not necessarily those of the ESCP, Ethicon, or NIHR
Screening policies, preventive measures and in-hospital infection of COVID-19 in global surgical practices
No full textBackground: In a surgical setting, COVID-19 patients may trigger in-hospital outbreaks and have worse postoperative outcomes. Despite these risks, there have been no consistent statements on surgical guidelines regarding the perioperative screening or management of COVID-19 patients, and we do not have objective global data that describe the current conditions surrounding this issue. This study aimed to clarify the current global surgical practice including COVID-19 screening, preventive measures and in-hospital infection under the COVID-19 pandemic, and to clarify the international gaps on infection control policies among countries worldwide.
Methods: During April 2-8, 2020, a cross-sectional online survey on surgical practice was distributed to surgeons worldwide through international surgical societies, social media and personal contacts. Main outcome and measures included preventive measures and screening policies of COVID-19 in surgical practice and centers' experiences of in-hospital COVID-19 infection. Data were analyzed by country's cumulative deaths number by April 8, 2020 (high risk, >5000; intermediate risk, 100-5000; low risk
Impact of asymptomatic COVID-19 patients in global surgical practice during the COVID-19 pandemic
No full textSurgeons’ practice and preferences for the anal fissure treatment: results from an international survey
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Surgeons’ practice and preferences for the anal fissure treatment: results from an international survey
No full text: The best nonoperative or operative anal fissure (AF) treatment is not yet established, and several options have been proposed. Aim is to report the surgeons' practice for the AF treatment. Thirty-four multiple-choice questions were developed. Seven questions were about to participants' demographics and, 27 questions about their clinical practice. Based on the specialty (general surgeon and colorectal surgeon), obtained data were divided and compared between two groups. Five-hundred surgeons were included (321 general and 179 colorectal surgeons). For both groups, duration of symptoms for at least 6 weeks is the most important factor for AF diagnosis (30.6%). Type of AF (acute vs chronic) is the most important factor which guide the therapeutic plan (44.4%). The first treatment of choice for acute AF is ointment application for both groups (59.6%). For the treatment of chronic AF, this data is confirmed by colorectal surgeons (57%), but not by the general surgeons who prefer the lateral internal sphincterotomy (LIS) (31.8%) (p = 0.0001). Botulin toxin injection is most performed by colorectal surgeons (58.7%) in comparison to general surgeons (20.9%) (p = 0.0001). Anal flap is mostly performed by colorectal surgeons (37.4%) in comparison to general surgeons (28.3%) (p = 0.0001). Fissurectomy alone is statistically significantly most performed by general surgeons in comparison to colorectal surgeons (57.9% and 43.6%, respectively) (p = 0.0020). This analysis provides useful information about the clinical practice for the management of a debated topic such as AF treatment. Shared guidelines and consensus especially focused on operative management are required to standardize the treatment and to improve postoperative results
A prognostic model for use before elective surgery to estimate the risk of postoperative pulmonary complications (GSU-Pulmonary Score): a development and validation study in three international cohorts
No full textBackground: Pulmonary complications are the most common cause of death after surgery. This study aimed to derive and externally validate a novel prognostic model that can be used before elective surgery to estimate the risk of postoperative pulmonary complications and to support resource allocation and prioritisation during pandemic recovery. Methods: Data from an international, prospective cohort study were used to develop a novel prognostic risk model for pulmonary complications after elective surgery in adult patients (aged ≥18 years) across all operation and disease types. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery, which was a composite of pneumonia, acute respiratory distress syndrome, and unexpected mechanical ventilation. Model development with candidate predictor variables was done in the GlobalSurg-CovidSurg Week dataset (global; October, 2020). Two structured machine learning techniques were explored (XGBoost and the least absolute shrinkage and selection operator [LASSO]), and the model with the best performance (GSU-Pulmonary Score) underwent internal validation using bootstrap resampling. The discrimination and calibration of the score were externally validated in two further prospective cohorts: CovidSurg-Cancer (worldwide; February to August, 2020, during the COVID-19 pandemic) and RECON (UK and Australasia; January to October, 2019, before the COVID-19 pandemic). The model was deployed as an online web application. The GlobalSurg-CovidSurg Week and CovidSurg-Cancer studies were registered with ClinicalTrials.gov, NCT04509986 and NCT04384926. Findings: Prognostic models were developed from 13 candidate predictor variables in data from 86 231 patients (1158 hospitals in 114 countries). External validation included 30 492 patients from CovidSurg-Cancer (726 hospitals in 75 countries) and 6789 from RECON (150 hospitals in three countries). The overall rates of pulmonary complications were 2·0% in derivation data, and 3·9% (CovidSurg-Cancer) and 4·7% (RECON) in the validation datasets. Penalised regression using LASSO had similar discrimination to XGBoost (area under the receiver operating curve [AUROC] 0·786, 95% CI 0·774-0·798 vs 0·785, 0·772-0·797), was more explainable, and required fewer covariables. The final GSU-Pulmonary Score included ten predictor variables and showed good discrimination and calibration upon internal validation (AUROC 0·773, 95% CI 0·751-0·795; Brier score 0·020, calibration in the large [CITL] 0·034, slope 0·954). The model performance was acceptable on external validation in CovidSurg-Cancer (AUROC 0·746, 95% CI 0·733-0·760; Brier score 0·036, CITL 0·109, slope 1·056), but with some miscalibration in RECON data (AUROC 0·716, 95% CI 0·689-0·744; Brier score 0·045, CITL 1·040, slope 1·009). Interpretation: This novel prognostic risk score uses simple predictor variables available at the time of a decision for elective surgery that can accurately stratify patients' risk of postoperative pulmonary complications, including during SARS-CoV-2 outbreaks. It could inform surgical consent, resource allocation, and hospital-level prioritisation as elective surgery is upscaled to address global backlogs. Funding: National Institute for Health Research
