62 research outputs found
Development of a model of three-dimensional imaging for the preoperative planning of TaTME
No full textSince total mesorectal excision (TME) was first described in the early 1930s and later popularised by Heald [1], efforts have been made to standardise the technique, following the correct embryological planes and using appropriate landmarks. Laparoscopic and robotically assisted approaches to the rectum have gained popularity during recent years, compelling colorectal surgeons to develop their skills and knowledge. Transanal TME (TaTME) is a new addition to the approaches in rectal surgery. Despite being associated with several benefits in selected patients, TaTME requires advanced technical skills and, more importantly, knowledge of the pelvic structures, planes and spaces as they are encountered moving cephalad from the perineum. Magnetic resonance imaging (MRI) is the gold standard for imaging of the pelvis and pelvic floor, but understanding of relevant anatomy when performing a new technique may be hampered by difficulty in interpretation of two-dimensional (2D) images when considering three-dimensional (3D) structures. We describe a new tool that could help understanding of TaTME planes and preoperative planning
Needs assessment in surgical undergraduate teaching in a South Asian cohort; implications for social, cultural and resource based adaptation of learning methods
No full text
Teaching and learning in higher education has undergone significant transformation during the past few decades. The novel concepts of student centred learning ha been accepted and adopted globally. However the evidence in this subject area is mainly derived from the western population. Research in the recent past has identified the conflicts of implementing these concepts across different cultures. A needs assessment was carried out amongst a cohort of medical undergrduates to regarding their lack of active participation in general in learning activities and small group discussions. Deficiency in language skills (34%), anxiety to make mistakes in public (46%) and reluctance to address the teachers directly (41%) were the leading reasons of lack of active participation. Several structural, resource and time related local factors were identified as reasons for poor contributions for the small group discussions. The student population however was more interested in conceptual learning versus an assessment-oriented teaching. The author discusses the requirement of cultural adaptation of the learning methods plus student orientation for higher education environment to suit socio-economic and cultural background of the locality based on these findings. </p
Risk factors for locally advanced cancer associated with ulcerative colitis: Results of a retrospective multicentric study in the era of biologics
No full textBACKGROUND:
Patients affected by ulcerative colitis (UC) are more likely to develop colorectal cancer, and are often diagnosed with lymph node involvement (N+) at surgery.
AIM:
To identify the risk factors for N+ cancer in UC patients.
METHODS:
Patients undergoing surgery from 2001 to 2018 in six European tertiary centres were included. N+ patients were compared to the control group (N-) for clinical variables. The evaluation of risk factors for N+ was assessed using univariate and multivariable logistic regression analyses.
RESULTS:
A total of 130 patients were included. Median duration of disease was 21 years (1-52). Forty patients (30.8%) were N+ at surgery. Eighteen (13.8%) developed cancer within 10 years from the onset of UC. Younger age at surgery (Odds ratio -OR- 0.96, p = 0.042), left colon location (OR 2.44, p = 0.045) and the presence of stricture (OR 5.07, p = 0.002) were associated with N+.
CONCLUSION:
Location in the left colon, presence of strictures and younger age strongly correlated with a higher risk of N+ cancer, which could develop before the starting point of surveillance. Duration, extension and severity of disease were not associated with N+. These results should be considered in the evaluation of risk of advanced cancer in UC patients
Mental Health Problems during Pregnancy and the Postpartum Period: A Multicenter Knowledge Assessment Survey among Healthcare Providers
No full textBackground. Mental illness related to pregnancy can have long-lasting consequences. Healthcare providers are often the most frequent medical contact with the potential for early detection of these. Objectives were to study the awareness regarding mental health problems during pregnancy and the postpartum period among healthcare providers. Methods. A cross-sectional study was carried out with healthcare providers including the nursing staff, midwifery staff, and medical officers working at obstetric wards in three tertiary care hospitals in Sri Lanka. A self-administered questionnaire assessed staff experience with mothers having mental problems, knowledge on mental health problems related to pregnancy, and knowledge about risk factors, common symptoms, and possible consequences on a five-point Likert scale from “Strongly Agree” to “Strongly Disagree.” Results. A total of 300 staff were approached and invited to participate. Only 152 responded to the questionnaire (response rate of 50.1%). Mean (SD) age was 35.8 (9.7) years and mean (SD) years of experience was 10.1 (9.1) years. Age more than 35 years of healthcare providers is associated with statistically significant (p=0.02) average knowledge scores on the consequences of maternal mental health problems. The symptom of “excessively worrying about baby’s health” had the lowest score across all three categories with an average of 34.2%. Only 42.8% have ever heard of EPDS. Overall awareness and knowledge about risk factors, symptoms, and consequences regarding pregnancy-related maternal mental health problems are generally good among the healthcare providers studied. However, some of the few aspects are not satisfactory. Health education of pregnant women, promoting regular in-service training sessions, improvement of infrastructure, and involvement of family members from the antenatal period were discussed by the majority. Conclusion. Despite good overall awareness and knowledge, application into practice with the utilization of validated assessments is poor. This may probably explain why Sri Lanka has a high prevalence of postpartum depression suggesting urgent attention
Overall Survival of Elderly Patients Having Surgery for Colorectal Cancer Is Comparable to Younger Patients: Results from a South Asian Population
No full textIntroduction. There has been a continuous debate on whether elderly patients with colorectal cancer (CRC) fair worse. The aim of this study is to assess the thirty-day mortality (TDM) and overall survival (OS) of elderly patients undergoing surgery for CRC. Method. OS between two groups (≥70 versus <70 years) having surgery for CRC was analyzed. Demographics, tumour characteristics, and serological markers were considered as independent factors. Multivariable analysis was done using the Cox proportional hazard model. We also compared overall survival in the elderly versus those <60 and <50 years. Results. 477 patients, 160 elderly (55% male; median age 75, range 70–89) and 317 younger patients (49% male; median age 55, range 16 to 69), were studied. Overall survival in CRC patients ≥70 is comparable to <70 (P=0.45) and <60 years (P=0.08). Poor OS was observed in the ≥70 versus <50 years (P=0.03). TDM in the elderly was poor (P<0.05). Postoperative cardiac complication was the only determinant affecting survival in the elderly (P=0.01). Conclusion. OS in elderly CRC patients having surgery is not worse compared to <70 and <60 years although the TDM was higher. Postoperative cardiac complications significantly affected OS in those ≥70 compared to those <50 years. Chronological age alone should not negatively influence surgical decision-making in the elderly
Colorectal cancer burden and trends in a South Asian cohort: experience from a regional tertiary care center in Sri Lanka
No full textAbstract Objective Colorectal cancer (CRC) burden is increasing in the south Asian region due to the changing socio-economic landscape and population demographics. There is a lack of robust high quality data from this region in order to evaluate the disease pattern and comparison. Using generalized linear models assuming Poisson distribution and model fitting, authors describe the variation in the landscape of CRC burden along time since 1997 at a regional tertiary care center in Sri Lanka. Results Analyzing 679 patients, it is observed that both colon and rectal cancers have significantly increased over time (pre 2000—61, 2000 to 2004—178, 2005 to 2009—190, 2010 to 2014–250; P < 0.05). Majority of the cancers were left sided (82%) while 77% were rectosigmoid. Over 25% of all CRC were diagnosed in patients less than 50 years and the median age at diagnosis is < 62 years. Increasing trend is seen in the stage at presentation while 33% of the rectal cancers received neoadjuvant chemoradiation. Left sided preponderance, younger age at presentation and advanced stage at presentation was observed. CRC disease pattern in the South Asian population may vary from that observed in the western population which has implications on disease surveillance and treatment
Neoadjuvant Chemoradiation for Rectal Cancer Achieves Satisfactory Tumour Regression and Local Recurrence – Result of a Dedicated Multi-disciplinary Approach from a South Asian Centre
No full textAbstract Background Pre-operative long-course chemoradiotherapy (CRT) for rectal cancer has resulted in improvement in rates of restorative rectal resection and local recurrence by inducing tumour downstaging and downsizing. Total mesorectal excision (TME) is a standardised surgical technique of low anterior resection aimed at the prevention of local tumour recurrence. The purpose of this study was to evaluate tumour response following CRT in a standardised group of patients with rectal cancer. Methods One hundred and thirty-one patients (79 male; 52 female, median age 57; interquartile range 47–62 years) of 153 with rectal cancer who underwent pre-operative long-course CRT were treated by standardised open low anterior resection at a median of 10 weeks post-CRT. Sixteen of 131 (12%) were 70 years or older. Median follow-up at the time of analysis was 15 months (interquartile range 6–45 months). Pathology reports were analysed based on AJCC-UICC classification using the TNM system. Data recorded were overall/subgrades of tumour regression; good, moderate or poor, lymph node harvest, local recurrence, disease-free and overall survival using standard statistical methods. Results 78% showed tumour regression post-CRT; 43% displayed good tumour regression/response while 22% had poor tumour regression/response. All patients had a pre-operative T-stage of either T3 or T4. Post-operation, good responders had a median T stage of T2 vs. T3 in poor responders (P = 0.0002). Overall, the median lymph node harvest was < 12. There was no difference in the number of nodes harvested in good vs. poor responders (Good/moderate-6 nodes vs. Poor- 8; P = 0.31). Good responders tended to have a lesser number of malignant nodes vs. poor responders (P = 0.31). Overall, local recurrence was 6.8% and the anal sphincter preservation rate was 89%. Predicted 5-year disease-free and overall survival were similar between good and poor responders. Conclusion Long-course CRT resulted in satisfactory tumour regression and enabled consideration for safe, sphincter-saving resection in rectal cancer. A dedicated multi-disciplinary team approach achieved a global benchmark for local recurrence in a resource-limited setting
Transanal Ileal Pouch-Anal Anastomosis for Ulcerative Colitis has Comparable Long-Term Functional Outcomes to Transabdominal Approach: A Multicentre Comparative Study
No full textBACKGROUND: The transanal approach to ileal pouch-anal anastomosis [Ta-IPAA] provides better access to the lower pelvis with lower short-term morbidity in ulcerative colitis [UC]. The aim of this study was to assess the long-term functional outcomes after Ta-IPAA vs transabdominal IPAA [Abd-IPAA] in UC. METHODS: A multicentre cohort analysis was performed between March 2002 and September 2017. Patient characteristics, surgical details and postoperative outcomes were compared. CGQL [Cleveland global quality of life] score at 12 months with a functioning pouch was considered the primary end point. RESULTS: A total of 374 patients [100 Ta-IPAA vs 274 Abd-IPAA] were included. Ta-IPAA demonstrated a comparable overall quality of life [CGQL score] to Abd-IPAA [0.75 ± 0.11 vs 0.71 ± 0.14; respectively, p = 0.1]. Quality of life [7.71 ± 1.17 vs 7.30 ± 1.46; p = 0.04] and energy-level items [7.16 ± 1.52 vs 6.66 ± 1.68; p = 0.03] were significantly better after Ta-IPAA, while the quality of health item was comparable [7.68 ± 1.26 vs 7.64 ± 1.44; p = 0.96]. Analysis excluding anastomotic leaks did not change the overall CGQL scores. Stool frequencies [>10/24 h: 22% vs 21%; p = 1.0] and the rate of a single episode of major incontinence during the following 12-month period [27% vs 26%; p = 0.89] were similar. The differences in 30-day morbidity rates [33% vs 41%; p = 0.2] and anastomotic leak rates were not significant [6% vs 13%; p = 0.09]. CONCLUSIONS: This study provides evidence of comparable long-term functional outcome and quality of life after Ta-IPAA and Abd-IPAA for UC
Role of SMAD proteins in colitis-associated cancer: from known to the unknown.
No full textSmall mothers against decapentaplegic (SMAD) proteins are a family of signal transduction molecules in transforming growth factor β (TGFβ) ligand pathways that have been found to have a key role in the pathogenesis of inflammatory bowel disease (IBD). Long standing IBD predisposes individuals to colitis-associated colorectal cancer (CAC), an entity that possess unique characteristics compared to hereditary and sporadic cancer. The ligands of the TGFβ super family along with SMADs have also been implicated in several aspects of colorectal cancer formation. SMAD proteins are shown to be involved in a number of potentially carcinogenic mechanisms such as altering gene transcription, controlling stem cell differentiation to causing epigenetic changes. Modulation of these proteins has emerged as a novel therapeutic intervention for IBD although its effect on carcinogenesis remains elusive. This account reviews available evidence linking SMAD proteins to CAC and explores the potential areas for future research in this area.Oncogene advance online publication, 4 September 2017; doi:10.1038/onc.2017.300
Molecular profiling of advanced breast cancer tumors is beneficial in assisting clinical treatment plans
No full textWe used data obtained by Caris Life Sciences, to evaluate the benefits of tailoring
treatments for a breast carcinoma cohort by using tumor molecular profiles to inform
decisions. Data for 92 breast cancer patients from the commercial Caris Molecular
Intelligence database was retrospectively divided into two groups, so that the first
always followed treatment recommendations, whereas in the second group all
patients received at least one drug after profiling that was predicted to lack benefit.
The biomarker and drug associations were based on tests including fluorescent
in
situ
hybridization and DNA sequencing, although immunohistochemistry was the main
test used.
Patients whose drugs matched those recommended according to their tumor
profile had an average overall survival of 667 days, compared to 510 days for patients
that did not (P=0.0316). In the matched treatment group, 26% of patients were
deceased by the last time of monitoring, whereas this was 41% in the unmatched
group (P=0.1257). We therefore confirm the ability of tumor molecular profiling to
improve survival of breast cancer patients. Immunohistochemistry biomarkers for
the androgen, estrogen and progesterone receptors were found to be prognostic for
survival
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