Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2018
The mainstay of management for locally advanced rectal cancer is chemoradiotherapy followed by su... more 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. 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. Of 2572 patients undergoing rectal cancer surgery in 277 participating centres across 44 countries, 673 (26...
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Sep 1, 2018
Laparoscopy has now been implemented as a standard of care for elective colonic resection around ... more 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. 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. 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 (l...
BO O K O F A BS TR A C TS 53 BO O K O F A BS TR A C TS 52 Introduction. Colorectal cancer is one ... more BO O K O F A BS TR A C TS 53 BO O K O F A BS TR A C TS 52 Introduction. Colorectal cancer is one of the leading causes of death in the world and early detection of colorectal cancer is necessary for the successful treatment. Environmental factors and genetic mutations are involved in the initiation and progression of this disease. MicroRNAs are new molecular markers that could be used both in diagnostic and in prognostic ways. MicroRNAs are small (19-24 nucleotides), endogenous, non-coding RNA molecules, which are known to regulate gene expression. Changes in microRNAs expression are identified in colorectal tumors. The aim of this study was to determine microRNA expression (miR-148a and miR-6253p) in colorectal tumors and its correlation with colorectal cancer progression. Materials and methods. A total of 60 colorectal cancer patients were enrolled to the study. MicroRNA was extracted from formalin-fixed, paraffin-embedded (FFPE) tissue sections using “miRNeasy FFPE Kit” (Qiagen, ...
Aims We decided to present several patient's cases that had several therapeutic endoscopies a... more Aims We decided to present several patient's cases that had several therapeutic endoscopies and follow ups after radicaltreatment of upper gastrointestinal cancer, as well as point out the problems associated with treatment delay due toCOVID-19 pandemic. Methods The patients we included had some therapeutic endoscopic procedures delayed due to pandemic. Results First patient - 56 years old, had oesophagus resection in June 2018, followed by gastroplasty and adjuvantchemotherapy. In August 2018 had a follow up where anastomose stricture was observed. Afterwards patient received 8 dilatationprocedures during year's time and in October 2019 self-expandable metallic stent (SEMS) was inserted to reduce thefrequency of dilatation procedures. On time evacuation 6 weeks after the insertion and a follow up in January 2020.Unfortunately, the stricture has formed repeatedly and patient has to continue dilatation procedures every month. Patient agrees for another SEMS just before the pa...
BACKGROUND: A right hemicolectomy is among the most commonly performed operations for colon cance... more BACKGROUND: A right hemicolectomy is among the most commonly performed operations for colon cancer, but modern high-quality, multination data addressing the morbidity and mortality rates are lacking. OBJECTIVE: This study reports the morbidity and mortality rates for right-sided colon cancer and identifies predictors for unfavorable short-term outcome after right hemicolectomy.
The Enhanced Recovery After Surgery (ERAS ®) Society guidelines aim to standardise perioperative ... more 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 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 (some submitted multiple responses). The majority were European (163/195 [83.6%]). Overall, respondents indicated they normally or always adhered to most individual ERAS ® principles (18/25 [72%]). Variability in uptake of principles was seen, with some universal uptake (e.g. prophylactic antibiotics; early mobilisation) whilst others demonstrated inconsistency between sites from 'rarely' to 'always' used (e.g. no nasogastric intubation; no preoperative fasting and carbohydrate drinks). When comparing practice to 2017, there were increases in certain principles such as prehabilitation, managing anaemia and postoperative nutrition-these differences broadly overlapped with 2018 ERAS ® guideline updates. Conclusions Uptake of ERAS ® principles varies across hospitals, and not all 25 principles are 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.
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2018
Transanal total mesorectal excision (TaTME) has rapidly emerged as a novel approach for rectal ca... more 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. 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. 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, 1.0...
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Sep 1, 2018
The optimal bowel preparation strategy to minimise the risk of anastomotic leak is yet to be dete... more The optimal bowel preparation strategy to minimise the risk of anastomotic leak is yet to be determined. This study aimed to determine whether oral antibiotics combined with mechanical bowel preparation (MBP+Abx) was associated with a reduced risk of anastomotic leak when compared to mechanical bowel preparation alone (MBP) or no bowel preparation (NBP). A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 Left Sided Colorectal Resection audit was performed. Patients undergoing elective left sided colonic or rectal resection with primary anastomosis between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak. Of 3676 patients across 343 centres in 47 countries, 618 (16.8%) received MBP+ABx, 1945 MBP (52.9%) and 1099 patients NBP (29.9%). Patients undergoing MBP+ABx had the lowest overall rate of anastomotic leak (6.1%, 9.2%, 8.7% respectively) in unadjusted analysis. After case-mix adjustm...
Intimate examinations are often distressing for patients. GMC cases with allegations of inappropr... more Intimate examinations are often distressing for patients. GMC cases with allegations of inappropriate examination or a chaperone not being present have risen over 60% in the past 5 years. Following recommendations in the Ayling report3 and the GMCs 'Intimate examinations and chaperones' our NHS Trust created a surgical admission proforma allowing for full documentation of rectal examinations. This audit aims to determine current use and documentation of chaperones in the Surgical Assessment Unit (SAU). Method: A prospective audit analysing case notes of 40 consecutive adult patients presenting to SAU. Multiple variables collected from a standardised clerking proforma. Result: 37.5%(n¼15) of patients were male and 62.5%(n¼25) female. Median (range) age was 54(16-91) years. 67.5%(n¼27) of had a chaperone present. Of these, 40.7%(n¼11) had name and grade recorded and 37.0%(n¼10) were countersigned. Commonest indication for examination was abdominal pain 35%(n¼14). Incidence of chaperone use by gender of assessor to patient was; F: F(78.6%),F: M(50.0%),M: F(63.7%),M: M(71.4%). Conclusion: Correct documentation of chaperone use falls short of complete compliance with the GMC guidelines in our hospital. However, the authors suggest that a structured area in the clerking proforma aids correct documentation, which is in the interest of all parties involved in intimate examinations.
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Jan 6, 2017
Anastomosis technique following right sided colonic resection is widely variable and may affect p... more Anastomosis technique following right sided colonic resection is widely variable and may affect patient outcomes. This study aimed to assess the association between leak and anastomosis technique (stapled versus handsewn) METHODS: This was a prospective, multicentre, international audit including patients undergoing elective or emergency right hemicolectomy or ileo-caecal resection operations over a two-month period in early 2015. The primary outcome measure was the presence of anastomotic leak within 30 days of surgery, using a pre-specified definition. Mixed effects logistic regression models were used to assess the association between leak and anastomosis method, adjusting for patient, disease and operative cofactors, with centre included as a random effect variable. This study included 3208 patients, of whom 78.4% (n=2515) underwent surgery for malignancy and 11.7% (n=375) for Crohn's disease. An anastomosis was performed in 94.8% (n=3041) of patients, which was handsewn in ...
Background: Affective disorders, mainly represented by major depression, are among the top three ... more Background: Affective disorders, mainly represented by major depression, are among the top three causes of debilitation in the world, being associated with severe morbidity and an increased risk of mortality [1]. Thus, major depression is a serious public health problem in modern society. Due to the high number of individuals with affective disorders, which are resistant to the established monoaminergic drug therapies, there is a great need to develop novel and more effective antidepressants [2]. Clinical studies show that ketamine, an NMDA receptor antagonist, produces a rapid and sustained antidepressant response, while classical antidepressants require repeated treatment for up to four weeks to produce similar effects [2]. Ketamine has a potential to be applied as an alternative intervention to patients with treatment resistant depression [3], but given methodological difficulties there are only few studies evaluating its effects in adequate animal models. Aim: This project aimed to assess whether systemic treatment with ketamine would improve the behavioural response in an animal model of a treatment resistant condition. Methods: Male Sprague-Dawley rats received subcutaneous injections of adrenocorticotropic hormone (ACTH; 1−24; 100ug/rat/day) or vehicle during 14 days. On the 14th day the animals were exposed to the pre-test session of forced swim (FST; 15 min, water at 24±1ºC) and after 24 hours they were exposed to the open-field test (OFT) followed by the FST test session (5 min, water at 24±1ºC). The animals received an intraperitoneal injection of ketamine (15 mg/kg) or vehicle or imipramine (3 injections of 15 mg/kg; 0, 5 and 23 h after the pre-test) 1 hour before the test session. All data was analysed by One-Way ANOVA followed by appropriate post-hoc. Results: The immobility time during the pre-test was increased on the group treated with ACTH [F(14,37) = 3.484; p < 0.05; Dunnett]. On ACTH pre-treated animals, ketamine, but not imipramine, reduced the immobility time when exposed to the test session [F(2,16) = 4.002; p < 0.05; Dunnett]. On vehicle pretreated animals, ketamine and imipramine reduced the immobility time when exposed to the test session [F(2,15) = 11.89; p < 0.05; Dunnett]. The OFT showed that any of the treatments increased the locomotor activity [F(5,26) = 3.138; p < 0.05; Tukey]. Conclusion: The data suggest that ACTH treatment can induce a pro-depressive-like effect, which highlights its role as an inducer of a treatment-resistant condition. The validity of ACTH repeated treatment as a model of treatment resistant depression is further P.2.a.007 Depression, anxiety and subjective stress in gastrointestinal cancer inpatients
Decreased pepsinogen (Pg) levels indicate gastric atrophy and are suggested for gastric cancer sc... more Decreased pepsinogen (Pg) levels indicate gastric atrophy and are suggested for gastric cancer screening, particularly for intestinal type of gas- tric cancer. To achieve high sensitivity of the screening, the majority of gastric cancer cases would be expected to present with low pepsinogen levels
Aim Aspiration is a common cause of pneumonia in patients with postoperative ileus. Insertion of ... more Aim Aspiration is a common cause of pneumonia in patients with postoperative ileus. Insertion of a nasogastric tube (NGT) is often performed, but this can be distressing. The aim of this study was to determine whether the timing of NGT insertion after surgery (before versus after vomiting) was associated with reduced rates of pneumonia in patients undergoing elective colorectal surgery. Method This was a preplanned secondary analysis of a multicentre, prospective cohort study. Patients undergoing elective colorectal surgery between January 2018 and April 2018 were eligible. Those receiving a NGT were divided into three groups, based on the timing of the insertion: routine NGT (inserted at the time of surgery), prophylactic NGT (inserted after surgery but before vomiting) and reactive NGT (inserted after surgery and after vomiting). The primary outcome was the development of pneumonia within 30 days of surgery, which was compared between the prophylactic and reactive NGT groups using multivariable regression analysis. Results A total of 4715 patients were included in the analysis and 1536 (32.6%) received a NGT. These were classified as routine in 926 (60.3%), reactive in 461 (30.0%) and prophylactic in 149 (9.7%). Two hundred patients (4.2%) developed pneumonia (no NGT 2.7%; routine NGT 5.2%; reactive NGT 10.6%; prophylactic NGT 11.4%). After adjustment for confounding factors, no significant difference in pneumonia rates was detected between the prophylactic and reactive NGT groups (odds ratio 1.03, 95% CI 0.56-1.87, P = 0.932). Conclusion In patients who required the insertion of a NGT after surgery, prophylactic insertion was not associated with fewer cases of pneumonia within 30 days of surgery compared with reactive insertion.
The impact of stapling technique and surgeon specialism on anastomotic failure after right-sided ... more The impact of stapling technique and surgeon specialism on anastomotic failure after right-sided colorectal resection: An international multi-centre, prospective audit On behalf of the 2015 European Society of Coloproctology collaborating group*
Although colorectal cancer (CRC) screening is included in organized programs of many countries wo... more Although colorectal cancer (CRC) screening is included in organized programs of many countries worldwide, there is still a place for better screening tools. In this study, 418 breath samples were collected from 65 patients with CRC, 22 with advanced or nonadvanced adenomas, and 122 control cases. All patients, including the controls, had undergone colonoscopy. The samples were analysed with two different techniques. The first technique relied on gas chromatography coupled with mass spectrometry (GC-MS) for identification and quantification of volatile organic compounds (VOCs). The T-test was used to identify significant VOCs (p values < 0.017). The second technique relied on sensor analysis with a pattern recognition method for building a breath pattern to identify different groups. Blind analysis or leave-one-out cross validation was conducted for validation. The GC-MS analysis revealed four significant VOCs that identified the tested groups; these were acetone and ethyl acetate (higher in CRC), ethanol and 4-methyl octane (lower in CRC). The sensor-analysis distinguished CRC from the control group with 85% sensitivity, 94% specificity and 91% accuracy. The performance of the sensors in identifying the advanced adenoma group from the non-advanced adenomas was 88% sensitivity, 100% specificity, and 94% accuracy. The performance of the sensors in identifying the advanced adenoma group was distinguished from the control group was 100% sensitivity, 88% specificity, and 94% accuracy. For summary, volatile marker testing by using sensor analysis is a promising noninvasive approach for CRC screening.
European Journal of Surgical Oncology (EJSO), 2009
Background: Although the mortality for gastric cancer is decreasing in Western Europe and United ... more Background: Although the mortality for gastric cancer is decreasing in Western Europe and United States, it still remains high in Eastern Europe. This study was aimed at evaluating short-and long-term results of surgical treatment of gastric cancer performed in Latvia Oncology Center. Methods: Retrospectively collected data from 461 patients who underwent gastrectomy with curative intent in Latvia Oncology Center from January 2001 to December 2005 were analyzed statistically. Results: An average (range) of 92.2 (81e102) R0eR1 gastrectomies was performed each year. Post-operative complications occurred in 75 patients (16.3%); in-hospital mortality was 3.3%. The overall 5-year survival was 50.8%. In 444 cases (96.3%) there was histopathologic confirmation of R0-resection with a 5-year survival of 52.5% (P < 0.001). Considering pT category, 5-year survival was 88.6% for pT1 patients, 65% for pT2, 42.3% for pT3 and 27% for pT4 (P < 0.001). Considering pN category, 5-year survival was 67% for pN0 patients, 30% for pN1 and 29% for pN2-3 (P < 0.001). Conclusions: Clinico-pathologic characteristics of patients who underwent resection with curative intent are comparable to other Western experiences. Short-as well as long-term results are also similar if not for pNþ patients where no difference between pN1 and pN2 cases was observed.
Background: Symptomatic benign liver tumours (BLT) may be an indication for surgery. Surgical tre... more Background: Symptomatic benign liver tumours (BLT) may be an indication for surgery. Surgical treatment exists of laparoscopic and open liver resection. However, surgical outcomes have never been compared before in a systematic review, as well as the influence of type of surgery on relief of symptoms and quality of life (QOL). Methods: Two independent reviewers performed a systematic literature search in Pubmed and Embase. All articles on surgery for symptomatic BLT were abstracted. Methodological quality was evaluated using the MINORS tool. Outcomes were divided in open and laparoscopic. Results: A total of 69 articles were analysed, including 4913 patients receiving surgery for BLT. 3749 patients received open surgery and 1164 laparoscopic. A total of 1022 major resections were performed: 581 open and 33 laparoscopic. Blood loss, operative time and length of hospital stay were respectively 457ml, 183min and 8,2days for open surgery, versus 124ml, 146 min and 6,4days for laparoscopic. The most common indication for surgery was symptoms: 61,9%. Overall, symptoms decreased from 69% preoperative to 16% postoperative. 2 out of 14 studies using a validated QOL questionnaire reported an advantage for laparoscopy, 12 didn't report differences. A total of 309 complications were reported: (7,2%) open and (3,7%) laparoscopic. Conclusion: Blood loss, operative time, length of hospital stay and complications were less for laparoscopic surgery, which can be explained by the majority of minor resections. However, as the percentages of complications are still far apart, it could be considered to perform more extensive laparoscopic surgery for BLT in selected patients.
Purpose: To investigate whether the ratio between metastatic and examined lymph nodes (N ratio) i... more Purpose: To investigate whether the ratio between metastatic and examined lymph nodes (N ratio) is a better prognostic factor as compared with traditional staging systems in patients with gastric cancer regardless of the extension of lymph node dissection.
Timely detection of gastric cancer (GC) and the related precancerous lesions could provide a tool... more Timely detection of gastric cancer (GC) and the related precancerous lesions could provide a tool for decreasing both cancer mortality and incidence. 968 breath samples were collected from 484 patients (including 99 with GC) for two different analyses. The first sample was analysed by gas chromatography linked to mass spectrometry (GCMS) while applying t test with multiple corrections (p value&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.017); the second by cross-reactive nanoarrays combined with pattern recognition. For the latter, 70% of the samples were randomly selected and used in the training set while the remaining 30% constituted the validation set. The operative link on gastric intestinal metaplasia (OLGIM) assessment staging system was used to stratify the presence/absence and risk level of precancerous lesions. Patients with OLGIM stages III-IV were considered to be at high risk. According to the GCMS results, patients with cancer as well as those at high risk had distinctive breath-print compositions. Eight significant volatile organic compounds (p value&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.017) were detected in exhaled breath in the different comparisons. The nanoarray analysis made it possible to discriminate between the patients with GC and the control group (OLGIM 0-IV) with 73% sensitivity, 98% specificity and 92% accuracy. The classification sensitivity, specificity, and accuracy between the subgroups was as follows: GC versus OLGIM 0-II-97%, 84% and 87%; GC versus OLGIM III-IV-93%, 80% and 90%; but OLGIM I-II versus OLGIM III-IV and dysplasia combined-83%, 60% and 61%, respectively. Nanoarray analysis could provide the missing non-invasive screening tool for GC and related precancerous lesions as well as for surveillance of the latter. Clinical Trials.gov number, NCT01420588 (3/11/2013).
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2018
The mainstay of management for locally advanced rectal cancer is chemoradiotherapy followed by su... more 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. 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. Of 2572 patients undergoing rectal cancer surgery in 277 participating centres across 44 countries, 673 (26...
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Sep 1, 2018
Laparoscopy has now been implemented as a standard of care for elective colonic resection around ... more 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. 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. 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 (l...
BO O K O F A BS TR A C TS 53 BO O K O F A BS TR A C TS 52 Introduction. Colorectal cancer is one ... more BO O K O F A BS TR A C TS 53 BO O K O F A BS TR A C TS 52 Introduction. Colorectal cancer is one of the leading causes of death in the world and early detection of colorectal cancer is necessary for the successful treatment. Environmental factors and genetic mutations are involved in the initiation and progression of this disease. MicroRNAs are new molecular markers that could be used both in diagnostic and in prognostic ways. MicroRNAs are small (19-24 nucleotides), endogenous, non-coding RNA molecules, which are known to regulate gene expression. Changes in microRNAs expression are identified in colorectal tumors. The aim of this study was to determine microRNA expression (miR-148a and miR-6253p) in colorectal tumors and its correlation with colorectal cancer progression. Materials and methods. A total of 60 colorectal cancer patients were enrolled to the study. MicroRNA was extracted from formalin-fixed, paraffin-embedded (FFPE) tissue sections using “miRNeasy FFPE Kit” (Qiagen, ...
Aims We decided to present several patient's cases that had several therapeutic endoscopies a... more Aims We decided to present several patient's cases that had several therapeutic endoscopies and follow ups after radicaltreatment of upper gastrointestinal cancer, as well as point out the problems associated with treatment delay due toCOVID-19 pandemic. Methods The patients we included had some therapeutic endoscopic procedures delayed due to pandemic. Results First patient - 56 years old, had oesophagus resection in June 2018, followed by gastroplasty and adjuvantchemotherapy. In August 2018 had a follow up where anastomose stricture was observed. Afterwards patient received 8 dilatationprocedures during year's time and in October 2019 self-expandable metallic stent (SEMS) was inserted to reduce thefrequency of dilatation procedures. On time evacuation 6 weeks after the insertion and a follow up in January 2020.Unfortunately, the stricture has formed repeatedly and patient has to continue dilatation procedures every month. Patient agrees for another SEMS just before the pa...
BACKGROUND: A right hemicolectomy is among the most commonly performed operations for colon cance... more BACKGROUND: A right hemicolectomy is among the most commonly performed operations for colon cancer, but modern high-quality, multination data addressing the morbidity and mortality rates are lacking. OBJECTIVE: This study reports the morbidity and mortality rates for right-sided colon cancer and identifies predictors for unfavorable short-term outcome after right hemicolectomy.
The Enhanced Recovery After Surgery (ERAS ®) Society guidelines aim to standardise perioperative ... more 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 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 (some submitted multiple responses). The majority were European (163/195 [83.6%]). Overall, respondents indicated they normally or always adhered to most individual ERAS ® principles (18/25 [72%]). Variability in uptake of principles was seen, with some universal uptake (e.g. prophylactic antibiotics; early mobilisation) whilst others demonstrated inconsistency between sites from 'rarely' to 'always' used (e.g. no nasogastric intubation; no preoperative fasting and carbohydrate drinks). When comparing practice to 2017, there were increases in certain principles such as prehabilitation, managing anaemia and postoperative nutrition-these differences broadly overlapped with 2018 ERAS ® guideline updates. Conclusions Uptake of ERAS ® principles varies across hospitals, and not all 25 principles are 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.
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2018
Transanal total mesorectal excision (TaTME) has rapidly emerged as a novel approach for rectal ca... more 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. 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. 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, 1.0...
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Sep 1, 2018
The optimal bowel preparation strategy to minimise the risk of anastomotic leak is yet to be dete... more The optimal bowel preparation strategy to minimise the risk of anastomotic leak is yet to be determined. This study aimed to determine whether oral antibiotics combined with mechanical bowel preparation (MBP+Abx) was associated with a reduced risk of anastomotic leak when compared to mechanical bowel preparation alone (MBP) or no bowel preparation (NBP). A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 Left Sided Colorectal Resection audit was performed. Patients undergoing elective left sided colonic or rectal resection with primary anastomosis between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak. Of 3676 patients across 343 centres in 47 countries, 618 (16.8%) received MBP+ABx, 1945 MBP (52.9%) and 1099 patients NBP (29.9%). Patients undergoing MBP+ABx had the lowest overall rate of anastomotic leak (6.1%, 9.2%, 8.7% respectively) in unadjusted analysis. After case-mix adjustm...
Intimate examinations are often distressing for patients. GMC cases with allegations of inappropr... more Intimate examinations are often distressing for patients. GMC cases with allegations of inappropriate examination or a chaperone not being present have risen over 60% in the past 5 years. Following recommendations in the Ayling report3 and the GMCs 'Intimate examinations and chaperones' our NHS Trust created a surgical admission proforma allowing for full documentation of rectal examinations. This audit aims to determine current use and documentation of chaperones in the Surgical Assessment Unit (SAU). Method: A prospective audit analysing case notes of 40 consecutive adult patients presenting to SAU. Multiple variables collected from a standardised clerking proforma. Result: 37.5%(n¼15) of patients were male and 62.5%(n¼25) female. Median (range) age was 54(16-91) years. 67.5%(n¼27) of had a chaperone present. Of these, 40.7%(n¼11) had name and grade recorded and 37.0%(n¼10) were countersigned. Commonest indication for examination was abdominal pain 35%(n¼14). Incidence of chaperone use by gender of assessor to patient was; F: F(78.6%),F: M(50.0%),M: F(63.7%),M: M(71.4%). Conclusion: Correct documentation of chaperone use falls short of complete compliance with the GMC guidelines in our hospital. However, the authors suggest that a structured area in the clerking proforma aids correct documentation, which is in the interest of all parties involved in intimate examinations.
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Jan 6, 2017
Anastomosis technique following right sided colonic resection is widely variable and may affect p... more Anastomosis technique following right sided colonic resection is widely variable and may affect patient outcomes. This study aimed to assess the association between leak and anastomosis technique (stapled versus handsewn) METHODS: This was a prospective, multicentre, international audit including patients undergoing elective or emergency right hemicolectomy or ileo-caecal resection operations over a two-month period in early 2015. The primary outcome measure was the presence of anastomotic leak within 30 days of surgery, using a pre-specified definition. Mixed effects logistic regression models were used to assess the association between leak and anastomosis method, adjusting for patient, disease and operative cofactors, with centre included as a random effect variable. This study included 3208 patients, of whom 78.4% (n=2515) underwent surgery for malignancy and 11.7% (n=375) for Crohn's disease. An anastomosis was performed in 94.8% (n=3041) of patients, which was handsewn in ...
Background: Affective disorders, mainly represented by major depression, are among the top three ... more Background: Affective disorders, mainly represented by major depression, are among the top three causes of debilitation in the world, being associated with severe morbidity and an increased risk of mortality [1]. Thus, major depression is a serious public health problem in modern society. Due to the high number of individuals with affective disorders, which are resistant to the established monoaminergic drug therapies, there is a great need to develop novel and more effective antidepressants [2]. Clinical studies show that ketamine, an NMDA receptor antagonist, produces a rapid and sustained antidepressant response, while classical antidepressants require repeated treatment for up to four weeks to produce similar effects [2]. Ketamine has a potential to be applied as an alternative intervention to patients with treatment resistant depression [3], but given methodological difficulties there are only few studies evaluating its effects in adequate animal models. Aim: This project aimed to assess whether systemic treatment with ketamine would improve the behavioural response in an animal model of a treatment resistant condition. Methods: Male Sprague-Dawley rats received subcutaneous injections of adrenocorticotropic hormone (ACTH; 1−24; 100ug/rat/day) or vehicle during 14 days. On the 14th day the animals were exposed to the pre-test session of forced swim (FST; 15 min, water at 24±1ºC) and after 24 hours they were exposed to the open-field test (OFT) followed by the FST test session (5 min, water at 24±1ºC). The animals received an intraperitoneal injection of ketamine (15 mg/kg) or vehicle or imipramine (3 injections of 15 mg/kg; 0, 5 and 23 h after the pre-test) 1 hour before the test session. All data was analysed by One-Way ANOVA followed by appropriate post-hoc. Results: The immobility time during the pre-test was increased on the group treated with ACTH [F(14,37) = 3.484; p < 0.05; Dunnett]. On ACTH pre-treated animals, ketamine, but not imipramine, reduced the immobility time when exposed to the test session [F(2,16) = 4.002; p < 0.05; Dunnett]. On vehicle pretreated animals, ketamine and imipramine reduced the immobility time when exposed to the test session [F(2,15) = 11.89; p < 0.05; Dunnett]. The OFT showed that any of the treatments increased the locomotor activity [F(5,26) = 3.138; p < 0.05; Tukey]. Conclusion: The data suggest that ACTH treatment can induce a pro-depressive-like effect, which highlights its role as an inducer of a treatment-resistant condition. The validity of ACTH repeated treatment as a model of treatment resistant depression is further P.2.a.007 Depression, anxiety and subjective stress in gastrointestinal cancer inpatients
Decreased pepsinogen (Pg) levels indicate gastric atrophy and are suggested for gastric cancer sc... more Decreased pepsinogen (Pg) levels indicate gastric atrophy and are suggested for gastric cancer screening, particularly for intestinal type of gas- tric cancer. To achieve high sensitivity of the screening, the majority of gastric cancer cases would be expected to present with low pepsinogen levels
Aim Aspiration is a common cause of pneumonia in patients with postoperative ileus. Insertion of ... more Aim Aspiration is a common cause of pneumonia in patients with postoperative ileus. Insertion of a nasogastric tube (NGT) is often performed, but this can be distressing. The aim of this study was to determine whether the timing of NGT insertion after surgery (before versus after vomiting) was associated with reduced rates of pneumonia in patients undergoing elective colorectal surgery. Method This was a preplanned secondary analysis of a multicentre, prospective cohort study. Patients undergoing elective colorectal surgery between January 2018 and April 2018 were eligible. Those receiving a NGT were divided into three groups, based on the timing of the insertion: routine NGT (inserted at the time of surgery), prophylactic NGT (inserted after surgery but before vomiting) and reactive NGT (inserted after surgery and after vomiting). The primary outcome was the development of pneumonia within 30 days of surgery, which was compared between the prophylactic and reactive NGT groups using multivariable regression analysis. Results A total of 4715 patients were included in the analysis and 1536 (32.6%) received a NGT. These were classified as routine in 926 (60.3%), reactive in 461 (30.0%) and prophylactic in 149 (9.7%). Two hundred patients (4.2%) developed pneumonia (no NGT 2.7%; routine NGT 5.2%; reactive NGT 10.6%; prophylactic NGT 11.4%). After adjustment for confounding factors, no significant difference in pneumonia rates was detected between the prophylactic and reactive NGT groups (odds ratio 1.03, 95% CI 0.56-1.87, P = 0.932). Conclusion In patients who required the insertion of a NGT after surgery, prophylactic insertion was not associated with fewer cases of pneumonia within 30 days of surgery compared with reactive insertion.
The impact of stapling technique and surgeon specialism on anastomotic failure after right-sided ... more The impact of stapling technique and surgeon specialism on anastomotic failure after right-sided colorectal resection: An international multi-centre, prospective audit On behalf of the 2015 European Society of Coloproctology collaborating group*
Although colorectal cancer (CRC) screening is included in organized programs of many countries wo... more Although colorectal cancer (CRC) screening is included in organized programs of many countries worldwide, there is still a place for better screening tools. In this study, 418 breath samples were collected from 65 patients with CRC, 22 with advanced or nonadvanced adenomas, and 122 control cases. All patients, including the controls, had undergone colonoscopy. The samples were analysed with two different techniques. The first technique relied on gas chromatography coupled with mass spectrometry (GC-MS) for identification and quantification of volatile organic compounds (VOCs). The T-test was used to identify significant VOCs (p values < 0.017). The second technique relied on sensor analysis with a pattern recognition method for building a breath pattern to identify different groups. Blind analysis or leave-one-out cross validation was conducted for validation. The GC-MS analysis revealed four significant VOCs that identified the tested groups; these were acetone and ethyl acetate (higher in CRC), ethanol and 4-methyl octane (lower in CRC). The sensor-analysis distinguished CRC from the control group with 85% sensitivity, 94% specificity and 91% accuracy. The performance of the sensors in identifying the advanced adenoma group from the non-advanced adenomas was 88% sensitivity, 100% specificity, and 94% accuracy. The performance of the sensors in identifying the advanced adenoma group was distinguished from the control group was 100% sensitivity, 88% specificity, and 94% accuracy. For summary, volatile marker testing by using sensor analysis is a promising noninvasive approach for CRC screening.
European Journal of Surgical Oncology (EJSO), 2009
Background: Although the mortality for gastric cancer is decreasing in Western Europe and United ... more Background: Although the mortality for gastric cancer is decreasing in Western Europe and United States, it still remains high in Eastern Europe. This study was aimed at evaluating short-and long-term results of surgical treatment of gastric cancer performed in Latvia Oncology Center. Methods: Retrospectively collected data from 461 patients who underwent gastrectomy with curative intent in Latvia Oncology Center from January 2001 to December 2005 were analyzed statistically. Results: An average (range) of 92.2 (81e102) R0eR1 gastrectomies was performed each year. Post-operative complications occurred in 75 patients (16.3%); in-hospital mortality was 3.3%. The overall 5-year survival was 50.8%. In 444 cases (96.3%) there was histopathologic confirmation of R0-resection with a 5-year survival of 52.5% (P < 0.001). Considering pT category, 5-year survival was 88.6% for pT1 patients, 65% for pT2, 42.3% for pT3 and 27% for pT4 (P < 0.001). Considering pN category, 5-year survival was 67% for pN0 patients, 30% for pN1 and 29% for pN2-3 (P < 0.001). Conclusions: Clinico-pathologic characteristics of patients who underwent resection with curative intent are comparable to other Western experiences. Short-as well as long-term results are also similar if not for pNþ patients where no difference between pN1 and pN2 cases was observed.
Background: Symptomatic benign liver tumours (BLT) may be an indication for surgery. Surgical tre... more Background: Symptomatic benign liver tumours (BLT) may be an indication for surgery. Surgical treatment exists of laparoscopic and open liver resection. However, surgical outcomes have never been compared before in a systematic review, as well as the influence of type of surgery on relief of symptoms and quality of life (QOL). Methods: Two independent reviewers performed a systematic literature search in Pubmed and Embase. All articles on surgery for symptomatic BLT were abstracted. Methodological quality was evaluated using the MINORS tool. Outcomes were divided in open and laparoscopic. Results: A total of 69 articles were analysed, including 4913 patients receiving surgery for BLT. 3749 patients received open surgery and 1164 laparoscopic. A total of 1022 major resections were performed: 581 open and 33 laparoscopic. Blood loss, operative time and length of hospital stay were respectively 457ml, 183min and 8,2days for open surgery, versus 124ml, 146 min and 6,4days for laparoscopic. The most common indication for surgery was symptoms: 61,9%. Overall, symptoms decreased from 69% preoperative to 16% postoperative. 2 out of 14 studies using a validated QOL questionnaire reported an advantage for laparoscopy, 12 didn't report differences. A total of 309 complications were reported: (7,2%) open and (3,7%) laparoscopic. Conclusion: Blood loss, operative time, length of hospital stay and complications were less for laparoscopic surgery, which can be explained by the majority of minor resections. However, as the percentages of complications are still far apart, it could be considered to perform more extensive laparoscopic surgery for BLT in selected patients.
Purpose: To investigate whether the ratio between metastatic and examined lymph nodes (N ratio) i... more Purpose: To investigate whether the ratio between metastatic and examined lymph nodes (N ratio) is a better prognostic factor as compared with traditional staging systems in patients with gastric cancer regardless of the extension of lymph node dissection.
Timely detection of gastric cancer (GC) and the related precancerous lesions could provide a tool... more Timely detection of gastric cancer (GC) and the related precancerous lesions could provide a tool for decreasing both cancer mortality and incidence. 968 breath samples were collected from 484 patients (including 99 with GC) for two different analyses. The first sample was analysed by gas chromatography linked to mass spectrometry (GCMS) while applying t test with multiple corrections (p value&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.017); the second by cross-reactive nanoarrays combined with pattern recognition. For the latter, 70% of the samples were randomly selected and used in the training set while the remaining 30% constituted the validation set. The operative link on gastric intestinal metaplasia (OLGIM) assessment staging system was used to stratify the presence/absence and risk level of precancerous lesions. Patients with OLGIM stages III-IV were considered to be at high risk. According to the GCMS results, patients with cancer as well as those at high risk had distinctive breath-print compositions. Eight significant volatile organic compounds (p value&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.017) were detected in exhaled breath in the different comparisons. The nanoarray analysis made it possible to discriminate between the patients with GC and the control group (OLGIM 0-IV) with 73% sensitivity, 98% specificity and 92% accuracy. The classification sensitivity, specificity, and accuracy between the subgroups was as follows: GC versus OLGIM 0-II-97%, 84% and 87%; GC versus OLGIM III-IV-93%, 80% and 90%; but OLGIM I-II versus OLGIM III-IV and dysplasia combined-83%, 60% and 61%, respectively. Nanoarray analysis could provide the missing non-invasive screening tool for GC and related precancerous lesions as well as for surveillance of the latter. Clinical Trials.gov number, NCT01420588 (3/11/2013).
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Papers by A. Sivins