Publications by authors named "Michel Adamina"

59 Publications

Patients' perceptions of surgery for inflammatory bowel disease.

Colorectal Dis 2021 Jul 16. Epub 2021 Jul 16.

Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.

Aim: Surgery is indicated in selected patients with inflammatory bowel disease (IBD). However, due to a negative perception, surgery may be delayed, leading to possible unfavourable outcomes. The aim of this work was to investigate patients' perceptions of surgery and the impact on reported outcomes.

Method: An international multilingual online survey was used to query IBD patients' experiences of surgery, information sources, expectations and concerns, quality of life (QoL) and feelings.

Results: The survey was completed by 425 of 510 participants. Crohn's disease was more frequent (61%) than ulcerative colitis (36%). Most patients primarily learned about surgery from their gastroenterologist and were informed of the risks and benefits by the surgeon. In almost one-third of patients indication for surgery was not a shared decision between gastroenterologist and surgeon. Seventy per cent of patients naïve to surgery were not aware of any surgical options. The majority of patients (80%) perceived surgery as the last option after many medical treatments rather than an alternative therapeutic option (20%). Sixteen per cent of patients obtained their primary information from the Internet, while 82.4% used the Internet to obtain additional information. Fear of surgical complications was cited by 73% of patients, while relief from symptoms was indicated by 31%. Most patients coped with their stoma better than expected or as they expected. Negative feelings decreased after surgery, while a lasting improvement in positive feelings and QoL was reported.

Conclusion: Despite the negative perception of surgery and the delayed involvement of surgeons as a source of information and in the decision-making process, the majority of respondents experienced positive outcomes from surgery, including improvement QoL and acceptance of the stoma.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/codi.15813DOI Listing
July 2021

Multidisciplinary management of elderly patients with rectal cancer: recommendations from the SICG (Italian Society of Geriatric Surgery), SIFIPAC (Italian Society of Surgical Pathophysiology), SICE (Italian Society of Endoscopic Surgery and new technologies), and the WSES (World Society of Emergency Surgery) International Consensus Project.

World J Emerg Surg 2021 Jul 2;16(1):35. Epub 2021 Jul 2.

UOC Chirurgia Generale - AOU san Giovanni di Dio e Ruggi d'Aragona, Università di Salerno, Salerno, Italy.

Background And Aims: Although rectal cancer is predominantly a disease of older patients, current guidelines do not incorporate optimal treatment recommendations for the elderly and address only partially the associated specific challenges encountered in this population. This results in a wide variation and disparity in delivering a standard of care to this subset of patients. As the burden of rectal cancer in the elderly population continues to increase, it is crucial to assess whether current recommendations on treatment strategies for the general population can be adopted for the older adults, with the same beneficial oncological and functional outcomes. This multidisciplinary experts' consensus aims to refine current rectal cancer-specific guidelines for the elderly population in order to help to maximize rectal cancer therapeutic strategies while minimizing adverse impacts on functional outcomes and quality of life for these patients.

Methods: The discussion among the steering group of clinical experts and methodologists from the societies' expert panel involved clinicians practicing in general surgery, colorectal surgery, surgical oncology, geriatric oncology, geriatrics, gastroenterologists, radiologists, oncologists, radiation oncologists, and endoscopists. Research topics and questions were formulated, revised, and unanimously approved by all experts in two subsequent modified Delphi rounds in December 2020-January 2021. The steering committee was divided into nine teams following the main research field of members. Each conducted their literature search and drafted statements and recommendations on their research question. Literature search has been updated up to 2020 and statements and recommendations have been developed according to the GRADE methodology. A modified Delphi methodology was implemented to reach agreement among the experts on all statements and recommendations.

Conclusions: The 2021 SICG-SIFIPAC-SICE-WSES consensus for the multidisciplinary management of elderly patients with rectal cancer aims to provide updated evidence-based statements and recommendations on each of the following topics: epidemiology, pre-intervention strategies, diagnosis and staging, neoadjuvant chemoradiation, surgery, watch and wait strategy, adjuvant chemotherapy, synchronous liver metastases, and emergency presentation of rectal cancer.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13017-021-00378-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8254305PMC
July 2021

Characteristics of Early-Onset vs Late-Onset Colorectal Cancer: A Review.

JAMA Surg 2021 Sep;156(9):865-874

Department of Surgery, Skåne University Hospital, Malmö, Sweden.

Importance: The incidence of early-onset colorectal cancer (younger than 50 years) is rising globally, the reasons for which are unclear. It appears to represent a unique disease process with different clinical, pathological, and molecular characteristics compared with late-onset colorectal cancer. Data on oncological outcomes are limited, and sensitivity to conventional neoadjuvant and adjuvant therapy regimens appear to be unknown. The purpose of this review is to summarize the available literature on early-onset colorectal cancer.

Observations: Within the next decade, it is estimated that 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in adults younger than 50 years. Potential risk factors include a Westernized diet, obesity, antibiotic usage, and alterations in the gut microbiome. Although genetic predisposition plays a role, most cases are sporadic. The full spectrum of germline and somatic sequence variations implicated remains unknown. Younger patients typically present with descending colonic or rectal cancer, advanced disease stage, and unfavorable histopathological features. Despite being more likely to receive neoadjuvant and adjuvant therapy, patients with early-onset disease demonstrate comparable oncological outcomes with their older counterparts.

Conclusions And Relevance: The clinicopathological features, underlying molecular profiles, and drivers of early-onset colorectal cancer differ from those of late-onset disease. Standardized, age-specific preventive, screening, diagnostic, and therapeutic strategies are required to optimize outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamasurg.2021.2380DOI Listing
September 2021

The impact of EAES Fellowship Programme: a five-year review and evaluation.

Surg Endosc 2021 Jun 8. Epub 2021 Jun 8.

Department of General Surgery, Linköping University Hospital, 581 85, Linköping, Sweden.

Background: The European Association of Endoscopic Surgery (EAES) fellowship programme was established in 2014, allowing nine surgeons annually to obtain experience and skills in minimally invasive surgery (MIS) from specialist centres across the Europe and United States. It aligns with the strategic focus of EAES Education and Training Committee on enabling Learning Mobility opportunities. To assess the impact of the programme, a survey was conducted aiming to evaluate the experience and impact of the programme and receive feedback for improvements.

Methods: A survey using a 5-point Likert scale was used to evaluate clinical, education and research experience. The impact on acquisition of new technical skills, change in clinical practice and ongoing collaboration with the host institute was assessed. The fellows selected between 2014 and 2018 were included. Ratings were analysed in percentage; thematic analysis was applied to the free-text feedbacks using qualitative analysis.

Results: All the fellows had good access to observing in operating theatres and 70.6% were able to assist. 91.2% participated in educational activities and 23.5% were able to contribute through teaching. 44.1% participated in research activities and 41.2% became an author/co-author of a publication from the host. 97.1% of fellows stated that their operative competency had increased, 94.3% gained new surgical skills and 85.7% was able to introduce new techniques in their hospitals. 74.29% agreed that the clinical experience led to a change in their practices. The most commonly suggested improvements were setting realistic target in clinical and research areas, increasing fellowship duration, and maximising theatre assisting opportunities. Nevertheless, 100% of fellows would recommend the fellowship to their peers.

Conclusion: EAES fellowship programme has shown a positive impact on acquiring and adopting new MIS techniques. To further refine the programme, an individualised approach should be adopted to set achievable learning objectives in clinical skills, education and research.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00464-021-08525-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8186018PMC
June 2021

At the crossroads of caution and intervention: anti-TNF therapy prior to elective CD surgery Authors' Reply to: "Anti-TNF therapy before intestinal surgery for Crohn's disease and the risks of postoperative complications".

J Crohns Colitis 2021 May 17. Epub 2021 May 17.

Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, Pieve Emanuele, Milan, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ecco-jcc/jjab092DOI Listing
May 2021

Contemporary snapshot of tumor regression grade (TRG) distribution in locally advanced rectal cancer: a cross sectional multicentric experience.

Updates Surg 2021 Apr 5. Epub 2021 Apr 5.

Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia.

Pre-operative chemoradiotherapy (CRT) followed by surgical resection is still the standard treatment for locally advanced low rectal cancer. Nowadays new strategies are emerging to treat patients with a complete response to pre-operative treatment, rendering the optimal management still controversial and under debate. The primary aim of this study was to obtain a snapshot of tumor regression grade (TRG) distribution after standard CRT. Second, we aimed to identify a correlation between clinical tumor stage (cT) and TRG, and to define the accuracy of magnetic resonance imaging (MRI) in the restaging setting. Between January 2017 and June 2019, a cross sectional multicentric study was performed in 22 referral centers of colon-rectal surgery including all patients with cT3-4Nx/cTxN1-2 rectal cancer who underwent pre-operative CRT. Shapiro-Wilk test was used for continuous data. Categorical variables were compared with Chi-squared test or Fisher's exact test, where appropriate. Accuracy of restaging MRI in the identification of pathologic complete response (pCR) was determined evaluating the correspondence with the histopathological examination of surgical specimens.In the present study, 689 patients were enrolled. Complete tumor regression rate was 16.9%. The "watch and wait" strategy was applied in 4.3% of TRG4 patients. A clinical correlation between more advanced tumors and moderate to absent tumor regression was found (p = 0.03). Post-neoadjuvant MRI had low sensibility (55%) and high specificity (83%) with accuracy of 82.8% in identifying TRG4 and pCR.Our data provided a contemporary description of the effects of pre-operative CRT on a large pool of locally advanced low rectal cancer patients treated in different colon-rectal surgical centers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13304-021-01044-0DOI Listing
April 2021

Abstracts presented at the 14th European Colorectal Congress (#ECCStGallen), 29.11.2020-2.12.2020, St.Gallen, Switzerland.

Tech Coloproctol 2021 Feb 22:607-656. Epub 2021 Feb 22.

Department of Surgery, Kantonsspital Winterthur, 8401, Winterthur, Switzerland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10151-021-02408-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7898491PMC
February 2021

ECCO Topical Review Optimising Reporting in Surgery, Endoscopy, and Histopathology.

J Crohns Colitis 2021 Jul;15(7):1089-1105

Department of Pathology, Sorbonne Université, AP-HP, Saint-Antoine hospital, Paris, France.

Background And Aims: Diagnosis and management of inflammatory bowel diseases [IBD] requires a lifelong multidisciplinary approach. The quality of medical reporting is crucial in this context. The present topical review addresses the need for optimised reporting in endoscopy, surgery, and histopathology.

Methods: A consensus expert panel consisting of gastroenterologists, surgeons, and pathologists, convened by the European Crohn's and Colitis Organisation, performed a systematic literature review. The following topics were covered: in endoscopy: [i] general IBD endoscopy; [ii] disease activity and surveillance; [iii] endoscopy treatment in IBD; in surgery: [iv] medical history with surgical relevance, surgical indication, and strategy; [v] operative approach; [vi] intraoperative disease description; [vii] operative steps; in pathology: [viii] macroscopic assessment and interpretation of resection specimens; [ix] IBD histology, including biopsies, surgical resections, and neoplasia; [x] IBD histology conclusion and report. Statements were developed using a Delphi methodology incorporating two consecutive rounds. Current practice positions were set when ≥ 80% of participants agreed on a recommendation.

Results: Thirty practice positions established a standard terminology for optimal reporting in endoscopy, surgery, and histopathology. Assessment of disease activity, surveillance recommendations, advice to surgeons for operative indication and strategies, including margins and extent of resection, and diagnostic criteria of IBD, as well as guidance for the interpretation of dysplasia and cancer, were handled. A standardised report including a core set of items to include in each specialty report, was defined.

Conclusions: Interdisciplinary high-quality care requires thorough and standardised reporting across specialties. This topical review offers an actionable framework and practice recommendations to optimise reporting in endoscopy, surgery, and histopathology.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ecco-jcc/jjab011DOI Listing
July 2021

Postoperative mortality after surgery for inflammatory bowel disease: The myth of Apollo and Artemis.

Dig Liver Dis 2021 01 11;53(1):52-53. Epub 2020 Nov 11.

Faculty of Medicine, University of Basel, Chief of Colorectal Surgery, Cantonal Hospital of Winterthur, 8401 Winterthur, Switzerland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.dld.2020.10.019DOI Listing
January 2021

EAES Recommendations for Recovery Plan in Minimally Invasive Surgery Amid COVID-19 Pandemic.

Surg Endosc 2021 01 10;35(1):1-17. Epub 2020 Nov 10.

Department of Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

Background: COVID-19 pandemic presented an unexpected challenge for the surgical community in general and Minimally Invasive Surgery (MIS) specialists in particular. This document aims to summarize recent evidence and experts' opinion and formulate recommendations to guide the surgical community on how to best organize the recovery plan for surgical activity across different sub-specialities after the COVID-19 pandemic.

Methods: Recommendations were developed through a Delphi process for establishment of expert consensus. Domain topics were formulated and subsequently subdivided into questions pertinent to different surgical specialities following the COVID-19 crisis. Sixty-five experts from 24 countries, representing the entire EAES board, were invited. Fifty clinicians and six engineers accepted the invitation and drafted statements based on specific key questions. Anonymous voting on the statements was performed until consensus was achieved, defined by at least 70% agreement.

Results: A total of 92 consensus statements were formulated with regard to safe resumption of surgery across eight domains, addressing general surgery, upper GI, lower GI, bariatrics, endocrine, HPB, abdominal wall and technology/research. The statements addressed elective and emergency services across all subspecialties with specific attention to the role of MIS during the recovery plan. Eighty-four of the statements were approved during the first round of Delphi voting (91.3%) and another 8 during the following round after substantial modification, resulting in a 100% consensus.

Conclusion: The recommendations formulated by the EAES board establish a framework for resumption of surgery following COVID-19 pandemic with particular focus on the role of MIS across surgical specialities. The statements have the potential for wide application in the clinical setting, education activities and research work across different healthcare systems.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00464-020-08131-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7653984PMC
January 2021

Treatment Strategies for Pilonidal Sinus Disease in Switzerland and Austria.

Medicina (Kaunas) 2020 Jul 9;56(7). Epub 2020 Jul 9.

Department of Surgery, Clinic of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, 8400 Winterthur, Zurich, Switzerland.

: No current nationwide consensus exists on pilonidal disease (PD) treatment in Switzerland and Austria. The objective of this study was to assess and compare the spectrum of PD treatment strategies in Switzerland and Austria. : A survey including 196 certified institutions (Switzerland, = 99 and Austria, = 97) was performed. Treatment strategies for both chronic and acute pilonidal disease were investigated, as well as evolution of treatment over the last 20 years. : In total, 92 of 196 (47%) hospitals participated in the survey. Recurrence rate (20%) was similar between the two countries. In acute pilonidal disease, a two-stage approach with incision and drainage as the first step was preferred over a one-stage procedure in both countries. In Austria, all patients with chronic pilonidal disease were treated as inpatients, whereas 28% of patients in Switzerland were treated on an outpatient basis ( = 0.0019). Median length of hospital stay was double in Austria (four days) compared to Switzerland (two days; < 0.001). Primary resection and off-midline closure ( = 0.017) and the use of tissue flaps ( = 0.023) were performed more commonly in Austria than in Switzerland. Minimally invasive techniques were performed more often in Switzerland than in Austria (52% vs. 4%, < 0.001). Overall, wide excision with secondary wound healing or midline closures declined over the last 20 years. : Treatment strategies for chronic PD differ between Austria and Switzerland with more and longer inpatient care in Austria, increasingly minimally invasive approaches in Switzerland, and outdated procedures still being performed in both countries. Overall, heterogeneity of practice dominates in both countries.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/medicina56070341DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7404453PMC
July 2020

Organizing a COVID-19 triage unit: a Swiss perspective.

Emerg Microbes Infect 2020 Dec;9(1):1506-1513

Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland.

With the rapid global spread of the acute respiratory syndrome coronavirus 2, urgent health-care measures have been implemented. We describe the organizational process in setting up a coronavirus disease 2019 triage unit in a Swiss tertiary care hospital. Our triage unit was set-up outside of the main hospital building and consists of three areas: 1. Pre-triage, 2. Triage, and 3. Triage . The Pre-triage check-points identify any potential COVID-19-infected patients and re-direct them to the main Triage area where trained medical staff screen which patients undergo diagnostic testing. If testing is indicated, nasopharyngeal swabs are performed. If patients require further investigations, they are referred to Triage . At this stage, patients are then discharged home after additional testing or admitted to the hospital for management. A total of 1265 patients were screened between 10 March 2020 and 12 April 2020 at our Triage unit. Of these, 112 (8.9%) tested positive. 73 (65%) of the positively-tested patients were female and 39 (35%) were male. The mean age for all patients was 43.8 years (SD 16.3 years). Distinguishing between genders, mean age for females was 41.1 (SD 16.5) and mean age for males was 48.6 (SD 14.9), with females being significantly younger than males ( < 0.001). Our triage unit was set-up as part of a large-scale restructuring process. Current challenges include low sensitivity for test results as well as limited staff and resources. We hope that our experience will help other health care institutions develop similar triage systems.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/22221751.2020.1787107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473308PMC
December 2020

EAES online educational resources: a survey of the membership of the European Association for Endoscopic Surgery (EAES).

Surg Endosc 2021 05 7;35(5):2059-2066. Epub 2020 May 7.

Department of Colorectal Surgery, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, PL6 8DH, UK.

Background: The European Association for Endoscopic Surgery (EAES) strives to be a leader in promoting the development and expansion of minimally invasive surgery (MIS). Part of the association's mission statement is "to become an information hub for all practitioners of MIS". It is therefore important that the education segment of the association continues to be actively monitored and updated to ensure this mission statement is met. This project aimed to understand the trainees requirement in fulfilling this role, and to develop an practical action plan to ensure such requirements are adequately met.

Methods: Two sequential questionnaires were sent to all members of the EAES. The questionnaires sought to understand the demographics of the EAES membership, and their training requirements. This followed a Delphi methodology. The data collected included training status, level of competence in laparoscopic surgery and tools needed for improving laparoscopic skills.

Results: Four hundred and sixty-five responded to the first survey, and 209 responded to the second survey. There were 112 trainees (24.1%) in the first round. More than 50% of trainees were less than 8 years from graduation from medical school. Only 162 (34.8%) of respondents performed MIS in more than half their practice. Videos of common procedures were ranked the highest in terms of what trainees required to help improve their laparoscopic skills, followed by e-learning modules.

Conclusion: There is a significant training gap identified amongst the trainee population of the EAES with regards to MIS training. Trainees were not performing MIS enough for them to feel confident with their skills. The EAES could fulfill this training requirement via expertly curated videos, and e-learning modules written by senior specialists.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00464-020-07602-8DOI Listing
May 2021

ECCO Guidelines on Therapeutics in Crohn's Disease: Surgical Treatment.

J Crohns Colitis 2020 Feb;14(2):155-168

Department of Gastroenterology, Hepatology and Nutrition, Pauls Stradins Clinical University Hospital, Department of Internal Medicine, Riga Stradiņš University, Riga, Latvia.

This article is the second in a series of two publications relating to the European Crohn's and Colitis Organisation [ECCO] evidence-based consensus on the management of Crohn's disease. The first article covers medical management; the present article addresses surgical management, including preoperative aspects and drug management before surgery. It also provides technical advice for a variety of common clinical situations. Both articles together represent the evidence-based recommendations of the ECCO for Crohn's disease and an update of previous guidelines.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ecco-jcc/jjz187DOI Listing
February 2020

Surgical Quality Assurance in COLOR III: Standardization and Competency Assessment in a Randomized Controlled Trial.

Ann Surg 2019 11;270(5):768-774

Department of Surgery and Cancer, Imperial College London, London, United kingdom.

Objective: The aim of this study was to develop an objective and reliable surgical quality assurance system (SQA) for COLOR III, an international multicenter randomized controlled trial (RCT) comparing transanal total mesorectal excision (TaTME) with laparoscopic approach for rectal cancer.

Background Of Summary Data: SQA influences outcome measures in RCTs such as lymph nodes harvest, in-hospital mortality, and locoregional cancer recurrence. However, levels of SQA are variable.

Method: Hierarchical task analysis of TaTME was performed. A 4-round Delphi methodology was applied for standardization of TaTME steps. Semistructured interviews were conducted in round 1 to identify key steps and tasks, which were rated as mandatory, optional, or prohibited in rounds 2 to 4 using questionnaires. Competency assessment tool (CAT) was developed and its content validity was examined by expert surgeons. Twenty unedited videos were assessed to test reliability using generalizability theory.

Results: Eighty-three of 101 surgical tasks identified reached 70% agreement (26 mandatory, 56 optional, and 1 prohibited). An operative guide of standardized TaTME was created. CAT is matrix of 9 steps and 4 performance qualities: exposure, execution, adverse event, and end-product. The overall G-coefficient was 0.883. Inter-rater and interitem reliability were 0.883 and 0.986. To enter COLOR III, 2 unedited TaTME and 1 laparoscopic TME videos were submitted and assessed by 2 independent assessors using CAT.

Conclusion: We described an iterative approach to develop an objective SQA within multicenter RCT. This approach provided standardization, the development of reliable and valid CAT, and the criteria for trial entry and monitoring surgical performance during the trial.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SLA.0000000000003537DOI Listing
November 2019

Perioperative Dietary Therapy in Inflammatory Bowel Disease.

J Crohns Colitis 2020 May;14(4):431-444

Department of Nutritional Sciences, King's College London, London, UK.

Background And Aims: The incidence of inflammatory bowel disease [IBD] is rising worldwide and no cure is available. Many patients require surgery and they often present with nutritional deficiencies. Although randomised controlled trials of dietary therapy are lacking, expert IBD centres have long-established interdisciplinary care, including tailored nutritional therapy, to optimise clinical outcomes and resource utilisation. This topical review aims to share expertise and offers current practice recommendations to optimise outcomes of IBD patients who undergo surgery.

Methods: A consensus expert panel consisting of dietitians, surgeons, and gastroenterologists, convened by the European Crohn's and Colitis Organisation, performed a systematic literature review. Nutritional evaluation and dietary needs, perioperative optimis ation, surgical complications, long-term needs, and special situations were critically appraised. Statements were developed using a Delphi methodology incorporating three successive rounds. Current practice positions were set when ≥80% of participants agreed on a recommendation.

Results: A total of 26 current practice positions were formulated which address the needs of IBD patients perioperatively and in the long term following surgery. Routine screening, perioperative optimisation by oral, enteral, or parenteral nutrition, dietary fibre, and supplements were reviewed. IBD-specific situations, including management of patients with a restorative proctocolectomy, an ostomy, strictures, or short-bowel syndrome, were addressed.

Conclusions: Perioperative dietary therapy improves the outcomes of IBD patients who undergo a surgical procedure. This topical review shares interdisciplinary expertise and provides guidance to optimise the outcomes of patients with Crohn's disease and ulcerative colitis. taking advantage of contemporary nutrition science.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ecco-jcc/jjz160DOI Listing
May 2020

Diagnostic Nodes of Patient Selection for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Among Colorectal Cancer Patients: A Swiss National Multicenter Survey.

Clin Colorectal Cancer 2019 12 26;18(4):e335-e342. Epub 2019 Jun 26.

Department of Radiation Oncology, Kantonsspital St Gallen, St Gallen, Switzerland.

Background: The management of patients with colorectal cancer (CRC) with peritoneal metastases is challenging, and the roles of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are unclear and debated among experts.

Materials And Methods: The experts of the Swiss Peritoneal Cancer Group were contacted and agreed to participate in this analysis. Experts from 9 centers in Switzerland provided their decision algorithms for CRS/HIPEC for patients with or at high risk for peritoneal metastases from CRC. Their responses were converted into decision trees on the basis of objective consensus methodology. The decision trees were used as a basis to identify consensus and discrepancies.

Results: The final treatment algorithms included a total of 5 decision criteria (age, Peritoneal Cancer Index [PCI], extraperitoneal metastases, Peritoneal Surface Disease Severity Score, and various risk factors [RF]) and 2 treatment options (HIPEC, yes or no). HIPEC was never recommended for patients without peritoneal metastases in the absence of RF for peritoneal metastases. For patients with a PCI ≤15 without organ metastases, all centers recommended CRS/HIPEC. There was also a consensus not to perform CRS/HIPEC in elderly patients (80 years and older), those with a PCI >20, and those with unresectable metastases. For patients with a PCI = 16 to 20, there was no consensus.

Conclusion: Multiple decision criteria relevant to all participating centers were identified. Because patient selection for CRS/HIPEC remains difficult, uniform criteria for the term "high risk" for peritoneal metastases and systemic metastases are helpful. Future trials and guidelines should take these criteria into account.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clcc.2019.06.002DOI Listing
December 2019

Primary Tumor Resection in Patients with Incurable Localized or Metastatic Colorectal Cancer: A Systematic Review and Meta-analysis.

World J Surg 2019 07;43(7):1829-1840

Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, West Middlesex University Hospital, Twickenham Road, Isleworth, London, TW7 6AF, UK.

Background: To assess the impact of primary tumor resection (PTR) on survival and morbidity in incurable colorectal cancer.

Methods: Systematic literature review and meta-analysis to compare PTR versus primary tumor intact (PTI).

Results: Seventy-seven studies were included, reporting on 159,991 participants (94,745 PTR; 65,246 PTI). PTR improved overall survival (hazard ratio [HR] 0.59, P < 0.0001; mean difference [MD] 7.27 months, P < 0.0001), cancer-specific survival (HR 0.47, MD 10.80), and progression-free survival (HR 0.76, MD 1.67). Overall survival remained significantly improved during subgroup analysis of asymptomatic patients (HR 0.69, MD 3.86), elderly patients (HR 0.46, MD 7.71), patients diagnosed after 2000 (HR 0.62, MD 7.29), patients with colon (HR 0.58, MD 6.31) or rectal (HR 0.54, MD 6.88) primary tumor, patients undergoing resection of primary tumor versus non-resectional surgery (NRS) to treat primary tumor complications (HR 0.56, MD 8.72), and of studies with propensity score analysis (HR 0.65, MD 5.68). Overall survival per treatment strategy was: [PTI/chemotherapy] 14.30 months, [PTI/bevacizumab] 17.27 months, [PTR/chemotherapy] 21.52 months, [PTR/bevacizumab] 27.52 months. PTR resulted in 4.5% perioperative mortality and 22.4% morbidity (major adverse events 10.2%, minor 18.5%, reoperation 2.5%, intraabdominal collection/sepsis 2.2%). PTI had 21.7% morbidity (obstruction 14.4%, anemia 11.0%, hemorrhage 1.5%, perforation 0.6%, adverse events requiring surgery 15.8%). NRS resulted in 10.6% perioperative mortality and 21.7% morbidity (major 7.9%, minor 21.7%, reoperation 0.1%).

Conclusions: PTR in patients with incurable colorectal cancer results in a limited improvement of survival without a significant increase in morbidity. PTR should be considered by the multidisciplinary team on an individual patient basis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00268-019-04984-2DOI Listing
July 2019

Open Versus Laparoscopic Versus Robotic Versus Transanal Mesorectal Excision for Rectal Cancer: A Systematic Review and Network Meta-analysis.

Ann Surg 2019 07;270(1):59-68

Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.

Objective: To compare techniques for rectal cancer resection.

Summary Background Data: Different surgical approaches exist for mesorectal excision.

Methods: Systematic literature review and Bayesian network meta-analysis performed.

Results: Twenty-nine randomized controlled trials included, reporting on 6237 participants, comparing: open versus laparoscopic versus robotic versus transanal mesorectal excision. No significant differences identified between treatments in intraoperative morbidity, conversion rate, grade III/IV morbidity, reoperation, anastomotic leak, nodes retrieved, involved distal margin, 5-year overall survival, and locoregional recurrence. Operative blood loss was less with laparoscopic surgery compared with open, and with robotic surgery compared with open and laparoscopic. Robotic operative time was longer compared with open, laparoscopic, and transanal. Laparoscopic operative time was longer compared with open. Laparoscopic surgery resulted in lower overall postoperative morbidity and fewer wound infections compared with open. Robotic surgery had fewer wound infections compared with open. Time to defecation was longer with open surgery compared with laparoscopic and robotic. Hospital stay was longer after open surgery compared with laparoscopic and robotic, and after laparoscopic surgery compared with robotic. Laparoscopic surgery resulted in more incomplete or nearly complete mesorectal excisions compared with open, and in more involved circumferential resection margins compared with transanal. Robotic surgery resulted in longer distal resection margins compared with open, laparoscopic, and transanal.

Conclusions: The different techniques result in comparable perioperative morbidity and long-term survival. The laparoscopic and robotic approaches may improve postoperative recovery, and the open and transanal approaches may improve oncological resection. Technique selection should be based on expected benefits by individual patient.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SLA.0000000000003227DOI Listing
July 2019

Laparoscopic right hemicolectomy with CME: standardization using the "critical view" concept.

Surg Endosc 2018 12 15;32(12):5021-5030. Epub 2018 Oct 15.

Department for Abdominal and Pediatric Surgery, Klinkverbund-Suedwest, Klinken Boeblingen, Bunsenstrasse 120, 71032, Boeblingen, Germany.

Background: Complete mesocolic excision is gradually becoming an established oncologic surgical principle for right hemicolectomy. However, the procedure is technically demanding and carries the risk of serious complications, especially when performed laparoscopically. A standardized procedure that minimizes technical hazards and facilitates teaching is, therefore, highly desirable.

Methods: An expert group of surgeons and one anatomist met three times. The initial aim was to achieve consensus about the surgical anatomy before agreeing on a sequence for dissection in laparoscopic CME. This proposal was evaluated and discussed in an anatomy workshop using post-mortem body donors along with videos of process-informed procedures, leading to a definite consensus.

Results: In order to provide a clear picture of the surgical anatomy, the "open book" model was developed, consisting of symbolic pages representing the corresponding dissection planes (retroperitoneal, ileocolic, transverse mesocolic, and mesogastric), vascular relations, and radicality criteria. The description of the procedure is based on eight preparative milestones, which all serve as critical views of safety. The chosen sequence of the milestones was designed to maximize control during central vascular dissection. Failure to reach any of the critical views should alert the surgeon to a possible incorrect dissection and to consider converting to an open procedure.

Conclusion: Combining the open-book anatomical model with a clearly structured dissection sequence, using critical views as safety checkpoints, may provide a safe and efficient platform for teaching laparoscopic right hemicolectomy with CME.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00464-018-6267-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208708PMC
December 2018

[Colorectal metastases - Current treatment strategies].

Ther Umsch 2018 ;75(10):634-641

1 Klinik für Viszeral- und Thoraxchirurgie, Kantonsspital Winterthur.

Colorectal metastases - Current treatment strategies In the course of their disease, more than 50 % of patients with colorectal cancer develop metastases. They are most frequently localized in the liver, followed by the peritoneum and the lungs. The therapeutic options and prognosis of colorectal metastases have improved markedly in recent years. Modern treatment concepts are multimodal and are customized for the individual patient by interdisciplinary tumour boards that follow widely recognised guidelines and norms. The recommendation of an appropriate treatment option in metastasized patients by an interdisciplinary panel of experts is of paramount importance. Besides technical possibilities, factors such as comorbidities, medical outcomes, quality of processes as well as patient-related outcome are all crucial in the decision-making process. In most patients diagnosed with distant metastases, the prognosis is determined by the extent of the liver burden. Hereby, the resection of the liver metastases is of utmost importance to improve the prognosis of a patient, since only those individuals who have successfully undergone resection have a chance for long-term disease free-survival. Whether liver metastases are resectable depends on sufficient volume and function of the future liver remnant (FLR). Manipulation of the FLR as well as upfront oncological treatment of metastases improves the resectability rates in patients with an advanced tumor load in the liver. Laparoscopic liver resection improves patient outcomes by reducing pain and results in a shortened hospital stay. Lung resection for pulmonary metastases as well as cytoreductive surgery for peritoneal metastases are important mainstays of modern personalized treatment concepts. However, results of ongoing trials are eagerly awaited to help quantify the prognostic effects of those therapies and assess their true therapeutic value.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1024/0040-5930/a001051DOI Listing
August 2019

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

Surg Endosc 2018 03 12;32(3):1091-1103. Epub 2017 Dec 12.

Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.

Background: The management of rectal cancer has evolved over the years, including the recent rise of Transanal Total Mesorectal Excision (TaTME). TaTME addresses the limitations created by the bony confines of the pelvis, bulky tumours, and fatty mesorectum, particularly for low rectal cancers. However, guidance is required to ensure safe implementation and to avoid the pitfalls and potential major morbidity encountered by the early adopters of TaTME. We report a broad international consensus statement, which provides a basis for optimal clinical practice.

Methods: Forty international experts were invited to participate based on clinical and academic achievements. The consensus statements were developed using Delphi methodology incorporating three successive rounds. Consensus was defined as agreement by 80% or more of the experts.

Results: A total of 37 colorectal surgeons from 20 countries and 5 continents (Europe, Asia, North and South America, Australasia) contributed to the consensus. Participation to the iterative Delphi rounds was 100%. An expert radiologist, pathologist, and medical oncologist provided recommendations to maximize relevance to current practice. Consensus was obtained on all seven different chapters: patient selection and surgical indication, perioperative management, patient positioning and operating room set up, surgical technique, devices and instruments, pelvic anatomy, TaTME training, and outcomes analysis.

Conclusions: This multidisciplinary consensus statement achieved more than 80% approval and can thus be graded as strong recommendation, yet acknowledging the current lack of high level evidence. It provides the best possible guidance for safe implementation and practice of Transanal Total Mesorectal Excision.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00464-017-5990-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5807525PMC
March 2018

Single-Incision and Natural Orifice Translumenal Endoscopic Surgery in Switzerland.

World J Surg 2017 Feb;41(2):449-456

Department of Surgery, Cantonal Hospital Baselland, Site Bruderholz, 4101, Bruderholz, Switzerland.

Background: Single-incision laparoscopy (SIL) and natural orifice translumenal endoscopic surgery (NOTES) aim at reducing surgical access trauma. To monitor the introduction of emerging technologies, the Swiss Association for Laparo- and Thoracoscopic Surgeons launched a database in 2010. The current status of SIL and NOTES in Switzerland is reported, and the techniques are compared.

Methods: The number and type of procedures, surgeon experience, their impressions of performance, conversion, and complications between 2010 and 2015 are described. A survey was used to acquire additional data not included in the registry.

Results: Nine centers included 650 procedures. Cholecystectomy (55 %) and sigmoidectomy (26 %) were most prevalent in both techniques. The number of active centers declined from 9 to 2 during the study period. The frequencies of taught procedures were 4 and 43 % for SIL and NOTES (p < 0.001), and surgeon self-estimated impression of performance was perfect in 50 and 89 %, respectively (p < 0.0001). Conversions in total were 3.6 and 5.7 %, respectively, and 1.1 % to open for both techniques. Morbidity was 5 % in SIL and 2.7 % in NOTES, with 0.8 % access-related complications in NOTES and none in SIL (p = 0.29). Of laparoscopic cholecystectomy, sigmoidectomy, and right hemicolectomy, 11.4 and 15.6 % of cases were operated using SIL or NOTES, respectively (p < 0.0001).

Conclusions: Although in selected specialized centers, a considerable proportion of patients were treated using novel techniques, a fading interest of the surgical community in SIL and NOTES was observed. The proportion of SIL and NOTES procedures taught is insufficient and calls for improvement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00268-016-3723-7DOI Listing
February 2017

3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn's Disease 2016: Part 2: Surgical Management and Special Situations.

J Crohns Colitis 2017 Feb 22;11(2):135-149. Epub 2016 Sep 22.

Paolo Gionchetti, IBD Unit, DIMEC, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.

This paper is the second in a series of two publications relating to the European Crohn's and Colitis Organisation [ECCO] evidence-based consensus on the diagnosis and management of Crohn's disease [CD] and concerns the surgical management of CD as well as special situations including management of perianal CD and extraintestinal manifestations. Diagnostic approaches and medical management of CD of this ECCO Consensus are covered in the first paper [Gomollon et al JCC 2016].
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ecco-jcc/jjw169DOI Listing
February 2017

Long-term results of endoscopic balloon dilation for treatment of colorectal anastomotic stenosis.

Surg Endosc 2016 10 19;30(10):4432-7. Epub 2016 Feb 19.

Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.

Background: Despite standardized techniques, anastomotic complications after colorectal resection remain a challenging problem. Among those, anastomotic stricture is a debilitating outcome which often requires multiple interventions and which is prone to recur. The present series investigates the long-term results of endoscopic balloon dilation for stenotic colorectal anastomosis.

Methods: Consecutive patients from a single institution who presented with an anastomotic stenosis after a colorectal resection were identified using a prospective clinical database. Medical records were systematically reviewed to detail patients' outcomes.

Results: Over 17 years (1988-2015), 2361 consecutive patients underwent a colorectal anastomosis. Of those, 76 patients (3.2 %) suffered a symptomatic anastomotic stenosis within a median of 5 months (interquartile range (IQR) 2-13) of the index procedure. All stenoses were primarily treated by endoscopic balloon dilation. Median follow-up was 11 years (IQR 7-14). In half the patients, one to two attempts at endoscopic balloon dilation definitively relieved the stenosis. Overall, the median number of endoscopic balloon dilation required was 3 (IQR 2-3). Recurrence rates at 1 year, 3 year, and 5 year were 11, 22, and 25 %, respectively. Median time to recurrence was 12 months (IQR 3-24). Ultimately, two patients (2.6 %) underwent an operation due to failure of endoscopic treatment. All other patients (97.4 %) were treated successfully with endoscopic balloon dilation. A total of 12 patients (15.7 %) suffered a complication from endoscopic dilation. Of those, 11 were minor bleeding and one was a perforation at the level of the anastomosis. All complications were managed conservatively, and no emergency procedure was required as a consequence of attempted endoscopic balloon dilation.

Conclusion: Endoscopic balloon dilation is a safe approach to effectively relieve an anastomotic stenosis following a colorectal resection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00464-016-4762-8DOI Listing
October 2016

Monitoring c-reactive protein after laparoscopic colorectal surgery excludes infectious complications and allows for safe and early discharge.

Surg Endosc 2014 Oct 23;28(10):2939-48. Epub 2014 May 23.

Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland,

Background: Early detection of infectious complications is urgently needed in the era of DRG-based compensation. This work assessed the diagnostic accuracy of c-reactive protein (CRP) level in the detection of infectious complications after laparoscopic colorectal resection.

Methods: Laparoscopic colorectal resections were identified from a prospective database. Complications were graded according to the Dindo-Clavien classification. Surgical site infections were defined according to the Centers of Disease Control. CRP level was routinely measured until postoperative day (POD) 7. Uni- and multivariate analysis were performed. Diagnostic accuracy was evaluated using receiver operating curves.

Results: 355 patients were operated for diverticulosis (88.7%), neoplasia (6.8%), and other causes (4.5%). Mean age and body mass index were 59.8 ± 13.7 years and 26.5 ± 15 kg/m(2). Left, right, and total laparoscopic colectomies were performed in 316, 33, and 6 patients. Complications occurred in 85 patients and 16 patients (4.5%) were reoperated. Fifty-one patients (14.4%) suffered from infectious complications at a median of 6 POD, while 9 anastomoses leaked (2.7%). In multivariate analysis, presence of an abscess at surgery was predictive of an infectious complication (OR 2.5, 95% CI 1.1-5.3), as were a body mass index >30 kg/m(2) and operative time >160 min in a bootstrap analysis. Overall, CRP peaked on POD 2 and declined thereafter. Most infectious complications were apparent starting on POD 6. A CRP <56 mg/l on POD 4 had a negative predictive value of 100% (95% CI 94.9-100%) to rule out infectious complications. Above 56 mg/l, sensitivity was 100% (95% CI 0.8-1) and specificity 49% (95% CI 0.4-0.6) for the development of infectious complications in the absence of clinical signs. This translated into a remarkable diagnostic accuracy of 78% (95% CI 0.7-0.9).

Conclusion: Monitoring CRP level in laparoscopic colorectal surgery demonstrated a high diagnostic accuracy for infectious complications, thus allowing for safe and early discharge.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00464-014-3556-0DOI Listing
October 2014

GM-CSF Production by Tumor Cells Is Associated with Improved Survival in Colorectal Cancer.

Clin Cancer Res 2014 Jun 15;20(12):3094-106. Epub 2014 Apr 15.

Authors' Affiliations: Department of Biomedicine, Institute for Surgical Research; Institute of Pathology, University of Basel; Department of Surgery, University Hospital, Basel; Ospedale Regionale, Lugano; Ospedale Regionale "San Giovanni," Bellinzona; Department of Surgery, Kantonsspital, St Gallen; Department of Surgery, Kantonsspital, Olten, Switzerland; Departments of General Surgery and Gastroenterology, Shanghai East Hospital, Tongji University, Shanghai, P.R. China; and Institute of Translational Pharmacology, National Research Council, Rome, Italy

Purpose: Colorectal cancer infiltration by CD16(+) myeloid cells correlates with improved prognosis. We addressed mechanistic clues and gene and protein expression of cytokines potentially associated with macrophage polarization.

Experimental Design: GM-CSF or M-CSF-stimulated peripheral blood CD14(+) cells from healthy donors were cocultured with colorectal cancer cells. Tumor cell proliferation was assessed by (3)H-thymidine incorporation. Expression of cytokine genes in colorectal cancer and autologous healthy mucosa was tested by quantitative, real-time PCR. A tumor microarray (TMA) including >1,200 colorectal cancer specimens was stained with GM-CSF- and M-CSF-specific antibodies. Clinicopathological features and overall survival were analyzed.

Results: GM-CSF induced CD16 expression in 66% ± 8% of monocytes, as compared with 28% ± 1% in cells stimulated by M-CSF (P = 0.011). GM-CSF but not M-CSF-stimulated macrophages significantly (P < 0.02) inhibited colorectal cancer cell proliferation. GM-CSF gene was expressed to significantly (n = 45, P < 0.0001) higher extents in colorectal cancer than in healthy mucosa, whereas M-CSF gene expression was similar in healthy mucosa and colorectal cancer. Accordingly, IL1β and IL23 genes, typically expressed by M1 macrophages, were expressed to significantly (P < 0.001) higher extents in colorectal cancer than in healthy mucosa. TMA staining revealed that GM-CSF production by tumor cells is associated with lower T stage (P = 0.02), "pushing" growth pattern (P = 0.004) and significantly (P = 0.0002) longer survival in mismatch-repair proficient colorectal cancer. Favorable prognostic effect of GM-CSF production by colorectal cancer cells was confirmed by multivariate analysis and was independent from CD16(+) and CD8(+) cell colorectal cancer infiltration. M-CSF expression had no significant prognostic relevance.

Conclusions: GM-CSF production by tumor cells is an independent favorable prognostic factor in colorectal cancer.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1158/1078-0432.CCR-13-2774DOI Listing
June 2014

A systematic review of economic evaluations of enhanced recovery pathways for colorectal surgery.

Ann Surg 2015 May;261(5):e138

Kantonsspital St Gallen, Department of Surgery, St Gallen, Switzerland CMU College of Medicine General Surgery, Central Michigan University, Saginaw, MI Department of Surgery, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH Section for Surgical Pathophysiology, Rigshospitalet Copenhagen University, Copenhagen, Denmark.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SLA.0000000000000679DOI Listing
May 2015
-->