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1. Perioperative management and anaesthetic considerations in pelvic exenterations using Delphi methodology: results from the PelvEx Collaborative

Author

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

Abstract

BACKGROUND: The multidisciplinary perioperative and anaesthetic management of patients undergoing pelvic exenteration is essential for good surgical outcomes. No clear guidelines have been established, and there is wide variation in clinical practice internationally. This consensus statement consolidates clinical experience and best practice collectively, and systematically addresses key domains in the perioperative and anaesthetic management. METHODS: The modified Delphi methodology was used to achieve consensus from the PelvEx Collaborative. The process included one round of online questionnaire involving controlled feedback and structured participant response, two rounds of editing, and one round of web-based voting. It was held from December 2019 to February 2020. Consensus was defined as more than 80 per cent agreement, whereas less than 80 per cent agreement indicated low consensus. RESULTS: The final consensus document contained 47 voted statements, across six key domains of perioperative and anaesthetic management in pelvic exenteration, comprising preoperative assessment and preparation, anaesthetic considerations, perioperative management, anticipating possible massive haemorrhage, stress response and postoperative critical care, and pain management. Consensus recommendations were developed, based on consensus agreement achieved on 34 statements. CONCLUSION: The perioperative and anaesthetic management of patients undergoing pelvic exenteration is best accomplished by a dedicated multidisciplinary team with relevant domain expertise in the setting of a specialized tertiary unit. This consensus statement has addressed key domains within the framework of current perioperative and anaesthetic management among patients undergoing pelvic exenteration, with an international perspective, to guide clinical practice, and has outlined areas for future clinical research.

Published
2021

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

Author

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

Abstract

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

Published
2020

3. Predicting outcomes of pelvic exenteration using machine learning

Author

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

Abstract

AIM: We aim to compare machine learning with neural network performance in predicting R0 resection (R0), length of stay > 14 days (LOS), major complication rates at 30 days postoperatively (COMP) and survival greater than 1 year (SURV) for patients having pelvic exenteration for locally advanced and recurrent rectal cancer. METHOD: A deep learning computer was built and the programming environment was established. The PelvEx Collaborative database was used which contains anonymized data on patients who underwent pelvic exenteration for locally advanced or locally recurrent colorectal cancer between 2004 and 2014. Logistic regression, a support vector machine and an artificial neural network (ANN) were trained. Twenty per cent of the data were used as a test set for calculating prediction accuracy for R0, LOS, COMP and SURV. Model performance was measured by plotting receiver operating characteristic (ROC) curves and calculating the area under the ROC curve (AUROC). RESULTS: Machine learning models and ANNs were trained on 1147 cases. The AUROC for all outcome predictions ranged from 0.608 to 0.793 indicating modest to moderate predictive ability. The models performed best at predicting LOS > 14 days with an AUROC of 0.793 using preoperative and operative data. Visualized logistic regression model weights indicate a varying impact of variables on the outcome in question. CONCLUSION: This paper highlights the potential for predictive modelling of large international databases. Current data allow moderate predictive ability of both complex ANNs and more classic methods.

Published
2020

4. Measurement invariance of the Functional Assessment of Cancer Therapy - Colorectal quality-of-life instrument among modes of administration

Author

Wong, CKH, Lam, CLK, Mulhern, B, Law, WL, Poon, JTC, Kwong, DLW, Tsang, J, Wong, CKH, Lam, CLK, Mulhern, B, Law, WL, Poon, JTC, Kwong, DLW, and Tsang, J

Abstract

Objectives: To test for the measurement invariance of the Functional Assessment of Cancer Therapy - Colorectal (FACT-C) in patients with colorectal neoplasms between two modes of administration (self- and interviewer administrations). It is important to establish the measurement invariance of the FACT-C across different modes of administration to ascertain whether it is valid to pool FACT-C data collected by different modes or to assess each group separately. Methods: A cross-sectional sample of 391 Chinese patients with colorectal neoplasms was recruited from specialist outpatient clinics between September 2009 and July 2010. Confirmatory factor analysis (CFA) was used to test the original five-factor model of the FACT-C on data collected by self- and interviewer administrations in single-group analysis. Multiple-group CFA was then used to compare the factor structure between the two modes of administration using chi-square tests and other goodness-of-fit statistics. Results: The hypothesized five-factor model of FACT-C demonstrated good fit in each group. Configural invariance and metric invariance were fully supported in multiple-group CFA. Some item intercepts and their corresponding error variances were not identical between administration groups, suggesting evidence of partial strict factorial invariance. Conclusions: Our results confirmed that the five-factor structure of FACT-C was invariant in Chinese patients using both self- and interviewer administrations. It is appropriate to pool or compare data in the emotional well-being and colorectal cancer subscale scores collected by both administrations. Measurement invariance in three items, one from each of the other subscales, may be contaminated by response bias between modes of administration. © 2012 The Author(s).

Published
2013

5. Measurement invariance of the Functional Assessment of Cancer Therapy - Colorectal quality-of-life instrument among modes of administration

Author

Wong, CKH, Lam, CLK, Mulhern, B, Law, WL, Poon, JTC, Kwong, DLW, Tsang, J, Wong, CKH, Lam, CLK, Mulhern, B, Law, WL, Poon, JTC, Kwong, DLW, and Tsang, J

Abstract

Objectives: To test for the measurement invariance of the Functional Assessment of Cancer Therapy - Colorectal (FACT-C) in patients with colorectal neoplasms between two modes of administration (self- and interviewer administrations). It is important to establish the measurement invariance of the FACT-C across different modes of administration to ascertain whether it is valid to pool FACT-C data collected by different modes or to assess each group separately. Methods: A cross-sectional sample of 391 Chinese patients with colorectal neoplasms was recruited from specialist outpatient clinics between September 2009 and July 2010. Confirmatory factor analysis (CFA) was used to test the original five-factor model of the FACT-C on data collected by self- and interviewer administrations in single-group analysis. Multiple-group CFA was then used to compare the factor structure between the two modes of administration using chi-square tests and other goodness-of-fit statistics. Results: The hypothesized five-factor model of FACT-C demonstrated good fit in each group. Configural invariance and metric invariance were fully supported in multiple-group CFA. Some item intercepts and their corresponding error variances were not identical between administration groups, suggesting evidence of partial strict factorial invariance. Conclusions: Our results confirmed that the five-factor structure of FACT-C was invariant in Chinese patients using both self- and interviewer administrations. It is appropriate to pool or compare data in the emotional well-being and colorectal cancer subscale scores collected by both administrations. Measurement invariance in three items, one from each of the other subscales, may be contaminated by response bias between modes of administration. © 2012 The Author(s).

Published
2013

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