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3. Carbon dioxide embolism associated with transanal total mesorectal excision surgery: A report from the international registries

Author

Dickson, E. A., Penna, M., Cunningham, C., Ratcliffe, F. M., Chantler, J., Crabtree, N. A., Tuynman, J. B., Albert, M. R., Monson, J. R. T., Hompes, R., Abdelmoaty, W., Adamina, M., Aigner, F., Alavi, K., Albers, B., Al Furajii, H., Allison, A., Eduardo, S., Araujo, A., Apostolides, G. Y., Arezzo, A., Arnold, S. J., Aryal, K., Ashamalla, S., Ashraf, Sana, Attaluri, V., Austin, R., Barugo-La, G., Beggs, A., Belgers, H. J., Bell, S., Bemelman, W., Berti, S., Biebl, M., Blondeel, J., Binky, B., Baloyiannis, I. -N., Bandyopadhyay, D., Boni, L., Bordeianou, L., Box, B., Boyce, S., Brokelman, W., Brown, C. J., Bruegger, L., Buchli, C., Christian Buchs, N., Bulut, O., Burt, C., Bursics, A., Cahill, R. A., Pablo Campana, J., Caricato, M., Caro-Tar-Rago, A., Casans, F., Cassinotti, E., Caycedo-Marulan-Da, A., Chadi, S. A., Chandrasinghe, P., Chaudhri, S., Chaumont, N., Chitsabesan, P., Coget, J., Collera, P., Coleman, M., Courtney, E. D., Dagbert, F., Dalton, S. J., Daniel, G., Clark, D. A., De-Drye, L., De La Torre, J., Dapri, G., Dayal, S. P., De Chaisemartin, C., Borja De Lacy, F., Blasco Delgado, O., Di Candido, F., Diaz Del Gobbo, G., De Graaf, E. J. R., Delrio, P., De Pooter, K., D'Hooge, P., Doornebosch, P., Duff, S., Du Jardin, P., Dzhumabaev, K. E., Tom Edwards, M., Egenvall, I., Espin, E., Eugenio, M., Egenvall, M. -I., Ravn Eriksen, J., Faerden, A. E., Faes, S., Simo Fernandez, V., Fichera, A., Fierens, J., Fierens, K., Forgan, T., Francis, N., Francombe, J., Francone, E., Francone, T., Gamage, B., Perez Garcia, J. A., Ethem Gecim, I., Van Geluwe, B., Gin-Gert, C., George, V., Gloeckler, M., Gogenur, I., Goulart, A., Grolich, T., Haas, E., Hameed, U., Hahnloser, D., Harikrishnan, A., Harris, G., Haunold, I., Hendrickse, C., Hendrickx, T., Heyns, M., Horwood, J., Huerga, D., Ito, M., Jarimba, A., Joeng, H. K. M., Jones, O., Jutten, G., Kala, Z., Kita, Y., Knol, J., Thengugal Kochupapy, R., Kneist, W., Kok, A. S. Y., Kusters, M., Lacy, A. M., Laka-Tos, M., Lal, R., Lakkis, Z., Leao, P., Lambrechts, A., Lee, L., Lelong, B., Leung, E., Lezoche, E., Sender Liberman, A., Lidder, P., An-Drade Lima, M., Loganathan, A., Lombana, L. J., Lorenzon, Laura, Loriz, H., Lukas, M., Lutrin, D., Mackey, P., Mamedli, Z. Z., Mansfield, S., Marcello, P., Marcoen, S., Romero Marcos, J. M., Marcy, T., Marecik, S., Marks, J., Marsanic, P., Mattacheo, A., Maun, D., May, D., Maykel, J. A., Mcarthur, D., Mccallum, I., Mccarthy, K., Mclemore, E. C., Ramon Sil-Viera Mendes, C., Messaris, E., Michalopoulos, A., Mikalauskas, S., Miles, A., Millan, M., Mills, S., Miskovic, D., Montroni, I., Moore, E., Moore, T., Mori, Simona, Morino, M., Muratore, A., Mutafchiyski, V., Myers, A., Van Nieuwenhove, Y., Nishizawa, Y., Ng, P., John Nolan, G., Obias, V., Ochsner, A., Hwan Oh, J., Onghena, T., Oommen, S., Orkin, B. A., Osman, K., Ouro, S., Panis, Y., Papavramidis, T., Von Papen, M., Papp, G., Paquette, I., Paraoan, M. T., Paredes, J. P., Pastor, C., Pattyn, P. R. L., Karim Perdawood, S., Wan Pei, C. F., Piehslinger, J., Penchev, D., Oliva Perez, R., Persiani, Roberto, Pfeffer, F., Terry Phang, P., Pokela, V., Picchetto, A., Poskus, E., Prieto, D., Que-Reshy, F. A., Ramcharan, S., Rauch, S., Rega, D., Reyes, J. C., Ris, F., Delgado Rivilla, S., Alexander Rockall, T., Roquete, P., Rossi, G., Ruffo, G., Sakai, Y. -S., Sands, D., Sao Juliao, G. P., Scala, Alessandro, Scala, D., Estevez Schwarz, L., Edmond Seid, V., Seitinger, G., Shaikh, I. A., Sharma, A., Siet-Ses, C., Singh, B., Helmer Sjo, O., Kyung Sohn, D., Sora-Via, C., Sosef, M. N., Spinelli, A., Speakman, C., Steele, S., Stephan, V., Stevenson, A. R. L., Stotland, P., Studer, P., Strypstein, S., Sylla, P., Szyszkowitz, A., Talwar, A., Tanis, P., Tejedor, P., Pastor Teso, E., Tognelli, J., Torkington, J., Tschann, P., Tuech, J. -J., Tuerler, A., Tzovaras, G., Ugolini, G., Vallribera, F., Vansteenkiste, F., Vangenechten, E., Verdaasdonk, E. G. G., Vilela, N., Walter, B., Warren, O. J., Visser, T., Warrier, S., Warner, M., Waru-Savitarne, J., Whiteford, M. H., Andreas Wik, T., Witzig, J. -A., Wolff, T., Wolthuis, A. M., Wynn, G., Ashraf S., Lorenzon L. (ORCID:0000-0001-6736-0383), Mori S., Persiani R. (ORCID:0000-0002-1537-5097), Scala A., Dickson, E. A., Penna, M., Cunningham, C., Ratcliffe, F. M., Chantler, J., Crabtree, N. A., Tuynman, J. B., Albert, M. R., Monson, J. R. T., Hompes, R., Abdelmoaty, W., Adamina, M., Aigner, F., Alavi, K., Albers, B., Al Furajii, H., Allison, A., Eduardo, S., Araujo, A., Apostolides, G. Y., Arezzo, A., Arnold, S. J., Aryal, K., Ashamalla, S., Ashraf, Sana, Attaluri, V., Austin, R., Barugo-La, G., Beggs, A., Belgers, H. J., Bell, S., Bemelman, W., Berti, S., Biebl, M., Blondeel, J., Binky, B., Baloyiannis, I. -N., Bandyopadhyay, D., Boni, L., Bordeianou, L., Box, B., Boyce, S., Brokelman, W., Brown, C. J., Bruegger, L., Buchli, C., Christian Buchs, N., Bulut, O., Burt, C., Bursics, A., Cahill, R. A., Pablo Campana, J., Caricato, M., Caro-Tar-Rago, A., Casans, F., Cassinotti, E., Caycedo-Marulan-Da, A., Chadi, S. A., Chandrasinghe, P., Chaudhri, S., Chaumont, N., Chitsabesan, P., Coget, J., Collera, P., Coleman, M., Courtney, E. D., Dagbert, F., Dalton, S. J., Daniel, G., Clark, D. A., De-Drye, L., De La Torre, J., Dapri, G., Dayal, S. P., De Chaisemartin, C., Borja De Lacy, F., Blasco Delgado, O., Di Candido, F., Diaz Del Gobbo, G., De Graaf, E. J. R., Delrio, P., De Pooter, K., D'Hooge, P., Doornebosch, P., Duff, S., Du Jardin, P., Dzhumabaev, K. E., Tom Edwards, M., Egenvall, I., Espin, E., Eugenio, M., Egenvall, M. -I., Ravn Eriksen, J., Faerden, A. E., Faes, S., Simo Fernandez, V., Fichera, A., Fierens, J., Fierens, K., Forgan, T., Francis, N., Francombe, J., Francone, E., Francone, T., Gamage, B., Perez Garcia, J. A., Ethem Gecim, I., Van Geluwe, B., Gin-Gert, C., George, V., Gloeckler, M., Gogenur, I., Goulart, A., Grolich, T., Haas, E., Hameed, U., Hahnloser, D., Harikrishnan, A., Harris, G., Haunold, I., Hendrickse, C., Hendrickx, T., Heyns, M., Horwood, J., Huerga, D., Ito, M., Jarimba, A., Joeng, H. K. M., Jones, O., Jutten, G., Kala, Z., Kita, Y., Knol, J., Thengugal Kochupapy, R., Kneist, W., Kok, A. S. Y., Kusters, M., Lacy, A. M., Laka-Tos, M., Lal, R., Lakkis, Z., Leao, P., Lambrechts, A., Lee, L., Lelong, B., Leung, E., Lezoche, E., Sender Liberman, A., Lidder, P., An-Drade Lima, M., Loganathan, A., Lombana, L. J., Lorenzon, Laura, Loriz, H., Lukas, M., Lutrin, D., Mackey, P., Mamedli, Z. Z., Mansfield, S., Marcello, P., Marcoen, S., Romero Marcos, J. M., Marcy, T., Marecik, S., Marks, J., Marsanic, P., Mattacheo, A., Maun, D., May, D., Maykel, J. A., Mcarthur, D., Mccallum, I., Mccarthy, K., Mclemore, E. C., Ramon Sil-Viera Mendes, C., Messaris, E., Michalopoulos, A., Mikalauskas, S., Miles, A., Millan, M., Mills, S., Miskovic, D., Montroni, I., Moore, E., Moore, T., Mori, Simona, Morino, M., Muratore, A., Mutafchiyski, V., Myers, A., Van Nieuwenhove, Y., Nishizawa, Y., Ng, P., John Nolan, G., Obias, V., Ochsner, A., Hwan Oh, J., Onghena, T., Oommen, S., Orkin, B. A., Osman, K., Ouro, S., Panis, Y., Papavramidis, T., Von Papen, M., Papp, G., Paquette, I., Paraoan, M. T., Paredes, J. P., Pastor, C., Pattyn, P. R. L., Karim Perdawood, S., Wan Pei, C. F., Piehslinger, J., Penchev, D., Oliva Perez, R., Persiani, Roberto, Pfeffer, F., Terry Phang, P., Pokela, V., Picchetto, A., Poskus, E., Prieto, D., Que-Reshy, F. A., Ramcharan, S., Rauch, S., Rega, D., Reyes, J. C., Ris, F., Delgado Rivilla, S., Alexander Rockall, T., Roquete, P., Rossi, G., Ruffo, G., Sakai, Y. -S., Sands, D., Sao Juliao, G. P., Scala, Alessandro, Scala, D., Estevez Schwarz, L., Edmond Seid, V., Seitinger, G., Shaikh, I. A., Sharma, A., Siet-Ses, C., Singh, B., Helmer Sjo, O., Kyung Sohn, D., Sora-Via, C., Sosef, M. N., Spinelli, A., Speakman, C., Steele, S., Stephan, V., Stevenson, A. R. L., Stotland, P., Studer, P., Strypstein, S., Sylla, P., Szyszkowitz, A., Talwar, A., Tanis, P., Tejedor, P., Pastor Teso, E., Tognelli, J., Torkington, J., Tschann, P., Tuech, J. -J., Tuerler, A., Tzovaras, G., Ugolini, G., Vallribera, F., Vansteenkiste, F., Vangenechten, E., Verdaasdonk, E. G. G., Vilela, N., Walter, B., Warren, O. J., Visser, T., Warrier, S., Warner, M., Waru-Savitarne, J., Whiteford, M. H., Andreas Wik, T., Witzig, J. -A., Wolff, T., Wolthuis, A. M., Wynn, G., Ashraf S., Lorenzon L. (ORCID:0000-0001-6736-0383), Mori S., Persiani R. (ORCID:0000-0002-1537-5097), and Scala A.

Abstract

BACKGROUND: Carbon dioxide embolus has been reported as a rare but clinically important risk associated with transanal total mesorectal excision surgery. To date, there exists limited data describing the incidence, risk factors, and management of carbon dioxide embolus in transanal total mesorectal excision. OBJECTIVE: This study aimed to obtain data from the transanal total mesorectal excision registries to identify trends and potential risk factors for carbon dioxide embolus specific to this surgical technique. DESIGN: Contributors to both the LOREC and OSTRiCh transanal total mesorectal excision registries were invited to report their incidence of carbon dioxide embolus. Case report forms were collected detailing the patient-specific and technical factors of each event. SETTINGS: The study was conducted at the collaborating centers from the international transanal total mesorectal excision registries. MAIN OUTCOME MEASURES: Characteristics and outcomes of patients with carbon dioxide embolus associated with transanal mesorectal excision were measured. RESULTS: Twenty-five cases were reported. The incidence of carbon dioxide embolus during transanal total mesorectal excision is estimated to be ≈0.4% (25/6375 cases). A fall in end tidal carbon dioxide was noted as the initial feature in 22 cases, with 13 (52%) developing signs of hemodynamic compromise. All of the events occurred in the transanal component of dissection, with mean (range) insufflation pressures of 15 mm Hg (12-20 mm Hg). Patients were predominantly (68%) in a Trendelenburg position, between 30° and 45°. Venous bleeding was reported in 20 cases at the time of carbon dioxide embolus, with periprostatic veins documented as the most common site (40%). After carbon dioxide embolus, 84% of cases were completed after hemodynamic stabilization. Two patients required cardiopulmonary resuscitation because of cardiovascular collapse. There were no deaths. LIMITATIONS: This is a retrospective study surveying r

Published
2019

4. International preoperative rectal cancer management: staging, neoadjuvant treatment, and impact of multidisciplinary teams

Author

Augestad KM, Lindsetmo RO, Stulberg J, Reynolds H, Senagore A, Champagne B, Heriot AG, Leblanc F, Delaney CP, Ambrosetti P, Andujar J, Baixuli J, Balen E, Baxter N, Beck D, Bemelman W, Bergamaschi R, Billingham R, Birch D, Bonardi R, Bonardi M, Bonjer J, Braga M, Buch H, Buechler M, Burnstein M, Campbell K, Caushaj P, Celebrezze J, Chang G, Cheong D, Cohen J, Colak T, Delaney C, Dhoore A, Douglas P, Dozois E, Efron J, Ellis N, Enker W, Fanelli RD, Fazio V, Fleshman J, Franklin M, Fry R, Garcia Aguilar J, Garcia Granero E, Habr Gama A, Hahnloser D, Harris G, Hasegawa H, Holm T, Horgan P, Hyman N, Irwin T, Joh YG, Jongen J, Kaiser A, Kang SB, Kariv Y, Kennedy R, Kessler H, Khan M, Kim SH, Krokowicz P, Kwok S, Lacy A, Larson D, Law WL, Lee E, Lippert H, Ludwig K, Lynch AC, MacRae H, Madbouly K, Maeda K, Marderstein E, Marino M, Marks J, Maurer C, McLeod R, Monson J, Mortensen N, Neary P, Newstead G, OBrien D, Orangio G, Orkin B, Page M, Påhlman L, Panis Y, Panton N, Pennickx F, Phang T, Pinedo Mancilla G, Post S, Rafferty J, Rajput A, Reis Neto dos JA, Rivadeneira D, Roselli J, Rosen H, Rossi G, Rouanet P, Rullier E, Schiedeck T, Schiessel R, Schlachta C, Schwenk W, Seow Choen F, Sim R, Sing WK, Stamos M, Sternberg J, Tuckson W, Vaccaro C, Vargas D, Vignali A, Vonen B, Weiss E, Wexner S, Whiteford M, Wibe A, Williams N, Woods R, Yamamoto T, Young Fadok T., UGOLINI, GIAMPAOLO, Augestad KM, Lindsetmo RO, Stulberg J, Reynolds H, Senagore A, Champagne B, Heriot AG, Leblanc F, Delaney CP, Ambrosetti P, Andujar J, Baixuli J, Balen E, Baxter N, Beck D, Bemelman W, Bergamaschi R, Billingham R, Birch D, Bonardi R, Bonardi M, Bonjer J, Braga M, Buch H, Buechler M, Burnstein M, Campbell K, Caushaj P, Celebrezze J, Chang G, Cheong D, Cohen J, Colak T, Delaney C, Dhoore A, Douglas P, Dozois E, Efron J, Ellis N, Enker W, Fanelli RD, Fazio V, Fleshman J, Franklin M, Fry R, Garcia-Aguilar J, Garcia-Granero E, Habr-Gama A, Hahnloser D, Harris G, Hasegawa H, Holm T, Horgan P, Hyman N, Irwin T, Joh YG, Jongen J, Kaiser A, Kang SB, Kariv Y, Kennedy R, Kessler H, Khan M, Kim SH, Krokowicz P, Kwok S, Lacy A, Larson D, Law WL, Lee E, Lippert H, Ludwig K, Lynch AC, MacRae H, Madbouly K, Maeda K, Marderstein E, Marino M, Marks J, Maurer C, McLeod R, Monson J, Mortensen N, Neary P, Newstead G, OBrien D, Orangio G, Orkin B, Page M, Påhlman L, Panis Y, Panton N, Pennickx F, Phang T, Pinedo Mancilla G, Post S, Rafferty J, Rajput A, Reis Neto dos JA, Rivadeneira D, Roselli J, Rosen H, Rossi G, Rouanet P, Rullier E, Schiedeck T, Schiessel R, Schlachta C, Schwenk W, Seow-Choen F, Sim R, Sing WK, Stamos M, Sternberg J, Tuckson W, Ugolini G, Vaccaro C, Vargas D, Vignali A, Vonen B, Weiss E, Wexner S, Whiteford M, Wibe A, Williams N, Woods R, Yamamoto T, Young-Fadok T., Augestad, K, Lindsetmo, R, Stulberg, J, Reynolds, H, Senagore, A, Champagne, B, Heriot, A, Leblanc, F, Delaney, C, Ambrosetti, P, Andujar, J, Baixuli, J, Balen, E, Baxter, N, Beck, D, Bemelman, W, Bergamaschi, R, Billingham, R, Birch, D, Bonardi, R, Bonardi, M, Bonjer, J, Braga, M, Buch, H, Buechler, M, Burnstein, M, Campbell, K, Caushaj, P, Celebrezze, J, Chang, G, Cheong, D, Cohen, J, Colak, T, Dhoore, A, Douglas, P, Dozois, E, Efron, J, Ellis, N, Enker, W, Fanelli, R, Fazio, V, Fleshman, J, Franklin, M, Fry, R, Garcia-Aguilar, J, Garcia-Granero, E, Habr-Gama, A, Hahnloser, D, Harris, G, Hasegawa, H, Holm, T, Horgan, P, Hyman, N, Irwin, T, Joh, Y, Jongen, J, Kaiser, A, Kang, S, Kariv, Y, Kennedy, R, Kessler, H, Khan, M, Kim, S, Krokowicz, P, Kwok, S, Lacy, A, Larson, D, Law, W, Lee, E, Lippert, H, Ludwig, K, Lynch, A, Macrae, H, Madbouly, K, Maeda, K, Marderstein, E, Marino, M, Marks, J, Maurer, C, Mcleod, R, Monson, J, Mortensen, N, Neary, P, Newstead, G, Obrien, D, Orangio, G, Orkin, B, Page, M, Pahlman, L, Panis, Y, Panton, N, Pennickx, F, Phang, T, Pinedo Mancilla, G, Post, S, Rafferty, J, Rajput, A, Reis Neto dos, J, Rivadeneira, D, Roselli, J, Rosen, H, Rossi, G, Rouanet, P, Rullier, E, Schiedeck, T, Schiessel, R, Schlachta, C, Schwenk, W, Seow-Choen, F, Sim, R, Sing, W, Stamos, M, Sternberg, J, Tuckson, W, Ugolini, G, Vaccaro, C, Vargas, D, Vignali, A, Vonen, B, Weiss, E, Wexner, S, Whiteford, M, Wibe, A, Williams, N, Woods, R, Yamamoto, T, and Young-Fadok, T

Subjects
medicine.medical_specialty, Internationality, Colorectal cancer, health care facilities, manpower, and services, medicine.medical_treatment, education, Preoperative care, Article, RECTAL CANCER, COLORECTAL SURGERY, Preoperative Care, MANAGEMENT, Medicine, Humans, Stage (cooking), health care economics and organizations, Neoadjuvant therapy, Neoplasm Staging, Patient Care Team, Rectal Neoplasm, medicine.diagnostic_test, business.industry, Rectal Neoplasms, General surgery, Cancer, Rectal examination, Vascular surgery, medicine.disease, humanities, Neoadjuvant Therapy, Surgery, Treatment Outcome, Health Care Survey, Health Care Surveys, Practice Guidelines as Topic, MULTIDISCIPLINARY TEAMS, Rectal Neoplasms - pathology - surgery - therapy, business, Human, Abdominal surgery
Abstract

Law, WL is one of the members of the International Rectal Cancer Study Group, BACKGROUND: Little is known regarding variations in preoperative treatment and practice for rectal cancer (RC) on an international level, yet practice variation may result in differences in recurrence and survival rates. METHODS: One hundred seventy-three international colorectal centers were invited to participate in a survey of preoperative management of rectal cancer. RESULTS: One hundred twenty-three (71%) responded, with a majority of respondents from North America, Europe, and Asia. Ninety-three percent have more than 5 years' experience with rectal cancer surgery. Fifty-five percent use CT scan, 35% MRI, 29% ERUS, 12% digital rectal examination and 1% PET scan in all RC cases. Seventy-four percent consider threatened circumferential margin (CRM) an indication for neoadjuvant treatment. Ninety-two percent prefer 5-FU-based long-course neoadjuvant chemoradiation therapy (CRT). A significant difference in practice exists between the US and non-US surgeons: poor histological differentiation as an indication for CRT (25% vs. 7.0%, p = 0.008), CRT for stage II and III rectal cancer (92% vs. 43%, p = 0.0001), MRI for all RC patients (20% vs. 42%, p = 0.03), and ERUS for all RC patients (43% vs. 21%, p = 0.01). Multidisciplinary team meetings significantly influence decisions for MRI (RR = 3.62), neoadjuvant treatment (threatened CRM, RR = 5.67, stage II + III RR = 2.98), quality of pathology report (RR = 4.85), and sphincter-saving surgery (RR = 3.81). CONCLUSIONS: There was little consensus on staging, neoadjuvant treatment, and preoperative management of rectal cancer. Regular multidisciplinary team meetings influence decisions about neoadjuvant treatment and staging methods., published_or_final_version

Published
2010

5. International preoperative rectal cancer management: staging, neoadjuvant treatment, and impact of multidisciplinary teams

Author

Augestad, K, Lindsetmo, R, Stulberg, J, Reynolds, H, Senagore, A, Champagne, B, Heriot, A, Leblanc, F, Delaney, C, Ambrosetti, P, Andujar, J, Baixuli, J, Balen, E, Baxter, N, Beck, D, Bemelman, W, Bergamaschi, R, Billingham, R, Birch, D, Bonardi, R, Bonardi, M, Bonjer, J, Braga, M, Buch, H, Buechler, M, Burnstein, M, Campbell, K, Caushaj, P, Celebrezze, J, Chang, G, Cheong, D, Cohen, J, Colak, T, Dhoore, A, Douglas, P, Dozois, E, Efron, J, Ellis, N, Enker, W, Fanelli, R, Fazio, V, Fleshman, J, Franklin, M, Fry, R, Garcia-Aguilar, J, Garcia-Granero, E, Habr-Gama, A, Hahnloser, D, Harris, G, Hasegawa, H, Holm, T, Horgan, P, Hyman, N, Irwin, T, Joh, Y, Jongen, J, Kaiser, A, Kang, S, Kariv, Y, Kennedy, R, Kessler, H, Khan, M, Kim, S, Krokowicz, P, Kwok, S, Lacy, A, Larson, D, Law, W, Lee, E, Lippert, H, Ludwig, K, Lynch, A, Macrae, H, Madbouly, K, Maeda, K, Marderstein, E, Marino, M, Marks, J, Maurer, C, Mcleod, R, Monson, J, Mortensen, N, Neary, P, Newstead, G, Obrien, D, Orangio, G, Orkin, B, Page, M, Pahlman, L, Panis, Y, Panton, N, Pennickx, F, Phang, T, Pinedo Mancilla, G, Post, S, Rafferty, J, Rajput, A, Reis Neto dos, J, Rivadeneira, D, Roselli, J, Rosen, H, Rossi, G, Rouanet, P, Rullier, E, Schiedeck, T, Schiessel, R, Schlachta, C, Schwenk, W, Seow-Choen, F, Sim, R, Sing, W, Stamos, M, Sternberg, J, Tuckson, W, Ugolini, G, Vaccaro, C, Vargas, D, Vignali, A, Vonen, B, Weiss, E, Wexner, S, Whiteford, M, Wibe, A, Williams, N, Woods, R, Yamamoto, T, Young-Fadok, T, Augestad K. M., Lindsetmo R. -O., Stulberg J., Reynolds H., Senagore A., Champagne B., Heriot A. G., Leblanc F., Delaney C. P., Ambrosetti P., Andujar J., Baixuli J., Balen E., Baxter N., Beck D., Bemelman W., Bergamaschi R., Billingham R., Birch D., Bonardi R., Bonardi M., Bonjer J., Braga M., Buch H., Buechler M., Burnstein M., Campbell K., Caushaj P., Celebrezze J., Chang G., Cheong D., Cohen J., Colak T., Dhoore A., Douglas P., Dozois E., Efron J., Ellis N., Enker W., Fanelli R. D., Fazio V., Fleshman J., Franklin M., Fry R., Garcia-Aguilar J., Garcia-Granero E., Habr-Gama A., Hahnloser D., Harris G., Hasegawa H., Holm T., Horgan P., Hyman N., Irwin T., Joh Y. G., Jongen J., Kaiser A., Kang S. B., Kariv Y., Kennedy R., Kessler H., Khan M., Kim S. H., Krokowicz P., Kwok S., Lacy A., Larson D., Law W. L., Lee E., Lippert H., Ludwig K., Lynch A. C., MacRae H., Madbouly K., Maeda K., Marderstein E., Marino M., Marks J., Maurer C., McLeod R., Monson J., Mortensen N., Neary P., Newstead G., OBrien D., Orangio G., Orkin B., Page M., Pahlman L., Panis Y., Panton N., Pennickx F., Phang T., Pinedo Mancilla G., Post S., Rafferty J., Rajput A., Reis Neto dos J. A., Rivadeneira D., Roselli J., Rosen H., Rossi G., Rouanet P., Rullier E., Schiedeck T., Schiessel R., Schlachta C., Schwenk W., Seow-Choen F., Sim R., Sing W. K., Stamos M., Sternberg J., Tuckson W., Ugolini G., Vaccaro C., Vargas D., Vignali A., Vonen B., Weiss E., Wexner S., Whiteford M., Wibe A., Williams N., Woods R., Yamamoto T., Young-Fadok T., Augestad, K, Lindsetmo, R, Stulberg, J, Reynolds, H, Senagore, A, Champagne, B, Heriot, A, Leblanc, F, Delaney, C, Ambrosetti, P, Andujar, J, Baixuli, J, Balen, E, Baxter, N, Beck, D, Bemelman, W, Bergamaschi, R, Billingham, R, Birch, D, Bonardi, R, Bonardi, M, Bonjer, J, Braga, M, Buch, H, Buechler, M, Burnstein, M, Campbell, K, Caushaj, P, Celebrezze, J, Chang, G, Cheong, D, Cohen, J, Colak, T, Dhoore, A, Douglas, P, Dozois, E, Efron, J, Ellis, N, Enker, W, Fanelli, R, Fazio, V, Fleshman, J, Franklin, M, Fry, R, Garcia-Aguilar, J, Garcia-Granero, E, Habr-Gama, A, Hahnloser, D, Harris, G, Hasegawa, H, Holm, T, Horgan, P, Hyman, N, Irwin, T, Joh, Y, Jongen, J, Kaiser, A, Kang, S, Kariv, Y, Kennedy, R, Kessler, H, Khan, M, Kim, S, Krokowicz, P, Kwok, S, Lacy, A, Larson, D, Law, W, Lee, E, Lippert, H, Ludwig, K, Lynch, A, Macrae, H, Madbouly, K, Maeda, K, Marderstein, E, Marino, M, Marks, J, Maurer, C, Mcleod, R, Monson, J, Mortensen, N, Neary, P, Newstead, G, Obrien, D, Orangio, G, Orkin, B, Page, M, Pahlman, L, Panis, Y, Panton, N, Pennickx, F, Phang, T, Pinedo Mancilla, G, Post, S, Rafferty, J, Rajput, A, Reis Neto dos, J, Rivadeneira, D, Roselli, J, Rosen, H, Rossi, G, Rouanet, P, Rullier, E, Schiedeck, T, Schiessel, R, Schlachta, C, Schwenk, W, Seow-Choen, F, Sim, R, Sing, W, Stamos, M, Sternberg, J, Tuckson, W, Ugolini, G, Vaccaro, C, Vargas, D, Vignali, A, Vonen, B, Weiss, E, Wexner, S, Whiteford, M, Wibe, A, Williams, N, Woods, R, Yamamoto, T, Young-Fadok, T, Augestad K. M., Lindsetmo R. -O., Stulberg J., Reynolds H., Senagore A., Champagne B., Heriot A. G., Leblanc F., Delaney C. P., Ambrosetti P., Andujar J., Baixuli J., Balen E., Baxter N., Beck D., Bemelman W., Bergamaschi R., Billingham R., Birch D., Bonardi R., Bonardi M., Bonjer J., Braga M., Buch H., Buechler M., Burnstein M., Campbell K., Caushaj P., Celebrezze J., Chang G., Cheong D., Cohen J., Colak T., Dhoore A., Douglas P., Dozois E., Efron J., Ellis N., Enker W., Fanelli R. D., Fazio V., Fleshman J., Franklin M., Fry R., Garcia-Aguilar J., Garcia-Granero E., Habr-Gama A., Hahnloser D., Harris G., Hasegawa H., Holm T., Horgan P., Hyman N., Irwin T., Joh Y. G., Jongen J., Kaiser A., Kang S. B., Kariv Y., Kennedy R., Kessler H., Khan M., Kim S. H., Krokowicz P., Kwok S., Lacy A., Larson D., Law W. L., Lee E., Lippert H., Ludwig K., Lynch A. C., MacRae H., Madbouly K., Maeda K., Marderstein E., Marino M., Marks J., Maurer C., McLeod R., Monson J., Mortensen N., Neary P., Newstead G., OBrien D., Orangio G., Orkin B., Page M., Pahlman L., Panis Y., Panton N., Pennickx F., Phang T., Pinedo Mancilla G., Post S., Rafferty J., Rajput A., Reis Neto dos J. A., Rivadeneira D., Roselli J., Rosen H., Rossi G., Rouanet P., Rullier E., Schiedeck T., Schiessel R., Schlachta C., Schwenk W., Seow-Choen F., Sim R., Sing W. K., Stamos M., Sternberg J., Tuckson W., Ugolini G., Vaccaro C., Vargas D., Vignali A., Vonen B., Weiss E., Wexner S., Whiteford M., Wibe A., Williams N., Woods R., Yamamoto T., and Young-Fadok T.

Abstract

Background Little is known regarding variations in preoperative treatment and practice for rectal cancer (RC) on an international level, yet practice variation may result in differences in recurrence and survival rates. Methods One hundred seventy-three international colorectal centers were invited to participate in a survey of preoperative management of rectal cancer. Results One hundred twenty-three (71%) responded, with a majority of respondents from North America, Europe, and Asia. Ninety-three percent have more than 5 years' experience with rectal cancer surgery. Fifty-five percent use CT scan, 35% MRI, 29% ERUS, 12% digital rectal examination and 1% PET scan in all RC cases. Seventyfour percent consider threatened circumferential margin (CRM) an indication for neoadjuvant treatment. Ninety-two percent prefer 5-FU-based long-course neoadjuvant chemoradiation therapy (CRT). A significant difference in practice exists between the US and non-US surgeons: poor histological differentiation as an indication for CRT (25% vs. 7.0%, p = 0.008), CRT for stage II and III rectal cancer (92% vs. 43%, p = 0.0001), MRI for all RC patients (20% vs. 42%, p = 0.03), and ERUS for all RC patients (43% vs. 21%, p = 0.01). Multidisciplinary team meetings significantly influence decisions for MRI (RR = 3.62), neoadjuvant treatment (threatened CRM, RR = 5.67, stage II III RR = 2.98), quality of pathology report (RR = 4.85), and sphincter-saving surgery (RR = 3.81). Conclusions There was little consensus on staging, neoadjuvant treatment, and preoperative management of rectal cancer. Regular multidisciplinary team meetings influence decisions about neoadjuvant treatment and staging methods.

Published
2010

7. Human anal motility while fasting, after feeding, and during sleep.

Author

Orkin BA, Hanson RB, Kelly KA, Phillips SF, and Dent J

Subjects
Adult, Duodenum physiology, Eating physiology, Fasting physiology, Female, Humans, Male, Manometry, Middle Aged, Pressure, Sleep physiology, Anal Canal physiology, Gastrointestinal Motility physiology
Abstract

The aim of this study was to determine whether the human anal sphincter responds dynamically to changing physiological states. In 19 healthy human subjects, intraluminal anal canal pressure was measured with a 5-cm perfused sleeve sensor during the day while fasting (3 hours) and after feeding (3 hours) and at night during sleep (8 hours). Daytime mean anal canal pressures (+/- SEM) while fasting (50 +/- 3 mm Hg) were similar to those after feeding (49 +/- 3 mm Hg) and to those at night during sleep (49 +/- 3 mm Hg). Marked minute-to-minute variations in mean pressure occurred in all three periods, however, as did large phasic increases and decreases in pressure (greater than 20 mm Hg) and small phasic changes in pressure less than 20 mm Hg (anal slow waves). The minute-to-minute variations in mean pressure were greater during the awake fed state (4 +/- 1 mm Hg/min) than at night during sleep (2 +/- 1 mm Hg/min; P less than 0.03), as were the number of large phasic waves per minute (increases in pressure: awake, fed = 0.5 +/- 1 waves/min, night = 0.3 +/- 0.1 waves/min, P less than 0.05; decreases in pressure: awake, fed = 0.4 +/- 0.1 waves/min, night = 0.2 +/- 0.1 waves/min, P less than 0.05). Anal small waves had a similar frequency of about 17 waves/min in all three states. In conclusion, the anal sphincter maintains a continuous pressure barrier to rectal outflow both during the day and at night during sleep. However, marked minute-to-minute variations in mean pressure and large phasic increases and decreases in pressure do occur. Both are fewer at night during sleep.

Published
1991
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8. Effect of cyclical unipolar depression on upper gastrointestinal motility and sleep.

Author

Talley NJ, Camilleri M, Orkin BA, and Kramlinger KG

Subjects
Aged, Aged, 80 and over, Electroencephalography, Female, Humans, Sleep, REM physiology, Depressive Disorder physiopathology, Gastrointestinal Motility, Sleep physiology
Abstract

Cyclic 48-h unipolar depression is a rare form of recurrent affective disorder. We studied a single patient to determine (a) if there is an association between psychiatric status and migrating motor complex activity; and (b) if phase III of the migrating motor complex is in phase with rapid eye movement sleep in depression. There was marked reduction in phase III of the migrating motor complex during the depressed (n = 7) compared with the euthymic phase (n = 13), and a lack of coherence between phase III migrating motor complex activity and sleep stages in both depressed and nondepressed phases. The depressed state may be associated with altered upper gastrointestinal motor function.

Published
1989
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