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2. Risk of Bowel Obstruction in Patients Undergoing Neoadjuvant Chemotherapy for High-risk Colon Cancer: A Nested Case-control Matched Analysis of an International, Multi-centre, Randomised Controlled Trial (FOxTROT)

Author

Glasbey, James, Glasbey, James, Beggs, Andrew, Glimelius, Bengt, Gray, Richard, Handley, Kelly, Laurberg, Søren, Magill, Laura, Murakami, Keigo, Palmer, Andy, Quirke, Philip, Seligman, Jenny, Seymour, Matt, Sinha, Yash, West, Nick, Morton, Dion, Glasbey, James, Handley, Kelly, Palmer, Andy, Morton, Dion, Crosby, T., Olliff, J., Peto (Chair), R., Brown, Gina, Ferry, David, Glimelius, Bengt, Gray, Richard, Handley, Kelly, Ismail, Tariq, Laurberg, Søren, Magill, Laura, Morton, Dion, Oliver, Alf, Quirke, Phil, Seymour, Matt, Scott, Nigel, Seligman, Jenny, Swift, Ian, Warren, Bryan, West, Nick, Northover, J., Parmar (Chair), M., Slevin, M., Magill, Laura, Gray, Richard, Handley, Kelly, Wilcockson, Adrian, Gray, Zoe, Lancaster, Dominic, Brown, James, Palmer, Andrew, Adie, Ladan, Kennedy, Georgia, Eld, M., Holt, G., Yilmaz, M., Spendler, K. Garm, Hansen, F., Laurberg, S., Rosenkilde, M., Ahlstrom, H., Glimelius, B., Abgamu, D., Day, N., Walsh, C., Bannister, J., Furniss, D., Morgan, S., Walkington, L., Yates, S., Branagan, G., Mustajab, A., O’Neil, H., Rees, C., Geh, I., Hendrickse, C., Langman, G., Pallan, A., Conn, A., Lowe, A., Ostrowski, J., Steward, M., Callaway, M., Falk, S., Thomas, M., Wong, N., Cast, J., Hartley, J., Roy, R., Tiam, R., Blunt, D., Cleator, S., Dawson, P., Goldin, R., Gujral, D., Lowdell, C., Ziprin, P., Clenton, S., Dewdney, A., Euinton, H., Furniss, D., Gupta, R., Tarapowewalla, D., Wilshaw, V., Braun, M., Chakrabarty, B., Hill, J., Laasch, H., Saunders, M., Cruickshank, N., Davies, M., Muzaffar, S., Orme, A., Punia, P., Rea, D., Campbell, F., Hughes, M., Palmer, D., Rooney, P., Abbott, G., Hamid, B., Vimalachandran, D., Berry, J., Hinson, F., Maarouf, Z., Nicoll, J., Adams, C., Denson, J., Jackson, S., Sherriff, D., Kweka, E., McAdam, G., Peters, M., Roy, R., Khaira, M., Kurien, G., Robinson, J., Wadsley, J., White, D., Young, R., Dega, R., Lamparelli, M., Orbell, J., Osborne, R., Taylor, P., Thomas, T., Gopalakrishnan, K., Jadhav, V., Scott-Brown, M., Baijal, S., Chapman, M., Glaholm, J., Nelson, C., Singh, R., Harrison, J., Last, K., Scott, D., Scullion, D., Lind, P., Milosavljevic, Z., Dent, J., Ilsley, D., Littleford, S., Roberts, C., Crabtree, M., Orrell, J., Sherwin, E., Smith, S., Soomal, R., Braun, M., De, A., Khan, A., Khan, U., Lavin, V., McBain, C., Radharkrishna, G., Sil, R., Weerasinghe, S., Hill, J., Lee, S., Wright, P., Church, R., Holland, C., Kunene, V., Thompson, A., Glynne-Jones, R., Goh, V., Livingstone, J., Richman, P., Barlow, C., Burn, P., Geraghty, J., Walther, J., Grumett, S., Mangalika, S., Qaiyum, M., Williams, G., Borgstein, R., Bridgewater, J., Melville, D., Rees, J., Coxon, F., Hainsworth, P., Needham, S., Scott, J., Asmussen, J., Hansen, T., Jensen, K., Pfeiffer, P., Alkhaldi, A., Brittenden, J., Jackson, A., Kamposioras, K., Kumaran, G., Macklin, C., Alexander, J., Harle, A., Hickish, T., Talbot, R., Tarver, D., Bridgewater, J., Partridge, W., Sundaresan, V., Vivekanandan, S., Agrawal, N., Higginson, A., Muthuramalingam, S., O’Leary, D., Devarajan, G., Gulati, M., Kerwat, R., Maisey, N., Mikhaeel, G., Ismail, T., Middleton, G., Page, A., Steven, N., Taniere, P., Gutmann, J., Huang, J., Raouf, S., Dunn, W., Escola, C. Lopez, Potter, V., Scholefield, J., Walker, G., Zaitoun, A., Eason, D., McPhail, N., Mmeka, W., Stenhouse, G., Watson, A., Fozard, B., Hickish, T., Snape, S., Ellis, R., Faux, W., Jenkins, R., Maskell, G., Kulkarni, R., Lund, J., Menon, S., Singh, R., Chandler, I., Daniels, I., Harries, S., Osborne, M., Bell, J., Krell, D., Mayer, A., Ogunbiyi, O., Watkins, J., Bronder, C., Eaton, D., Taylor, A., Brown, G., Cunningham, D., Tekkis, P., Wotherspoon, A., Dobson, M., Mitchell, P., Pitt, M., Scott, N., Susnerwala, S., Adab, F., Britton, I., Ghiridaran, S., Howitt, C., Kirby, R., Biddlestone, L., Dalton, S., De Winton, E., Phillips, A., Ferry, D., Grumett, S., Kawesha, A., Maleki, K., Momtahan, N., Burnett, H., Hayes, S., Soop, M., Branagan, G., Cook, I., Cook, S., Iveson, T., Shablak, A., Coup, A., Hamid, A., Moore, P., O’Toole, L., Pai, D., Bateman, A., Bateman, A., Blaquiere, R., Nichols, P., Chappell, M., Dworkin, M., Jain, S., Tsang, D., Hopkins, K., Loveday, E., Lyons, A., Rooney, N., Ali, N., Chatterjee, M., Chiphang, A., Dundas, S., Myint, A. Sun, Zeiderman, M., Beharry, N., Chong, H., Lofts, F., Melville, D., Finan, P., Seymour, M., Tolan, D., West, N., Anyamene, N., Burling, D., Kennedy, R., Moorghen, M., Agrawal, S., Hasan, J., Mehta, S., Saeed, M., Burgess, P., John, L., Lowndes, S., Planner, A., Campbell, F., Hughes, M., Rooney, P., Smith, D., Hochhauser, D., Obichere, A., Rodriguez-Justo, M., Shiu, K., Taylor, S., Correa, P., James, S., Shatwell, W., Williams, N., Brady, J., Lanaspre, E., Mikhaeel, G., Ahmad, M., Gill, T., Wilson, D., Adams, R., Beehen, R., Morgan, M., Lindh, B., Adams, R., Morgan, M., Ford, A., Gopal, K., Pranesh, N., Shareef, D., Tighe, M., Busby, K., Correa, P., Sanders, S., Sinha, R., Ahmad, R., Desai, S., Ramesh, S., Hilman, S., Lott, M., O’Brien, J., Radstone, D., West, D., Amin, S., Hampton, J., Hornbuckle, J., Kitsanta, P., Ali, M., Desai, A., Hadaki, M., Hall, M., Arul, D., Hochhauser, D., Leonard, P., Mukhtar, H., Murray, D., Baxter, A., Churn, M., Farrugia, D., Lake, S., Smith, G., Bansal, A., Chandran, P., Corr, C., Gollins, S., Davenport, A., Saunders, M., Sukumar, S., Bathurst, N., Beaumont, E., Cooper, E., Francis, N., Sephton, M., Sparrow, G., Clarke, A., Haselden, J., Last, K., Woodcock, N., Atkinson, M., Gollins, S., Gupta, M., Maw, A., Abdullah, N., Bale, C., and Lord, M.

Published
2023
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3. Palliative pelvic exenteration: A systematic review of patient-centered outcomes

Author

Kroon, Hidde M., Dudi-Venkata, N.N., Bedrikovetski, S., Thomas, M.L., Kelly, M.E., Aalbers, A.G.J., Abdul Aziz, N., Abraham-Nordling, M., Akiyoshi, T., Alberda, W., Andric, M., Antoniou, A., Austin, K.K., Baker, R.P., Bali, M., Baseckas, G., Bednarski, B.K., Beets, G.L., Berg, P.L., Beynon, J., Biondo, S., Bordeianou, L., Brunner, M., Buchwald, P., Burger, J.W.A., Burling, D., Campain, N., Chan, K.K.L., Chang, G.J., Chew, M.H., C Chong, P., Christensen, H.K., Codd, M., Colquhoun, A.J., Corr, A., Coscia, M., Coyne, P.E., Creavin, B., Damjanovic, L., Daniels, I.R., Davies, M., Davies, R.J., de Wilt, J.H.W., Denost, Q., Dietz, D., Dozois, E.J., Duff, M., Eglinton, T., Enriquez-Navascues, J.M., Evans, M.D., Fearnhead, N.S., Frizelle, F.A., Garcia-Granero, E., Garcia-Sabrido, J.L., Gentilini, L., George, M.L., Glynn, R., Golda, T., Griffiths, B., Harris, D.A., Evans, M., Hagemans, J.A.W., Harji, D.P., Heriot, A.G., Hohenberger, W., Holm, T., Jenkins, J.T., Kapur, S., Kanemitsu, Y., Kelley, S.R., Keller, D.S., Kim, H., Koh, C.E., Kok, N.F.M., Kokelaar, R., Kontovounisios, C., Kusters, M., Larson, D.W., Law, W.L., Laurberg, S., Lee, P., Lydrup, M.L., Lynch, A.C., Mantyh, C., Mathis, K.L., Martling, A., Meijerink, W.J.H.J., Merkel, S., Mehta, A.M., McDermott, F.D., McGrath, J.S., Mirnezami, A., Morton, J.R., Mullaney, T.G., Mesquita-Neto, J.W., Nielsen, M.B., Nieuwenhuijzen, G.A.P., Nilsson, P.J., O'Connell, P.R., Palmer, G., Patsouras, D., Pellino, G., Poggioli, G., Quinn, M., Quyn, A., Radwan, R.W., Rasheed, S., Rasmussen, P.C., Regenbogen, S.E., Rocha, R., Rothbarth, J., Roxburgh, C., Rutten, H.J.T., Ryan, É., Sagar, P.M., Saklani, A., Schizas, A.M.P., Schwarzkopf, E., Scripcariu, V., Shaikh, I., Shida, D., Simpson, A., Smart, N.J., Smith, J.J., Solomon, M.J., Sørensen, M.M., Steele, S.R., Steffens, D., Stocchi, L., Stylianides, N.A., Tekkis, P.P., Taylor, C., Tsarkov, P., Tsukamoto, S., Turner, W.H., Tuynman, J.B., van Ramshorst, G.H., van Zoggel, D., Vasquez-Jimenez, W., Verhoef, C., Verstegen, M., Wakeman, C., Warrier, S., Wasmuth, H.H., Weiser, M.R., Wheeler, J.M.D., Wild, J., Yip, J., Winter, D.C., and Sammour, T.

Published
2019
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4. Making an IMPACT: A priority setting consultation exercise to improve outcomes in patients with locally advanced, recurrent and metastatic colorectal cancer

Author

Acheson, A., Adams, K., Adams, R., Alsina, D., Antoniou, A., Arnott, R., Bach, S., Battersby, N., Bedford, M., Beggs, A., Belcher, E., Boulstridge, L., Boyle, K., Bradbury, J., Braun, M., Brown, E., Brown, G., Burling, D., Cameron, I., Campbell, K., Carney, K., Cecil, T., Chapman, M., Chapman, S., Chong, P., Coyne, P., Clark, S., Crane, S., Daniels, I., Davies, J., Davies, L., Davies, M., Dawson, C., Dawson, P., Duff, M., Demick, A., Elavia, K., Gardner, R., Evans, M., Fenwick, S., Galbraith, S., Good, J., Gilbert, D., Griffiths, B., Hargest, R., Hill, J., Hompes, R., Huguet, E., Jenkins, J., Kapur, S., Karandikar, S., Katte, C., Kumar, N., Langman, G., Lim, M., Lopes de Azevedo-Gilbert, R., Macdonald, A., Machesney, M., Mathur, P., Maxwell-Armstrong, C., McArthur, D., McDermott, F., McDermott, U., Mirnezami, A., Mitchell, P., Mohamed, F., Moran, B., Morris, M., Murphy, J., Nakas, A., Norris, C., O'Dwyer, S., Panagiotopoulou, I., Pellino, G., Polignano, F., Powell, C., Renehan, A., Rowbottom, P., Sagar, P., Samuel, L., Seligmann, J., Shaikh, I., Simpson, A., Skaife, P., Skarrot, P., Speake, W., Stearns, A., Stylianides, N.A., Sutton, P., Swarnkar, K., Taylor, C., Tebala, G., Thorpe, G., Tiernan, J., Toogood, G., Vimalchandran, D., Walker, K., Walsh, C., Warren, O., Wasan, H., Welsh, F., Wheeler, J., Whitley, S., Wilson, M., Winter, D., Youssef, H., Vallance, A.E., Harji, D., and Fearnhead, N.S.

Published
2019
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6. Minimum standards of pelvic exenterative practice:PelvEx Collaborative guideline

Author

Fahy, MR, Kelly, ME, Aalbers, AGJ, Abdul Aziz, N, Abecasis, N, Abraham-Nordling, M, Akiyoshi, T, Alberda, W, Albert, M, Andric, M, Angeles, MA, Angenete, E, Antoniou, A, Auer, R, Austin, KK, Aytac, E, Aziz, O, Bacalbasa, N, Baker, RP, Bali, M, Baransi, S, Baseckas, G, Bebington, B, Bedford, M, Bednarski, BK, Beets, GL, Berg, PL, Bergzoll, C, Beynon, J, Biondo, S, Boyle, K, Bordeianou, L, Brecelj, E, 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, Ceelan, W, Chan, KKL, Chang, GJ, Chang, M, Chew, MH, Chok, AY, Chong, P, Clouston, H, Codd, M, Collins, D, Colquhoun, AJ, Constantinides, J, Corr, A, Coscia, M, Cosimelli, M, Cotsoglou, C, Coyne, PE, Croner, RS, Damjanovich, L, Daniels, IR, Davies, M, Delaney, CP, de Wilt, JHW, Denost, Q, Deutsch, C, Dietz, D, Domingo, S, Dozois, EJ, Drozdov, E, Duff, M, Eglinton, T, Enriquez-Navascues, JM, Espín-Basany, E, Evans, MD, Eyjólfsdóttir, B, Fearnhead, NS, Ferron, G, Flatmark, K, Fleming, FJ, Flor, B, Folkesson, J, Frizelle, FA, Funder, J, Gallego, MA, Gargiulo, M, García-Granero, E, García-Sabrido, JL, Gava, VG, Gentilini, L, George, ML, George, V, Georgiou, P, Ghosh, A, Ghouti, L, Gil-Moreno, A, Giner, F, Ginther, DN, Glyn, T, 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, Hompes, R, Hornung, B, Hurton, S, Hyun, E, Ito, M, Iversen, LH, Jenkins, JT, Jourand, K, Kaffenberger, S, Kandaswamy, GV, Kapur, S, Kanemitsu, Y, Kazi, M, Kelley, SR, Keller, DS, Ketelaers, SHJ, Khan, MS, Kiran, RP, Kim, H, Kim, HJ, Koh, CE, Kok, NFM, Kokelaar, R, Kontovounisios, C, Kose, F, Koutra, M, Kristensen, HØ, Kroon, HM, Kumar, S, Kusters, M, Lago, V, Lampe, B, Lakkis, Z, Larach, JT, Larkin, JO, Larsen, SG, Larson, DW, Law, WL, Lee, PJ, Limbert, M, Loria, A, Lydrup, ML, Lyons, A, Lynch, AC, Maciel, J, Manfredelli, S, Mann, C, Mantyh, C, Mathis, KL, Marques, CFS, Martinez, A, Martling, A, Mehigan, BJ, Meijerink, WJHJ, Merchea, A, Merkel, S, Mehta, AM, Mikalauskas, S, McArthur, DR, McCormick, JJ, McCormick, P, McDermott, FD, McGrath, JS, Malde, S, Mirnezami, A, Monson, JRT, Navarro, AS, Negoi, I, Neto, JWM, Ng, JL, Nguyen, B, Nielsen, MB, Nieuwenhuijzen, GAP, Nilsson, PJ, Nordkamp, S, Nugent, T, Oliver, A, O’Dwyer, ST, O’Sullivan, NJ, Paarnio, K, Palmer, G, Pappou, E, Park, J, Patsouras, D, Peacock, O, Pellino, G, Peterson, AC, Pinson, J, Poggioli, G, Proud, D, Quinn, M, Quyn, A, Rajendran, N, Radwan, RW, Rao, C, Rasheed, S, Rausa, E, Regenbogen, SE, Reims, HM, Renehan, A, Rintala, J, Rocha, R, Rochester, M, Rohila, J, Rothbarth, J, Rottoli, M, Roxburgh, C, Rutten, HJT, Safar, B, Sagar, PM, Sahai, A, Saklani, A, Sammour, T, Sayyed, R, Schizas, AMP, Schwarzkopf, E, Scripcariu, D, Scripcariu, V, Selvasekar, C, Shaikh, I, Simpson, A, Skeie-Jensen, T, Smart, NJ, Smart, P, Smith, JJ, Solbakken, AM, Solomon, MJ, Sørensen, MM, Sorrentino, L, Steele, SR, Steffens, D, Stitzenberg, K, Stocchi, L, Stylianides, NA, Swartling, T, Spasojevic, M, Sumrien, H, Sutton, PA, Swartking, T, Takala, H, Tan, EJ, Taylor, C, Tekin, A, Tekkis, PP, Teras, J, Thaysen, HV, Thurairaja, R, Thorgersen, EB, Toh, EL, Tsarkov, P, Tsukada, Y, Tsukamoto, S, Tuech, JJ, Turner, WH, Tuynman, JB, Valente, M, van Ramshorst, GH, van Zoggel, D, Vasquez-Jimenez, W, Vather, R, Verhoef, C, Vierimaa, M, Vizzielli, G, Voogt, ELK, Uehara, K, Urrejola, G, Wakeman, C, Warrier, SK, Wasmuth, HH, Waters, PS, Weber, K, Weiser, MR, Wheeler, JMD, Wild, J, Williams, A, Wilson, M, Wolthuis, A, Yano, H, Yip, B, Yip, J, Yoo, RN, Zappa, MA, Winter, DC, Fahy, Mr, Kelly, Me, Aalbers, Agj, Abdul Aziz, N, Abecasis, N, Abraham-Nordling, M, Akiyoshi, T, Alberda, W, Albert, M, Andric, M, Angeles, Ma, Angenete, E, Antoniou, A, Auer, R, Austin, Kk, Aytac, E, Aziz, O, Bacalbasa, N, Baker, Rp, Bali, M, Baransi, S, Baseckas, G, Bebington, B, Bedford, M, Bednarski, Bk, Beets, Gl, Berg, Pl, Bergzoll, C, Beynon, J, Biondo, S, Boyle, K, Bordeianou, L, Brecelj, E, 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, Ceelan, W, Chan, Kkl, Chang, Gj, Chang, M, Chew, Mh, Chok, Ay, Chong, P, Clouston, H, Codd, M, Collins, D, Colquhoun, Aj, Constantinides, J, Corr, A, Coscia, M, Cosimelli, M, Cotsoglou, C, Coyne, Pe, Croner, R, Damjanovich, L, Daniels, Ir, Davies, M, Delaney, Cp, de Wilt, Jhw, Denost, Q, Deutsch, C, Dietz, D, Domingo, S, Dozois, Ej, Drozdov, E, Duff, M, Eglinton, T, Enriquez-Navascues, Jm, Espín-Basany, E, Evans, Md, Eyjólfsdóttir, B, Fearnhead, N, Ferron, G, Flatmark, K, Fleming, Fj, Flor, B, Folkesson, J, Frizelle, Fa, Funder, J, Gallego, Ma, Gargiulo, M, García-Granero, E, García-Sabrido, Jl, Gava, Vg, Gentilini, L, George, Ml, George, V, Georgiou, P, Ghosh, A, Ghouti, L, Gil-Moreno, A, Giner, F, Ginther, Dn, Glyn, T, 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, Hompes, R, Hornung, B, Hurton, S, Hyun, E, Ito, M, Iversen, Lh, Jenkins, Jt, Jourand, K, Kaffenberger, S, Kandaswamy, Gv, Kapur, S, Kanemitsu, Y, Kazi, M, Kelley, Sr, Keller, D, Ketelaers, Shj, Khan, M, Kiran, Rp, Kim, H, Kim, Hj, Koh, Ce, Kok, Nfm, Kokelaar, R, Kontovounisios, C, Kose, F, Koutra, M, Kristensen, Hø, Kroon, Hm, Kumar, S, Kusters, M, Lago, V, Lampe, B, Lakkis, Z, Larach, Jt, Larkin, Jo, Larsen, Sg, Larson, Dw, Law, Wl, Lee, Pj, Limbert, M, Loria, A, Lydrup, Ml, Lyons, A, Lynch, Ac, Maciel, J, Manfredelli, S, Mann, C, Mantyh, C, Mathis, Kl, Marques, Cf, Martinez, A, Martling, A, Mehigan, Bj, Meijerink, Wjhj, Merchea, A, Merkel, S, Mehta, Am, Mikalauskas, S, Mcarthur, Dr, Mccormick, Jj, Mccormick, P, Mcdermott, Fd, Mcgrath, J, Malde, S, Mirnezami, A, Monson, Jrt, Navarro, A, Negoi, I, Neto, Jwm, Ng, Jl, Nguyen, B, Nielsen, Mb, Nieuwenhuijzen, Gap, Nilsson, Pj, Nordkamp, S, Nugent, T, Oliver, A, O’Dwyer, St, O’Sullivan, Nj, Paarnio, K, Palmer, G, Pappou, E, Park, J, Patsouras, D, Peacock, O, Pellino, G, Peterson, Ac, Pinson, J, Poggioli, G, Proud, D, Quinn, M, Quyn, A, Rajendran, N, Radwan, Rw, Rao, C, Rasheed, S, Rausa, E, Regenbogen, Se, Reims, Hm, Renehan, A, Rintala, J, Rocha, R, Rochester, M, Rohila, J, Rothbarth, J, Rottoli, M, Roxburgh, C, Rutten, Hjt, Safar, B, Sagar, Pm, Sahai, A, Saklani, A, Sammour, T, Sayyed, R, Schizas, Amp, Schwarzkopf, E, Scripcariu, D, Scripcariu, V, Selvasekar, C, Shaikh, I, Simpson, A, Skeie-Jensen, T, Smart, Nj, Smart, P, Smith, Jj, Solbakken, Am, Solomon, Mj, Sørensen, Mm, Sorrentino, L, Steele, Sr, Steffens, D, Stitzenberg, K, Stocchi, L, Stylianides, Na, Swartling, T, Spasojevic, M, Sumrien, H, Sutton, Pa, Swartking, T, Takala, H, Tan, Ej, Taylor, C, Tekin, A, Tekkis, Pp, Teras, J, Thaysen, Hv, Thurairaja, R, Thorgersen, Eb, Toh, El, Tsarkov, P, Tsukada, Y, Tsukamoto, S, Tuech, Jj, Turner, Wh, Tuynman, Jb, Valente, M, van Ramshorst, Gh, van Zoggel, D, Vasquez-Jimenez, W, Vather, R, Verhoef, C, Vierimaa, M, Vizzielli, G, Voogt, Elk, Uehara, K, Urrejola, G, Wakeman, C, Warrier, Sk, Wasmuth, Hh, Waters, P, Weber, K, Weiser, Mr, Wheeler, Jmd, Wild, J, Williams, A, Wilson, M, Wolthuis, A, Yano, H, Yip, B, Yip, J, Yoo, Rn, Zappa, Ma, Winter, Dc, Surgery, CCA - Cancer Treatment and quality of life, CCA - Imaging and biomarkers, and Amsterdam Gastroenterology Endocrinology Metabolism

Subjects
Neoplasm Recurrence, Local/surgery, Humans, Surgery, Neoplasm Recurrence, Local, Pelvic Exenteration
Abstract

This document outlines the important aspects of caring for patients who have been diagnosed with advanced pelvic cancer. It is primarily aimed at those who are establishing a service that adequately caters to this patient group. The relevant literature has been summarized and an attempt made to simplify the approach to management of these complex cases.

Published
2022
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7. Simultaneous pelvic exenteration and liver resection for primary rectal cancer with synchronous liver metastases: results from the PelvEx Collaborative

Author

Kelly, M. E., Aalbers, A. G. J., Abdul Aziz, N., Abecasis, N., Abraham‐Nordling, M., Akiyoshi, T., Alberda, W., Albert, M., Andric, M., Angenete, E., Antoniou, A., Auer, R., Austin, K. K., Aziz, O., Baker, R. P., Bali, M., Baseckas, G., Bebington, B., Bednarski, B. K., Beets, G. L., Berg, P. L., Beynon, J., Biondo, S., Boyle, K., Bordeianou, L., Bremers, A. B., Brunner, M., Buchwald, P., Bui, A., Burgess, A., Burger, J. W. A., Burling, D., Burns, E., Campain, N., Carvalhal, S., Castro, L., Caycedo‐Marulanda, A., Chan, K. K. L., Chang, G. J., Chew, M. H., Chong, P. C., Christensen, H. K., Clouston, H., Codd, M., Collins, D., Colquhoun, A. J., Corr, A., Coscia, M., Coyne, P. E., Creavin, B., Croner, R. S., Damjanovic, L., Daniels, I. R., Davies, M., Davies, R. J., Delaney, C. P., Denost, Q., Deutsch, C., Dietz, D., Domingo, S., Dozois, E. J., Duff, M., Eglinton, T., Enrique‐Navascues, J. M., Espin‐Basany, E., Evans, M. D., Fearnhead, N. S., Flatmark, K., Fleming, F., Frizelle, F. A., Gallego, M. A., Garcia‐Granero, E., Garcia‐Sabrido, J. L., Gentilini, L., George, M. L., Ghouti, L., Giner, F., Ginther, N., Glynn, R., Golda, T., Griffiths, B., Harris, D. A., Hagemans, J. A. W., Hanchanale, V., Harji, D. P., Helewa, R. M., Heriot, A. G., Hochman, D., Hohenberger, W., Holm, T., Hompes, R., Jenkins, J. T., Kaffenberger, S., Kandaswamy, G. V., Kapur, S., Kanemitsu, Y., Kelley, S. R., Keller, D. S., Khan, M. S., Kiran, R. P., Kim, H., Kim, H. J., Koh, C. E., Kok, N. F. M., Kokelaar, R., Kontovounisios, C., Kristensen, H. Ø., Kroon, H. M., Kusters, M., Lago, V., Larsen, S. G., Larson, D. W., Law, W. L., Laurberg, S., Lee, P. J., Limbert, M., Lydrup, M. L., Lyons, A., Lynch, A. C., Mantyh, C., Mathis, K. L., Margues, C. F. S., Martling, A., Meijerink, W. J. H. J., Merkel, S., Mehta, A. M., McArthur, D. R., McDermott, F. D., McGrath, J. S., Malde, S., Mirnezami, A., Monson, J. R. T., Morton, J. R., Mullaney, T. G., Negoi, I., Neto, J. W. M., Nguyen, B., Nielsen, M. B., Nieuwenhuijzen, G. A. P., Nilsson, P. J., O’Connell, P. R., O’Dwyer, S. T., Palmer, G., Pappou, E., Park, J., Patsouras, D., Pellino, G., Peterson, A. C., Poggioli, G., Proud, D., Quinn, M., Quyn, A., Radwan, R. W., van Ramshorst, G. H., Rasheed, S., Rasmussen, P. C., Regenbogen, S. E., Renehan, A., Rocha, R., Rochester, M., Rohila, J., Rothbarth, J., Rottoli, M., Roxburgh, C., Rutten, H. J. T., Ryan, É. J., Safar, B., Sagar, P. M., Sahai, A., Saklani, A., Sammour, T., Sayyed, R., Schizas, A. M. P., Schwarzkopf, E., Scripcariu, V., Selvasekar, C., Shaikh, I., Hellawell, G., Shida, D., Simpson, A., Smart, N. J., Smart, P., Smith, J. J., Solbakken, A. M., Solomon, M. J., Sørensen, M. M., Steele, S. R., Steffens, D., Stitzenberg, K., Stocchi, L., Stylianides, N. A., Sumrien, H., Sutton, P. A., Swartking, T., Taylor, C., Tekkis, P. P., Teras, J., Thurairaja, R., Toh, E. L., Tsarkov, P., Tsukada, Y., Tsukamoto, S., Tuech, J. J., Turner, W. H., Tuynman, J. B., Vasquez‐Jimenez, W., Verhoef, C., Vizzielli, G., Voogt, E. L. K., Uehara, K., Wakeman, C., Warrier, S., Wasmuth, H. H., Weber, K., Weiser, M. R., Wheeler, J. M. D., Wild, J., Wilson, M., de Wilt, J. H. W., Wolthuis, A., Yano, H., Yip, B., Yip, J., Yoo, R. N., van Zoggel, D., Winter, D. C., Kelly, M. E., Aalbers, A. G. J., Abdul Aziz, N., Abecasis, N., Abraham‐nordling, M., Akiyoshi, T., Alberda, W., Albert, M., Andric, M., Angenete, E., Antoniou, A., Auer, R., Austin, K. K., Aziz, O., Baker, R. P., Bali, M., Baseckas, G., Bebington, B., Bednarski, B. K., Beets, G. L., Berg, P. L., Beynon, J., Biondo, S., Boyle, K., Bordeianou, L., Bremers, A. B., Brunner, M., Buchwald, P., Bui, A., Burgess, A., Burger, J. W. A., Burling, D., Burns, E., Campain, N., Carvalhal, S., Castro, L., Caycedo‐marulanda, A., Chan, K. K. L., Chang, G. J., Chew, M. H., Chong, P. C., Christensen, H. K., Clouston, H., Codd, M., Collins, D., Colquhoun, A. J., Corr, A., Coscia, M., Coyne, P. E., Creavin, B., Croner, R. S., Damjanovic, L., Daniels, I. R., Davies, M., Davies, R. J., Delaney, C. P., Denost, Q., Deutsch, C., Dietz, D., Domingo, S., Dozois, E. J., Duff, M., Eglinton, T., Enrique‐navascues, J. M., Espin‐basany, E., Evans, M. D., Fearnhead, N. S., Flatmark, K., Fleming, F., Frizelle, F. A., Gallego, M. A., Garcia‐granero, E., Garcia‐sabrido, J. L., Gentilini, L., George, M. L., Ghouti, L., Giner, F., Ginther, N., Glynn, R., Golda, T., Griffiths, B., Harris, D. A., Hagemans, J. A. W., Hanchanale, V., Harji, D. P., Helewa, R. M., Heriot, A. G., Hochman, D., Hohenberger, W., Holm, T., Hompes, R., Jenkins, J. T., Kaffenberger, S., Kandaswamy, G. V., Kapur, S., Kanemitsu, Y., Kelley, S. R., Keller, D. S., Khan, M. S., Kiran, R. P., Kim, H., Kim, H. J., Koh, C. E., Kok, N. F. M., Kokelaar, R., Kontovounisios, C., Kristensen, H. Ø., Kroon, H. M., Kusters, M., Lago, V., Larsen, S. G., Larson, D. W., Law, W. L., Laurberg, S., Lee, P. J., Limbert, M., Lydrup, M. L., Lyons, A., Lynch, A. C., Mantyh, C., Mathis, K. L., Margues, C. F. S., Martling, A., Meijerink, W. J. H. J., Merkel, S., Mehta, A. M., Mcarthur, D. R., Mcdermott, F. D., Mcgrath, J. S., Malde, S., Mirnezami, A., Monson, J. R. T., Morton, J. R., Mullaney, T. G., Negoi, I., Neto, J. W. M., Nguyen, B., Nielsen, M. B., Nieuwenhuijzen, G. A. P., Nilsson, P. J., O’Connell, P. R., O’Dwyer, S. T., Palmer, G., Pappou, E., Park, J., Patsouras, D., Pellino, G., Peterson, A. C., Poggioli, G., Proud, D., Quinn, M., Quyn, A., Radwan, R. W., van Ramshorst, G. H., Rasheed, S., Rasmussen, P. C., Regenbogen, S. E., Renehan, A., Rocha, R., Rochester, M., Rohila, J., Rothbarth, J., Rottoli, M., Roxburgh, C., Rutten, H. J. T., Ryan, É. J., Safar, B., Sagar, P. M., Sahai, A., Saklani, A., Sammour, T., Sayyed, R., Schizas, A. M. P., Schwarzkopf, E., Scripcariu, V., Selvasekar, C., Shaikh, I., Hellawell, G., Shida, D., Simpson, A., Smart, N. J., Smart, P., Smith, J. J., Solbakken, A. M., Solomon, M. J., Sørensen, M. M., Steele, S. R., Steffens, D., Stitzenberg, K., Stocchi, L., Stylianides, N. A., Sumrien, H., Sutton, P. A., Swartking, T., Taylor, C., Tekkis, P. P., Teras, J., Thurairaja, R., Toh, E. L., Tsarkov, P., Tsukada, Y., Tsukamoto, S., Tuech, J. J., Turner, W. H., Tuynman, J. B., Vasquez‐jimenez, W., Verhoef, C., Vizzielli, G., Voogt, E. L. K., Uehara, K., Wakeman, C., Warrier, S., Wasmuth, H. H., Weber, K., Weiser, M. R., Wheeler, J. M. D., Wild, J., Wilson, M., de Wilt, J. H. W., Wolthuis, A., Yano, H., Yip, B., Yip, J., Yoo, R. N., van Zoggel, D., Winter, D. C., 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, 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, 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, Surgery, CCA - Cancer Treatment and quality of life, and Amsterdam Gastroenterology Endocrinology Metabolism

Subjects
Male, medicine.medical_specialty, Adolescent, Colorectal cancer, survival outcomes, medicine.medical_treatment, surgical outcome, surgical outcomes, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], 03 medical and health sciences, 0302 clinical medicine, SDG 3 - Good Health and Well-being, Interquartile range, medicine, Humans, liver metastasi, Rectal cancer, Retrospective Studies, Pelvic exenteration, business.industry, Rectal Neoplasms, Mortality rate, Liver Neoplasms, Gastroenterology, Postoperative complication, Perioperative, medicine.disease, Surgery, Pelvic Exenteration, liver metastasis, Treatment Outcome, 030220 oncology & carcinogenesis, international collaboration, Resection margin, 030211 gastroenterology & hepatology, Hepatectomy, Neoplasm Recurrence, Local, business
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
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9. Management strategies for patients with advanced rectal cancer and liver metastases using modified Delphi methodology: results from the PelvEx Collaborative

Author

Kelly M. E., Agj A., Abdul Aziz N., Abecasis N., Abraham-Nordling M., Akiyoshi T., Alberda W., Albert M., Andric M., Angenete E., Antoniou A., Auer R., Austin K. K., Aziz O., Baker R. P., Bali M., Baseckas G., Bebington B., Bednarski B. K., Beets G. L., Berg P. L., Beynon J., Biondo S., Boyle K., Bordeianou L., Bremers A. B., Brunner M., Buchwald P., Bui A., Burgess A., Jwa B., Burling D., Campain N., Carvalhal S., Castro L., Caycedo-Marulanda A., Kkl C., Chang G. J., Chew M. H., Chong P., Christensen H. K., Clouston H., Codd M., Collins D., Colquhoun A. J., Corr A., Coscia M., Coyne P. E., Creavin B., Croner R. S., Damjanovic L., Daniels I. R., Davies M., Davies R. J., Delaney C. P., de Wilt J., Denost Q., Deutsch C., Dietz D., Domingo S., Dozois E. J., Duff M., Eglinton T., Enrique-Navascues J. M., Espin-Basany E., Evans M. D., Fearnhead N. S., Flatmark K., Fleming F., Frizelle F. A., Gallego M. A., Garcia-Granero E., Garcia-Sabrido J. L., Gentilini L., George M. L., Ghouti L., Giner F., Ginther N., Glynn R., Golda T., Griffiths B., Harris D. A., Jaw H., Hanchanale V., Harji D. P., Helewa R. M., Heriot A. G., Hochman D., Hohenberger W., Holm T., Hompes R., Jenkins J. T., Kaffenberger S., Kandaswamy G. V., Kapur S., Kanemitsu Y., Kelley S. R., Keller D. S., Khan M. S., Kiran R. P., Kim H., Kim H. J., Koh C. E., Nfm K., Kokelaar R., Kontovounisios C., Kristensen H. O., Kroon H. M., Kusters M., Lago V., Larsen S. G., Larson D. W., Law W. L., Laurberg S., Lee P. J., Limbert M., Lydrup M. L., Lyons A., Lynch A. C., Mantyh C., Mathis K. L., Cfs M., Martling A., Wjhj M., Merkel S., Mehta A. M., McArthur D. R., McDermott F. D., McGrath J. S., Malde S., Mirnezami A., Jrt M., Morton J. R., Mullaney T. G., Negoi I., Jwm N., Nguyen B., Nielsen M. B., Gap N., Nilsson P. J., O'Connell P. R., O'Dwyer S. T., Palmer G., Pappou E., Park J., Patsouras D., Pellino G., Peterson A. C., Poggioli G., Proud D., Quinn M., Quyn A., Radwan R. W., Rasheed S., Rasmussen P. C., Regenbogen S. E., Renehan A., Rocha R., Rochester M., Rohila J., Rothbarth J., Rottoli M., Roxburgh C., Hjt R., Ryan E. J., Safar B., Sagar P. M., Sahai A., Saklani A., Sammour T., Sayyed R., Amp S., Schwarzkopf E., Scripcariu V., Selvasekar C., Shaikh I., Shellawell G., Shida D., Simpson A., Smart N. J., Smart P., Smith J. J., Solbakken A. M., Solomon M. J., Sorensen M. M., Steele S. R., Steffens D., Stitzenberg K., Stocchi L., Stylianides N. A., Sumrien H., Sutton P. A., Swartking T., Taylor C., Tekkis P. P., Teras J., Thurairaja R., Toh E. L., Tsarkov P., Tsukada Y., Tsukamoto S., Tuech J. J., Turner W. H., Tuynman J. B., van Ramshorst G., van Zoggel D., Vasquez-Jimenez W., Verhoef C., Vizzielli G., Elk V., Uehara K., Wakeman C., Warrier S., Wasmuth H. H., Weber K., Weiser M. R., Jmd W., Wild J., Wilson M., Wolthuis A., Yano H., Yip B., Yip J., Yoo R. N., Winter D. C., Rottoli M, Poggioli G, Kelly, M. E., Agj, A., Abdul Aziz, N., Abecasis, N., Abraham-Nordling, M., Akiyoshi, T., Alberda, W., Albert, M., Andric, M., Angenete, E., Antoniou, A., Auer, R., Austin, K. K., Aziz, O., Baker, R. P., Bali, M., Baseckas, G., Bebington, B., Bednarski, B. K., Beets, G. L., Berg, P. L., Beynon, J., Biondo, S., Boyle, K., Bordeianou, L., Bremers, A. B., Brunner, M., Buchwald, P., Bui, A., Burgess, A., Jwa, B., Burling, D., Campain, N., Carvalhal, S., Castro, L., Caycedo-Marulanda, A., Kkl, C., Chang, G. J., Chew, M. H., Chong, P., Christensen, H. K., Clouston, H., Codd, M., Collins, D., Colquhoun, A. J., Corr, A., Coscia, M., Coyne, P. E., Creavin, B., Croner, R. S., Damjanovic, L., Daniels, I. R., Davies, M., Davies, R. J., Delaney, C. P., de Wilt, J., Denost, Q., Deutsch, C., Dietz, D., Domingo, S., Dozois, E. J., Duff, M., Eglinton, T., Enrique-Navascues, J. M., Espin-Basany, E., Evans, M. D., Fearnhead, N. S., Flatmark, K., Fleming, F., Frizelle, F. A., Gallego, M. A., Garcia-Granero, E., Garcia-Sabrido, J. L., Gentilini, L., George, M. L., Ghouti, L., Giner, F., Ginther, N., Glynn, R., Golda, T., Griffiths, B., Harris, D. A., Jaw, H., Hanchanale, V., Harji, D. P., Helewa, R. M., Heriot, A. G., Hochman, D., Hohenberger, W., Holm, T., Hompes, R., Jenkins, J. T., Kaffenberger, S., Kandaswamy, G. V., Kapur, S., Kanemitsu, Y., Kelley, S. R., Keller, D. S., Khan, M. S., Kiran, R. P., Kim, H., Kim, H. J., Koh, C. E., Nfm, K., Kokelaar, R., Kontovounisios, C., Kristensen, H. O., Kroon, H. M., Kusters, M., Lago, V., Larsen, S. G., Larson, D. W., Law, W. L., Laurberg, S., Lee, P. J., Limbert, M., Lydrup, M. L., Lyons, A., Lynch, A. C., Mantyh, C., Mathis, K. L., Cfs, M., Martling, A., Wjhj, M., Merkel, S., Mehta, A. M., Mcarthur, D. R., Mcdermott, F. D., Mcgrath, J. S., Malde, S., Mirnezami, A., Jrt, M., Morton, J. R., Mullaney, T. G., Negoi, I., Jwm, N., Nguyen, B., Nielsen, M. B., Gap, N., Nilsson, P. J., O'Connell, P. R., O'Dwyer, S. T., Palmer, G., Pappou, E., Park, J., Patsouras, D., Pellino, G., Peterson, A. C., Poggioli, G., Proud, D., Quinn, M., Quyn, A., Radwan, R. W., Rasheed, S., Rasmussen, P. C., Regenbogen, S. E., Renehan, A., Rocha, R., Rochester, M., Rohila, J., Rothbarth, J., Rottoli, M., Roxburgh, C., Hjt, R., Ryan, E. J., Safar, B., Sagar, P. M., Sahai, A., Saklani, A., Sammour, T., Sayyed, R., Amp, S., Schwarzkopf, E., Scripcariu, V., Selvasekar, C., Shaikh, I., Shellawell, G., Shida, D., Simpson, A., Smart, N. J., Smart, P., Smith, J. J., Solbakken, A. M., Solomon, M. J., Sorensen, M. M., Steele, S. R., Steffens, D., Stitzenberg, K., Stocchi, L., Stylianides, N. A., Sumrien, H., Sutton, P. A., Swartking, T., Taylor, C., Tekkis, P. P., Teras, J., Thurairaja, R., Toh, E. L., Tsarkov, P., Tsukada, Y., Tsukamoto, S., Tuech, J. J., Turner, W. H., Tuynman, J. B., van Ramshorst, G., van Zoggel, D., Vasquez-Jimenez, W., Verhoef, C., Vizzielli, G., Elk, V., Uehara, K., Wakeman, C., Warrier, S., Wasmuth, H. H., Weber, K., Weiser, M. R., Jmd, W., Wild, J., Wilson, M., Wolthuis, A., Yano, H., Yip, B., Yip, J., Yoo, R. N., Winter, D. C., and Academic Medical Center

Subjects
Liver metastasisSurvival Outcome, medicine.medical_specialty, survival outcomes, Colorectal cancer, surgical outcome, medicine.medical_treatment, Delphi method, Rectum, Disease, surgical outcomes, 03 medical and health sciences, Liver disease, 0302 clinical medicine, SDG 3 - Good Health and Well-being, Hepatectomy, Humans, Medicine, liver metastasi, Rectal cancer, Neoplasm Staging, Pelvic exenteration, Rectal Neoplasms, business.industry, General surgery, Liver Neoplasms, Gastroenterology, Induction chemotherapy, medicine.disease, liver metastasis, medicine.anatomical_structure, 030220 oncology & carcinogenesis, international collaboration, 030211 gastroenterology & hepatology, business
Abstract

Aim: A total of 15–20% of patients with rectal cancer have liver metastases on presentation. The management of these patients is controversial. Heterogeneity in management strategies is considerable, with management often being dependent on local resources and available expertise. Method: Members of the PelvEx Collaborative were invited to participate in the generation of a consensus statement on the optimal management of patients with advanced rectal cancer with liver involvement. Fifteen statements were created for topical discussion on diagnostic and management issues. Panellists were asked to vote on statements and anonymous feedback was given. A collaborative meeting was used to discuss any nuances and clarify any obscurity. Consensus was considered when > 85% agreement on a statement was achieved. Results: A total of 135 participants were involved in the final round of the Delphi questionnaire. Nine of the 15 statements reached consensus regarding the management of patients with advanced rectal cancer and oligometastatic liver disease. Routine use of liver MRI was not recommended for patients with locally advanced rectal cancer, unless there was concern for metastatic disease on initial computed tomography staging scan. Induction chemotherapy was advocated as first-line treatment in those with synchronous liver metastases in locally advanced rectal cancer. In the presence of symptomatic primary disease, a diverting stoma may be required to facilitate induction chemotherapy. Overall, only one-quarter of the panellists would consider simultaneous pelvic exenteration and liver resection. Conclusion: This Delphi process highlights the diverse treatment of advanced rectal cancer with liver metastases and provides recommendations from an experienced international group regarding the multidisciplinary management approach.

Published
2020
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10. Contemporary management of locally advanced and recurrent rectal cancer: views from the PelvEx collaborative

Author

Kelly M. E., O’Sullivan N. J., Fahy M. R., Aalbers A. G. J., Abdul Aziz N., Abecasis N., Abraham-Nordling M., Abu Saadeh F., Akiyoshi T., Alberda W., Albert M., Andric M., Angeles M. A., Angenete E., Antoniou A., Auer R., Austin K. K., Aytac E., Aziz O., Bacalbasa N., Baker R. P., Bali M., Baransi S., Baseckas G., Bebington B., Bedford M., Bednarski B. K., Beets G. L., Berg P. L., Bergzoll C., Beynon J., Biondo S., Boyle K., Bordeianou L., Brecelj E., Bremers A. B., Brunner M., Buchwald P., Bui A., Burgess A., Burger J. W. A., Burling D., Burns E., Campain N., Carvalhal S., Castro L., Caycedo-Marulanda A., Ceelen W., Chan K. K. L., Chang G. J., Chang M., Chew M. H., Chok A. Y., Chong P., Clouston H., Codd M., Collins D., Colquhoun A. J., Constantinides J., Corr A., Coscia M., Cosimelli M., Cotsoglou C., Coyne P. E., Croner R. S., Damjanovich L., Daniels I. R., Davies M., Delaney C. P., de Wilt J. H. W., Denost Q., Deutsch C., Dietz D., Domingo S., Dozois E. J., Drozdov E., Duff M., Eglinton T., Enriquez-Navascues J. M., Espín-Basany E., Evans M. D., Eyjólfsdóttir B., Fearnhead N. S., Ferron G., Fichtner-Feigl S., Flatmark K., Fleming F. J., Flor B., Folkesson J., Frizelle F. A., Funder J., Gallego M. A., Gargiulo M., García-Granero E., García-Sabrido J. L., Gava V. G., Gentilini L., George M. L., George V., Georgiou P., Ghosh A., Ghouti L., Gil-Moreno A., Giner F., Ginther D. N., Glyn T., Glynn R., Golda T., Griffiths B., Harris D. A., Hanchanale V., Harji D. P., Harris C., Helewa R. M., Hellawell G., Heriot A. G., Hochman D., HohenbergerW., Holm T., Hompes R., Hornung B., Hurton S., Hyun E., Ito M., Iversen L. H., Jenkins J. T., Jourand K., Kaffenberger S., Kandaswamy G. V., Kapur S., Kanemitsu Y., Kazi M., Kelley S. R., Keller D. S., Ketelaers S. H. J., Khan M. S., Kiran R. P., Kim H., Kim H. J., Koh C. E., Kok N. F. M., Kokelaar R., Kontovounisios C., Kose F., Koutra M., Kristensen H. Ø., Kroon H. M., Kumar S., Kusters M., Lago V., Lampe B., Lakkis Z., Larach J. T., Larkin J. O., Larsen S. G., Larson D. W., Law W. L., Lee P. J., Limbert M., Loria A., Lydrup ML., Lyons A., Lynch A. C., Maciel J., Manfredelli S., Mann C., Mantyh C., Mathis K. L., Marques C. F. S., Martinez A., Martling A., Mehigan B. J., MeijerinkW. J. H. J., Merchea A., Merkel S., Mehta A. M., Mikalauskas S., McArthur D. R., McCormick J. J., McCormick P., McDermott F. D., McGrath J. S., Malde S., Mirnezami A., Monson J. R. T., Navarro A. S., Neeff H., Negoi I., Neto J. W. M., Ng J. L., Nguyen B., Nielsen M. B., Nieuwenhuijzen G. A. P., Nilsson P. J., Nordkamp S., Nugent T., Oliver A., O’Dwyer S. T., Paarnio K., Palmer G., Pappou E., Park J., Patsouras D., Peacock O., Pellino G., Peterson A. C., Pfeffer F., Pinson J., Poggioli G., Proud D., Quinn M., Quyn A., Rajendran N., Radwan R. W., Rao C., Rasheed S., Rausa E., Regenbogen S. E., Reims H. M., Renehan A., Rintala J., Rocha R., Rochester M., Rohila J., Rothbarth J., Rottoli M., Roxburgh C., Rutten H. J. T., Safar B., Sagar P. M., Sahai A., Saklani A., Sammour T., Sayyed R., Schizas A. M. P., Schwarzkopf E., Scripcariu D., Scripcariu V., Selvasekar C., Shaikh I., Simpson A., Skeie-Jensen T., Smart N. J., Smart P., Smith J. J., Solbakken A. M., Solomon M. J., Sørensen M. M., Sorrentino L., Steele S. R., Steffens D., Stitzenberg K., Stocchi L., Stylianides N. A., Swartling T., Spasojevic M., Sumrien H., Sutton P. A., Swartking T., Takala H., Tan E. J., Taylor C., Taylor D., Tekin A., Tekkis P. P., Teras J., Thaysen H. V., Thurairaja R., Thorgersen E. B., Tiernan J., Toh E. L., Tolenaar J., Tsarkov P., Tsukada Y., Tsukamoto S., Tuech J. J., Turner W. H., Tuynman J. B., Valente M., van Ramshorst G. H., van Rees J., van Zoggel D., Vasquez-JimenezW., Vather R., Verhoef C., Vierimaa M., Vizzielli G., Voogt E. L. K., Uehara K., Urrejola G., Wakeman C., Warrier S. K., Wasmuth H. H., Waters P. S., Weber K., Weiser M. R., Wheeler J. M. D., Wild J., Williams A., Wilson M., Wolthuis A., Yano H., Yip B., Yoo R. N., Zappa M. A., Winter D. C., and Kelly M.E., O’Sullivan N.J., Fahy M.R., Aalbers A.G.J., Abdul Aziz N., Abecasis N., Abraham-Nordling M., Abu Saadeh F., Akiyoshi T., Alberda W., Albert M., Andric M., Angeles M.A., Angenete E., Antoniou A., Auer R., Austin K.K., Aytac E., Aziz O., Bacalbasa N., Baker R.P., Bali M., Baransi S., Baseckas G., Bebington B., Bedford M., Bednarski B.K., Beets G.L., Berg P.L., Bergzoll C., Beynon J., Biondo S., Boyle K., Bordeianou L., Brecelj E., Bremers A.B., Brunner M., Buchwald P., Bui A., Burgess A., Burger J.W.A., Burling D., Burns E., Campain N., Carvalhal S., Castro L., Caycedo-Marulanda A., Ceelen W., Chan K.K.L., Chang G.J., Chang M., Chew M.H., Chok A.Y., Chong P., Clouston H., Codd M., Collins D., Colquhoun A.J., Constantinides J., Corr A., Coscia M., Cosimelli M., Cotsoglou C., Coyne P.E., Croner R.S., Damjanovich L., Daniels I.R., Davies M., Delaney C.P., de Wilt J.H.W., Denost Q., Deutsch C., Dietz D., Domingo S., Dozois E.J., Drozdov E., Duff M., Eglinton T., Enriquez-Navascues J.M., Espín-Basany E., Evans M.D., Eyjólfsdóttir B., Fearnhead N.S., Ferron G., Fichtner-Feigl S., Flatmark K., Fleming F.J., Flor B., Folkesson J., Frizelle F.A., Funder J., Gallego M.A., Gargiulo M., García-Granero E., García-Sabrido J.L., Gargiulo M., Gava V.G., Gentilini L., George M.L., George V., Georgiou P., Ghosh A., Ghouti L., Gil-Moreno A., Giner F., Ginther D.N., Glyn T., Glynn R., Golda T., Griffiths B., Harris D.A., Hanchanale V., Harji D.P., Harris C., Helewa R.M., Hellawell G., Heriot A.G., Hochman D., HohenbergerW., Holm T., Hompes R., Hornung B., Hurton S., Hyun E., Ito M., Iversen L.H., Jenkins J.T., Jourand K., Kaffenberger S., Kandaswamy G.V., Kapur S., Kanemitsu Y., Kazi M., Kelley S.R., Keller D.S., Ketelaers S.H.J., Khan M.S., Kiran R.P., Kim H., Kim H.J., Koh C.E., Kok N.F.M., Kokelaar R., Kontovounisios C., Kose F., Koutra M., Kristensen H.Ø., Kroon H.M., Kumar S., Kusters M., Lago V., Lampe B., Lakkis Z., Larach J.T., Larkin J.O., Larsen S.G., Larson D.W., Law W.L., Lee P.J., Limbert M., Loria A., Lydrup ML., Lyons A., Lynch A.C., Maciel J., Manfredelli S., Mann C., Mantyh C., Mathis K.L., Marques C.F.S., Martinez A., Martling A., Mehigan B.J., MeijerinkW.J.H.J., Merchea A., Merkel S., Mehta A.M., Mikalauskas S., McArthur D.R., McCormick J.J., McCormick P., McDermott F.D., McGrath J.S., Malde S., Mirnezami A., Monson J.R.T., Navarro A.S., Neeff H., Negoi I., Neto J.W.M., Ng J.L., Nguyen B., Nielsen M.B., Nieuwenhuijzen G.A.P., Nilsson P.J., Nordkamp S., Nugent T., Oliver A., O’Dwyer S.T., Paarnio K., Palmer G., Pappou E., Park J., Patsouras D., Peacock O., Pellino G., Peterson A.C., Pfeffer F., Pinson J., Poggioli G., Proud D., Quinn M., Quyn A., Rajendran N., Radwan R.W., Rajendran N., Rao C., Rasheed S., Rausa E., Regenbogen S.E., Reims H.M., Renehan A., Rintala J., Rocha R., Rochester M., Rohila J., Rothbarth J., Rottoli M., Roxburgh C., Rutten H.J.T., Safar B., Sagar P.M., Sahai A., Saklani A., Sammour T., Sayyed R., Schizas A.M.P., Schwarzkopf E., Scripcariu D., Scripcariu V., Selvasekar C., Shaikh I., Simpson A., Skeie-Jensen T., Smart N.J., Smart P., Smith J.J., Solbakken A.M., Solomon M.J., Sørensen M.M., Sorrentino L., Steele S.R., Steffens D., Stitzenberg K., Stocchi L., Stylianides N.A., Swartling T., Spasojevic M., Sumrien H., Sutton P.A., Swartking T., Takala H., Tan E.J., Taylor C., Taylor D., Tekin A., Tekkis P.P., Teras J., Thaysen H.V., Thurairaja R., Thorgersen E.B., Tiernan J., Toh E.L., Tolenaar J., Tsarkov P., Tsukada Y., Tsukamoto S., Tuech J.J., Turner W.H., Tuynman J.B., Valente M., van Ramshorst G.H., van Rees J., van Zoggel D., Vasquez-JimenezW., Vather R., Verhoef C., Vierimaa M., Vizzielli G., Voogt E.L.K., Uehara K., Urrejola G., Wakeman C., Warrier S.K.,Wasmuth H.H.,Waters P.S.,Weber K.,Weiser M.R., Wheeler J.M.D.,Wild J., Williams A., Wilson M., Wolthuis A., Yano H., Yip B., Yoo R.N., Zappa M.A., Winter D.C.

Subjects
Cancer Research, perioperative care, ENHANCED RECOVERY, diagnostic, EXENTERATION, surgical management, surgical outcomes, recurrent rectal cancer, SDG 3 - Good Health and Well-being, locally advanced rectal cancer, QUALITY-OF-LIFE, Medicine and Health Sciences, diagnostics, 1112 Oncology and Carcinogenesis, PATHOLOGICAL COMPLETE RESPONSE, rectal cancer, SURGICAL TECHNIQUES, OUTCOMES, Science & Technology, HYPERTHERMIC INTRAPERITONEAL, PelvEx Collaborative, CHEMOTHERAPY, WHOLE-BODY MRI, NEOADJUVANT CHEMORADIOTHERAPY, Oncology, quality of life, CYTOREDUCTIVE SURGERY, HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY, Life Sciences & Biomedicine
Abstract

Pelvic exenteration is a complex operation performed for locally advanced and recurrent pelvic cancers. The goal of surgery is to achieve clear margins, therefore identifying adjacent or involved organs, bone, muscle, nerves and/or vascular structures that may need resection. While these extensive resections are potentially curative, they can be associated with substantial morbidity. Recently, there has been a move to centralize care to specialized units, as this facilitates better multidisciplinary care input. Advancements in pelvic oncology and surgical innovation have redefined the boundaries of pelvic exenterative surgery. Combined with improved neoadjuvant therapies, advances in diagnostics, and better reconstructive techniques have provided quicker recovery and better quality of life outcomes, with improved survival This article provides highlights of the current management of advanced pelvic cancers in terms of surgical strategy and potential future developments.

Published
2022
Full Text
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12. Faecal immunochemical testing (FIT) in patients with signs or symptoms of suspected colorectal cancer (CRC): a joint guideline from the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the British Society of Gastroenterology (BSG)

Author

Monahan, KJ, Davies, MM, Abulafi, M, Banerjea, A, Nicholson, BD, Arasaradnam, R, Barker, N, Benton, S, Booth, R, Burling, D, Carten, RV, D'Souza, N, East, JE, Kleijnen, J, Machesney, M, Pettman, M, Pipe, J, Saker, L, Sharp, L, Stephenson, J, and Steele, RJC

Subjects
COLORECTAL CANCER, COLONOSCOPY, BLOOD-TEST, Science & Technology, Gastroenterology & Hepatology, Gastroenterology, PRIMARY-CARE, 1103 Clinical Sciences, STOOL MARKERS, COLORECTAL SURGERY, CT COLONOGRAPHY, RISK-FACTORS, EXTRACOLONIC FINDINGS, QUALITY, 1114 Paediatrics and Reproductive Medicine, DIAGNOSTIC-ACCURACY, ANEMIA, COMPUTED TOMOGRAPHIC COLONOGRAPHY, Life Sciences & Biomedicine, HEMOGLOBIN
Abstract

Faecal immunochemical testing (FIT) has a high sensitivity for the detection of colorectal cancer (CRC). In a symptomatic population FIT may identify those patients who require colorectal investigation with the highest priority. FIT offers considerable advantages over the use of symptoms alone, as an objective measure of risk with a vastly superior positive predictive value for CRC, while conversely identifying a truly low risk cohort of patients. The aim of this guideline was to provide a clear strategy for the use of FIT in the diagnostic pathway of people with signs or symptoms of a suspected diagnosis of CRC. The guideline was jointly developed by the Association of Coloproctology of Great Britain and Ireland/British Society of Gastroenterology, specifically by a 21-member multidisciplinary guideline development group (GDG). A systematic review of 13 535 publications was undertaken to develop 23 evidence and expert opinion-based recommendations for the triage of people with symptoms of a suspected CRC diagnosis in primary care. In order to achieve consensus among a broad group of key stakeholders, we completed an extended Delphi of the GDG, and also 61 other individuals across the UK and Ireland, including by members of the public, charities and primary and secondary care. Seventeen research recommendations were also prioritised to inform clinical management. [Abstract copyright: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.]

Published
2022

13. The impact of the COVID-19 pandemic on the Management of Locally Advanced Primary/Recurrent Rectal Cancer

Author

Chok A. Y., Kontovounisios C., Rasheed S., Kelly M. E., Agj A., Abdul Aziz N., Abecasis N., Abraham-Nordling M., Akiyoshi T., Alberda W., Albert M., Andric M., Angenete E., Antoniou A., Auer R., Austin K. K., Aziz O., Baker R. P., Bali M., Baseckas G., Bebington B., Bedford M., Bednarski B. K., Beets G. L., Berg P. L., Beynon J., Biondo S., Boyle K., Bordeianou L., Bremers A. B., Brunner M., Buchwald P., Bui A., Burgess A., Jwa B., Burling D., Burns E., Campain N., Carvalhal S., Castro L., Caycedo-Marulanda A., Kkl C., Chang G. J., Chang M., Chew M. H., Chong P., Christensen H. K., Clouston H., Codd M., Collins D., Colquhoun A. J., Corr A., Coscia M., Cosimelli M., Coyne P. E., Creavin B., Croner R. S., Damjanovic L., Daniels I. R., Davies M., Davies R. J., Delaney C. P., Jhw D. W., Denost Q., Deutsch C., Dietz D., Domingo S., Dozois E. J., Duff M., Eglinton T., Enrique-Navascues J. M., Espin-Basany E., Evans M. D., Fearnhead N. S., Flatmark K., Fleming F., Frizelle F. A., Gallego M. A., Garcia-Granero E., Garcia-Sabrido J. L., Gentilini L., George M. L., George V., Ghouti L., Giner F., Ginther N., Glynn R., Golda T., Griffiths B., Harris D. A., Jaw H., Hanchanale V., Harji D. P., Helewa R. M., Hellawell G., Heriot A. G., Hochman D., Hohenberger W., Holm T., Hompes R., Jenkins J. T., Kaffenberger S., Kandaswamy G. V., Kapur S., Kanemitsu Y., Kelley S. R., Keller D. S., Khan M. S., Kim H., Kim H. J., Koh C. E., Nfm K., Kokelaar R., Kristensen H. O., Kroon H. M., Kusters M., Lago V., Larsen S. G., Larson D. W., Law W. L., Laurberg S., Lee P. J., Limbert M., Lydrup M. L., Lyons A., Lynch A. C., Mantyh C., Mathis K. L., Cfs M., Martling A., Wjhj M., Merkel S., Mehta A. M., McArthur D. R., McDermott F. D., McGrath J. S., Malde S., Mirnezami A., Jrt M., Morton J. R., Mullaney T. G., Negoi I., Jwm N., Ng J. L., Nguyen B., Nielsen M. B., Gap N., Nilsson P. J., Oliver A., O'Dwyer S. T., Palmer G., Pappou E., Park J., Patsouras D., Pellino G., Peterson A. C., Poggioli G., Proud D., Quinn M., Quyn A., Radwan R. W., Rasmussen P. C., Rausa E., Regenbogen S. E., Renehan A., Rocha R., Rochester M., Rohila J., Rothbarth J., Rottoli M., Roxburgh C., Hjt R., Ryan E. J., Safar B., Sagar P. M., Sahai A., Saklani A., Sammour T., Sayyed R., Amp S., Schwarzkopf E., Scripcariu V., Selvasekar C., Shaikh I., Shida D., Simpson A., Smart N. J., Smart P., Smith J. J., Solbakken A. M., Solomon M. J., Sorensen M. M., Steele S. R., Steffens D., Stitzenberg K., Stocchi L., Stylianides N. A., Swartling T., Sumrien H., Sutton P. A., Swartking T., Tan E. J., Taylor C., Teras J., Thurairaja R., Toh E. L., Tsarkov P., Tsukada Y., Tsukamoto S., Tuech J. J., Turner W. H., Tuynman J. B., van Ramshorst G. H., van Zoggel D., Vasquez-Jimenez W., Verhoef C., Vizzielli G., Elk V., Uehara K., Wakeman C., Warrier S., Wasmuth H. H., Weber K., Weiser M. R., Jmd W., Wild J., Wilson M., Wolthuis A., Yano H., Yip B., Yip J., Yoo R. N., Zappa M. A., Winter D. C., Tekkis P. P., Chok A.Y., Kontovounisios C., Rasheed S., Kelly M.E., Agj A., Abdul Aziz N., Abecasis N., Abraham-Nordling M., Akiyoshi T., Alberda W., Albert M., Andric M., Angenete E., Antoniou A., Auer R., Austin K.K., Aziz O., Baker R.P., Bali M., Baseckas G., Bebington B., Bedford M., Bednarski B.K., Beets G.L., Berg P.L., Beynon J., Biondo S., Boyle K., Bordeianou L., Bremers A.B., Brunner M., Buchwald P., Bui A., Burgess A., Jwa B., Burling D., Burns E., Campain N., Carvalhal S., Castro L., Caycedo-Marulanda A., Kkl C., Chang G.J., Chang M., Chew M.H., Chong P., Christensen H.K., Clouston H., Codd M., Collins D., Colquhoun A.J., Corr A., Coscia M., Cosimelli M., Coyne P.E., Creavin B., Croner R.S., Damjanovic L., Daniels I.R., Davies M., Davies R.J., Delaney C.P., Jhw D.W., Denost Q., Deutsch C., Dietz D., Domingo S., Dozois E.J., Duff M., Eglinton T., Enrique-Navascues J.M., Espin-Basany E., Evans M.D., Fearnhead N.S., Flatmark K., Fleming F., Frizelle F.A., Gallego M.A., Garcia-Granero E., Garcia-Sabrido J.L., Gentilini L., George M.L., George V., Ghouti L., Giner F., Ginther N., Glynn R., Golda T., Griffiths B., Harris D.A., Jaw H., Hanchanale V., Harji D.P., Helewa R.M., Hellawell G., Heriot A.G., Hochman D., Hohenberger W., Holm T., Hompes R., Jenkins J.T., Kaffenberger S., Kandaswamy G.V., Kapur S., Kanemitsu Y., Kelley S.R., Keller D.S., Khan M.S., Kim H., Kim H.J., Koh C.E., Nfm K., Kokelaar R., Kristensen H.O., Kroon H.M., Kusters M., Lago V., Larsen S.G., Larson D.W., Law W.L., Laurberg S., Lee P.J., Limbert M., Lydrup M.L., Lyons A., Lynch A.C., Mantyh C., Mathis K.L., Cfs M., Martling A., Wjhj M., Merkel S., Mehta A.M., McArthur D.R., McDermott F.D., McGrath J.S., Malde S., Mirnezami A., Jrt M., Morton J.R., Mullaney T.G., Negoi I., Jwm N., Ng J.L., Nguyen B., Nielsen M.B., Gap N., Nilsson P.J., Oliver A., O'Dwyer S.T., Palmer G., Pappou E., Park J., Patsouras D., Pellino G., Peterson A.C., Poggioli G., Proud D., Quinn M., Quyn A., Radwan R.W., Rasmussen P.C., Rausa E., Regenbogen S.E., Renehan A., Rocha R., Rochester M., Rohila J., Rothbarth J., Rottoli M., Roxburgh C., Hjt R., Ryan E.J., Safar B., Sagar P.M., Sahai A., Saklani A., Sammour T., Sayyed R., Amp S., Schwarzkopf E., Scripcariu V., Selvasekar C., Shaikh I., Shida D., Simpson A., Smart N.J., Smart P., Smith J.J., Solbakken A.M., Solomon M.J., Sorensen M.M., Steele S.R., Steffens D., Stitzenberg K., Stocchi L., Stylianides N.A., Swartling T., Sumrien H., Sutton P.A., Swartking T., Tan E.J., Taylor C., Teras J., Thurairaja R., Toh E.L., Tsarkov P., Tsukada Y., Tsukamoto S., Tuech J.J., Turner W.H., Tuynman J.B., van Ramshorst G.H., van Zoggel D., Vasquez-Jimenez W., Verhoef C., Vizzielli G., Elk V., Uehara K., Wakeman C., Warrier S., Wasmuth H.H., Weber K., Weiser M.R., Jmd W., Wild J., Wilson M., Wolthuis A., Yano H., Yip B., Yip J., Yoo R.N., Zappa M.A., Winter D.C., Tekkis P.P., Chok, A. Y., Kontovounisios, C., Rasheed, S., Kelly, M. E., Agj, A., Abdul Aziz, N., Abecasis, N., Abraham-Nordling, M., Akiyoshi, T., Alberda, W., Albert, M., Andric, M., Angenete, E., Antoniou, A., Auer, R., Austin, K. K., Aziz, O., Baker, R. P., Bali, M., Baseckas, G., Bebington, B., Bedford, M., Bednarski, B. K., Beets, G. L., Berg, P. L., Beynon, J., Biondo, S., Boyle, K., Bordeianou, L., Bremers, A. B., Brunner, M., Buchwald, P., Bui, A., Burgess, A., Jwa, B., Burling, D., Burns, E., Campain, N., Carvalhal, S., Castro, L., Caycedo-Marulanda, A., Kkl, C., Chang, G. J., Chang, M., Chew, M. H., Chong, P., Christensen, H. K., Clouston, H., Codd, M., Collins, D., Colquhoun, A. J., Corr, A., Coscia, M., Cosimelli, M., Coyne, P. E., Creavin, B., Croner, R. S., Damjanovic, L., Daniels, I. R., Davies, M., Davies, R. J., Delaney, C. P., Jhw, D. W., Denost, Q., Deutsch, C., Dietz, D., Domingo, S., Dozois, E. J., Duff, M., Eglinton, T., Enrique-Navascues, J. M., Espin-Basany, E., Evans, M. D., Fearnhead, N. S., Flatmark, K., Fleming, F., Frizelle, F. A., Gallego, M. A., Garcia-Granero, E., Garcia-Sabrido, J. L., Gentilini, L., George, M. L., George, V., Ghouti, L., Giner, F., Ginther, N., Glynn, R., Golda, T., Griffiths, B., Harris, D. A., Jaw, H., Hanchanale, V., Harji, D. P., Helewa, R. M., Hellawell, G., Heriot, A. G., Hochman, D., Hohenberger, W., Holm, T., Hompes, R., Jenkins, J. T., Kaffenberger, S., Kandaswamy, G. V., Kapur, S., Kanemitsu, Y., Kelley, S. R., Keller, D. S., Khan, M. S., Kim, H., Kim, H. J., Koh, C. E., Nfm, K., Kokelaar, R., Kristensen, H. O., Kroon, H. M., Kusters, M., Lago, V., Larsen, S. G., Larson, D. W., Law, W. L., Laurberg, S., Lee, P. J., Limbert, M., Lydrup, M. L., Lyons, A., Lynch, A. C., Mantyh, C., Mathis, K. L., Cfs, M., Martling, A., Wjhj, M., Merkel, S., Mehta, A. M., Mcarthur, D. R., Mcdermott, F. D., Mcgrath, J. S., Malde, S., Mirnezami, A., Jrt, M., Morton, J. R., Mullaney, T. G., Negoi, I., Jwm, N., Ng, J. L., Nguyen, B., Nielsen, M. B., Gap, N., Nilsson, P. J., Oliver, A., O'Dwyer, S. T., Palmer, G., Pappou, E., Park, J., Patsouras, D., Pellino, G., Peterson, A. C., Poggioli, G., Proud, D., Quinn, M., Quyn, A., Radwan, R. W., Rasmussen, P. C., Rausa, E., Regenbogen, S. E., Renehan, A., Rocha, R., Rochester, M., Rohila, J., Rothbarth, J., Rottoli, M., Roxburgh, C., Hjt, R., Ryan, E. J., Safar, B., Sagar, P. M., Sahai, A., Saklani, A., Sammour, T., Sayyed, R., Amp, S., Schwarzkopf, E., Scripcariu, V., Selvasekar, C., Shaikh, I., Shida, D., Simpson, A., Smart, N. J., Smart, P., Smith, J. J., Solbakken, A. M., Solomon, M. J., Sorensen, M. M., Steele, S. R., Steffens, D., Stitzenberg, K., Stocchi, L., Stylianides, N. A., Swartling, T., Sumrien, H., Sutton, P. A., Swartking, T., Tan, E. J., Taylor, C., Teras, J., Thurairaja, R., Toh, E. L., Tsarkov, P., Tsukada, Y., Tsukamoto, S., Tuech, J. J., Turner, W. H., Tuynman, J. B., van Ramshorst, G. H., van Zoggel, D., Vasquez-Jimenez, W., Verhoef, C., Vizzielli, G., Elk, V., Uehara, K., Wakeman, C., Warrier, S., Wasmuth, H. H., Weber, K., Weiser, M. R., Jmd, W., Wild, J., Wilson, M., Wolthuis, A., Yano, H., Yip, B., Yip, J., Yoo, R. N., Zappa, M. A., Winter, D. C., Tekkis, P. P., and Surgery

Subjects
Oncology, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Locally advanced, MEDLINE, Comorbidity, COVID-19 - advanced - recurrent - primary - rectal cancer, SDG 3 - Good Health and Well-being, Internal medicine, Pandemic, Correspondence, medicine, Combined Modality Therapy, Humans, General, Pandemics, Recurrent Rectal Cancer, Neoplasm Staging, business.industry, Rectal Neoplasms, SARS-CoV-2, COVID-19, medicine.disease, Neoplasm staging, Surgery, Neoplasm Recurrence, Local, business
Published
2020

14. Predicting outcomes of pelvic exenteration using machine learning

Author

Dudurych I., Kelly M. E., Aalbers A. G. J., Abdul Aziz N., Abecasis N., Abraham-Nordling M., Akiyoshi T., Alberda W., Albert M., Andric M., Angenete E., Antoniou A., Auer R., Austin K. K., Aziz O., Baker R. P., Bali M., Baseckas G., Bebington B., Bedford M., Bednarski B. K., Beets G. L., Berg P. L., Beynon J., Biondo S., Boyle K., Bordeianou L., Bremers A. B., Brunner M., Buchwald P., Bui A., Burgess A., Burger J. W. A., Burling D., Burns E., Campain N., Carvalhal S., Castro L., Caycedo-Marulanda A., Chan K. K. L., Chang G. J., Chew M. H., Chok A. K., Chong P., Christensen H. K., Clouston H., Codd M., Collins D., Colquhoun A. J., Corr A., Coscia M., Coyne P. E., Creavin B., Croner R. S., Damjanovic L., Daniels I. R., Davies M., Davies R. J., Delaney C. P., Wilt J. H. W., Denost Q., Deutsch C., Dietz D., Domingo S., Dozois E. J., Duff M., Eglinton T., Enrique-Navascues J. M., Espin-Basany E., Evans M. D., Fearnhead N. S., Flatmark K., Fleming F., Frizelle F. A., Gallego M. A., Garcia-Granero E., Garcia-Sabrido J. L., Gentilini L., George M. L., George V., Ghouti L., Giner F., Ginther N., Glynn R., Golda T., Griffiths B., Harris D. A., Hagemans J. A. W., Hanchanale V., Harji D. P., Helewa R. M., Heriot A. G., Hochman D., Hohenberger W., Holm T., Hompes R., Jenkins J. T., Kaffenberger S., Kandaswamy G. V., Kapur S., Kanemitsu Y., Kelley S. R., Keller D. S., Khan M. S., Kiran R. P., Kim H., Kim H. J., Koh C. E., Kok N. F. M., Kokelaar R., Kontovounisios C., Kristensen H. O., Kroon H. M., Kusters M., Lago V., Larsen S. G., Larson D. W., Law W. L., Laurberg S., Lee P. J., Limbert M., Lydrup M. L., Lyons A., Lynch A. C., Mantyh C., Mathis K. L., Margues C. F. S., Martling A., Meijerink W. J. H. J., Merkel S., Mehta A. M., McArthur D. R., McDermott F. D., McGrath J. S., Malde S., Mirnezami A., Monson J. R. T., Morton J. R., Mullaney T. G., Negoi I., Neto J. W. M., Nguyen B., Nielsen M. B., Nieuwenhuijzen G. A. P., Nilsson P. J., Oliver A., O'Connell P. R., O'Dwyer S. T., Palmer G., Pappou E., Park J., Patsouras D., Pellino G., Peterson A. C., Poggioli G., Proud D., Quinn M., Quyn A., Radwan R. W., Rasheed S., Rasmussen P. C., Regenbogen S. E., Renehan A., Rocha R., Rochester M., Rohila J., Rothbarth J., Rottoli M., Roxburgh C., Rutten H. J. T., Ryan E. J., Safar B., Sagar P. M., Sahai A., Saklani A., Sammour T., Sayyed R., Schizas A. M. P., Schwarzkopf E., Scripcariu V., Selvasekar C., Shaikh I., Shellawell G., Shida D., Simpson A., Smart N. J., Smart P., Smith J. J., Solbakken A. M., Solomon M. J., Sorensen M. M., Steele S. R., Steffens D., Stitzenberg K., Stocchi L., Stylianides N. A., Swartling T., Sumrien H., Sutton P. A., Swartking T., Tan E. J., Taylor C., Tekkis P. P., Teras J., Thurairaja R., Toh E. L., Tsarkov P., Tsukada Y., Tsukamoto S., Tuech J. J., Turner W. H., Tuynman J. B., van Ramshorst G. H., van Zoggel D., Vasquez-Jimenez W., Verhoef C., Vizzielli G., Voogt E. L. K., Uehara K., Wakeman C., Warrier S., Wasmuth H. H., Weber K., Weiser M. R., Wheeler J. M. D., Wild J., Wilson M., Wolthuis A., Yano H., Yip B., Yip J., Yoo R. N., Winter D. C., Dudurych I., Kelly M.E., Aalbers A.G.J., Abdul Aziz N., Abecasis N., Abraham-Nordling M., Akiyoshi T., Alberda W., Albert M., Andric M., Angenete E., Antoniou A., Auer R., Austin K.K., Aziz O., Baker R.P., Bali M., Baseckas G., Bebington B., Bedford M., Bednarski B.K., Beets G.L., Berg P.L., Beynon J., Biondo S., Boyle K., Bordeianou L., Bremers A.B., Brunner M., Buchwald P., Bui A., Burgess A., Burger J.W.A., Burling D., Burns E., Campain N., Carvalhal S., Castro L., Caycedo-Marulanda A., Chan K.K.L., Chang G.J., Chew M.H., Chok A.K., Chong P., Christensen H.K., Clouston H., Codd M., Collins D., Colquhoun A.J., Corr A., Coscia M., Coyne P.E., Creavin B., Croner R.S., Damjanovic L., Daniels I.R., Davies M., Davies R.J., Delaney C.P., Wilt J.H.W., Denost Q., Deutsch C., Dietz D., Domingo S., Dozois E.J., Duff M., Eglinton T., Enrique-Navascues J.M., Espin-Basany E., Evans M.D., Fearnhead N.S., Flatmark K., Fleming F., Frizelle F.A., Gallego M.A., Garcia-Granero E., Garcia-Sabrido J.L., Gentilini L., George M.L., George V., Ghouti L., Giner F., Ginther N., Glynn R., Golda T., Griffiths B., Harris D.A., Hagemans J.A.W., Hanchanale V., Harji D.P., Helewa R.M., Heriot A.G., Hochman D., Hohenberger W., Holm T., Hompes R., Jenkins J.T., Kaffenberger S., Kandaswamy G.V., Kapur S., Kanemitsu Y., Kelley S.R., Keller D.S., Khan M.S., Kiran R.P., Kim H., Kim H.J., Koh C.E., Kok N.F.M., Kokelaar R., Kontovounisios C., Kristensen H.O., Kroon H.M., Kusters M., Lago V., Larsen S.G., Larson D.W., Law W.L., Laurberg S., Lee P.J., Limbert M., Lydrup M.L., Lyons A., Lynch A.C., Mantyh C., Mathis K.L., Margues C.F.S., Martling A., Meijerink W.J.H.J., Merkel S., Mehta A.M., McArthur D.R., McDermott F.D., McGrath J.S., Malde S., Mirnezami A., Monson J.R.T., Morton J.R., Mullaney T.G., Negoi I., Neto J.W.M., Nguyen B., Nielsen M.B., Nieuwenhuijzen G.A.P., Nilsson P.J., Oliver A., O'Connell P.R., O'Dwyer S.T., Palmer G., Pappou E., Park J., Patsouras D., Pellino G., Peterson A.C., Poggioli G., Proud D., Quinn M., Quyn A., Radwan R.W., Rasheed S., Rasmussen P.C., Regenbogen S.E., Renehan A., Rocha R., Rochester M., Rohila J., Rothbarth J., Rottoli M., Roxburgh C., Rutten H.J.T., Ryan E.J., Safar B., Sagar P.M., Sahai A., Saklani A., Sammour T., Sayyed R., Schizas A.M.P., Schwarzkopf E., Scripcariu V., Selvasekar C., Shaikh I., Shellawell G., Shida D., Simpson A., Smart N.J., Smart P., Smith J.J., Solbakken A.M., Solomon M.J., Sorensen M.M., Steele S.R., Steffens D., Stitzenberg K., Stocchi L., Stylianides N.A., Swartling T., Sumrien H., Sutton P.A., Swartking T., Tan E.J., Taylor C., Tekkis P.P., Teras J., Thurairaja R., Toh E.L., Tsarkov P., Tsukada Y., Tsukamoto S., Tuech J.J., Turner W.H., Tuynman J.B., van Ramshorst G.H., van Zoggel D., Vasquez-Jimenez W., Verhoef C., Vizzielli G., Voogt E.L.K., Uehara K., Wakeman C., Warrier S., Wasmuth H.H., Weber K., Weiser M.R., Wheeler J.M.D., Wild J., Wilson M., Wolthuis A., Yano H., Yip B., Yip J., Yoo R.N., Winter D.C., Surgery, Dudurych, I., Kelly, M. E., Aalbers, A. G. J., Abdul Aziz, N., Abecasis, N., Abraham-Nordling, M., Akiyoshi, T., Alberda, W., Albert, M., Andric, M., Angenete, E., Antoniou, A., Auer, R., Austin, K. K., Aziz, O., Baker, R. P., Bali, M., Baseckas, G., Bebington, B., Bedford, M., Bednarski, B. K., Beets, G. L., Berg, P. L., Beynon, J., Biondo, S., Boyle, K., Bordeianou, L., Bremers, A. B., Brunner, M., Buchwald, P., Bui, A., Burgess, A., Burger, J. W. A., Burling, D., Burns, E., Campain, N., Carvalhal, S., Castro, L., Caycedo-Marulanda, A., Chan, K. K. L., Chang, G. J., Chew, M. H., Chok, A. K., Chong, P., Christensen, H. K., Clouston, H., Codd, M., Collins, D., Colquhoun, A. J., Corr, A., Coscia, M., Coyne, P. E., Creavin, B., Croner, R. S., Damjanovic, L., Daniels, I. R., Davies, M., Davies, R. J., Delaney, C. P., Wilt, J. H. W., Denost, Q., Deutsch, C., Dietz, D., Domingo, S., Dozois, E. J., Duff, M., Eglinton, T., Enrique-Navascues, J. M., Espin-Basany, E., Evans, M. D., Fearnhead, N. S., Flatmark, K., Fleming, F., Frizelle, F. A., Gallego, M. A., Garcia-Granero, E., Garcia-Sabrido, J. L., Gentilini, L., George, M. L., George, V., Ghouti, L., Giner, F., Ginther, N., Glynn, R., Golda, T., Griffiths, B., Harris, D. A., Hagemans, J. A. W., Hanchanale, V., Harji, D. P., Helewa, R. M., Heriot, A. G., Hochman, D., Hohenberger, W., Holm, T., Hompes, R., Jenkins, J. T., Kaffenberger, S., Kandaswamy, G. V., Kapur, S., Kanemitsu, Y., Kelley, S. R., Keller, D. S., Khan, M. S., Kiran, R. P., Kim, H., Kim, H. J., Koh, C. E., Kok, N. F. M., Kokelaar, R., Kontovounisios, C., Kristensen, H. O., Kroon, H. M., Kusters, M., Lago, V., Larsen, S. G., Larson, D. W., Law, W. L., Laurberg, S., Lee, P. J., Limbert, M., Lydrup, M. L., Lyons, A., Lynch, A. C., Mantyh, C., Mathis, K. L., Margues, C. F. S., Martling, A., Meijerink, W. J. H. J., Merkel, S., Mehta, A. M., Mcarthur, D. R., Mcdermott, F. D., Mcgrath, J. S., Malde, S., Mirnezami, A., Monson, J. R. T., Morton, J. R., Mullaney, T. G., Negoi, I., Neto, J. W. M., Nguyen, B., Nielsen, M. B., Nieuwenhuijzen, G. A. P., Nilsson, P. J., Oliver, A., O'Connell, P. R., O'Dwyer, S. T., Palmer, G., Pappou, E., Park, J., Patsouras, D., Pellino, G., Peterson, A. C., Poggioli, G., Proud, D., Quinn, M., Quyn, A., Radwan, R. W., Rasheed, S., Rasmussen, P. C., Regenbogen, S. E., Renehan, A., Rocha, R., Rochester, M., Rohila, J., Rothbarth, J., Rottoli, M., Roxburgh, C., Rutten, H. J. T., Ryan, E. J., Safar, B., Sagar, P. M., Sahai, A., Saklani, A., Sammour, T., Sayyed, R., Schizas, A. M. P., Schwarzkopf, E., Scripcariu, V., Selvasekar, C., Shaikh, I., Shellawell, G., Shida, D., Simpson, A., Smart, N. J., Smart, P., Smith, J. J., Solbakken, A. M., Solomon, M. J., Sorensen, M. M., Steele, S. R., Steffens, D., Stitzenberg, K., Stocchi, L., Stylianides, N. A., Swartling, T., Sumrien, H., Sutton, P. A., Swartking, T., Tan, E. J., Taylor, C., Tekkis, P. P., Teras, J., Thurairaja, R., Toh, E. L., Tsarkov, P., Tsukada, Y., Tsukamoto, S., Tuech, J. J., Turner, W. H., Tuynman, J. B., van Ramshorst, G. H., van Zoggel, D., Vasquez-Jimenez, W., Verhoef, C., Vizzielli, G., Voogt, E. L. K., Uehara, K., Wakeman, C., Warrier, S., Wasmuth, H. H., Weber, K., Weiser, M. R., Wheeler, J. M. D., Wild, J., Wilson, M., Wolthuis, A., Yano, H., Yip, B., Yip, J., Yoo, R. N., and Winter, D. C.

Subjects
Artificial intelligence, medicine.medical_treatment, Machine learning, computer.software_genre, Logistic regression, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], SDG 3 - Good Health and Well-being, Medicine, Humans, Pelvic exenteration, Receiver operating characteristic, Artificial neural network, business.industry, Rectal Neoplasms, Deep learning, Gastroenterology, Prognosis, pelvic exenteration, Support vector machine, machine learning, Test set, colorectal surgery, Neoplasm Recurrence, Local, business, computer, Predictive modelling, artificial neural network
Abstract

Aim: We aim to compare machine learning with neural network performance in predicting R0 resection (R0), length of stay >14days (LOS), major complication rates at 30days 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 >14days 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

17. The 'Pelvic exenteration lexicon': Creating a common language for complex pelvic cancer surgery.

Author

Burns, E. M., Quyn, A., Al Kadhi, O., Angelopoulos, G., Armitage, J., Baker, R., Barton, D., Beekharry, R., Beggs, A., Blades, R., Boyle, K., Brown, G., Burling, D., Challacombe, B., Chong, P., Chowdhury, A., Collins, D., Coop, A., Corr, A., and Coyne, P.

Subjects
PELVIC exenteration, ONCOLOGIC surgery, LEXICON, SCIATIC nerve, SEMI-structured interviews
Abstract

Aim: Pelvic exenteration surgery is an umbrella term for a multitude of operative techniques for locally advanced and recurrent pelvic malignancy. Currently, there is heterogeneity in the operative description that limits the interpretation of patient outcome and collaboration between units through standardized data collection. Our study aims to develop a consensus lexicon to describe the operative components of extended and exenteration pelvic surgery. Method: This study adopted a mixed‐methods approach using semi‐structured interviews, questionnaires, focus groups and validation exercises involving pelvic exenteration experts from centres in the UK. Qualitative data were collected, and descriptive statistics are presented. Results: We identified eight headings with 32 subheadings that encompass all components of the extent of the potential surgery. The lexicon was validated by 15 UK specialists. A 'high‐complexity pelvic exenteration' was defined as encompassing 'conventional pelvic exenteration' with the extension of surgery to remove bony structures or the structures in the pelvic sidewall. Pelvic sidewall structures include major vessels, sciatic nerves and/or bone. Bony structures include the sacrum and/or pubic bones. Conclusion: This pelvic exenteration lexicon will permit classification of the surgical approach used that will improve data synthesis, allow more accurate activity recording for audit and ultimately improved outcomes for patients. [ABSTRACT FROM AUTHOR]

Published
2023
Full Text
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18. Perioperative management and anaesthetic considerations in pelvic exenterations using Delphi methodology: results from the PelvEx Collaborative

Author

PelvEx Collaborative, [missing], Chok, A Y, Oliver, A, Rasheed, S, Tan, E J, Kelly, M E, Aalbers, A G J, Abdul Aziz, N, Abecasis, N, Abraham-Nordling, M, Akiyoshi, T, Alberda, W, Albert, M, Andric, M, Angenete, E, Antoniou, A, Auer, R, Austin, K K, Aziz, O, Baker, R P, Bali, M, Baseckas, G, Bebington, B, Bedford, M, Bednarski, B K, Beets, G L, Berg, P L, Beynon, J, Biondo, S, Boyle, K, Bordeianou, L, Bremers, A B, Brunner, M, Buchwald, P, Bui, A, Burgess, A, Burger, J W A, Burling, D, Burns, E, Campain, N, Carvalhal, S, Castro, L, Caycedo-Marulanda, A, Chan, K K L, Chang, G J, Chew, M H, Chong, P, Christensen, H K, Clouston, H, Codd, M, Collins, D, Colquhoun, A J, Corr, A, Coscia, M, Coyne, P E, Creavin, B, Croner, R S, Damjanovic, L, Daniels, I R, Davies, M, Davies, R J, Delaney, C P, de Wilt, J H W, Denost, Q, Deutsch, C, Dietz, D, Domingo, S, Dozois, E J, Duff, M, Eglinton, T, Enrique-Navascues, J M, Espin-Basany, E, Evans, M D, Fearnhead, N S, Flatmark, K, Fleming, F, Frizelle, F A, Gallego, M A, Garcia-Granero, E, Garcia-Sabrido, J L, Gentilini, L, George, M L, George, V, Ghouti, L, Giner, F, Ginther, N, Glynn, R, Golda, T, Griffiths, B, Harris, D A, Hagemans, J A W, Hanchanale, V, Harji, D P, Helewa, R M, Hellawell, G, Heriot, A G, Hochman, D, Hohenberger, W, Holm, T, Holmström, A, Hompes, R, Jenkins, J T, Kaffenberger, S, Kandaswamy, G V, Kapur, S, Kanemitsu, Y, Kelley, S R, Keller, D S, Khan, M S, Kim, H, Kim, H J, Koh, C E, Kok, N F M, Kokelaar, R, Kontovounisios, C, Kristensen, H Ø, Kroon, H M, Kusters, M, Lago, V, Larsen, S G, Larson, D W, Law, W L, Laurberg, S, Lee, P J, Limbert, M, Lydrup, M L, Lyons, A, Lynch, A C, Mantyh, C, Mathis, K L, Margues, C F S, Martling, A, Meijerink, W J H J, Merkel, S, Mehta, A M, McArthur, D R, McDermott, F D, McGrath, J S, Malde, S, Mirnezami, A, Monson, J R T, Morton, J R, Mullaney, T G, Negoi, I, Neto, J W M, Nguyen, B, Nielsen, M B, Nieuwenhuijzen, G A P, Nilsson, P J, O’Dwyer, S T, Palmer, G, Pappou, E, Park, J, Patsouras, D, Pellino, G, Peterson, A C, Poggioli, G, Proud, D, Quinn, M, Quyn, A, Radwan, R W, Rasmussen, P C, Rausa, E, Regenbogen, S E, Renehan, A, Rocha, R, Rochester, M, Rohila, J, Rothbarth, J, Rottoli, M, Roxburgh, C, Rutten, H J T, Ryan, É J, Safar, B, Sagar, P M, Sahai, A, Saklani, A, Sammour, T, Sayyed, R, Schizas, A M P, Schwarzkopf, E, Scripcariu, V, Selvasekar, C, Shaikh, I, Shida, D, Simpson, A, Smart, N J, Smart, P, Smith, J J, Solbakken, A M, Solomon, M J, Sørensen, M M, Steele, S R, Steffens, D, Stitzenberg, K, Stocchi, L, Stylianides, N A, Swartling, T, Sumrien, H, Sutton, P A, Swartking, T, Taylor, C, Teras, J, Thurairaja, R, Toh, E L, Tsarkov, P, Tsukada, Y, Tsukamoto, S, Tuech, J J, Turner, W H, Tuynman, J B, van Ramshorst, Gabriëlle, Zoggel, D van, Vasquez-Jimenez, W, Verhoef, C, Vizzielli, G, Voogt, E L K, Uehara, K, Wakeman, C, Warrier, S, Wasmuth, H H, Weber, K, Weiser, M R, Wheeler, J M D, Wild, J, Wilson, M, Wolthuis, A, Yano, H, Yip, B, Yip, J, Yoo, R N, Winter, D C, Tekkis, P P, Surgery, Chok, A Y, Oliver, A, Rasheed, S, Tan, E J, Kelly, M E, Aalbers, A G J, Abdul Aziz, N, Abecasis, N, Abraham-Nordling, M, Akiyoshi, T, Alberda, W, Albert, M, Andric, M, Angenete, E, Antoniou, A, Auer, R, Austin, K K, Aziz, O, Baker, R P, Bali, M, Baseckas, G, Bebington, B, Bedford, M, Bednarski, B K, Beets, G L, Berg, P L, Beynon, J, Biondo, S, Boyle, K, Bordeianou, L, Bremers, A B, Brunner, M, Buchwald, P, Bui, A, Burgess, A, Burger, J W A, Burling, D, Burns, E, Campain, N, Carvalhal, S, Castro, L, Caycedo-Marulanda, A, Chan, K K L, Chang, G J, Chew, M H, Chong, P, Christensen, H K, Clouston, H, Codd, M, Collins, D, Colquhoun, A J, Corr, A, Coscia, M, Coyne, P E, Creavin, B, Croner, R S, Damjanovic, L, Daniels, I R, Davies, M, Davies, R J, Delaney, C P, de Wilt, J H W, Denost, Q, Deutsch, C, Dietz, D, Domingo, S, Dozois, E J, Duff, M, Eglinton, T, Enrique-Navascues, J M, Espin-Basany, E, Evans, M D, Fearnhead, N S, Flatmark, K, Fleming, F, Frizelle, F A, Gallego, M A, Garcia-Granero, E, Garcia-Sabrido, J L, Gentilini, L, George, M L, George, V, Ghouti, L, Giner, F, Ginther, N, Glynn, R, Golda, T, Griffiths, B, Harris, D A, Hagemans, J A W, Hanchanale, V, Harji, D P, Helewa, R M, Hellawell, G, Heriot, A G, Hochman, D, Hohenberger, W, Holm, T, Holmström, A, Hompes, R, Jenkins, J T, Kaffenberger, S, Kandaswamy, G V, Kapur, S, Kanemitsu, Y, Kelley, S R, Keller, D S, Khan, M S, Kim, H, Kim, H J, Koh, C E, Kok, N F M, Kokelaar, R, Kontovounisios, C, Kristensen, H Ø, Kroon, H M, Kusters, M, Lago, V, Larsen, S G, Larson, D W, Law, W L, Laurberg, S, Lee, P J, Limbert, M, Lydrup, M L, Lyons, A, Lynch, A C, Mantyh, C, Mathis, K L, Margues, C F S, Martling, A, Meijerink, W J H J, Merkel, S, Mehta, A M, McArthur, D R, McDermott, F D, McGrath, J S, Malde, S, Mirnezami, A, Monson, J R T, Morton, J R, Mullaney, T G, Negoi, I, Neto, J W M, Nguyen, B, Nielsen, M B, Nieuwenhuijzen, G A P, Nilsson, P J, O’Dwyer, S T, Palmer, G, Pappou, E, Park, J, Patsouras, D, Pellino, G, Peterson, A C, Poggioli, G, Proud, D, Quinn, M, Quyn, A, Radwan, R W, Rasmussen, P C, Rausa, E, Regenbogen, S E, Renehan, A, Rocha, R, Rochester, M, Rohila, J, Rothbarth, J, Rottoli, M, Roxburgh, C, Rutten, H J T, Ryan, É J, Safar, B, Sagar, P M, Sahai, A, Saklani, A, Sammour, T, Sayyed, R, Schizas, A M P, Schwarzkopf, E, Scripcariu, V, Selvasekar, C, Shaikh, I, Shida, D, Simpson, A, Smart, N J, Smart, P, Smith, J J, Solbakken, A M, Solomon, M J, Sørensen, M M, Steele, S R, Steffens, D, Stitzenberg, K, Stocchi, L, Stylianides, N A, Swartling, T, Sumrien, H, Sutton, P A, Swartking, T, Taylor, C, Teras, J, Thurairaja, R, Toh, E L, Tsarkov, P, Tsukada, Y, Tsukamoto, S, Tuech, J J, Turner, W H, Tuynman, J B, Ramshorst, G H van, Zoggel, D van, Vasquez-Jimenez, W, Verhoef, C, Vizzielli, G, Voogt, E L K, Uehara, K, Wakeman, C, Warrier, S, Wasmuth, H H, Weber, K, Weiser, M R, Wheeler, J M D, Wild, J, Wilson, M, Wolthuis, A, Yano, H, Yip, B, Yip, J, Yoo, R N, Winter, D C, Tekkis, P P, Mcarthur, D R, Mcdermott, F D, Mcgrath, J S, Psychiatrie & Neuropsychologie, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, Faculteit FHML Centraal, Health Services Research, RS: CAPHRI - R1 - Ageing and Long-Term Care, RS: FdR IC Goederenrecht, School Office GROW, and Amsterdam Gastroenterology Endocrinology Metabolism

Subjects
BLOOD-TRANSFUSION, CARDIAC RISK, AcademicSubjects/MED00910, medicine.medical_treatment, Delphi method, Computer-assisted web interviewing, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], 0302 clinical medicine, 030202 anesthesiology, Multidisciplinary approach, Medicine and Health Sciences, Medicine, humans, RISK, COMPLICATIONS, Perioperative management - anaesthetic - pelvic exenterations - rectal cancer - Delphi - PelvEx Collaborative, Manchester Cancer Research Centre, General Medicine, SYSTEMIC INFLAMMATORY RESPONSE, 030220 oncology & carcinogenesis, Original Article, Medical emergency, EPIDURAL-ANESTHESIA, AcademicSubjects/MED00010, Life Sciences & Biomedicine, Consensus, ENHANCED RECOVERY, Best practice, education, MEDLINE, patient care team/organization & administration, 03 medical and health sciences, anesthetics, Humans, MAJOR ABDOMINAL-SURGERY, METAANALYSIS, RECTAL-CANCER, Anesthetics, Patient Care Team, Science & Technology, Pelvic exenteration, business.industry, ResearchInstitutes_Networks_Beacons/mcrc, MORTALITY, LONG-TERM SURVIVAL, Perioperative, COMPARTMENT SYNDROME, medicine.disease, pelvic exenteration, Pelvic Exenteration, Subject-matter expert, consensus, Surgery, business
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., The PelvEx Collaborative consensus statement systematically addresses the perioperative and anaesthetic management of patients undergoing pelvic exenteration (PE). Using the modified Delphi methodology, recommendations across six key clinical domains comprising preoperative assessment and preparation, anaesthetic considerations, perioperative management, anticipating possible massive haemorrhage, stress response and postoperative critical care, and pain management were developed. pelvic exenteratio and recommendation

Published
2021
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21. Changing outcomes following pelvic exenteration for locally advanced and recurrent rectal cancer

Author

Kelly, M. E., Aalbers, A. G. J., Aziz, N. Abdul, Abraham-Nordling, M., Alberda, W., Antoniou, A., Austin, K. K., Baker, R., Bali, M., Baseckas, G., Bednarski, B. K., Beets, G. L., Berg, P. L., Beynon, J., Biondo, S., Bordeianou, L., Brunner, M., Buchwald, P., Burger, J. W. A., Burling, D., Campain, N., Chan, K. K. L., Chang, G., Chew, M. H., Chong, P. C., Christensen, H. K., Codd, M., Colquhoun, A. J., Corr, A., Coscia, M., Coyne, P. E., Creavin, B., Damjanovic, L., Daniels, I. R., Davies, M., Davies, R. J., de Wilt, J. H. W., Denost, Q., Deutsch, C., Dietz, D., Dozois, E. J., Duff, M., Eglinton, T., Evans, M., Evans, M. D., Fearnhead, N. S., Frizelle, F. A., Garcia-Granero, E., Garcia-Sabrido, J. L., Gentilini, L., George, M. L., Glynn, R., Golda, T., Griffiths, B., Hagemans, J. A. W., Harji, D. P., Harris, D. A., Heriot, A. A. G., Hohenberger, W., Holm, T., Jenkins, J. T., Kanemitsu, Y., Kapur, S., Keller, D. S., Kelley, S. R., Kim, H., Koh, C. E., Kok, N. F. M., Kokelaar, R., Kontovounisios, C., Kusters, M., Larson, D. W., Laurberg, S., Law, W. L., Lee, P., Lydrup, M. L., Lynch, A. C., Martling, A., Mathis, K. L., Meijerink, W. J. H. J., Mentha, A. M., Merkel, S., McDermott, F. D., McGrath, J. S., Mihailo, A., Mirnezami, A., Morton, J. R., Mullaney, T. G., Nielsen, M. B., Nieuwenhuijzen, G. A. P., Nilsson, P. J., O'Connell, P. R., Palmer, G., Patsouras, D., Pellino, G., Poggioli, G., Quinn, M., Quyn, A., Radwan, R. W., Rasheed, S., Rasmussen, P. C., Rocha, R., Rothbarth, J., Roxburgh, C., Rutten, H. J. T., Ryan, E., Sagar, P. M., Sammour, T., Schizas, A. M. P., Schwarzkopf, E., Scripcariu, V, Shaikh, I, Shida, D., Simpson, A., Smart, N. J., Smith, J., Solomon, M. J., Sorensen, M. M., Steele, S. R., Steffens, D., Stocchi, L., Stylianides, N. A., Taylor, C., Tekkis, P. P., Tsukamoto, S., Turner, W. H., Tuynman, J. B., van Ramshorst, Gabriëlle, van Zoggel, D., Vasquez-Jimenez, W., Verhoef, C., Verstegen, M., Wakeman, C., Warrier, S., Wasmuth, H. H., Weiser, M. R., Wheeler, J. M. D., Wild, J., Winter, D. C., Yip, J., Kelly, M. E., Aalbers, A. G. J., Aziz, N. Abdul, Abraham‐Nordling, M., Alberda, W., Antoniou, A., Austin, K. K., Baker, R., Bali, M., Baseckas, G., Bednarski, B. K., Beets, G. L., Berg, P. L., Beynon, J., Biondo, S., Bordeianou, L., Brunner, M., Buchwald, P., Burger, J. W. A., Burling, D., Campain, N., Chan, K. K. L., Chang, G., Chew, M. H., Chong, P. C., Christensen, H. K., Codd, M., Colquhoun, A. J., Corr, A., Coscia, M., Coyne, P. E., Creavin, B., Damjanovic, L., Daniels, I. R., Davies, M., Davies, R. J., Wilt, J. H. W., Denost, Q., Deutsch, C., Dietz, D., Dozois, E. J., Duff, M., Eglinton, T., Evans, M., Evans, M.D., Fearnhead, N. S., Frizelle, F. A., Garcia‐Granero, E., Garcia‐Sabrido, J. L., Gentilini, L., George, M. L., Glynn, R., Golda, T., Griffiths, B., Hagemans, J. A.W., Harji, D. P., Harris, D. A., Heriot, A. A. G., Hohenberger, W., Holm, T., Jenkins, J. T., Kanemitsu, Y., Kapur, S., Keller, D. S., Kelley, S. R., Kim, H., Koh, C. E., Kok, N. F. M., Kokelaar, R., Kontovounisios, C., Kusters, M., Larson, D. W., Laurberg, S., Law, W. L., Lee, P., Lydrup, M. L., Lynch, A. C., Martling, A., Mathis, K. L., Meijerink, W. J. H. J., Mentha, A. M., Merkel, S., McDermott, F. D., McGrath, J. S., Mihailo, A., Mirnezami, A., Morton, J. R., Mullaney, T. G., Nielsen, M. B., Nieuwenhuijzen, G. A. P., Nilsson, P. J., O'Connell, P. R., Palmer, G., Patsouras, D., Pellino, G., Poggioli, G., Quinn, M., Quyn, A., Radwan, R. W., Rasheed, S., Rasmussen, P. C., Rocha, R., Rothbarth, J., Roxburgh, C., Rutten, H. J. T., Ryan, É., Sagar, P. M., Sammour, T., Schizas, A. M. P., Schwarzkopf, E., Scripcariu, V., Shaikh, I., Shida, D., Simpson, A., Smart, N. J., Smith, J., Solomon, M. J., Sørensen, M.M., Steele, S. R., Steffens, D., Stocchi, L., Stylianides, N. A., Taylor, C., Tekkis, P. P., Tsukamoto, S., Turner, W. H., Tuynman, J. B., Ramshorst, G. H., Zoggel, D., Vasquez‐Jimenez, W., Verhoef, C., Verstegen, M., Wakeman, C., Warrier, S., Wasmuth, H. H., Weiser, M. R., Wheeler, J. M. D., Wild, J., Winter, D. C., Yip, J., Kelly, Me, Aalbers, Agj, Aziz, Na, Abraham-Nordling, M, Alberda, W, Antoniou, A, Austin, Kk, Baker, R, Bali, M, Baseckas, G, Bednarski, Bk, Beets, Gl, Berg, Pl, Beynon, J, Biondo, S, Bordeianou, L, Brunner, M, Buchwald, P, Burger, Jwa, Burling, D, Campain, N, Chan, Kkl, Chang, G, Chew, Mh, Chong, Pc, Christensen, Hk, Codd, M, Colquhoun, Aj, Corr, A, Coscia, M, Coyne, Pe, Creavin, B, Damjanovic, L, Daniels, Ir, Davies, M, Davies, Rj, de Wilt, Jhw, Denost, Q, Deutsch, C, Dietz, D, Dozois, Ej, Duff, M, Eglinton, T, Evans, M, Evans, Md, Fearnhead, N, Frizelle, Fa, Garcia-Granero, E, Garcia-Sabrido, Jl, Gentilini, L, George, Ml, Glynn, R, Golda, T, Griffiths, B, Hagemans, Jaw, Harji, Dp, Harris, Da, Heriot, Aag, Hohenberger, W, Holm, T, Jenkins, Jt, Kanemitsu, Y, Kapur, S, Keller, D, Kelley, Sr, Kim, H, Koh, Ce, Kok, Nfm, Kokelaar, R, Kontovounisios, C, Kusters, M, Larson, Dw, Laurberg, S, Law, Wl, Lee, P, Lydrup, Ml, Lynch, Ac, Martling, A, Mathis, Kl, Meijerink, Wjhj, Mentha, Am, Merkel, S, Mcdermott, Fd, Mcgrath, J, Mihailo, A, Mirnezami, A, Morton, Jr, Mullaney, Tg, Nielsen, Mb, Nieuwenhuijzen, Gap, Nilsson, Pj, O'Connell, Pr, Palmer, G, Patsouras, D, Pellino, G, Poggioli, G, Quinn, M, Quyn, A, Radwan, Rw, Rasheed, S, Rasmussen, Pc, Rocha, R, Rothbarth, J, Roxburgh, C, Rutten, Hjt, Ryan, E, Sagar, Pm, Sammour, T, Schizas, Amp, Schwarzkopf, E, Scripcariu, V, Shaikh, I, Shida, D, Simpson, A, Smart, Nj, Smith, J, Solomon, Mj, Sorensen, Mm, Steele, Sr, Steffens, D, Stocchi, L, Stylianides, Na, Taylor, C, Tekkis, Pp, Tsukamoto, S, Turner, Wh, Tuynman, Jb, van Ramshorst, Gh, van Zoggel, D, Vasquez-Jimenez, W, Verhoef, C, Verstegen, M, Wakeman, C, Warrier, S, Wasmuth, Hh, Weiser, Mr, Wheeler, Jmd, Wild, J, Winter, Dc, and Yip, J

Subjects
Male, Blood transfusion, Colorectal cancer, medicine.medical_treatment, Surgical Flaps, COLORECTAL-CANCER, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], Postoperative Complications, Retrospective Studie, Medicine and Health Sciences, Mortality rate, General Medicine, Middle Aged, Treatment Outcome, medicine.anatomical_structure, HOSPITAL VOLUME, SURVIVAL, Original Article, Female, Life Sciences & Biomedicine, Human, medicine.medical_specialty, lcsh:Surgery, Rectum, Subgroup analysis, SDG 3 - Good Health and Well-being, medicine, Humans, Blood Transfusion, Retrospective Studies, Aged, Science & Technology, Pelvic exenteration, Rectal Neoplasms, business.industry, MORTALITY, PelvEx Collaborative, Retrospective cohort study, Original Articles, lcsh:RD1-811, Length of Stay, medicine.disease, SURGEON VOLUME, Pelvic Exenteration, Surgery, Surgical Flap, Postoperative Complication, Neoplasm Recurrence, Local, business, Complication
Abstract

Contains fulltext : 215764.pdf (Publisher’s version ) (Open Access) Background: Pelvic exenteration for locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LRRC) is technically challenging but increasingly performed in specialist centres. The aim of this study was to compare outcomes of exenteration over time. Methods: This was a multicentre retrospective study of patients who underwent exenteration for LARC and LRRC between 2004 and 2015. Surgical outcomes, including rate of bone resection, flap reconstruction, margin status and transfusion rates, were examined. Outcomes between higher- and lower-volume centres were also evaluated. Results: Some 2472 patients underwent pelvic exenteration for LARC and LRRC across 26 institutions. For LARC, rates of bone resection or flap reconstruction increased from 2004 to 2015, from 3.5 to 12.8 per cent, and from 12.0 to 29.4 per cent respectively. Fewer units of intraoperative blood were transfused over this interval (median 4 to 2 units; P = 0.040). Subgroup analysis showed that bone resection and flap reconstruction rates increased in lower- and higher-volume centres. R0 resection rates significantly increased in low-volume centres but not in high-volume centres over time (low-volume: from 62.5 to 80.0 per cent, P = 0.001; high-volume: from 83.5 to 88.4 per cent, P = 0.660). For LRRC, no significant trends over time were observed for bone resection or flap reconstruction rates. The median number of units of intraoperative blood transfused decreased from 5 to 2.5 units (P < 0.001). R0 resection rates did not increase in either low-volume (from 51.7 to 60.4 per cent; P = 0.610) or higher-volume (from 48.6 to 65.5 per cent; P = 0.100) centres. No significant differences in length of hospital stay, 30-day complication, reintervention or mortality rates were observed over time. Conclusion: Radical resection, bone resection and flap reconstruction rates were performed more frequently over time, while transfusion requirements decreased.

Published
2019

30. 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

33. Pelvic Exenteration for Advanced Nonrectal Pelvic Malignancy

Author

Kelly ME, Ryan E ´ J, Aalbers AGJ, Abdul Aziz N, Abraham-Nordling M, Alberda W, Antoniou A, Austin KK, Baker R, Bali M, Baseckas G, Bednarski BK, Beets GL, Berg PL, Beynon J, Biondo S, Bordeianou L, Bremers AB, Brunner M, Buchwald P, Burger JWA, Burling D, Campain N, Chan KKL, Chang GJ, Chew MH, C Chong P, Christensen HK, Codd M, Colquhoun AJ, Corr A, Coscia M, Coyne PE, Creavin B, Damjanovic L, Daniels IR, Davies M, Davies RJ, deWilt JHW, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois EJ, Duff M, Eglinton T, Evans MD, Fearnhead NS, Frizelle FA, Garcia-Granero E, Garcia-Sabrido JL, GentiliniL, George ML, Glynn R, Golda T, Griffiths B, Harris DA, Evans M, Hagemans JAW, Harji DP, Heriot AG, HohenbergerW, Holm T, Humphries E, Jansson-Palmer G, Jenkins JT, Kapur S, Kanemitsu Y, Kelley SR, Keller DS, Kim H, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kroon H, Kusters M, Lago V, Larson DW, Law WL, Laurberg S, Lee P, Lydrup ML, Lynch AC, Mathis KL, Martling A, Meijerink WJHJ, Merkel S, Mehta AM, McDermott FD, McGrath JS, Mihailo A, Mirnezami A, Morton JR, Mullaney TG, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, O’Connell PR, Palmer G, Patsouras D, Pellino G, Poggioli G, Quinn M, Quyn A, Radwan RW, Rasheed S, Rasmussen PC, Rocha R, Rothbarth J, Roxburgh C, Rutten HJT, Sagar PM, Sammour T, Schizas AMP, Schwarzkopf E, Scripcariu V, Shaikh I, Shida D, Simpson A, Smart NJ, Smith JJ, Solomon MJ, Sørensen MM, Steele SR, Steffens D, Stocchi L, Stylianides NA, Tekkis PP, Taylor C, Tsukamoto S, Turner WH, Tuynman JB, vanRamshorst GH, van Zoggel D, Vasquez-JimenezW, Verhoef C, WakemanC, Warrier S, Wasmuth HH, Weiser MR, Wheeler JMD, Wild J, Yip J, Winter DC., Gilberto Poggioli, Kelly, Me, Ryan, E ´ J, Aalbers, Agj, Abdul Aziz, N, Abraham-Nordling, M, Alberda, W, Antoniou, A, Austin, Kk, Baker, R, Bali, M, Baseckas, G, Bednarski, Bk, Beets, Gl, Berg, Pl, Beynon, J, Biondo, S, Bordeianou, L, Bremers, Ab, Brunner, M, Buchwald, P, Burger, Jwa, Burling, D, Campain, N, Chan, Kkl, Chang, Gj, Chew, Mh, C Chong, P, Christensen, Hk, Codd, M, Colquhoun, Aj, Corr, A, Coscia, M, Coyne, Pe, Creavin, B, Damjanovic, L, Daniels, Ir, Davies, M, Davies, Rj, Dewilt, Jhw, Denost, Q, Deutsch, C, Dietz, D, Domingo, S, Dozois, Ej, Duff, M, Eglinton, T, Evans, Md, Fearnhead, N, Frizelle, Fa, Garcia-Granero, E, Garcia-Sabrido, Jl, Gentilinil, George, Ml, Glynn, R, Golda, T, Griffiths, B, Harris, Da, Evans, M, Hagemans, Jaw, Harji, Dp, Heriot, Ag, Hohenbergerw, Holm, T, Humphries, E, Jansson-Palmer, G, Jenkins, Jt, Kapur, S, Kanemitsu, Y, Kelley, Sr, Keller, D, Kim, H, Koh, Ce, Kok, Nfm, Kokelaar, R, Kontovounisios, C, Kroon, H, Kusters, M, Lago, V, Larson, Dw, Law, Wl, Laurberg, S, Lee, P, Lydrup, Ml, Lynch, Ac, Mathis, Kl, Martling, A, Meijerink, Wjhj, Merkel, S, Mehta, Am, Mcdermott, Fd, Mcgrath, J, Mihailo, A, Mirnezami, A, Morton, Jr, Mullaney, Tg, Nielsen, Mb, Nieuwenhuijzen, Gap, Nilsson, Pj, O’Connell, Pr, Palmer, G, Patsouras, D, Pellino, G, Poggioli, G, Quinn, M, Quyn, A, Radwan, Rw, Rasheed, S, Rasmussen, Pc, Rocha, R, Rothbarth, J, Roxburgh, C, Rutten, Hjt, Sagar, Pm, Sammour, T, Schizas, Amp, Schwarzkopf, E, Scripcariu, V, Shaikh, I, Shida, D, Simpson, A, Smart, Nj, Smith, Jj, Solomon, Mj, Sørensen, Mm, Steele, Sr, Steffens, D, Stocchi, L, Stylianides, Na, Tekkis, Pp, Taylor, C, Tsukamoto, S, Turner, Wh, Tuynman, Jb, Vanramshorst, Gh, van Zoggel, D, Vasquez-JimenezW, Verhoef, C, Wakemanc, Warrier, S, Wasmuth, Hh, Weiser, Mr, Wheeler, Jmd, Wild, J, Yip, J, and Winter, Dc.

Subjects
Pelvic Neoplasm, Databases, Factual, medicine.medical_treatment, Tertiary Care Center, Kaplan-Meier Estimate, Cohort Studies, Tertiary Care Centers, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], 0302 clinical medicine, Retrospective Studie, Cause of Death, Pelvic Neoplasms, Neoadjuvant therapy, Cervical cancer, Aged, 80 and over, Mortality rate, Middle Aged, Prognosis, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Female, Survival Analysi, Human, medicine.medical_specialty, Prognosi, Malignancy, Risk Assessment, Disease-Free Survival, 03 medical and health sciences, SDG 3 - Good Health and Well-being, medicine, Humans, Neoplasm Invasiveness, Survival analysis, Proportional Hazards Models, Retrospective Studies, Aged, Neoplasm Staging, Neoplasm Invasivene, Pelvic exenteration, business.industry, medicine.disease, Survival Analysis, Surgery, Pelvic Exenteration, Proportional Hazards Model, Cohort Studie, Neoplasm Recurrence, Local, Ovarian cancer, business
Abstract

Item does not contain fulltext OBJECTIVE: To determine factors associated with outcomes following pelvic exenteration for advanced nonrectal pelvic malignancy. BACKGROUND: The PelvEx Collaborative provides large volume data from specialist centers to ascertain factors associated with improved outcomes. METHODS: Consecutive patients who underwent pelvic exenteration for nonrectal pelvic malignancy between 2006 and 2017 were identified from 22 tertiary centers. Patient demographics, neoadjuvant therapy, histopathological assessment, length of stay, 30-day major complication/mortality rate were recorded.The primary endpoints were factors associated with survival. The secondary endpoints included the difference in margin rates across the cohorts, impact of neoadjuvant treatment on survival, associated morbidity, and mortality. RESULTS: One thousand two hundred ninety-three patients were identified. 40.4% (n = 523) had gynecological malignancies (endometrial, ovarian, cervical, and vaginal), 35.7% (n = 462) urological (bladder), 18.1% (n = 234) anal, and 5.7% had sarcoma (n = 74).The median age across the cohort was 63 years (range, 23-85). The median 30-day mortality rate was 1.7%, with the highest rates occurring following exenteration for recurrent sarcoma or locally advanced cervical cancer (3.3% each). The median length of hospital stay was 17.5 days. 34.5% of patients experienced a major complication, with highest rate occurring in those having salvage surgery for anal cancer.Multivariable analysis showed R0 resection was the main factor associated with long-term survival. The 3-year overall-survival rate for R0 resection was 48% for endometrial malignancy, 40.6% for ovarian, 49.4% for cervical, 43.8% for vaginal, 59% for bladder, 48.3% for anal, and 48.1% for sarcoma. CONCLUSION: Pelvic exenteration remains an important treatment in selected patients with advanced or recurrent nonrectal pelvic malignancy. The range in 3-year overall survival following R0 resection (40%-59%) reflects the diversity of tumor types.

Published
2019

34. 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

35. 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

36. The global cost of pelvic exenteration:in-hospital perioperative costs

Author

Kelly, M. E., Agj, Aalbers, Abdul Aziz, N., Abecasis, N., Abraham-Nordling, M., Akiyoshi, T., Alberda, W., Albert, M., Andric, M., Angenete, E., Antoniou, A., Auer, R., Austin, K. K., Aziz, O., Baker, R. P., Bali, M., Baseckas, G., Bebington, B., Bedford, M., Bednarski, B. K., Beets, G. L., Berg, P. L., Beynon, J., Biondo, S., Boyle, K., Bordeianou, L., Bremers, A. B., Brunner, M., Buchwald, P., Bui, A., Burgess, A., Jwa, Burger, Burling, D., Burns, E., Campain, N., Carvalhal, S., Castro, L., Caycedo-Marulanda, A., Kkl, Chan, Chang, G. J., Chang, M., Chew, M. H., Chok, A. K., Chong, P., Christensen, H. K., Clouston, H., Codd, M., Collins, D., Colquhoun, A. J., Corr, A., Coscia, M., Cosimelli, M., Coyne, P. E., Croner, R. S., Damjanovic, L., Daniels, I. R., Davies, M., Davies, R. J., Delaney, C. P., Jhw, Wilt, Denost, Q., Deutsch, C., Dietz, D., Domingo, S., Dozois, E. J., Duff, M., Eglinton, T., Enrique-Navascues, J. M., Espin-Basany, E., Evans, M. D., Eyjólfsdóttir, B., Fahy, M., Fearnhead, N. S., Flatmark, K., Fleming, F., Folkesson, J., Frizelle, F. A., Gallego, M. A., Garcia-Granero, E., Garcia-Sabrido, J. L., Gentilini, L., George, M. L., George, V., Ghouti, L., Giner, F., Ginther, N., Glynn, R., Golda, T., Griffiths, B., Harris, D. A., Jaw, Hagemans, Hanchanale, V., Harji, D. P., Helewa, R. M., Hellawell, G., Heriot, A. G., Hochman, D., Hohenberger, W., Holm, T., Hompes, R., Jenkins, J. T., Kaffenberger, S., Kandaswamy, G. V., Kapur, S., Kanemitsu, Y., Kelley, S. R., Keller, D. S., Khan, M. S., Kim, H. J., Koh, C. E., Nfm, Kok, Kokelaar, R., Kontovounisios, C., Kristensen, H., Kroon, H. M., Kumar, S., Kusters, M., Lago, V., Lakkis, Z., Larsen, S. G., Larson, D. W., Law, W. L., Laurberg, S., Lee, P. J., Limbert, M., Lydrup, M. L., Lyons, A., Lynch, A. C., Mantyh, C., Mathis, K. L., Cfs, Margues, Martling, A., Wjhj, Meijerink, Merchea, A., Merkel, S., Mehta, A. M., McArthur, D. R., McDermott, F. D., McGrath, J. S., Malde, S., Mirnezami, A., Jrt, Monson, Morton, J. R., Mullaney, T. G., Negoi, I., Jwm, Neto, Ng, J. L., Nguyen, B., Nielsen, M. B., Gap, Nieuwenhuijzen, Nilsson, P. J., Oliver, A., O'Dwyer, S. T., Palmer, G., Pappou, E., Park, J., Patsouras, D., Pellino, G., Peterson, A. C., Poggioli, G., Proud, D., Quinn, M., Quyn, A., Rajendran, N., Radwan, R. W., Rasheed, S., Rasmussen, P. C., Rausa, E., Regenbogen, S. E., Renehan, A., Rocha, R., Rochester, M., Rohila, J., Rothbarth, J., Rottoli, M., Roxburgh, C., Hjt, Rutten, Safar, B., Sagar, P. M., Sahai, A., Saklani, A., Sammour, T., Sayyed, R., Amp, Schizas, Schwarzkopf, E., Scripcariu, V., Selvasekar, C., Shaikh, I., Shida, D., Simpson, A., Skeie-Jensen, T., Smart, N. J., Smart, P., Smith, J. J., Solbakken, A. M., Solomon, M. J., Sørensen, M. M., Steele, S. R., Steffens, D., Stitzenberg, K., Stocchi, L., Stylianides, N. A., Swartling, T., Sumrien, H., Sutton, P. A., Swartking, T., Tan, E. J., Taylor, C., Tekkis, P. P., Teras, J., Thurairaja, R., Toh, E. L., Tsarkov, P., Tsukada, Y., Tsukamoto, S., Tuech, J. J., Turner, W. H., Tuynman, J. B., van Ramshorst, G. H., van Zoggel, D., Vasquez-Jimenez, W., Verhoef, C., Vizzielli, G., Elk, Voogt, Uehara, K., Wakeman, C., Warrier, S., Wasmuth, H. H., Weber, K., Weiser, M. R., Jmd, Wheeler, Wild, J., Wilson, M., Wolthuis, A., Yano, H., Yip, B., Yip, J., Yoo, R. N., Zappa, M. A., Winter, D. C., Kelly, M. E., Agj, Aalbers, Abdul Aziz, N., Abecasis, N., Abraham-Nordling, M., Akiyoshi, T., Alberda, W., Albert, M., Andric, M., Angenete, E., Antoniou, A., Auer, R., Austin, K. K., Aziz, O., Baker, R. P., Bali, M., Baseckas, G., Bebington, B., Bedford, M., Bednarski, B. K., Beets, G. L., Berg, P. L., Beynon, J., Biondo, S., Boyle, K., Bordeianou, L., Bremers, A. B., Brunner, M., Buchwald, P., Bui, A., Burgess, A., Jwa, Burger, Burling, D., Burns, E., Campain, N., Carvalhal, S., Castro, L., Caycedo-Marulanda, A., Kkl, Chan, Chang, G. J., Chang, M., Chew, M. H., Chok, A. K., Chong, P., Christensen, H. K., Clouston, H., Codd, M., Collins, D., Colquhoun, A. J., Corr, A., Coscia, M., Cosimelli, M., Coyne, P. E., Croner, R. S., Damjanovic, L., Daniels, I. R., Davies, M., Davies, R. J., Delaney, C. P., Jhw, Wilt, Denost, Q., Deutsch, C., Dietz, D., Domingo, S., Dozois, E. J., Duff, M., Eglinton, T., Enrique-Navascues, J. M., Espin-Basany, E., Evans, M. D., Eyjólfsdóttir, B., Fahy, M., Fearnhead, N. S., Flatmark, K., Fleming, F., Folkesson, J., Frizelle, F. A., Gallego, M. A., Garcia-Granero, E., Garcia-Sabrido, J. L., Gentilini, L., George, M. L., George, V., Ghouti, L., Giner, F., Ginther, N., Glynn, R., Golda, T., Griffiths, B., Harris, D. A., Jaw, Hagemans, Hanchanale, V., Harji, D. P., Helewa, R. M., Hellawell, G., Heriot, A. G., Hochman, D., Hohenberger, W., Holm, T., Hompes, R., Jenkins, J. T., Kaffenberger, S., Kandaswamy, G. V., Kapur, S., Kanemitsu, Y., Kelley, S. R., Keller, D. S., Khan, M. S., Kim, H. J., Koh, C. E., Nfm, Kok, Kokelaar, R., Kontovounisios, C., Kristensen, H., Kroon, H. M., Kumar, S., Kusters, M., Lago, V., Lakkis, Z., Larsen, S. G., Larson, D. W., Law, W. L., Laurberg, S., Lee, P. J., Limbert, M., Lydrup, M. L., Lyons, A., Lynch, A. C., Mantyh, C., Mathis, K. L., Cfs, Margues, Martling, A., Wjhj, Meijerink, Merchea, A., Merkel, S., Mehta, A. M., McArthur, D. R., McDermott, F. D., McGrath, J. S., Malde, S., Mirnezami, A., Jrt, Monson, Morton, J. R., Mullaney, T. G., Negoi, I., Jwm, Neto, Ng, J. L., Nguyen, B., Nielsen, M. B., Gap, Nieuwenhuijzen, Nilsson, P. J., Oliver, A., O'Dwyer, S. T., Palmer, G., Pappou, E., Park, J., Patsouras, D., Pellino, G., Peterson, A. C., Poggioli, G., Proud, D., Quinn, M., Quyn, A., Rajendran, N., Radwan, R. W., Rasheed, S., Rasmussen, P. C., Rausa, E., Regenbogen, S. E., Renehan, A., Rocha, R., Rochester, M., Rohila, J., Rothbarth, J., Rottoli, M., Roxburgh, C., Hjt, Rutten, Safar, B., Sagar, P. M., Sahai, A., Saklani, A., Sammour, T., Sayyed, R., Amp, Schizas, Schwarzkopf, E., Scripcariu, V., Selvasekar, C., Shaikh, I., Shida, D., Simpson, A., Skeie-Jensen, T., Smart, N. J., Smart, P., Smith, J. J., Solbakken, A. M., Solomon, M. J., Sørensen, M. M., Steele, S. R., Steffens, D., Stitzenberg, K., Stocchi, L., Stylianides, N. A., Swartling, T., Sumrien, H., Sutton, P. A., Swartking, T., Tan, E. J., Taylor, C., Tekkis, P. P., Teras, J., Thurairaja, R., Toh, E. L., Tsarkov, P., Tsukada, Y., Tsukamoto, S., Tuech, J. J., Turner, W. H., Tuynman, J. B., van Ramshorst, G. H., van Zoggel, D., Vasquez-Jimenez, W., Verhoef, C., Vizzielli, G., Elk, Voogt, Uehara, K., Wakeman, C., Warrier, S., Wasmuth, H. H., Weber, K., Weiser, M. R., Jmd, Wheeler, Wild, J., Wilson, M., Wolthuis, A., Yano, H., Yip, B., Yip, J., Yoo, R. N., Zappa, M. A., and Winter, D. C.

Published
2020

37. The impact of the COVID-19 pandemic on the Management of Locally Advanced Primary/Recurrent Rectal Cancer

Author

Chok, A. Y., Kontovounisios, C., Rasheed, S., Kelly, M. E., Agj, Aalbers, Abdul Aziz, N., Abecasis, N., Abraham-Nordling, M., Akiyoshi, T., Alberda, W., Albert, M., Andric, M., Angenete, E., Antoniou, A., Auer, R., Austin, K. K., Aziz, O., Baker, R. P., Bali, M., Baseckas, G., Bebington, B., Bedford, M., Bednarski, B. K., Beets, G. L., Berg, P. L., Beynon, J., Biondo, S., Boyle, K., Bordeianou, L., Bremers, A. B., Brunner, M., Buchwald, P., Bui, A., Burgess, A., Jwa, Burger, Burling, D., Khan, M. S., Kim, H., Kroon, H. M., Kusters, M., Quinn, M., Rocha, R., Rothbarth, J., Smith, J. J., Tan, E. J., van Ramshorst, G. H., Verhoef, C., Wilson, M., Winter, D. C., Chok, A. Y., Kontovounisios, C., Rasheed, S., Kelly, M. E., Agj, Aalbers, Abdul Aziz, N., Abecasis, N., Abraham-Nordling, M., Akiyoshi, T., Alberda, W., Albert, M., Andric, M., Angenete, E., Antoniou, A., Auer, R., Austin, K. K., Aziz, O., Baker, R. P., Bali, M., Baseckas, G., Bebington, B., Bedford, M., Bednarski, B. K., Beets, G. L., Berg, P. L., Beynon, J., Biondo, S., Boyle, K., Bordeianou, L., Bremers, A. B., Brunner, M., Buchwald, P., Bui, A., Burgess, A., Jwa, Burger, Burling, D., Khan, M. S., Kim, H., Kroon, H. M., Kusters, M., Quinn, M., Rocha, R., Rothbarth, J., Smith, J. J., Tan, E. J., van Ramshorst, G. H., Verhoef, C., Wilson, M., and Winter, D. C.

Published
2020

50. Volume assessment magnetic resonance imaging technique for monitoring perianal Crohn's fistulas

Author

Lung, PFC, Sahnan, K, Burling, D, Burn, J, Tozer, P, Yassin, N, Adegbola, SO, Baldwin-Cleland, R, Warusavitarne, J, Gupta, A, Faiz, O, Phillips, RKS, Hart, AL, and Royal College of Surgeons of England

Subjects
Science & Technology, Gastroenterology & Hepatology, PERINEAL, CHILDREN, THERAPY, DISEASE, MAINTENANCE, fistula: Crohn's disease, ABSCESS, INFLIXIMAB, MANAGEMENT, TRIAL, PREDICTORS, Life Sciences & Biomedicine, MRI
Abstract

Background: Perianal Crohn’s fistula and their response to anti-tumour necrosis factor (TNF) therapies are best assessed with magnetic resonance imaging (MRI), but radiologist reporting is subjective and variable. This study investigates whether segmentation software could provide precise and reproducible objective measurements of fistula volume. Methods: Retrospective analysis of patients with perianal Crohn’s fistula at our institution between 2007 and 2013. Pre- and post-biologic MRI scans were used with varying time intervals. A total of two radiologists recorded fistula volumes, mean signal intensity and time taken to measure fistula volumes using validated Open Source segmentation software. A total of three radiologists assessed fistula response to treatment (improved, worse or unchanged) by comparing MRI scans. Results: A total of 18 cases were reviewed for this pilot study. Inter-observer variability was very good for volume and mean signal intensity; intra-class correlation (ICC) 0.95 [95% confidence interval (CI) 0.91–0.98] and 0.95 (95% CI 0.90–0.97) respectively. Intra-observer variability was very good for volume and mean signal intensity; ICC 0.99 (95% CI 0.97–0.99) and 0.98 (95% CI 0.95–0.99) respectively. Average time taken to measure fistula volume was 202 s and 250 s for readers 1 and 2. Agreement between three specialist radiologists was good [kappa 0.69 (95% CI 0.49–0.90)] for the subjective assessment of fistula response. Significant association was found between objective percentage volume change and subjective consensus agreement of response (p = 0.001). Median volume change for improved, stable or worsening fistula response was −67% [interquartile range (IQR): −78, −47], 0% (IQR: −16, +17), and +487% (IQR: +217, +559) respectively. Conclusion: Quantification of fistula volumes and signal intensities is feasible and reliable, providing an objective measure of perianal Crohn’s fistula and response to treatment.

Published
2018

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