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2. Anastomotic leak following oesophagectomy: research priorities from an international Delphi consensus study

Author

Kamarajah, Sivesh K, Mohamed, Imran, Nepogodiev, Dmitri, Evans, Richard PT, Hodson, James, Griffiths, Ewen A, Singh, Pritam, Committee, Steering, Alderson, Derek, Bundred, James, Evans, Richard, Gossage, James, Jefferies, Benjamin, Mckay, Siobhan, Siaw-Acheampong, Kobby, van Hillegersberg, Richard, Vohra, Ravinder, Wanigsooriya, Kasun, Whitehouse, Tony, Bekele, A, Achiam, Mp, Ahmed, H, Ainsworth, A, Akhtar, K, Akkapulu, N, Al-Khyatt, W, Alasmar, M, Alemu, Bn, Alfieri, R, Alkhaffaf, B, Alvarez, Ls, Amahu, V, Andreollo, Na, Arias, F, Ariyarathenam, A, Arndt, A, Athanasiou, A, Azagra, Js, Baban, C, Babor, R, Baili, E, Balla, A, Beenen, E, Bendixen, M, Bennett, J, Bergeat, D, Bernardes, Aj, Bernardi, D, Berrisford, R, Bianchi, A, Bjelovic, M, Blencowe, N, Boddy, A, Bogdan, S, Bolger, J, Bonavina, L, Bouras, G, Bouwense, S, Bowrey, D, Bragg, D, Bright, Tn, Broderick, S, Buduhan, G, Byrne, B, Carey, D, Carroll, P, Carrott, P, Casaca, R, Castro, Rg, Catton, J, Cerdeira, Mp, Chang, Ac, Charalabopoulos, A, Chaudry, A, Choh, C, Ciprian, B, Ciubotaru, C, Coe, P, Colak, E, Colino, Rb, Colucci, N, Costa, Pm, Daniela, K, Das, N, Davies, A, Davies, N, de Manzoni, G, del Val, Id, Dexter, S, Dolan, J, Donlon, N, Donohoe, C, Duffy, J, Dwerryhouse, S, Egberts, Jh, Ekwunife, C, Elhadi, A, Elhadi, M, Elliott, Ja, Elnagar, H, Elnagar, F, Faraj, Ha, Farooq, N, Fearon, N, Fekaj, E, Forshaw, M, Freire, J, Gacevski, G, Gaedcke, J, Giacopuzzi, S, Gijón, Mm, Gisbertz, S, Golcher, H, Gordon, A, Gossage, J, Griffiths, E, Grimminger, P, Guner, A, Gutknecht, S, Harustiak, T, Hedberg, J, Heisterkamp, J, Hii, M, Hindmarsh, A, Holm, J, Hornby, S, Isik, A, Izbicki, J, Jagadesham, V, Jaunoo, S, Johansson, J, Johnson, Ma, Johnston, B, Kapoulas, S, Kauppi, J, Kauppila, Jh, Kechagias, A, Kelly, M, Kelty, C, Kennedy, A, Khan, M, Khattak, S, Kidane, B, Kjaer, Dw, Klarenbeek, B, Korkolis, Dp, Koshy, Rm, Krantz, S, Lagarde, S, Larsen, Mh, Lau, Pc, Leeder, Pc, Leite, Js, Liakakos, T, Madhavan, A, Mahdi, Si, Mahendran, Ha, Mahmoodzadeh, H, Majbar, A, Manatakis, D, Markar, S, Martijnse, I, Matei, B, Matos da Costa, P, Mccormack, K, Mcnally, S, Meriläinen, S, Merrett, N, Migliore, M, Mingol, F, Mitton, D, Mogoanta, Ss, Mönig, Sp, Moorthy, K, Muhinga, M, Mwachiro, M, Naeem, A, Nasir, I, Navidi, M, Negoi, I, Negoiţă, V, Niazi, Sk, Nilsson, M, Pazdro, A, Pera, M, Perez, Cj, Perivoliotis, K, Peters, C, Phillips, Aw, Powell, A, Prove, L, Pucher, Ph, Rahman, S, Räsänen, Jv, Read, M, Reeh, M, Reim, D, Reynolds, J, Robb, Wb, Robertson, K, Rodica, B, Rosero, G, Rosman, C, Saadeh, L, Santos, Eg, Saunders, J, Sayyed, R, Schizas, D, Scurtu, Rr, Sekhniaidze, D, Serralheiro, Pa, Sevinç, B, Sgromo, B, Shakeel, O, Siemsen, M, Skipworth, R, Smith, B, Soares, A, Spillane, J, Steliga, Ma, Sundbom, M, Sydiuk, A, Takahashi, Aml, Talbot, M, Tan, B, Tareen, Ma, Tewari, N, Tez, M, Theodorou, D, Tita, A, Toledo, E, Townend, Pj, Triantafyllou, T, Trugeda, M, Tucker, O, Turner, P, Turrado, V, Underwood, T, Vaccari, S, Valmasoni, M, van Berge Henegouwen, M, van Boxel, G, van den Berg, Jw, van der Sluis, P, van Hillegersberg, R, van Lanschot, Jjb, van Workum, F, Vickers, J, Videira, J, Viswanath, Y, Vohra, R, Voon, K, Wadley, M, Walker, R, Wallner, B, Walsh, Tn, Weindelmayer, J, Welch, N, Wheatley, T, Wijnhoven, B, Wong, Lf, Yanni, F, Yeung, J, Zacharakis, Null, and Moenig, Stefan Paul

Subjects
medicine.medical_specialty, Leak, Biomedical Research, Delphi Technique, Steering committee, medicine.medical_treatment, Delphi method, Anastomotic Leak, 030230 surgery, Esophagectomy, Evidence-Based Medicine, Humans, Surveys and Questionnaires, Research, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], 03 medical and health sciences, 0302 clinical medicine, medicine, computer.programming_language, ddc:617, business.industry, General surgery, 030220 oncology & carcinogenesis, Surgery, business, computer, Delphi
Abstract

Background The Oesophago-Gastric Anastomosis Audit (OGAA) is an international collaborative group set up to study anastomotic leak outcomes after oesophagectomy for cancer. This Delphi study aimed to prioritize future research areas of unmet clinical need in RCTs to reduce anastomotic leaks. Methods A modified Delphi process was overseen by the OGAA committee, national leads, and engaged clinicians from high-income countries (HICs) and low/middle-income countries (LMICs). A three-stage iterative process was used to prioritize research topics, including a scoping systematic review (stage 1), and two rounds of anonymous electronic voting (stages 2 and 3) addressing research priority and ability to recruit. Stratified analyses were performed by country income. Results In stage 1, the steering committee proposed research topics across six domains: preoperative optimization, surgical oncology, technical approach, anastomotic technique, enhanced recovery and nutrition, and management of leaks. In stages 2 and stage 3, 192 and 171 respondents respectively participated in online voting. Prioritized research topics include prehabilitation, anastomotic technique, and timing of surgery after neoadjuvant chemo(radio)therapy. Stratified analyses by country income demonstrated no significant differences in research priorities between HICs and LMICs. However, for ability to recruit, there were significant differences between LMICs and HICs for themes related to the technical approach (minimally invasive, width of gastric tube, ischaemic preconditioning) and location of the anastomosis. Conclusion Several areas of research priority are consistent across LMICs and HICs, but discrepancies in ability to recruit by country income will inform future study design.

Published
2020
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4. Characterisation of fractalkine/CX3CL1 and fractalkine receptor (CX3CR1) expression in abdominal aortic aneurysm disease.

Author

Patel A, Jagadesham VP, Porter KE, Scott DJ, and Carding SR

Subjects
Aged, Aortic Aneurysm, Abdominal pathology, Atherosclerosis immunology, CX3C Chemokine Receptor 1, Case-Control Studies, Cells, Cultured, Endothelial Cells immunology, Female, Flow Cytometry, Humans, Immunohistochemistry, Inflammation pathology, Killer Cells, Natural immunology, Leukocytes, Mononuclear pathology, Male, Middle Aged, Muscle, Smooth, Vascular immunology, Myocytes, Smooth Muscle immunology, Recombinant Proteins metabolism, T-Lymphocytes immunology, Tumor Necrosis Factor-alpha metabolism, Aortic Aneurysm, Abdominal immunology, Chemokine CX3CL1 metabolism, Inflammation immunology, Leukocytes, Mononuclear immunology, Receptors, Chemokine metabolism
Abstract

Objectives: Fractalkine (CX3CL1) promotes adhesion and extravasation of leucocytes through interactions with fractalkine receptor (CX3CR1) expressed on CD56+/CD16+ NK cells and CD8+ T cells. The current study aims to test the hypothesis the CX3CL1-CX3CR1 interaction contributes to the inflammatory infiltrate in AAA tissue., Design and Methods: Immunohistochemistry (IHC) was used to define expression of CX3CR1 in AAA tissue. Multi-parametric flow cytometry (FC) was used to determine CX3CR1 expression on T-cells (CD3+) and NK cells (CD56+) from AAA tissue and peripheral blood of AAA patients and healthy controls. Regulation of CX3CL1 expression by vascular endothelial (vEC) and smooth muscle cells (vSMC) was examined in vitro using primary cell cultures., Results: CX3CR1+ cells were detected in 19/28 AAA tissue samples and predominately localised in the adventitia. PBMCs from patients with AAA demonstrated higher percentages of CX3CR1+ NK cells (60.0-88.6%) and T cells (7.5-39.4%) compared with healthy controls. Furthermore, the frequency of CX3CR1+ NK cells (91%) and T cells (94%) in inflammatory AAA tissue were higher than in atherosclerotic AAA tissue. The pro-inflammatory cytokine TNFalpha increased expression of fractalkine by vSMC and vEC., Conclusion: CX3CL1+ and CX3CR1+ cells are present in AAA disease and their interaction may contribute to the recruitment of inflammatory cells seen in AAA tissue.

Published
2008
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5. Intra-operative Doppler flow measurement do not predict 'at-risk' status of infrainguinal bypass grafts.

Author

Jagadesham VP, Snowdon S, Weston MJ, and Kent PJ

Subjects
Aged, Aged, 80 and over, Arterial Occlusive Diseases diagnostic imaging, Arterial Occlusive Diseases surgery, Blood Flow Velocity, Female, Follow-Up Studies, Humans, Male, Middle Aged, Popliteal Artery diagnostic imaging, Popliteal Artery surgery, Prospective Studies, Reproducibility of Results, Risk Factors, Treatment Outcome, Vascular Patency, Arterial Occlusive Diseases physiopathology, Blood Vessel Prosthesis, Inguinal Canal blood supply, Monitoring, Intraoperative methods, Saphenous Vein transplantation, Ultrasonography, Doppler, Duplex
Abstract

Aims: Patients undergoing infrainguinal arterial reconstruction using vein conduits, frequently undergo intra-operative Doppler flow measurements to determine technical adequacy. The aim of this study was to determine the proportion of vein grafts with normal intra-operative haemodynamic parameters that were subsequently discovered to be 'at risk' on post-operative duplex surveillance scanning., Methods: We prospectively collected data on 82, primary infrainguinal vein bypass grafts. Post papaverine graft flow and peripheral resistance were measured using the Scimed Opdop intra-operative Doppler machine. All grafts were determined to be technically adequate on the basis of measured peripheral resistance units (mPRU) being < or =1. At 1 week, a post-operative duplex surveillance scan was performed. At risk status was determined and compared to the intra-operative Doppler flow measurement. Statistical analysis was performed using the Mann-Whitney U-test., Results: The post-operative duplex scan demonstrated that 53 (65%) of the 82 vein bypass grafts were diagnosed as being 'not at risk'; and 29 (35%) were regarded as at risk. When the groups were compared, there was no significant difference in intra-operative haemodynamic parameters between those not at risk and those at risk (P=0.19, Mann-Whitney U-test). The 1 month primary patency rate was 79% with a secondary patency rate of 100%., Conclusion: Despite normal intra-operative Doppler flow measurements, 35% of vein grafts were regarded as being at risk at the 1 week post-operative duplex surveillance scan. No single value may be universally applicable for identifying at risk grafts intraoperatively. Indeed, graft failure appears to be a multifactorial process.

Published
2005
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