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Article: The Antineoplastic Effect of Heparin on Colorectal Cancer: A Review of the Literature.

Giannas, Emmanuel / Kontovounisios, Christos

2023 Volume 12, Issue 22

Abstract: Heparin and derivatives are commonly used for thrombophylaxis in surgical colorectal cancer (CRC) patients. Recent studies have suggested that, besides its protective effect on the incidence of venous thromboembolism, heparin has an anti-cancer effect. ... ...

Abstract	Heparin and derivatives are commonly used for thrombophylaxis in surgical colorectal cancer (CRC) patients. Recent studies have suggested that, besides its protective effect on the incidence of venous thromboembolism, heparin has an anti-cancer effect. The aim of this review was to explore the literature and report the antineoplastic effect of heparin and derivatives on CRC. MEDLINE and EMBASE databases were searched for relevant articles. Nineteen studies were included (
Language	English
Publishing date	2023-11-19
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12227173
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: The Use of Mechanical Bowel Preparation and Oral Antibiotic Prophylaxis in Elective Colorectal Surgery: A Call for Change in Practice.

Petrou, Nikoletta A / Kontovounisios, Christos

Cancers

2022 Volume 14, Issue 23

Abstract: Elective colorectal surgery is associated with one of the highest rates of surgical site infections (SSIs), which result in prolonged length of stay, morbidity, and mortality for these patients and have a significant financial burden to healthcare ... ...

Abstract	Elective colorectal surgery is associated with one of the highest rates of surgical site infections (SSIs), which result in prolonged length of stay, morbidity, and mortality for these patients and have a significant financial burden to healthcare systems. In an effort to reduce the frequency of SSI rates associated with colorectal surgery, the 2018 World Health Organisation (WHO) guidelines recommend the routine use of mechanical bowel preparation (MBP) and oral antibiotic prophylaxis (OAP) in adult patients undergoing elective colorectal surgery. However, this recommendation remains a topic of debate internationally. The National Institute of Clinical Excellence (NICE) guidelines, last revised in 2019, recommend against the routine use of MBP and do not address the issue of OAP. In this communication, we reviewed the current guidelines and examined the most recent evidence from randomised-control trials (RCTs) and meta-analyses on the effect of MBP and OAP on SSI rates since the 2019 NICE guideline review. This recent evidence clearly demonstrated an SSI-risk-reduction benefit with the additional use of OAP and the combination of MBP and OAP in this group of patients, and we therefore highlight the need for change of the current NICE guidelines.
Language	English
Publishing date	2022-12-04
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers14235990
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Article: Validation of a Tool-Based Visual Anorectal Examination Advanced Simulator for the Early Detection of Colorectal Cancer.

Grayson, Niamh / Haghighi Osgouei, Reza / Huang, Renke / Tekkis, Paris / Bello, Fernando / Kontovounisios, Christos

Journal of clinical medicine

2024 Volume 13, Issue 5

Abstract: Rectal examination through proctoscopy or rigid sigmoidoscopy is a common investigation in clinical practice. It is an important diagnostic tool for the workup and management of anorectal pathologies. Performing the examination can be daunting not only ... ...

Abstract	Rectal examination through proctoscopy or rigid sigmoidoscopy is a common investigation in clinical practice. It is an important diagnostic tool for the workup and management of anorectal pathologies. Performing the examination can be daunting not only for patients but also for junior doctors. There are associated risks with the procedure, such as pain, diagnostic failure, and perforation of the bowel. Simulation-based training is recognised as an important adjunct in clinical education. It allows students and doctors to practice skills and techniques at their own pace in a risk-free environment. These skills can then be transferred to and developed further in clinical practice. There is extensive research published regarding the role of simulation-based training in endoscopy, however, we identified no published study regarding simulation-based training in rigid sigmoidoscopy or proctoscopy. This study aims to establish the initial face, content, and construct validity of a tool-based visual anorectal examination advanced simulator model for proctoscopy and rigid sigmoidoscopy. This innovative, highly realistic simulated environment aims to enhance the training of healthcare professionals and improve the efficiency of detecting and diagnosing distal colorectal disease.
Language	English
Publishing date	2024-02-29
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm13051423
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Article: Re-Do Plastic Reconstruction for Locally Advanced and Recurrent Colorectal Cancer Following a beyond Total Mesorectal Excision (TME) Operation-Key Considerations.

Giannas, Emmanuel / Kavallieros, Konstantinos / Nanidis, Theodoros / Giannas, John / Tekkis, Paris / Kontovounisios, Christos

Journal of clinical medicine

2024 Volume 13, Issue 5

Abstract: Innovation in surgery and pelvic oncology have redefined the boundaries of pelvic exenteration for CRC. However, surgical approaches and outcomes following repeat exenteration and reconstruction are not well described. The resulting defect from a second ... ...

Abstract	Innovation in surgery and pelvic oncology have redefined the boundaries of pelvic exenteration for CRC. However, surgical approaches and outcomes following repeat exenteration and reconstruction are not well described. The resulting defect from a second beyond Total Mesorectal Excision (TME) presents a challenge to the reconstructive surgeon. The aim of this study was to explore reconstructive options for patients undergoing repeat beyond TME for recurrent CRC following previous beyond TME and regional reconstruction. MEDLINE and Embase were searched for relevant articles, yielding 2353 studies. However, following full text review and the application of the inclusion criteria, all the studies were excluded. This study demonstrated the lack of reporting on re-do reconstruction techniques following repeat exenteration for recurrent CRC. Based on this finding, we conducted a point-by-point discussion of certain key aspects that should be taken into consideration when approaching this patient cohort.
Language	English
Publishing date	2024-02-21
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm13051228
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Article ; Online: Laparoscopic totally extraperitoneal hernia repair in patients with a history of previous abdominopelvic surgery.

Hayward, Romilly / Smith, Jacob J / Kontovounisios, Christos / Qiu, Shengyang / Warren, Oliver J

Updates in surgery

2024

Abstract: A retrospective cohort study of patients undergoing laparoscopic inguinal hernia repair compared short- and long-term outcomes between individuals with or without history of previous abdominopelvic surgery, aiming to determine the feasibility of totally ... ...

Abstract	A retrospective cohort study of patients undergoing laparoscopic inguinal hernia repair compared short- and long-term outcomes between individuals with or without history of previous abdominopelvic surgery, aiming to determine the feasibility of totally extraperitoneal (TEP) repair within this population. All patients who underwent elective TEP inguinal hernia repair by one consultant surgeon across three London hospitals from January 2017 to May 2023 were retrospectively analysed to assess perioperative outcomes. Two hundred sixty-two patients were identified, of whom two hundred forty-three (93%) underwent laparoscopic TEP repair. The most frequent complications were haematoma (6.2%) and seroma (4.1%). Recurrence occurred in four cases (1.6% of operations, 1.1% of hernias). One hundred eighty-four patients (76%) underwent day-case surgery. There were no mesh infections or explanations, vascular or visceral injuries, port-site hernias, damage to testicle, or persisting numbness. There were no requirements for blood transfusion, returns to theatre, or readmissions within 30 days. There was one conversion to open and one death within 60 days of surgery. Eighty-three (34%) had a history of previous AP surgery. There was no significant difference in perioperative outcomes between the AP and non-AP arms. This finding carried true for subgroup analysis of 44 patients whose AP surgical history did not include previous inguinal hernia repair and for those undergoing repair of recurrent hernia. In expert hands, laparoscopic TEP repair is associated with excellent outcomes and low rates of long-term complications, and thus should be considered as standard for patients regardless of a history of AP surgery.
Language	English
Publishing date	2024-04-23
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2572692-4
ISSN	2038-3312 ; 2038-131X
ISSN (online)	2038-3312
ISSN	2038-131X
DOI	10.1007/s13304-024-01810-w
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Article ; Online: The role of masterclasses in surgical oncology training: experience from a colorectal cancer surgery masterclass.

Kontovounisios, Christos

International journal of colorectal disease

2015 Volume 31, Issue 5, Page(s) 1065–1066

MeSH term(s)	Colorectal Surgery/education ; Education, Medical, Graduate ; Humans ; Surgeons ; Surgical Oncology/education
Language	English
Publishing date	2015-09-26
Publishing country	Germany
Document type	Letter
ZDB-ID	84975-3
ISSN	1432-1262 ; 0179-1958
ISSN (online)	1432-1262
ISSN	0179-1958
DOI	10.1007/s00384-015-2387-3
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Article: Facilitating the Adoption and Evolution of Digital Technologies Through Re-conceptualization.

Tekkis, Nicholas Pari / Richmond-Smith, Rebecca / Pellino, Gianluca / Kontovounisios, Christos

Frontiers in surgery

2022 Volume 9, Page(s) 840595

Abstract: Background: The NHS has been making steps toward greater efficiency and cutting costs to maintain quality of care despite constraints, but without innovation the NHS will not be able to meet its increasing financial demands. The purpose of this article ... ...

Abstract	Background: The NHS has been making steps toward greater efficiency and cutting costs to maintain quality of care despite constraints, but without innovation the NHS will not be able to meet its increasing financial demands. The purpose of this article is to analyse a single potentially transformative technology's path of adoption in the NHS [3D printing (3DP)]. Methods: Analysis of 3DP and its current value propositions. Re-conceptualization of the technology to gain insights into these value propositions and identify the capabilities it may provide. Analysis of previous business models to identify where this value is not fully captured and development of a new business model, followed by exploration of benefits and potential limitations of this new model. Results: 3D printing applications can be broadly categorized into anatomical modeling, implants, and tools. Conceptualizing 3D imaging using the layered architecture model suggests the potential of 3DP to evolve the current imaging and modeling infrastructure of the NHS, and as such should be adopted to facilitate this potential. Conclusion: 3D printing is an innovation with large potential for generativity, and it is important that it is integrated at a level that could both stimulate and communicate its benefits. Re-conceptualization identified a backbone within the NHS that could facilitate it as a point of entry, and the most successful installations have been through this channel. However, progress on the frontier is currently limited by both physical and organizational boundaries, the resolution of which is paramount for the current and future success of this technology.
Language	English
Publishing date	2022-02-22
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2773823-1
ISSN	2296-875X
ISSN	2296-875X
DOI	10.3389/fsurg.2022.840595
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Article: Management and Outcomes in Anal Canal Adenocarcinomas-A Systematic Review.

Taliadoros, Vasilis / Rafique, Henna / Rasheed, Shahnawaz / Tekkis, Paris / Kontovounisios, Christos

Cancers

2022 Volume 14, Issue 15

Abstract: 1) Background: Anal canal adenocarcinomas constitute 1% of all gastrointestinal tract cancers. There is a current lack of consensus and NICE guidelines in the United Kingdom regarding the management of this disease. The overall objective was to perform ... ...

Abstract	(1) Background: Anal canal adenocarcinomas constitute 1% of all gastrointestinal tract cancers. There is a current lack of consensus and NICE guidelines in the United Kingdom regarding the management of this disease. The overall objective was to perform a systematic review on the multitude of practice and subsequent outcomes in this group. (2) Methods: The MEDLINE, EMBASE, EMCARE and CINAHL databases were interrogated between 2011 to 2021. PRISMA guidelines were used to select relevant studies. The primary outcome measure was 5-year overall survival (OS). Secondary outcome measures included both local recurrences (LR) and distant metastases (DM). The Newcastle-Ottawa Scale (NOS) was used to assess the quality of studies retrieved. The study was registered on PROSPERO (338286). (3) Results: Fifteen studies were included. Overall, there were 11,967 participants who were demographically matched. There were 2090 subjects in the largest study and five subjects in the smallest study. Treatment modalities varied from neoadjuvant chemoradiotherapy (CRT), CRT and surgery (CRT + S), surgery then CRT (S + CRT) and surgery only (S). Five-year OS ranged from 30.2% to 91% across the literature. LR rates ranged from 22% to 29%; DM ranged from 6% to 60%. Study heterogeneity precluded meta-analysis. (4) Conclusions: Trimodality treatment with neoadjuvant chemoradiotherapy (CRT) followed by radical surgery of abdominoperineal excision of rectum (APER) appeared to be the most effective approach, giving the best survival outcomes according to the current data.
Language	English
Publishing date	2022-07-31
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers14153738
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Article ; Online: The Effect of Perioperative Administration of Probiotics on Colorectal Cancer Surgery Outcomes.

Pitsillides, Louise / Pellino, Gianluca / Tekkis, Paris / Kontovounisios, Christos

Nutrients

2021 Volume 13, Issue 5

Abstract: The perioperative care of colorectal cancer (CRC) patients includes antibiotics. Although antibiotics do provide a certain protection against infections, they do not eliminate them completely, and they do carry risks of microbial resistance and ... ...

Abstract	The perioperative care of colorectal cancer (CRC) patients includes antibiotics. Although antibiotics do provide a certain protection against infections, they do not eliminate them completely, and they do carry risks of microbial resistance and disruption of the microbiome. Probiotics can maintain the microbiome's balance postoperatively by maintaining intestinal mucosal integrity and reducing bacterial translocation (BT). This review aims to assess the role of probiotics in the perioperative management of CRC patients. The outcomes were categorised into: postoperative infectious and non-infectious complications, BT rate analysis, and intestinal permeability assessment. Fifteen randomised controlled trials (RCTs) were included. There was a trend towards lower rates of postoperative infectious and non-infectious complications with probiotics versus placebo. Probiotics reduced BT, maintained intestinal mucosal permeability, and provided a better balance of beneficial to pathogenic microorganisms. Heterogeneity among RCTs was high. Factors that influence the effect of probiotics include the species used, using a combination vs. single species, the duration of administration, and the location of the bowel resection. Although this review provided evidence for how probiotics possibly operate and reported notable evidence that probiotics can lower rates of infections, heterogeneity was observed. In order to corroborate the findings, future RCTs should keep the aforementioned factors constant.
MeSH term(s)	Colorectal Neoplasms/surgery ; Humans ; Perioperative Care/methods ; Postoperative Complications/prevention & control ; Probiotics/administration & dosage ; Probiotics/pharmacology
Language	English
Publishing date	2021-04-25
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2518386-2
ISSN	2072-6643 ; 2072-6643
ISSN (online)	2072-6643
ISSN	2072-6643
DOI	10.3390/nu13051451
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Article ; Online: Patient-reported Outcome Measures in Ileoanal Pouch Surgery: a Systematic Review.

Warsop, Zakary Ismail / Manzo, Carlo Alberto / Yu, Natalie / Yusuf, Bilal / Kontovounisios, Christos / Celentano, Valerio

Journal of Crohn's & colitis

2023 Volume 18, Issue 3, Page(s) 479–487

Abstract: Objective: To summarise frequency, type, and heterogeneity of patient-reported outcomes measures [PROMs] in papers reporting on outcomes after ileal pouch anal anastomosis [IPAA].: Background: Prevalence of ulcerative colitis [UC] has risen in ... ...

Abstract	Objective: To summarise frequency, type, and heterogeneity of patient-reported outcomes measures [PROMs] in papers reporting on outcomes after ileal pouch anal anastomosis [IPAA]. Background: Prevalence of ulcerative colitis [UC] has risen in Western countries, and one in three patients requires surgery. IPAA is a frequently performed procedure for UC, and a lack of standardisation is manifest in reporting outcomes for inflammatory bowel disease [IBD] despite the clear need for inclusion of PROMs as primary outcomes in IBD trials. Methods: Scopus, Pubmed, and Web of Science databases were searched from January 2010 to January 2023 for studies investigating outcomes in IPAA surgery. The primary outcome was the proportion of studies reporting outcomes for IPAA surgery for UC, which included PROMs. Results: The search identified a total of 8028 studies which, after de-duplication and exclusion, were reduced to 79 articles assessing outcomes after IPAA surgery. In all 44 [55.7%] reported PROMs, with 23 including validated questionnaires and 21 papers using authors' questions, 22 different PROMs were identified, with bowel function as the most investigated item. The majority of studies [67/79, 85%] were retrospective, only 14/79 [18%] were prospective papers and only two were [2.5%] randomised, controlled trials. Conclusions: Only half of the papers reviewed used PROMs. The main reported item is bowel function and urogenital, social, and psychological functions are the most neglected. There is lack of standardisation for use of PROMs in IPAA. Complexity of UC and of outcomes after IPAA demands a change in clinical practice and follow-up, given how crucial PROMs are, compared with their non-routine use.
MeSH term(s)	Humans ; Colitis, Ulcerative/surgery ; Colonic Pouches/adverse effects ; Inflammatory Bowel Diseases ; Patient Reported Outcome Measures
Language	English
Publishing date	2023-09-27
Publishing country	England
Document type	Systematic Review ; Journal Article
ZDB-ID	2390120-2
ISSN	1876-4479 ; 1873-9946
ISSN (online)	1876-4479
ISSN	1873-9946
DOI	10.1093/ecco-jcc/jjad163
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