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Article ; Online: The impact of age on complications, survival, and cause of death following colon cancer surgery.

Aquina, Christopher T / Mohile, Supriya G / Tejani, Mohamedtaki A / Becerra, Adan Z / Xu, Zhaomin / Hensley, Bradley J / Arsalani-Zadeh, Reza / Boscoe, Francis P / Schymura, Maria J / Noyes, Katia / Monson, John Rt / Fleming, Fergal J

British journal of cancer

2017 Volume 116, Issue 3, Page(s) 389–397

Abstract: Background: Given scarce data regarding the relationship among age, complications, and survival beyond the 30-day postoperative period for oncology patients in the United States, this study identified age-related differences in complications and the ... ...

Abstract	Background: Given scarce data regarding the relationship among age, complications, and survival beyond the 30-day postoperative period for oncology patients in the United States, this study identified age-related differences in complications and the rate and cause of 1-year mortality following colon cancer surgery. Methods: The NY State Cancer Registry and Statewide Planning and Research Cooperative System identified stage I-III colon cancer resections (2004-2011). Multivariable logistic regression and survival analyses assessed the relationship among age (<65, 65-74, ⩾75), complications, 1-year survival, and cause of death. Results: Among 24 426 patients surviving >30 days, 1-year mortality was 8.5%. Older age groups had higher complication rates, and older age and complications were independently associated with 1-year mortality (P<0.0001). Increasing age was associated with a decrease in the proportion of deaths from colon cancer with a concomitant increase in the proportion of deaths from cardiovascular disease. Older age and sepsis were independently associated with higher risk of colon cancer-specific death (65-74: HR=1.59, 95% CI=1.26-2.00; ⩾75: HR=2.57, 95% CI=2.09-3.16; sepsis: HR=2.58, 95% CI=2.13-3.11) and cardiovascular disease-specific death (65-74: HR=3.72, 95% CI=2.29-6.05; ⩾75: HR=7.02, 95% CI=4.44-11.10; sepsis: HR=2.33, 95% CI=1.81-2.99). Conclusions: Older age and sepsis are associated with higher 1-year overall, cancer-specific, and cardiovascular-specific mortality, highlighting the importance of geriatric assessment, multidisciplinary care, and cardiovascular optimisation for older patients and those with infectious complications.
MeSH term(s)	Age Factors ; Aged ; Aging/physiology ; Cardiovascular Diseases/mortality ; Cause of Death ; Colonic Neoplasms/mortality ; Colonic Neoplasms/surgery ; Female ; Geriatric Assessment ; Humans ; Male ; Postoperative Complications/epidemiology ; Postoperative Complications/mortality ; Postoperative Period ; Risk Factors ; Survival Analysis ; United States
Language	English
Publishing date	2017-01-05
Publishing country	England
Document type	Journal Article
ZDB-ID	80075-2
ISSN	1532-1827 ; 0007-0920
ISSN (online)	1532-1827
ISSN	0007-0920
DOI	10.1038/bjc.2016.421
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Advances in Radiotherapy in Operable Rectal Cancer

Suppiah, Aravind / Hartley, John E. / Monson, John R.T.

Digestive Surgery

2009 Volume 26, Issue 3, Page(s) 187–199

Abstract: Aims: Radiotherapy (RT) reduces local recurrence in rectal cancer but the optimal treatment schedule is unknown. Relevant questions in designing optimal therapy are set out. This review identifies evidence that influences current practice and shapes ... ...

Institution	Academic Surgical Unit, University of Hull and Castle Hill Hospital, Cottingham, UK University of Rochester Medical Centre, Rochester, N.Y., USA
Abstract	Aims: Radiotherapy (RT) reduces local recurrence in rectal cancer but the optimal treatment schedule is unknown. Relevant questions in designing optimal therapy are set out. This review identifies evidence that influences current practice and shapes future trials in treatment of operable rectal cancer. Methods: PubMed and MEDLINE search. Results: RT reduces local recurrence and pre-operative treatment is superior to post-operative treatment. Longer interval to surgery and concurrent chemotherapy are associated with greater downstaging, although influence on sphincter preservation and survival is minimal. Short-course RT (SCRT) demonstrates lower recurrence, but with long-term dysfunction and minimal survival benefit. The role of SCRT should be re-evaluated to encompass new criteria/areas. Conclusion: SCRT should be used selectively rather than as a blanket treatment policy. SCRT compounds functional morbidity caused by mesorectal excision which may be excessive in some patient groups, especially early-stage rectal cancer or frail elderly patients. RT and local excision may be a feasible surgical alternative in these groups. Alternatively, SCRT and delayed surgery may be a future alternative to current long-course chemoradiotherapy. As survival is only marginally affected despite low local recurrence, future trials should aim to address metastatic disease. End points which incorporate function and quality of life must be used.
Keywords	Radiotherapy ; Chemotherapy ; Adjuvant treatment ; Rectal cancer
Language	English
Publishing date	2009-06-03
Publisher	S. Karger AG
Publishing place	Basel, Switzerland
Document type	Article
Note	Review
ZDB-ID	605888-7
ISSN	1421-9883 ; 0253-4886
ISSN (online)	1421-9883
ISSN	0253-4886
DOI	10.1159/000219931
Database	Karger publisher's database

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Article: Surgical readmissions: results of integrating pre-, peri- and postsurgical care.

Noyes, Katia / Baack-Kukreja, Janet / Messing, Edward M / Schoeniger, Luke / Galka, Eva / Pan, Wei / Xueya, Cai / Fleming, Fergal J / Monson, John Rt / Mohile, Supriya G / Francone, Todd

Nursing open

2016 Volume 3, Issue 3, Page(s) 168–178

Abstract: Aims: To explore the feasibility of recruiting surgical oncology patients and implementing a surgical integrated discharge (SID) programme led by advanced practice providers (APP).: Background: Burden of illness and complexity of treatment regimen ... ...

Abstract	Aims: To explore the feasibility of recruiting surgical oncology patients and implementing a surgical integrated discharge (SID) programme led by advanced practice providers (APP). Background: Burden of illness and complexity of treatment regimen makes it challenging for surgical oncology patients to participate in research. Surgical oncology nurses may have the necessary expertise to overcome this problem. Design: Controlled longitudinal prospective observational study. Methods: The SID programme included multidisciplinary care coordination, regular communication among APPs and proactive postdischarge follow-up. Administrative databases were used to identify matching historical controls ( Results: Patient enrolment was 84%. The main challenges for the programme implementation included incompatible health information systems among care settings, variation in care processes among hospital units and need for provider behaviour change. Conclusions: Most surgical oncology patients are willing to participate in outcomes programmes when contacted by familiar clinical personnel but programme implementation requires leadership support, communication among care teams and training and infrastructure.
Language	English
Publishing date	2016-05-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	2809556-X
ISSN	2054-1058
ISSN	2054-1058
DOI	10.1002/nop2.52
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Article ; Online: Chemotherapy plus percutaneous radiofrequency ablation in patients with inoperable colorectal liver metastases.

Sgouros, Joseph / Cast, James / Garadi, Krishna K / Belechri, Maria / Breen, David J / Monson, John Rt / Maraveyas, Anthony

World journal of gastrointestinal oncology

2011 Volume 3, Issue 4, Page(s) 60–66

Abstract: Aim: To access the efficacy of chemotherapy plus radiofrequency ablation (RFA) as one line of treatment in inoperable colorectal liver metastases.: Methods: Eligible patients were included in three Phase II studies. In the first study percutaneous ... ...

Abstract	Aim: To access the efficacy of chemotherapy plus radiofrequency ablation (RFA) as one line of treatment in inoperable colorectal liver metastases. Methods: Eligible patients were included in three Phase II studies. In the first study percutaneous RFA was used first followed by 6 cycles of 5-fluorouracil, leucovorin and irinotecan combination (FOLFIRI) (adjunctive chemotherapy trial). In the other two, chemotherapy (FOLFIRI or 5-fluorouracil, leucovorin and oxaliplatin combination) up to 12 cycles was used first with percutaneous RFA offered to responding patients (primary chemotherapy trials). Results: Thirteen patients were included in the adjunctive chemotherapy trial and 17 in the other two. At inclusion they had 1-4 liver metastases (up to 6.5 cm in size). Two patients died during chemotherapy. All patients in the adjunctive chemotherapy trial and 44% in the primary chemotherapy studies had their metastases ablated. Median PFS and overall survival in the adjunctive study were 13 and 24 mo respectively while in the primary chemotherapy studies they were 10 and 21 mo respectively. Eighty one percent of the patients had tumour relapse in at least one previously ablated lesion. Conclusion: Chemotherapy plus RFA in patients with low volume inoperable colorectal liver metastases seems safe and relatively effective. The high local recurrence rate is of concern.
Language	English
Publishing date	2011-02-23
Publishing country	China
Document type	Journal Article
ZDB-ID	2573696-6
ISSN	1948-5204 ; 1948-5204
ISSN (online)	1948-5204
ISSN	1948-5204
DOI	10.4251/wjgo.v3.i4.60
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Parastomal Hernia: A Growing Problem with New Solutions

Aquina, Christopher T. / Iannuzzi, James C. / Probst, Christian P. / Kelly, Kristin N. / Noyes, Katia / Fleming, Fergal J. / Monson, John R.T.

Digestive Surgery

2014 Volume 31, Issue 4-5, Page(s) 366–376

Abstract: Parastomal hernia is one of the most common complications following stoma creation and its prevalence is only expected to increase. It often leads to a decrease in the quality of life for patients due to discomfort, pain, frequent ostomy appliance ... ...

Abstract	Parastomal hernia is one of the most common complications following stoma creation and its prevalence is only expected to increase. It often leads to a decrease in the quality of life for patients due to discomfort, pain, frequent ostomy appliance leakage, or peristomal skin irritation and can result in significantly increased healthcare costs. Surgical technique for parastomal hernia repair has evolved significantly over the past two decades with the introduction of new types of mesh and laparoscopic procedures. The use of prophylactic mesh in high-risk patients at the time of stoma creation has gained attention in lieu of several promising studies that have emerged in the recent days. This review will attempt to demonstrate the burden that parastomal hernias present to patients, surgeons, and the healthcare system and also provide an overview of the current management and surgical techniques at both preventing and treating parastomal hernias.© 2014 S. Karger AG, Basel
Keywords	Hernia ; Parastomal hernia ; Colorectal surgery ; Review
Language	English
Publisher	S. Karger AG
Publishing place	Basel
Publishing country	Switzerland
Document type	Article ; Online
ZDB-ID	605888-7
ISSN	1421-9883 ; 0253-4886 ; 0253-4886
ISSN (online)	1421-9883
ISSN	0253-4886
DOI	10.1159/000369279
Database	Karger publisher's database

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Article ; Online: Laparoscopy for Colorectal Malignancy

Pillinger, Stephen H. / Monson, John R.T.

Digestive Surgery

2005 Volume 22, Issue 1-2, Page(s) 34–40

Abstract: Laparoscopy for colorectal pathology is technically demanding with a steep learning curve. In expert hands, there is no doubt that there is a place for laparoscopy in the operative armamentarium for the treatment of benign disease. The question of its ... ...

Abstract	Laparoscopy for colorectal pathology is technically demanding with a steep learning curve. In expert hands, there is no doubt that there is a place for laparoscopy in the operative armamentarium for the treatment of benign disease. The question of its application in the treatment of carcinoma is more difficult to address. The evidence available suggests that laparoscopic resection is a feasible and appropriate option for the treatment of colorectal carcinoma. The skill and technology to perform the procedure are developing apace, and level 1 evidence to support it is tantalizingly close. This paper will outline the development of the technique, the operative approach, and the available evidence for its use in the treatment of carcinoma.
Keywords	Laparoscopy ; Colorectal malignancy ; Laparoscopic surgery, indications/contra-indications ; Laparoscopic techniques
Language	English
Publisher	S. Karger AG
Publishing place	Basel
Publishing country	Switzerland
Document type	Article ; Online
ZDB-ID	605888-7
ISSN	1421-9883 ; 0253-4886 ; 0253-4886
ISSN (online)	1421-9883
ISSN	0253-4886
DOI	10.1159/000085344
Database	Karger publisher's database

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Article: Laparoscopy for Colorectal Malignancy

Pillinger, Stephen H. / Monson, John R.T.

Digestive Surgery

2005 Volume 22, Issue 1-2, Page(s) 34–40

Institution	The University of Hull, Academic Surgical Unit, Castle Hill Hospital, Cottingham, UK
Abstract	Laparoscopy for colorectal pathology is technically demanding with a steep learning curve. In expert hands, there is no doubt that there is a place for laparoscopy in the operative armamentarium for the treatment of benign disease. The question of its application in the treatment of carcinoma is more difficult to address. The evidence available suggests that laparoscopic resection is a feasible and appropriate option for the treatment of colorectal carcinoma. The skill and technology to perform the procedure are developing apace, and level 1 evidence to support it is tantalizingly close. This paper will outline the development of the technique, the operative approach, and the available evidence for its use in the treatment of carcinoma.
Keywords	Laparoscopic techniques ; Laparoscopic surgery, indications/contra-indications ; Laparoscopy ; Colorectal malignancy
Language	English
Publishing date	2005-05-11
Publisher	S. Karger AG
Publishing place	Basel, Switzerland
Document type	Article
Note	Review
ZDB-ID	605888-7
ISSN	1421-9883 ; 0253-4886
ISSN (online)	1421-9883
ISSN	0253-4886
DOI	10.1159/000085344
Database	Karger publisher's database

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Article: Local Excision of Rectal Cancer: Review of Literature

Nastro, Piero / Beral, Daniel / Hartley, John / Monson, John R.T.

Digestive Surgery

2005 Volume 22, Issue 1-2, Page(s) 6–15

Abstract: In selected patients, local excision of rectal cancer may be an alternative to radical surgery such as abdominoperineal excision of the rectum or anterior resection. Local excision carries lower mortality and morbidity, without the functional disturbance ...

Institution	University of Hull Academic Surgical Unit, Castle Hill Hospital, Cottingham, UK
Abstract	In selected patients, local excision of rectal cancer may be an alternative to radical surgery such as abdominoperineal excision of the rectum or anterior resection. Local excision carries lower mortality and morbidity, without the functional disturbance or alteration in body image that can be associated with radical surgery. There are several techniques of local therapy for rectal cancer, with most experience being available in transanal excision. Transanal endoscopic microsurgery is also used but experience with this newer technique is limited. Patient selection is the most important factor in successful local excision, however specific criteria for selecting patients have not been universally accepted. Review of the published literature is difficult because of the variation in adjuvant therapy regimes and follow-up strategies, as well as results reported in terms of local recurrence and survival rates. There is increasing evidence to suggest that local excision should be restricted to patients with T1 stage rectal cancer without high-risk factors. The place for local excision in patients with T2 or high-risk T1 tumours requires prospective, randomised multi-centre trials comparing radical surgery with local excision, with or without adjuvant therapy.
Keywords	Local excision, rectal cancer ; Transanal excision ; Endoscopic microsurgery, transanal ; Rectal cancer
Language	English
Publishing date	2005-05-11
Publisher	S. Karger AG
Publishing place	Basel, Switzerland
Document type	Article
Note	Review
ZDB-ID	605888-7
ISSN	1421-9883 ; 0253-4886
ISSN (online)	1421-9883
ISSN	0253-4886
DOI	10.1159/000084345
Database	Karger publisher's database

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Article ; Online: Local Excision of Rectal Cancer: Review of Literature

Nastro, Piero / Beral, Daniel / Hartley, John / Monson, John R.T.

Digestive Surgery

2005 Volume 22, Issue 1-2, Page(s) 15–16

Abstract	In selected patients, local excision of rectal cancer may be an alternative to radical surgery such as abdominoperineal excision of the rectum or anterior resection. Local excision carries lower mortality and morbidity, without the functional disturbance or alteration in body image that can be associated with radical surgery. There are several techniques of local therapy for rectal cancer, with most experience being available in transanal excision. Transanal endoscopic microsurgery is also used but experience with this newer technique is limited. Patient selection is the most important factor in successful local excision, however specific criteria for selecting patients have not been universally accepted. Review of the published literature is difficult because of the variation in adjuvant therapy regimes and follow-up strategies, as well as results reported in terms of local recurrence and survival rates. There is increasing evidence to suggest that local excision should be restricted to patients with T1 stage rectal cancer without high-risk factors. The place for local excision in patients with T2 or high-risk T1 tumours requires prospective, randomised multi-centre trials comparing radical surgery with local excision, with or without adjuvant therapy.
Keywords	Local excision, rectal cancer ; Transanal excision ; Endoscopic microsurgery, transanal ; Rectal cancer
Language	English
Publisher	S. Karger AG
Publishing place	Basel
Publishing country	Switzerland
Document type	Article ; Online
ZDB-ID	605888-7
ISSN	1421-9983 ; 1421-9883 ; 0253-4886 ; 0253-4886
ISSN (online)	1421-9983 ; 1421-9883
ISSN	0253-4886
DOI	10.1159/000084345
Database	Karger publisher's database

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Article ; Online: Transanal Endoscopic Microsurgery: Where Are We Now?

Maslekar, Sushil / Beral, Daniel L. / White, Tim J. / Pillinger, Steve H. / Monson, John R.T.

Digestive Surgery

2006 Volume 23, Issue 1-2, Page(s) 12–22

Abstract: Aims: This review of literature aimed to assess the role and establish the current status of transanal endoscopic microsurgery (TEM) in the management of benign and malignant rectal lesions. Methods: Areview of the literature was undertaken through the ... ...

Abstract	Aims: This review of literature aimed to assess the role and establish the current status of transanal endoscopic microsurgery (TEM) in the management of benign and malignant rectal lesions. Methods: Areview of the literature was undertaken through the Medline database and by cross-referencing previous publications, thus identifying 54 relevant publications on TEM in the management of rectal lesions. Aggregated results of various parameters were calculated but statistical comparisons deemed unsuitable due to heterogeneity of data. Results: The TEM procedure is associated with good functional results, morbidity of 4% and zero procedure-related mortality. The local recurrence rates after TEM excision is 4.5% (range 0-14) for benign rectal lesions, 6% (0-13) for T1 cancers, 14% (range 0-50) for T2 cancers and 20% (range 14-67%) for T3 cancers. Local recurrences after TEM can be surgically salvaged with good disease free survival rates. Conclusions: The TEM procedure clearly offers the benefits of good exposure of the operative field allowing extremely precise dissection and access to high rectal lesions unresectable by other methods. For pTis and low risk pT1 lesions, the oncological results are comparable to the more traditional formal resection. The routine use of TEM for high-risk pT1 and higher stage lesions is not an oncologically sound choice at the present moment.
Keywords	Transanal endoscopic microsurgery ; Local excision ; Rectal adenoma ; Rectal cancer
Language	English
Publisher	S. Karger AG
Publishing place	Basel
Publishing country	Switzerland
Document type	Article ; Online
ZDB-ID	605888-7
ISSN	1421-9883 ; 0253-4886 ; 0253-4886
ISSN (online)	1421-9883
ISSN	0253-4886
DOI	10.1159/000091957
Database	Karger publisher's database

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