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Article ; Online: Response to Raj et al Abdominoperineal resection by trans-anal TME approach: are we refuting the technology a bit too early?

Patel, Sunil V / Brown, Carl J / Caycedo-Marulanda, Antonio

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

2023 Volume 25, Issue 7, Page(s) 1538–1539

MeSH term(s)	Humans ; Anal Canal ; Proctectomy ; Technology
Language	English
Publishing date	2023-05-03
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	1440017-0
ISSN	1463-1318 ; 1462-8910
ISSN (online)	1463-1318
ISSN	1462-8910
DOI	10.1111/codi.16567
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Zs.A 5799: Show issues

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Article ; Online: Smartphone Application Versus Standard Instruction for Colonoscopic Preparation: A Randomized Controlled Trial.

Patel, Sunil V / Yu, David / Taylor, Connie / McKay, Jackie / Hookey, Lawrence

Journal of clinical gastroenterology

2024

Abstract: Objective: To compare smartphone application (Colonoscopic Preparation) instructions versus paper instructions for bowel preparation for colonoscopy.: Background: Adhering to bowel preparation instructions is important to ensure a high-quality ... ...

Abstract	Objective: To compare smartphone application (Colonoscopic Preparation) instructions versus paper instructions for bowel preparation for colonoscopy. Background: Adhering to bowel preparation instructions is important to ensure a high-quality colonoscopy. Patients and methods: This randomized controlled trial included individuals undergoing colonoscopy at a tertiary care hospital. Individuals were randomized (1:1) to receive instructions through a smartphone application or traditional paper instructions. The primary outcome was the quality of the bowel preparation as measured by the Boston Bowel Preparation Score. Secondary outcomes included cecal intubation and polyp detection. Patient satisfaction was assessed using a previously developed questionnaire. Results: A total of 238 individuals were randomized (n = 119 in each group), with 202 available for the intention-to-treat analysis (N = 97 in the app group and 105 in the paper group). The groups had similar demographics, indications for colonoscopy, and type of bowel preparation. The primary outcome (Boston Bowel Preparation Score) demonstrated no difference between groups (Colonoscopic Preparation app mean: 7.26 vs paper mean: 7.28, P = 0.91). There was no difference in cecal intubation (P = 0.37), at least one polyp detected (P = 0.43), or the mean number of polyps removed (P = 0.11). A higher proportion strongly agreed or agreed that they would use the smartphone app compared with paper instructions (89.4% vs 70.1%, P = 0.001). Conclusions: Smartphone instructions performed similarly to traditional paper instructions for those willing to use the application. Local patient preferences need to be considered before making changes in the method of delivery of medical instructions.
Language	English
Publishing date	2024-03-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	448460-5
ISSN	1539-2031 ; 0192-0790
ISSN (online)	1539-2031
ISSN	0192-0790
DOI	10.1097/MCG.0000000000001988
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Zs.A 1523: Show issues

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Article ; Online: Applying the fragility index to randomized controlled trials evaluating total neoadjuvant therapy for rectal cancer: A methodological survey.

McKechnie, Tyler / Brennan, Kelly / Eskicioglu, Cagla / Farooq, Ameer / Patel, Sunil V

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

2024 Volume 194, Page(s) 110148

Abstract: Background: Recently, there has been significant interest in, and adoption of, total neoadjuvant therapy (TNT) for locally advanced rectal cancer (LARC). We designed the present study to assess the robustness of the randomized controlled trials (RCTs) ... ...

Abstract	Background: Recently, there has been significant interest in, and adoption of, total neoadjuvant therapy (TNT) for locally advanced rectal cancer (LARC). We designed the present study to assess the robustness of the randomized controlled trials (RCTs) evaluating contemporary TNTs for LARC using the fragility index (FI). Materials and methods: Relevant articles were identified through a review article by Johnson et al. in the Canadian Journal of Surgery. Dichotomous outcomes within these RCTs were eligible for inclusion if the reported effect size had a p-value < 0.05. The main outcome was FI for each included outcome. Walsh et al.'s method of calculating FI was utilized. Correlations between FI and research characteristics were assessed using the Spearman's rank correlation coefficients. Risk of bias was assessed using Cochrane recommended tools. Results: Ten RCTs were identified with 25 outcomes having statistically significant differences between groups. Eleven outcomes were time-to-event outcomes, while the remainder were dichotomous outcomes. Approximately half (n = 13) were oncologic outcomes. The median FI was 2 (interquartile range [IQR] 1-16). The number of patients lost to follow-up exceeded the FI in 17 outcomes (68.0 %) and thus these results were considered "fragile". Lower FI was associated with high risk of bias (rho = -0.5594) and greater loss to follow-up (rho = -0.4394), while higher FI was associated with large study size (rho = 0.5120). Conclusions: The robustness of outcomes from trials assessing TNT for LARC was found to be questionable. Most outcomes were fragile, as determined by the FI. This survey is limited by the number of included studies.
MeSH term(s)	Humans ; Rectal Neoplasms/therapy ; Rectal Neoplasms/pathology ; Neoadjuvant Therapy ; Randomized Controlled Trials as Topic
Language	English
Publishing date	2024-02-08
Publishing country	Ireland
Document type	Journal Article ; Review
ZDB-ID	605646-5
ISSN	1879-0887 ; 0167-8140
ISSN (online)	1879-0887
ISSN	0167-8140
DOI	10.1016/j.radonc.2024.110148
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Zs.A 1926: Show issues

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Article ; Online: Venous invasion detectable only by elastic stain shows weak prognostic value in colon cancer.

Fei, Linda Y N / Patel, Sunil V / Popa, Teodora / Boudreau, Lee / Caycedo-Marulanda, Antonio / Grin, Andrea / Wang, Tao

Histopathology

2024 Volume 84, Issue 6, Page(s) 1038–1046

Abstract: Aims: Large venous invasion (VI) is prognostically significant in colon cancer. The increased use of elastic stains by pathologists results in higher VI detection rates compared to routine stains alone. This study assesses the prognostic value of VI ... ...

Abstract	Aims: Large venous invasion (VI) is prognostically significant in colon cancer. The increased use of elastic stains by pathologists results in higher VI detection rates compared to routine stains alone. This study assesses the prognostic value of VI detected by elastic versus routine stains. Methods and results: Colon cancers resected between 2014 and 2017 underwent pathology slide review for VI. Cases without VI on routine stain were stained by elastic trichrome and re-examined. Demographic, clinical, pathological and outcome data were gathered by retrospective review. Kaplan-Meier curves with log-rank tests were performed for survival categorised by VI status. Cox regression was performed for multivariate analysis. Of 277 cases, 97 (35%) showed VI by routine stain alone, with an additional 58 (21%) discovered by subsequent elastic stains. Thus, elastic trichrome increased VI detection by 60%. However, only VI detected by routine stain showed worse overall survival (P < 0.001). VI detected by elastic stain only was not prognostically different from cases without VI (P = 0.428). For stage 2 cancers, VI was not prognostically significant regardless of method of detection. For stage 3 cases, only VI detected by routine stain was prognostic for overall survival (P = 0.002) with a hazard ratio of 4.04 by multivariate regression (P = 0.028). Conclusions: VI detectable only by elastic stains do not show prognostic significance for survival in colon cancer. For pathologists with high baseline VI detections rates on routine stain, reflexive use of elastic stain may be of limited value.
MeSH term(s)	Humans ; Prognosis ; Coloring Agents ; Colorectal Neoplasms/pathology ; Neoplasm Staging ; Colonic Neoplasms/diagnosis ; Colonic Neoplasms/pathology ; Neoplasm Invasiveness/pathology ; Retrospective Studies
Chemical Substances	Coloring Agents
Language	English
Publishing date	2024-01-22
Publishing country	England
Document type	Journal Article
ZDB-ID	131914-0
ISSN	1365-2559 ; 0309-0167
ISSN (online)	1365-2559
ISSN	0309-0167
DOI	10.1111/his.15149
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Zs.A 1328: Show issues

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Article ; Online: A systematic review and meta-analysis of oncological outcomes with transanal total mesorectal excision for rectal cancer.

Neary, Emma / Ibrahim, Tarek / Verschoor, Chris P / Zhang, Lisa / Patel, Sunil V / Chadi, Sami A / Caycedo-Marulanda, Antonio

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

2024

Abstract: Aim: Transanal total mesorectal (taTME) excision is a method used to assist in the radical removal of the rectum. By adopting the concept of natural orifice surgery, it offers potential benefits over conventional techniques. Early enthusiasm for this ... ...

Abstract	Aim: Transanal total mesorectal (taTME) excision is a method used to assist in the radical removal of the rectum. By adopting the concept of natural orifice surgery, it offers potential benefits over conventional techniques. Early enthusiasm for this strategy led to its rapid and widespread adoption. The imposing of a local moratorium was precipitated by the discovery in Norway of an uncommon multifocal pattern of locoregional recurrence. The aim of this systematic review and meta-analysis was to determine the incidence of local recurrence after taTME for rectal cancer. Method: Conforming to the Cochrane Handbook for Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines checklist, a systematic review and meta-analysis was conducted. This included case series and comparative studies between taTME and preferentially laparoscopic procedures published between 2010 and 2021. Results: There were a total of 1175 studies retrieved. After removal and screening for quality and relevance, the final analysis contained 40 studies. The local recurrence rate following taTME was 3.4% (95% CI 2.9%-3.9%, I Conclusion: Our data suggest that the local recurrence for regular laparoscopic and transanal TME surgeries may be comparable, suggesting that taTME can be performed without influencing locoregional oncological outcomes in patients treated at specialized institutions and who have been cautiously selected.
Language	English
Publishing date	2024-04-08
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1440017-0
ISSN	1463-1318 ; 1462-8910
ISSN (online)	1463-1318
ISSN	1462-8910
DOI	10.1111/codi.16982
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Zs.A 5799: Show issues

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Article ; Online: The impact of robotic rectal cancer surgery at a Canadian regional cancer centre: a retrospective cohort study.

Patel, Sunil V / Wiseman, Vanessa / Zhang, Lisa / Merchant, Shaila J / Caycedo-Marulanda, Antonio / MacDonald, P Hugh

Canadian journal of surgery. Journal canadien de chirurgie

2024 Volume 67, Issue 3, Page(s) E206–E213

Abstract: Background: Although robotic surgery has several advantages over other minimally invasive surgery (MIS) techniques for rectal cancer surgery, the uptake in Canada has been limited owing to a perceived increase in cost and lack of training. The objective ...

Abstract	Background: Although robotic surgery has several advantages over other minimally invasive surgery (MIS) techniques for rectal cancer surgery, the uptake in Canada has been limited owing to a perceived increase in cost and lack of training. The objective of this study was to determine the impact of access to robotic surgery in a Canadian setting. Methods: We conducted a retrospective cohort study involving consecutive adults undergoing surgical resection for rectal cancer between 2017 and 2020. The primary exposure was access to robotic surgery. Outcomes included MIS utilization, short-term outcomes, total cost of care, and quality of surgical resection. We completed univariate and multivariate analyses. Results: We included 171 individuals in this cohort study (85 in the prerobotic period and 86 in the robotic period). The 2 groups had similar baseline characteristics. A higher proportion of individuals underwent successful MIS in the robotic phase (86% v. 46%, Conclusion: Access to robotic rectal cancer surgery increased successful completion of MIS and shortened hospital stay, with a similar total cost of care. Robotic rectal cancer surgery can enhance patient outcomes in the Canadian setting.
MeSH term(s)	Humans ; Robotic Surgical Procedures/statistics & numerical data ; Robotic Surgical Procedures/economics ; Retrospective Studies ; Rectal Neoplasms/surgery ; Male ; Female ; Middle Aged ; Aged ; Canada ; Length of Stay/statistics & numerical data ; Cancer Care Facilities/statistics & numerical data
Language	English
Publishing date	2024-05-01
Publishing country	Canada
Document type	Journal Article
ZDB-ID	410651-9
ISSN	1488-2310 ; 0008-428X
ISSN (online)	1488-2310
ISSN	0008-428X
DOI	10.1503/cjs.002523
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Zs.A 221: Show issues

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Article ; Online: Reviewing the Reviewers Potential Financial Conflicts of Interest in Editorial Boards of Surgery Journals.

Elsolh, Basheer / Brar, Amanpreet / Gyawali, Bishal / Patel, Sunil V

Annals of surgery

2021 Volume 276, Issue 6, Page(s) e1089–e1094

Abstract: Objective: To assess the prevalence, magnitude, and disclosure status of industry funding in editorial boards of surgery journals.: Summary of background data: Financial COI can bias research. Although authors seeking to publish in peer-reviewed ... ...

Abstract	Objective: To assess the prevalence, magnitude, and disclosure status of industry funding in editorial boards of surgery journals. Summary of background data: Financial COI can bias research. Although authors seeking to publish in peer-reviewed surgery journals are required to provide COI disclosures, editorial board members' COI disclosures are generally not disclosed to readers. Methods: We present a cross-sectional analysis of industry funding to editorial board members of high-impact surgery journals. We reviewed top US-based surgery journals by impact factor to determine the presence of financial COI in members of each journal's editorial board. The prevalence and magnitude of COI was determined using 2018 industry reported payments found in the Centers for Medicare and Medicaid Services Open Payments database. Journal websites were also reviewed looking for the presence of editorial board disclosure statements. Results: A total of 1002 names of editorial board members from the top 10 high-impact American surgery journals were identified. Of 688 individual physicians based in the USA, 452 (65.7%) were found to have received industry payments in 2018, totaling $21,916,503 with a median funding amount per physician of $1253 (interquartile range $156-$10,769). Funding levels varied by surgical specialty and journal. Editorial board disclosure information was found in only 3.3% of physicians. Conclusions: Industry funding to editorial board members of high impact surgery journals is prevalent and underreported. Mechanisms of disclosure for COI are needed at the editorial board level to provide readers full transparency. This would acknowledge this COI of editorial board members, and thereby attempt to potentially further reduce the risk of bias in editorial decisions.
MeSH term(s)	Aged ; United States ; Humans ; Conflict of Interest ; Cross-Sectional Studies ; Medicare ; Periodicals as Topic ; Disclosure
Language	English
Publishing date	2021-06-02
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000004929
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Article ; Online: Delayed vs. Early Appendectomy (DELAY) trial for adult patients with acute appendicitis: Study protocol for a randomized controlled trial.

Zhang, Lisa / Lemke, Madeline / Mir, Zuhaib M / Patel, Sunil V

Contemporary clinical trials

2021 Volume 102, Page(s) 106288

Abstract: Introduction: Early appendectomy in patients diagnosed with acute appendicitis is the current standard of treatment in North America. Timely intervention is suggested to avoid the complications associated with perforated appendicitis; however, safety of ...

Abstract	Introduction: Early appendectomy in patients diagnosed with acute appendicitis is the current standard of treatment in North America. Timely intervention is suggested to avoid the complications associated with perforated appendicitis; however, safety of nighttime operating is a competing concern, with mixed results demonstrated thus far. Objectives: This multi-center prospective randomized controlled trial aims to assess whether delaying appendectomy until the following morning versus early appendectomy overnight affects the rate of surgical complications in adult patients diagnosed with acute appendicitis in the evening hours. Methods: This is a randomized, controlled trial across two academic institutions with blinded outcome assessors. Patients presenting with imaging-confirmed appendicitis with an expected appendectomy between 8 pm and 4 am and within 6 h of decision to operate will be randomized to early appendectomy (with 6 h of randomization, control arm) or delayed to the following morning (after 6 am, intervention arm). Primary outcome will be 30 day postoperative complications, defined as a composite of: mortality, readmission to hospital, emergency department visit, percutaneous drain insertion, reoperation, prolonged hospital stay (>7 days), and postoperative complications. Secondary outcome measures are operative time, length of stay, time to emergency department visit and compliance to treatment. Discussion: This is a feasible and pragmatic clinical trial, intended to provide evidence for challenging decision making for the most common surgical disease worldwide. Results of this study will aid surgeons and health care administrators on how to appropriately triage appendectomies for patients with acute appendicitis who present overnight.
MeSH term(s)	Acute Disease ; Adult ; Appendectomy ; Appendicitis/surgery ; Humans ; Length of Stay ; Multicenter Studies as Topic ; Postoperative Complications/epidemiology ; Prospective Studies ; Randomized Controlled Trials as Topic ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2021-01-23
Publishing country	United States
Document type	Clinical Trial Protocol ; Journal Article
ZDB-ID	2182176-8
ISSN	1559-2030 ; 1551-7144
ISSN (online)	1559-2030
ISSN	1551-7144
DOI	10.1016/j.cct.2021.106288
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Article ; Online: Delayed Versus Early Laparoscopic Appendectomy for Adult Patients With Acute Appendicitis: A Randomized Controlled Trial.

Patel, Sunil V / Zhang, Lisa / Mir, Zuhaib M / Lemke, Madeline / Leeper, William R / Allen, Laura J / Walser, Eric / Vogt, Kelly

Annals of surgery

2023 Volume 279, Issue 1, Page(s) 88–93

Abstract: Objective: To assess whether delaying appendectomy until the following morning is non-inferior to immediate surgery in those with acute appendicitis presenting at night.: Background: Despite a lack of supporting evidence, those with acute ... ...

Abstract	Objective: To assess whether delaying appendectomy until the following morning is non-inferior to immediate surgery in those with acute appendicitis presenting at night. Background: Despite a lack of supporting evidence, those with acute appendicitis who present at night frequently have surgery delayed until the after morning. Methods: The delay trial is a noninferiority randomized controlled trial conducted between 2018 and 22 at 2 tertiary care hospitals in Canada. Adults with imaging confirmed acute appendicitis who presented at night (8:00 pm -4:00 am ). Delaying surgery until after 6:00 am was compared with immediate surgery. The primary outcome was 30-day postoperative complications. An a prior noninferiority margin of 15% was deemed clinically relevant. Results: One hundred twenty-seven of the planned 140 patients were enrolled in the Delayed Versus Early Laparoscopic Appendectomy (DELAY) trial (59 in the delayed group and 68 in the immediate group). The two groups were similar at baseline. The mean time between the decision to operate and surgery was longer in the delayed group (11.0 vs 4.4 hours, P < 0.0001). The primary outcome occurred in 6/59 (10.2%) of those in the delayed group versus 15/67 (22.4%) of those in the immediate group ( P = 0.07). The difference between groups met the a priori noninferiority criteria of +15% (risk difference -12.2%, 95% CI: -24.4% to +0.4%, test of noninferiority P < 0.0001). Conclusions: The DELAY study is the first trial to assess delaying appendectomy in those with acute appendicitis. We demonstrate the noninferiority of delaying surgery until the after morning.
MeSH term(s)	Adult ; Humans ; Acute Disease ; Appendectomy/methods ; Appendicitis/surgery ; Appendicitis/complications ; Laparoscopy/methods ; Postoperative Complications/epidemiology ; Postoperative Complications/surgery
Language	English
Publishing date	2023-07-13
Publishing country	United States
Document type	Equivalence Trial ; Journal Article ; Randomized Controlled Trial
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000005996
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Article ; Online: Emergency Colorectal Surgery in Those with Cirrhosis: A Population-based Study Assessing Practice Patterns, Outcomes and Predictors of Mortality.

Zhang, Lisa / Brennan, Kelly / Flemming, Jennifer A / Nanji, Sulaiman / Djerboua, Maya / Merchant, Shaila J / Caycedo-Marulanda, Antonio / Patel, Sunil V

Journal of the Canadian Association of Gastroenterology

2023 Volume 7, Issue 2, Page(s) 160–168

Abstract: Background: Those with cirrhosis who require emergency colorectal surgery are at risk for poor outcomes. Although risk predictions models exists, these tools are not specific to colorectal surgery, nor were they developed in a contemporary setting. Thus, ...

Abstract	Background: Those with cirrhosis who require emergency colorectal surgery are at risk for poor outcomes. Although risk predictions models exists, these tools are not specific to colorectal surgery, nor were they developed in a contemporary setting. Thus, the objective of this study was to assess the outcomes in this population and determine whether cirrhosis etiology and/or the Model for End Stage Liver Disease (MELD-Na) is associated with mortality. Methods: This population-based study included those with cirrhosis undergoing emergent colorectal surgery between 2009 and 2017. All eligible individuals in Ontario were identified using administrative databases. The primary outcome was 90-day mortality. Results: Nine hundred and twenty-seven individuals (57%) (male) were included. The most common cirrhosis etiology was non-alcoholic fatty liver disease (NAFLD) (50%) and alcohol related (32%). Overall 90-day mortality was 32%. Multivariable survival analysis demonstrated those with alcohol-related disease were at increased risk of 90-day mortality (hazards ratio [HR] 1.53, 95% confidence interval [CI] 1.2-2.0 vs. NAFLD [ref]). Surgery for colorectal cancer was associated with better survival (HR 0.27, 95%CI 0.16-0.47). In the subgroup analysis of those with an available MELD-Na score ( Conclusion: Individuals with cirrhosis who require emergent colorectal surgery have a high risk of postoperative complications, including mortality. Increasing MELD-Na score is associated with mortality and can be used to risk stratify individuals.
Language	English
Publishing date	2023-10-20
Publishing country	England
Document type	Journal Article
ZDB-ID	2940642-0
ISSN	2515-2092 ; 2515-2084
ISSN (online)	2515-2092
ISSN	2515-2084
DOI	10.1093/jcag/gwad040
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