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  1. Article ; Online: Transanal versus conventional total mesorectal excision for rectal cancer using the IDEAL framework for implementation.

    Robertson, R L / Karimuddin, A / Phang, T / Raval, M / Brown, C

    BJS open

    2021  Volume 5, Issue 2

    Abstract: Background: Transanal total mesorectal excision (TaTME) is an innovative technique for distal rectal cancer dissection. It has been shown to have similar short-term outcomes to conventional open and laparoscopic total mesorectal excision (cTME), but ... ...

    Abstract Background: Transanal total mesorectal excision (TaTME) is an innovative technique for distal rectal cancer dissection. It has been shown to have similar short-term outcomes to conventional open and laparoscopic total mesorectal excision (cTME), but recent studies have raised concern about increased morbidity and local recurrence rates. The aim of this study was to assess outcomes after TaTME versus cTME for rectal cancer.
    Methods: TaTME was implemented in 2014 using IDEAL principles in a single institution. The institution maintains databases for all patients undergoing rectal cancer surgery. This retrospective review compared data collected from all patients who had TaTME with those from a propensity-matched cohort of patients who underwent cTME. The primary outcome was a composite pathological measure combining margin status and quality of total mesorectal excision (TME). Short-term clinical and survival outcomes were also measured.
    Results: Propensity matching created 109 matched pairs for analysis. Nine patients (8.3 per cent) undergoing TaTME had positive margins and/or incomplete TME, compared with 11 (10.5 per cent) undergoing cTME (P = 0.65). There were no significant differences in morbidity between the TaTME and cTME groups, including number of anastomotic leaks (13.8 versus 18.3 per cent; P = 0.37). The estimated 3-year local recurrence-free survival rate was 96.3 per cent in both groups (P = 0.39). Estimated 3-year overall (93.6 per cent for TaTME versus 94.5 per cent for cTME; P = 0.09) and disease-free (88.1 versus 76.1 per cent; P = 0.90) survival rates were similar.
    Conclusion: TaTME provided similar outcomes to cTME for rectal cancer with the application of IDEAL principles.
    MeSH term(s) Aged ; Anastomotic Leak/etiology ; Digestive System Surgical Procedures ; Female ; Humans ; Laparoscopy/methods ; Male ; Middle Aged ; Neoplasm Recurrence, Local/pathology ; Postoperative Complications/etiology ; Propensity Score ; Rectal Neoplasms/surgery ; Rectum/surgery ; Retrospective Studies ; Transanal Endoscopic Surgery/methods ; Treatment Outcome
    Language English
    Publishing date 2021-04-22
    Publishing country England
    Document type Journal Article
    ISSN 2474-9842
    ISSN (online) 2474-9842
    DOI 10.1093/bjsopen/zrab002
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  2. Article ; Online: Oncological Outcomes of Transanal Endoscopic Surgery for the Surgical Management of T2 and T3 Rectal Cancer.

    Johnson, Garrett G R J / Robertson, Reagan L / Vergis, Ashley / Raval, Manoj / Phang, Terry / Karimuddin, Ahmer / Brown, Carl

    Diseases of the colon and rectum

    2023  Volume 66, Issue 7, Page(s) 1012–1021

    Abstract: Background: Transanal endoscopic surgery is an organ-sparing treatment for early rectal cancer. Patients with advanced lesions are recommended for total mesorectal excision. However, some patients have prohibitive comorbidities or refuse major surgery.!# ...

    Abstract Background: Transanal endoscopic surgery is an organ-sparing treatment for early rectal cancer. Patients with advanced lesions are recommended for total mesorectal excision. However, some patients have prohibitive comorbidities or refuse major surgery.
    Objective: To assess the cancer outcomes of patients with T2 or T3 rectal cancers who received transanal endoscopic surgery as their sole surgical treatment.
    Design: This study used a prospectively maintained database.
    Setting: A tertiary hospital in Canada.
    Patients: Patients who underwent transanal endoscopic surgery for pathology-confirmed T2 or T3 rectal adenocarcinomas from 2007-2020 were included.
    Main outcome measures: Disease-free survival and overall survival, stratified by tumor stage and reason for transanal endoscopic surgery.
    Results: Among the included 132 patients (T2, n = 96; T3, n = 36), average follow-up was 22 months. Twenty-eight decline oncologic resection, whereas 104 had preclusive comorbidities. Fifteen patients (11.4%) had disease recurrence (4 local, 11 metastatic). Three-year disease-free survival was 86.5% (95% CI, 77.1-95.9) for T2 and 67.9% (95% CI, 46.3-89.5) for T3 tumors. Mean disease-free survival was longer for T2 (75.0 mo; 95% CI, 67.8-82.1) compared to T3 cancers (50 mo; 95% CI, 37.7-62.3; p = 0.037). Three-year disease-free survival for patients who declined radical excision was 84.0% (95% CI, 67.1-100) versus 80.7% (95% CI, 69.7-91.7) in patients too comorbid for surgery. Three-year overall survival rate was 84.9% (95% CI, 73.9-95.9) for T2 and 49.0% (95% CI, 26.7-71.3) for T3 tumors. Patients who declined radical resection had similar 3-year overall survival (89.7%; 95% CI, 76.2-100) compared to patients who were unable to undergo excision because of medical comorbidities (98.1%; 95% CI, 95.6-100).
    Limitations: Small sample, single institution, and surgeon experience.
    Conclusions: Oncologic outcomes are compromised in patients treated by transanal endoscopic surgery for T2 and T3 rectal cancer. Transanal endoscopic surgery remains an option for informed patients who prefer to avoid radical resection. See Video Abstract at http://links.lww.com/DCR/C200 .
    Resultados oncolgicos de la ciruga endoscpica transanal para el manejo quirrgico del cncer de recto t y t: ANTECEDENTES:La cirugía endoscópica transanal es un tratamiento de conservación de órganos para el cáncer de recto en estadio temprano. A los pacisentes con lesiones avanzadas se les recomienda la escisión total del mesorrecto. Sin embargo, algunos pacientes tienen comorbilidades prohibitivas o rechazan una cirugía mayor.OBJETIVO:Evaluar los resultados del cáncer de pacientes con cáncer de recto T2 o T3 que recibieron cirugía endoscópica transanal como único tratamiento quirúrgico.DISEÑO:Este estudio utilizó una base de datos mantenida prospectivamente.ENTORNO CLINICO:Un hospital terciario en CanadáPACIENTES:Aquellos que se sometieron a cirugía endoscópica transanal por adenocarcinomas rectales T2 o T3 confirmados por patología de 2007-2020. Se excluyeron los pacientes cuya cirugía se realizó por recurrencia del cáncer o posteriormente fueron sometidos a resección radical.PRINCIPALES MEDIDAS DE VALORACIÓN:Supervivencia libre de enfermedad y supervivencia global, estratificada por estadio del tumor y motivo de la cirugía endoscópica transanal.RESULTADOS:Se incluyeron 132 pacientes (T2, n = 96; T3, n = 36). El seguimiento medio fue de 22 meses (DE ± 23,4). 104 pacientes tenían comorbilidades significativas, mientras que 28 rechazaron la resección oncológica. Quince pacientes (11,4%) tuvieron recurrencia de la enfermedad (4 locales, 11 metastásicos). La supervivencia libre de enfermedad a los tres años para los tumores T2 fue del 86,5 % (IC del 95%: 77,1-95,9) y del 67,9% (IC del 95%: 46,3-89,5) para los tumores T3. La supervivencia libre de enfermedad media fue más prolongada para los cánceres T2 (75,0 meses, IC del 95%: 67,8 a 82,1) en comparación con los cánceres T3 (50 meses, IC del 95%: 37,7 a 62,3, p = 0,037). La supervivencia sin enfermedad a los tres años para los pacientes que rechazaron la escisión mesorrectal total fue del 84,0% (IC del 95%: 67,1-100), mientras que los pacientes con demasiada comorbilidad médica para la cirugía tuvieron una supervivencia sin enfermedad a los tres años del 80,7% (IC del 95%: 69.7-91.7). La supervivencia general a los tres años fue del 84,9% (IC del 95%: 73,9 a 95,9) para los tumores T2 y del 49,0% (IC del 95%: 26,7 a 71,3) para los tumores T3. Los pacientes que rechazaron la resección radical tuvieron una supervivencia general similar a los tres años (89,7%, IC del 95%: 76,2-100), en comparación con los pacientes que no pudieron someterse a una escisión mesorrectal total debido a comorbilidades médicas (98,1%, IC del 95%: 95,6-100).LIMITACIONES:Muestra pequeña, institución única, experiencia del cirujano.CONCLUSIONES:Los resultados oncológicos están comprometidos en pacientes tratados con cirugía endoscópica transanal por cáncer de recto T2 y T3. Sin embargo, la cirugía endoscópica transanal sigue siendo una opción para pacientes informados que prefieren evitar la resección radical. Consulte Video Resumen en http://links.lww.com/DCR/C200 . (Traducción-Dr. Ingrid Melo ).
    MeSH term(s) Humans ; Treatment Outcome ; Neoplasm Recurrence, Local/epidemiology ; Neoplasm Recurrence, Local/pathology ; Rectal Neoplasms/pathology ; Transanal Endoscopic Surgery ; Adenocarcinoma/pathology ; Neoplasm Staging ; Retrospective Studies
    Language English
    Publishing date 2023-03-06
    Publishing country United States
    Document type Video-Audio Media ; Journal Article
    ZDB-ID 212581-x
    ISSN 1530-0358 ; 0012-3706
    ISSN (online) 1530-0358
    ISSN 0012-3706
    DOI 10.1097/DCR.0000000000002617
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  3. Article ; Online: R and Bioconductor solutions for alternative splicing detection.

    Phang, Tzulip

    Human genomics

    2009  Volume 4, Issue 2, Page(s) 131–135

    Abstract: The detection of alternative splicing using microarray technology involves multiple computational steps: normalisation, filtering, detection and visualisation. In this review, these analyses are approached using the R and Bioconductor open-source ... ...

    Abstract The detection of alternative splicing using microarray technology involves multiple computational steps: normalisation, filtering, detection and visualisation. In this review, these analyses are approached using the R and Bioconductor open-source computation solution. There is some discussion on how to integrate different Bioconductor packages, and some of their major features are demonstrated. In addition, the Xmap Genome Browser is incorporated as an integral part of the analysis and annotation workflow.
    MeSH term(s) Algorithms ; Alternative Splicing ; Database Management Systems ; Databases, Genetic ; Humans ; Internet ; Oligonucleotide Array Sequence Analysis ; Software
    Language English
    Publishing date 2009-12-28
    Publishing country England
    Document type Journal Article
    ZDB-ID 2147618-4
    ISSN 1479-7364 ; 1479-7364
    ISSN (online) 1479-7364
    ISSN 1479-7364
    DOI 10.1186/1479-7364-4-2-131
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  4. Article ; Online: The relationship between perceptions of shared decision-making and patient-reported outcomes in a cross-sectional cohort of haemorrhoidectomy patients.

    Merali, Khalil / Karimuddin, Ahmer / Crump, Trafford / Brown, Carl / Phang, Terry / Raval, Manoj / Liu, Guiping / Sutherland, Jason M

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

    2022  Volume 24, Issue 4, Page(s) 504–510

    Abstract: Aim: Shared decision-making between patients and clinicians is important to surgical practice and patients' perceptions of their healthcare experience. This study aims to measure associations between patients' perceptions of their shared decision-making ...

    Abstract Aim: Shared decision-making between patients and clinicians is important to surgical practice and patients' perceptions of their healthcare experience. This study aims to measure associations between patients' perceptions of their shared decision-making (SDM) process and health-related quality of life among a cohort of patients choosing surgical management of an elective surgical procedure, haemorrhoidectomy.
    Methods: This study is a single-site study based in Vancouver, Canada. Consecutive patients of five colorectal surgeons registered for elective haemorrhoidectomy between September 2016 and June 2020 were eligible to participate. Participants completed the CollaboRATE instrument which measures patients' perceptions of their SDM after the surgical consultation, along with a number of other patient-reported outcomes.
    Results: The participation rate was 45.3%, with 157 patients scheduled for haemorrhoidectomy providing complete information. Unadjusted results found that participants having the most comorbidities reported better communication with their surgeon. The adjusted results show that socioeconomic status and depression were associated with lower CollaboRATE scores. There was no effect of sex, pain interference, anxiety or perceived health status on participants' CollaboRATE scores.
    Conclusion: This study found evidence that participants with lower economic status or those reporting depressive symptoms had worse perceptions of their SDM process with their surgeon. These findings suggest that special attention should be paid to the surgical decision-making process for these patient populations.
    MeSH term(s) Cross-Sectional Studies ; Decision Making, Shared ; Hemorrhoidectomy ; Humans ; Patient Reported Outcome Measures ; Quality of Life
    Language English
    Publishing date 2022-01-21
    Publishing country England
    Document type Journal Article
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.16039
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  5. Article ; Online: Microenvironmental regulation of T-cells in pulmonary hypertension.

    Plecitá-Hlavatá, Lydie / Brázdová, Andrea / Křivonosková, Monika / Hu, Cheng-Jun / Phang, Tzu / Tauber, Jan / Li, Min / Zhang, Hui / Hoetzenecker, Konrad / Crnkovic, Slaven / Kwapiszewska, Grazyna / Stenmark, Kurt R

    Frontiers in immunology

    2023  Volume 14, Page(s) 1223122

    Abstract: Introduction: In pulmonary hypertension (PH), pulmonary arterial remodeling is often accompanied by perivascular inflammation. The inflammation is characterized by the accumulation of activated macrophages and lymphocytes within the adventitial stroma, ... ...

    Abstract Introduction: In pulmonary hypertension (PH), pulmonary arterial remodeling is often accompanied by perivascular inflammation. The inflammation is characterized by the accumulation of activated macrophages and lymphocytes within the adventitial stroma, which is comprised primarily of fibroblasts. The well-known ability of fibroblasts to secrete interleukins and chemokines has previously been implicated as contributing to this tissue-specific inflammation in PH vessels. We were interested if pulmonary fibroblasts from PH arteries contribute to microenvironmental changes that could activate and polarize T-cells in PH.
    Methods: We used single-cell RNA sequencing of intact bovine distal pulmonary arteries (dPAs) from PH and control animals and flow cytometry, mRNA expression analysis, and respirometry analysis of blood-derived bovine/human T-cells exposed to conditioned media obtained from pulmonary fibroblasts of PH/control animals and IPAH/control patients (CM-(h)PH Fibs vs CM-(h)CO Fibs).
    Results: Single-cell RNA sequencing of intact bovine dPAs from PH and control animals revealed a pro-inflammatory phenotype of CD4+ T-cells and simultaneous absence of regulatory T-cells (FoxP3+ Tregs). By exposing T-cells to CM-(h)PH Fibs we stimulated their proinflammatory differentiation documented by increased IFNγ and decreased IL4, IL10, and TGFβ mRNA and protein expression. Interestingly, we demonstrated a reduction in the number of suppressive T-cell subsets, i.e., human/bovine Tregs and bovine γδ T-cells treated with CM-(h)PH-Fibs. We also noted inhibition of anti-inflammatory cytokine expression (IL10, TGFβ, IL4). Pro-inflammatory polarization of bovine T-cells exposed to CM-PH Fibs correlated with metabolic shift to glycolysis and lactate production with increased prooxidant intracellular status as well as increased proliferation of T-cells. To determine whether metabolic reprogramming of PH-Fibs was directly contributing to the effects of PH-Fibs conditioned media on T-cell polarization, we treated PH-Fibs with the HDAC inhibitor SAHA, which was previously shown to normalize metabolic status and examined the effects of the conditioned media. We observed significant suppression of inflammatory polarization associated with decreased T-cell proliferation and recovery of mitochondrial energy metabolism.
    Conclusion: This study demonstrates how the pulmonary fibroblast-derived microenvironment can activate and differentiate T-cells to trigger local inflammation, which is part of the vascular wall remodeling process in PH.
    MeSH term(s) Humans ; Animals ; Cattle ; Hypertension, Pulmonary/metabolism ; Culture Media, Conditioned/metabolism ; Interleukin-10 ; Interleukin-4 ; Inflammation/metabolism ; T-Lymphocyte Subsets/metabolism ; Transforming Growth Factor beta
    Chemical Substances Culture Media, Conditioned ; Interleukin-10 (130068-27-8) ; Interleukin-4 (207137-56-2) ; Transforming Growth Factor beta
    Language English
    Publishing date 2023-07-11
    Publishing country Switzerland
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2606827-8
    ISSN 1664-3224 ; 1664-3224
    ISSN (online) 1664-3224
    ISSN 1664-3224
    DOI 10.3389/fimmu.2023.1223122
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  6. Article ; Online: The impact of laparoscopic technique on the rate of perineal hernia after abdominoperineal resection of the rectum.

    Black, Anna J / Karimuddin, Ahmer / Raval, Manoj / Phang, Terry / Brown, Carl J

    Surgical endoscopy

    2020  Volume 35, Issue 6, Page(s) 3014–3024

    Abstract: Aim: To determine the impact of surgical technique on the incidence of perineal hernia after abdominoperineal resection (APR).: Methods: A retrospective analysis was performed on patients who underwent APR between May 2007 and March 2018 at our ... ...

    Abstract Aim: To determine the impact of surgical technique on the incidence of perineal hernia after abdominoperineal resection (APR).
    Methods: A retrospective analysis was performed on patients who underwent APR between May 2007 and March 2018 at our institution using our prospectively maintained Colorectal Cancer Database. Demographic and clinical parameters were compared between the open APR (OAPR) and laparoscopic APR (LAPR) groups using Student's t test, chi-squared, or Fisher's exact test. Putative risk factors were then analyzed using a Cox proportional hazard model with perineal hernia as the outcome.
    Results: The study included 261 patients (191 OAPR and 70 LAPR). Intraoperative blood loss (596.0 ± 633.4 vs. 307.0 ± 307.2 mL, p < 0.001), duration of OR (249.6 ± 115.6 vs. 212.6 ± 75.1 min, p = 0.004), and length of stay (15.6 ± 18.0 vs. 10.4 ± 12.6 days, p = 0.031) were all greater for OAPR than LAPR patients, but wound complications other than hernia did not differ significantly. Perineal hernia was observed in 2.1% of OAPR and 12.9% of LAPR patients. In multivariable analysis, significant risk factors for perineal hernia were age, laparoscopic technique, and closure of the perineal wound with myocutaneous flap (HR 1.08, 11.13, and 31.51, respectively, all p < 0.05).
    Conclusions: LAPR, although associated with less blood loss and shorter length of hospital stay than OAPR, was a significant risk factor for perineal hernia.
    MeSH term(s) Hernia ; Humans ; Laparoscopy ; Perineum/surgery ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Proctectomy/adverse effects ; Rectal Neoplasms/surgery ; Rectum ; Retrospective Studies
    Language English
    Publishing date 2020-06-22
    Publishing country Germany
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639039-0
    ISSN 1432-2218 ; 0930-2794
    ISSN (online) 1432-2218
    ISSN 0930-2794
    DOI 10.1007/s00464-020-07746-7
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  7. Article ; Online: Health and quality of life among a cohort of patients having lateral internal sphincterotomy for anal fissures.

    Sutherland, J M / Karimuddin, A / Liu, G / Crump, T / Akbar, H / Phang, T / Redfern, K / Manoharan, S / Brown, C J / Raval, M J

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

    2020  Volume 22, Issue 11, Page(s) 1658–1666

    Abstract: Aim: The aim of this study is to report changes in health-related quality of life attributable to lateral internal sphincterotomy for treatment of anal fissure. There is very little evidence on whether the overall health-related quality of life of ... ...

    Abstract Aim: The aim of this study is to report changes in health-related quality of life attributable to lateral internal sphincterotomy for treatment of anal fissure. There is very little evidence on whether the overall health-related quality of life of patients is detrimentally affected by the condition, or which aspects of self-perceived health status improve after lateral internal sphincterotomy. This study will articulate which aspects of health tend to improve and guide postoperative expectations appropriately. Knowledge gained from this study may also identify gaps in an individual patient's episode of care.
    Method: Patients were prospectively identified when they consented to surgical treatment of their anal fissure and were contacted by phone to participate. Participants completed a number of patient-reported outcomes preoperatively and 6 months postoperatively. Faecal incontinence-related quality of life, pain and depression were measured at both time points. The severity of faecal incontinence was measured at both times.
    Results: Participants reported high levels of pain preoperatively. Postoperatively, improvement in pain exceeded the threshold of clinical relevance (P < 0.01). Thirty-five per cent of participants reported significant effects of faecal incontinence preoperatively, while 26% did so postoperatively. Participants with multiple comorbidities were more likely to report faecal incontinence postoperatively than preoperatively.
    Conclusion: This study reports that lateral internal sphincterotomy improved pain symptoms without adverse effects on continence. Not all domains of health-related quality of life were similarly positively affected by anal fissure repair.
    MeSH term(s) Anal Canal/surgery ; Chronic Disease ; Fissure in Ano/surgery ; Humans ; Lateral Internal Sphincterotomy ; Quality of Life ; Treatment Outcome
    Language English
    Publishing date 2020-07-04
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.15191
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  8. Article ; Online: Study protocol evaluating the use of bowel stimulation before loop ileostomy closure to reduce postoperative ileus: a multicenter randomized controlled trial.

    Garfinkle, R / Trabulsi, N / Morin, N / Phang, T / Liberman, S / Feldman, L / Fried, G / Boutros, M

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

    2017  Volume 19, Issue 11, Page(s) 1024–1029

    Abstract: Aim: Postoperative ileus is the most commonly observed morbidity following ileostomy closure. Studies have demonstrated that the defunctionalized bowel of a loop ileostomy undergoes a series of functional and structural changes, such as atrophy of the ... ...

    Abstract Aim: Postoperative ileus is the most commonly observed morbidity following ileostomy closure. Studies have demonstrated that the defunctionalized bowel of a loop ileostomy undergoes a series of functional and structural changes, such as atrophy of the intestinal villi and muscular layers, which may contribute to ileus. A single-centre study in Spain demonstrated that preoperative bowel stimulation via the distal limb of the loop ileostomy decreased postoperative ileus, length of stay and time to gastrointestinal function.
    Method: A multicentre randomized controlled trial involving patients from Canadian institutions was designed to evaluate the effect of preoperative bowel stimulation before ileostomy closure on postoperative ileus. Stimulation will include canalizing the distal limb of the ileostomy loop with an 18Fr Foley catheter and infusing it with a solution of 500 ml of normal saline mixed with 30 g of a thickening agent (Nestle
    Discussion: This manuscript discusses the potential benefits of preoperative bowel stimulation in improving postoperative outcomes and outlines our protocol for the first multicenter study to evaluate preoperative bowel stimulation before ileostomy closure. The results of this study could have considerable implications for the care of patients undergoing ileostomy closure.
    MeSH term(s) Adult ; Aged ; Canada ; Clinical Protocols ; Electric Stimulation Therapy/methods ; Female ; Humans ; Ileostomy/adverse effects ; Ileostomy/methods ; Ileus/etiology ; Ileus/prevention & control ; Intestinal Diseases/etiology ; Intestinal Diseases/prevention & control ; Intestines ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications/etiology ; Postoperative Complications/prevention & control ; Postoperative Period ; Preoperative Care/methods ; Recovery of Function ; Time Factors ; Treatment Outcome ; Young Adult
    Language English
    Publishing date 2017-11
    Publishing country England
    Document type Journal Article ; Multicenter Study ; Randomized Controlled Trial
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.13720
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  9. Article ; Online: Report from the 24th Annual Western Canadian Gastrointestinal Cancer Consensus Conference on Colorectal Cancer, Richmond, British Columbia, 28-29, October 2022.

    Gill, Sharlene / Ahmed, Shahid / Anderson, Brady / Berry, Scott / Lim, Howard / Phang, Terry / Sharma, Ankur / Solar Vasconcelos, Joao Paulo / Gill, Karamjit / Iqbal, Mussawar / Tankel, Keith / Chan, Theresa / Recsky, Magdalena / Nuk, Jennifer / Paul, James / Mahmood, Shazia

    Current oncology (Toronto, Ont.)

    2023  Volume 30, Issue 9, Page(s) 7964–7983

    Abstract: The 24th annual Western Canadian Gastrointestinal Cancer Consensus Conference (WCGCCC) was held in Richmond, British Columbia, on 28-29 October 2022. The WCGCCC is an interactive multidisciplinary conference attended by healthcare professionals from ... ...

    Abstract The 24th annual Western Canadian Gastrointestinal Cancer Consensus Conference (WCGCCC) was held in Richmond, British Columbia, on 28-29 October 2022. The WCGCCC is an interactive multidisciplinary conference attended by healthcare professionals from across Western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba) who are involved in the care of patients with gastrointestinal cancer. Surgical, medical, and radiation oncologists; pathologists; radiologists; and allied health care professionals such as dieticians, nurses and a genetic counsellor participated in presentation and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses current issues in the management of colorectal cancer.
    Language English
    Publishing date 2023-08-29
    Publishing country Switzerland
    Document type Congress
    ZDB-ID 1236972-x
    ISSN 1718-7729 ; 1198-0052
    ISSN (online) 1718-7729
    ISSN 1198-0052
    DOI 10.3390/curroncol30090579
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  10. Article ; Online: Transanal total mesorectal excision for abdominoperineal resection is associated with poor oncological outcomes in rectal cancer patients: A word of caution from a multicentric Canadian cohort study.

    Caycedo-Marulanda, Antonio / Verschoor, Chris P / Brown, Carl P / Karimuddin, Ahmer / Raval, Manoj / Phang, Terry / Vikis, Elena / Melich, George / Patel, Sunil V

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

    2022  Volume 24, Issue 4, Page(s) 380–387

    Abstract: Aim: The main objective of this study was to compare the oncological outcomes of patients undergoing abdominoperineal resection (APR) versus low anterior resection (LAR) through a transanal total mesorectal excision (taTME) approach.: Method: A total ...

    Abstract Aim: The main objective of this study was to compare the oncological outcomes of patients undergoing abdominoperineal resection (APR) versus low anterior resection (LAR) through a transanal total mesorectal excision (taTME) approach.
    Method: A total of 360 adult patients with a diagnosis of rectal cancer were enrolled at participating centres from the Canadian taTME Expert Collaboration. Forty-three patients received taTME-APR and received 317 taTME-LAR. Demographic, operative, pathological and follow-up data were collected and merged into a single database. Results are presented as hazard ratio (HR) and 95% confidence interval. All analyses were performed in the R environment (v.3.6).
    Results: The proportion of patients with a positive circumferential radial margin status was higher in the taTME-APR group than the taTME-LAR group (21% vs. 9%, p = 0.001). Complete TME was achieved in 91% of those undergoing APR compared with 96% of those undergoing LAR (p = 0.25). APR was associated with a greater rate of local recurrence relative to LAR, although it was not significant [crude HR = 3.53 (95% CI 0.92-13.53)]. Circumferential margin positivity was significantly associated with a higher rate of systemic recurrence [crude HR = 3.59 (95% CI 1.38-9.3)].
    Conclusion: Our results demonstrate inferior outcomes in those undergoing taTME-APR compared with taTME-LAR. The use of this technique for this particular indication needs to be carefully considered.
    MeSH term(s) Adult ; Canada ; Cohort Studies ; Humans ; Laparoscopy/methods ; Margins of Excision ; Postoperative Complications/etiology ; Proctectomy/methods ; Rectal Neoplasms/etiology ; Rectal Neoplasms/surgery ; Rectum/surgery ; Transanal Endoscopic Surgery/methods ; Treatment Outcome
    Language English
    Publishing date 2022-01-10
    Publishing country England
    Document type Journal Article
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.16033
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