Anthony Antoniou - Academia.edu (original) (raw)

Papers by Anthony Antoniou

Research paper thumbnail of Advances in Colorectal Cancer

BioMed Research International, 2016

Research paper thumbnail of Saving the NHS: a surgical perspective

British Journal of Healthcare Management, 2012

Research paper thumbnail of Differences in presentation and progression between severe FIC1 and BSEP deficiencies

Journal of Hepatology, 2010

Background & Aims-Progressive familial intrahepatic cholestasis (PFIC) with normal serum levels o... more Background & Aims-Progressive familial intrahepatic cholestasis (PFIC) with normal serum levels of gamma-glutamyltranspeptidase can result from mutations in ATP8B1 (encoding familial intrahepatic cholestasis 1 [FIC1]) or ABCB11 (encoding bile salt export pump [BSEP]). We evaluated clinical and laboratory features of disease in patients diagnosed with PFIC, who carried mutations in ATP8B1 (FIC1 deficiency) or ABCB11 (BSEP deficiency). Our goal was to identify features that distinguish presentation and course of these 2 disorders, thus facilitating diagnosis and elucidating the differing consequences of ATP8B1 and ABCB11 mutations. Methods-A retrospective multi-center study was conducted, using questionnaires and chart review. Available clinical and biochemical data from 145 PFIC patients with mutations in either ATP8B1 (61 "FIC1 patients") or ABCB11 (84 "BSEP patients") were evaluated. Results-At presentation, serum aminotransferase and bile salt levels were higher in BSEP patients; serum alkaline phosphatase values were higher, and serum albumin values were lower, in FIC1 patients. Elevated white blood cell counts, and giant or multinucleate cells at liver biopsy, were more common in BSEP patients. BSEP patients more often had gallstones and portal hypertension. Diarrhea, pancreatic disease, rickets, pneumonia, abnormal sweat tests, hearing impairment, and poor growth were more common in FIC1 patients. Among BSEP patients, the course of disease was less rapidly progressive in patients bearing the D482G mutation. Conclusions-Severe forms of FIC1 and BSEP deficiency differed. BSEP patients manifested more severe hepatobiliary disease, while FIC1 patients showed greater evidence of extrahepatic disease.

Research paper thumbnail of Should Laparoscopic Cholecystectomy be Practiced in the Developing World?

Research paper thumbnail of Surgical therapy for appendiceal neuroendocrine tumours: is appendicectomy adequate?

Endocrine Abstracts, 2017

Research paper thumbnail of Evolution in the Management of Presacral Tumours

European Journal of Surgical Oncology, 2020

Research paper thumbnail of Perineal Flap Reconstruction Following Pelvic Exenteration

European Journal of Surgical Oncology, 2020

Background: Presacral tumours represent a small group of pathologies encountered by colorectal su... more Background: Presacral tumours represent a small group of pathologies encountered by colorectal surgeons where specialist input is likely to be required. They represent a disparate number of pathological phemonmena which are classified together through a shared anatomical association.

Research paper thumbnail of PTH-040 Laparoscopic-assisted colonoscopic polypectomy is a safe and effective option for difficult polyps: a single tertiary referral centre experience

Gut, 2015

There was a significant difference in diagnostic yield between groups A vs B and A vs C (p = <0.0... more There was a significant difference in diagnostic yield between groups A vs B and A vs C (p = <0.05). When comparing patients with abnormal LFT (B+C) against patients with normal LFT (A+D), there was also a significant difference (p = <0.05).

Research paper thumbnail of Learning Curve for the Management of Recurrent and Locally Advanced Primary Rectal Cancer: a single team's experience

European Journal of Surgical Oncology, 2010

Aim The study aimed to define the learning curve required to gain satisfactory training to perfor... more Aim The study aimed to define the learning curve required to gain satisfactory training to perform pelvic exenterative surgery for recurrent or locally advanced primary rectal cancer. Method Consecutive patients undergoing exenterative pelvic surgery for recurrent and locally advanced primary rectal cancer, by one surgical team, between 2006 and 2011 were studied. They were divided into quartiles (Q1-Q4) according to the date of surgery. A riskadjusted cumulative sum (RA-CUSUM) model was used to evaluate the learning curve. The chi-squared test with gamma ordinal was used to assess the change with time in the four quartiles. Results One hundred patients (70 males; median age 61 (25-85) years; 55 primary cancers) were included in the study. Thirty patients underwent abdominosacral resection. The number of patients who underwent plastic reconstruction (n = 53) increased from 12 in Q1 to 15 in Q4 (P = 0.781). The median operation time, intra-operative blood loss and hospital stay were 8 (3-17) h, 1.5 (0.1-17) l and 15 (9-82) days respectively. There was no significant change with time. Complete resection (R0) was achieved in 78 patients. Microscopic (R1) or macroscopic (R2) residual disease was present in 15 and seven patients respectively. The number of major complications was 20, and minor 30. RA-CU-SUM analysis demonstrated an improvement in any complications after 14, in major after 12 and in minor after 25 operations. Conclusion Pelvic exenterative surgery for recurrent or locally advanced primary rectal cancer is complex and requires a minimum of 14 cases for an expert colorectal surgeon to gain the desirable training and experience to improve morbidity.

Research paper thumbnail of The value of extended lateral pelvic lymphadenectomy in recurrent and locally advanced primary rectal cancer

European Journal of Surgical Oncology, 2010

Research paper thumbnail of Diagnostic accuracy and value of magnetic resonance imaging (MRI) in planning exenterative pelvic surgery for advanced colorectal cancer

European Journal of Cancer, 2013

To assess the diagnostic accuracy of magnetic resonance imaging (MRI) in detecting colorectal tum... more To assess the diagnostic accuracy of magnetic resonance imaging (MRI) in detecting colorectal tumour invasion according to seven intrapelvic compartments for planning exenterative pelvic surgery. Sixty-three consecutive patients underwent preoperative MRI planning for exenterative surgery, defined as operative excision beyond conventional mesenteric planes for locally advanced (n=23) and recurrent (n=41) pelvic colorectal cancer. The institutional research committee approved of the study and waived the need for a consent form as the images were retrospectively assessed. Two radiologists reported tumour invasion for each of seven anatomic surgical resection compartments, blinded to histopathology and the intraoperative findings. Sensitivity, specificity and predictive values were calculated for the seven intrapelvic compartments. Cox regression analysis was used to calculate the risk of death and recurrence. Overall interobserver agreement was assessed using Cohen&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Kappa coefficient (k). The sensitivity of MRI was ≥93.3% in all but the lateral compartment where it was 89.3%. Specificity for the posterior (82.2%) and anterior compartments below the peritoneal reflection (86.4%) was lower compared to the other compartments. Agreement between the two radiologists was found to be good or very good for all compartments (k&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.72). An MRI diagnosis of tumour invasion in the anterior compartment above the peritoneal reflection was associated with a poorer survival (p=0.012). MRI is accurate in predicting the extent of colorectal tumour within the pelvis and therefore can be used to determine the type of surgery required for curative resection. It should always be used to stage patients with advanced colorectal pelvic cancer.

Research paper thumbnail of Consensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes

British Journal of Surgery, 2013

Consensus abstract Background The management of primary rectal cancer beyond total mesorectal exc... more Consensus abstract Background The management of primary rectal cancer beyond total mesorectal excision planes (PRC-bTME) and recurrent rectal cancer (RRC) is challenging. There is global variation in standards and no guidelines exist. To achieve cure most patients require extended, multivisceral, exenterative surgery, beyond conventional total mesorectal excision planes. The aim of the Beyond TME Group was to achieve consensus on the definitions and principles of management, and to identify areas of research priority. Methods Delphi methodology was used to achieve consensus. The Group consisted of invited experts from surgery, radiology, oncology and pathology. The process included two international dedicated discussion conferences, formal feedback, three rounds of editing and two rounds of anonymized web-based voting. Consensus was achieved with more than 80 per cent agreement; less than 80 per cent agreement indicated low consensus. During conferences held in September 2011 and Ma...

Research paper thumbnail of Traditional and Laparoscopic Appendectomy in Adults

Annals of Surgery, 2008

Objective: This study investigated length of stay, readmission rates, and postoperative mortality... more Objective: This study investigated length of stay, readmission rates, and postoperative mortality in adult patients undergoing traditional and laparoscopic appendectomy in England between April 1, 1996, and March 31, 2006. Methods: All procedures coded to the "H01-Emergency Excision of Appendix" procedure code in the Hospital Episode Statistics database were included. Multivariate analyses were used to identify independent predictors of length of hospital stay, 30-day and 365day mortality. Results: A total of 259,735 procedures were assigned to the H01-Emergency excision of appendix OPCS-4 3-digit code procedure between 1996 and 2006. A laparoscopic technique was employed in 16,315 (6.3%). A greater proportion of deaths occurred in hospital within 30 days of "open" appendectomy surgery (0.25%) compared with procedures utilizing a laparoscopic technique (0.09%, P Ͻ 0.001). One-year mortality rates, measured over a 5-year period, were also higher after open surgery (0.64% vs. 0.29%, P Ͻ 0.001). Multiple logistic regressions demonstrated that an open operative technique, older age, male gender, and increasing comorbidity were strong independent determinants of early and 1-year postoperative mortality after emergency appendectomy. The duration of stay for patients undergoing open emergency appendectomy exceeded that for patients undergoing the laparoscopic technique (P Ͻ 0.001). Patients undergoing a laparoscopic technique were, however, more likely to be readmitted within 28 days of surgery (7.10% vs. 4.95%, P Ͻ 0.001). Conclusions: Laparoscopic appendectomy is safe and associated with lower postoperative mortality rates than open procedures. The cost implications are uncertain as this technique is associated with shorter hospital stay but higher subsequent readmission rates.

Research paper thumbnail of A National Perspective on the Decline of Abdominoperineal Resection for Rectal Cancer

Annals of Surgery, 2008

Objective: To assess rates of abdominoperineal excision of the rectum (APER) for rectal cancer be... more Objective: To assess rates of abdominoperineal excision of the rectum (APER) for rectal cancer between centers and over time, and to evaluate the influence of patient characteristics, including social deprivation, on APER rate. Methods: Data on patients undergoing APER or anterior resection (AR) in England were extracted from a national administrative database for the years 1996 to 2004. The primary outcome was the proportion of patients presenting with rectal cancer undergoing APER. Hierarchical logistic regression was used to identify independent factors associated with a nonrestorative resection. Results: Data on 52,643 patients were analyzed, 13,109(24.9%) of whom underwent APER. The APER rate significantly reduced over the study period from 29.4% to 21.2% (P Ͻ 0.001). Operative mortality following AR decreased significantly during the period of study (5.1% to 4.2%, P ϭ 0.002), while that following APER did not (P ϭ 0.075). Male patients were more likely to undergo APER (P Ͻ 0.001), whereas those with an emergency presentation more commonly underwent AR (P Ͻ 0.001). Independent predictors of increased APER rate were male gender (odds ratio ͓OR͔ ϭ 1.239, P Ͻ 0.001) and social deprivation (most vs. least deprived; OR ϭ 1.589, P Ͻ 0.001), whereas increasing patient age (OR ϭ 0.977, P ϭ 0.027 per 10-year increase), year of study (2003/4 vs. 1996/7; OR ϭ 0.646, P Ͻ 0.001) and initial presentation as an emergency (OR ϭ 0.713, P Ͻ 0.001) were associated with lower APER rates. After accounting for case-mix, there was significant between-center variability in APER rates. Conclusion: Socially deprived patients were more likely to undergo abdominoperineal resection. Significant improvements in rates of nonrestorative resection were seen over time but although short-term outcomes following AR have improved, those following APER have not. Permanent stoma rates following rectal cancer surgery may be considered a surrogate marker of surgical quality.

Research paper thumbnail of Systematic Review of Pelvic Exenteration With En Bloc Sacrectomy for Recurrent Rectal Adenocarcinoma: R0 Resection Predicts Disease-free Survival

Diseases of the colon and rectum, 2017

The management of recurrent rectal cancer is challenging. At the present time, pelvic exenteratio... more The management of recurrent rectal cancer is challenging. At the present time, pelvic exenteration with en bloc sacrectomy offers the only hope of a lasting cure. The purpose of this study was to evaluate clinical outcome measures and complication rates following sacrectomy for recurrent rectal cancer. A search was conducted on Pub Med for English language articles relevant to sacrectomy for recurrent rectal cancer with no time limitations. Studies reported sacrectomy with survival data for recurrent rectal adenocarcinoma. Disease-free survival following sacrectomy for recurrent rectal cancer was the main outcome measured. A total of 220 patients with recurrent rectal cancer were included from 7 studies, of which 160 were men and 60 were women. Overall median operative time was 717 (570-992) minutes and blood loss was 3.7 (1.7-6.2) L. An R0 (>1-mm resection margin) resection was achieved in 78% of patients. Disease-free survival associated with R0 resection was 55% at a median fo...

Research paper thumbnail of Metabolic Syndrome (Mets) and Risk of Colorectal Cancer (CRC): A Systematic Review and Meta-Analysis

World Journal of Surgical Medical and Radiation Oncology, Jul 19, 2015

Introduction: Metabolic syndrome (MetS) is a commonly associated with cardiovascular disease and ... more Introduction: Metabolic syndrome (MetS) is a commonly associated with cardiovascular disease and diabetes. Interest in the relationship between MetS and cancer has been evolving. The aim of this systematic review and meta-analysis is to evaluate the association between MetS and the risk of colorectal cancer (CRC). Method: Case-control and prospective cohort studies with CRC incidence or mortality in participants with and without MetS were included in the analysis. Results: Fifteen studies, which reported an association between MetS and CRC, were included. This comprised 12,019 cases of CRC in a total of 739,731 participants. The results showed that MetS confers a significant increase in the risk of CRC incidence (OR 1·52, 95% CI 1·33 - 1·73). When studies that did not adjust for confounders were excluded, the effect estimate was similar (OR 1.41, 95% CI 1·25 - 1·58). MetS is associated with an increased risk (51%) of CRC in both males and females. Conclusion: It may be beneficial to identify and optimally treat MetS components as part of the screening or preventive measures for risk factor modification of CRC.

Research paper thumbnail of Presentation, management and outcomes of ileoanal pouch cancer: a single‐centre experience

Colorectal Disease, 2021

It is now over 40 years since restorative proctocolectomy (RPC) with formation of ileoanal pouch ... more It is now over 40 years since restorative proctocolectomy (RPC) with formation of ileoanal pouch was pioneered by Parks and Nicholls [1]. During that time the operative technique has evolved, in particular the reservoir configuration (S, W, J and H) and the method of pouchanal anastomosis. Initially the anastomotic technique involved mucosectomy and handsewn anastomosis, which was largely superseded by the use of circular staplers. Both techniques leave behind residual rectal tissue which is susceptible to the original pathology;

Research paper thumbnail of Implementation of a clinical pathway for the surgical treatment of colorectal cancer during the COVID‐19 pandemic

Colorectal Disease, 2020

Aim This report summarizes the early experience of implementing elective colorectal cancer surger... more Aim This report summarizes the early experience of implementing elective colorectal cancer surgery during the COVID-19 pandemic. Methods A pathway to minimize the risk of including COVID-19-positive patients for elective surgery was established. Prioritization and additional safety measures were introduced into clinical practice. Minimal invasive surgery was used where appropriate. Results Thirty-eight patients were prioritized, and 23 patients underwent surgery (eight colon, 14 rectal and one anal cancer). The minimal invasive surgery rate was 78%. There were no major postoperative complications or patients diagnosed with COVID-19. Histopathological outcomes were similar to normal practice. Conclusion A safe pathway to offer standard high-quality surgery to colorectal cancer patients during the COVID-19 pandemic is feasible.

Research paper thumbnail of Small cell rectal cancer: a therapeutic challenge

BMJ Case Reports, 2021

A generally well 71-year-old man presented to his general practitioner with altered bowel habit a... more A generally well 71-year-old man presented to his general practitioner with altered bowel habit and haematochezia. Colonoscopy revealed a malignant-appearing rectal mass, with histological features of extrapulmonary small cell carcinoma (EPSCC) of the rectum. Imaging demonstrated limited stage disease with a threatened circumferential resection margin. He was treated with a modified platinum chemoradiotherapy regimen for small cell lung cancer with an excellent response. Unfortunately, his cardiac function precluded surgery at the time and the patient subsequently developed hepatic metastases with local disease recurrence, and died 15 months following his initial diagnosis. Rectal EPSCC is a rare diagnosis, and this case represented a challenge for the multidisciplinary team given the limited evidence base. Medical therapy reflects extrapolation of small cell lung cancer treatment and the role of surgery is less clearly defined given aggressive and refractory disease is common. Immu...

Research paper thumbnail of The impact of the COVID-19 pandemic on the Management of Locally Advanced Primary/Recurrent Rectal Cancer

British Journal of Surgery, 2020

Research paper thumbnail of Advances in Colorectal Cancer

BioMed Research International, 2016

Research paper thumbnail of Saving the NHS: a surgical perspective

British Journal of Healthcare Management, 2012

Research paper thumbnail of Differences in presentation and progression between severe FIC1 and BSEP deficiencies

Journal of Hepatology, 2010

Background & Aims-Progressive familial intrahepatic cholestasis (PFIC) with normal serum levels o... more Background & Aims-Progressive familial intrahepatic cholestasis (PFIC) with normal serum levels of gamma-glutamyltranspeptidase can result from mutations in ATP8B1 (encoding familial intrahepatic cholestasis 1 [FIC1]) or ABCB11 (encoding bile salt export pump [BSEP]). We evaluated clinical and laboratory features of disease in patients diagnosed with PFIC, who carried mutations in ATP8B1 (FIC1 deficiency) or ABCB11 (BSEP deficiency). Our goal was to identify features that distinguish presentation and course of these 2 disorders, thus facilitating diagnosis and elucidating the differing consequences of ATP8B1 and ABCB11 mutations. Methods-A retrospective multi-center study was conducted, using questionnaires and chart review. Available clinical and biochemical data from 145 PFIC patients with mutations in either ATP8B1 (61 "FIC1 patients") or ABCB11 (84 "BSEP patients") were evaluated. Results-At presentation, serum aminotransferase and bile salt levels were higher in BSEP patients; serum alkaline phosphatase values were higher, and serum albumin values were lower, in FIC1 patients. Elevated white blood cell counts, and giant or multinucleate cells at liver biopsy, were more common in BSEP patients. BSEP patients more often had gallstones and portal hypertension. Diarrhea, pancreatic disease, rickets, pneumonia, abnormal sweat tests, hearing impairment, and poor growth were more common in FIC1 patients. Among BSEP patients, the course of disease was less rapidly progressive in patients bearing the D482G mutation. Conclusions-Severe forms of FIC1 and BSEP deficiency differed. BSEP patients manifested more severe hepatobiliary disease, while FIC1 patients showed greater evidence of extrahepatic disease.

Research paper thumbnail of Should Laparoscopic Cholecystectomy be Practiced in the Developing World?

Research paper thumbnail of Surgical therapy for appendiceal neuroendocrine tumours: is appendicectomy adequate?

Endocrine Abstracts, 2017

Research paper thumbnail of Evolution in the Management of Presacral Tumours

European Journal of Surgical Oncology, 2020

Research paper thumbnail of Perineal Flap Reconstruction Following Pelvic Exenteration

European Journal of Surgical Oncology, 2020

Background: Presacral tumours represent a small group of pathologies encountered by colorectal su... more Background: Presacral tumours represent a small group of pathologies encountered by colorectal surgeons where specialist input is likely to be required. They represent a disparate number of pathological phemonmena which are classified together through a shared anatomical association.

Research paper thumbnail of PTH-040 Laparoscopic-assisted colonoscopic polypectomy is a safe and effective option for difficult polyps: a single tertiary referral centre experience

Gut, 2015

There was a significant difference in diagnostic yield between groups A vs B and A vs C (p = <0.0... more There was a significant difference in diagnostic yield between groups A vs B and A vs C (p = <0.05). When comparing patients with abnormal LFT (B+C) against patients with normal LFT (A+D), there was also a significant difference (p = <0.05).

Research paper thumbnail of Learning Curve for the Management of Recurrent and Locally Advanced Primary Rectal Cancer: a single team's experience

European Journal of Surgical Oncology, 2010

Aim The study aimed to define the learning curve required to gain satisfactory training to perfor... more Aim The study aimed to define the learning curve required to gain satisfactory training to perform pelvic exenterative surgery for recurrent or locally advanced primary rectal cancer. Method Consecutive patients undergoing exenterative pelvic surgery for recurrent and locally advanced primary rectal cancer, by one surgical team, between 2006 and 2011 were studied. They were divided into quartiles (Q1-Q4) according to the date of surgery. A riskadjusted cumulative sum (RA-CUSUM) model was used to evaluate the learning curve. The chi-squared test with gamma ordinal was used to assess the change with time in the four quartiles. Results One hundred patients (70 males; median age 61 (25-85) years; 55 primary cancers) were included in the study. Thirty patients underwent abdominosacral resection. The number of patients who underwent plastic reconstruction (n = 53) increased from 12 in Q1 to 15 in Q4 (P = 0.781). The median operation time, intra-operative blood loss and hospital stay were 8 (3-17) h, 1.5 (0.1-17) l and 15 (9-82) days respectively. There was no significant change with time. Complete resection (R0) was achieved in 78 patients. Microscopic (R1) or macroscopic (R2) residual disease was present in 15 and seven patients respectively. The number of major complications was 20, and minor 30. RA-CU-SUM analysis demonstrated an improvement in any complications after 14, in major after 12 and in minor after 25 operations. Conclusion Pelvic exenterative surgery for recurrent or locally advanced primary rectal cancer is complex and requires a minimum of 14 cases for an expert colorectal surgeon to gain the desirable training and experience to improve morbidity.

Research paper thumbnail of The value of extended lateral pelvic lymphadenectomy in recurrent and locally advanced primary rectal cancer

European Journal of Surgical Oncology, 2010

Research paper thumbnail of Diagnostic accuracy and value of magnetic resonance imaging (MRI) in planning exenterative pelvic surgery for advanced colorectal cancer

European Journal of Cancer, 2013

To assess the diagnostic accuracy of magnetic resonance imaging (MRI) in detecting colorectal tum... more To assess the diagnostic accuracy of magnetic resonance imaging (MRI) in detecting colorectal tumour invasion according to seven intrapelvic compartments for planning exenterative pelvic surgery. Sixty-three consecutive patients underwent preoperative MRI planning for exenterative surgery, defined as operative excision beyond conventional mesenteric planes for locally advanced (n=23) and recurrent (n=41) pelvic colorectal cancer. The institutional research committee approved of the study and waived the need for a consent form as the images were retrospectively assessed. Two radiologists reported tumour invasion for each of seven anatomic surgical resection compartments, blinded to histopathology and the intraoperative findings. Sensitivity, specificity and predictive values were calculated for the seven intrapelvic compartments. Cox regression analysis was used to calculate the risk of death and recurrence. Overall interobserver agreement was assessed using Cohen&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Kappa coefficient (k). The sensitivity of MRI was ≥93.3% in all but the lateral compartment where it was 89.3%. Specificity for the posterior (82.2%) and anterior compartments below the peritoneal reflection (86.4%) was lower compared to the other compartments. Agreement between the two radiologists was found to be good or very good for all compartments (k&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.72). An MRI diagnosis of tumour invasion in the anterior compartment above the peritoneal reflection was associated with a poorer survival (p=0.012). MRI is accurate in predicting the extent of colorectal tumour within the pelvis and therefore can be used to determine the type of surgery required for curative resection. It should always be used to stage patients with advanced colorectal pelvic cancer.

Research paper thumbnail of Consensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes

British Journal of Surgery, 2013

Consensus abstract Background The management of primary rectal cancer beyond total mesorectal exc... more Consensus abstract Background The management of primary rectal cancer beyond total mesorectal excision planes (PRC-bTME) and recurrent rectal cancer (RRC) is challenging. There is global variation in standards and no guidelines exist. To achieve cure most patients require extended, multivisceral, exenterative surgery, beyond conventional total mesorectal excision planes. The aim of the Beyond TME Group was to achieve consensus on the definitions and principles of management, and to identify areas of research priority. Methods Delphi methodology was used to achieve consensus. The Group consisted of invited experts from surgery, radiology, oncology and pathology. The process included two international dedicated discussion conferences, formal feedback, three rounds of editing and two rounds of anonymized web-based voting. Consensus was achieved with more than 80 per cent agreement; less than 80 per cent agreement indicated low consensus. During conferences held in September 2011 and Ma...

Research paper thumbnail of Traditional and Laparoscopic Appendectomy in Adults

Annals of Surgery, 2008

Objective: This study investigated length of stay, readmission rates, and postoperative mortality... more Objective: This study investigated length of stay, readmission rates, and postoperative mortality in adult patients undergoing traditional and laparoscopic appendectomy in England between April 1, 1996, and March 31, 2006. Methods: All procedures coded to the "H01-Emergency Excision of Appendix" procedure code in the Hospital Episode Statistics database were included. Multivariate analyses were used to identify independent predictors of length of hospital stay, 30-day and 365day mortality. Results: A total of 259,735 procedures were assigned to the H01-Emergency excision of appendix OPCS-4 3-digit code procedure between 1996 and 2006. A laparoscopic technique was employed in 16,315 (6.3%). A greater proportion of deaths occurred in hospital within 30 days of "open" appendectomy surgery (0.25%) compared with procedures utilizing a laparoscopic technique (0.09%, P Ͻ 0.001). One-year mortality rates, measured over a 5-year period, were also higher after open surgery (0.64% vs. 0.29%, P Ͻ 0.001). Multiple logistic regressions demonstrated that an open operative technique, older age, male gender, and increasing comorbidity were strong independent determinants of early and 1-year postoperative mortality after emergency appendectomy. The duration of stay for patients undergoing open emergency appendectomy exceeded that for patients undergoing the laparoscopic technique (P Ͻ 0.001). Patients undergoing a laparoscopic technique were, however, more likely to be readmitted within 28 days of surgery (7.10% vs. 4.95%, P Ͻ 0.001). Conclusions: Laparoscopic appendectomy is safe and associated with lower postoperative mortality rates than open procedures. The cost implications are uncertain as this technique is associated with shorter hospital stay but higher subsequent readmission rates.

Research paper thumbnail of A National Perspective on the Decline of Abdominoperineal Resection for Rectal Cancer

Annals of Surgery, 2008

Objective: To assess rates of abdominoperineal excision of the rectum (APER) for rectal cancer be... more Objective: To assess rates of abdominoperineal excision of the rectum (APER) for rectal cancer between centers and over time, and to evaluate the influence of patient characteristics, including social deprivation, on APER rate. Methods: Data on patients undergoing APER or anterior resection (AR) in England were extracted from a national administrative database for the years 1996 to 2004. The primary outcome was the proportion of patients presenting with rectal cancer undergoing APER. Hierarchical logistic regression was used to identify independent factors associated with a nonrestorative resection. Results: Data on 52,643 patients were analyzed, 13,109(24.9%) of whom underwent APER. The APER rate significantly reduced over the study period from 29.4% to 21.2% (P Ͻ 0.001). Operative mortality following AR decreased significantly during the period of study (5.1% to 4.2%, P ϭ 0.002), while that following APER did not (P ϭ 0.075). Male patients were more likely to undergo APER (P Ͻ 0.001), whereas those with an emergency presentation more commonly underwent AR (P Ͻ 0.001). Independent predictors of increased APER rate were male gender (odds ratio ͓OR͔ ϭ 1.239, P Ͻ 0.001) and social deprivation (most vs. least deprived; OR ϭ 1.589, P Ͻ 0.001), whereas increasing patient age (OR ϭ 0.977, P ϭ 0.027 per 10-year increase), year of study (2003/4 vs. 1996/7; OR ϭ 0.646, P Ͻ 0.001) and initial presentation as an emergency (OR ϭ 0.713, P Ͻ 0.001) were associated with lower APER rates. After accounting for case-mix, there was significant between-center variability in APER rates. Conclusion: Socially deprived patients were more likely to undergo abdominoperineal resection. Significant improvements in rates of nonrestorative resection were seen over time but although short-term outcomes following AR have improved, those following APER have not. Permanent stoma rates following rectal cancer surgery may be considered a surrogate marker of surgical quality.

Research paper thumbnail of Systematic Review of Pelvic Exenteration With En Bloc Sacrectomy for Recurrent Rectal Adenocarcinoma: R0 Resection Predicts Disease-free Survival

Diseases of the colon and rectum, 2017

The management of recurrent rectal cancer is challenging. At the present time, pelvic exenteratio... more The management of recurrent rectal cancer is challenging. At the present time, pelvic exenteration with en bloc sacrectomy offers the only hope of a lasting cure. The purpose of this study was to evaluate clinical outcome measures and complication rates following sacrectomy for recurrent rectal cancer. A search was conducted on Pub Med for English language articles relevant to sacrectomy for recurrent rectal cancer with no time limitations. Studies reported sacrectomy with survival data for recurrent rectal adenocarcinoma. Disease-free survival following sacrectomy for recurrent rectal cancer was the main outcome measured. A total of 220 patients with recurrent rectal cancer were included from 7 studies, of which 160 were men and 60 were women. Overall median operative time was 717 (570-992) minutes and blood loss was 3.7 (1.7-6.2) L. An R0 (>1-mm resection margin) resection was achieved in 78% of patients. Disease-free survival associated with R0 resection was 55% at a median fo...

Research paper thumbnail of Metabolic Syndrome (Mets) and Risk of Colorectal Cancer (CRC): A Systematic Review and Meta-Analysis

World Journal of Surgical Medical and Radiation Oncology, Jul 19, 2015

Introduction: Metabolic syndrome (MetS) is a commonly associated with cardiovascular disease and ... more Introduction: Metabolic syndrome (MetS) is a commonly associated with cardiovascular disease and diabetes. Interest in the relationship between MetS and cancer has been evolving. The aim of this systematic review and meta-analysis is to evaluate the association between MetS and the risk of colorectal cancer (CRC). Method: Case-control and prospective cohort studies with CRC incidence or mortality in participants with and without MetS were included in the analysis. Results: Fifteen studies, which reported an association between MetS and CRC, were included. This comprised 12,019 cases of CRC in a total of 739,731 participants. The results showed that MetS confers a significant increase in the risk of CRC incidence (OR 1·52, 95% CI 1·33 - 1·73). When studies that did not adjust for confounders were excluded, the effect estimate was similar (OR 1.41, 95% CI 1·25 - 1·58). MetS is associated with an increased risk (51%) of CRC in both males and females. Conclusion: It may be beneficial to identify and optimally treat MetS components as part of the screening or preventive measures for risk factor modification of CRC.

Research paper thumbnail of Presentation, management and outcomes of ileoanal pouch cancer: a single‐centre experience

Colorectal Disease, 2021

It is now over 40 years since restorative proctocolectomy (RPC) with formation of ileoanal pouch ... more It is now over 40 years since restorative proctocolectomy (RPC) with formation of ileoanal pouch was pioneered by Parks and Nicholls [1]. During that time the operative technique has evolved, in particular the reservoir configuration (S, W, J and H) and the method of pouchanal anastomosis. Initially the anastomotic technique involved mucosectomy and handsewn anastomosis, which was largely superseded by the use of circular staplers. Both techniques leave behind residual rectal tissue which is susceptible to the original pathology;

Research paper thumbnail of Implementation of a clinical pathway for the surgical treatment of colorectal cancer during the COVID‐19 pandemic

Colorectal Disease, 2020

Aim This report summarizes the early experience of implementing elective colorectal cancer surger... more Aim This report summarizes the early experience of implementing elective colorectal cancer surgery during the COVID-19 pandemic. Methods A pathway to minimize the risk of including COVID-19-positive patients for elective surgery was established. Prioritization and additional safety measures were introduced into clinical practice. Minimal invasive surgery was used where appropriate. Results Thirty-eight patients were prioritized, and 23 patients underwent surgery (eight colon, 14 rectal and one anal cancer). The minimal invasive surgery rate was 78%. There were no major postoperative complications or patients diagnosed with COVID-19. Histopathological outcomes were similar to normal practice. Conclusion A safe pathway to offer standard high-quality surgery to colorectal cancer patients during the COVID-19 pandemic is feasible.

Research paper thumbnail of Small cell rectal cancer: a therapeutic challenge

BMJ Case Reports, 2021

A generally well 71-year-old man presented to his general practitioner with altered bowel habit a... more A generally well 71-year-old man presented to his general practitioner with altered bowel habit and haematochezia. Colonoscopy revealed a malignant-appearing rectal mass, with histological features of extrapulmonary small cell carcinoma (EPSCC) of the rectum. Imaging demonstrated limited stage disease with a threatened circumferential resection margin. He was treated with a modified platinum chemoradiotherapy regimen for small cell lung cancer with an excellent response. Unfortunately, his cardiac function precluded surgery at the time and the patient subsequently developed hepatic metastases with local disease recurrence, and died 15 months following his initial diagnosis. Rectal EPSCC is a rare diagnosis, and this case represented a challenge for the multidisciplinary team given the limited evidence base. Medical therapy reflects extrapolation of small cell lung cancer treatment and the role of surgery is less clearly defined given aggressive and refractory disease is common. Immu...

Research paper thumbnail of The impact of the COVID-19 pandemic on the Management of Locally Advanced Primary/Recurrent Rectal Cancer

British Journal of Surgery, 2020