Browsing by Author "Larach J.T."

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    Application of minimally invasive approaches to pelvic exenteration for locally advanced and locally recurrent pelvic malignancy - A narrative review of outcomes in an evolving field
    (2022) Casey L.; Kong J.C.; Warrier S.K.; Larach J.T.; Waters P.S.; McCormick J.J.; Heriot A.G.
    © 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical OncologyIntroduction: Minimally invasive surgical techniques are being successfully used to treat locally advanced and recurrent pelvic malignancy of colorectal origin. This review aims to describe the application of minimally invasive approaches to pelvic exenteration and compare current reported surgical outcomes. Methods and results: A literature search was performed of PubMed, Google Scholar and EMBASE for studies on pelvic exenteration with locally advanced or recurrent rectal cancer utilising minimally invasive techniques. A total of 22 studies were reviewed, including four case reports describing novel approaches. Discussion: Laparoscopic, robotic and trans-anal total mesenteric excision (TaTME) aided pelvic exenteration methods have recently demonstrated low post-operative morbidity and mortality trends. Minimally invasive methods also have improved rates of R0 resection in modest cohort studies. Hybrid methods have also been proposed to overcome observed technical difficulties such as the narrow male pelvis and obese habitus. There is still limited data beyond case report and small cohort studies on challenging patient groups such as those with recurrent rectal cancer or bony involvement, as a consequence of patient selection for these novel approaches. Conclusion: International, multicentre studies have provided the best opportunity to explore efficacy of these methods on a larger scale. Further research is required into patient selection, safety and long-term outcomes of these approaches within high volume centres practicing beyond the surgical learning curve.
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    Are we doing enough to assess surgical quality in advanced colon and rectal cancer?
    (Academic Press, 2021) Warrier S.K.; Larach J.T.; Kong J.C.H.; Waters P.S.; McCormick J.J.; Heriot A.G.; Warrier S.K.; Smart P.J.; McCormick J.J.; Heriot A.G.; Larach J.T.; Smart P.J.
    © 2021 Sociedad Medica de Santiago. All rights reserved.Background: Previous studies have assessed the role of Type 1 diabetes (DM1) antibodies as predictors of the natural history of disease. Aim: To determine the frequency and combinations of positivity for DM1 antibodies in patients with DM1 and the relationship between antibody positivity and the age of the patient. To explore the relationship between history of insulin therapy or diabetic ketoacidosis (DKA) at the onset of the disease with antibody positivity in a subsample. Material and Methods: Data was gathered from every sample processed for DM1 antibodies in our laboratory between January 2015 and September 2019. Medical records from 84 patients who tested positive for at least one antibody were revised to study the relationship between insulin therapy or DKA at the onset of the disease with antibody positivity. Results: Forty percent of DM1 antibody tests were positive. Among positive tests, 1, 2, 3 or 4 DM1 antibodies were detected in 48%, 33%, 17% and 3% of cases, respectively. The likelihood of testing positive was inversely related with age for ICA, GAD, IA-2, ZnT8 and directly proportional for IAA (β = -0,012; -0,013; -0,014; -0,009; 0,005 respectively). An association between DKA at the onset of the disease and IA-2 positivity was observed (Odds ratio (OR) 5.38 95% confidence intervals (CI) 1.79 - 16.16, P < 0.01). No association was found between IAA positivity and history of insulin therapy (OR 2.25 95%CI 0.63 - 7.90, P = 0.2403). Conclusions: The results obtained from this study represent a novel local profile of DM1 antibody data, highlighting a relationship between antibody positivity and age.
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    Colopleural fistula as a rare presentation of mucormycotic infection
    (Springer, 2023) Jarry C.; Rissios J.P.; Vela J.; Solovera M.E.; Bannura F.; Larach J.T.; CEDEUS (Chile)
    © 2022 European Mathematical Society.Let G be the topological fundamental group of a given nonsingular complex projective surface. We prove that the Chern slopes c12(S)/c2(S) of minimal nonsingular surfaces of general type S with π1(S) ≃ G are dense in the interval [1; 3].
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    Gastrointestinal bleeding due to vascular malformation secondary to mesenteric-gonadal portosystemic shunt in pre-transplant chronic liver disease
    (Springer, 2023) Moya Abuhadba R.; Steffens Venegas E.; Iglesias Bettini A.; Roa J.C.; Besa C.; Espino A.; Larach J.T.; CEDEUS (Chile)
    © The Author(s), under exclusive license to Springer Nature Switzerland AG 2021. All rights reserved.This chapter addresses the study of the validity of high-stakes assessments, such as those used in the admissions to higher education and professional certification. This study requires, as an initial stage, making explicit the uses that will be given to the scores obtained in those instruments. The specification of the uses can be done through the study of the program theory or logic model. The chapter discusses and gives examples of validity studies that examine the most frequent uses for these types of measures: predictive validity studies and the validity of performance standards. It is argued that the adequate use of high-stakes assessments requires measures that do not present irrelevant variance of the construct. Methodologies for those analyses are presented. It is also proposed that the validity argument should not be limited to the empirical verification of the measures intended goals, but it should also include the possible occurrence of unexpected consequences. Some of the most frequent unexpected consequences in the literature are discussed.
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    Oncological reasons for performing a complete mesocolic excision: a systematic review and meta-analysis
    (2021) Kong J.C.; Larach J.T.; Heriot A.; Warrier S.K.; Kong J.C.; Heriot A.; Warrier S.K.; Kong J.C.; Heriot A.; Warrier S.K.; Prabhakaran S.; Choy K.T.; Larach J.T.
    © 2021 Royal Australasian College of SurgeonsBackground: While complete mesocolic excision (CME) has been shown to have an oncological benefit as compared to conventional colonic surgery for colon surgery, this benefit must be weighed up against the risk of major intra-abdominal complications. This paper aimed to assess the comparative oncological benefits of CME. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic review of the literature until May 2020 was performed. Comparative studies assessing CME versus conventional colonic surgery for colon cancer were compared, and outcomes were pooled. Results: A total of 700 publications were identified, of which 19 were found to meet the inclusion criteria. A total of 25 886 patients were compared, with 14 431 patients in the CME arm. CME was associated with a significantly higher rate of vascular injury (odds ratio 3, P < 0.001). Rates of local and distant recurrence were lower in the CME group (odds ratio 0.66 and 0.73, respectively, both P < 0.001). CME patients had a significantly higher lymph node yield (P < 0.001). While no significant differences were noted between the two groups in terms of pooled 3- or 5-year disease-free survival, pooled 5-year overall survival was significantly higher in the CME group (relative risk 0.82, P < 0.001). Conclusion: Based on the available evidence, CME is associated with improved oncologic outcomes at the expense of higher complication rates, including vascular injury. The oncological benefits need to weighed up against a multitude of factors including the level of hospital support, surgeon experience, patient age, and associated comorbidities.