Browsing by Author "Waters P.S."

Now showing 1 - 2 of 2
  • No Thumbnail Available
    Item
    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.
  • No Thumbnail Available
    Item
    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.