Browsing by Author "Di Candido, F."

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Risk factors for locally advanced cancer associated with ulcerative colitis: Results of a retrospective multicentric study in the era of biologics
(Elsevier, 2020) Rottoli, M.; Tanzanu, M.; Di Candido, F.; Colombo, F.; Frontali, A.; Chandrasinghe, P.C.; Pellino, G.; Frasson, M.; Warusavitarne, J.; Panis, Y.; Sampietro, G.M.; Spinelli, A.; Poggioli, G.
BACKGROUND: Patients affected by ulcerative colitis (UC) are more likely to develop colorectal cancer, and are often diagnosed with lymph node involvement (N+) at surgery. AIM: To identify the risk factors for N+ cancer in UC patients. METHODS: Patients undergoing surgery from 2001 to 2018 in six European tertiary centres were included. N+ patients were compared to the control group (N-) for clinical variables. The evaluation of risk factors for N+ was assessed using univariate and multivariable logistic regression analyses. RESULTS: A total of 130 patients were included. Median duration of disease was 21 years (1-52). Forty patients (30.8%) were N+ at surgery. Eighteen (13.8%) developed cancer within 10 years from the onset of UC. Younger age at surgery (Odds ratio -OR- 0.96, p = 0.042), left colon location (OR 2.44, p = 0.045) and the presence of stricture (OR 5.07, p = 0.002) were associated with N+. CONCLUSION: Location in the left colon, presence of strictures and younger age strongly correlated with a higher risk of N+ cancer, which could develop before the starting point of surveillance. Duration, extension and severity of disease were not associated with N+. These results should be considered in the evaluation of risk of advanced cancer in UC patients. KEYWORDS: Cancer; Lymph nodes; Ulcerative colitis.
Technical variations and feasibility of transanal ileal pouch-anal anastomosis for ulcerative colitis and inflammatory bowel disease unclassified across continents.
(Springer-Verlag, 2018) Zaghiyan, K.; Warusavitarne, J.; Spinelli, A.; Chandrasinghe, P.; Di Candido, F.; Fleshner, P.
PURPOSE: Initial reports of transanal ileal pouch-anal anastomosis (taIPAA) suggest safety and feasibility compared with transabdominal IPAA. The purpose of this study was to evaluate differences in technique and results of taIPAA in three centers performing taIPAA across two continents. METHODS: Prospective IPAA registries from three institutions in the US and Europe were queried for patients undergoing taIPAA. Demographic, preoperative, intraoperative, and postoperative data were compiled into a single database and evaluated. RESULTS: Sixty-two patients (median age 38 years; range 16-68 years, 43 (69%) male) underwent taIPAA in the three centers (USA 24, UK 23, Italy 15). Most patients had had a subtotal colectomy before taIPAA [n = 55 (89%)]. Median surgical time was 266 min (range 180-576 min) and blood loss 100 ml (range 10-500 ml). Technical variations across the three institutions included proctectomy plane of dissection (intramesorectal or total mesorectal excision plane), specimen extraction site (future ileostomy site vs. anus), ileo-anal anastomosis technique (stapled vs. hand sewn) and use of fluorescence angiography. Despite technical differences, anastomotic leak rates (5/62; 8%) and overall complications (18/62; 29%) were acceptable across the three centers. CONCLUSIONS: This is the first collaborative report showing safety and feasibility of taIPAA. Despite technical variations, outcomes are similar across centers. A large multi-institutional, international IPAA collaborative is needed to compare technical factors and outcomes.
Transanal minimal invasive proctectomy (TaMIP) for perineal Crohn’s disease; a multi-centre prospective cohort study
(Oxford University Press, 2019) Chandrasinghe, P.; Di Candido, F.; Warusavitarne, J.; Spinelli, A.
BACKGROUND: Transanal minimally invasive proctectomy (TaMIP) has some advantages particularly in relation to access to the deep pelvis. Key challenges faced with the TaMIP approach for proctectomy in Crohn’s disease are the diseased pelvis and inflamed, bulky mesorectum causing difficult planes. This study aims to assess the short-term outcomes and perineal wound complications following TaMIP for Crohn’s disease. METHODS: All patients undergoing TaMIP proctectomy between 2014 and 2018, at 2 tertiary care referral centres were prospectively evaluated. Thirty-day morbidity, operative details and perineal wound complications were analysed. RESULTS:A total of 33 patients (M 42%, age 38.5 years; range 26 to 77) have undergone TaMIP for Crohn’s disease. Surgeries were performed as double single port procedures with either complete mesorectal excision or close rectal dissection. The mean operative time was 120 min (range: 60–240) for the perineal procedure and 234 min (range: 140–279) for the total procedure. One case (3%) had to be converted to an open procedure due to difficult dissection and haemorrhage. Ninety per cent of the patients were ASA II and 54.5% underwent completion proctectomy while 45.5% had a panproctocolectomy as a single procedure. Four patients (12%; II 2, III 2) had complications which were Clavien-Dindo II and above. One patient had re-intervention for a pelvic collection while another patient had a ureteric injury. Vacuum dressing was used for primary wound closure in one patient. Major perineal wound dehiscence was seen in 6% (2 of 33) of the patients while one needed vacuum therapy. In long-term follow-up one patient developed an enterocutaneous fistula at the abdominal wound while 7 (21%) chronic perineal sinuses were reported. CONCLUSIONS:Perineal Crohn’s disease poses a challenge for transanal minimally invasive surgery due to the chronic inflammation and perineal sepsis. Transanal approach offers a safe and feasible option for perineal Crohn’s disease. The commonest complication following TaMIP is the development of a chronic perineal sinus and evaluation with laparoscopic and open techniques would be useful to ascertain if this rate is different.