Shahnawaz Rasheed

Leptin interacts with glucagon-like peptide-1 neurons to reduce food intake and body weight in rodents

The adipose tissue hormone, leptin, and the neuropeptide glucagon‐like peptide‐1 (7–36) amide (GLP‐1) both reduce food intake and body weight in rodents. Using dual in situ hybridization, long isoform leptin receptor (OB‐Rb) was localized to GLP‐1 neurons originating in the nucleus of the solitary tract. ICV injection of the specific GLP‐1 receptor antagonist, exendin(9–39), at the onset of dark phase, did not affect feeding in saline pre‐treated controls, but blocked the reduction in food intake and body weight of leptin pre‐treated rats. These findings suggest that GLP‐1 neurons are a potential target for leptin in its control of feeding.

Management of the malignant colorectal polyp: ACPGBI position statement†

*Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK, †Torbay Hospital, Torquay, UK, ‡Department of General Surgery, Manchester Royal Infirmary, Manchester, UK, §Royal Infirmary, Glasgow, UK, ¶Department of Histopathology, Royal Bolton NHS Foundation Trust, Bolton, UK, **Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK, ††The Royal Marsden Hospital, London, UK, ‡‡Salisbury NHS Foundation Trust, Salisbury, UK and §§Department of Histopathology, University Hospital of South Manchester, Manchester, UK

Complete mesocolic excision in colorectal cancer: a systematic review.

AIM Several studies have suggested an increased lymph node yield, reduced locoregional recurrence and increased disease-free survival after complete mesocolic excision (CME) for colorectal cancer. This review was undertaken to assess the use of CME for colon cancer by evaluating the technique and its clinical outcome. METHOD A literature search of publications was performed using PubMed and Medline. Only studies published in English were included. Studies assessed for quality and data were extracted by two independent reviewers. End-points included number of lymph nodes per patient, quality of the plane of mesocolic excision, postoperative mortality and morbidity, 5-year locoregional recurrence and 5-year cancer-specific survival. RESULTS There were 34 articles comprising 12 retrospective studies, nine prospective studies and 13 original articles including case series, observational studies and editorials. Of the prospective studies, four reported an increased lymph node harvest and a survival benefit. The others reported an improvement in the quality of the specimen as assessed by histopathological examination. Laparoscopic CME has the same oncological outcome as open surgery but completeness of excision during laparoscopy may be compromised for tumours in the transverse colon. CONCLUSION Studies demonstrate that CME removes significantly more tissue around the tumour including maximal lymph node clearance. There is little information on serious adverse events after CME and a long-term survival benefit has not been proved.

The Influence of Circumferential Resection Margins on Long-Term Outcomes Following Rectal Cancer Surgery

PURPOSE: Circumferential resection margin involvement after rectal cancer surgery is associated with local recurrence and decreased survival, but definitions of “safe” margins vary. This study assessed the influence of various circumferential margins on long-term outcome from rectal cancer surgery. METHODS: Data were extracted from a rectal cancer database of patients undergoing rectal resection at a tertiary referral center between 1971 and 1996. The influence of circumferential margins on five-year local recurrence and cancer-specific survival were assessed using Cox regression. RESULTS: Circumferential margin measurements were available from 435 patients (median follow-up, 70.4 months). Cancer-specific survival at five years was 80.8%, 69.2%, 59.2%, and 34.1% for tumors with a circumferential resection margin of >10 mm, 3-10 mm, 2 mm, and ≤1mm, respectively (P < 0.001). Local recurrence at five years was 9.0%, 14.7%, and 25.8% for margins >10 mm, 2-10 mm, and ≤1 mm, respectively (P = 0.001). Independent predictors of cancer-specific mortality were circumferential margins of ≤1 mm vs. >10 mm (odds ratio = 3.38, P = 0.014) or 2 mm (odds ratio = 2.24, P = 0.029), Dukes Stage (C2 vs. A: odds ratio = 15.18, P < 0.001), and vascular invasion (present vs. absent: odds ratio = 1.51, P = 0.033). Local recurrence was predicted by a margin of ≤1 mm (odds ratio = 2.29, P = 0.041), gender (female vs. male: odds ratio = 0.25, P = 0.002), Dukes Stage (C2 vs. A: odds ratio = 28.89, P = 0.003), and vascular invasion (extramural vs. none: odds ratio = 2.04, P = 0.024). CONCLUSION: Circumferential margins ≤2 mm are associated with significantly reduced cancer-specific survival, and margins ≤1 mm with increased local recurrence, when other factors are accounted for, challenging the assumption that a circumferential resection margin of ≤1 mm is safe.

Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids

The aim was to compare the clinical outcomes and effectiveness of surgical treatments for haemorrhoids.

A systematic review of transanal total mesorectal excision: is this the future of rectal cancer surgery?

The surgical technique used for transanal total mesorectal excision (TaTME) was reviewed including the oncological quality of resection and the peri‐operative outcome.

A systematic review of sacral nerve stimulation for low anterior resection syndrome

The efficacy of sacral nerve stimulation (SNS) in low anterior resection syndrome (LARS) is largely undocumented. A review of the literature was carried out to study this question.

Systematic review of emergent laparoscopic colorectal surgery for benign and malignant disease

Laparoscopic surgery has become well established in the management of both and malignant colorectal disease. The last decade has seen increasing numbers of surgeons trained to a high standard in minimally-invasive surgery. However there has not been the same enthusiasm for the use of laparoscopy in emergency colorectal surgery. There is a perception that emergent surgery is technically more difficult and may lead to worse outcomes. The present review aims to provide a comprehensive and critical appraisal of the available literature on the use of laparoscopic colorectal surgery (LCS) in the emergency setting. The literature is broadly divided by the underlying pathology; that is, inflammatory bowel disease, diverticulitis and malignant obstruction. There were no randomized trials and the majority of the studies were case-matched series or comparative studies. The overall trend was that LCS is associated with shorter hospital stay, par or fewer complications but an increased operating time.Emergency LCS can be safely undertaken for both benign and malignant disease providing there is appropriate patient selection, the surgeon is adequately experienced and there are sufficient resources to allow for a potentially more complex operation.

Care of non-communicable diseases in emergencies

Introduction Emergencies include natural disasters such as earthquakes and severe meteorological events, but also armed confl ict and its consequences, such as civil disruption and refugee crises (sometimes termed chronic emergencies). The health component of the humanitarian response to emergencies has traditionally focused on management of acute conditions such as trauma and infectious illnesses. However, noncommunicable diseases (NCDs) such as diabetes, hypertension, cardiovascular disease, cancer, and chronic lung disease are now leading causes of disability and death in low-income and middle-income countries (LMICs) and disaster-prone areas. NCDs require ongoing management for optimal outcomes, which is challenging in emergency settings because natural disasters or confl icts increase the risk of acute NCD exacerbations and decrease the ability of health systems to respond. Also, complex emergencies compromise NCD prevention and control over a prolonged period; limited access to timely treatment can lead to poor outcomes for patients and impose the high costs of managing complications on humanitarian agencies. Therefore, a more comprehensive approach to NCD management in emergencies is an important but neglected aspect of humanitarian response. Management of NCDs in emergencies requires inclusion of NCD care into standard operating procedures, which would facilitate horizontal and vertical integration with other aspects of relief eff orts. Humanitarian response in emergencies can be divided into three phases: mitigation and preparedness, emergency response, and post-emergency phase. Existing guidance for humanitarian response identifi es certain NCD-relevant considerations, but these chiefl y refer to the emergency response phase and are limited in scope. Here we propose the content of a minimally adequate response to NCDs in emergencies. This Viewpoint proposes specifi c actions organised by phase of the humanitarian response (fi gure), as well as some potential indicators for assessment of progress. We selected actions for inclusion based on their potential to reduce morbidity and mortality while minimising administrative and logistical burden for humanitarian responders. Where possible, we have prioritised actions that align with existing eff orts to strengthen NCD care.

A Systematic Review to Assess Resection Margin Status After Abdominoperineal Excision and Pelvic Exenteration for Rectal Cancer.

Objective: The aim of this study was to assess resection margin status and its impact on survival after abdominoperineal excision and pelvic exenteration for primary or recurrent rectal cancer. Summary of Background Data: Resection margin is important to guide therapy and to evaluate patient prognosis. Methods: A meta-analysis was performed to assess the impact of resection margin status on survival, and a regression analysis to analyze positive resection margin rates reported in the literature. Results: The analysis included 111 studies reporting on 19,607 participants after abdominoperineal excision, and 30 studies reporting on 1326 participants after pelvic exenteration. The positive resection margin rates for abdominoperineal excision were 14.7% and 24.0% for pelvic exenteration. The overall survival and disease-free survival rates were significantly worse for patients with positive compared with negative resection margins after abdominoperineal excision [hazard ratio (HR) 2.64, P < 0.01; HR 3.70, P < 0.01, respectively] and after pelvic exenteration (HR 2.23, P < 0.01; HR 2.93, P < 0.01, respectively). For patients undergoing abdominoperineal excision with positive resection margins, the reported tumor sites were 57% anterior, 15% posterior, 10% left or right lateral, 8% circumferential, 10% unspecified. A significant decrease in positive resection margin rates was identified over time for abdominoperineal excision. Although positive resection margin rates did not significantly change with the size of the study, some small size studies reported higher than expected positive resection margin rates. Conclusions: Resection margin status influences survival and a multidisciplinary approach in experienced centers may result in reduced positive resection margins. For advanced anterior rectal cancer, posterior pelvic exenteration instead of abdominoperineal excision may improve resection margins.