ORCID Profile
0000-0002-9614-6113
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Publisher: Wiley
Date: 20-10-2020
DOI: 10.1111/CODI.14856
Abstract: Continuity of the mesentery has recently been established and may provide an anatomical basis for optimal colorectal resectional surgery. Preliminary data from operative specimen measurements suggest there is a tapering in the mesentery of the distal sigmoid. A mesenteric waist in this area may be a risk factor for local recurrence of colorectal cancer. This study aimed to investigate the anatomical characteristics of the mesentery at the colorectal junction. In this cross-sectional study, 20 patients were recruited. After planned colorectal resection, the surgical specimens were scanned in a MRI system and subsequently dissected and photographed as per national pathology guidelines. Mesenteric surface area and linear measurements were compared between MRI and pathology to establish the presence and location of a mesenteric waist. Specimen analysis confirmed that a narrowing in the mesenteric surface area was consistently apparent at the rectosigmoid junction. Above the anterior peritoneal reflection, the surface area and posterior distance of the mesentery of the upper rectum initially decreased before increasing as the mesentery of the sigmoid colon. These anatomical properties created the appearance of a mesenteric 'waist' at the rectosigmoid junction. Using the anterior reflection as a reference landmark, the rectosigmoid waist occurred at a mean height of 23.6 and 21.7 mm on MRI and pathology, respectively. A rectosigmoid waist occurs at the junction of the mesorectum and mesocolon, and is a mesenteric landmark for the rectum that is present on both radiology and pathology.
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.EJSO.2018.09.028
Abstract: Colon cancer outcomes are now inferior to rectal cancer outcomes. The sigmoid colon is the most common site of colonic cancer. The aim of this review was to investigate the oncological outcomes for sigmoid cancer. A systematic review and meta-analysis was performed. We included any study of the oncological outcomes for sigmoid cancer such as local recurrence, distant recurrence and disease free survival. A systematic search was conducted in Medline from inception to November 2016. Study quality was evaluated with the Newcastle-Ottawa Scale. The study was registered on PROSPERO (CRD42017069326). The search terms returned 1323 results. We identified a total of 17 eligible studies including 5953 patients. The pooled local recurrence rate was 10.5% in 15 studies with 5148 patients (95% CI 0.07-0.14) and heterogeneity measured by I The pooled local recurrence rate of sigmoid cancer of 10.5% is higher than contemporary rates of local recurrence of rectal cancer. A large number of papers fail to describe or include R1 resections of sigmoid cancer, which are frequently described as palliative.
Publisher: Wiley
Date: 26-09-2018
DOI: 10.1111/CODI.14398
Abstract: This study aimed to assess the reliability of measurements and bony landmarks for the rectosigmoid junction on MRI. The staging MRI scans for 100 patients were reviewed. The junction of the mesorectum and mesocolon was used to identify the rectum and sigmoid. The performance of current metric measurements or bony landmarks was then compared against the actual anatomical bowel segment. The mean distance of the sigmoid take-off from the anal verge was 12.6 cm (SD 1.8 cm, range 9.4-19.0 cm). At a cutoff of 12 cm, the anatomical bowel segment was found to be sigmoid colon rather than rectum in 35% of patients. At 15 and 16 cm the bowel segment was sigmoid in 84% and 96% of patients, respectively. At the sacral promontory and the third sacral segment, the bowel segment was sigmoid in 28% and 100% of patients, respectively. Current definitions of the rectum that rely on arbitrary measurements or bony landmarks will not locate the correct point of transition between the rectum and sigmoid in the majority of patients. The sigmoid take-off offers an alternative, anatomically bespoke, landmark.
Publisher: Wiley
Date: 27-06-2022
DOI: 10.1111/CODI.16222
Publisher: BMJ
Date: 21-10-2020
DOI: 10.1136/GUTJNL-2020-321956
Abstract: To assess whether a faecal immunochemical test (FIT) could be used to select patients with suspected colorectal cancer (CRC) symptoms for urgent investigation. Multicentre, double-blinded diagnostic accuracy study in 50 National Health Service (NHS) hospitals across England between October 2017 and December 2019. Patients referred to secondary care with suspected CRC symptoms meeting NHS England criteria for urgent 2 weeks wait referral and triaged to investigation with colonoscopy were invited to perform a quantitative FIT. The sensitivity of FIT for CRC, and effect of relevant variables on its diagnostic accuracy was assessed. 9822 patients were included in the final analysis. The prevalence of CRC at colonoscopy was 3.3%. The FIT positivity decreased from 37.2% to 19.0% and 7.6%, respectively, at cut-offs of 2, 10 and 150 µg haemoglobin/g faeces (µg/g). The positive predictive values of FIT for CRC at these cut-offs were 8.7% (95% CI, 7.8% to 9.7%), 16.1% (95% CI 14.4% to 17.8%) and 31.1% (95% CI 27.8% to 34.6%), respectively, and the negative predictive values were 99.8% (95% CI 99.7% to 99.9%), 99.6% (95% CI 99.5% to 99.7%) and 98.9% (95% CI 98.7% to 99.1%), respectively. The sensitivity of FIT for CRC decreased at the same cut-offs from 97.0% (95% CI 94.5% to 98.5%) to 90.9% (95% CI 87.2% to 93.8%) and 70.8% (95% CI 65.6% to 75.7%), respectively, while the specificity increased from 64.9% (95% CI 63.9% to 65.8%) to 83.5% (95% CI 82.8% to 84.3%) and 94.6% (95% CI 94.1% to 95.0%), respectively. The area under the receiver operating characteristic curve was 0.93 (95% CI 0.92 to 0.95). FIT sensitivity is maximised to 97.0% at the lowest cut-off (2 µg/g) a negative FIT result at this cut-off can effectively rule out CRC and a positive FIT result is better than symptoms to select patients for urgent investigations. ISRCTN49676259 .
Publisher: Oxford University Press (OUP)
Date: 23-03-2021
DOI: 10.1093/BJS/ZNAA132
Abstract: This study investigated whether a quantitative faecal immunochemical test (FIT) could be used to select patients with either high- or low-risk symptoms of colorectal cancer for urgent investigation. A double-blinded diagnostic accuracy study was conducted in 50 hospitals in England between October 2017 and December 2019. Patients were eligible for inclusion if they had been referred to secondary care with suspected colorectal cancer symptoms meeting national criteria for urgent referral and triaged to investigation with colonoscopy. The study included 9822 patients, of whom 7194 (73.2 per cent) had high-risk symptoms, 1994 (20.3 per cent) low-risk symptoms, and 634 (6.5 per cent) had other symptoms warranting urgent referral. In patients with high-risk symptoms, the sensitivity of FIT for colorectal cancer at cut-off values of 2 and 10 μg haemoglobin per g faeces was 97.7 (95 per cent c.i. 95.0 to 99.1) and 92.2 (88.2 to 95.2) per cent respectively, compared with 94.3 (84.3 to 98.8) and 86.8 (74.7 to 94.5) per cent in patients with low-risk symptoms at the same cut-off points. At cut-off values of 2, 10, and 150 μg/g, the positive predictive value for colorectal cancer was 8.9, 16.2, and 30.5 per cent respectively for those with high-risk symptoms, and 8.4, 16.9, and 35.5 per cent for those with low-risk symptoms. FIT safely selects patients with high or low risk symptoms of colorectal cancer for investigation.
Publisher: Wiley
Date: 17-10-2022
DOI: 10.1111/CODI.16357
Publisher: Wiley
Date: 10-08-2021
DOI: 10.1111/CODI.15786
Abstract: Detection of early onset colorectal cancer is challenging, and remains a rare diagnosis amongst younger people with gastrointestinal symptoms. We investigated whether faecal immunochemical testing (FIT) could identify younger patients at higher risk of colorectal cancer or serious bowel disease including colorectal cancer, inflammatory bowel disease or advanced adenomas. A subgroup analysis was performed of symptomatic patients under 50 years of age ( ) from the NICE FIT study, a multicentre, prospective diagnostic accuracy study of FIT conducted between October 2017 and December 2019. The diagnostic accuracy of FIT for colorectal cancer and serious bowel disease was investigated in younger patients at different faecal haemoglobin (f‐Hb) cut‐offs of 2, 10 and 150 µg blood/g faeces (µg/g). Early onset colorectal cancer was diagnosed in 1.5% (16/1103) of younger symptomatic patients. The sensitivity of FIT for younger patients aged was 87.5% (95% CI 61.7%–98.4%), 81.3% (54.4%–96.0%) and 68.8% (41.3%–89.0%) at f‐Hb cut‐offs of 2, 10 and 150 µg/g, respectively. The positive predictive value for colorectal cancer increased from 4.2% (2.3%–6.9%) to 11.5% (5.9%–19.6%) at cut‐offs of 2 and 150 µg/g, while the positive predictive value for serious bowel disease increased from 31.3% (26.3%–36.5%) to 65.6% (55.2%–75.0%) at the same cut‐offs. The negative predictive value of FIT for colorectal cancer remained above 99.5% at all cut‐offs. Detectable f‐Hb on FIT in symptomatic younger patients may indicate referral for investigation of colorectal cancer and serious bowel disease.
Publisher: Wiley
Date: 23-08-2022
DOI: 10.1111/CODI.16294
Abstract: To determine the efficacy of a new 2-week wait pathway that uses the faecal immunochemical test (FIT) in primary care to triage patients with high and low risk symptoms suspicious of colorectal cancer (CRC). This service improvement pilot follows 2017 National Institute for Health and Care Excellence guidance, that recommended using FIT to guide referral of patients with low risk, but not high risk symptoms, which continue to be referrred on the 2-week pathway. Patients with high- and low-risk CRC symptoms were tested with FIT and those with faecal haemoglobin (f-Hb) ≥9.5 μg haemoglobin/g faeces (hereafter μg/g) were referred to secondary care. Results were tracked and primary care prompted to refer if timely referral was not made. Between December 2019 and October 2020, 5672 patients presented to primary care with high and/or low risk symptoms warranting investigations. Of these, 622 (11%) patients were referred without a FIT, of whom 36 (5.8%) had CRC. The remaining 5050 patients had a FIT, of which 4187 (83%) were processed to produce a quantitative result. Of these, 1085 patients (25.9%) had an f-Hb ≥9.5 μg/g and of those, 982 patients (90.5%) were referred and 56 (5.7%) had CRC. A total of 3102 patients (74.1%) had an f-Hb <9.5 μg/g, of which 456 (14.7%) were referred and three (0.7%) had CRC. A total of 97 cancers were diagnosed with a cancer prevalence of 1.7%. A 2-week wait pathway incorporating FIT as a triage tool can be implemented successfully in primary care to identify symptomatic patients at highest risk of CRC.
Publisher: Wiley
Date: 15-03-2021
DOI: 10.1111/CODI.15593
Abstract: The aim of this work was to investigate whether the faecal immunochemical test (FIT) could safely rule out colorectal cancer (CRC) in patients with rectal bleeding (RB). This was a multicentre, double‐blinded diagnostic accuracy study in 50 National Health Service hospitals. Patients referred from primary care with suspected CRC on an urgent 2‐week‐wait pathway were asked to perform a FIT prior to colonoscopy. The primary outcome measure was the sensitivity of the FIT for CRC in patients with RB versus nonrectal bleeding symptoms (NRB). The secondary outcome measures included the diagnostic accuracy of the FIT for CRC and other serious bowel disease. Of 9822 patients included in the study, 3143 (32.0%) were referred with RB. CRC was present in 4.7% of patients with RB versus 2.7% of patients with NRB ( p 0.05). Faecal haemoglobin ( f ‐Hb) was detectable ( µg/g) in 44.1% of patients with RB and 33.9% with NRB ( p 0.05). In RB patients, CRC was present in 10.4% when f ‐Hb was µg/g compared with 0.1% when f ‐Hb was not detected. Flexible sigmoidoscopy in this group would further reduce the risk of CRC to 0.03%. The sensitivity of the FIT for CRC in RB versus NRB groups was 98.6% (95% CI 95.2%–99.8%) vs 95.6% (91.5%–98.1%) for f ‐Hb µg/g and 96.6% (92.2%–98.9%) vs 86.3 (80.4%–90.9%) for f ‐Hb µg/g. Faecal haemoglobin is not always detectable in patients with RB 56% of patients had undetectable f ‐Hb ( µg/g) and CRC was present in 0.1%. The high sensitivity of the FIT can be used to rule out CRC in patients with RB and triage them more appropriately for investigation.
Publisher: BMJ
Date: 12-07-2022
DOI: 10.1136/GUTJNL-2022-327985
Abstract: Faecal immunochemical testing (FIT) has a high sensitivity for the detection of colorectal cancer (CRC). In a symptomatic population FIT may identify those patients who require colorectal investigation with the highest priority. FIT offers considerable advantages over the use of symptoms alone, as an objective measure of risk with a vastly superior positive predictive value for CRC, while conversely identifying a truly low risk cohort of patients. The aim of this guideline was to provide a clear strategy for the use of FIT in the diagnostic pathway of people with signs or symptoms of a suspected diagnosis of CRC. The guideline was jointly developed by the Association of Coloproctology of Great Britain and Ireland/British Society of Gastroenterology, specifically by a 21-member multidisciplinary guideline development group (GDG). A systematic review of 13 535 publications was undertaken to develop 23 evidence and expert opinion-based recommendations for the triage of people with symptoms of a suspected CRC diagnosis in primary care. In order to achieve consensus among a broad group of key stakeholders, we completed an extended Delphi of the GDG, and also 61 other in iduals across the UK and Ireland, including by members of the public, charities and primary and secondary care. Seventeen research recommendations were also prioritised to inform clinical management.
Publisher: Oxford University Press (OUP)
Date: 13-05-2020
DOI: 10.1002/BJS.11695
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.EJCA.2019.08.020
Abstract: Tumour deposits (TDs) are a poor prognostic marker in colorectal cancer, but their significance after neoadjuvant chemoradiotherapy is less certain because this group of patients is excluded in most studies. Post-treatment TD might even be a sign of tumour response. No previous reviews have assessed outcomes in this group. A systematic review and meta-analysis was undertaken according to Preferred Reporting for Systematic Reviews and Meta-Analyses guidelines to determine the relevance of post-treatment TD. Inclusion criteria were studies assessing TD in patients who had undergone pre-operative treatment with radiotherapy and/or chemotherapy and reporting prevalence and survival outcomes. Studies that did not include histological review of cases were excluded. Eight studies and 1283 patients were included in the review. Prevalence of TDs varied from 11.8% to 44.2% (mean 23.7%), similar to untreated patients. The presence of TDs after chemoradiotherapy was associated with invasion depth, lymph node involvement, perineural invasion and synchronous metastases. The pooled hazard ratio for 5-year adverse disease-free survival was 2.3 (95% confidence interval [CI]: 1.8-2.9), and that for overall survival was 2.5 (95% CI: 1.9-3.3). One study showed a survival benefit with adjuvant therapy in the TD-positive group. In analogy with untreated patients, the presence of TDs in patients with rectal cancer after neoadjuvant treatment is associated with advanced disease and a poor outcome.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Nigel D'Souza.