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Published in:

01-07-2014

Perioperative characterization of anastomotic doughnuts with high-resolution probe-based confocal laser endomicroscopy in colorectal cancer surgery: a feasibility study

Authors: Giovanni D. De Palma, Gaetano Luglio, Stefania Staibano, Luigi Bucci, Dario Esposito, Francesco Maione, Massimo Mascolo, Gennaro Ilardi, Pietro Forestieri

Published in: Surgical Endoscopy | Issue 7/2014

Abstract

Background

Confocal laser enables in vivo real-time histopathology of the mucosa layer of gastrointestinal tract. The aim of this study was to assess the feasibility and the role of probe-based confocal laser endomicroscopy in extemporary examination of staple rings of patients with colorectal cancer.

Methods

This was a prospective, single-center pilot study. Patients who underwent end-to-end stapled surgical resection for colorectal cancer were included. Confocal imaging was analyzed with great attention to image quality evaluation of cellular morphology and cellular structures of the serosal, muscular, and mucosal layers of the doughnuts than comparing results with definitive histopathology.

Results

Twenty-six doughnuts were analyzed. Real-time video sequences were obtained in all patients, with a total of 204 mosaic images. For each doughnut, most of the images were adequate for evaluation of cellular morphology and cellular structure of the serosal, muscular, and mucosal layers.

Conclusions

Perioperative assessment of doughnut tissues in patients with colorectal cancer by confocal laser endomicroscopy is feasible and safe. Prospective studies are warranted for further evaluation of the clinical impact of this technology during surgery.

Slieker JC, Daams F, Mulder IM, Jeekel J, Lange JF (2013) Systematic review of the technique of colorectal anastomosis (review). JAMA Surg 148(2):190–201PubMedCrossRef

Ho YH, Ashour MA (2010) Techniques for colorectal anastomosis (review). World J Gastroenterol 16(13):1610–1621PubMedCentralPubMedCrossRef

Quirke P, Morris E (2007) Reporting colorectal cancer (review). Histopathology 50:103–112PubMedCrossRef

Bull AD, Biffin AH, Mella J, Radcliffe AG, Stamatakis JD, Steele RJ, Williams GT (1997) Colorectal cancer pathology reporting: a regional audit. J Clin Pathol 50:138–142PubMedCentralPubMedCrossRef

Speake WJ, Abercrombie JF (2003) Should “doughnut” histology be routinely performed following anterior resection for rectal cancer? Ann R Coll Surg Engl 85:26–27PubMedCentralPubMedCrossRef

Morgan A, Dawson PM, Smith JJ (2006) Histological examination of circular stapled “doughnuts”: questionable routine practice? Surgeon 4:75–77PubMedCrossRef

Pullybank AM, Kirwan C, Rigby HS, Dixon AR (2001) Is routine histological reporting of doughnuts justified after anterior resection for colorectal cancer? Colorectal Dis 3:198–200CrossRef

De Palma GD (2009) Confocal laser endomicroscopy in the “in vivo” histological diagnosis of the gastrointestinal tract. World J Gastroenterol 15:5770–5775PubMedCentralPubMedCrossRef

De Palma GD, Wallace MB, Giovannini M (2012) Confocal laser endomicroscopy. Gastroenterol Res Pract 2012:216209PubMedCentralPubMedCrossRef

10.

Wu J, Pan YM, Wang TT, Hu B (2013) Confocal laser endomicroscopy for detection of neoplasia in Barrett’s esophagus: a meta-analysis. Dis Esophagus. doi:10.1111/dote.12085

11.

De Palma GD, Staibano S, Siciliano S, Persico M, Masone S, Maione F, Siano M, Mascolo M, Esposito D, Salvatori F, Persico G (2010) In vivo characterisation of superficial colorectal neoplastic lesions with high-resolution probe-based confocal laser endomicroscopy in combination with video-mosaicing: a feasibility study to enhance routine endoscopy. Dig Liver Dis 42(11):791–797PubMedCrossRef

12.

Dong YY, Li YQ, Yu YB, Liu J, Li M, Luan XR (2013) Meta-analysis of confocal laser endomicroscopy for the detection of colorectal neoplasia. Colorectal Dis. doi:10.1111/codi.12329 PubMed

13.

Mascolo M, Staibano S, Ilardi G, Siano M, Vecchione ML, Esposito D, De Rosa G, De Palma GD (2012) Probe-based confocal laser endomicroscopy evaluation of colon preneoplastic lesions, with particular attention to the aberrant crypt foci, and comparative assessment with histological features obtained by conventional endoscopy. Gastroenterol Res Pract 2012:645173PubMedCentralPubMedCrossRef

14.

Rispo A, Castiglione F, Staibano S, Esposito D, Maione F, Siano M, Salvatori F, Masone S, Persico M, De Palma GD (2012) Diagnostic accuracy of confocal laser endomicroscopy in diagnosing dysplasia in patients affected by long-standing ulcerative colitis. World J Gastrointest Endosc 4(9):414–420PubMedCentralPubMedCrossRef

15.

Atasoy S, Mateus D, Meining A, Yang GZ, Navab N (2011) Targeted optical biopsies for surveillance endoscopies. Med Image Comput Comput Assist Interv 14(pt 3):83–90PubMed

16.

Goetz M (2013) Endomicroscopy and targeted imaging of gastric neoplasia. Gastrointest Endosc Clin N Am 23(3):597–606PubMedCrossRef

17.

Bok GH, Jeon SR, Cho JY, Cho JH, Lee WC, Jin SY, Choi IH, Kim HG, Lee TH, Park EJ (2013) The accuracy of probe-based confocal endomicroscopy versus conventional endoscopic biopsies for the diagnosis of superficial gastric neoplasia. Gastrointest Endosc 77(6):899–908PubMedCrossRef

18.

De Palma GD, Staibano S, Siciliano S, Maione F, Siano M, Esposito D, Persico G (2011) In-vivo characterization of DALM in ulcerative colitis with high-resolution probe-based confocal laser endomicroscopy. World J Gastroenterol 17(5):677–680PubMedCentralPubMedCrossRef

19.

von Delius S, Feussner H, Wilhelm D, Karagianni A, Henke J, Schmid RM, Meining A (2007) Transgastric in vivo histology in the peritoneal cavity using miniprobe-based confocal fluorescence microscopy in an acute porcine model. Endoscopy 39(5):407–411CrossRef

20.

Becker V, Wallace MB, Fockens P, von Delius S, Woodward TA, Raimondo M, Voermans RP, Meining A (2010) Needle-based confocal endomicroscopy for in vivo histology of intra-abdominal organs: first results in a porcine model (with videos). Gastrointest Endosc 71(7):1260–1266PubMedCrossRef

21.

Mennone A, Nathanson MH (2011) Needle-based confocal laser endomicroscopy to assess liver histology in vivo. Gastrointest Endosc 73(2):338–344PubMedCentralPubMedCrossRef

22.

Goetz M, Kiesslich R, Dienes HP, Drebber U, Murr E, Hoffman A, Kanzler S, Galle PR, Delaney P, Neurath MF (2008) In vivo confocal laser endomicroscopy of the human liver: a novel method for assessing liver microarchitecture in real time. Endoscopy 40(7):554–562PubMedCrossRef

23.

Konda VJ, Aslanian HR, Wallace MB, Siddiqui UD, Hart J, Waxman I (2011) First assessment of needle-based confocal laser endomicroscopy during EUS-FNA procedures of the pancreas (with videos). Gastrointest Endosc 74(5):1049–1060PubMedCrossRef

24.

Samarasena JB, Nakai Y, Chang KJ (2012) Endoscopic ultrasonography-guided fine-needle aspiration of pancreatic cystic lesions: a practical approach to diagnosis and management. Gastrointest Endosc Clin N Am 22(2):169–185 viiPubMedCrossRef

25.

Giglio MC, Persico M, Quarto G, Benassai G, Luglio G, Tarquini R, Celentano V, Sollazzo V, Bucci L (2013) Intersphinteric resection for rectal cancer: role in fecal continence and quality of life. Ann Ital Chir 84:287–290PubMed

26.

Vernava AM III, Moran M, Rothenberger DA, Wong WD (1992) A prospective evaluation of distal margins in carcinoma of the rectum. Surg Gynecol Obstet 175:333–336PubMed

27.

Hayden DM, Jakate S, Pinzon MC, Giusto D, Francescatti AB, Brand MI, Saclarides TJ (2012) Tumor scatter after neoadjuvant therapy for rectal cancer: are we dealing with an invisible margin? Dis Colon Rectum 55(12):1206–1212PubMedCrossRef

Title: Perioperative characterization of anastomotic doughnuts with high-resolution probe-based confocal laser endomicroscopy in colorectal cancer surgery: a feasibility study
Authors: Giovanni D. De Palma
Gaetano Luglio
Stefania Staibano
Luigi Bucci
Dario Esposito
Francesco Maione
Massimo Mascolo
Gennaro Ilardi
Pietro Forestieri
Publication date: 01-07-2014
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 7/2014
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-014-3429-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Perioperative characterization of anastomotic doughnuts with high-resolution probe-based confocal laser endomicroscopy in colorectal cancer surgery: a feasibility study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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