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Role of artificial intelligence in colorectal cancer

Artificial Intelligence in Gastrointestinal Endoscopy 2024年第2期5卷 31-40页

作者： Gita Lingam Taner Shakir Rawen Kader manish chand Department of General Surgery Princess Alexandra HospitalHarlow CM201QXUnited Kingdom Department of Colorectal Surgery University College LondonLondon W1W 7TYUnited Kingdom Department of Gastroenterology University College LondonUniversity College London Hospitals Nhs Foundation TrustLondon W1BUnited Kingdom Gastroenterological Intervention Centre University College LondonLondon W1W 7TSUnited Kingdom

The sphere of artificial intelligence(AI)is ever expanding.Applications for clinical practice have been emerging over recent years.Although its uptake has been most prominent in endoscopy,this represents only one aspect of holistic patient care.There are a multitude of other potential avenues in which gastrointestinal care may be involved.We aim to review the role of AI in colorectal cancer as a whole.We performed broad scoping and focused searches of the applications of AI in the field of colorectal cancer.All trials including qualitative research were included from the year 2000 onwards.Studies were grouped into pre-operative,intra-operative and post-operative aspects.Preoperatively,the major use is with endoscopic recognition.Colonoscopy has embraced the use for human derived classifications such as Narrow-band Imaging International Colorectal Endoscopic,Japan Narrow-band Imaging Expert Team,Paris and Kudo.However,novel detection and diagnostic methods have arisen from advances in AI classification.Intra-operatively,adjuncts such as image enhanced identification of structures and assessment of perfusion have led to improvements in clinical outcomes.Post-operatively,monitoring and surveillance have taken strides with potential socioeconomic and environmental savings.The uses of AI within the umbrella of colorectal surgery are multiple.We have identified existing technologies which are already augmenting cancer care.The future applications are exciting and could at least match,if not surpass human standards.

关键词： Artificial intelligence Colorectal cancer Pre-operative Intra-operative Post-operative Adjuncts Colonoscopy

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Evolution of transanal total mesorectal excision for rectal cancer:From top to bottom

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World Journal of Gastrointestinal Surgery 2018年第3期10卷 28-39页

作者： Sameh Hany Emile F Borja de Lacy Deborah Susan Keller Beatriz Martin-Perez Sadir Alrawi Antonio M Lacy manish chand Department of General Surgery Mansoura Faculty of Medicine Department of Surgery Hospital Clinic University of Barcelona GENIE Centre University College London Department of Surgery and Interventional Sciences University College London Hospitals NHS Trusts Department of Surgical Oncology Alzahra Cancer Center Al Zahra Hospital

The gold standard for curative treatment of locally advanced rectal cancer involves radical resection with a total mesorectal excision(TME). TME is the most effective treatment strategy to reduce local recurrence and improve survival outcomes regardless of the surgical platform used. However, there are associated morbidities, functional consequences, and quality of life(QoL) issues associated with TME; these risks must be considered during the modern-day multidisciplinary treatment for rectal cancer. This has led to the development of new surgical techniques to improve patient, oncologic, and QoL outcomes. In this work, we review the evolution of TME to the transanal total mesorectal excision(TaTME) through more traditional minimally invasive platforms. The review the development, safety and feasibility, proposed benefits and risks of the procedure, implementation and education models, and future direction for research and implementation of the TaTME in colorectal surgery. While satisfactory short-term results have been reported, the procedure is in its infancy, and long term outcomes and definitive results from controlled trials are pending.As evidence for safety and feasibility accumulates,structured training programs to standardize teaching,training, and safe expansion will aid the safe spread of the TaTME.

关键词： Rectal cancer Total mesorectal excision Transanal total mesorectal excision Sphincter sparing surgery Colorectal surgery

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Defining response to radiotherapy in rectal cancer using magnetic resonance imaging and histopathological scales

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World Journal of Gastroenterology 2016年第37期22卷 8414-8434页

作者： Muhammed RS Siddiqui Jemma Bhoday Nicholas J Battersby manish chand Nicholas P West Al-Mutaz Abulafi Paris P Tekkis Gina Brown Department of Colorectal Surgery Croydon University Hospital Croydon London CR7 7YE United Kingdom Department of Radiology Royal Marsden Hospital Sutton SM2 5PT United Kingdom Pathology and Tumour Biology Leeds Institute of Cancer and Pathology St. James's University Hospital Leeds LS9 7TF United Kingdom Department of Surgery Royal Marsden Hospital Fulham Rd London SM2 5PT United Kingdom

AIM To define good and poor regression using pathology and magnetic resonance imaging(MRI) regression scales after neo-adjuvant chemotherapy for rectal cancer.METHODS A systematic review was performed on all studies up to December 2015, without language restriction, t h a t w e r e i d e n t i f i e d f r o m M E D L I N E, C o c h r a n e Controlled Trials Register(1960-2015), and EMBASE(1991-2015). Searches were performed of article bibliographies and conference abstracts. MeS H and text words used included "tumour regression", "mr TRG", "poor response" and "colorectal cancers". Clinical studies using either MRI or histopathological tumour regression grade(TRG) scales to define good and poor responders were included in relation to outcomes [local recurrence(LR), distant recurrence(DR), disease-free survival(DFS), and overall survival(OS)]. There was no age restriction or stage of cancer restriction for patient inclusion. Data were extracted by two authors working independently and using pre-defined outcome measures.RESULTS Quantitative data(prevalence) were extracted and analysed according to meta-analytical techniques using comprehensive meta-analysis. Qualitative data(LR, DR, DFS and OS) were presented as ranges. The overall proportion of poor responders after neo-adjuvant chemoradiotherapy(CRT) was 37.7%(95%CI: 30.1-45.8). There were 19 different reported histopathological scales and one MRI regression scale(mrT RG). Clinical studies used nine and six histopathological scales for poor and good responders, respectively. All studies using MRI to define good and poor response used one scale. The most common histopathological definition for good response was the Mandard grades 1 and 2 or Dworak grades 3 and 4; Mandard 3, 4 and 5 and Dworak 0, 1 and 2 were used for poor response. For histopathological grades, the 5-year outcomes for poor responders were LR 3.4%-4.3%, DR 14.3%-20.3%, DFS 61.7%-68.1% and OS 60.7-69.1. Good pathological response 5-year outcomes were LR 0%-1.8%, DR 0%-11.6%, DFS 78.4%-86.7%, and OS 7

关键词： Tumour regression mrT RG Poor response Neo-adjuvant therapy Rectal cancer

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Novel biomarkers for patient stratification in colorectal cancer:A review of definitions,emerging concepts,and data

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World Journal of Gastrointestinal Oncology 2018年第7期10卷 145-158页

作者： manish chand Deborah S Keller Reza Mirnezami Marc Bullock Aneel Bhangu Brendan Moran Paris P Tekkis Gina Brown Alex Mirnezami Mariana Berho GENIE Centre University College LondonLondon W1W 7TSUnited Kingdom Department of Surgery Columbia University Medical CentreNew YorkNY 10032United States Department of Surgery Imperial College LondonLondon SW7 2AZUnited Kingdom Department of Surgery University of SouthamptonSouthampton SO17 1BJUnited Kingdom Department of Surgery University of BirminghamBirmingham B15 2QUUnited Kingdom Department of Colorectal Surgery North Hampshire HospitalBasingstoke RG24 7ALUnited Kingdom Department of Colorectal Surgery Royal Marsden Hospital and Imperial College LondonLondon SW3 6JJUnited Kingdom Department of Radiology Royal Marsden Hospital and Imperial College LondonLondon SW3 6JJUnited Kingdom Department of Surgical Oncology University of Southampton and NIHRSouthampton SO17 1BJUnited Kingdom Department of Pathology Cleveland Clinic FloridaWestonFL 33331United States

Colorectal cancer(CRC) treatment has become more personalised,incorporating a combination of the individual patient risk assessment,gene testing,and chemotherapy with surgery for optimal care.The improvement of staging with high-resolution imaging has allowed more selective treatments,optimising survival outcomes.The next step is to identify biomarkers that can inform clinicians of expected prognosis and offer the most beneficial treatment,while reducing unnecessary morbidity for the patient.The search for biomarkers in CRC has been of significant interest,with questions remaining on their impact and applicability.The study of biomarkers can be broadly divided into metabolic,molecular,micro RNA,epithelial-to-mesenchymal-transition(EMT),and imaging classes.Although numerous molecules have claimed to impact prognosis and treatment,their clinical application has been limited.Furthermore,routine testing of prognostic markers with no demonstrable influence on response to treatment is a questionable practice,as it increases cost and can adversely affect expectations of treatment.In this review we focus on recent developments and emerging biomarkers with potential utility for clinical translation in CRC.We examine and critically appraise novel imaging and molecular-based approaches; evaluate the promising array of micro RNAs,analyze metabolic profiles,and highlight key findings for biomarker potential in the EMT pathway.

关键词： Biomarker Colorectal cancer Epithelial-tomesenchymal-transition pathway Molecular biomarker MicroRNA Metabolic biomarker Imaging biomarker Tumour regression grade

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Systematic review of prognostic importance of extramuralvenous invasion in rectal cancer

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World Journal of Gastroenterology 2016年第4期22卷 1721-1726页

作者： manish chand Muhammed RS Siddiqui Ian Swift Gina Brown Royal Marsden Hospital London SM2 5PTUnited Kingdom Croydon University Hospital London CR7 9YEUnited Kingdom

AIM: To systematically review the survival outcomes relating to extramural venous invasion in rectal cancer.METHODS: A systematic review was conducted using PRISMA guidelines. An electronic search was carried out using MEDLINE, EMBASE, CINAHL, Cochrane library databases, Google scholar and Pub Med until October 2014. Search terms were used in combination to yield articles on extramural venous invasion in rectal cancer. Outcome measures included prevalence and 5-year survival rates. These were graphically displayed using Forest plots. Statistical analysis of the data was carried out.RESULTS: Fourteen studies reported the prevalence of extramural venous invasion(EMVI) positive patients. Prevalence ranged from 9%-61%. The pooled prevalence of EMVI positivity was 26% [Random effects: Event rate 0.26(0.18, 0.36)]. Most studies showed that EMVI related to worse oncological outcomes. The pooled overall survival was 39.5% [Random effects: Event rate 0.395(0.29, 0.51)].CONCLUSION: Historically, there has been huge variation in the prevalence of EMVI through inconsistent reporting. However the presence of EMVI clearly leads to worse survival outcomes. As detection rates become more consistent, EMVI may be considered as part of risk-stratification in rectal cancer. Standardised histopathological definitions and the use of magnetic resonance imaging to identify EMVI will improve detection rates in the future.

关键词： Extramural venous invasion Rectal cancer Overall survival Pathology Vascular invasion magneticresonance imaging

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

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World Journal of Gastroenterology 2014年第45期20卷 16956-16963页

作者： manish chand Muhammed RS Siddiqui Ashish Gupta Shahnawaz Rasheed Paris Tekkis Amjad Parvaiz Alex H Mirnezami Tahseen Qureshi Department of Surgery Royal Marsden Hospital Department of Surgery Croydon University Hospital Department of Minimally-Invasive Surgery Queen Alexandra Hospital Department of Surgery Southampton University Hospital Department of Surgery Poole Hospital

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 minimallyinvasive 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.

关键词： Laparoscopic surgery Colorectal disease Colorectal

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Obese patients have similar short-term outcomes to nonobese in laparoscopic colorectal surgery

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World Journal of Gastrointestinal Surgery 2015年第10期7卷 261-266页

作者： manish chand Henry D De'Ath Muhammed Siddiqui Chetanya Mehta Shahnawaz Rasheed James Bromilow Tahseen Qureshi Department of Surgery Poole General Hospital

AIM: To determine whether obese patients undergoing laparoscopic surgery within an enhanced recovery program had worse short-term outcomes.METHODS: A prospective study of consecutive patients undergoing laparoscopic colorectal resection was carried out between 2008 and 2011 in a single institution. Patients were divided in groups based on body mass index(BMI). Short-term outcomes including operative data, length of stay, complications and readmission rates were recorded and compared between the groups. Continuous data were analysed using t-test or oneway Analysis of Variance. χ2 test was used to compare categorical data.RESULTS: Two hundred and fifty four patients were included over the study period. The majority of individuals(41.7%) recruited were of a healthy weight(BMI 25) does not lead to worse short-term outcomes in laparoscopic colorectal surgery and therefore such patients should not be precluded from laparoscopic surgery.

关键词： Laparoscopic surgery Colorectal cancer Obese: body

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