National implementation of an optimal standardised technique for right-sided colon cancer:protocol of an interventional sequential cohort study (Right study)

Purpose: Minimally invasive right hemicolectomy (MIRH) is the cornerstone of treatment for patients with right-sided colon cancer. This operation has evolved during recent decades, with many innovations and improvements but this has also resulted in high variability of uptake with subsequent substantial variableness. The aim of this ongoing study is to identify current surgical variations, determine the most optimal and standardised MIRH and nationally train and implement that technique to improve short-term clinical and long-term oncological outcomes. Methods: The Right study is a national multicentre prospective interventional sequential cohort study. Firstly, current local practice was evaluated. Subsequently, a standardised surgical technique for right-sided colon cancer was determined using the Delphi consensus method, and this procedure was trained during hands-on courses. The standardised MIRH will be implemented with proctoring (implementation cohort), after which the performance will be monitored (consolidation cohort). Patients who will receive a minimally invasive (extended) right hemicolectomy for cT1-3N0-2M0 colon cancer will be included. The primary outcome is patient safety reflected in the 90-day overall complication rate according to the Clavien–Dindo classification. Secondary outcomes will include intraoperative complications, 90-day mortality rate, number of resected tumour-positive lymph nodes, completeness of mesocolic excision, surgical quality score, locoregional and distant recurrence and 5-year overall survival. A total number of 1095 patients (365 per cohort) will be included. Discussion: The Right study is designed to safely implement the best surgical practice concerning patients with right-sided colon cancer aiming to standardise and improve the surgical quality of MIRH at a national level. Trial registration: ClinicalTrials.gov: NCT04889456, May 2021.</p

Met expression is an independent prognostic risk factor in patients with oesophageal adenocarcinoma

Oesophageal adenocarcinoma is an aggressive malignancy with propensity for early lymphatic and haematogenous dissemination. Since conventional TNM staging does not provide accurate prognostic information, novel molecular prognostic markers and potential therapeutic targets are subject of intense research. The aim of the present study was to study the prognostic significance of Met, the hepatic growth factor (HGF) receptor and a possible target for therapy in comparison to cyclooxygenase-2 (COX-2). Tumour sections from 145 consecutive patients undergoing intentionally curative surgery for oesophageal adenocarcinoma were immunohistochemically analysed for Met and COX-2 expression. Clinicopathological data were prospectively collected for all patients. Patients with high Met expression had significantly reduced overall and disease-specific 5-year survival rates (P⩽0.001 and P⩽0.001, respectively) and were more likely to develop distant metastases (P=0.002) and local recurrences (P=0.004) compared to patients with low Met expression. High COX-2 expression tended to be correlated with poor long-term survival but this did not reach statistical significance. Expression of Met was recognised as a significant and independent prognostic factor by stage-specific analysis and multivariate analysis (relative risk=2.3; 95% CI=1.3–4.1). These findings support the importance of Met in oesophageal adenocarcinoma and support the concept of Met tyrosine kinase inhibition as (neo-) adjuvant treatment

Biliary tract visualization using near-infrared imaging with indocyanine green during laparoscopic cholecystectomy: results of a systematic review

Contains fulltext : 174508.pdf (publisher's version ) (Open Access)BACKGROUND: Near-infrared imaging with indocyanine green (ICG) has been extensively investigated during laparoscopic cholecystectomy (LC). However, methods vary between studies, especially regarding patient selection, dosage and timing. The aim of this systematic review was to evaluate the potential of the near-infrared imaging technique with ICG to identify biliary structures during LC. METHODS: A comprehensive systematic literature search was performed. Prospective trials examining the use of ICG during LC were included. Primary outcome was biliary tract visualization. Risk of bias was assessed using ROBINS-I. Secondly, a meta-analysis was performed comparing ICG to intraoperative cholangiography (IOC) for identification of biliary structures. GRADE was used to assess the quality of the evidence. RESULTS: Nineteen studies were included. Based upon the pooled data from 13 studies, cystic duct (Lusch et al. in J Endourol 28:261-266, 2014) visualization was 86.5% (95% CI 71.2-96.6%) prior to dissection of Calot's triangle with a 2.5-mg dosage of ICG and 96.5% (95% CI 93.9-98.4%) after dissection. The results were not appreciably different when the dosage was based upon bodyweight. There is moderate quality evidence that the CD is more frequently visualized using ICG than IOC (RR 1.16; 95% CI 1.00-1.35); however, this difference was not statistically significant. CONCLUSION: This systematic review provides equal results for biliary tract visualization with near-infrared imaging with ICG during LC compared to IOC. Near-infrared imaging with ICG has the potential to replace IOC for biliary mapping. However, methods of near-infrared imaging with ICG vary. Future research is necessary for optimization and standardization of the near-infrared ICG technique

Supercoherent States, Super K\"ahler Geometry and Geometric Quantization

Generalized coherent states provide a means of connecting square integrable representations of a semi-simple Lie group with the symplectic geometry of some of its homogeneous spaces. In the first part of the present work this point of view is extended to the supersymmetric context, through the study of the OSp(2/2) coherent states. These are explicitly constructed starting from the known abstract typical and atypical representations of osp(2/2). Their underlying geometries turn out to be those of supersymplectic OSp(2/2) homogeneous spaces. Moment maps identifying the latter with coadjoint orbits of OSp(2/2) are exhibited via Berezin's symbols. When considered within Rothstein's general paradigm, these results lead to a natural general definition of a super K\"ahler supermanifold, the supergeometry of which is determined in terms of the usual geometry of holomorphic Hermitian vector bundles over K\"ahler manifolds. In particular, the supergeometry of the above orbits is interpreted in terms of the geometry of Einstein-Hermitian vector bundles. In the second part, an extension of the full geometric quantization procedure is applied to the same coadjoint orbits. Thanks to the super K\"ahler character of the latter, this procedure leads to explicit super unitary irreducible representations of OSp(2/2) in super Hilbert spaces of $L^2$ superholomorphic sections of prequantum bundles of the Kostant type. This work lays the foundations of a program aimed at classifying Lie supergroups' coadjoint orbits and their associated irreducible representations, ultimately leading to harmonic superanalysis. For this purpose a set of consistent conventions is exhibited.Comment: 53 pages, AMS-LaTeX (or LaTeX+AMSfonts

Symplectic connections and Fedosov's quantization on supermanifolds

A (biased and incomplete) review of the status of the theory of symplectic connections on supermanifolds is presented. Also, some comments regarding Fedosov's technique of quantization are made.Comment: Submitted to J. of Phys. Conf. Se

Projective Fourier Duality and Weyl Quantization

The Weyl-Wigner correspondence prescription, which makes large use of Fourier duality, is reexamined from the point of view of Kac algebras, the most general background for noncommutative Fourier analysis allowing for that property. It is shown how the standard Kac structure has to be extended in order to accommodate the physical requirements. An Abelian and a symmetric projective Kac algebras are shown to provide, in close parallel to the standard case, a new dual framework and a well-defined notion of projective Fourier duality for the group of translations on the plane. The Weyl formula arises naturally as an irreducible component of the duality mapping between these projective algebras.Comment: LaTeX 2.09 with NFSS or AMSLaTeX 1.1. 102Kb, 44 pages, no figures. requires subeqnarray.sty, amssymb.sty, amsfonts.sty. Final version with text improvements and crucial typos correction

Laparoscopic Versus Robot-Assisted Versus Transanal Low Anterior Resection:3-Year Oncologic Results for a Population-Based Cohort in Experienced Centers

BACKGROUND: Laparoscopic, robot-assisted, and transanal total mesorectal excision are the minimally invasive techniques used most for rectal cancer surgery. Because data regarding oncologic results are lacking, this study aimed to compare these three techniques while taking the learning curve into account. METHODS: This retrospective population-based study cohort included all patients between 2015 and 2017 who underwent a low anterior resection at 11 dedicated centers that had completed the learning curve of the specific technique. The primary outcome was overall survival (OS) during a 3-year follow-up period. The secondary outcomes were 3-year disease-free survival (DFS) and 3-year local recurrence rate. Statistical analysis was performed using Cox-regression. RESULTS: The 617 patients enrolled in the study included 252 who underwent a laparoscopic resection, 205 who underwent a robot-assisted resection, and 160 who underwent a transanal low anterior resection. The oncologic outcomes were equal between the three techniques. The 3-year OS rate was 90% for laparoscopic resection, 90.4% for robot-assisted resection, and 87.6% for transanal low anterior resection. The 3-year DFS rate was 77.8% for laparoscopic resection, 75.8% for robot-assisted resection, and 78.8% for transanal low anterior resection. The 3-year local recurrence rate was in 6.1% for laparoscopic resection, 6.4% for robot-assisted resection, and 5.7% for transanal procedures. Cox-regression did not show a significant difference between the techniques while taking confounders into account. CONCLUSION: The oncologic results during the 3-year follow-up were good and comparable between laparoscopic, robot-assisted, and transanal total mesorectal technique at experienced centers. These techniques can be performed safely in experienced hands

Obstruction Results in Quantization Theory

We define the quantization structures for Poisson algebras necessary to generalise Groenewold and Van Hove's result that there is no consistent quantization for the Poisson algebra of Euclidean phase space. Recently a similar obstruction was obtained for the sphere, though surprising enough there is no obstruction to the quantization of the torus. In this paper we want to analyze the circumstances under which such obstructions appear. In this context we review the known results for the Poisson algebras of Euclidean space, the sphere and the torus.Comment: 34 pages, Latex. To appear in J. Nonlinear Scienc

Comparison of laparoscopic versus robot-assisted versus transanal total mesorectal excision surgery for rectal cancer:a retrospective propensity score-matched cohort study of short-term outcomes

BACKGROUND: Laparoscopic total mesorectal excision (TME) surgery for rectal cancer has important technical limitations. Robot-assisted and transanal TME (TaTME) may overcome these limitations, potentially leading to lower conversion rates and reduced morbidity. However, comparative data between the three approaches are lacking. The aim of this study was to compare short-term outcomes for laparoscopic TME, robot-assisted TME and TaTME in expert centres. METHODS: Patients undergoing rectal cancer surgery between 2015 and 2017 in expert centres for laparoscopic, robot-assisted or TaTME were included. Outcomes for TME surgery performed by the specialized technique in the expert centres were compared after propensity score matching. The primary outcome was conversion rate. Secondary outcomes were morbidity and pathological outcomes. RESULTS: A total of 1078 patients were included. In rectal cancer surgery in general, the overall rate of primary anastomosis was 39.4, 61.9 and 61.9 per cent in laparoscopic, robot-assisted and TaTME centres respectively (P < 0.001). For specialized techniques in expert centres excluding abdominoperineal resection (APR), the rate of primary anastomosis was 66.7 per cent in laparoscopic, 89.8 per cent in robot-assisted and 84.3 per cent in TaTME (P < 0.001). Conversion rates were 3.7 , 4.6 and 1.9 per cent in laparoscopic, robot-assisted and TaTME respectively (P = 0.134). The number of incomplete specimens, circumferential resection margin involvement rate and morbidity rates did not differ. CONCLUSION: In the minimally invasive treatment of rectal cancer more primary anastomoses are created in robotic and TaTME expert centres

Cotangent bundle quantization: Entangling of metric and magnetic field

For manifolds $\cal M$ of noncompact type endowed with an affine connection (for example, the Levi-Civita connection) and a closed 2-form (magnetic field) we define a Hilbert algebra structure in the space $L^2(T^*\cal M)$ and construct an irreducible representation of this algebra in $L^2(\cal M)$. This algebra is automatically extended to polynomial in momenta functions and distributions. Under some natural conditions this algebra is unique. The non-commutative product over $T^*\cal M$ is given by an explicit integral formula. This product is exact (not formal) and is expressed in invariant geometrical terms. Our analysis reveals this product has a front, which is described in terms of geodesic triangles in $\cal M$. The quantization of $\delta$-functions induces a family of symplectic reflections in $T^*\cal M$ and generates a magneto-geodesic connection $\Gamma$ on $T^*\cal M$. This symplectic connection entangles, on the phase space level, the original affine structure on $\cal M$ and the magnetic field. In the classical approximation, the $\hbar^2$-part of the quantum product contains the Ricci curvature of $\Gamma$ and a magneto-geodesic coupling tensor.Comment: Latex, 38 pages, 5 figures, minor correction