Contemporary Management of Locally Advanced and Recurrent Rectal Cancer: Views from the PelvEx Collaborative

Pelvic exenteration is a complex operation performed for locally advanced and recurrent pelvic cancers. The goal of surgery is to achieve clear margins, therefore identifying adjacent or involved organs, bone, muscle, nerves and/or vascular structures that may need resection. While these extensive resections are potentially curative, they can be associated with substantial morbidity. Recently, there has been a move to centralize care to specialized units, as this facilitates better multi-disciplinary care input. Advancements in pelvic oncology and surgical innovation have redefined the boundaries of pelvic exenterative surgery. Combined with improved neoadjuvant therapies, advances in diagnostics, and better reconstructive techniques have provided quicker recovery and better quality of life outcomes, with improved survival This article provides highlights of the current management of advanced pelvic cancers in terms of surgical strategy and potential future developments

Olive mill wastewater treatment in microbial fuel cells

Olive mill wastewaters create significant environmental issues in olive-processing countries. One of the most hazardous groups of pollutants in these wastewaters is phenolic compounds. Here, olive mill wastewater was used as substrate and treated in single-chamber air-cathode microbial fuel cells. Olive mill wastewater yielded a maximum voltage of 381 mV on an external resistance of 1 kΩ. Notable decreases in the contents of 3,4-dihydroxybenzoic acid, tyrosol, gallic acid and p-coumaric acid were detected. Chemical oxygen demand removal rates were 65 % while removal of total phenolics by the process was lower (49 %). Microbial community analysis during the olive mill wastewater treating MFC has shown that both exoelectrogenic and phenol-degrading microorganisms have been enriched during the operation. Brevundimonas-, Sphingomonas- and Novosphingobium-related phylotypes were enriched on the anode biofilm, while Alphaproteobacteria and Bacteriodetes dominated the cathode biofilm. As one of the novel studies, it has been demonstrated that recalcitrant olive mill wastewaters could be treated and utilized for power generation in microbial fuel cells

Beating the empty pelvis syndrome: the PelvEx Collaborative core outcome set study protocol

Introduction: the empty pelvis syndrome is a significant source of morbidity following pelvic exenteration surgery. It remains poorly defined with research in this field being heterogeneous and of low quality. Furthermore, there has been minimal engagement with patient representatives following pelvic exenteration with respect to the empty pelvic syndrome. ‘PelvEx—Beating the empty pelvis syndrome’ aims to engage both patient representatives and healthcare professionals to achieve an international consensus on a core outcome set, pathophysiology and mitigation of the empty pelvis syndrome.Methods and analysis: a modified-Delphi approach will be followed with a three-stage study design. First, statements will be longlisted using a recent systematic review, healthcare professional event, patient and public engagement, and Delphi piloting. Second, statements will be shortlisted using up to three rounds of online modified Delphi. Third, statements will be confirmed and instruments for measurable statements selected using a virtual patient-representative consensus meeting, and finally a face-to-face healthcare professional consensus meeting.Ethics and dissemination: the University of Southampton Faculty of Medicine ethics committee has approved this protocol, which is registered as a study with the Core Outcome Measures in Effectiveness Trials Initiative. Publication of this study will increase the potential for comparative research to further understanding and prevent the empty pelvis syndrome.Trial registration number: NCT05683795.</p

Effective coupling of phenol adsorption and photodegradation at the surface of micro-and mesoporous TiO2-activated carbon materials

International audienceNovel titania supported activated carbon catalysts were prepared by a straightforward titania coating route of a microporous activated carbon (AC) derived from shea nut shells, and investigated in phenol photocatalytic degradation. The proposed coating method enables a fixation of the preformed titania anatase nanoparticles (TiO2 NPs) in the external porosity thus allowing their accessibility towards UV irradiation, without causing any reduction of the AC specific area. Interestingly, the coating treatment reshapes the porous texture of the as-prepared TiO2–AC composite materials resulting in an improvement of the adsorption capacity and the formation of an additional mesoporosity on the TiO2-AC surface. Photocatalytic experiments carried out in a batch reactor led to 97% elimination rate of phenol in an aqueous solution with the AC catalysts containing TiO2 NPs in the range from 11 to 34 wt%. The photodegradation performance of the TiO2–AC catalysts was maintained over several successive cycles, without the need of any regeneration treatment. Considering both the textural and microstructural features of the composite materials and their associated phenol removal kinetics, in this paper, we provide new insights into phenol photodegradation pathway involving an effective coupling of adsorption and photodegradation functionalities, resulting in a photo-assisted regeneration mechanism of the catalyst

Contemporary results from the PelvEx collaborative: improvements in surgical outcomes for locally advanced and recurrent rectal cancer

AimThe PelvEx Collaborative collates global data on outcomes following exenterative surgery for locally advanced and locally recurrent rectal cancer (LARC and LRRC, respectively). The aim of this study is to report contemporary data from within the collaborative and benchmark it against previous PelvEx publications. MethodAnonymized data from 45 units that performed pelvic exenteration for LARC or LRRC between 2017 and 2021 were reviewed. The primary endpoints were surgical outcomes, including resection margin status, radicality of surgery, rates of reconstruction and associated morbidity and/or mortality. ResultsOf 2186 patients who underwent an exenteration for either LARC or LRRC, 1386 (63.4%) had LARC and 800 (36.6%) had LRRC. The proportion of males to females was 1232:954. Median age was 62 years (interquartile range 52-71 years) compared with a median age of 63 in both historical LARC and LRRC cohorts. Compared with the original reported PelvEx data (2004-2014), there has been an increase in negative margin (R0) rates from 79.8% to 84.8% and from 55.4% to 71.7% in the LARC and LRRC cohorts, respectively. Bone resection and flap reconstruction rates have increased accordingly in both cohorts (8.2%-19.6% and 22.6%-32% for LARC and 20.3%-41.9% and 17.4%-32.1% in LRRC, respectively). Despite this, major morbidity has not increased. ConclusionIn the modern era, patients undergoing pelvic exenteration for advanced rectal cancer are undergoing more radical surgery and are more likely to achieve a negative resection margin (R0) with no increase in major morbidity