James Wei Tatt Toh

James Wei Tatt Toh
Westmead Hospital | SWAHS · Division of Colorectal Surgery, Department of Surgery

BSc MBBS (UNSW) FRACS PhD (USyd)

About

132
Publications
11,501
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679
Citations
Additional affiliations
May 2017 - present
Westmead Hospital
Position
  • Colorectal Surgeon
February 2016 - February 2017
Concord Repatriation General Hospital
Position
  • Fellow
February 2015 - February 2016
Bankstown-Lidcombe Hospital
Position
  • Colorectal Fellow

Publications

Publications (132)
Article
Background: Most patients with Crohn's disease still require surgery despite significant advances in medical therapy, surveillance, and management strategies. Objective: The purpose of this study was to assess surgical strategies and outcomes in Crohn's disease, including surgical recurrence and emergency surgery. Design: This was a multicente...
Article
Full-text available
There has been a resurgence of interest in the use of mechanical bowel preparation (MBP) and oral antibiotics (OAB) before elective colorectal surgery. Until now, clinical trials and meta-analyses have not compared all 4 approaches (MBP with OAB, OAB only, MBP only, or no preparation) simultaneously. Objective: To perform a network meta-analysis t...
Article
Minimally invasive laparoscopic low or ultra-low anterior resection may present as a complex, technically difficult challenge to even the most experienced of colorectal surgeons. This is because, within the narrow confines of the pelvis, there is usually limited visibility, and difficult manoeuvrability of rigid laparoscopic instrumentation with re...
Article
BACKGROUND Recent studies in non-colorectal malignancy have associated T resident memory (TRM) cells with improved patient survival. It is unknown if TRM plays a role in colorectal cancer (CRC). AIM To examine the potential role of TRM cells in providing immunogenicity in CRC stratified by microsatellite instability (MSI) and BRAF status. METHODS...
Article
Background Lynch syndrome is associated with the most common form of heritable bowel cancer. There remains limited level 1 evidence on survival outcomes and rate of metachronous tumor associated with Lynch syndrome colorectal cancer. Methods A systematic literature search of original studies was performed on Ovid searching MEDLINE, Embase, Cochran...
Article
Full-text available
The initial immune response to HIV determines transmission. However, due to technical limitations we still do not have a comparative map of early mucosal transmission events. By combining RNAscope, cyclic immunofluorescence, and image analysis tools, we quantify HIV transmission signatures in intact human colorectal explants within 2 h of topical e...
Article
Full-text available
Background Recent studies have described the finding of the Arc of Riolan (AoR) crossing the inferior mesenteric vein (IMV) seen during high ligation of IMV while performing minimally invasive colectomies. However, the AoR usually has a medial course, and this variant AoR anatomic course and the clinical importance of its preservation during spleni...
Article
Introduction: Sigmoid volvulus is a potentially devastating and life-threatening condition associated with sigmoid colon redundancy. Many of the classical radiological signs are considered to represent the two adjacent loops of bowel in a mesentero-axial volvulus. However, limited case reports and series have reported on an organo-axial subtype of...
Article
Lymphatic drainage is typically in the direction of arterial supply, and lymphatic drainage for right-sided colon cancers typically travels to ileocolic lymph nodes. It is rare for right-sided colon cancers to metastasize to the lateral pelvic side wall lymph nodes in the absence of local invasion or other distant metastases. In this report, we pre...
Article
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Background Whilst Enhanced Recovery after Surgery (ERAS) has been widely accepted in the international colorectal surgery community, there remains significant variations in ERAS programme implementations, compliance rates and best practice recommendations in international guidelines. Methods A questionnaire was distributed to colorectal surgeons f...
Preprint
Full-text available
The initial immune response to HIV is critical in determining transmission. However, due to technical limitations we still do not have a comparative map of early mucosal transmission events. We combined RNAscope, cyclic-immunofluorescence and novel image analysis tools to quantify HIV transmission dynamics in intact human colorectal tissue. We mapp...
Article
Full-text available
Background To inform effective genomic medicine strategies, it is important to examine current approaches and gaps in well-established applications. Lynch syndrome (LS) causes 3–5% of colorectal cancers (CRCs). While guidelines commonly recommend LS tumour testing of all CRC patients, implementation in health systems is known to be highly variable....
Article
Full-text available
There is not a clear consensus on which pathological features and biomarkers are important in guiding prognosis and adjuvant therapy in colon cancer. The Pathology in Colon Cancer, Prognosis and Uptake of Adjuvant Therapy (PiCC UP) Australia and New Zealand questionnaire was distributed to colorectal surgeons, medical oncologists and pathologists a...
Article
Full-text available
The prognostication of colorectal cancer (CRC) has traditionally relied on staging as defined by the Union for International Cancer Control (UICC) and American Joint Committee on Cancer (AJCC) TNM staging classifications. However, clinically, there appears to be differences in survival patterns independent of stage, suggesting a complex interaction...
Article
Full-text available
PurposeFournier’s gangrene (FG) is a rare potentially lethal necrotising infection of the perineum. While the gold standard management is early and aggressive surgical debridement, the evidence in the literature is unclear as to the role and outcomes of diversional stoma.MethodsA systematic review was conducted to identify studies investigating the...
Article
Full-text available
Background Intestinal neutrophil recruitment is a characteristic feature of the earliest stages of inflammatory bowel disease (IBD). Neutrophil elastase (NE) and myeloperoxidase (MPO) mediate the formation of neutrophil extracellular traps (NETs); NETs produce the bactericidal oxidant hypochlorous acid (HOCl), causing host tissue damage when unregu...
Article
Full-text available
The human intestine contains numerous mononuclear phagocytes (MNP), including subsets of conventional dendritic cells (cDC), macrophages (Mf) and monocytes, each playing their own unique role within the intestinal immune system and homeostasis. The ability to isolate and interrogate MNPs from fresh human tissue is crucial if we are to understand th...
Article
Restorative low anterior resection (LAR) for rectal cancer carries a significant risk of anastomotic leak: one of the most feared complications in colorectal surgery. Operative management may include takedown of the anastomosis and end colostomy which, in some cases, is permanent. Other contemporary operative measures include over the scope clips a...
Article
Full-text available
Introduction For the past two decades, microsatellite instability (MSI) has been reported as a robust clinical biomarker associated with survival advantage attributed to its immunogenicity. However, MSI is also associated with high-risk adverse pathological features (poorly differentiated, mucinous, signet cell, higher grade) and exhibits a double-...
Article
Full-text available
Background: Microsatellite instability (MSI) testing is important for the classification of Lynch syndrome, as a prognostic marker and as a guide for adjuvant chemotherapy in colorectal cancer (CRC). The gold standard for determining MSI status has traditionally been fluorescent multiplex polymerase chain reaction (PCR) and capillary gel electroph...
Poster
Full-text available
Aims Overseas birth is associated with survival advantage in colorectal cancer in Australia. We wished to analyse this survival based on global region of birth, controlling for cancer-specific and other causes of death. Methods Patients from a database of colorectal cancers resected from 5 hospitals in Western Sydney from 2010 to 2016 (n = 1596)...
Article
Full-text available
Purpose: Enhanced Recovery After Surgery (ERAS) has become standard of care in colorectal surgery. However, there is not a universally accepted colorectal ERAS protocol and significant variations in care exist between institutions. The aim of this study was to examine the impact of variations in ERAS interventions and complications on length of sta...
Article
Full-text available
Background: The incidence of rectal cancer is higher in the older population. In developed nations, there has been a rise in incidence in young onset colorectal cancer (CRC). We examined the outcomes of locally advanced rectal cancer (LARC) in younger patients (yRC) compared with older patients, using a retrospective audit. Methods: All cases of...
Chapter
The recent results of the robotic-assisted vs. conventional laparoscopic surgery for rectal cancer (ROLARR) trial reported no difference in risk of conversion to open laparotomy between the robotic and laparoscopic group. The study concluded that robotic-assisted laparoscopic surgery, when performed by surgeons with varying experience with robotic...
Article
Background: There has been much debate as to the importance of mechanical bowel preparation (MBP) and oral antibiotic agents (OAB) prior to elective colorectal surgery over the past two decades. There is no consensus between international guidelines. Methods: The Australia and New Zealand Mechanical Bowel Preparation and Oral Antibiotics (ANZ-MBP-...
Article
Full-text available
Background: There is significant variation in attitude both towards the role of microsatellite instability (MSI) in predicting prognosis, and towards its role in guiding which Stage II colon cancer patients may benefit from adjuvant chemotherapy. Aim: To examine the current status of specialist attitudes towards MSI in guiding prognosis and adju...
Article
Full-text available
BACKGROUND Surgical site infections (SSIs) are the most common cause of health care-associated infections in surgical patients. It is unclear if incisional negative pressure wound therapy (NPWT) can reduce the risk of SSIs in patients after open abdominal surgery. METHODS A prospective, non-blinded multi-centre randomised controlled trial (RCT) wa...
Article
Introduction: The standard of care for locoregionally advanced rectal cancer is neoadjuvant therapy (NA CRT) prior to surgery, of which 10-30% experience a complete pathologic response (pCR). There has been interest in using imaging features, also known as radiomics features, to predict pCR and potentially avoid surgery. This systematic review aims...
Article
Fournier's gangrene (FG) is a rapidly progressing infective necrotising fasciitis of the perianal, perineal and genital region. It is characterised by its aggressive nature and high mortality rates of between 15% and 50%. While it has been commonly found to primarily develop from urological sources, there have been increasing reports of the role of...
Article
Full-text available
Helicobacter pylori is a class one carcinogen which causes chronic atrophic gastritis, gastric intestinal metaplasia, dysplasia and adenocarcinoma. The mechanisms by which H. pylori interacts with other risk and protective factors, particularly vitamin C in gastric carcinogenesis are complex. Gastric carcinogenesis includes metabolic, environmental...
Poster
Purpose: Watch-and-wait for clinical complete response (cCR) following neoadjuvant chemoradiotherapy is gaining momentum. cCR is seen when there is only a flat white scar without an ulcer or nodularity. However, there have been recent concerns raised in the literature regarding misclassification, early regrowth and metastases. Method: A 61-year-ol...
Poster
Purpose: There is debate as to whether oral metronidazole provides any benefit in post‐operative pain post haemorrhoidectomy. Methodology: Five electronic databases including Pubmed, Medline, Embase, Ovid and Cochrane Register of Controlled Trials as well as the clinical trial registries were searched from date of inception to 12th February 2019....
Presentation
Purpose: ERAS programs vary between institutions, and different pre‐operative, intra‐operative and post‐operative strategies are utilized by different colorectal units / surgeons to improve the quality of care received by patients undergoing elective colorectal surgery. Methods: As part of the ANZ‐MBP‐OAB questionnaire, questions used to assess sp...
Poster
Purpose: Approximately ten percent of patient undergoing colorectal surgery have prolonged post‐operative ileus, impacting on length of stay, hospital costs, readmission rates and morbidity. Methods: Data on 207 consecutive patients undergoing elective colorectal surgery were entered prospectively into an Enhanced Recovery After Surgery (ERAS) dat...
Poster
Purpose: There are concerns that bowel preparation with or without antibiotics may impact the microbiome. Methodology: Five electronic databases including Pubmed, Medline, Embase, Ovid and Cochrane Register of Controlled Trials as well as the clinical trial registries were searched from date of inception to 19th September 2019. Any studies reporti...
Article
Full-text available
Purpose: Open haemorrhoidectomy is associated with significant postoperative pain. Metronidazole is commonly prescribed in the postoperative period as an adjunct to analgesia in pain management. Methods: In our systematic review, studies were identified using PubMed/MEDLINE, Embase/Ovid and Cochrane Register of Controlled Trials databases. Studi...
Article
Full-text available
Microsatellite instability (MSI) in colorectal cancer (CRC) is a marker of immunogenicity and is associated with an increased abundance of tumour infiltrating lymphocytes (TILs). In this subgroup of colorectal cancer, it is unknown if these characteristics translate into a measurable difference in circulating tumour cell (CTC) release into peripher...
Article
253 Background: In early and advanced colorectal cancer (CRC), there is limited data comparing the influence of mucinous (MAC) with non-mucinous adenocarcinoma (NMAC) histology on clinical outcomes. We investigated the association between histological type and outcomes in CRC. Methods: Medical records of patients with stage II, III and IV CRC refer...
Article
73 Background: There is limited data regarding the association between peritoneal carcinomatosis (PC) and clinical outcomes in colorectal cancer (CRC). We examined the incidence of PC and explored the relationship to survival (RFS & OS) in CRC. Methods: The demographic and clinical details of patients with stage II/III CRC referred to a tertiary ce...
Article
Background: The National Surgical Quality Improvement Program (NSQIP) is widely used in North America for benchmarking. In 2015, NSQIP was introduced to four New South Wales public hospitals. The aim of this study is to investigate the agreement between NSQIP and administrative data in the Australian setting; to compare the performance of models d...
Article
Background Colorectal cancers with microsatellite instability (MSI) are associated with abundance of tumour infiltrating lymphocytes (TILs). Recent studies have shown that a proportion of TILs may actually be resident memory T cells, not just a continuous circulation of T cells. Methods Patients with known MSI and BRAF status were eligible for inc...
Article
Background Microsatellite instability (MSI) is thought to be a marker of immunogenicity and better prognosis in colorectal cancer (CRC). However, the mechanism by which MSI confers a survival advantage is not well known and there is a range of results reported in the literature. Methods A systematic literature search of original studies was perfor...
Article
Background Laparoscopic ventral mesh rectopexy (LVR) is a treatment with promising results in external rectal prolapse, rectal intussusception, and rectocele. Because of the emergence of robotic-assisted surgery and the technical advantage it provides, we examined the potential role and place of robotic surgery in ventral rectopexy. Methods MEDLIN...
Presentation
Best oral research presentation Asia Pacific Federation of Coloproctology
Article
Full-text available
Although durable clinical responses are achieved in a significant number of patients given Immune checkpoint inhibitors (ICI), like anti-CTLA-4 and anti-PD-1 inhibitors, some of the cancers have shown little or no response to ICI therapy. Even within the known responsive cancers, there is often a subset of non-responsive patients. Due to the accele...
Article
500 Background: The incidence of rectal cancer is higher in the older population. In developed nations there has been a rise in incidence in young onset rectal cancer (yRC). We evaluated and compared the presentation and survival outcomes of treatments for locally advanced rectal cancer in yRC patients to that of older patients. Methods: All cases...
Article
Full-text available
Background The usage of robotic surgery in rectal cancer is increasing, but there is an ongoing debate as to whether it provides any benefit. The aim of the present study was to determine if robotic surgery results in less conversion to an open operation than laparoscopic rectal cancer surgery. Methods A meta-analysis was performed according to Pr...
Article
Full-text available
Background There is significant variation in the use of mechanical bowel preparation and oral antibiotics prior to left-sided elective colorectal surgery. There has been no consensus internationally. Methods This was a retrospective analysis of the 2015 American College of Surgeons National Surgical Quality Improvement Program database. Patients w...
Article
Background: There is a relatively high risk of anastomotic leak in low anterior resection (LAR), associated with significant morbidity and mortality. This systematic review and meta-analysis aims to compare diverting stoma vs. no stoma for LAR in terms of leak rates, reoperations, mortality rates and complication rates. Methods: We systematically...
Presentation
Abstract Purpose The arc of Riolan provides collateral mesenteric circulation in 10%-20% of individuals. However, its name (artery of Moskowitz, meandering artery of Gonzalez, arch of Treves, anastomotic maxima of Haller) and more importantly its course has been widely debated. We recently reported that the arc of Riolan actually crosses anterior t...