P J Guillou

St. James University, Сент-Джеймс, New York, United States

Are you P J Guillou?

Claim your profile

Publications (256)1452.54 Total impact

  • [Show abstract] [Hide abstract] ABSTRACT: New editions of the TNM staging system for colorectal cancer have been subject to extensive criticism. In the current study, we evaluate each edition of TNM and analyze stage migration caused by the different versions. Two independent test populations were used: participants derived from a randomized surgical trial from the United Kingdom (n = 455) and patients from a population-based series from Sweden (n = 505). All slides from these patient cases were reviewed with special attention for the presence of tumor deposits. Tumor deposits were classified according to the fifth, sixth, and seventh editions of TNM and correlated with prognosis. Every change in edition of TNM led to a stage migration of between 33% and 64% in patients with tumor deposits. Reproducibility was best in the fifth edition of TNM. The prognostic value of the seventh edition was best only when all tumor deposits irrespective of size or contour were included as lymph nodes. The prognostic value of the fifth edition was better than that of the sixth. We demonstrate there is a place for tumor deposits in the staging of patients with colorectal cancer. However, many questions remain about their definition and the reproducibility and use of this category in special situations, such as after neoadjuvant treatment. These should be the subject of additional research before use as a factor in TNM staging. This work demonstrates the necessity of testing modifications before their introduction.
    No preview · Article · Jun 2011 · Journal of Clinical Oncology
  • D G Jayne · H C Thorpe · J Copeland · P Quirke · J M Brown · P J Guillou
    [Show abstract] [Hide abstract] ABSTRACT: The UK Medical Research Council CLASICC trial assessed the safety and efficacy of laparoscopically assisted surgery in comparison with open surgery for colorectal cancer. The results of the 5-year follow-up analysis are presented. Five-year outcomes were analysed and included overall and disease-free survival, and local, distant and wound/port-site recurrences. Two exploratory analyses were performed to evaluate the effect of age (70 years or less, or more than 70 years) on overall survival between the two groups, and the effect of the learning curve. No differences were found between laparoscopically assisted and open surgery in terms of overall survival, disease-free survival, and local and distant recurrence. Wound/port-site recurrence rates in the laparoscopic arm remained stable at 2.4 per cent. Conversion to open operation was associated with significantly worse overall but not disease-free survival, which was most marked in the early follow-up period. The effect of surgery did not differ between the age groups, and surgical experience did not impact on the 5-year results. The 5-year analyses confirm the oncological safety of laparoscopic surgery for both colonic and rectal cancer. The use of laparoscopic surgery to maximize short-term outcomes does not compromise the long-term oncological results. Registration number: ISRCTN74883561 (http://www.controlled-trials.com).
    No preview · Article · Nov 2010 · British Journal of Surgery
  • [Show abstract] [Hide abstract] ABSTRACT: This study investigated adhesive intestinal obstruction (AIO) and incisional hernia (IH) in patients undergoing laparoscopically assisted and open surgery for colorectal cancer. In a case-note review of patients randomized to the Medical Research Council's Conventional versus Laparoscopic-Assisted Surgery In Colorectal Cancer (CLASICC) trial, primary and key secondary endpoints were AIO and IH admission rates respectively. Of 411 patients, 11 were admitted for AIO: four (3.1 per cent) of 131 patients in the open arm of the trial versus seven (2.5 per cent) of 280 in the laparoscopic arm (difference 0.6 (95 per cent confidence interval (c.i.) - 2.9 to 4.0) per cent). Thirty-six patients developed IH: 12 (9.2 per cent) after open versus 24 (8.6 per cent) after laparoscopic surgery (difference 0.6 (95 per cent c.i. - 5.3 to 6.5) per cent). Results by actual procedure showed higher AIO and IH rates in the 24.5 per cent of patients who converted from laparoscopic to open surgery (AIO: 2.3, 2.0 and 6 per cent; IH: 8.6, 7.4 and 11 per cent-for open, laparoscopic and converted operations respectively). Although this study has not confirmed that laparoscopic surgery reduces rates of AIO and IH after colorectal cancer surgery, trends suggest that a reduction in conversion to open surgery and elimination of port-site hernias may produce such an effect. Registration number for CLASICC trial: ISRCTN74883561 (http://www.controlled-trials.com).
    No preview · Article · Dec 2009 · British Journal of Surgery
  • P. A. Paraskeva · A. Darzi · P. J. Guillou · J. R.T. Monson
    [Show abstract] [Hide abstract] ABSTRACT: Laparoscopic techniques in general are being increasingly exploited in surgery. One recently introduced procedure is laparoscopic hernia repair, which potentially offers a shorter recovery time, a return to normal activity and a significant reduction in groin discomfort for patients. Unlike other laparoscopic procedures such as laparoscopic cholecystectomy and appendicectomy where the anatomy encountered by the surgeon through the laparoscope is essentially the same as that seen at open surgery, laparoscopic repair of an inguinal hernia requires a different anatomical approach and the development of a different technique for repair. The anatomy of the inguinal region as seen laparoscopically is unfamiliar to most surgeons. Consequently, so that the procedure is completed successfully without causing damage to anatomical structures or the potential for post-operative recurrence, a detailed anatomical knowledge is essential. In this paper, the intra-abdominal anatomy of the inguinal region is revisited with the aid of diagrams and photographs, to aid the surgeon in understanding the laparoscopic anatomy of the region. In addition the critical elements of successful repair are discussed with respect to anatomical landmarks.
    No preview · Article · Jul 2009 · Minimally Invasive Therapy & Allied Technologies
  • Source
    R Rajaganeshan · R Prasad · P.J. Guillou · N Scott · G Poston · D.G. Jayne
    [Show abstract] [Hide abstract] ABSTRACT: To understand the role of hypoxia in cancer progression of primary colorectal cancer and colorectal liver metastases. To look at associations of hypoxia with more aggressive phenotypes. Archival tissue was retrieved from 55 patients and tissue micro arrays were constructed using tissue from the margin and the centre of the tumour. Hypoxia markers Hif-1alpha, Vegf, CA-9, VHL and Glut-1 were visualised using immunohistochemical detection and quantified using semi-quantitative analysis of the digitised images. Clinical details and outcome data were retrieved by case note review and collated with hypoxia markers data in a statistical database. Significantly increased expression of all markers were found at the tumour margin compared to the tumour centre, both in primary colorectal cancer (CRC) and liver metastases. Pushing margin CRC was associated with increased Vegf expression. Positive correlations were observed between Hif-1alpha and Vegf (p<0.001), and Hif-1alpha and VHL (p<0.001) in primary CRC, but no relationship was seen between Hif-1alpha and either Glut-1 or CA-9. A significant trend to worse disease-free survival was also noted with increased margin expression of Hif-1alpha (p<0.001) and VHL (p=0.02) in primary CRC, but not for any of the other markers. This study underlines the importance of the invasive margin in colorectal cancer biology. It is the area most responsive to hypoxic influences and its dependence on its ability to up-regulate Hif-1alpha has a significant impact on disease-free survival.
    Full-text · Article · Jun 2009 · European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
  • [Show abstract] [Hide abstract] ABSTRACT: Introduction: The benefits of neoadjuvant therapy in the treatment of patients with resectable oesophageal carcinoma are controversial. Patients with locally advanced carcinomas were entered into a phase II trial of preoperative chemotherapy and radiotherapy followed by oesophagectomy.Methods: Fifty-five patients aged <70 years with T3 ± N1 oesophageal tumours were recruited between February 1998 and July 2001. Patients received 12 weeks of chemotherapy with four cycles of cisplatin 60 mg m−2 plus infusional 5FU (300 mg m−2, days 1–42; 225 mg m−2, days 43–75). Radiotherapy 45Gy was administered on days 43–75. Two stage en-bloc oesophagectomy with two field lymphadenectomy was undertaken 6 weeks after neoadjuvant therapy.Results: Forty-one patients (74 per cent) completed the treatment. Two patients (3.6 per cent) died during neoadjuvant therapy (SVC obstruction, perforated diverticular disease), while four withdrew due to toxicity. In eight patients (14.5 per cent), the tumour progressed on therapy. Overall mortality was 5/55 (9.1 per cent) with a postoperative mortality of 3/41 (7.3 per cent). Significant postoperative morbidity was observed in 19/41 (46.3 per cent). The tumour was downstaged in 34/41 (83 per cent) with a pathological complete response in 26.8 per cent. Median lymph node yield was 18, there was no proximal or distal margin involvement and a positive circumferential margin in 25 per cent. Median survival on an intention to treat basis was 26 months, and it was 38 months in the patients who underwent surgical resection.Conclusions: Preoperative neoadjuvant therapy followed by en-bloc oesophagectomy can be undertaken with acceptable levels of morbidity and mortality. The survival data appears promising and this study should act as a platform for the initiation of a phase III multicentre trial.
    No preview · Article · Jan 2009 · British Journal of Surgery
  • No preview · Article · Jan 2009
  • C C Thorn · T C Freeman · N Scott · P J Guillou · D G Jayne
    [Show abstract] [Hide abstract] ABSTRACT: The morphology of the invasive margin in colorectal cancer can be described as either pushing or infiltrative. These phenotypes carry prognostic significance, particularly in node negative disease, and provide an excellent model for the study of invasive behaviour in vivo. The marginal edges of 16 stage-matched tumours exhibiting these contrasting growth patterns were microdissected. The extracted mRNA was amplified and hybridised to a 9546 feature oligonucleotide array. Selected differentials were validated using real-time polymerase chain reaction and the protein product was interrogated by using immunohistochemistry. After stringent quality control and filtering of data generated, 39 genes were identified as being significantly differentially expressed between the two types of marginal edge. Several genes involved in cellular metabolism were identified as differentials including lactate dehydrogenase B (LDHB) and modulators of glucose transport. The LDH expression profile differs between the invasive phenotypes. A hypothesis is proposed in which altered metabolism is a cause of contrasting invasive behaviour independent of the hypoxia-inducible factor mediated hypoxic response, consistent with the Warburg phenomenon.
    No preview · Article · Nov 2008 · Gut
  • R Rajaganeshan · R Prasad · P J Guillou · G Poston · N Scott · D G Jayne
    [Show abstract] [Hide abstract] ABSTRACT: Tumour hypoxia has been shown to be a predictor of early distant relapse in node-negative breast and cervical cancer. The purpose of the present study was to determine the role of hypoxia in predicting patients who are at high risk of disease recurrence in Dukes B colorectal cancers. Archival tissue was retrieved from 52 patients who had undergone surgical resection for primary colorectal cancer. Tissue micro-arrays were constructed using tissue from the margin and the centre of the tumour. Hypoxia markers hypoxia-inducible factor (Hif)-1 alpha, vascular endothelial growth factor (VEGF), carbonic anhydrase (CA)-9 and glucose transporter (Glut)-1 were visualised using immunohistochemical detection and quantified using semi-quantitative analysis of the digitised images. Clinical details and outcome data were retrieved by case note review and collated with hypoxia markers data in a statistical database. Primary colorectal cancers with a high Hif-1 alpha expression tended to have a significantly worse disease-free survival (log rank p < 0.001) and overall survival (log rank p = 0.012). VEGF was also a significant predictor of disease recurrence in primary colorectal cancers (p = 0.015). Significant correlations were also noted between Hif-1 alpha and VEGF (Pearson's p = 0.009). Glut-1 and CA-9 did not show a similar pattern with no differences in the expression pattern and no correlation observed with any of the markers. Multivariate analysis of prognostic factors showed vascular invasion (p < 0.001) and Hif-1 alpha at the tumour margin (p < 0.001) to be independent predictors for the development of liver metastases. These results suggest an important role for Hif-1 alpha and VEGF in colorectal cancer progression, with both markers biological mechanisms directly interlinked through the hypoxic pathway. Identification of high-risk patients using the above factors will improve treatment strategies in node-negative disease and help improve patient outcome.
    No preview · Article · Aug 2008 · International Journal of Colorectal Disease
  • No preview · Article · Feb 2008 · Journal de Chirurgie
  • Source
    Pierre J. Guillou
    Preview · Chapter · Jan 2008
  • No preview · Conference Paper · Jan 2008
  • David G. Jayne · Pierre J. Guillou · Julia M. Brown · Helen C. Thorpe
    No preview · Article · Nov 2007 · Journal of Clinical Oncology
  • [Show abstract] [Hide abstract] ABSTRACT: The aim of the current study is to report the long-term outcomes after laparoscopic-assisted surgery compared with conventional open surgery within the context of the UK MRC CLASICC trial. Results from randomized trials have indicated that laparoscopic surgery for colon cancer is as effective as open surgery in the short term. Few data are available on rectal cancer, and long-term data on survival and recurrence are now required. The United Kingdom Medical Research Council Conventional versus Laparoscopic-Assisted Surgery in Colorectal Cancer (UK MRC CLASICC; clinical trials number ISRCTN 74883561) trial study comparing conventional versus laparoscopic-assisted surgery in patients with cancer of the colon and rectum. The randomization ratio was 2:1 in favor of laparoscopic surgery. Long-term outcomes (3-year overall survival [OS], disease-free survival [DFS], local recurrence, and quality of life [QoL]) have now been determined on an intention-to-treat basis. Seven hundred ninety-four patients were recruited (526 laparoscopic and 268 open). Overall, there were no differences in the long-term outcomes. The differences in survival rates were OS of 1.8% (95% CI, -5.2% to 8.8%; P = .55), DFS of -1.4% (95% CI, -9.5% to 6.7%; P = .70), local recurrence of -0.8% (95% CI, -5.7% to 4.2%; P = .76), and QoL (P > .01 for all scales). Higher positivity of the circumferential resection margin was reported after laparoscopic anterior resection (AR), but it did not translate into an increased incidence of local recurrence. Successful laparoscopic-assisted surgery for colon cancer is as effective as open surgery in terms of oncological outcomes and preservation of QoL. Long-term outcomes for patients with rectal cancer were similar in those undergoing abdominoperineal resection and AR, and support the continued use of laparoscopic surgery in these patients.
    No preview · Article · Aug 2007 · Journal of Clinical Oncology
  • Source
    [Show abstract] [Hide abstract] ABSTRACT: To perform a meta-analysis of trials randomizing patients with colon cancer to laparoscopically assisted or open colectomy to enhance the power in determining whether laparoscopic colectomy for cancer is oncologically safe. The databases of the Barcelona, Clinical Outcomes of Surgical Therapy (COST), Colon Cancer Laparoscopic or Open Resection (COLOR), and Conventional vs Laparoscopic-Assisted Surgery in Patients With Colorectal Cancer (CLASICC) trials were the data sources for the study. Patients who had at least 3 years of complete follow-up data were selected. Patients who had undergone curative surgery before March 1, 2000, were studied. Three-year disease-free survival and overall survival were the primary outcomes of this analysis. Of 1765 patients, 229 were excluded, leaving 796 patients in the laparoscopically assisted arm and 740 patients in the open arm for analysis. Three-year disease-free survival rates in the laparoscopically assisted and open arms were 75.8% and 75.3%, respectively (95% confidence interval [CI] of the difference, -5% to 4%). The associated common hazard ratio (laparoscopically assisted vs open surgery with adjustment for sex, age, and stage) was 0.99 (95% CI, 0.80-1.22; P = .92). The 3-year overall survival rate after laparoscopic surgery was 82.2% and after open surgery was 83.5% (95% CI of the difference, -3% to 5%). The associated hazard ratio was 1.07 (95% CI, 0.83-1.37; P = .61). Disease-free and overall survival rates for stages I, II, and III evaluated separately did not differ between the 2 treatments. Laparoscopically assisted colectomy for cancer is oncologically safe.
    Full-text · Article · Apr 2007 · Archives of Surgery
  • Source
    [Show abstract] [Hide abstract] ABSTRACT: The nature of the invasive growth pattern and microvessel density (MVD) have been suggested to be predictors of prognosis in primary colorectal cancer (CRC) and colorectal liver metastases. The purpose of the present study was to determine whether these two histological features were interrelated and to assess their relative influence on disease recurrence and survival following surgical resection. Archival tissue was retrieved from 55 patients who had undergone surgical resection for primary CRC and matching liver metastases. The nature of the invasive margin was determined by haematoxylin and eosin (H&E) histochemistry. Microvessel density was visualised using immunohistochemical detection of CD31 antigen and quantified using image capture computer software. Clinical details and outcome data were retrieved by case note review and collated with invasive margin and MVD data in a statistical database. Primary CRCs with a pushing margin tended to form capsulated liver metastases (P<0.001) and had a significantly better disease-free survival than the infiltrative margin tumours (log rank P=0.01). Primary cancers with a high MVD tended to form high MVD liver metastases (P=0.007). Microvessel density was a significant predictor of disease recurrence in primary CRCs (P=0.006), but not liver metastases. These results suggest that primary CRCs and their liver metastases show common histological features. This may reflect common mechanisms underlying the tumour-host interaction.
    Full-text · Article · Apr 2007 · British Journal of Cancer
  • No preview · Article · Mar 2007 · Annals of The Royal College of Surgeons of England
  • Source
    [Show abstract] [Hide abstract] ABSTRACT: Pancreatic body carcinoma has a poor prognosis with advanced disease at presentation. Recent experience at multidisciplinary team (MDT) meetings suggests increasing prevalence. Our aim was to determine if introduction of MDT meetings has affected the natural history of this disease. Retrospective diagnostic and survival data were collected from 1995 to 2006 at two large teaching hospitals, and divided into pre- and post 2003 groups (based on MDT introduction). Thirty-one patients with pancreatic body carcinoma (median age at diagnosis 72 years; range 43-87 years). Commonest symptoms at presentation were abdominal pain and weight loss. Eight patients (25.8%) were diagnosed pre MDT (median age 71.5 years, range: 60-87 years) and 23 patients (74.2%) were diagnosed post MDT (median age 67 years, range: 43-85 years; P=0.299 vs. pre MDT). There was a significantly (P=0.024) greater prevalence of more advanced tumours post MDT (stage IV: 15/23, 65.2%) than pre MDT (stage IV: 2/8, 25.0%). Neither tumour markers nor liver biochemistry differentiated tumour stage. Best supportive care was offered to 16 patients (51.6%) while 12 patients (38.7%) were suitable for chemotherapy: 2 out of 8 pre MDT (25.0%) and 10 out of 23 (43.5%) post MDT (P=0.433). For stage III tumours, post MDT patients tended to be younger (median 59 years vs. 74.5 years, P=0.042). Survival was not significantly increased after MDT introduction but chemotherapy offered significant survival benefit on multivariate analysis (P=0.042; hazard ratio: 0.39, 95% CI: 0.16-0.97). The trend is towards increased prevalence of pancreatic body cancer and more advanced disease at presentation. Chemotherapy was associated with a survival benefit, although the introduction of the MDT has not significantly altered disease management.
    Preview · Article · Feb 2007 · JOP: Journal of the pancreas
  • H Thorpe · D G Jayne · P J Guillou · P Quirke · J Copeland · J M Brown
    [Show abstract] [Hide abstract] ABSTRACT: Intraoperative conversion from laparoscopically assisted to open surgery for colorectal cancer is thought to be influenced by several patient factors. Analysis of the Conventional versus Laparoscopic-Assisted Surgery In Colorectal Cancer (CLASICC) Trial data aimed to identify these risk factors. Of 488 laparoscopically assisted procedures attempted, 143 (29.3 per cent) were converted to open operation. Patient factors considered in multivariable analyses were age, sex, previous abdominal incisions, body mass index (BMI), tumour site, tumour diameter, pathological tumour (pT) and pathological node (pN) stage, extent of tumour spread from the muscularis propria, liver and peritoneal metastases, and American Society of Anesthesiologists (ASA) grade. As BMI was missing for 30.7 per cent of patients, two approaches were employed: one considered BMI as a possible risk factor and one did not. When BMI was taken into consideration, male sex (odds ratio (OR) 2.07; P = 0.020), BMI (OR 1.10; P = 0.006) and extent of tumour spread from the muscularis propria (OR 1.08; P < 0.001) were independent predictors of conversion. When BMI was not considered, extent of tumour spread (OR 1.07; P < 0.001) and male sex (OR 2.05; P = 0.004) were again identified, as were tumour site (OR 2.11; P = 0.005) and ASA grade (II versus I, OR 0.92; III versus I, OR 2.74; P = 0.012). Intraoperative conversion is more likely with larger BMI, in men, patients with rectal cancer, those graded ASA III or when there is greater local tumour spread.
    No preview · Article · Feb 2007 · British Journal of Surgery
  • D.G. Jayne · P.J. Guillou · H. Thorpe
    No preview · Article · Jan 2007

Publication Stats

10k Citations
1,452.54 Total Impact Points


  • 1980-2011
    • St. James University
      Сент-Джеймс, New York, United States
  • 2001-2009
    • Leeds Teaching Hospitals NHS Trust
      • Department of Radiology
      Leeds, England, United Kingdom
  • 1982-2004
    • Saint James School Of Medicine
      Park Ridge, Illinois, United States
  • 1986-2002
    • Leeds Beckett University
      Leeds, England, United Kingdom
  • 1973-2000
    • University of Leeds
      • School of Medicine
      Leeds, England, United Kingdom
  • 1995
    • University of Hull
      Kingston upon Hull, England, United Kingdom
  • 1991-1995
    • Imperial College Healthcare NHS Trust
      Londinium, England, United Kingdom
    • The Adelaide and Meath Hospital Ireland
      Dublin, Leinster, Ireland
  • 1994
    • Ashford Hospital
      Tarndarnya, South Australia, Australia
  • 1991-1993
    • Imperial College London
      Londinium, England, United Kingdom
  • 1990
    • St. Vincent's Private Hospital
      Dublin, Leinster, Ireland
  • 1981
    • The Queen Elizabeth Hospital
      Tarndarnya, South Australia, Australia