key: cord-0956100-v857wnfh
authors: Glasbey, James C.; Nepogodiev, Dmitri; Simoes, Joana F. F.; Omar, Omar M.; Venn, Mary L.; Evans, Jonathan P.; Futaba, Kaori; Knowles, Charles H.; Minaya‐Bravo, Ana; Mohan, Helen; Chand, Manish; Pockney, Peter; Di Saverio, Salomone; Smart, Neil; Vallance, Abigail; Vimalachandran, Dale; Wilkin, Richard J. W.; Siaw‐Acheampong, Kwabena; Benson, Ruth A.; Bywater, Edward; Chaudhry, Daoud; Dawson, Brett E.; Glasbey, James C.; Gujjuri, Rohan R.; Heritage, Emily; Jones, Conor S.; Kamarajah, Sivesh K.; Khatri, Chetan; Khaw, Rachel A.; Keatley, James M.; Knight, Andrew; Lawday, Samuel; Mann, Harvinder S.; Marson, Ella J.; McLean, Kenneth A.; Mckay, Siobhan C.; Mills, Emily C.; Nepogodiev, Dmitri; Pellino, Gianluca; Picciochi, Maria; Taylor, Elliott H.; Tiwari, Abhinav; Trout, Isobel M.; Venn, Mary L.; Smart, Neil J.; Minaya‐Bravo, Ana; Evans, Jonathan P.; Gallo, Gaetano; Moug, Susan; Pata, Francesco; Vallance, Abigail; Vimalchandran, Dale; Pockney, Peter; Di Saverio, Salomone; Abbott, Tom E. F.; Abukhalaf, Sadi; Adamina, Michel; Ademuyiwa, Adesoji O.; Agarwal, Arnav; Akkulak, Murat; Alameer, Ehab; Alderson, Derek; Alakaloko, Felix; Albertsmeiers, Markus; Alser, Osaid; Alshaar, Muhammad; Alshryda, Sattar; Arnaud, Alexis P.; Magne Augestad, Knut; Ayasra, Faris; Azevedo, José; Bankhead‐Kendall, Brittany K.; Barlow, Emma; Beard, David; Benson, Ruth A.; Blanco‐Colino, Ruth; Brar, Amanpreet; Minaya‐Bravo, Ana; Breen, Kerry A.; Bretherton, Chris; Lima Buarque, Igor; Burke, Joshua; Caruana, Edward J.; Chaar, Mohammad; Chakrabortee, Sohini; Christensen, Peter; Cox, Daniel; Cukier, Moises; Cunha, Miguel F.; Davidson, Giana H.; Desai, Anant; Drake, Thomas M.; Edwards, John G.; Elhadi, Muhammed; Emile, Sameh; Farik, Shebani; Fiore, Marco; Edward Fitzgerald, J.; Ford, Samuel; Garmanova, Tatiana; Gallo, Gaetano; Ghosh, Dhruv; Gomes, Mendonça Ataíde Gustavo; Grecinos, Gustavo; Griffiths, Ewen A.; Gründl, Madalegna; Halkias, Constantine; Harrison, Ewen M.; Hisham, Intisar; Hutchinson, Peter J.; Hwang, Shelley; Isik, Arda; Jenkinson, Michael D.; Jonker, Pascal; Kaafarani, Haytham M. A.; Keller, Debby; Kolias, Angelos; Kruijff, Schelto; Lawani, Ismail; Lederhuber, Hans; Leventoglu, Sezai; Litvin, Andrey; Loehrer, Andrew; Löffler, Markus W.; Lorena, Aguilera Maria; Modolo, Marta Maria; Major, Piotr; Martin, Janet; Mashbari, Hassan N.; Mazingi, Dennis; Metallidis, Symeon; Minaya‐Bravo, Ana; Mohan, Helen M.; Moore, Rachel; Moszkowicz, David; Moug, Susan; Ng‐Kamstra, Joshua S.; Maimbo, Mayaba; Negoi, Ionut; Niquen, Milagros; Ntirenganya, Faustin; Olivos, Maricarmen; Oussama, Kacimi; Outani, Oumaima; Dione Parreno‐Sacdalanm, Marie; Pata, Francesco; Rivera, Jose Perez Carlos; Pinkney, Thomas D.; van der Plas, Willemijn; Pockney, Peter; Qureshi, Ahmad; Radenkovic, Dejan; Ramos‐De la Medina, Antonio; Roberts, Keith; Roslani, April C.; Rutegård, Martin; Santos, Irène; Satoi, Sohei; Sayyed, Raza; Schache, Andrew; Schnitzbauer, Andreas A.; Seyi‐Olajide, Justina O.; Sharma, Neil; Shaw, Richard; Shu, Sebastian; Soreide, Kjetil; Spinelli, Antonino; Stewart, Grant D.; Sund, Malin; Sundar, Sudha; Tabiri, Stephen; Townend, Philip; Tsoulfas, Georgios; van Ramshorst, Gabrielle H.; Vidya, Raghavan; Vimalachandran, Dale; Warren, Oliver J.; Wedderburn, Duane; Wright, Naomi; Alurralde, C.; Caram, E. L.; Eskinazi, D.; Badra, R.; García, J. S.; Lucchini, S. M.; Cecire, J.; Salindera, S.; Sutherland, A.; Ahn, J. H.; Chen, S.; Gauri, N.; Jang, S.; Jia, F.; Mulligan, C.; Yang, W.; Ye, G.; Zhang, H.; Moss, J.; Richards, T.; Thian, A.; Vo, U. G.; Bagraith, K.; Chan, E.; Ho, D.; Jeyarajan, E.; Jordan, S.; Nolan, G. J.; Von Papen, M.; Wullschleger, M.; Egoroff, N.; Gani, J.; Lott, N.; Pockney, P.; Phan, D.; Townend, D.; Bong, C.; Gundara, J.; Bowman, S.; Guerra, G. R.; Dudi‐Venkata, N. N.; Kroon, H. M.; Sammour, T.; Mitchell, D.; Swinson, B.; Messner, F.; Öfner, D.; Emmanuel, K.; Grechenig, M.; Gruber, R.; Harald, M.; Öhlberger, L.; Presl, J.; Wimmer, A.; Barker, D.; Boyce, R.; Doyle, A.; Eastmond, A.; Gill, R.; O’Shea, M.; Padmore, G.; Paquette, N.; Phillips, E.; St. John, S.; Walkes, K.; Flamey, N.; Pattyn, P.; Oosterlinck, W.; Van den Eynde, J.; Van den Eynde, R.; Sokolov, M.; Boutros, M.; Caminsky, N. G.; Ghitulescu, G.; Demyttenaere, S.; Garfinkle, R.; Nessim, C.; Stevenson, J.; Bačić, G.; Karlović, D.; Kršul, D.; Zelić, M.; Bakmaz, B.; Ćoza, I.; Dijan, E.; Katusic, Z.; Mihanovic, J.; Rakvin, I.; Frantzeskou, K.; Gouvas, N.; Kokkinos, G.; Papatheodorou, P.; Pozotou, I.; Stavrinidou, O.; Yiallourou, A.; Martinek, L.; Skrovina, M.; Szubota, I.; Ebbehøj, A..L.; Krarup, P.; Schlesinger, N.; Smith, H.; AL Sayed, M.; Ashoush, F.; Elazzazy, E.; Essam, E.; Eweda, M.; Hassan, E.; Metwalli, M.; Qatora Mourad, M.; Sabry, M. S. A.; Samih, A.; Samir Abdelaal, A.; Shehata, S.; Shenit, K.; Attia, D.; Kamal, N.; Osman, N.; Alaa, S.; Hamza, H. M.; Melghazaly, S.; Mohammed, M. M.; Nageh, M. A.; Saad, M. M.; Yousof, E. A.; Eldaly, A. S.; Amira, G.; Sallam, I.; Sherief, M.; Sherif, A.; Ghaly, G.; Hamdy, R.; Morsi, A.; Salem, H.; Sherif, G.; Abdeldayem, H.; Abdelkader Salama, I.; Balabel, M.; Fayed, Y.; Sherif, A. E.; Kauppila, J. H.; Sarjanoja, E.; Helminen, O.; Huhta, H.; Beyrne, C.; Jouffret, L.; Marie‐Macron, L.; Lakkis, Z.; Manfredelli, S.; Chebaro, A.; El Amrani, M.; Lecolle, K.; Piessen, G.; Pruvot, F. R.; Zerbib, P.; Ballouhey, Q.; Barrat, B.; Taibi, A.; Bergeat, D.; Merdrignac, A.; Le Roy, B.; Perotto, L. O.; Scalabre, A.; Aimé, A.; Ezanno, A.; Malgras, B.; Bouche, P. A.; Tzedakis, S.; Cotte, E.; Glehen, O.; Kepenekian, V.; Passot, G.; D’Urso, A.; Mutter, D.; Seeliger, B.; Bonnet, S.; Denet, C.; Fuks, D.; Laforest, A.; Pourcher, G.; Seguin‐givelet, A.; Tribillon, E.; Duchalais, E.; Bork, U.; Fritzmann, J.; Praetorius, C.; Weitz, J.; Welsch, T.; Beyer, K.; Kamphues, C.; Lauscher, J. C.; Loch, F. N.; Schineis, C.; Becker, R.; Jonescheit, J.; Pergolini, I.; Reim, D.; Boeker, C.; Hakami, I.; Mall, J.; Albertsmeier, M.; Kappenberger, A.; Schiergens, T.; Werner, J.; Nowak, K.; Reinhard, T.; Kleeff, J.; Michalski, C.; Ronellenfitsch, U.; Bertolani, E.; Königsrainer, A.; Löffler, M. W.; Quante, M.; Steidle, C.; Überrück, L.; Yurttas, C.; Izbicki, J.; Nitschke, C.; Perez, D.; Uzunoglu, F. G.; Antonakis, P.; Contis, I.; Dellaportas, D.; Gklavas, A.; Konstadoulakis, M.; Memos, N.; Papaconstantinou, I.; Polydorou, A.; Theodosopoulos, T.; Vezakis, A.; Antonopoulou, M. I.; Manatakis, D. K.; Tasis, N.; Arkadopoulos, N.; Danias, N.; Economopoulou, P.; Frountzas, M.; Kokoropoulos, P.; Larentzakis, A.; Michalopoulos, N.; Parasyris, S.; Selmani, J.; Sidiropoulos, T.; Vassiliu, P.; Bouchagier, K.; Klimopoulos, S.; Paspaliari, D.; Stylianidis, G.; Baxevanidou, K.; Bouliaris, K.; Chatzikomnitsa, P.; Efthimiou, M.; Giaglaras, A.; Kalfountzos, C.; Koukoulis, G.; Ntziovara, A. M.; Petropoulos, K.; Soulikia, K.; Tsiamalou, I.; Zervas, K.; Zourntou, S.; Baloyiannis, I; Diamantis, A.; Perivoliotis, K.; Tzovaras, G.; Christidis, P.; Ioannidis, O.; Loutzidou, L.; Karaitianos, I.; Tsirlis, T.; Charalabopoulos, A.; Liakakos, T.; Baili, E.; Schizas, D.; Spartalis, E.; Syllaios, A.; Zografos, C.; Athanasakis, E.; Chrysos, E.; Tsiaoussis, I.; Xenaki, S.; Xynos, E.; Futaba, K.; Ho, M. F.; Hon, S. F.; Mak, T. W. C.; Ng, S. S. M.; Foo, C. C.; Banky, B.; Suszták, N.; Bhat, G. A.; Chowdri, N. A.; Mehraj, A.; Parray, F.; Shah, Z. A.; Wani, R.; Ahmed, Z.; Bali, R.; Laharwal, A.; Mahmood, M.; Mir, I.; Mohammad, Z.; Muzamil, J.; Rashid, A.; Aremu, M.; Canas‐Martinez, A.; Cullivan, O.; Murphy, C.; Owens, P.; Pickett, L.; Corrigan*, M.; Daly, A.; Fleming, C.; Jordan, P.; Killeen, S.; Lynch, N.; O’Brien, N.; Syed, W. A. S.; Vernon, L.; Fahey, B. A.; Larkin, J. O.; Mccormick, P.; Mehigan, B. J.; Mohan, H.; Shokuhi, P.; Smith, J.; Bashir, Y.; Bass, G. A.; Connelly, T. M.; Creavin, B.; Earley, H.; Elliott, J. A.; Gillis, A. E.; Kavanagh, D. O.; Neary, P. C.; O’Riordan, J. M.; Reynolds, I. S.; Rice, D.; Ridgway, P. F.; Umair, M.; Whelan, M.; Corless, K.; Finnegan, L.; Fowler, A.; Hogan, A.; Lowery, A.; McKevitt, Kv; Ryan, Év; Coffey, J. C.; Cunningham, R. M.; Devine, M.; Nally, D.; Peirce, C.; Hardy, N. P.; Neary, P. M.; O’Malley, S.; Ryan, M.; Macina, S.; Mariani, N. M.; Opocher, E.; Pisani Ceretti, A.; Bianco, F.; Marino, M. V.; Mirabella, A.; Vaccarella, G.; Agostini, C.; Alemanno, G.; Bartolini, I.; Bergamini, C.; Bruscino, A.; De Vincenti, R.; Di Bella, A.; Fortuna, L.; Maltinti, G.; Muiesan, P.; Prosperi, P.; Ringressi, M. N.; Risaliti, M.; Taddei, A.; Tucci, R.; Campagnaro, T.; Guglielmi, A.; Pedrazzani, C.; Rattizzato, S.; Ruzzenente, A.; Turri, G.; Bellora, P.; D’Aloisio, Gv; Ferrari, M.; Francone, E.; Gentilli, S.; Nikaj, H.; Bianchini, M.; Chiarugi, M.; Coccolini, F.; Di Franco, G.; Furbetta, N.; Gianardi, D.; Guadagni, S.; Morelli, L.; Palmeri, M.; Tartaglia, D.; Anania, G.; Carcoforo, P.; Chiozza, M.; De Troia, A.; Koleva Radica, M.; Portinari, M.; Sibilla, M. G.; Urbani, A.; Fabbri, N.; Feo, C. V.; Gennari, S.; Parini, S.; Righini, E.; Annessi, V.; Castro Ruiz, C.; Montella, M. T.; Zizzo, M.; Grossi, U.; Novello, S.; Romano, M.; Rossi, S.; Zanus, G.; Esposito, G.; Frongia, F.; Pisanu, A.; Podda, M.; Belluco, C.; Lauretta, A.; Montori, G.; Moras, L.; Olivieri, M.; Feo, C. F.; Perra, T.; Porcu, A.; Scanu, A. M.; Aversano, A.; Carbone, F.; Delrio, P.; Di Lauro, K.; Fares Bucci, A.; Rega, D.; Spiezio, G.; Calabrò, M.; Farnesi, F.; Lunghi, E. G.; Muratore, A.; Pipitone Federico, N. S.; De Palma, G. D.; Luglio, G.; Pagano, G.; Tropeano, F. P.; Baldari, L.; Boni, L.; Cassinotti, E.; Cosimelli, M.; Fiore, M.; Guaglio, M.; Sorrentino, L.; Agnes, A.; Alfieri, S.; Belia, F.; Biondi, A.; Cozza, V.; D’Ugo, D.; De Simone, V.; Litta, F.; Lorenzon, L.; Marra, A. A.; Marzi, F.; Parello, A.; Persiani, R.; Ratto, C.; Rosa, F.; Scrima, O.; Sganga, G.; Belli, A.; Izzo, F.; Patrone, R.; Carrano, F. M.; Carvello, M. M.; Di Candido, F.; Maroli, A.; Spinelli, A.; Aprile, A.; Batistotti, P.; Massobrio, A.; Pertile, D.; Scabini, S.; Soriero, D.; De Manzoni Garberini, A.; Federico, P.; Maida, P.; Marra, E.; Marte, G.; Petrillo, A.; Tammaro, P.; Tufo, A.; Berselli, M.; Borroni, G.; Cocozza, E.; Conti, L.; Desio, M.; Rizzi, A.; Baldi, C.; Corbellini, C.; Sampietro, G. M.; Baldini, E.; Capelli, P.; Conti, L.; Isolani, S. M.; Ribolla, M.; Bondurri, A.; Colombo, F.; Ferrario, L.; Guerci, C.; Maffioli, A.; Armao, T.; Ballabio, M.; Bisagni, P.; Gagliano, A.; Longhi, M.; Madonini, M.; Pizzini, P.; Mochet, S.; Usai, A.; Bianco, F.; Incollingo, P.; Mancini, S.; Marino Cosentino, L.; Sagnotta, A.; Nespoli, L. C.; Tamini, N.; Anastasi, A.; Bartalucci, B.; Bellacci, A.; Canonico, G.; Capezzuoli, L.; Di Martino, C.; Ipponi, P.; Linari, C.; Montelatici, M.; Nelli, T.; Spagni, G.; Tirloni, L.; Vitali, A.; Abate, E.; Casati, M.; Casiraghi, T.; Laface, L.; Schiavo, M.; Arminio, A.; Cotoia, A.; Lizzi, V.; Vovola, F.; Vergari, R.; D’Ugo, S.; Depalma, N.; Spampinato, M. G.; Brachini, G.; Chiappini, A.; Cicerchia, P. M.; Cirillo, B.; De Toma, G.; Fiori, E.; Fonsi, G. B.; Iannone, I.; La Torre, F.; Lapolla, P.; Meneghini, S.; Mingoli, A.; Sapienza, P.; Zambon, M.; Capolupo, G. T.; Mazzotta, E.; Gattolin, A.; Migliore, M.; Rimonda, R.; Sasia, D.; Travaglio, E.; Cervellera, M.; Gori, A.; Sartarelli, L.; Tonini, V.; Chessa, A.; Fiorini, A.; Norcini, C.; Colletti, G.; Confalonieri, M.; Costanzi, A.; Frattaruolo, C.; Mari, G.; Monteleone, M.; De Nardi, P.; Parise, P.; Vignali, A.; Belvedere, A.; Bernante, P.; Jovine, E.; Neri, J.; Parlanti, D.; Pezzuto, A. P.; Poggioli, G.; Rottoli, M.; Tanzanu, M.; Violante, T.; Borghi, F.; Cianflocca, D.; Di Maria Grimaldi, S.; Donati, D.; Gelarda, E.; Giraudo, G.; Giuffrida, M. C.; Marano, A.; Palagi, S.; Pellegrino, L.; Peluso, C.; Testa, V.; Agresta, F.; Prando, D.; Zese, M.; Armatura, G.; Frena, A.; Scotton, G.; Gallo, G.; Sammarco, G.; Vescio, G.; Di Marzo, F.; Fontana, T.; Kanemitsu, Y.; Moritani, K.; Al Abdallah, M.; Ayasra, F.; Ayasra, Y.; Qasem, A.; Fahmawee, T.; Hmedat, A.; Obeidat, K.; Abou Chaar, M. K.; Al‐Masri, M.; Al‐Najjar, H.; Alawneh, F.; Alkadeeki, G.; Al Maadany, F. S.; Aldokali, N.; Senossi, O.; Subhi, M. T.; Burgan, D.; Kamoka, E.; Kilani, A. I.; Ellojli, I.; Kredan, A.; Bradulskis, S.; Dainius, E.; Kubiliute, E.; Kutkevičius, J.; Parseliunas, A.; Subocius, A.; Venskutonis, D.; Rasoaherinomenjanahary, F.; Razafindrahita, J. B.; Samison, L. H.; Hamdan, K. H.; Ibrahim, M. R.; Tan, J. A.; Thanapal, M. R.; Amin Sahid, N.; Hayati, F.; Jayasilan, J.; Sriram, R. K.; Che Jusoh,; Subramaniam, S. M. A.; Hussain, A. H.; Mohamed Sidek, A. S.; Mohd Yunus, M. F.; Soh, J. Y.; Wong, M.; Zakaria, A. D.; Zakaria, Z.; Fathi, N. Q.; Xavier, R. G.; Roslani, A. C.; Buerba, G. A.; Mercado, M. Á.; Posadas‐Trujillo, O. E.; Salgado‐Nesme, N.; Sarre, C.; Amrani, L.; El Ahmadi, B.; El Bouazizi, Y.; Majbar, A. M.; Benkabbou, A.; Mohsine, R.; Souadka, A.; Hompes, R.; Meima‐van Praag, E. M.; Pronk, A. J. M.; Sharabiany, S.; Grotenhuis, B.; Hartveld, L.; Posma‐Bouman, L.; Derksen, T.; Franken, J.; Oosterling, S.; Konsten, J.; Van Heinsbergen, M.; Olaogun, J.; Abdur‐Rahman, L.; Adeyeye, A.; Bello, J.; Olasehinde, O.; Popoola, A.; Jamal, A.; Kerawala, A. A.; Memon, A. S.; Nafees Ahmed, R.; Rai, L.; Ayub, B.; Ramesh, P.; Sayyed, R.; Butt, U. I.; Kashif, M.; Qureshi, A.; Farooka, M. W.; Ayyaz, M.; Ayubi, A.; Waqar, S. H.; Major, P.; Azevedo, C.; Machado, D.; Mendes, F.; De Sousa, X.; Fernandes, U.; Ferreira, C.; Guidi, G.; Marçal, A.; Marques, R.; Martins, D.; Vaz Pereira, R.; Vieira, B.; Almeida, J. I.; Ferraz, I.; Ribeiro, C. G.; Lima da Silva, C.; Lopes, L.; Marialva, J.; Pereira, C.; Almeida‐Reis, R.; Ribeiro, A.; Tavares, F.; Teixeira, M.; Correia de Sá, T.; Costa, M. J. M. A.; Fernandes, V.; Machado, N.; Nunes Coelho, M.; Afonso, J.; Santos, R.; Saraiva, P.; Silva, R.; Tavares, F.; Teixeira, M.; Almeida, A. C.; Amaral, M. J.; Andrade, R.; Camacho, C.; Costa, M.; Lázaro, A.; Nogueira, O.; Oliveira, A; Ruivo, A; Silva, M; Simões, J; Devezas, V; Jácome, F; Nogueiro, J; Pereira, A.; Santos‐Sousa, H.; Vaz, S.; Pinto, J.; Tojal, A.; Cardoso, P.; Cardoso, N.; Domingos, J. C.; Henriques, P.; Manso, M. I.; Martins dos Santos, G.; Martins, R.; Morais, H.; Pereira, R.; Revez, T.; Ribeiro, R.; Ribeiro, V.I.; Soares, A. P.; Sousa, S.; Teixeira, J.; Amorim, E.; Baptista, V. H.; Cunha, M. F.; Bandovas, J. P.; Borges, N.; Chumbinho, B.; Figueiredo de Barros, I.; Frade, S.; Gomes, J.; Kam da Silva Andrade, A.; Pereira Rodrigues, A.; Pina, S.; Silva, N.; Silveira Nunes, I.; Sousa, R.; Azevedo, P.; Costeira, B.; Cunha, C.; Garrido, R.; Miranda, P.; Peralta Ferreira, M.; Sousa Fernandes, M.; Galvão, D.; Vieira, A.; Patrício, B.; Santos, P. M. D. D.; Vieira Paiva Lopes, A. C.; Cunha, R.; Faustino, A.; Freitas, A.; Mendes, J. R.; Parreira, R.; Abreu da Silva, A.; Claro, M.; Costa Santos, D.; Deus, A. C.; Grilo, J. V.; Borges, F.; Corte Real, J.; Henriques, S.; Lima, M. J.; Matos Costa, P.; Brito da Silva, F.; Caiado, A.; Fonseca, F.; Ângelo, M.; Baiao, J. M.; Martins Jordão, D.; Vieira Caroço, T.; Baía, C.; Canotilho, R.; Correia, A. M.; Ferreira Pinto, A. P.; Peyroteo, M.; Videira, J. F.; Kassir, R.; Sauvat, F.; Bezede, C.; Chitul, A.; Ciofic, E.; Cristian, D.; Grama, F.; Bonci, E.; Gata, V.; Titu, S.; Garmanova, T.; Kazachenko, E.; Markaryan, D.; Rodimov, S.; Tsarkov, P.; Tulina, I.; Litvina, Y.; Provozina, A.; Agapov, M.; Galliamov, E.; Kakotkin, V.; Kubyshkin, V.; Kamalov, A.; Semina, E.; Alshahrani, M.; Alsharif, F.; Eskander, M.; Alharthi, M.; Aljiffry, M.; Basendowah, M.; Malibary, N.; Nassif, M.; Saleem, A.; Samkari, A.; Trabulsi, N.; Al Awwad, S.; Alghamdi, M.; Alnumani, T.; Al Habes, H.; Alqannas, M.; Alyami, M.; Alzamanan, M.; Cortés Guiral, D.; Elawad, A.; AlAamer, O.; Alselaim, N.; Al‐Khayal, K.; Alhassan, N.; Alobeed, O.; Alshammari, S.; Bin Nasser, A.; Bin Traiki, T.; Nouh, T.; Zubaidi, A. M.; Aleksić, L.; Antic, A.; Barisic, G.; Ceranic, M.; Grubač, Ž.; Jelenkovic, J.; Kecmanović, D.; Kmezić, S.; Knezevic, D.; Krivokapic, Z.; Latinčić, S.; Markovic, V.; Matić, S.; Miladinov, M.; Pavlov, M.; Pejovic, I.; Tadic, B.; Vasljević, J.; Velickovic, D.; Buta, M.; Cvetkovic, A.; Gacic, S.; Goran, M.; Jeftic, N.; Markovic, I.; Milanović, M.; Nikolic, S.; Pejnovic, L.; Savković, N.; Stevic, D.; Vucic, N.; Zegarac, M.; Karamarkovic, A.; Kenic, M.; Kovacevic, B.; Krdzic, I.; Lieske, B.; Almgla, N.; Boutall, A.; Herman, A.; Kloppers, C.; Nel, D.; Rayamajhi, S.; Paniagua García Señorans, M.; Vigorita, V.; Acrich, E.; Baena Sanfeliu, E.; Barrios, O.; Golda, T.; Santanach, C.; Serrano‐Navidad, M.; Sorribas Grifell, M.; Vives, R. V.; Escolà, D.; Jiménez, A.; Cayetano Paniagua, L.; Gómez Fernández, L.; Collera, P.; Diaz Del Gobbo, R.; Farre Font, R.; Flores Clotet, R.; Gómez Díaz, C. J.; Guàrdia, N.; Guariglia, C. A.; Osorio, A.; Sanchez Jimenez, R.; Sanchon, L.; Soto Montesinos, C.; Alonso‐Lamberti, L.; García‐Quijada, J.; Jimenez Miramón, J.; Jimenez, V.; Jover, J. M.; Leon, R.; Rodriguez, J. L.; Salazar, A.; Valle Rubio, A.; Aguado, H.; Bravo Infante, R.; De Lacy, F. B.; Lacy, A. M.; Otero, A.; Turrado‐Rodriguez, V.; Valverde, S.; Anula, R.; Cano‐Valderrama, O.; Del Campo Martín, M.; Díez‐Valladares, L.; Domínguez, I.; Dziakova, J.; García Alonso, M.; García Romero, E.; Gómez Latorre, L.; Muguerza, J. M.; Pizarro, M. J.; Saez Carlin, P.; Sánchez del Pueblo, C.; Sánchez‐Pernaute, A.; Sanz Ortega, G.; Sanz‐Lopez, R.; Torres, A.; Garcés‐Albir, M.; Lopez, F.; Martín‐Arévalo, J.; Moro‐Valdezate, D.; Pla‐Marti, V.; Beltrán de Heredia, J.; De Andrés Asenjo, B.; Gómez Sanz, T.; Jezieniecki, C.; Nuñez Del Barrio, H.; Ortiz de Solórzano Aurusa, F. J.; Romero de Diego, A.; Ruiz Soriano, M.; Trujillo Díaz, J.; Vázquez Fernández, A.; Lora‐Cumplido, P.; Sosa, M. V.; Gonzalez‐Gonzalez, E.; Minaya Bravo, A. M.; Alonso de la Fuente, N.; Jimenez Toscano, M.; Grau‐Talens, E. J.; Martin‐Perez, B.; Benavides Buleje, J. A.; Carrasco Prats, M.; Giménez FrancésFrancés, C.; Muñoz Camarena, J. M.; Parra Baños, P. A.; Peña, E.; Ramirez Faraco, M.; Ruiz‐Marín, M.; Valero Soriano, M.; Estaire Gómez, M.; Fernández Camuñas, Á.; Garcia Santos, E. P.; Jimenez Higuera, E.; Martínez‐Pinedo, C.; Muñoz‐Atienza, V.; Padilla‐Valverde, D.; Picón Rodríguez, R.; Sánchez‐García, S.; Sanchez‐Pelaez, D.; Colombari, R. C.; Del Valle, E.; Fernández, M.; Lozano Lominchar, P.; Martín, L.; Rey Valcarcel, C.; Zorrilla Ortúzar, J.; Alcaide Matas, F.; García Pérez, J. M.; Troncoso Pereira, P.; Mora‐Guzmán, I.; Achalandabaso Boira, M.; Sales Mallafré, R.; Marín, H.; Prieto Calvo, M.; Villalabeitia Ateca, I.; De Andres Olabarria, U.; Durán Ballesteros, M.; Fernández Pablos, F. J.; Ibáñez‐Aguirre, F. 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S.; Townson, A.; Tweedle, E.; Angelou, D.; Choynowski, M.; McAree, B.; McCanny, A.; Neely, D.; Mosley, F.; Arrowsmith, L.; Campbell, W.; Grove, T.; Kontovounisios, C.; Warren, O.; Clifford, R.; Eardley, N.; Krishnan, E.; Manu, N.; Martin, E.; Roy Mahapatra, S.; Serevina, O. L.; Smith, C.; Vimalachandran, D.; Emslie, K.; Labib, P.; Minto, G.; Natale, J.; Panahi, P.; Rogers, L.; Abubakar, A.; Akhter Rahman, M. M.; Chan, E.; O’Brien, H.; Sasapu, K.; Ng, H. J.; Day, A.; Hunt, A.; Laskar, N.; Gupta, A.; Steinke, J.; Thrumurthy, S.; Massie, E.; McGivern, K.; Rutherford, D.; Wilson, M.; Handa, S.; Kaushal, M.; Kler, A.; Patel, P.; Redfern, J.; Tezas, S.; Aawsaj, Y.; Barry, C.; Blackwell, L.; Emerson, H.; Fisher, A.; Katory, M.; Mustafa, A.; Kretzmer, L.; Lalou, L.; Manku, B.; Parwaiz, I.; Stafford, J.; Abdelkarim, M.; Asqalan, A.; Gala, T.; Ibrahim, S.; Maw, A.; Mithany, R.; Morgan, R.; Sundaram Venkatesan, G.; Boulton, A. 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S.; Keeler, B.; Egan, R.; Fabre, I.; Harries, R.; Li, Z.; Parkins, K.; Spencer, N.; Thompson, D.; Gemmell, C.; Grieco, C.; Hunt, L.; Mahmoud Ali, F.; Seebah, K.; Shaikh, I.; Sreedharan, L.; Youssef, M.; Shah, J.; McLarty, N.; Mills, S.; Shenfine, A.; Sahnan, K.; Michel, M.; Patil, S.; Ravindran, S.; Sarveswaran, J.; Scott, L.; Bhangu, A.; Cato, L. D.; Kamal, M.; Kulkarni, R.; Parente, A.; Saeed, S.; Vijayan, D.; Kaul, S.; Khan, A. H.; Khan, F.; Mukherjee, S.; Patel, M.; Sarigul, M.; Singh, S.; Adiamah, A.; Brewer, H.; Chowdhury, A.; Evans, J.; Humes, D.; Jackman, J.; Koh, A.; Lewis‐Lloyd, C.; Oyende, O.; Reilly, J.; Worku, D.; Bisset, C.; Moug, S. J.; Math, S.; Sarantitis, I.; Timbrell, S.; Vitone, L.; Faulkner, G.; Brixton, G.; Findlay, L.; Majkowska, A.; Manson, J.; Potter, R.; Bhalla, A.; Chia, Z.; Daliya, P.; Grimley, E.; Malcolm, F. L.; Theophilidou, E.; Daniels, I. 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S.; Goodrum, S.; Whitmore, H.; Balasubramaniam, D.; Jayasankar, B.; Kapoor, S.; Ramachandran, A.; Beech, N.; Chand, M.; Green, L.; Kiconco, H.; McEwen, R.; Pereca, J.; Gash, K.; Gourbault, L.; Maccabe, T.; Newton, C.; Baig, M.; Bates, H.; Dunne, N.; Khajuria, A.; Ng, V.; Sarma, D. R.; Shortland, T.; Tewari, N.; Akhtar, M. A.; Brunt, A.; McIntyre, J.; Milne, K.; Rashid, M. M.; Sgrò, A.; Stewart, K. E.; Turnbull, A.; Aguilar Gonzalez, M.; Talukder, S.; Eskander, P.; Hanna, M.; Olivier, J.; Magee, C.; Powell, S.; Flindall, I.; Hanson, A.; Mahendran, V.; Green, S.; Lim, M.; MacDonald, L.; Miu, V.; Onos, L.; Sheridan, K.; Young, R.; Alam, F.; Griffiths, O.; Houlden, C.; Kolli, V. S.; Lala, A. K.; Seymour, Z.; Haynes, A.; Hill, C.; Leede, E.; McElhinney, K.; Olson, K. A.; Riley, C.; Thornhill, M.; Etchill, E.; Gabre‐Kidan, A.; Jenny, H.; Kent, A.; Ladd, M. R.; Long, C.; Malapati, H.; Margalit, A.; Rapaport, S.; Rose, J.; Stevens, K.; Tsai, L.; Vervoort, D.; Yesantharao, P.; Bigelow, B.; Klaristenfeld, D.; Huynh, K.; Azam, M.; Choudhry, A.; Marx, W.; Abel, M. K.; Boeck, M.; Chern, H.; Kornblith, L.; Nunez‐Garcia, B.; Ozgediz, D.; Glencer, A.; Sarin, A.; Varma, M.; Abbott, D.; Acher, A.; Aiken, T.; Barrett, J.; Foley, E.; Schwartz, P.; Zafar, S. N.; Hawkins, A.; Maiga, A.; Bhat, M. A.; Fahey, B. A.; Uyanik, M. S.
title: Outcomes from elective colorectal cancer surgery during the SARS‐CoV‐2 pandemic
date: 2020-12-17
journal: Colorectal Dis
DOI: 10.1111/codi.15431
sha: c2b1a4b2e6e924e5fd762bc9d36d31053b41fb9f
doc_id: 956100
cord_uid: v857wnfh

AIM: This study aimed to describe the change in surgical practice and the impact of SARS‐CoV‐2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS‐CoV‐2 pandemic. METHOD: This was an international cohort study of patients undergoing elective resection of colon or rectal cancer without preoperative suspicion of SARS‐CoV‐2. Centres entered data from their first recorded case of COVID‐19 until 19 April 2020. The primary outcome was 30‐day mortality. Secondary outcomes included anastomotic leak, postoperative SARS‐CoV‐2 and a comparison with prepandemic European Society of Coloproctology cohort data. RESULTS: From 2073 patients in 40 countries, 1.3% (27/2073) had a defunctioning stoma and 3.0% (63/2073) had an end stoma instead of an anastomosis only. Thirty‐day mortality was 1.8% (38/2073), the incidence of postoperative SARS‐CoV‐2 was 3.8% (78/2073) and the anastomotic leak rate was 4.9% (86/1738). Mortality was lowest in patients without a leak or SARS‐CoV‐2 (14/1601, 0.9%) and highest in patients with both a leak and SARS‐CoV‐2 (5/13, 38.5%). Mortality was independently associated with anastomotic leak (adjusted odds ratio 6.01, 95% confidence interval 2.58–14.06), postoperative SARS‐CoV‐2 (16.90, 7.86–36.38), male sex (2.46, 1.01–5.93), age >70 years (2.87, 1.32–6.20) and advanced cancer stage (3.43, 1.16–10.21). Compared with prepandemic data, there were fewer anastomotic leaks (4.9% versus 7.7%) and an overall shorter length of stay (6 versus 7 days) but higher mortality (1.7% versus 1.1%). CONCLUSION: Surgeons need to further mitigate against both SARS‐CoV‐2 and anastomotic leak when offering surgery during current and future COVID‐19 waves based on patient, operative and organizational risks.

COVIDSurg COllabOratIVe panproctocolectomy. A full list of operative procedures is included in Table S1 in the Supporting Information.

The primary outcome measure was mortality within the 30 days following surgery. Secondary outcome measures were anastomotic leak, admission to critical care (including high-dependency areas), postoperative SARS-CoV-2 infection and total length of hospital stay up to 30 days after surgery. Postoperative SARS-CoV-2 infection was defined as a positive swab or CT thorax in line with locally implemented protocols, or a clinical diagnosis of symptoms in keeping with COVID-19 in patients where no swab test or CT scan was available.

Data were collected on the intraoperative decision on stoma formation. Where patients had a stoma, surgeons were asked if this was their 'normal practice' or a 'change in practice due to COVID-19'. The group with a stoma created as a change in practice were labelled 'COVID-end-stoma' or 'COVID-defunctioning-stoma' for tables and analyses. If the patient had a stoma formed and the surgeon indicated a 'change in practice due to COVID-19', they were asked to list all the reasons that applied to that case for this change ( Figure S1 ).

Prepandemic data on colorectal cancer surgery were obtained from published European Society of Coloproctology (ESCP) 2015 Right

Hemicolectomy Audit [19] [20] [21] and the 2017 Left Colon, Sigmoid and Rectal Resections Audit [18, 22] Data. Data from 5792 patients from 54 countries undergoing segmental resection for a colonic or rectal cancer were used for comparison with the equivalent cohort undergoing surgery during the pandemic. These data provided a contemporaneous and detailed comparison of case selection and outcomes during the pandemic and prepandemic periods. Data were not presented in these studies for total or subtotal colectomy, so no comparison was made with these operation types. TNM staging data were not available from the 2015 Right Hemicolectomy Audit and therefore comparison was not made in that field.

The study was conducted according to guidelines set by the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement for observational studies [23] . The chisquare test was used to compare differences in categorical data apart from when cell sizes were small, when Fisher's exact tests were used. Continuous nonparametric data are presented as medians and interquartile ranges and median differences between groups were compared using the Mann-Whitney U-test. Missing data are included in summary tables.

For the primary outcome of 30-day mortality, a multilevel logistic regression was used to evaluate the impact of postoperative SARS-CoV-2 and anastomotic leak on death after surgery, summarized using odds ratios (ORs) with 95% confidence intervals (95% CIs). Country was included in the model as a random effect. The model also included clinically plausible preoperative and intraoperative factors in order to adjust for covariates and reduce the risk of confounding factors (age, sex, ASA grade, disease stage and operation type). Chi-square tests and Fisher's exact tests were using to compare outcomes for those with a COVID-stoma and those without. Similar methods were used to compare pandemic data with published prepandemic data. Analysis was performed used Stata SE version 16.1, (StataCorp, Texas, USA).

This analysis included 2073 patients undergoing resection of a colonic or rectal cancer in 270 hospitals from 40 countries (Table S2) Of these patients, 1236 (59.6%) were men (Table 1) 

The overall rate of stoma formation was 34.2% (708/2073), which was more frequent than the rate of 27.2% in the prepandemic era (1573/5792). The change in practice of patients having a COVIDstoma was small: 4.3% (90/2073) of all patients (Table 2) . Of patients with a new COVID-stoma, 70% (63/90) had an end stoma, far greater than the prepandemic rate for end stoma formation of 43.6% (686/1573) (Table 5) . Colorectal trainees were more likely to be the named lead surgeon when defunctioning COVID-stomas were formed (8.3%, 11/133) when compared with colorectal consultants (0.9%, 13/1521) and general surgical consultants (0.6%, 2/322) Table 2 . This contrasts with the prepandemic era when a colorectal trainee was the named lead surgeon in 4.4% (97/2218) of procedures where a stoma was formed. More COVID-end-stomas were formed in patients undergoing rectal resections, in those who had an open approach to surgery and in those who received either no neoadjuvant therapy or long-course neoadjuvant radiotherapy (Table 2) . This is also reflected in an increase in the number of end stoma formations Table S3 . Table 2 ).

There were slight but nonsignificant differences in patients who had a COVID-stoma compared with those who did not ( TA B L E 2 Additional number of stomas formed due to COVID-19 in relation to all patients undergoing surgery mortality (1.1% versus 1.9%). There was shorter length of stay in the group with a COVID-stoma (4.5 days versus 6.0 days). Similarly, no difference in outcomes was observed in patients undergoing COVID-stoma when stratified by cancer location (Table S4 ).

The reason for change in practice was explored in patients who IV and having a total/subtotal/panproctocolectomy (see Table 4 for adjusted ORs). 

Pandemic data are compared with prepandemic data from ESCPpublished cohort data in Table 5 . There were few differences between patient characteristics across different operations. Overall, during the pandemic, patients selected for surgery were fitter (with lower ASA grade), more stomas were formed and a stapled technique was used more frequently than hand-sewn anastomosis (Table 5) .

Outcomes following surgery during the pandemic included fewer anastomotic leaks and admissions to critical care; however, mortality was higher during the pandemic than in prepandemic era (Table 5 ).

In patients who had an anastomotic leak, mortality was 8.6%, (6/70) in the pandemic data. In the prepandemic data, the mortality in those who had a leak was 6.6% (26/395).

Mortality associated with an anastomotic leak and postoperative SARS-CoV-2 during the first waves of the COVID-19 pandemic was extremely high. A small change in stoma practice was observed, with fewer than 5% of patients receiving a COVID-stoma when they would usually have had an anastomosis only. Although those patients did not suffer any adverse outcomes, those measures alone did not reduce the overall complication rates seen in this study. In comparison with published mortality data following perioperative SARS-CoV-2 infection alone, the relative risk of death was almost 60% higher in combination with anastomotic leak (24.1% versus 34.8%) [11] .

Comparison with previous ESCP cohort data identifies some of the selection bias that took place during these phases of the pandemic. There was an increased use of stapled anastomosis, fewer admissions to intensive care and a shorter length of stay. These all suggest efforts by surgeons and patients to reduce the duration of surgery, resource usage and hospital stay. Rectal cancer patients undergoing surgery seemed to be fitter than in data from the ESCP audits, with a higher proportion of patients of ASA grades 1-2.

Slightly fewer patients underwent neoadjuvant therapy compared with before the pandemic, which suggests a greater element of delayed surgery or 'watch and wait' strategies during the pandemic.

Outcomes from patients who had neoadjuvant therapies and were either delayed or did not have surgery are awaited. There may be an increased flow of patients 'postpandemic', both needing surgery and needing monitoring, who will require additional support from already strained surgical systems.

This study had limitations. First, this was an observational study in the first phase of the pandemic, where guideline implementation was incomplete. Data on implementation of guidelines by each hospital or country were not captured in this study. Second, the absolute change in practice presented was small, so firm conclusions cannot be drawn around the safety of the wider adoption of risk-averse practices. Third, comparison with the prepandemic ESCP audit dataset may be biased through undetected patient-, hospital-and country-level differences that could preclude direct comparison, therefore the results must be interpreted with caution and firm conclusions should not be drawn. Fourth, data were not presented for patients who had surgery delayed due to or had an alternative treatment strategy. We therefore present an incomplete picture of the care of colorectal cancer patients during the pandemic. Fifth, change in practice to COVID-stoma was reported by the surgeon and is therefore subjectively reported. We Clear data and safe strategies are needed to continue to provide safe surgery during future pandemic waves. This study highlights several patient, operative and organizational factors that may bring benefit and need further testing. At a patient level, selection of fitter patients, who will benefit most from curative surgery during peaks of pandemics, is logical. This has been previously recommended to both conserve critical care capacity and avoid exposing high-risk patients to nosocomial SARS-CoV-2 transmission [3, 9] . At an operative level, the avoidance of leaks seems paramount. Forming stomas alone is not necessarily the solution, as they carry their own risks and morbidity. Selecting lower-risk patients for anastomosis, use of defunctioning stomas and more liberal use of end stomas in highrisk patients might be best supported through formal risk stratifi- 

Data-sharing requests will be considered by the management group upon written request to the corresponding author. If agreed, deidentified participant data will be available, subject to a data-sharing agreement.

There are no conflicts of interest to declare. 

COVIDSurg COllabOratIVe had no role in study design, data collection, analysis and interpretation or writing of this report. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the UK Department of Health and Social Care. 

Sher-I-Kashmir Institute of

Azienda Unità Sanitaria Locale -IRCCS di

COVIDSurg COllabOratIVe

Vittorio Emanuele' -Gela)

School of Medical Sciences and Hospital

Instituto Nacional de Ciencias Médicas y Nutrición 'Salvador Zubirán')

* (Hospital de Santo Espirito da Ilha Terceira)

Hospital de Torres Vedras -Centro Hospitalar do Oeste)

Litoral Alentejano)

Clinic of Coloproctology and Minimally Invasive Surgery

Ministry of National Guard

Clinic for Digestive Surgery

Kanuni Sultan Suleyman Training and Research Hospital)

Sisli Hamidiye Etfal Training and Research Hospital)

Stepping Hill Hospital)