The British journal of surgery
-
Review Meta Analysis
Meta-analysis of prognostic factors for overall survival in patients with resected hilar cholangiocarcinoma.
Hilar cholangiocarcinoma is staged using the AJCC staging system. Numerous other prognostically important histopathological and demographic characteristics have been reported. The objective of this meta-analysis was to assess statistically the effect of postresectional tumour characteristics on overall survival of patients undergoing attempted radical curative resection for hilar cholangiocarcinoma. ⋯ Several tumour biological variables not included in the seventh edition of the AJCC classification affect overall survival. These require incorporation into prognostic models to ensure a personalized approach to prognostication and treatment.
-
Proton pump inhibitors are the mainstay of treatment for gastro-oesophageal reflux disease, but are associated with ongoing costs and side-effects. Antireflux surgery is cost-effective and is preferred by many patients. A total (360o or Nissen) fundoplication is the traditional procedure, but other variations including partial fundoplications are also commonly performed, with the aim of achieving durable reflux control with minimal dysphagia. Many RCTs and some pairwise meta-analyses have compared some of these procedures but there is still uncertainty about which, if any, is superior. Network meta-analysis allows multiple simultaneous comparisons and robust synthesis of the available evidence in these situations. A network meta-analysis comparing all antireflux procedures was performed to identify which has the most favourable outcomes at short-term (3-12 months), medium-term (1-5 years) and long-term (10 years and more than 10 years) follow-up. ⋯ Posterior partial fundoplication provides the best balance of long-term, durable reflux control with less dysphagia, compared with other treatments.
-
Randomized Controlled Trial
Detection of carcinoembryonic antigen in peritoneal fluid of patients undergoing laparoscopic distal gastrectomy with complete mesogastric excision.
Surgery for gastric cancer may result in free intraperitoneal cancer cells. This study aimed to determine whether laparoscopic gastrectomy with complete mesogastric excision (D2 + CME) reduces the number of free intraperitoneal cancer cells. ⋯ Laparoscopic distal gastrectomy with complete mesogastric excision reduces the number of free intraperitoneal cancer cells and is associated with a better disease-free survival than conventional D2 gastrectomy.
-
Multicenter Study Observational Study
Outcomes of patients receiving a massive transfusion for major trauma.
The benefits of high transfusion ratios (plasma to red blood cells and platelets to red blood cells) on survival in injured patients who receive massive transfusions remain uncertain. This study aimed to assess the association between transfusion ratios and adverse events and survival in patients undergoing massive transfusion for major trauma. ⋯ In this study, transfusion strategies with high plasma to red blood cell and platelet to red blood cell ratios did not have survival benefits, but were associated with an increase in adverse events.
-
Multicenter Study Observational Study
Oncological outcome after MRI-based selection for neoadjuvant chemoradiotherapy in the OCUM Rectal Cancer Trial.
It is not clear whether all patients with rectal cancer need chemoradiotherapy. A restrictive use of neoadjuvant chemoradiotherapy (nCRT) based on MRI findings for rectal cancer was investigated in this study. ⋯ Restriction of nCRT to high-risk patients achieved good results.