The British journal of surgery
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Multicenter Study Meta Analysis
Multicentre analysis of oncological and survival outcomes following anastomotic leakage after rectal cancer surgery.
The association between diverting stomas and symptomatic anastomotic leakage after rectal cancer surgery was studied, as well as the impact of leakage on local recurrence, distant metastasis, and disease-free, overall and cancer-specific survival. ⋯ Diverting stomas were associated with less symptomatic anastomotic leakage. Oncological outcome was not significantly influenced by leakage, but overall survival was reduced.
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Randomized Controlled Trial Comparative Study
Prospective randomized trial using cost-utility analysis of early versus delayed laparoscopic cholecystectomy for acute gallbladder disease.
This randomized controlled trial compared the cost-utility of early laparoscopic cholecystectomy with that for conventional management of newly diagnosed acute gallbladder disease. ⋯ In this pragmatic trial, the cost-utilities of both the early and conventional approaches were similar, but the incremental cost per additional QALY gained favoured conventional management.
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This is the third leading article in the Journal's series on major trauma. In it Karim Brohi, Professor of Trauma Sciences at Queen Mary University of London, deals with the important topic of the defects in blood coagulation that are often encountered after serious injury.
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Comparative Study
Second and third hepatectomies for recurrent hepatocellular carcinoma are justified.
Liver resection is the main curative treatment for hepatocellular carcinoma (HCC), but recurrence rates are high. The remnant liver is the most common site of recurrence, but the role of repeat hepatectomy in the treatment of recurrent HCC is controversial. ⋯ Second and third hepatectomies seem justified for hepatic recurrence of HCC. The role of fourth hepatectomy needs further investigation.
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Comparative Study
Laparoscopic and open treatment of hepatocellular carcinoma in patients with cirrhosis.
Few studies have compared survival and recurrence rates between laparoscopic and open liver resection for hepatocellular carcinoma in patients with cirrhosis. ⋯ Laparoscopic resection of HCC in cirrhotic liver is feasible and safe in selected patients. Adequate long-term survival and recurrence is achieved compared with open surgery, when stratified for tumour characteristics known to be related to survival outcome.