scholarly journals Laparoscopic surgery for colon cancer

2020 ◽  
Vol 42 (5) ◽  
pp. 413-420 ◽  
Author(s):  
Vinzenz Völkel ◽  
Teresa Draeger ◽  
Michael Gerken ◽  
Monika Klinkhammer-Schalke ◽  
Stefan Benz ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Clinical Practice ◽  
Laparoscopic Surgery ◽  
Cohort Studies ◽  
Retrospective Cohort ◽  
Randomized Clinical Trials ◽  
Postoperative Mortality ◽  
Duration Of Surgery ◽  
Retrospective Cohort Studies

Abstract Background To evaluate a new procedure in daily clinical practice, it might not be sufficient to rely exclusively on the findings of randomized clinical trials (RCTs). This is the first systematic review providing a synthesis of the most important RCTs and relevant retrospective cohort studies on short- and long-term outcomes of laparoscopic surgery in colon cancer patients. Materials and methods In a literature search, more than 1800 relevant publications on the topic were identified. Relevant RCTs and representative high-quality retrospective studies were selected based on the widely accepted Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria. Finally, 9 RCTs and 14 retrospective cohort studies were included. Results Laparoscopic surgery for colon cancer is associated with a slightly longer duration of surgery, but a variety of studies show an association with a lower rate of postoperative complications and a shorter duration of hospital stay. Particularly in older patients with more frequent comorbidities, laparoscopy seems to contribute to decreasing postoperative mortality. Concerning long-term oncologic outcomes, the laparoscopic and open techniques were shown to be at least equivalent. Conclusion The findings of the existing relevant RCTs on laparoscopic surgery for colon cancer are mostly confirmed by representative retrospective cohort studies based on real-world data; therefore, its further implementation into clinical practice can be recommended.

scholarly journals Difference in surgical outcomes of rectal cancer by study design: meta-analyses of randomized clinical trials, case-matched studies, and cohort studies

BJS Open ◽  
2021 ◽  
Vol 5 (2) ◽  
Author(s):  
N Hoshino ◽  
T Sakamoto ◽  
K Hida ◽  
Y Takahashi ◽  
H Okada ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Robotic Surgery ◽  
Cohort Studies ◽  
Anastomotic Leakage ◽  
Study Design ◽  
Randomized Clinical Trials ◽  
Postoperative Mortality ◽  
Resection Margins ◽  
Meta Analyses

Abstract Background RCTs are considered the standard in surgical research, whereas case-matched studies and propensity score matching studies are conducted as an alternative option. Both study designs have been used to investigate the potential superiority of robotic surgery over laparoscopic surgery for rectal cancer. However, no conclusion has been reached regarding whether there are differences in findings according to study design. This study aimed to examine similarities and differences in findings relating to robotic surgery for rectal cancer by study design. Methods A comprehensive literature search was conducted using PubMed, Scopus, and Cochrane CENTRAL to identify RCTs, case-matched studies, and cohort studies that compared robotic versus laparoscopic surgery for rectal cancer. Primary outcomes were incidence of postoperative overall complications, incidence of anastomotic leakage, and postoperative mortality. Meta-analyses were performed for each study design using a random-effects model. Results Fifty-nine articles were identified and reviewed. No differences were observed in incidence of anastomotic leakage, mortality, rate of positive circumferential resection margins, conversion rate, and duration of operation by study design. With respect to the incidence of postoperative overall complications and duration of hospital stay, the superiority of robotic surgery was most evident in cohort studies (risk ratio (RR) 0.83, 95 per cent c.i. 0.74 to 0.92, P < 0.001; mean difference (MD) –1.11 (95 per cent c.i. –1.86 to –0.36) days, P = 0.004; respectively), and least evident in RCTs (RR 1.12, 0.91 to 1.38, P = 0.27; MD –0.28 (–1.44 to 0.88) days, P = 0.64; respectively). Conclusion Results of case-matched studies were often similar to those of RCTs in terms of outcomes of robotic surgery for rectal cancer. However, case-matched studies occasionally overestimated the effects of interventions compared with RCTs.

Impact of radiotherapy for local control in T3 N0 rectal cancer managed with total mesorectal excision: A systematic review and meta-analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 3604-3604
Author(s):  
Jesus C. Fabregas ◽  
Andrew Bang ◽  
Michael Tjong ◽  
Michael Kucharczyk
Keyword(s):  
Rectal Cancer ◽  
Relative Risk ◽  
Cohort Studies ◽  
Total Mesorectal Excision ◽  
Retrospective Cohort ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Rectal Adenocarcinoma ◽  
Mesorectal Excision ◽  
Retrospective Cohort Studies

3604 Background: Total mesorectal excision (TME) significantly improved rectal cancer outcomes. Radiotherapy (RT) is recommended for T3N0 rectal cancers, though benefit has not been demonstrated in combination with TME for this specific population. This meta-analysis could provide evidence to ameliorate toxicities from treatment. Methods: Randomized clinical trials and observational studies published until October 18, 2020 were identified via PubMed and Embase. Objective: To determine whether RT decreased the risk of local recurrence (LR) in T3N0 rectal cancer managed with TME. Study Selection and Extraction: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were observed for literature search, extraction, and screening. Studies with LR data specific to T3N0M0 rectal cancer, treated with and without RT, were included. Reviews, non-English articles, and non-TME studies were excluded. Newcastle Ottawa Scale (NOS) evaluated quality. Meta-analysis was done with a random-effects model. Main outcome: Meta-analysis of the relative risk of LR was conducted. Results: 7,246 studies were screened, 134 full-text studies assessed for eligibility, 5 studies were included in the final analysis. No randomized data reported results specific to our study population. Five retrospective cohort studies involving 932 participants reported LR outcomes. The median follow-up ranged from 38.4 months up to 71 months. Four studies took place in Asia (797 participants) and one in North America (135 participants) (Table). Quality according to NOS ranged from 7–9. The estimated average relative risk for LR at 5 years was 0.63 (95% CI 0.31–1.29; I2=41.8%) when RT was used. Conclusions: This meta-analysis’ supports that there is no clear benefit to LR with the addition of RT in T3N0 patients with rectal adenocarcinoma undergoing TME. As meta-analysis was limited to retrospective cohort studies, there is concern for bias. Registration Prospero number CRD42020216058 .[Table: see text]

scholarly journals The safety and effectiveness of chenodeoxycholic acid treatment in patients with cerebrotendinous xanthomatosis: two retrospective cohort studies

2019 ◽  
Vol 41 (4) ◽  
pp. 943-949 ◽  
Author(s):  
Aad Verrips ◽  
Maria Teresa Dotti ◽  
Andrea Mignarri ◽  
Bianca M. L. Stelten ◽  
Sue Verma ◽  
...  
Keyword(s):  
Cohort Studies ◽  
Chenodeoxycholic Acid ◽  
Retrospective Cohort ◽  
Signs And Symptoms ◽  
Term Treatment ◽  
Cerebrotendinous Xanthomatosis ◽  
Long Term Treatment ◽  
Retrospective Cohort Studies ◽  
The Impact

Abstract Objective To evaluate the safety and effectiveness of chenodeoxycholic acid (CDCA) treatment in patients with cerebrotendinous xanthomatosis (CTX). Methods Two retrospective cohort studies were conducted in CTX patients who underwent CDCA treatment: one in the Netherlands (NL; CDCA-STUK-15-001) and one in Italy (IT; CDCA-STRCH-CR-14-001). Eligible patients were aged 2–75 years, had been diagnosed with CTX, and were treated with CDCA orally for ≥1 year. The impact of CDCA treatment on biochemical markers (including serum cholestanol levels) and disease signs and symptoms were assessed, in addition to the safety and tolerability of CDCA treatment. Results A total of 35 patients were screened in the NL study and were diagnosed with CTX at 25.6 (± 13.7 SD) years on average. These patients were treated with CDCA and followed up for a median of 9.00 (range: 0.4–26.3) years. In addition, 28 patients were enrolled in the IT study and were diagnosed at 35.0 (± 11.4 SD) years on average (median duration of CDCA treatment: 5.75 [range: 0.0–25.0] years). Signs and symptoms of disease resolved, improved, or remained stable in many patients, with concomitant improvements in biochemical marker levels (serum cholestanol, p < 0.001; 7α-hydroxy-4-cholesten-3-one, p < 0.001 [IT study]). Conclusions The outcomes of these retrospective cohort studies indicate that CDCA is effective in the long-term treatment of CTX, with an acceptable safety profile.

Atrial Fibrillation and Mortality in the Oldest Old after Surgery for Hip Fractures

Gerontology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Amit Frenkel ◽  
Vladimir Zeldetz ◽  
Roni Gat ◽  
Yair Binyamin ◽  
Asaf Acker ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Hip Fractures ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Oldest Old ◽  
Postoperative Mortality ◽  
Patient Characteristics ◽  
One Year

Introduction: One-year mortality following hip fractures increases steeply with age, from 2% in the 60- to 69-year-old population up to 28% in the oldest old (older than 90 years). Of the various factors that contribute to hip fractures, atrial fibrillation (AF) is an independent risk factor at any age. Objective: The objective of this study was to assess the association of AF with mortality among the oldest old with hip fractures. Method: This is a retrospective cohort study of 701 persons above age 90 years who underwent orthopedic repair for a hip fracture during 2000–2018. Of them, 218 (31%) had AF at hospital admission. The primary outcome was survival following surgery. We compared patient characteristics and 30-day, 180-day, 1-year, and 3-year survival between patients with and without AF. Results: The adjusted odds ratio for 30-day postoperative mortality for those with AF versus without AF group was 1.03 (95% confidence interval [CI] 0.63–1.66). Survival estimates were higher among those without AF than with AF at 180 days postoperative: 0.85 (95% CI 0.82–0.89) versus 0.68 (95% CI 0.61–0.74), p < 0.001; at 1 year postoperative: 0.68 (95% CI 0.63–0.72) versus 0.48 (95% CI 0.42–0.55), p < 0.001; and at 3 years postoperative: 0.47 (95% CI 0.42–0.52) versus 0.28 (95% CI 0.27–0.34), p < 0.001. Conclusions: Among individuals aged >90 years, operated for hip fractures, mortality was similar for those with and without AF at 30 days postoperative. However, the survival curves diverged sharply after 180 days. Our findings suggest that AF is not an immediate surgical risk factor, but rather confers increased long-term risk in this population.

Assessing the Feasibility of Retrospective Cohort Studies

1987 ◽  
Vol 12 (4) ◽  
pp. 419-430 ◽  
Author(s):  
Kyle Steenland ◽  
Leslie Stayner ◽  
Alice Greife
Keyword(s):  
Cohort Studies ◽  
Retrospective Cohort ◽  
Retrospective Cohort Studies

Management of Oral Anticoagulation Therapy After Gastrointestinal Bleeding: Whether to, When to, and How to Restart an Anticoagulation Therapy

2017 ◽  
Vol 51 (11) ◽  
pp. 1000-1007 ◽  
Author(s):  
Kazuhiko Kido ◽  
Michael J. Scalese
Keyword(s):  
Gastrointestinal Bleeding ◽  
Cohort Studies ◽  
Oral Anticoagulation ◽  
Retrospective Cohort ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Cochrane Library ◽  
Oral Anticoagulation Therapy ◽  
Retrospective Cohort Studies

Objective: To evaluate current clinical evidence for management of oral anticoagulation therapy after gastrointestinal bleeding (GIB) with an emphasis on whether to, when to, and how to resume an anticoagulation therapy. Data Sources: Relevant articles from MEDLINE, Cochrane Library, and EMBASE databases were identified from 1946 through May 20, 2017, using the keywords: gastrointestinal hemorrhage or gastrointestinal bleeding and antithrombotic therapy or anticoagulation therapy or warfarin or dabigatran or rivaroxaban or apixaban or edoxaban.Study Selection and Data Extraction: All English-language studies assessing management of oral anticoagulation therapy after GIB were evaluated. Data Synthesis: A total of 9 studies were identified. Four retrospective cohort studies showed that resuming anticoagulation therapy was associated with significantly lower rate of thromboembolism (TE) in the general population. Meta-analyses and prospective cohort studies also supported this finding. Two retrospective cohort studies indicated an increase in GIB when anticoagulation reinitiation occurred in less than 7 days without a decrease in TE. Resuming therapy between 7 and 15 days did not demonstrate a significant increase in GIB or TE. A large retrospective study showed that apixaban was associated with the significantly lowest risk of GIB compared with both rivaroxaban and dabigatran. Conclusion: Anticoagulation therapy resumption is recommended, with resumption being considered between 7 and 14 days following GIB regardless of the therapy chosen. Data for warfarin management after GIB should be applied with caution to direct oral anticoagulants (DOACs) because of the quicker onset and experimental nature of reversal agents. Apixaban may be a preferred option when restarting a DOAC therapy.

scholarly journals Incidence of primary graft dysfunction after lung transplantation is altered by timing of allograft implantation

Thorax ◽  
2018 ◽  
Vol 74 (4) ◽  
pp. 413-416 ◽  
Author(s):  
Peter S Cunningham ◽  
Robert Maidstone ◽  
Hannah J Durrington ◽  
Rajamayier V Venkateswaran ◽  
Marcelo Cypel ◽  
...  
Keyword(s):  
Cohort Studies ◽  
Lung Transplantation ◽  
Organ Preservation ◽  
Retrospective Cohort ◽  
Circadian Regulation ◽  
Primary Graft Dysfunction ◽  
Graft Dysfunction ◽  
Donor Lung ◽  
Retrospective Cohort Studies ◽  
Clock Protein

The importance of circadian factors in managing patients is poorly understood. We present two retrospective cohort studies showing that lungs reperfused between 4 and 8 AM have a higher incidence (OR 1.12; 95% CI 1.03 to 1.21; p=0.01) of primary graft dysfunction (PGD) in the first 72 hours after transplantation. Cooling of the donor lung, occurring during organ preservation, shifts the donor circadian clock causing desynchrony with the recipient. The clock protein REV-ERBα directly regulates PGD biomarkers explaining this circadian regulation while also allowing them to be manipulated with synthetic REV-ERB ligands.

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