ABSTRACT
Objective: To conduct a meta-analysis of reported evidence on surgical management for symptomatic giant liver hemangiomas
Methodology: A systematic literature search was conducted to identify studies on adult patient surgeries for symptomatic giant liver hemangiomas from January 2009 to July 2015. The primary outcome measures included postoperative symptom resolution, mortality, complications, and blood transfusions. Quality of life after surgery was taken as a secondary outcome. Meta-analysis was performed using a random-effect model with comprehensive meta-analysis software
Results: Fourteen studies with 1,557 patients were included. There were only two mortalities. Overall event rate for minor and major complications was low as 0.15 and 0.14, respectively, with a high symptom resolution rate of 0.69 [95%, CI 0.64-0.73]. Pooled analysis for blood transfusion stayed insignificant due to high calculated heterogeneity across studies. Quality of life results after surgery are reported good by three studies, in most of their patients. The adverse outcome rate between enucleation and resection was comparable
Conclusion: Liver hemangioma surgery is a safe treatment option with negligible mortality and low morbidity. It is effective in terms of symptom control and overall quality of life
ABSTRACT
Objective: To analyze overall survival patterns of our pancreatic cancer patient population managed with a curative or palliative intent
Study Design: Analytical study
Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from January 2000 till February 2015
Methodology: A retrospective review of the data of all of our pancreatic cancer patients was performed, using the hospital information system. Patients with tumor other than adenocarcinoma or a histopathologic diagnosis not made at our hospital are excluded from the study, along with patients having an incomplete medical record for all included variables. The main outcome measure was overall survival in months from the date of diagnosis. All results were segregated and analyzed according to the intervention modality used, i.e. group A: surgery with curative intent, group B: Palliative chemotherapy, and group C: Supportive care. Results were controlled for the confounding variables including age, gender, significant comorbid conditions, stage of disease at initial presentation, tumor location, and histological grade
Results: Among the 197 patients fulfilling the inclusion criteria, 21 [10.7%] were excluded as they were lost to follow-up. Overall Kaplan-Meier survival analysis gave a 56% one-year survival, 22% at 3- and 16% at 5-year. The subset analysis on Cox-regression survival plot showed inferior survival with advancing stage of the disease and a treatment less than definitive surgical resection and adjuvant chemotherapy. On Cox-proportional regression analysis, stage of the disease and treatment modality were only independent predictive factors for overall survival [p < 0.01]
Conclusion: Stage for stage, surgery with curative intent [group A] or palliative chemotherapy [group B] showed a trend towards improved survival as compared to supportive management [group C] alone. The results were more significant for surgical resection arm
ABSTRACT
Rectovaginal fistula following sexual intercourse is rarely reported. It is a social stigma; and without adequate treatment and social support, the patient may end-up in isolation. A thorough knowledge of the problem and management is essential for successful outcome. We report a case of low rectovaginal fistula in a newly married female managed trans-vaginally with prior defunctioning colostomy