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1.
J Visc Surg ; 154(6): 387-399, 2017 Dec.
Article in English | MEDLINE | ID: mdl-29113714

ABSTRACT

BACKGROUND: Hemicolectomy is the treatment of choice for intestinal obstruction from right colon cancer. This review compares the laparoscopic vs open access in hemicolectomy for patients with right colon cancer. METHODS: A systematic review and meta-analysis of clinical studies published after January 2017 was performed according to the Prisma guidelines. The study has been recorded on the Prospero register (CRD42016044108). RESULTS: Five studies were included for review. Only one anastomotic leak was reported in conventional open anastomosis group (1.9%) and none of the studies included in the meta-analysis reported re-operations during the first 30 postoperative days. The 30-day postoperative mortality did not differ between the two groups. The length of incision, blood loss, early mobilization after surgery, the 30-day postoperative overall complication rate and hospital length of stay were significantly shorter in the laparoscopic group. The difference in the duration of procedure was statistically significant in favor of the open group. The number of dissected lymph nodes, the overall survival at 5 years and time to flatus were described only in one study, without any significant difference. Finally, none of the trials reported any information concerning differences in the costs between the two techniques. CONCLUSIONS: The better outcomes described in this study achieved with laparoscopy, must be interpreted with caution because of the small number of patients involved, the selection and publication bias and the low level of evidence of the analysed trials. Indeed, the advantages of a minimally invasive approach, which have been demonstrated by the present meta-analysis, should encourage the use of laparoscopy also in emergency setting.


Subject(s)
Colectomy/methods , Colonic Neoplasms/surgery , Intestinal Obstruction/pathology , Intestinal Obstruction/surgery , Laparoscopy/methods , Colectomy/adverse effects , Colonic Neoplasms/complications , Colonic Neoplasms/pathology , Female , Humans , Intestinal Obstruction/etiology , Laparoscopy/adverse effects , Laparotomy/adverse effects , Laparotomy/methods , Male , Postoperative Complications/physiopathology , Postoperative Complications/surgery , Prognosis , Randomized Controlled Trials as Topic , Reoperation , Survival Analysis , Treatment Outcome
2.
Tech Coloproctol ; 21(2): 93-110, 2017 Feb.
Article in English | MEDLINE | ID: mdl-28197792

ABSTRACT

This systematic review and meta-analysis investigates current evidence on the therapeutic role of laparoscopic lavage in the management of diverticular peritonitis. A systematic review of the literature was performed on PubMed until June 2016, according to preferred reporting items for systematic reviews and meta-analyses guidelines. All randomised controlled trials comparing laparoscopic lavage with surgical resection, irrespective of anastomosis or stoma formation, were analysed. After assessment of titles and full text, 3 randomised trials fulfilled the inclusion criteria. Overall the quality of evidence was low because of serious concerns regarding the risk of bias and imprecision. In the laparoscopic lavage group, there was a statistically significant higher rate of postoperative intra-abdominal abscess (RR 2.54, 95% CI 1.34-4.83), a lower rate of postoperative wound infection (RR 0.10, 95% CI 0.02-0.51), and a shorter length of postoperative hospital stay during index admission (WMD = -2.03, 95% CI -2.59 to -1.47). There were no statistically significant differences in terms of postoperative mortality at index admission or within 30 days from intervention in all Hinchey stages and in Hinchey stage III, postoperative mortality at 12 months, surgical reintervention at index admission or within 30-90 days from index intervention, stoma rate at 12 months, or adverse events within 90 days of any Clavien-Dindo grade. The surgical reintervention rate at 12 months from index intervention was significantly lower in the laparoscopic lavage group (RR 0.57, 95% CI 0.38-0.86), but these data included emergency reintervention and planned intervention (stoma reversal). This systematic review and meta-analysis did not demonstrate any significant difference between laparoscopic peritoneal lavage and traditional surgical resection in patients with peritonitis from perforated diverticular disease, in terms of postoperative mortality and early reoperation rate. Laparoscopic lavage was associated with a lower rate of stoma formation. However, the finding of a significantly higher rate of postoperative intra-abdominal abscess in patients who underwent laparoscopic lavage compared to those who underwent surgical resection is of concern. Since the aim of surgery in patients with peritonitis is to treat the sepsis, if one technique is associated with more postoperative abscesses, then the technique is ineffective. Even so, laparoscopic lavage does not appear fundamentally inferior to traditional surgical resection and this technique may achieve reasonable outcomes with minimal invasiveness.


Subject(s)
Diverticulitis/therapy , Laparoscopy/methods , Peritoneal Lavage/methods , Peritonitis/therapy , Postoperative Complications/etiology , Abdominal Abscess/etiology , Adolescent , Adult , Aged , Aged, 80 and over , Diverticulitis/complications , Diverticulitis/surgery , Female , Humans , Intestinal Perforation/complications , Intestinal Perforation/surgery , Intestines/surgery , Length of Stay , Male , Middle Aged , Peritonitis/etiology , Peritonitis/surgery , Randomized Controlled Trials as Topic , Reoperation/statistics & numerical data , Severity of Illness Index , Surgical Stomas/statistics & numerical data , Treatment Outcome , Young Adult
3.
Tech Coloproctol ; 21(3): 177-184, 2017 Mar.
Article in English | MEDLINE | ID: mdl-28132113

ABSTRACT

Anastomotic leak following colorectal surgery can be a devastating adverse event. The ideal stapling device should be capable of rapid creation of an anastomosis with serosal apposition without the persistence of a foreign body or a foreign body reaction which potentially contribute to early anastomotic dehiscence or late anastomotic stricture. A systematic review was performed examining available data on controlled randomized and non-randomized trials assessing the NiTi compression anastomosis ring-(NiTi CAR™) (NiTi Solutions, Netanyah Israel) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards. A protocol for this meta-analysis has been registered on PROSPERO (CRD42016050934). The initial search yielded 45 potentially relevant articles. After screening titles and abstracts for relevance and assessment for eligibility, 39 of these articles were eventually excluded leaving 6 studies for analysis in the review. Regarding the primary outcome measure, the overall anastomotic leak rate was 2.2% (5/230) in the compression anastomosis group compared with 3% (10/335) in the conventional anastomosis group; this difference was not statistically significant (RR 0.75, 95% CI 0.25-2.24; participants = 565; studies = 6; I 2 = 0%). There were no statistically significant differences between compression and conventional anastomoses in any of the secondary outcomes. This review was unable to demonstrate any statistically significant differences in favor of the compression anastomosis technique over conventional manual or stapled mechanical anastomoses.


Subject(s)
Anastomotic Leak/prevention & control , Colon/surgery , Pressure , Rectum/surgery , Surgical Stapling/instrumentation , Anastomosis, Surgical/instrumentation , Anastomosis, Surgical/methods , Anastomotic Leak/etiology , Controlled Clinical Trials as Topic , Humans , Surgical Stapling/methods , Treatment Outcome
4.
Cancer Invest ; 27(4): 443-52, 2009 May.
Article in English | MEDLINE | ID: mdl-19212830

ABSTRACT

To determine the role of the reactive stroma in cancer progression, we investigated decorin (DCN) and transforming growth factor-beta (TGF-beta expression, and matrix metalloproteinase-2 (MMP-2) activity in the tumorous esophagus. We found statistically insignificantly decreased levels of DCN expression in the pathological tissues. No obvious alterations in TGF-beta expression were noticed. The highly significant increase in MMP-2 activity in cancers did not result in elevated levels of TGF-beta dimers. Therefore, the system of TGF-beta liberation from its complex with DCN by activated MMP-2 does not seem to contribute to esophageal cancerogenesis, although this hypothesis should be reevaluated with a larger study group.


Subject(s)
Carcinoma, Squamous Cell/chemistry , Esophageal Neoplasms/chemistry , Extracellular Matrix Proteins/analysis , Matrix Metalloproteinase 2/analysis , Proteoglycans/analysis , Transforming Growth Factor beta/analysis , Adult , Aged , Carcinoma, Squamous Cell/enzymology , Carcinoma, Squamous Cell/genetics , Decorin , Enzyme Activation , Esophageal Neoplasms/enzymology , Esophageal Neoplasms/genetics , Extracellular Matrix Proteins/genetics , Female , Gene Expression Regulation, Enzymologic , Gene Expression Regulation, Neoplastic , Humans , Immunohistochemistry , Male , Matrix Metalloproteinase 2/genetics , Middle Aged , Protein Isoforms , Proteoglycans/genetics , Reverse Transcriptase Polymerase Chain Reaction , Stromal Cells/chemistry , Transforming Growth Factor beta/genetics , Transforming Growth Factor beta1/analysis , Transforming Growth Factor beta2/analysis , Transforming Growth Factor beta3/analysis
5.
J Hand Surg Br ; 30(6): 570-3, 2005 Dec.
Article in English | MEDLINE | ID: mdl-16055243

ABSTRACT

The aim of this paper was to examine participation of the epidermal growth factor receptor (EGF-R) signal pathway in the pathogenesis of Dupuytren's disease. The study showed changes in the ratio of membrane EGF-R to its intracellular level during the different clinical stages of Dupuytren's contracture progression. Our observations of a high ratio of surface to intracellular EGF-R in the palmar aponeurosis of patients with second degree of Dupuytren's disease (Iselin's classification), which was significantly higher than this ratio in control palmar fascia (P=0.022), would suggest that EGF-R has a role in the involutional phase of the disease.


Subject(s)
Dupuytren Contracture/physiopathology , ErbB Receptors/physiology , Aged , Cell Proliferation , Disease Progression , Dupuytren Contracture/pathology , Female , Humans , Male , Middle Aged
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