1,721,058 research outputs found
Hyponatremia could identify patients with intrabdominal sepsis and anastomotic leak after colorectal surgery: a systematic review of the literature
No full textAnastomotic leak (AL) is a serious post-operative complication in colorectal surgery. It can lead to devastating morbidity and mortality. Clinicians usually depend on a combination of clinical, biochemical and radiological findings to diagnose this problem. In our article, we tried to look if electrolyte disturbances could be indicators for intra-abdominal sepsis due to AL. Systematic review of the literature identifies a potential correlation between electrolyte alterations and AL in digestive surgery. The following databases were searched: PubMed, EMBASE and MIDLINE. The review adhered to the PRISMA statement for systematic review. Our literature search did not identify any articles linking any electrolyte disturbances-except for hyponatremia-to AL. Pathophysiology of these electrolyte disturbances does not seem to be linked to AL, except for hyponatremia which might be explained. Our review included 442 patients with intra-abdominal sepsis and 1133 controls. The mean specificity of hyponatremia being associated with intra-abdominal sepsis is 86%, whereas mean sensitivity is 28%. Hyponatremia seems to be a significant and clinically relevant marker for of intra-abdominal sepsis and AL
Fungal microbiome in colorectal cancer: a systematic review
No full textColorectal cancer (CRC) is the third cause of cancer-related death worldwide. It has been estimated that more than one million new cases occur every year. Several studies have investigated the role of host bacteria as agents protecting against or increasing the risk of CRC, but few have assessed the fungal microbiome in patients with CRC. Fungal dysbiosis has been studied in colorectal diseases (e.g. inflammatory bowel diseases), but few researches compared the fungal microbiome of CRC patients with those of controls. The current study represents a systematic review aimed at assessing the expression and diversity of fungi in patients with CRC and non-CRC individuals. Here, we discuss the fungal species that could be implied in CRC development and alterations that can be induced by the presence of CRC, and the potential implications for future research
Clinicopathological factors and survival outcomes of signet-ring cell and mucinous carcinoma versus adenocarcinoma of the colon and rectum: a systematic review and meta-analysis
Full text linkBackground:
Histological subtypes of colorectal cancer may be associated with varied prognostic features. This systematic review and meta-analysis aimed to compare clinicopathological characteristics, recurrence and overall survival between colorectal signet-ring cell (SC) and mucinous carcinoma (MC) to conventional adenocarcinoma (AC).
Methods:
A literature search of MEDLINE, EMBASE, Ovid and Cochrane Library was performed for studies that reported data on clinicopathological and survival outcomes on SC and/or MC versus AC from January 1985 to May 2020. Meta-analysis was performed using random-effect models and between-study heterogeneity was assessed.
Results:
Thirty studies of 1,087,055 patients were included: 11,510 (1.06%) with SC, 110,179 (10.13%) with MC and 965,366 (88.81%) with AC. Patients with SC were younger than patients with AC (WMD − 0.47; 95% CI − 0.84 to –0.10; I2 88.6%; p = 0.014) and more likely to have right-sided disease (OR 2.12; 95% CI 1.72–2.60; I2 82.9%; p < 0.001). Locoregional recurrence at 5 years was more frequent in patients with SC (OR 2.81; 95% CI 1.40–5.65; I2 0.0%; p = 0.004) and MC (OR 1.92; 95% CI 1.18–3.15; I2 74.0%; p = 0.009). 5-year overall survival was significantly reduced when comparing SC and MC to AC (HR 2.54; 95% CI 1.98–3.27; I2 99.1%; p < 0.001 and HR 1.38; 95% CI 1.19–1.61; I2 98.6%; p < 0.001, respectively).
Conclusion:
SC and MC are associated with right-sided lesions, advanced stage at presentation, higher rates of recurrence and poorer overall survival. This has strong implications towards surgical and oncological management and surveillance of colorectal cancer
Comparison of western and asian guidelines concerning the management of colon cancer
No full textBACKGROUND: Guidelines are important to standardize treatments and optimize outcomes. Several societies have published authoritative guidelines for patients with colon cancer, and a certain degree of variation can be predicted. OBJECTIVE: This study aims to compare Western and Asian guidelines for the management of colon cancer. DATA SOURCES: A literature review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies published between 2010 and 2017 by the online resources from the official Web sites of the societies/panels. Sources included guidelines by European Society of Medical Oncology, the Japanese Society for Cancer of the Colon and Rectum, and the National Comprehensive Cancer Network. STUDY SELECTION: Only full-text studies and the latest guidelines dealing with colon cancer were included. Studies and guidelines were separately assessed by 2 authors, who independently identified discrepancies and areas for further research. These were discussed and agreed with by all the authors. MAIN OUTCOME MEASURES: The recommendations of the guidelines of each society were compared, seeking discrepancies and potential areas for improvement. RESULTS: Endoscopic techniques for the management of early colon cancer are discussed in detail in the Asian guidelines. Asian guidelines advocate extended (D3) lymphadenectomy on a routine basis in T3/T4 and in selected T2 patients, whereas such an approach is still under investigation in Western countries. Only US guidelines describe neoadjuvant chemotherapy and radiotherapy. All the guidelines recommend adjuvant treatment in selected stage II patients, but agreement exists that this is performed without solid evidence, because better outcomes are hypothesized based on studies including stage III or stage II/III patients. The role of cytoreductive surgery with intra-abdominal chemotherapy is dubious, and European guidelines only recommend it in the setting of trials. Asian guidelines endorse an aggressive surgical approach to peritoneal disease. Only US guidelines include a patient advocate in the drafting panel. LIMITATIONS: Bias may have arisen from country-specific socioeconomic and cultural issues, and from the latest available updates. CONCLUSIONS: Surgical approaches to colon cancer differ significantly among Western and Asian guidelines, reflecting different concepts of treatment. The role of adjuvant treatment in node-negative disease and quality-of-life assessment need further research
Oncological outcomes of multimodality treatment for patients undergoing surgery for locally recurrent rectal cancer: A systematic review
No full textThere are several strategies in the management of locally recurrent rectal cancer (LRRC) with the optimum treatment yet to be established. This systematic review aims to compare oncological outcomes in patients undergoing surgery for LRRC who underwent neoadjuvant radiotherapy or chemoradiotherapy (CRT), adjuvant CRT, surgery only or surgery and intraoperative radiotherapy (IORT)
Wearable Devices in Colorectal Surgery: A Scoping Review
No full textWearable devices are increasingly utilised to monitor patients perioperatively, allowing for continuous data collection and early complication detection. There is considerable variability in the types and usage settings of wearables, particularly within colorectal surgery. To address this, a scoping review was conducted to investigate current utilisation of wearable devices in colorectal surgery. A systematic search across MEDLINE and Embase was conducted following PRISMA Scoping Review guidelines. Results were synthesised narratively, categorised by perioperative phase (preoperative; postoperative; combination), and supplemented with descriptive statistics and tables. Out of 1525 studies initially identified, 20 were included, reporting data on 10 different wearable devices. Use of wearable devices varied across settings with those used preoperatively tending to focus on baseline physical status or prehabilitation, while postoperative use centred around monitoring and identification of complications. Wearable devices can enhance perioperative monitoring, enable proactive interventions, and promote personalised care for improved patient outcomes in colorectal surgery
The Role of Pudendal Nerve Block in Colorectal Surgery: A Systematic Review
No full textackground: Colorectal surgery is associated with significant pain often requiring opioid and non-opioid analgesics. Pudendal nerve blocks (PNBs) can be administered with the aim to reduce pain and improve patient satisfaction. However, there are no current accepted guidelines for the use of PNB in colorectal surgery.
Method: We evaluated the available literature on the role of PNB in colorectal surgery to determine which technique and anesthetic agent may provide optimal pain relief and safety. Studies from January 1970 to December 2019 assessing PNB in colorectal surgery were retrieved from MEDLINE and EMBASE databases. Indication for PNB, technique, anesthetic agent, postoperative pain outcomes, patient satisfaction and complications were extracted.
Results: We initially identified 339 studies of which 17 (nine randomized controlled trials, three cohort studies, one case-control study and four reviews) specifically met the inclusion criteria. The most common indication found for PNB is hemorrhoidectomy using either bupivacaine or lidocaine. The anatomical landmark and neurostimulation are the most favorable techniques being applied. The majority of studies reported better pain scores, less analgesia requirement and higher patient satisfaction when performing a bilateral PNB, with no major complications.
Conclusions: The current evidence, though limited, supports the use of bilateral PNBs in colorectal surgical procedures in particular hemorrhoidectomies. PNBs can be safe and effective in improving patient outcomes particularly when using bupivacaine or lidocaine with either the anatomical landmark or neurostimulation technique
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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