European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
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Historical Article
Adenocarcinoma of the pancreas: Does prognosis depend on mode of lymph node invasion?
Lymph node (LN) invasion in pancreatic ductal adenocarcinoma (PDAC) is the most important prognostic factor after surgical resection. The mechanisms of LN invasion include lymphatic spreading and/or direct extension from the main tumor. However, few studies have assessed the impact of these different patterns of invasion on prognosis. ⋯ Direct invasion of LN by the tumor is predictive of reduced survival, but has little impact compared to standard LN involvement and perineural invasion.
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"Unplanned reoperations" has been advocated as a quality measure in colorectal cancer surgery as it is correlated with complications and postoperative mortality at a patient level. However, little is known about the relation between reoperation rates and postoperative mortality rates at a hospital level. ⋯ Reoperation rates after elective colorectal cancer resections varied. Hospitals with significantly higher reoperation rates than average did not have higher mortality rates. The group with lowest reoperation rates also had lower postoperative mortality rates; however, this did not apply to all hospitals in the group. In conclusion, 'reoperations' seems suitable as benchmark information to hospitals but less suitable to detect poor performers. Best practices should be identified as hospitals with both low reoperation- and mortality rates.
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Sacral chordomas are rare low-to-intermediate grade malignant tumours, which arise from remnants of the embryonic notochord. This review explores prognostic factors in the management of sacral chordomas and provides guidance on the optimal treatment regimens based on the current literature. ⋯ Operative resection with wide resection margins offers the best long-term prognosis. Inadequate resection margins, large tumour size, dedifferentiation, and greater cephalad chordoma extension are associated with poor oncological outcomes. Routine long-term follow-up is essential to enable early detection and treatment of recurrent disease.
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Observational Study
The effects of neoadjuvant chemoradiotherapy on physical fitness and morbidity in rectal cancer surgery patients.
Neoadjuvant chemoradiotherapy (NACRT) followed by surgery for resectable locally advanced rectal cancer improves outcome compared with surgery alone. Our primary hypothesis was that NACRT impairs objectively-measured physical fitness. We also wished to explore the relationship between fitness and postoperative outcome. ⋯ NACRT before major rectal cancer surgery significantly decreased physical fitness as assessed by CPET.
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Meta Analysis Comparative Study
Pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy: a meta-analysis of randomized control trials.
Postoperative pancreatic fistula (PF) is the leading morbidity after pancreaticoduodenectomy (PD). The pancreatoenteric anastomosis method after PD is associated with the occurrence of PF. Evidence shows that pancreaticogastrostomy (PG) is possibly superior to pancreaticojejunostomy (PJ) in reducing the incidence of PF after PD; however, this remains to be definitively confirmed. ⋯ PG seemed to be superior to PJ in reducing the incidence of PF and intra-abdominal fluid collection after PD.