The British journal of surgery
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Review Comparative Study
Systematic review of surgical management of synchronous colorectal liver metastases.
The optimal management of colorectal cancer with synchronous liver metastases has not yet been elucidated. The aim of the present study was systematically to review current evidence concerning the timing and sequence of surgical interventions: colon first, liver first or simultaneous. ⋯ None of the three surgical strategies for synchronous colorectal liver metastases appeared inferior to the others.
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Comparative Study
Long-term cost-effectiveness analysis of endovascular versus open repair for abdominal aortic aneurysm based on four randomized clinical trials.
A number of published economic evaluations of elective endovascular aneurysm repair (EVAR) versus open repair for abdominal aortic aneurysm (AAA) have come to differing conclusions about whether EVAR is cost-effective. This paper reviews the current evidence base and presents up-to-date cost-effectiveness analyses in the light of results of four randomized clinical trials: EVAR-1, DREAM, OVER and ACE. ⋯ These analyses did not find that EVAR is cost-effective compared with open repair in the long term in trials conducted in European centres. EVAR did appear to be cost-effective based on the OVER trial, conducted in the USA. Caution must be exercised when transferring the results of economic evaluations from one country to another.
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Comparative Study
Comparison of three ultrasound methods of measuring the diameter of the abdominal aorta.
Three ultrasound methods of measuring the diameter of the abdominal aorta exist: the outer-to-outer (OTO) method, where callipers are placed on the outer layer of the aortic wall; the inner-to-inner (ITI) method, where callipers are placed on the inner layer of the aortic wall; and the leading edge-to-leading edge (LELE) method, where callipers are placed on the outer layer of the anterior wall and the inner layer of the posterior wall. The aim was to determine the variability of the three methods, differences between them, and the consequences on prevalence estimates. ⋯ LELE measurement was the most reproducible method of measuring the abdominal aorta. All methods showed a high degree of variability.
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Comparative Study
Outcome of sleeve gastrectomy as a primary bariatric procedure.
Sleeve gastrectomy is being performed increasingly in Europe. Data on long-term outcome would be helpful in defining the role of sleeve gastrectomy. The aim of this study was to evaluate the outcome of sleeve gastrectomy as a primary bariatric procedure. ⋯ Sleeve gastrectomy is a safe and effective bariatric procedure. Maximum weight loss was achieved after 4 years. Long-term results regarding weight loss and co-morbidities were satisfactory.
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In colonic cancer, the number of harvested lymph nodes is associated with prognosis. The aim of this study was to determine the contribution of small lymph nodes to pathological staging, and to analyse the hypothesis that node size is a confounder in the relationship between prognosis and nodal harvest. ⋯ The contribution of lymph nodes smaller than 3 mm to nodal staging is limited. Increased node size is associated with increased nodal yield, and could be a confounder in the relationship between prognosis and nodal harvest in patients with N0 disease.