The British journal of surgery
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Pragmatic Clinical Trial
Effectiveness of a multidisciplinary patient care bundle for reducing surgical-site infections.
Surgical-site infection (SSI) is associated with significant healthcare costs. To reduce the high rate of SSI among patients undergoing colorectal surgery at a cancer centre, a comprehensive care bundle was implemented and its efficacy tested. ⋯ Meaningful reductions in SSI can be achieved by implementing a multidisciplinary care bundle at a hospital-wide level.
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Observational Study
Magnetic resonance tumour regression grade and pathological correlates in patients with rectal cancer.
Evidence to support the specific use of magnetic resonance tumour regression grade (mrTRG) is inadequate. The aim of this study was to investigate the pathological characteristics of mrTRG after chemoradiotherapy (CRT) for rectal cancer and the implications for surgery. ⋯ Patients with mrTRG1 without tumour spread may be suitable for TAE.
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Lymph node regression and survival following neoadjuvant chemotherapy in oesophageal adenocarcinoma.
The aim was to define the pathological response in lymph nodes following neoadjuvant chemotherapy for oesophageal adenocarcinoma and to quantify any associated survival benefit. ⋯ Lymph node regression is a strong prognostic factor and may be more important than response in the primary tumour.
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After neoadjuvant chemoradiotherapy (nCRT) plus surgery for oesophageal cancer, 29 per cent of patients have a pathologically complete response in the resection specimen. Active surveillance after nCRT (instead of standard oesophagectomy) may improve health-related quality of life (HRQoL), but patients need to undergo frequent diagnostic tests and it is unknown whether survival is worse than that after standard oesophagectomy. Factors that influence patients' preferences, and trade-offs that patients are willing to make in their choice between surgery and active surveillance were investigated here. ⋯ Patients are willing to trade off substantial 5-year survival to achieve a reduction in the risk that oesophagectomy is necessary.
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Internal herniation, a serious complication after bariatric surgery, is challenging to diagnose. The aim of this study was to determine the accuracy of abdominal CT in diagnosing internal herniation. ⋯ Abdominal CT is an important tool in diagnosing internal herniation, with a high specificity and a high negative predictive value.