The British journal of surgery
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Comparative Study
Comparison of angioplasty and bypass surgery for critical limb ischaemia in patients with infrapopliteal peripheral artery disease.
Both infrapopliteal (IP) bypass surgery and percutaneous transluminal angioplasty have been shown to be effective in patients with critical limb ischaemia (CLI). The most appropriate method of revascularization has yet to be established, as no randomized trials have been reported. The aim of this study was to compare the outcomes of patients with similar characteristics treated using either revascularization method. ⋯ There was no difference in limb salvage rates, but patency and amputation-free survival rates were better 1 year after bypass surgery.
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In 2011, the Dutch Upper Gastrointestinal Cancer Audit (DUCA) group began nationwide registration of all patients undergoing surgery with the intention of resection for oesophageal or gastric cancer. The aim of this study was to describe the initiation and implementation of this process along with an overview of the results. ⋯ Nationwide implementation of the DUCA has been successful. The results indicate a positive trend for various process and outcome measures.
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Observational Study
Prospective cohort study of laparoscopic and open hepatectomy for hepatocellular carcinoma.
The safety and feasibility of laparoscopic hepatectomy for hepatocellular carcinoma (HCC) with a diameter of 5 cm or less is well recognized. The role of laparoscopy in treating large HCC (5-10 cm) remains controversial. This prospective cohort study was undertaken to assess the short- and long-term outcomes of laparoscopic hepatectomy for large HCC and to compare this approach with open hepatectomy. ⋯ Laparoscopic hepatectomy is safe and feasible for the treatment of patients with large HCC.
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Achalasia can be subdivided into manometric subtypes according to the Chicago classification. These subtypes are proposed to predict outcome after treatment. This hypothesis was tested using a database of patients who underwent laparoscopic Heller's cardiomyotomy with anterior fundoplication. ⋯ Type III achalasia is a predictor of poor outcome after cardiomyotomy. There was no difference in outcome between types I and II achalasia.
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A 'surgery as needed' strategy has been proposed for patients with oesophageal cancer who truly achieve a pathological complete response (pCR) following neoadjuvant chemoradiotherapy (nCRT). However, the ability to detect residual disease remains problematic. This study investigated the anatomical locations and pathological characteristics of residual cancer in patients with oesophageal squamous cell carcinoma (SCC) who achieved a near pCR following nCRT. ⋯ Better tools for predicting pCR are required before considering a 'surgery as needed' approach in the management of oesophageal cancer.