The British journal of surgery
-
Randomized Controlled Trial Multicenter Study Comparative Study
Cost-effectiveness of supervised exercise therapy compared with endovascular revascularization for intermittent claudication.
Current guidelines recommend supervised exercise therapy (SET) as the preferred initial treatment for patients with intermittent claudication. The availability of SET programmes is, however, limited and such programmes are often not reimbursed. Evidence for the long-term cost-effectiveness of SET compared with endovascular revascularization (ER) as primary treatment for intermittent claudication might aid widespread adoption in clinical practice. ⋯ SET is a more cost-effective primary treatment for intermittent claudication than ER. These results support implementation of supervised exercise programmes in clinical practice.
-
Review Meta Analysis
Meta-analysis of aberrant lymphatic drainage in recurrent breast cancer.
Sentinel node biopsy (SNB) in recurrent breast cancer offers targeted axillary staging compared with axillary lymph node dissection (ALND) or no treatment. The evidence for lymphatic mapping in recurrent breast cancer is reviewed, focusing on aberrant drainage and its implications for patient management. ⋯ Lymphatic mapping is feasible in recurrent breast cancer. It avoids ALND in over 50 per cent of patients who have undergone SNB, and allows the 4 per cent of patients with metastatically involved aberrant nodes to receive targeted surgical and adjuvant therapies.
-
Observational Study
Outcomes after extended pancreatectomy in patients with borderline resectable and locally advanced pancreatic cancer.
In the recent International Study Group of Pancreatic Surgery (ISGPS) consensus on extended pancreatectomy, several issues on perioperative outcome and long-term survival remained unclear. Robust data on outcomes are sparse. The present study aimed to assess the outcome of extended pancreatectomy for borderline resectable and locally advanced pancreatic cancer. ⋯ Extended resections are associated with increased perioperative morbidity and mortality, particularly when extended total pancreatectomy is performed. Favourable long-term outcome is achieved in some patients.
-
Multicenter Study Observational Study
Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases.
The aims of this prospective population-based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals. ⋯ Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.