The British journal of surgery
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Multicenter Study Comparative Study Observational Study
Oncological outcome following anastomotic leak in rectal surgery.
The influence of anastomotic leak on local recurrence and survival remains debated in rectal cancer. ⋯ Anastomotic leak after low anterior resection did not affect oncological outcomes in these patients.
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Subclinical Cushing's syndrome (SCS) is a condition of biochemical cortisol excess without the classical clinical features of overt hypercortisolism; it may be associated with some consequences of metabolic syndrome. The most appropriate treatment remains controversial. This study aimed to assess the outcomes of adrenalectomy for SCS. ⋯ Laparoscopic adrenalectomy seems to be beneficial in reversing several metabolic effects of hypercortisolism, with a low morbidity rate. However, the heterogeneity and low quality of the available studies preclude definitive recommendations.
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Multicenter Study Comparative Study Observational Study
Cost-utility analysis of operative versus non-operative treatment for colorectal liver metastases.
Surgical resection of colorectal liver metastases (CRLMs) is the standard of care when possible, although this strategy has not been compared with non-operative interventions in controlled trials. Although survival outcomes are clear, the cost-effectiveness of surgery is not. This study aimed to estimate the cost-effectiveness of resection for CRLMs compared with non-operative treatment (palliative care including chemotherapy). ⋯ Operative treatment of CRLMs yields greater survival than non-operative treatment, and is both more effective and less costly.
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Randomized Controlled Trial Comparative Study
Randomized clinical trial of sacral versus percutaneous tibial nerve stimulation in patients with faecal incontinence.
Sacral nerve stimulation (SNS) is a well established therapy for faecal incontinence (FI). Percutaneous tibial nerve stimulation (PTNS) is a newer, less invasive, treatment. The effectiveness and acceptability of these treatments have not been compared systematically. ⋯ In the short term, both SNS and PTNS provide some clinical benefit to patients with FI. Registration numbers: 2010-018728-15 and 10479 (http://public.ukcrn.org.uk/search/StudyDetail.aspx?StudyID=10479).
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Primary aldosteronism (PA) is the most common cause of secondary hypertension. The main aims of this paper were to review outcome after surgical versus medical treatment of PA and partial versus total adrenalectomy in patients with PA. ⋯ Recommendations for treatment of PA are hampered by the lack of randomized trials, but support surgical resection of unilateral disease. Partial adrenalectomy may be an option in selected patients.