The British journal of surgery
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The advent of affordable technologies to perform detailed molecular profiling of tumours has transformed understanding of the specific genetic events that promote carcinogenesis and which may be exploited therapeutically. The application of targeted therapeutics has led to improved outcomes in advanced disease and this approach is beginning to become established in the management of potentially curable disease for surgical patients. ⋯ A large number of ongoing clinical trials are evaluating novel targeted agents as neoadjuvant therapy in operable GI tumours. Therefore, further progress in the management of early-stage disease will undoubtedly be made over the next few years as these trials continue to report potentially practice-changing results.
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Although surgical resection remains the central element in curative treatment of gastrointestinal cancer, increasing emphasis and resource has been focused on neoadjuvant or adjuvant therapy. Developments in these modalities have improved outcomes, but far less attention has been paid to improving oncological outcomes through optimization of perioperative care. ⋯ A wider view on long-term effects of expanded or targeted enhanced recovery protocols is warranted.
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Randomized Controlled Trial Comparative Study
Randomized clinical trial of trigger point infiltration with lidocaine to diagnose anterior cutaneous nerve entrapment syndrome.
Anterior cutaneous nerve entrapment syndrome (ACNES) is hardly considered in the differential diagnosis of chronic abdominal pain. Some even doubt the existence of such a syndrome and attribute reported successful treatment results to a placebo effect. The objective was to clarify the role of local anaesthetic injection in diagnosing ACNES. The hypothesis was that pain attenuation following lidocaine injection would be greater than that after saline injection. ⋯ NTR2016 (Nederlands Trial Register; http://www.trialregister.nl).
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Multicenter Study
Integration of patient-reported outcome measures with key clinical outcomes after immediate latissimus dorsi breast reconstruction and adjuvant treatment.
Clinical evidence on patient-reported outcome measures (PROMS) in breast reconstruction is lacking. The aim of this study was to evaluate PROMs in implant-assisted latissimus dorsi (LDI) or tissue-only autologous latissimus dorsi (ALD) flap reconstruction in relation to complications and adjuvant treatments. ⋯ There is evidence of similar HRQL between types of latissimus dorsi breast reconstruction for up to a year after surgery. There appear to be no overarching effects for radiotherapy after mastectomy on the specific HRQL domains studied in the short term. The identification of variables that affect HRQL is important, including their integration into the analysis of PROMs.
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Historically, the preoperative and postoperative care of patients with gastrointestinal cancer was provided by surgeons. Contemporary perioperative care is a truly multidisciplinary endeavour with implications for cancer-specific outcomes. ⋯ Multidisciplinary management of perioperative patient care has improved outcomes.