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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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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For over 10 years sacral nerve stimulation (SNS) has been used for patients with constipation resistant to conservative treatment. A review of the literature is presented. ⋯ SNS appears to be an effective treatment for constipation, but this needs to be confirmed in larger prospective studies with longer follow-up. Improved outcome measures need to be adopted given the multiple symptoms that constipation may be associated with. Comparison with other established surgical therapies also needs consideration.
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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.
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Multicenter Study
Multicentre European study of preoperative biliary drainage for hilar cholangiocarcinoma.
Indications for preoperative biliary drainage (PBD) in the context of hepatectomy for hilar malignancies are still debated. The aim of this study was to investigate current European practice regarding biliary drainage before hepatectomy for Klatskin tumours. ⋯ PBD does not affect overall mortality in jaundiced patients with hilar cholangiocarcinoma, but there may be a difference between patients undergoing right-sided versus left-sided hepatectomy.