The European journal of surgery = Acta chirurgica
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The five years survival rate for patients with gastric cancer is 15-25%. With the aim of improving survival, chemotherapy has been used in different adjuvant settings. Similarly, but with the aim of improving quality of life and prolonging life, chemotherapy has been used extensively in metastatic disease. In this review we have included studies of systemic and intraperitoneal chemotherapy given before, during or after operation and for advanced disease. A meta-analysis has been made on the 21 randomised studies that used adjuvant systemic chemotherapy postoperatively. A significant survival benefit for the patients treated postoperatively compared with controls was identified (odds ratio (OR) 0.84, 95% confidence interval (CI) 0.74 to 0.96). When western and Asian studies were analysed separately we found no survival benefit for the treated patients in the western groups (OR 0.96 (95 CI 0.83 to 1.12)). Flaws in the conduct of several trials made it difficult to draw firm conclusions, including the exclusion of a small but clinically meaningful survival benefit. Preoperative or neoadjuvant chemotherapy has shown effects in some patients, but no significant benefit was found in the few randomised studies. The few studies that reported intraperitoneal therapy showed no detectable survival benefit either. In patients with advanced disease, four small randomised studies found significantly longer survival in the treated patients. The survival benefit is in the range of 3-9 months, and there were also improvements of the quality of life. Several drug combinations have been tested, however, with no confirmed superiority for a particular regimen. ⋯ Adjuvant chemotherapy cannot be recommended as a routine because of the lack of confirmed beneficial effects. Some patients with advanced disease will have a clinically important benefit from palliative chemotherapy, so this can be recommended for patients who are otherwise in good health.
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To evaluate recurrence rate and chronic groin pain three years after hernia repair and to validate a postal questionnaire with selective physical examination as a method of follow-up. ⋯ The incidence of recurrence and chronic pain after hernia repair requires continuous audit in non-specialised units. Participation in a register and follow-up by a three-item questionnaire and selective physical examination provides a solid basis for quality control.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Prophylaxis of nausea and vomiting after laparoscopic cholecystectomy with ramosetron: randomised controlled trial.
To evaluate the efficacy and safety of ramosetron (a 5-hydroxytryptamine type 3 receptor antagonist) for the prevention of nausea and vomiting after laparoscopic cholecystectomy. ⋯ Ramosetron 0.3 mg was the minimum effective dose for preventing postoperative nausea and vomiting during 0 to 48 hours after anaesthesia in patients undergoing laparoscopic cholecystectomy.
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Randomized Controlled Trial Comparative Study Clinical Trial
Local anaesthesia in elective inguinal hernia repair: a randomised, double-blind study comparing the efficacy of levobupivacaine with racemic bupivacaine.
To assess the use of infiltration with local anaesthetics levobupivacaine and bupivacaine, during inguinal hernia repair. ⋯ Levobupivacaine exerts a similar anaesthetic and analgesic effect to racemic bupivacaine when infiltrated both intraoperatively and during the early postoperative period for elective inguinal hernia repair.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of local, spinal, and general anaesthesia for inguinal herniorrhaphy.
To compare local, spinal, and general anaesthesia for inguinal hemiorraphy in otherwise healthy patients with respect to duration of operation, time in operating room, postoperative pain, complications, rehabilitation, and satisfaction. ⋯ Local anaesthesia is suitable for day-case hernia repair with fewer postoperative problems and less analgesia requirement. Patients also reported greater satisfaction. Local anaesthesia may be preferred to other methods.