bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomized trial of needlescopic versus laparoscopic cholecystectomy
Authors: Cheah W K , Lenzi J E , So J B Y , Kum C K , Goh P M Y 
Published: March 2003

Abstract

Background
Several studies have reported the feasibility of using ‘needlescopic’ instruments with a diameter less than 3 mm in minimally invasive surgery. This study reports a comparison of needlescopic cholecystectomy and laparoscopic cholecystectomy.

Methods
Seventy-five patients with symptomatic chronic cholelithiasis were randomized to needlescopic (n = 37) or laparoscopic (n = 38) cholecystectomy.

Results
The duration of surgery in the two groups was similar. Patients in the needlescopic group had less pain (mean visual analogue score 2·2 versus 3·6; P &lt; 0·003) and had smaller scars (median length 17·0 versus 25·0 mm; P &lt; 0·001). In addition, patients in the needlescopic group tended to require fewer intramuscular pethidine injections (P = 0·05). However, oral analgesic requirements in the two groups were similar. There were no complications in either group.

Conclusion
Needlescopic cholecystectomy resulted in less postoperative pain and a smaller surgical scar than laparoscopic cholecystectomy in patients with chronic cholecystitis.
Impact of mammographic interval on stage and survival after the diagnosis of contralateral breast cancer
Authors: Kaas R , Hart A A M , Besnard A P E , Peterse J L , Rutgers E J T 
Published: March 2003

Abstract

Background
Following treatment for primary breast cancer, annual mammography and regular clinical breast examination is advised. The aim of this study was to investigate whether annual mammography resulted in an improvement in stage of contralateral breast cancers compared with mammography performed at a longer interval.

Methods
This was a retrospective analysis of patients treated for breast cancer, who developed a contralateral breast cancer between 1977 and 1998. Patients were stratified into two groups according to mammographic interval.

Results
Data were available for 275 patients who developed contralateral breast cancer during follow-up. Annual mammography was performed in 51 per cent; these patients were a mean of 5 years younger at diagnosis. Patients who had annual or biennial mammography had comparable rates of impalpable contralateral breast cancer, 30 and 27 per cent respectively. The tumours were of favourable stages in 60 and 58 per cent respectively. Five-year disease-free survival following diagnosis of contralateral breast cancer was 75 per cent in both groups. When the contralateral lesion was detected by mammography, disease-free survival was better, irrespective of the stage of the ipsilateral breast cancer.

Conclusion
No difference was found between the two groups in stage distribution and disease-free survival after the diagnosis of contralateral breast cancer. Survival was better in patients in whom the contralateral breast cancer was first detected by mammography.
High-risk colorectal adenomas and serum insulin-like growth factors
Authors: Renehan A G , Painter J E , Atkin W S , Potten C S , Shalet S M , O'Dwyer S T 
Published: March 2003

Abstract

Background
This study investigated the hypothesis that circulating levels of insulin-like growth factor (IGF) I and its main binding protein (IGFBP-3) predict for the presence of colorectal adenomas, surrogate markers of colorectal cancer risk.

Methods
Within the Flexi-Scope Trial (healthy volunteers aged 55–64 years), at one study centre, IGF-I and IGFBP-3 levels in serum samples collected prospectively from 442 attendants were measured. Of these, 100 individuals underwent a complete screening colonoscopy. There were 47 normal examinations, while in 11 examinations low-risk adenomas and in 42 examinations high-risk adenomas were identified. Estimates of relative risk (RR) for the adenomatous stages were calculated by means of unconditional logistic regression, adjusting for known risk factors.

Results
Mean serum IGF-I and IGFBP-3 levels were similar in individuals with a normal colonoscopy finding and in those with low-risk adenomas. By contrast, the mean(s.d.) serum IGF-I level was increased (190(53) versus 169(54) µg/l; P = 0·06) and the serum IGFBP-3 concentration was significantly decreased (3·22(0·60) versus 3·47(0·62) mg/l; P = 0·05) in individuals with high-risk adenomas compared with levels in those with normal colonoscopy and low-risk adenomas combined. Levels were unaffected by removal of the adenomas. With high-risk adenoma as the dependent factor, regression models demonstrated a significant positive association with IGF-I after controlling for IGFBP-3 (RR per one standard deviation (1s.d.) change 4·39 (95 per cent confidence interval (c.i.) 1·31–14·7); P = 0·02) and, independently, an inverse association with IGFBP-3 after adjustment for IGF-I (RR per 1s.d. change 0·41 (95 per cent c.i. 0·20–0·82); P = 0·01).

Conclusion
These findings suggest that circulating IGF-I and IGFBP-3 levels are related to future colorectal cancer risk and, specifically, may predict adenoma progression.
Inhibition of matrix metalloproteinases enhances breaking strength of colonic anastomoses in an experimental model
Authors: Syk I , Ågren M S , Adawi D , Jeppsson B 
Published: March 2003

Abstract

Background
The breaking strength of colonic anastomoses declines after operation to a minimum at days 3–4, with a subsequent risk of anastomotic dehiscence. The mechanism is thought to be collagen degradation by matrix metalloproteinases (MMPs). This study examined the pathogenic role of MMPs on the mechanical strength of colonic anastomoses by giving the synthetic broad-spectrum MMP inhibitor BB-1101 systemically.

Methods
Forty-eight male Sprague–Dawley rats were treated daily for 7 days with BB-1101 30 mg/kg or vehicle alone (control) starting 2 days before operation. The breaking strength of standardized left-sided colonic anastomoses was measured on postoperative days 1, 3 and 7.

Results
Serum BB-1101 levels were increased at 100 nmol/l in BB-1101-treated rats. The anastomotic breaking strength was 48 per cent higher (P = 0·02) in BB-1101-treated animals compared with controls on postoperative day 3. Neither collagen accumulation nor infiltration of neutrophils in the anastomotic area was influenced by BB-1101 treatment. Net deposition of new collagen in subcutaneous sponges was unaffected by the BB-1101.

Conclusion
The enhanced breaking strength of colonic anastomoses during the critical early postoperative phase found after administration of a broad-spectrum MMP inhibitor implies that MMPs might increase the risk of anastomotic dehiscence.
Presented in part to the third joint meeting of the European Tissue Repair Society and the Wound Healing Society in Bordeaux, France, 24–28 August 1999, and published in abstract form in Wound Repair Regen 1999; 7: A321
Positron emission tomography and colorectal cancer
Authors: Arulampalam T H A , Costa D C , Loizidou M , Visvikis D , Ell P J , Taylor I 
Published: March 2003

Abstract

Background
The oncological applications of positron emission tomography (PET) have gained widespread acceptance. This rapidly evolving technology has been applied successfully to colorectal cancer, but has not yet become part of routine clinical practice. This review considers (1) the biological basis for the use of PET in colorectal cancer, (2) the technical aspects of PET relevant to the referring clinician and (3) the application of PET to the management of primary and recurrent disease.

Methods
A Medline database search was performed for the period 1980–2000. Experience was also drawn from the first 40 patients with colorectal cancer investigated at this institution.

Results and conclusion
PET has a proven role, and is cost effective in the management of recurrent cancer and the monitoring of therapy. However, further evaluation is still required to justify its routine use for other indications in colorectal cancer. Development of new positron-labelled radio- pharmaceuticals, in parallel with advances in detector technology and innovative models for tracer production and distribution, means that the availability of PET and its applications in the management of colorectal cancer will expand over the coming years.
Treatment strategy for patients with middle and lower third bile duct cancer
Authors: Todoroki T , Kawamoto T , Koike N , Fukao K , Shoda J , Takahashi H 
Published: March 2003

Abstract

Background
The prognosis for patients with middle and lower third bile duct carcinoma remains poor. This study was conducted to identify independent predictors for survival, as well as the patterns of recurrence after curative resection.

Methods
Sixty-seven patients with pathologically verified middle and/or lower third bile duct carcinoma were analysed retrospectively by Cox regression analysis for predictors of survival.

Results
The overall 5-year survival rate after resection was 39 per cent, and 0 per cent for patients who did not undergo resection. The 5-year survival rate was 63 per cent in 26 patients without microscopic residual disease (R0), 16 per cent in 25 patients with microscopic residual tumour (R1) and 0 per cent in six patients with macroscopic residual tumour (R2); ten patients did not undergo resection. Radiotherapy improved the 5-year survival rate in eight patients who had R1 resection compared with the rate in 17 patients who underwent resection alone (8 versus 0), but not significantly so (P = 0·137); however, median survival was significantly longer (P = 0·004) in six patients who had R2 resection compared with that in ten inoperable patients (11·4 versus 3·5 months). Multivariate analysis revealed that the primary tumour and tumour node metastasis (TNM) stage were independent predictors of survival; 13 clinicopathological factors were not independent prognostic factors. Of 26 patients having R0 resection, one had a locoregional relapse only, six had distant metastases only, and five had both types of recurrence. The liver was the most frequent site for metastasis, and microscopic venous invasion (MVI) in the primary tumour was a significant predictor of liver metastasis.

Conclusion
Curative (R0) resection is only one step in curing cancer, and radiotherapy may play a beneficial role in controlling locoregional residual tumour. MVI could be a useful indicator of when systemic adjuvant therapy should be implemented to prevent liver metastasis after R0 resection, although no effective systemic treatment has yet been developed.
Lymph node micrometastasis and prognosis in patients with oesophageal squamous cell carcinoma
Authors: Sato F , Shimada Y , Li Z , Watanabe G , Maeda M , Imamura M 
Published: March 2003

Abstract

Background
The purpose of this study was to investigate whether the presence of lymph node micrometastasis in pathological lymph node-negative (pN0) oesophageal squamous cell carcinoma had prognostic value.

Methods
Some 1840 lymph nodes were obtained from 50 patients with pN0 oesophageal squamous cell carcinoma who underwent curative resection of the primary tumour with systematic lymphadenectomy. These lymph nodes were examined immunohistochemically with anticytokeratin antibody (AE1/AE3). Lymph node micrometastases newly detected by immunohistochemistry were classified as micrometastasis. Additionally, lymph node micrometastases were classified into three stages: stage 1, one individual AE1/AE3-positive cell; stage 2, multiple individual positive cells; stage 3, one or multiple positive clusters.

Results
Micrometastases were detected in 20 patients (40 per cent). A higher stage of micrometastasis was associated with greater pathological tumour (pT) size (P = 0·023). Recurrent tumours developed in nine patients. However, the frequency of recurrence was similar in patients with, or without, micrometastasis (five of 20 and four of 30 patients respectively; P = 0·25). Twenty-three of 30 patients without micrometastasis survived, whereas 15 of 20 patients with micrometastasis were still alive (5-year overall survival 75 and 78 percent respectively, P = 0·91). Twenty-six of 30 patients without micrometastasis had no recurrence, whereas 15 of 20 patients with micrometastasis had no recurrence (5-year relapse-free survival 86 and 73 per cent respectively, P = 0·37). There was no significant difference in prognosis with respect to the stages of micrometastasis. Multivariate analysis also showed that micrometastasis was not an independent prognostic factor (P = 0·73).

Conclusion
Immunohistochemical detection of lymph node micrometastasis may be an indicator of lymphatic dissemination of tumour cells. However, the presence of micrometastasis had no impact on the prognosis of node-negative patients with oesophageal squamous cell carcinoma.
Other primary cancers occurring after treatment of superficial oesophageal cancer
Authors: Kokawa A , Yamaguchi H , Tachimori Y , Kato H , Watanabe H , Nakanishi Y 
Published: March 2003

Abstract

Background
Recent advances in endoscopic diagnosis and treatment have led to better prognosis for patients with superficial oesophageal cancer. The incidence of subsequent other primary cancer (SOPC) has become a new problem for patients who survive after treatment of superficial oesophageal cancer.

Methods
Between 1966 and 1998, 368 patients with superficial oesophageal cancer, histologically confirmed as squamous cell carcinoma after resection, were reviewed for the presence of SOPC.

Results
Among the 368 patients, 43 developed SOPC. The most frequent sites of SOPC were the stomach (11 patients) and hypopharynx (11). Subsequent cancers of the stomach and hypopharynx developed significantly more frequently in heavy smokers. The 5-year cumulative occurrence rate of subsequent cancers within the fields of endoscopy of the upper gastrointestinal tract (stomach, hypopharynx and residual oesophagus) was 15 per cent.

Conclusion
Gastric and hypopharyngeal cancers were frequently found after resection of superficial oesophageal cancer. A history of heavy smoking at the time of initial resection may be a risk factor. To make an early diagnosis of subsequent cancers, follow-up observation by upper gastrointestinal endoscopy is important after treatment of oesophageal cancer.
Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer
Authors: Nesbakken A , Nygaard K , Lunde O C 
Published: March 2003

Abstract

Background
Few studies have evaluated the long-term functional outcome after anastomotic leakage in the treatment of rectal cancer.

Methods
Between 1993 and 1998, 147 patients were admitted with resectable rectal carcinoma, and 92 underwent low anterior resection (LAR). Seventeen patients (18 per cent) developed clinical anastomotic leakage. The functional outcome of 11 of 12 patients, in whom the stoma was subsequently closed and bowel continuity was restored without stricture, was compared with that of 11 matched patients who had undergone LAR without leakage. Anorectal manovolumetry and symptom scoring on visual analogue scales were done 12–48 months after stoma closure.

Results
Nine patients made an uneventful recovery after the initial treatment of anastomotic leakage. Eight developed serious septic complications, four of whom had a pelvic abscess, but there was no death. Five patients had chronic complications that precluded closure of the stoma. Patients who had experienced leakage showed reduced neorectal capacity (120 versus 180 ml; P = 0·04), more evacuation problems (P = 0·02), and a trend towards more faecal urgency (P = 0·09) and incontinence (P = 0·06) than control patients.

Conclusion
Stoma closure was not possible in five of 17 patients who had experienced anastomotic leakage. Patients who had the stoma closed had impaired long-term anorectal function compared with control patients without leakage.
Immune-stimulating effects of low-dose perioperative recombinant granulocyte–macrophage colony-stimulating factor in patients operated on for primary colorectal carcinoma
Authors: Mels A K , Statius Muller M G , van Leeuwen P A M , von Blomberg B M E , Scheper R J , Cuesta M A , Beelen R H J , Meijer S 
Published: March 2003

Abstract

Background
Surgery induces a postoperative immunosuppression, thereby possibly facilitating the outgrowth of pre-existing occult metastases or the seeding of disseminated tumour cells in patients with primary colorectal carcinoma operated on with curative intent. The hypothesis that adjuvant therapy with perioperative recombinant human granulocyte–macrophage colony-stimulating factor (rhGM-CSF) would minimize postoperative immunosuppression was investigated in this pilot study.

Methods
Patients were allocated randomly to receive daily subcutaneous injections with either saline (n = 8) or rhGM-CSF 2·8 µg per kg body-weight (n = 8) from 3 days before operation until 4 days afterwards. Phytohaemagglutinin (PHA) skin test reactivity, monocyte human leucocyte antigen (HLA) DR expression and the extent of the acute-phase response, by determination of white blood cell count and differentiation, plasma interleukin (IL) 6 levels and body temperature in the perioperative period, were examined.

Results
rhGM-CSF treatment minimized postoperative suppression in PHA skin test reactivity and increased the numbers of neutrophils and monocytes while enhancing the expression of HLA-DR in the postoperative period. Additionally, both postoperative plasma IL-6 levels and the incidence of fever tended to be higher in the rhGM-CSF group.

Conclusion
In this pilot study, perioperative administration of low-dose rhGM-CSF stimulated certain immune functions that are normally depressed after operation. The implications for the antitumour responses directly after operation and the formation of liver metastases are currently under investigation.
Stoma-related complications are more frequent after transverse colostomy than loop ileostomy: a prospective randomized clinical trial
Authors: Edwards D P , Leppington-Clarke A , Sexton R , Heald R J , Moran B J 
Published: March 2003

Abstract

Background
The consequences of leakage from low colorectal or coloanal anastomoses are reduced by the use of a loop stoma to divert the faecal stream. Controversy continues as to whether loop ileostomy (LI) or loop transverse colostomy (LTC) is the optimal method of defunctioning such anastomoses.

Methods
Patients requiring defunctioning following anterior resection and total mesorectal excision were randomized to receive either LI or LTC. Comparison was made between the groups regarding the difficulty of stoma formation and closure, the recovery after stoma closure and stoma-related complications. The minimum follow-up after stoma closure was 6 months (median 36 months).

Results
Between October 1995 and August 1999, 70 patients were randomized (LTC 36, LI 34) of whom 63 underwent stoma closure (LTC 31, LI 32). There were no significant differences in the difficulty of formation or closure, or in the postoperative recovery between the groups. However, there were ten complications related directly to the stoma in the LTC group: faecal fistula (one patient), prolapse (two), parastomal hernia (two) and incisional hernia during follow-up (five). None of these complications occurred in the LI group.

Conclusion
In this randomized study, the frequency of herniation before or after colostomy closure supports the choice of LI as a method of defunctioning a low anastomosis. Both methods appear to provide satisfactory protection for the low anastomosis.
European Study Group for Pancreatic Cancer-1 interim results: a European randomized study to assess the roles of adjuvant chemotherapy and chemoradiation in resectable pancreatic cancer
Authors: Neoptolemos J P , Dunn J A , Moffitt D D , Almond J , Link K , Beger H , Bassi C , Pederzoli P , Dervenis C , Fernandez-Cruz L , Lacaine F , Spooner D , Kerr D J , Friess H , Büchler M 
Published: March 2003

Abstract

Background
Pancreatic cancer affects 8–12 per 100 000 population per year in Europe. Following resection, the long-term survival rate is only 10–15 per cent and the role of adjuvant treatment is uncertain. The aims of the study were to answer two questions: (1) whether there is a role for chemoradiation (40 Gy and 5-fluorouracil (5-FU), and (2) whether there is a role for chemotherapy (5-FU–folinic acid (FA)) weekly).

Methods
A multicentre European prospective randomized controlled trial was organized by the European Study Group for Pancreatic Cancer (ESPAC). A 2 × 2 factorial design was used, asking both questions of the same patient, and a pragmatic design asking only one of the two questions of each patient. The data were reviewed at regular intervals by the Independent Data and Safety Monitoring Committee (IDSMC).

Results
Some 531 patients with pancreatic ductal adenocarcinoma were randomized from 80 clinicians in 11 countries. Randomization was stratified by resection margin involvement; 82 per cent of patients were negative. Some 239 patients (45 per cent) are alive to date, at a median follow-up of 9 (interquartile range 1–24) months. Preliminary results show no evidence of a benefit for chemoradiation treatment (median survival 14 months with chemoradiation versus 15·7 months without; P = 0·24). There is some evidence of a survival benefit for patients having chemotherapy (median survival 19·5 months versus 13·5 months with no chemotherapy; P = 0·003). The effect is reduced when taking into account whether patients received radiotherapy (P = 0·01), indicating that radiotherapy may reduce the overall benefit of the chemotherapy. The IDSMC recommended closing recruitment to the chemoradiotherapy arm.

Conclusion
There is no role for adjuvant chemoradiotherapy in pancreatic cancer, but there may be a role for chemotherapy. ESPAC-3 is now randomizing between (1) surgery alone, (2) 5FU–FA and (3) gemcitabine.
Initial results with a minimally invasive technique of pancreatic necrosectomy
Authors: Slavin J , Ghaneh P , Sutton R , Hartley M R , Hughes M , Garvey C , Rowlands P , Neoptolemos J P 
Published: March 2003

Abstract

Background
The aim of the study was to evaluate the initial results with a new technique of minimally invasive pancreatic necrosectomy (MIPN).

Methods
A retrospective audit was carried out of pancreatic necrosectomies performed on one unit from October 1996. Patients were divided into two groups: those admitted before November 1998 who underwent a conventional open necrosectomy and those admitted after this date who were considered for treatment with MIPN.

Results
Thirty-one patients underwent pancreatic necrosectomy, of which 20 cases were tertiary referrals. Thirteen patients (median age 51 (range 33–77) years; ten men, three women) admitted before November 1998 underwent a conventional open technique; seven of these patients died. Since then, 18 patients (median age 59 (range 33–74) years; ten women, eight men) have undergone necrosectomy, 12 by MIPN (median of 3 (range 1–6) procedures) and six by an open technique. Reasons for using an open technique included a left renal adenocarcinoma (one patient), poor access route (three patients) and failure to insert a guidewire under computed tomographic control (two patients). There were two deaths during this later period (P &lt; 0·05, Fisher's exact test in comparison with the earlier time period). In patients who were discharged there was no difference in length of stay in the intensive treatment unit (median 5 (range 0–24) versus 5 (range 0–84) days) or in-hospital stay (median 66 (range 29–159) versus 75 (range 31–202) days) between the two time periods.

Conclusion
A minimally invasive approach provides a promising alternative to open pancreatic necrosectomy.