排序方式: 共有38条查询结果,搜索用时 15 毫秒
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Eyitayo O. Owolabi RN PhD Samukelisiwe Nyamathe MBChB Conran Joseph PhD Lee-Ann Jacobs-Nzuzi Khuabi PhD Rene G. English MBChB MMed FCPHM PhD Adriaan Vlok MBChB FC MMed PhD Elaine Erasmus FCEM MMed EM DipPEC MBChB Heike I. Geduld MBChB FCEM MMed Hendrick J. Lategan BSc MBBCh MMed FCEM Kathryn M. Chu MD MPH FACS FASCRS 《Journal of evaluation in clinical practice》2023,29(2):380-391
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Cillian Clancy MB BCh MRCSI John P. Burke PhD MRCSI Mitchel Barry MD FRCSI Matthew F. Kalady MD FASCRS J. Calvin Coffey PhD FRCSI 《Annals of surgical oncology》2014,21(12):3900-3908
Background
Approximately 20 % of patients diagnosed with colorectal cancer will have distant metastases at first presentation (stage IV disease). The effect of removing the primary tumor on survival for patients with stage IV disease with unresectable metastases remains unclear. To address this a meta-analysis of all studies comparing primary tumor resection with chemotherapy alone in cases of stage IV colorectal cancer with unresectable metastases was performed.Methods
A comprehensive search for published studies examining the effect of primary tumor resection in the setting of colorectal cancer with unresectable metastases was performed. Each study was reviewed and data extracted. Random-effects methods were used to combine data.Results
There were 21 studies including a total of 44,226 patients that met the inclusion criteria. Resection of the primary tumor in patients with unresectable metastases compared with chemotherapy alone was associated with a lower mortality risk (OR 0.28; 95 % CI 0.165–0.474; P < 0.001), translating into a difference in mean survival of 6.4 months in favor of resection (95 % CI 5.025–7.858, P < 0.001). Patients who underwent resection of the primary tumor were more likely to have liver metastasis only (OR 1.551; 95 % CI 1.247–1.929; P < 0.001), were less likely to have ≥2 metastasis (OR 0.653; 95 % CI 0.508–0.839; P = 0.001), and were less likely to have rectal cancer (OR 0.495; 95 % CI 0.390–0.629; P < 0.001). There was significant cross-study heterogeneity.Conclusions
Resection of the primary tumor may confer a survival advantage in stage IV colorectal cancer with unresectable metastases but significant selection bias exists in current studies. Randomized controlled trials are essential to validate these findings. 相似文献6.
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Andreas M. Kaiser MD FACS FASCRS Daniel Klaristenfeld MD Robert W. Beart MD FACS FASCRS 《Annals of surgical oncology》2012,19(13):4150-4160
Purpose
Reduction of local recurrences has been achieved by radiotherapy, but also by improved surgical technique (total mesorectal excision). Radiotherapy has adverse effects and cannot exceed local dose limits. Neoadjuvant radiotherapy may result in overtreatment. We aimed to define the minimum local benefit that would have to be postulated for radiotherapy in order to bring a benefit to the overall cohort. We hypothesized that saving radiotherapy as treatment for a subset of patients with high-risk tumors and local recurrences improves the outcome of the overall cohort. We sought to simulate preoperative versus postoperative radiotherapy in theoretical decision analysis model based on published recurrence rates, with overall survival being the primary end point.Methods
Computerized literature search for studies published between 1996 and 2011, supplemented by manual review of the retrieved reference lists.Results
Postoperative radiotherapy evolved as preferred strategy with cure rates of 65.6?% vs. 63.7?% for postoperative and neoadjuvant radiotherapy, respectively, and a decrease of radiation exposure to 42.9?% of the cohort. The system was sensitive to (1) the fraction of stage I cancers included in the cohort, (2) the difference between local recurrence rates (LRR) for neoadjuvant radiotherapy, adjuvant radiotherapy, or surgery-only approach, and (3) the compliance with the postoperative radiotherapy. If the surgery-only recurrence was set to the published 10?%, 13?%, and 27?%, respectively, adjuvant radiotherapy had to achieve LRR below the threshold values of 6.3?%, 8.5?%, and 18.3?% to reverse the impact of compliance.Conclusions
Radiotherapy only improves cancer-specific survival of the cohort if there is a large difference in LRR with versus without it. Routine treatment may therefore be inferior to a tailored radiotherapy regimen. 相似文献9.
The initial enthusiastic application of laparoscopic techniques to colorectal surgical procedures was tempered in the early
1990s by reports of tumor implants in the laparoscopic incisions. Substantial evidence has accumulated, including evidence
from randomized controlled trials, to support that laparoscopic resection results in oncologic outcomes similar to open resection,
when performed by well-trained, experienced surgeons. This review was developed in conjunction with guidelines published by
the Society of American Gastrointestinal and Endoscopic Surgeons. Data from the surgical literature concerning laparoscopic
resection of curable colorectal cancer was evaluated regarding diagnostic evaluation, preoperative preparation, operative
techniques, prevention of tumor implants, and training and experience. Recommendations are accompanied by an assessment of
the level of supporting evidence available at the time of the development of the guidelines. 相似文献