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  • Springer (CrossRef)  (17)
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  • 1
    Language: English
    In: Surgical endoscopy, July 2013, Vol.27(7), pp.2526-41
    Description: The aim of this study is to evaluate the most cost-effective treatment strategy using preperitoneal mesh for patients with recurrent inguinal hernia. Currently, the issue of cost-effectiveness is entirely unresolved. A decision analysis was carried out based on the results of a systematic literature review of articles concerning recurrent inguinal hernia repair that were published between 1979 and 2011. A virtual cohort was programmed to undergo three different treatment procedures: (1) laparoscopic totally extraperitoneal hernia repair (TEP), (2) open preperitoneal mesh repair according to Stoppa, and (3) open preperitoneal mesh repair according to Nyhus. We carried out a base-case analysis and varied all variables over a broad range of reasonable hypotheses in multiple one-way and two-way sensitivity analyses. The average cost-effectiveness ratio of Nyhus, Stoppa, and TEP per quality-adjusted life year was US $ ($)1,942, $1,948, and $2,011, respectively. In terms of the incremental cost-effectiveness ratio (ICER), Stoppa was dominated. The choice between TEP or Nyhus procedure depends on the combination of a specific center's rates of recurrence and morbidity as disclosed by three-way sensitivity analysis. Nyhus and TEP repairs are possible optimal choices depending primarily on the institution's rates of recurrence and morbidity. Based on our net benefit-related decision analysis, a hypothetical "fixed budget trade-off" suggests potential annual incremental health system cost savings of $200,000 attained by shifting care for 1,000 patients from TEP to Nyhus repair (depending on clinical end-points, which is a decisive factor).
    Keywords: Decision Trees ; Surgical Mesh ; Hernia, Inguinal -- Economics ; Laparoscopy -- Economics
    ISSN: 09302794
    E-ISSN: 1432-2218
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  • 2
    Language: English
    In: Digestive Diseases and Sciences, 2010, Vol.55(11), pp.3031-3040
    Description: Byline: George Sgourakis (1,2), Ines Gockel (1), Arnold Radtke (1), Thomas J. Musholt (1), Stephan Timm (1), Andreas Rink (1), Achilleas Tsiamis (3), Constantine Karaliotas (2), Hauke Lang (1) Keywords: Minimally invasive esophagectomy; Open esophagectomy; Meta-analysis; Evidence based medicine; Publication bias; Barrett's esophagus Abstract: Background A meta-analysis of the current literature was performed to compare the perioperative outcome measures and oncological impact between minimally invasive and open esophagectomy. Methods Using the electronic databases Medline, Embase, Pubmed and the Cochrane Library, we performed a meta-analysis pooling the effects of outcomes of 1,008 patients enrolled into eight comparative studies, using classic and modern meta-analytic methods. Results Two comparisons were considered for this systematic review: (I) open thoracotomy vs. VATS/laparoscopy esophagectomy and (II) open thoracotomy vs. VATS esophagectomy. In comparison I: both procedures report equally comparable outcomes (removed lymph nodes, 30-day mortality, 3-year survival) with the exception of overall morbidity (P = 0.038 in favor of the MIE arm) and anastomotic stricture (P 〈 0.001 in favor of the open thoracotomy arm). In comparison II: No differences were noted between treatment arms concerning postoperative outcomes and survival. Conclusions In summary, both arms were comparable with regard to perioperative results and prognosis. Further prospective comparative or randomized-controlled trials focusing on the oncological impact of MIE are needed. Author Affiliation: (1) Department of General and Abdominal Surgery, Johannes Gutenberg University Hospital, Mainz, Germany (2) 2nd Surgical Department and Surgical Oncology Unit, Korgialenio--Benakio Red Cross Hospital, 11 Mantzarou St., Neo Psychiko, 15451, Athens, Greece (3) Department of Colorectal and Laparoscopic Surgery, James Paget University Hospital, Norfolk, UK Article History: Registration Date: 03/02/2010 Received Date: 15/11/2009 Accepted Date: 03/02/2010 Online Date: 26/02/2010
    Keywords: Minimally invasive esophagectomy ; Open esophagectomy ; Meta-analysis ; Evidence based medicine ; Publication bias ; Barrett’s esophagus
    ISSN: 0163-2116
    E-ISSN: 1573-2568
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  • 3
    Language: English
    In: Digestive Diseases and Sciences, 2010, Vol.55(11), pp.3018-3030
    Description: Byline: George Sgourakis (1,2), Ines Gockel (2), Arnold Radtke (2), Georgia Dedemadi (1), Konstantinos Goumas (1), Sofia Mylona (1), Hauke Lang (2), Achilleas Tsiamis (3), Constantine Karaliotas (1) Keywords: Meta-analysis; Evidence based; Publication bias; Jadad composite scale; Esophageal stents; Esophageal palliation; Brachytherapy; Thermal tumor ablation; Reflux; Malignant dysphagia Abstract: Background The objective of this study was to examine the impact of self-expanding stents versus locoregional treatment modalities in the setting of esophageal cancer palliation. Methods The present meta-analysis pooled the effects of outcomes of 1,027 patients enrolled in 16 randomized controlled trials. Results The meta-analysis revealed an advantage to the use of stents compared to locoregional modality treatments with respect to the number of patients requiring reinterventions, although the latter treatment arm had a higher 1-year survival. No difference was observed between the use of the antireflux stents and conventional stents in relieving reflux. Previous chemoradiotherapy had no impact on complications, procedural deaths, and overall patient survival. Differences in outcomes among stents were minimal. Conclusions Conventional self-expanding stents and anti-reflux stents are equally effective. Although the risk difference for 1-year survival favoured locoregional palliative treatment modalities, the latter were associated with a higher number of patients requiring reintervention. Author Affiliation: (1) 2nd Surgical Department and Surgical Oncology Unit, "Korgialenio--Benakio" Red Cross Hospital, 11 Mantzarou Str., Neo Psychiko, Athens, 15451, Greece (2) Department of General and Abdominal Surgery, Johannes Gutenberg University Hospital, Mainz, Germany (3) Department of Colorectal and Laparoscopic Surgery, James Paget University Hospital, Norfolk, UK Article History: Registration Date: 12/04/2010 Received Date: 13/11/2009 Accepted Date: 12/04/2010 Online Date: 04/05/2010
    Keywords: Meta-analysis ; Evidence based ; Publication bias ; Jadad composite scale ; Esophageal stents ; Esophageal palliation ; Brachytherapy ; Thermal tumor ablation ; Reflux ; Malignant dysphagia
    ISSN: 0163-2116
    E-ISSN: 1573-2568
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  • 4
    Language: English
    In: Tumor Biology, 2014, Vol.35(6), pp.5993-6002
    Description: This pilot study aimed to determine the feasibility of serum neurotensin/IL-8 values being used as a screening tool for colorectal cancer. Fifty-six patients and 15 healthy controls were assigned to seven groups according to their disease entity based on theater records and histology report. Blood samples for neurotensin and IL-8 were measured using an enzyme-linked immunosorbent assay. There were no differences in the clinical and biochemical parameters of patients and controls. Group ( p  = 0.003) and age ( p  = 0.059, marginally significant) were independent predictors of neurotensin plasma values. Neurotensin ( p  = 0.004) and IL-8 ( p  = 0.029) differed between healthy and colorectal cancer patients. Neurotensin values differentiate the control group from all remaining groups. The value of plasma neurotensin ≤54.47 pg/ml at enrollment selected by receiver operating characteristic (ROC) curves demonstrated a sensitivity of 77 %, specificity of 90 %, and an estimate of area under ROC curve (accuracy) of 85 % in predicting colorectal cancer. At enrollment, the value of plasma IL-8 ≥8.83 pg/ml had a sensitivity of 85 %, specificity 80 %, and an estimate of area under ROC curve (accuracy) of 81 % in predicting colorectal cancer. IL-8 should be used complementary to neurotensin due to its lower specificity. None of the colorectal cancer patients displayed a combination of high neurotensin and low IL-8 values (beyond cutoffs). It seems that a blood neurotensin/IL-8 system may be used as a screening tool for colorectal cancer, but much has to be done before it is validated in larger-scale prospective studies.
    Keywords: IL-8 ; Neurotensin ; Colon cancer ; Rectal cancer ; Colorectal cancer screening ; Sensitivity and specificity
    ISSN: 1010-4283
    E-ISSN: 1423-0380
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  • 5
    Language: English
    In: World Journal of Surgery, 2011, Vol.35(5), pp.1010-1016
    Description: The present study was designed to evaluate the impact of the tyrosine kinase ligands VEGF-A/C/D, PDGF-A/B on tumor dissemination and survival in gastric cancer. This is the first study analyzing all these parameters in a homogeneous patient population undergoing surgery. The expression pattern of VEGF-A/C/D and PDGF-A/B was analyzed by reverse transcriptase polymerase chain reaction (RT-PCR) in 69 samples of human gastric adenocarcinoma and correlated with tumor stage and survival. Expression of the ligand VEGF-D significantly correlated with distant metastatic disease (P=0.00001) but not with patient survival. However, VEGF-A inversely correlated with M1 and grading, PDGF-A inversely correlated with pT and pN category. In contrast, VEGF-C and PDGF-B did not have an impact on clinicopathological parameters. The ligand VEGF-D, rather than the other ligands or tyrosine kinase receptors analyzed, is associated with progressive disease in gastric cancer patients undergoing surgery. The VEGF-D ligand might be a helpful marker indicating disseminated disease, and targeting VEGF-D may be a potential therapeutic strategy, although limitations imposed by the selected sample population have to be considered critically.
    Keywords: Adenocarcinoma -- Pathology ; Stomach Neoplasms -- Pathology ; Vascular Endothelial Growth Factor A -- Metabolism ; Vascular Endothelial Growth Factor C -- Metabolism ; Vascular Endothelial Growth Factor D -- Metabolism;
    ISSN: 0364-2313
    E-ISSN: 1432-2323
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  • 6
    Language: English
    In: Journal of Gastrointestinal Surgery, 2010, Vol.14(Supplement 1), pp.46-57
    Description: Issue Title: Festschrift: Tom R. DeMeester Heller myotomy leads to good-excellent long-term results in 90% of patients with achalasia and thereby has evolved to the "first-line" therapy. Failure of surgical treatment, however, remains an urgent problem which has been discussed controversially recently. A systematic review of the literature was performed to analyze the long-term results of failures after Heller's operation with emphasis on treatment by remedial myotomy. Other reinterventions and their causes after failure of surgical treatment in patients with achalasia are discussed.[PUBLICATION ]
    Keywords: Myotomy ; Achalasia ; LES ; Laparoscopic myotomy ; Heller myotomy
    ISSN: 1091-255X
    E-ISSN: 1873-4626
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  • 7
    Language: English
    In: Journal of Gastrointestinal Surgery, 2009, Vol.13(10), pp.1869-1869
    Description: BACKGROUND: Insulinomas, benign in the vast majority, are the prevailing pancreatic endocrine tumors amenable to surgical resection which is beneficial in most instances. This study aimed to compare the results of laparoscopic vs. open surgery enucleation of insulinomas.METHODS: From October 1999 to June 2008, 12 case series of enucleation for benign insulinoma in the body and tail of the pancreas were identified through retrospective review of medical records. Main outcome measures were recurrent hypoglycemia, conversion to open procedure, complications, and length of hospital stay.RESULTS: Seven patients were addressed with open and five with laparoscopic procedure. Mean age was 55 years (36-69). Lesions were identified preoperatively (via computed tomography and endoscopic ultrasonography) in 5/7 in the open and 4/5 in the laparoscopic group. Intraoperative ultrasound identified the rest of insulinomas. One conversion to the open approach was mandatory because the insulinoma was resting on the portal vein. The mean operative time and hospital stay was 92 min (66-126)/14 days (11-22) for the open and 121 min (89-187)/11 days (5-18) for the laparoscopic procedure (including conversion) (p 〈 0.5 in both comparisons). Pancreatic fistula rate was respectively 28.57% (2/7) and 20% (1/5) (p = 0.65). Mortality was nil. Mean follow-up was 54 months (3-109). Recurrent hypoglycemia was documented in one patient of the laparoscopic group (p = 0.46) but blood glucose concentrations remained stable with diazoxide.CONCLUSION: Laparoscopic insulinoma enucleation seems to be a feasible and safe approach associated with reduction in hospital stay and comparable rates of pancreatic fistula in relation to open surgery.
    Keywords: Pancreatic insulinoma ; Laparoscopic enucleation ; Intraoperative ultrasound
    ISSN: 1091-255X
    E-ISSN: 1873-4626
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  • 8
    Language: English
    In: International Journal of Colorectal Disease, 2008, Vol.23(9), pp.825-832
    Description: AIMSThe objective of this study was to compare the perioperative, short-term, and long-term outcomes of stapled hemorrhoidectomy with Ferguson hemorrhoidectomy. MATERIALS AND METHODSThe present meta-analysis pooled the effects of outcomes of a total 926 patients treated with stapled or Ferguson hemorrhoidectomy in five out of 122 screened for retrieval randomized controlled trials using the fixed-effects or a random-effects model. RESULTSStapled hemorroidectomy was equivalent to the Ferguson procedure in comparisons pertaining to the following outcomes: hospital stay, postoperative hemorrhage requiring intervention, early postoperative bleeding 〈4 weeks, late postoperative bleeding 〈8 weeks, and the presence of anal pathology at 1 year follow-up. Stapled hemorrhoidectomy was superior with impact to operative time, pain visual analogue scale score at 24 h, urinary retention, and wound healing. CONCLUSIONSThere is convincingly apparent evidence about the safety and efficacy of stapled hemorrhoidectomy in the comparison with the well-established Ferguson procedure.
    Keywords: Meta-analysis ; Evidence-based ; Publication bias ; Jadad composite scale ; Stapled hemorrhoidectomy ; Ferguson hemorrhoidectomy
    ISSN: 0179-1958
    E-ISSN: 1432-1262
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  • 9
    Language: English
    In: International Journal of Colorectal Disease, 2010, Vol.25(4), pp.417-424
    Description: Chemokines and their receptors have been proposed to distinctly contribute to tumor growth, dissemination, and local immune escape. The aim of this study was to evaluate the relevance of the chemokine receptor CCR5 expression for the progression of human colorectal cancer. CCR5 expression was assessed by RT-PCR analysis in 103 colorectal cancer patients. Intensity of CCR5 expression was correlated with both tumor and patient characteristics. Infiltration of tumor margins with CD8(+) T cells in the context of CCR5 expression was analyzed by immunohistochemistry in additional 18 colorectal cancer specimens. Human colorectal cancer revealed variable intensities of CCR5 expression ranging from absent (48/103: 47%), weak (30/103: 29%), intermediate (13/103: 13%), to strong (12/103: 12%). Absent or weak CCR5 expression was significantly associated with advanced UICC stages (P=0.02) and lymphatic metastasis (P=0.05). In addition, CCR5 expression positively correlated with CD8(+) T-cell infiltration in tumor margins (P=0.001). In summary, intermediate and strong CCR5 expression was significantly associated with nonmetastatic colorectal cancer and increased CD8(+) T-cell infiltration.
    Keywords: CCR5 ; Chemokine receptor ; T-cell infiltration ; Colorectal cancer
    ISSN: 0179-1958
    E-ISSN: 1432-1262
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  • 10
    Language: English
    In: Langenbeck's Archives of Surgery, 2009, Vol.394(1), pp.205-207
    Description: Byline: Andreas D. Rink (1,2), George Sgourakis (2), Georgios C. Sotiropoulos (2), Hauke Lang (2), Karl-Heinz Vestweber (1) Keywords: Low anterior resection; Evacuation; Rectal reservoir; Defecation disorder; Constipation Abstract: Background Colon J-pouch (JCP) reconstructions result in a better functional outcome than straight coloanal anastomosis (SCA) in terms of continence and frequency of defecation after rectal resection but might be associated with more evacuation difficulties. In order to evaluate this hypothesis, we systematically reviewed the literature to collect data on evacuation disorders after rectal resection in randomized or otherwise comparative trials. Materials and methods Randomized controlled trials and comparative trials evaluating CJP versus SCA, latero-terminal anastomosis (LTA), and transverse coloplasty pouch (TCP) were ascertained by methodical search using Medline, Embase, and PubMed. Pooled estimates of outcomes were calculated for early-, intermediate-, and long-term follow-up. Primary meta-analysis outcomes were sensation of incomplete evacuation, prolonged evacuation, use of laxatives, use of enemas and suppositories, and stool fragmentation. Results When compared to SCA, CJP was associated with significantly less "prolongation of evacuation" but more "use of laxatives" in the intermediate-term follow-up, while both less "sensation of incomplete evacuation" and less "fragmentation" was found after CJP in the long-term. When compared to TCP, CJP was associated with significantly less fragmentation in the intermediate-term follow-up. Conclusions Evacuation disorders are a unique problem of low anterior resection and are not specifically related to the colon J-pouch. Author Affiliation: (1) Department of Surgery, Leverkusen General Hospital, Am Gesundheitspark 11, 51375, Leverkusen, Germany (2) Clinic of General and Abdominal Surgery, Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany Article History: Registration Date: 03/06/2008 Received Date: 26/05/2008 Accepted Date: 26/06/2008 Online Date: 24/07/2008 Article note: An erratum to this article can be found at http://dx.doi.org/10.1007/s00423-008-0415-2
    Keywords: Surgery -- Analysis ; Gastrointestinal Agents -- Analysis ; Online Health Care Information Services -- Analysis ; Civilian Evacuation -- Analysis ; Reservoirs (Water) -- Analysis;
    ISSN: 1435-2443
    E-ISSN: 1435-2451
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