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  • SpringerLink  (16)
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  • 1
    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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  • 2
    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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  • 3
    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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  • 4
    Language: English
    In: Surgical Endoscopy, 2013, Vol.27(7), pp.2526-2541
    Keywords: TEP ; Stoppa procedure ; Nyhus procedure ; Decision analysis ; Quality-adjusted life years ; Incremental cost-effectiveness ratio
    ISSN: 0930-2794
    E-ISSN: 1432-2218
    Source: Springer Science & Business Media B.V.
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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: 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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  • 8
    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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  • 9
    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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  • 10
    Language: English
    In: International Journal of Colorectal Disease, 2009, Vol.24(7), pp.845-850
    Description: Byline: Maximilian Bockhorn (1), Georgios Sotiropoulos (1), Jan Neuhaus (1), George Sgourakis (1), Sien-Yi Sheu (2), Ernesto Molmenti (1), Christian Fingas (1), Tanja Trarbach (3), Andreja Frilling (1), Christoph E. Broelsch (1) Keywords: Liver metastases; Resection; Lymphatic vessel infiltration; Vascular invasion Abstract: Objective The purpose of this study was to evaluate the effect of intrahepatic microvascular and lymphatic infiltration on survival in cases of colorectal liver metastases. Materials and methods Prospectively collected data of 331 patients were analyzed for microvascular invasion (V), lymphatic infiltration (L), and resection margins (R) with respect to overall and disease-free survival. Results One-, 3-, and 5-year overall survival rates for R0 resected patients were 89%, 64%, and 39%, respectively. The corresponding survival rates for R1 resected patients were 83%, 42%, and 24% (p〈0.001). The sole presence of microvascular invasion (V1) or lymphatic infiltration (L1) was not associated with a diminished overall survival (p〉0.05). However, patients with a combination of L1V1 had a significantly worse overall survival of 68%, 20%, and 0% when compared to L0V0 patients. This difference was not influenced by the status of the resection margin. No other parameter investigated was found to be of predictive value. Conclusions The presence of combined lymphatic and vascular invasion (L1V1) constitutes a predictor of poor overall and disease-free survival. This subgroup of patients might benefit from adjuvant strategies such as chemotherapeutic treatment. Author Affiliation: (1) Department of General-, Visceral- and Thoracic Surgery, University Hospital Hamburg Eppendorf, 20246, Hamburg, Germany (2) Department of Pathology and Neuropathology, University Hospital Essen, Essen, Germany (3) Department of Oncology, University Hospital Essen, Essen, Germany Article History: Registration Date: 29/01/2009 Accepted Date: 29/01/2009 Online Date: 25/02/2009
    Keywords: Liver metastases ; Resection ; Lymphatic vessel infiltration ; Vascular invasion
    ISSN: 0179-1958
    E-ISSN: 1432-1262
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