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  • 1
    Language: English
    In: Expert Review of Anticancer Therapy, 01 April 2011, Vol.11(4), pp.601-612
    Description: Lymph node status is the most important single prognostic factor in esophageal cancer. The detection of involved lymph nodes is therefore the key to cure. This article will provide a meta-analysis and metaregression analysis on the diagnostic performances of current lymph node-detection devices; discuss the recent status of the sentinel lymph node concept in esophageal cancer by the two sentinel node-mapping procedures (the radio-guided and the blue dye techniques) and the developing computed tomography (CT) lymphography; discuss the detection of micrometastases; and the potential clinical application of molecular-based patients' profiles. Combined use of endoscopic ultrasonography fine-needle aspiration and CT significantly improves the diagnostic performance for regional lymph node metastases. Endoscopic ultrasonography is highly sensitive and specific for celiac lymph node metastases, while CT should mostly be performed in order to exclude other abdominal lymph node metastases. Sentinel lymph node navigation may be feasible for cT1N0 or cT2N0 esophageal cancer, and immunohistochemical staining of micrometastatic disease might be feasible in combination with this modality.
    Keywords: Esophageal Cancer ; Imaging Devices ; Lymph Node Metastasis ; Meta-Analysis ; Micrometastasis ; Molecular Markers ; Sentinel Lymph Node Navigation ; Systematic Review ; Medicine
    ISSN: 1473-7140
    E-ISSN: 1744-8328
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  • 2
    Language: English
    In: Gastroenterology, 2011, Vol.141(6), pp.e1-e2
    Keywords: Medicine
    ISSN: 0016-5085
    E-ISSN: 1528-0012
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  • 3
    Language: English
    In: Gastroenterology, 2010, Vol.138(5), pp.1667,2025-1667,2025
    Keywords: Medicine
    ISSN: 0016-5085
    E-ISSN: 1528-0012
    Source: ScienceDirect Journals (Elsevier)
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  • 4
    Language: English
    In: Gastroenterology, 2010, Vol.139(4), pp.e5-e7
    Keywords: Medicine
    ISSN: 0016-5085
    E-ISSN: 1528-0012
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  • 5
    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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  • 6
    Language: English
    In: Expert Review of Anticancer Therapy, 01 September 2010, Vol.10(9), pp.1345-1347
    Keywords: Endoscopic Resection ; Endoscopic Submucosal Dissection ; Radical Oncologic Surgery ; Superficial Esophageal Cancer ; Medicine
    ISSN: 1473-7140
    E-ISSN: 1744-8328
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  • 7
    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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  • 8
    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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  • 9
    Language: English
    In: Expert Review of Anticancer Therapy, 01 April 2011, Vol.11(4), pp.571-578
    Description: There has been much recent debate regarding the best surgical procedure to treat esophageal cancer, in particular with regard to the optimum extent of lymphadenectomy to improve survival while minimizing morbidity. No results obtained by prospective, randomized studies on the comparison of radical esophagectomy and extended lymphadenectomy with limited or less invasive resections following neoadjuvant therapy with regard to perioperative morbidity and prognosis are available to date. Until now, there has been no evidence suggesting the usefulness of sentinel lymph node navigation in esophageal cancers, regardless of the cell type. Furthermore, the question as to the benefits and risks of two-field and three-field lymphadenectomy in esophageal cancer has not yet been conclusively answered. This article will discuss the recent status of lymph node-dissection procedures stage-dependently according to the two different tumor entities and with regard to minimally invasive esophagectomy, including the novel 2010 Tumor, Node, Metastasis-staging system.
    Keywords: Esophageal Cancer ; Individualized Lymph Node Dissection Strategies ; Limited Resection and Limited Lymphadenectomy ; Lymph Node Metastasis ; Minimally Invasive Esophagectomy ; Neoadjuvant Therapy ; Three-Field/Two-Field Lymphadenectomy ; Medicine
    ISSN: 1473-7140
    E-ISSN: 1744-8328
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  • 10
    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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