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World Journal of Gastroenterology Jul 2019Neoplasms arising in the esophagus may coexist with other solid organ or gastrointestinal tract neoplasms in 6% to 15% of patients. Resection of both tumors...
BACKGROUND
Neoplasms arising in the esophagus may coexist with other solid organ or gastrointestinal tract neoplasms in 6% to 15% of patients. Resection of both tumors synchronously or in a staged procedure provides the best chances for long-term survival. Synchronous resection of both esophageal and second primary malignancy may be feasible in a subset of patients; however, literature on this topic remains rather scarce.
AIM
To analyze the operative techniques employed in esophageal resections combined with gastric, pancreatic, lung, colorectal, kidney and liver resections and define postoperative outcomes in each case.
METHODS
We conducted a systematic review according to PRISMA guidelines. We searched the Medline database for cases of patients with esophageal tumors coexisting with a second primary tumor located in another organ that underwent synchronous resection of both neoplasms. All English language articles deemed eligible for inclusion were accessed in full text. Exclusion criteria included: (1) Hematological malignancies; (2) Head/neck/pharyngeal neoplasms; (3) Second primary neoplasms in the esophagus or the gastroesophageal junction; (4) Second primary neoplasms not surgically excised; and (5) Preclinical studies. Data regarding the operative strategy employed, perioperative outcomes and long-term outcomes were extracted and analyzed using descriptive statistics.
RESULTS
The systematic literature search yielded 23 eligible studies incorporating a total of 117 patients. Of these patients, 71% had a second primary neoplasm in the stomach. Those who underwent total gastrectomy had a reconstruction using either a colonic ( = 23) or a jejunal ( = 3) conduit while for those who underwent gastric preserving resections (., non-anatomic/wedge/distal gastrectomies) a conventional gastric pull-up was employed. Likewise, in cases of patients who underwent esophagectomy combined with pancreaticoduodenectomy (15% of the cohort), the decision to preserve part of the stomach or not dictated the reconstruction method (whether by a gastric pull-up or a colonic/jejunal limb). For the remaining patients with coexisting lung/colorectal/kidney/liver neoplasms (14% of the entire patient population) the types of resections and operative techniques employed were identical to those used when treating each malignancy separately.
CONCLUSION
Despite the poor quality of available evidence and the great interstudy heterogeneity, combined procedures may be feasible with acceptable safety and satisfactory oncologic outcomes on individual basis.
Topics: Clinical Decision-Making; Colorectal Neoplasms; Esophageal Neoplasms; Esophagectomy; Feasibility Studies; Gastrectomy; Hepatectomy; Humans; Kidney Neoplasms; Liver Neoplasms; Lung Neoplasms; Neoplasms, Multiple Primary; Nephrectomy; Pancreatic Neoplasms; Pancreaticoduodenectomy; Patient Selection; Pneumonectomy; Stomach Neoplasms; Survival Analysis; Survival Rate; Treatment Outcome
PubMed: 31341367
DOI: 10.3748/wjg.v25.i26.3438 -
The olecranon aperture of the humerus: a meta-analysis with anthropological and clinical discussion.Homo : Internationale Zeitschrift Fur... Aug 2019The olecranon aperture is an anatomical variant of the humerus that communicates the olecranon fossa with the coronoid fossa. It is also known as the supratrochlear... (Meta-Analysis)
Meta-Analysis
The olecranon aperture is an anatomical variant of the humerus that communicates the olecranon fossa with the coronoid fossa. It is also known as the supratrochlear foramen. Older anatomical textbooks refer to it as a rare variation caused by the perforation of the thin bony plate which separates both fossae. This anatomical variant may be confused as an osteolytic lesion of the humerus in radiographic images. The present work aims to perform a meta-analysis of the olecranon aperture. Heterogeneity between studies was evaluated using I2 estimation and the Cochran Q statistic test. A random effect model was used for all analyses. A total of sixty-one studies (20,338 humeri) were included in this meta-analysis. The pooled prevalence of the olecranon aperture was 21.9% (95% confidence interval: 18.6% to 25.3%). This variant was more commonly found in female than in male bones (statistically significant difference). The olecranon aperture is a common anatomical variant among the general population, although individuals from Africa possess a higher predisposition to develop it. The name supratrochlear foramen is incorrect, as foramina are conduit to vessels or nerves, as such, we propose the term olecranon aperture.
Topics: Anthropology, Physical; Female; Humans; Humerus; Male; Olecranon Process
PubMed: 31475286
DOI: 10.1127/homo/2019/1025