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European Journal of Surgical Oncology :... Aug 2022The extent of lymphadenectomy in colon cancer (CC) is a matter of debate. One argument of extensive surgery is that it may prevent lymph node recurrence (LNR). However,... (Review)
Review
BACKGROUND
The extent of lymphadenectomy in colon cancer (CC) is a matter of debate. One argument of extensive surgery is that it may prevent lymph node recurrence (LNR). However, the incidence of LNR after surgery for CC is unknown. Here, we performed a systematic review of the incidence of LNR after either standard (D2) surgery or extensive resection (complete mesocolic excision, CME, D3).
METHODS
PubMed, Embase, Web of Science, and CENTRAL were searched for studies reporting on patients with primary stage I-III CC who developed locoregional or distant LNR. Methodological quality was scored using the QualSyst tool. The difference in overall and lymph node (LN) recurrence rate between CME/D3 and standard/D2 resection was statistically evaluated using non-parametric tests. Registered with PROPERO as CRD42020203288.
RESULTS
From an initial 12.744 records, 24 studies were included, representing 13.521 CC patients. A majority of patients had right CC (64%), stage III disease (51%), and received adjuvant chemotherapy (57%). The mean number of examined nodes ranged from 14 to 30. The median overall recurrence rate was 14% in the CME/D3 group, and 19% in the standard/D2 group (P = 0.638). The median proportion of patients with any LNR was 1.7% in the CME/D3 group, and 1.2% in the standard/D2 group (P = 0.677). The median incidence of locoregional, potentially preventable LNR was 0% in the CME/D3 group and 0.4% in the standard/D2 group (P = 0.274).
CONCLUSIONS
The incidence of locoregional, potentially preventable LNR after surgery for CC is low (<1%), and is not affected by the extent of lymphadenectomy.
Topics: Colectomy; Colonic Neoplasms; Humans; Incidence; Lymph Node Excision; Lymph Nodes; Mesocolon; Neoplasm Recurrence, Local
PubMed: 35513966
DOI: 10.1016/j.ejso.2022.04.019 -
Medicine Apr 2022Mesenteric panniculitis (MP) is a non-specific, localized inflammation at the mesentery of small intestines which often gets detected on computed tomography. An... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Mesenteric panniculitis (MP) is a non-specific, localized inflammation at the mesentery of small intestines which often gets detected on computed tomography. An association with malignant neoplasms remains unclear. We performed a systematic review and meta-analysis to examine the association of malignancy with MP.
METHODS
MEDLINE, EMBASE, Web of Science, and Cochrane databases were searched for articles published from inception to 2020 that evaluated the association of malignant neoplasms with MP in comparison with control groups. Using random-effects method, a summary odds ratio (OR) estimate with 95% confidence intervals for malignant neoplasms in MP was estimated.
RESULTS
Four case-control studies reporting data on 415 MP patients against 1132 matched-controls met inclusion criteria and were analyzed. The pooled OR for finding a malignant neoplasm in patients with MP was 0.907 (95% CI: 0.688-1.196; P = .489). The heterogeneity was mild and non-significant. Also, there was no heightened risk of any specific type of malignancy with MP. Three more case-series with unmatched-control groups (MP: 282, unmatched-controls: 17,691) were included in a separate analysis where the pooled OR of finding a malignant neoplasm was 2.963 (95% CI: 1.434-6.121; P = .003). There was substantial heterogeneity in this group.
CONCLUSION
This meta-analysis of matched controlled studies proves absence of any significant association of malignant neoplasms with MP. Our study also demonstrates that the putative association of malignancy with MP is mainly driven by uncontrolled studies or case-series.
Topics: Databases, Factual; Humans; Mesentery; Neoplasms; Panniculitis, Peritoneal; Tomography, X-Ray Computed
PubMed: 35512070
DOI: 10.1097/MD.0000000000029143 -
World Journal of Surgery Aug 2022Since 1910, omentectomy has been an essential component of radical gastrectomy for advanced gastric cancer. However, researchers have recently questioned the benefit of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Since 1910, omentectomy has been an essential component of radical gastrectomy for advanced gastric cancer. However, researchers have recently questioned the benefit of omentectomy in radical gastrectomy. The aim of this meta-analysis was to compare omentectomy and omentum preservation in gastrectomy for advanced gastric cancer in terms of survival outcomes and short-term outcomes.
METHODS
The PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched. Studies that compared omentum preservation with omentectomy were included. Overall survival (OS) and relapse-free survival (RFS) were analyzed as primary outcomes.
RESULTS
Of 3509 records screened, one randomized clinical trial and five propensity-score matched retrospective studies with 1661 patients were selected. Omentum preservation was associated with improved OS (hazard ratio [HR] = 0.757, 95% confidence interval [CI] = 0.603-0.950, P = 0.016, I = 0%), but not with improved RFS (HR = 0.821, 95% CI = 0.668-1.009, P = 0.060, I = 9%) compared with omentectomy for advanced gastric cancer. Furthermore, less blood loss and shorter operation time were found in the omentum preservation group than in the omentectomy group. Additionally, the rate of peritoneal recurrence, the number of harvested lymph nodes, and the incidences of postoperative complications and ileus were comparable in the two groups.
CONCLUSIONS
Basing on the current literature, gastrectomy with omentum preservation was associated with improved OS and short-term outcomes compared with omentectomy for advanced gastric cancer. Further randomized trials are required to confirm the survival benefit of omentum-preserving gastrectomy.
Topics: Gastrectomy; Humans; Neoplasm Recurrence, Local; Omentum; Randomized Controlled Trials as Topic; Retrospective Studies; Stomach Neoplasms
PubMed: 35462593
DOI: 10.1007/s00268-022-06562-5 -
International Journal of Surgery... May 2022
Meta-Analysis
A commentary on "Gastrectomy with omentum preservation versus gastrectomy with omentectomy for locally advanced gastric cancer: A systematic review and meta-analysis" [Int. J. Surg. 96 (2021) 106176].
Topics: Gastrectomy; Humans; Omentum; Stomach Neoplasms
PubMed: 35429659
DOI: 10.1016/j.ijsu.2022.106615 -
Ultrasound in Obstetrics & Gynecology :... Oct 2022The aim of this systematic review and meta-analysis was to evaluate the diagnostic accuracy of the sliding sign on transvaginal ultrasound (TVS) in detecting pouch of... (Meta-Analysis)
Meta-Analysis Review
Diagnostic accuracy of sliding sign for detecting pouch of Douglas obliteration and bowel involvement in women with suspected endometriosis: systematic review and meta-analysis.
OBJECTIVE
The aim of this systematic review and meta-analysis was to evaluate the diagnostic accuracy of the sliding sign on transvaginal ultrasound (TVS) in detecting pouch of Douglas obliteration and bowel involvement in patients with suspected endometriosis, using laparoscopy as the reference standard.
METHODS
A search for studies evaluating the role of the sliding sign in the assessment of pouch of Douglas obliteration and/or bowel involvement using laparoscopy as the reference standard published from January 2000 to October 2021 was performed in PubMed/MEDLINE, Web of Science, CINAHL, The Cochrane Library, ClinicalTrials.gov and SCOPUS databases. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) was used to evaluate the quality of the studies. Analyses were performed using MIDAS and METANDI commands in STATA.
RESULTS
A total of 334 citations were identified. Eight studies were included in the analysis, resulting in 938 and 963 patients available for analysis of the diagnostic accuracy of the sliding sign for pouch of Douglas obliteration and bowel involvement, respectively. The mean prevalence of pouch of Douglas obliteration was 37% and the mean prevalence of bowel involvement was 23%. The pooled estimated sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of the sliding sign on TVS for detecting pouch of Douglas obliteration were 88% (95% CI, 81-93%), 94% (95% CI, 91-96%), 15.3 (95% CI, 10.2-22.9), 0.12 (95% CI, 0.07-0.21) and 123 (95% CI, 62-244), respectively. The heterogeneity was moderate for sensitivity and low for specificity for detecting pouch of Douglas obliteration. The pooled estimated sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of the sliding sign on TVS for detecting bowel involvement were 81% (95% CI, 64-91%), 95% (95% CI, 91-97%), 16.0 (95% CI, 9.0-28.6), 0.20 (95% CI, 0.10-0.40) and 81 (95% CI, 34-191), respectively. The heterogeneity for the meta-analysis of diagnostic accuracy for bowel involvement was high.
CONCLUSION
The sliding sign on TVS has good diagnostic performance for predicting pouch of Douglas obliteration and bowel involvement in women with suspected endometriosis. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Douglas' Pouch; Endometriosis; Female; Humans; Laparoscopy; Sensitivity and Specificity; Ultrasonography
PubMed: 35289968
DOI: 10.1002/uog.24900 -
Urology Sep 2022We reviewed neovaginal colonization and inflammatory patterns, and factors that may impact this. A systematic review of the neovaginal microbiome was conducted in... (Review)
Review
We reviewed neovaginal colonization and inflammatory patterns, and factors that may impact this. A systematic review of the neovaginal microbiome was conducted in concordance with PRISMA guidelines through October 2021. Thirteen articles were included, totaling 458 patients. Neovaginal constructions were most commonly performed with penile and scrotal skin grafts, sigmoid segments, and peritoneal grafts. The neovaginal microflora identified were generally polymicrobial and shared similarities with the native tissue. Nine studies identified Lactobacillus: 5 of 6 for penile skin, 1 of 3 for sigmoid, 1 of 1 for peritoneum, and 2 of 3 for other graft types, suggesting that the neovagina may support Lactobacillus either innately, via rectal migration or oral probiotic supplementation. A polymicrobial, bacterial vaginosis-like environment was found in 9 studies. Inflammatory markers were also described: 2 of 6 for penile skin, 2 of 3 for sigmoid, 0 of 1 for peritoneum, and 1 of 3 for other graft types. Scant data were available on the impact of postsurgical duration, oral hormones, dilating, sexual practices, or douching on the neovaginal microbiome. Understanding and optimizing the polymicrobial neovaginal microenvironment may improve surgical outcomes, specifically inflammatory, pain, and infectious. Future research should focus on standardizing testing, classification systems, and treating neovaginal dysbiosis.
Topics: Female; Hormones; Humans; Male; Microbiota; Penis; Sex Reassignment Surgery; Vagina
PubMed: 35276200
DOI: 10.1016/j.urology.2022.02.021 -
Abdominal Radiology (New York) May 2022Imaging of the peritoneum and related pathology is a challenge. Among peritoneal diseases, malignant peritoneal mesothelioma (MPeM) is an uncommon tumor with poor... (Review)
Review
PURPOSE
Imaging of the peritoneum and related pathology is a challenge. Among peritoneal diseases, malignant peritoneal mesothelioma (MPeM) is an uncommon tumor with poor prognosis. To date, there are no specific guidelines or imaging protocols dedicated for the peritoneum and MPeM. The objective of this study was to analyze the literature describing imaging modalities used for MPeM to determine their relative clinical efficacy and review commonly reported imaging features of MPeM to promote standardized reporting.
METHODS
We performed a systematic review of original research articles discussing imaging modalities in MPeM from 1999 to 2020. Effectiveness measures and common findings were compared across imaging modalities.
RESULTS
Among 582 studies analyzed, the most-used imaging modality was CT (54.3%). In the differentiation of MPeM from peritoneal carcinomatosis, one study found CT had a diagnostic sensitivity of 53%, specificity of 100%, and accuracy of 68%. Two studies found fluorodeoxyglucose positron emission tomography (FDG-PET) had sensitivity of 86-92%, specificity of 83-89%, and accuracy of 87-89%. Another study found magnetic resonance imaging (MRI) was the best predictor of the peritoneal carcinomatosis index. Characteristics shown to best differentiate MPeM from other diseases included ascites, peritoneal thickening, mesenteric thickening, pleural plaques, maximum tumor dimension, and number of masses.
CONCLUSION
Most published MPeM imaging studies utilized CT. PET/CT or MRI appear promising, and future studies should compare effectiveness of these modalities. MPeM imaging reports should highlight ascites, number of and maximum tumor dimension, peritoneal/mesenteric thickening, and associated pleural plaques, allowing for better aggregation of MPeM imaging data across studies.
Topics: Ascites; Humans; Mesothelioma; Peritoneal Neoplasms; Positron Emission Tomography Computed Tomography; Tomography, X-Ray Computed
PubMed: 35257201
DOI: 10.1007/s00261-022-03464-x -
International Journal of Molecular... Feb 2022Mesothelioma is a rare tumor, frequently associated with asbestos exposure, arising from pleura and peritoneum. Traditionally, diagnosis and treatment have been...
Mesothelioma is a rare tumor, frequently associated with asbestos exposure, arising from pleura and peritoneum. Traditionally, diagnosis and treatment have been difficult in a clinical setting. The treatment is based on a trimodal approach involving surgery, chemotherapy, and radiotherapy. The introduction of chemotherapy improved the overall survival. However, the regimen of pemetrexed/cisplatin doublet has not been changed as a standard treatment since 2004. Novel combinations of ipilimumab and nivolumab have only been approved for clinical use in late 2020. The aim of this review was to systematically summarize findings on novel treatment options in mesothelioma. We searched available medical databases online, such as PubMed and Clinicaltrials.gov, to systematically review the literature on novel approaches in immunotherapy, vaccines, and Chimeric Antigen Receptor (CAR)-T cell therapy in mesothelioma. We manually screened 1127 articles on PubMed and 450 trials on ClinicalTrials.gov, and 24 papers and 12 clinical trials published in the last ten years were included in this review. Immunotherapy that was swiftly introduced to treat other thoracic malignancies was slow to reach desirable survival endpoints in mesothelioma, possibly due to limited patient numbers. Novel treatment approaches, such as CAR-T cell therapy, are being investigated. As the incidence of mesothelioma is still rising globally, novel treatment options based on a better understanding of the tumor microenvironment and the genetic drivers that modulate it are needed to support future precision-based therapies.
Topics: Animals; Cell- and Tissue-Based Therapy; Clinical Trials as Topic; Humans; Immunotherapy; Mesothelioma; Receptors, Chimeric Antigen; T-Lymphocytes; Tumor Microenvironment
PubMed: 35216091
DOI: 10.3390/ijms23041975 -
Metabolites Feb 2022Peritoneal dialysis (PD) is an effective and frequent dialysis modality in adults, particularly preferred in infants and young children with end-stage renal disease... (Review)
Review
Peritoneal dialysis (PD) is an effective and frequent dialysis modality in adults, particularly preferred in infants and young children with end-stage renal disease (ESRD). Long-term exposure of the peritoneal membrane to dialysis solutions results in severe morphologic and functional alterations. Peritoneal dialysis effluent biomarkers are based on omics technologies, which could predict the onset or confirm the diagnosis of peritoneal membrane dysfunction, would allow the development of accurate early prognostic tools and, potentially, the identification of future therapeutic targets. The purpose of our study was to critically review the literature on the impact and the effectiveness of metabolomics technologies in peritoneal health. The main search was performed in electronic databases (PubMed/MEDLINE, Embase and Cochrane Central Register of Controlled Trials) from inception to December 2020, using various combinations of Medical Subject Headings (MeSH). The main search highlighted nine studies, of which seven were evaluated in detail. Metabolomics technologies may provide significant input in the recognition of peritoneal membrane dysfunction in PD patients and provide evidence of early intervention strategies that could protect peritoneum health and function.
PubMed: 35208219
DOI: 10.3390/metabo12020145 -
Mikrobiyoloji Bulteni Jan 2022An increase is observed in the frequency and diversity of fungal infections in the world and in our country. Improving the quality of patient care in infections due to...
An increase is observed in the frequency and diversity of fungal infections in the world and in our country. Improving the quality of patient care in infections due to rare moulds depends on early diagnosis and appropriate treatment. Raising awareness about these infections will facilitate taking the necessary steps for diagnosis and treatment in similar cases. In addition to 165 cases out of 96 studies included in this review article, 28 studies reporting rare mould isolation with limited case information were examined. The number of studies reporting cases that meet the criteria has increased over the years. The most frequently reported mould was Fusarium spp. (n= 74), followed by Scedosporium/Pseudallescheria spp. (n= 20). In 25 of the cases, dematiaceous fungi were isolated. Eye (n= 44), skin/soft tissue (n= 35), disseminated (n= 34) peritoneum (n= 13), respiratory tract (n= 13), sinus (n= 12), central nervous system (n= 10), nail (n= 3) and urinary system (n= 1) involvement was detected in the cases. Two cases due to Scedosporium apiospermum and Fonsecaea pedrosoi started locally but spread over time. Among eye involvements, two outbreak reports in which Fusarium spp. was the causative agent drew attention. Of the patients with disseminated involvement, only two who developed Exophiala dermatitidis infection did not have any conditions affecting the immune system. In all peritoneal infections, the patient had a peritoneal catheter (12 for continuous ambulatory peritoneal dialysis and one for drainage). In seven out of 10 cases with central nervous system involvement, dematiaceous fungi were isolated. Appropriate diagnosis and treatment of cases due to rare mould infections can be improved by providing knowledge on the subject in the world and in our country. In these infections where treatment success is limited, correct identification of the causative agent and application of appropriate treatment provides an advantage for clinical success. In this review article, publications from Turkey in Pubmed, Scopus and TR Directory records were searched based on The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) rules and the situation of rare mould infections in our country have been discussed.
Topics: Antifungal Agents; Fungi; Fusarium; Humans; Mycoses; Scedosporium; Turkey
PubMed: 35088969
DOI: 10.5578/mb.20229914