Systematic Review Of Outcomes Research Articles

Systematic Review of Outcomes Following 10-Year Mark of Spine Patient Outcomes Research Trial for Intervertebral Disc Herniation.

We performed a comprehensive search of Pubmed, MEDLINE, and EMBASE for English-language studies of all levels of evidence pertaining to SPORT, in accordance with Preferred Reported Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We aim to summarize the 10-year clinical outcomes of SPORT and its numerous follow-up studies for intervertebral disc herniation. The Spine Patient Outcomes Research Trial (SPORT) was a landmark study. SPORT compared surgical and nonoperative management of the three most common spinal pathologies. Keywords utilized included: SPORT, spine patient outcomes research trial, disc herniation, and surgical outcomes. The observational cohort analysis revealed statically greater improvement in primary outcomes at 3 months and 2 years in patients who had surgery, while analysis of the randomized control trial cohort failed to show a significant difference based on the intent-to-treat principle due to significant patient crossover. However, 4 year and 8 year as-treated analysis showed statistically greater improvements in those patients who were treated surgically. SPORT's subgroup analysis evaluated important factors when considering the treatment of IDH, including patient characteristics, level of herniation, duration of symptoms, recurrence of pain, presence of retrolistheiss, patient functional status, effects of previous treatment with epidural steroid injections and opioid medication, outcomes after incidental durotomy, MRI reader reliability, reoperation rates, and risk factors for reoperation. The clinical impact of SPORT was also investigated and included comparison of SPORT patients to NSQIP patients to determine generalizability, outcome differences in SPORT's surgical center sites, patient preferences, patient expectations, level of education, and effects of watching an evidence-based video. Ten years after its inception, SPORT has made strides in standardization and optimization of treatment for spinal pathologies. SPORT has provided clinicians with insight about outcomes of surgical and nonoperative treatment of IDH. Results showed significantly greater improvements in patients treated surgically. 3.

Management of metastatic vertebral lesions by interventional techniques: Systematic review of outcomes.

Vertebral metastases represent an important cause of cancer-related morbidity and mortality. Among all available treatments, interventional percutaneous techniques have recently emerged as potential strategies for the management of oncologic patients with vertebral lesions. Minimally invasive image-guided therapies include “ablative” and “consolidative” ones. According to the number of metastases and the patient's performance status, ablative techniques can be performed with a curative or a palliative purpose since necrosis induced by critic changes of intralesional temperature determines both tumor debulking and destruction of pain receptors. On the other hand, consolidative treatments are based on the injection of polymethylmethacrylate cement to improve structural vertebral integrity and obtain pain alleviation and prevention of skeletal-related events. This article reviews the current recommendations supporting the role of interventional radiology in the management of vertebral metastases, focusing on the last updates in literature.

Systematic Review of Outcomes Following 10-year Mark of Spine Patient Outcomes Research Trial (SPORT) for Spinal Stenosis.

We performed a comprehensive search of Pubmed, MEDLINE, and EMBASE for all English-language studies of all levels of evidence pertaining to SPORT, in accordance with Preferred Reported Items for Systematic Reviews and Meta-analayses (PRISMA) guidelines. We aim to summarize the 10-year clinical outcomes of SPORT and its numerous follow-up studies for spinal stenosis. The Spine Patient Outcomes Research Trial (SPORT) was a landmark randomized control trial including approximately 2,500 patients at 13 clinics across the country. SPORT compared surgical and nonoperative management of the three most common spinal pathologies. Keywords utilized in the literature search included: SPORT, spine patient outcomes research trial, spinal stenosis, and surgical outcomes. Surgical intervention showed significantly greater improvement in pain and physical function scales from 6 weeks through 4 years. However, between 4 and 8 years, the difference between the two groups diminished, and the benefits in both groups stabilized. Secondary factors investigated showed that smoking was a confounding variable for treatment benefits and a positive sedimentation sign correlated with a greater surgical treatment effect. Obese patients were found to have higher rates of infection and reoperation and less improvement from baseline function. Risk factors for reoperation included duration of pretreatment symptoms for longer than 12 months, increased age, multiple levels of stenosis, predominant back pain, no physical therapy, greater leg pain, the use of antidepressants and no neurogenic claudication upon enrollment. Ten years after its inception, SPORT has made strides in standardization and optimization of treatment for spinal pathologies. SPORT has provided clinicians with insight about outcomes of surgical and nonoperative treatment of spinal stenosis. Results showed significantly greater improvement through 4 year follow up in those patients that received surgical treatment, however the difference between the surgical and nonsurgical groups diminished at 8 year follow up. 3.

Discussion: Consolidation Time and Relapse: A Systematic Review of Outcomes in Internal versus External Midface Distraction for Syndromic Craniosynostosis.

Discussion: Consolidation Time and Relapse: A Systematic Review of Outcomes in Internal versus External Midface Distraction for Syndromic Craniosynostosis.

Comparing Functional Behavior Assessment-Based Interventions and Non-functional Behavior Assessment-Based Interventions: A Systematic Review of Outcomes and Methodological Quality of Studies

This review compared the effectiveness of functional behavior assessment-based interventions (FBAI) versus non-functional behavior assessment-based interventions (NFBAI) through an examination of 24 single-case design (SCD) studies that directly compared the effects of these intervention approaches. This review also systematically examined the quality of these studies. All of the reviewed studies reported relative effectiveness of FBAI over NFBAI in reducing problem behaviors, showing a higher percentage of behavior reduction in FBAI than NFBAI conditions. None of the reviewed studies met all of the What Works Clearinghouse Design Standards for SCD (Kratochwill et al. in Single-case designs technical documentation, 2010). We discussed methods of comparing the effects of FBAI versus NFBAI and made methodological suggestions for future research in this area.

Consolidation Time and Relapse: A Systematic Review of Outcomes in Internal versus External Midface Distraction for Syndromic Craniosynostosis.

The choice between internal and external distraction osteogenesis for midface advancement in patients with syndromic craniosynostosis is based primarily on surgeon preference and expertise. However, differences in outcomes between the two techniques have been sparingly compared. In this work, the authors performed a systematic review to compare outcomes between internal versus external midface distraction. A systematic review was performed of studies published between 1998 and 2018 (61 studies included; n = 689 patients). Operative characteristics, early reoperations, complications, and relapse rates were extracted. Bias evaluation was performed using the Newcastle-Ottawa instrument. Statistical analyses were performed with independent samples t tests and linear regression analyses (p < 0.05 considered significant). The authors found that external distraction was associated with more Le Fort III osteotomies and hardware adjustments (p = 0.023), whereas internal distraction was associated with more monobloc osteotomies and longer consolidation times (p = 0.008). No significant differences in the distance of midface advancement, reoperations, complications, or relapse rates were noted between internal versus external distraction, although external distraction trended toward a slightly higher relapse rate. Regardless of distraction protocol, consolidation time was found to be a strong negative predictor for relapse (beta = -0.792; p = 0.02). No significant differences were demonstrated in advancement distance, reoperative rates, complication rates, or relapse rates for internal versus external distraction for midface advancement. Regardless of distraction type, consolidation time was strongly inversely associated with relapse rates. The trend toward higher relapse in external distraction is potentially explained by the significantly lower consolidation times.

Learning curve for robotic surgery in children: a systematic review of outcomes and fellowship programs

The learning curve (LC) of a new technique is fundamental for its application and assessment, and for the training. Literature was analysed to define the LCs of different surgical procedures and the impact of fellowship programs. MEDLINE, EMBASE and paediatric surgical journals' databases from January 1995 to December 2018 were systematically analysed. Two independent residents sought for articles providing description of robotic-assisted procedures' LCs in paediatric age/population. Seventeen articles were selected, describing LC of robotic-assisted pyeloplasty (n = 9), fundoplication (n = 4), cholecystectomy (n = 2), choledochal cyst resection (n = 1) and lingual tonsillectomy (n = 1), with 721 procedures. Ten studies refer to one single surgeon; six to more than one; one does not specify the number of operators. Eleven studies are unicentric retrospective, two multicentric retrospective, three prospective and one is a comparative analysis between a retrospective case series and a prospective cohort. The most recruited parameter is operative time alone in 3 articles, associated with complications in 12, length of hospital stay in 6, blood loss in 3, resolution in 4 and narcotic use in 2. The LC is described as impacting procedural planning (n = 17), training (n = 9) and economic costs (n = 2). To date, operative time is the most reported outcome to measure LC and proficiency. Efforts are needed to consider measures of surgical expertise and patient status. Robotic training should be standardized on targeted programs planned upon well-defined LCs.

A Systematic Review of Outcomes and Patient Satisfaction Following Surgical and Non-surgical Treatments for Hair Loss.

This systematic review aims to examine surgical and non-surgical treatments and identify those procedures that are most effective in terms of patient satisfaction. A systematic review protocol was developed a priori in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses-Protocols (PRISMA-P) guidelines. The search was conducted in accordance with the PRISMA guidelines, the Cochrane handbook. A multistep search of the PubMed, MEDLINE, Embase, PreMEDLINE, Ebase, CINAHL, PsycINFO, and Cochrane databases was performed to identify studies on hair loss causes and hair loss treatment with different surgical and non-surgical techniques RESULTS: Our search generated a total of 781 articles; 646 studies were excluded based on the content of the abstracts, and an additional 105 studies were excluded based on the content of the complete article. We performed a review of the 30 remaining studies, which had sufficient data for inclusion, and met all the aforementioned inclusion criteria. Of the 30 studies, four were about minoxidil, four about finasteride, two about dutasteride, three about phototherapy, six about platelet-rich plasma injection, four about follicular unit transplantation technique, six about follicular unit extraction technique, and one about patient satisfaction following surgical treatment without a specified surgical technique. Only three studies used a patient-reported outcome measurement. Our study is the first comprehensive systematic review of hair loss, looking at the problem from different points of view, and focusing on finding the best solution for the patient. In the literature, there is currently no algorithm for the management of patients who go to a plastic surgeon for a solution to the problem of hair loss. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Endovascular Super-Selective Intra-Arterial Chemotherapy for Retinoblastoma: Systematic Review and Institutional Experience

Abstract INTRODUCTION Selective intra-arterial delivery of chemotherapy (IAC) via microcatheter infusion into the ophthalmic artery has become an increasingly popular treatment modality to accomplish globe salvage in children with retinoblastoma. While previously limited to highly specialized centers, interest in and popularity of this treatment are growing. Here, we provide a comprehensive review of available data in addition to our own experience. METHODS Systematic literature review was conducted using PRISMA guidelines and 22 studies were identified that met inclusion criteria. In our own series, consecutive patients undergoing IAC for retinoblastoma were identified between January 2009 and December 2016. Pertinent data, including tumor grade, enucleation vs globe salvage, and both ocular and systemic adverse events were recorded. RESULTS In all1593 total eyes were treated as reported in 22 studies published between 2011 and 2019. Among those in which tumor staging data was available, 396 (27.6%) were less advanced (Reese–Ellsworth A-C, or International Classification I-III) and 997 (69.4%) were more advanced (D-E, IV-V). A total of 21 studies included data on systemic and/or ocular complications, which with few exceptions were transient and resulted in no permanent morbidity. A single permanent neurological complication occurred. Analysis of our institutional experience demonstrated a globe salvage rate of 73% (identical to pooled data from the literature). In 442 procedures, our ocular and systemic complication rates were 10.6% and 13.8%, respectively; virtually all were transient phenomena including orbital edema, myelosuppression, and and brief intraprocedural bronchospasm/bradycardia during drug delivery. CONCLUSION Although reported predominantly in retrospective series, a systematic review of outcomes in selective IAC for retinoblastoma demonstrates efficacy (73% globe salvage rate) with minimal morbidity, even in advanced disease. Our own results reflect a similar experience and taken together, provide strong evidence that this treatment modality is safe and effective. The data support adoption of this technique as first-line therapy for globe salvage in selected cases of retinoblastoma.

Patients participating as co-researchers in health research: A systematic review of outcomes and experiences.

Aims: We aimed to map out the scope and type of health research studies with patients involved as co-researchers throughout the research process and to explore the outcomes and experiences of such research. Methods: We conducted a narrative review by systematically searching selected databases. A total of 1451 hits were identified and screened, and 17 studies were included and categorised by type of health problem, design, publication sources and modes of presentation. We conducted an inductive, iterative analysis of outcomes and experiences of patient involvement. Results: We identified two types of impact from studies with patients participating as co-researchers: (a) patient involvement as primary focus, where seven articles largely reported and reflected upon the shared experiences, and (b) patient involvement as strategy, where 10 articles presented results from empirical studies of specific health problems, with patient involvement used as a strategy to expand understanding. The first group of studies reported collaborative processes and resource investments, while the second group addressed specific health problems from a distinctive perspective due to patient involvement. Several studies in both groups repeated or confirmed positive values of user involvement rather than providing original findings. In both groups, methodological standards were often downgraded to provide access for the co-researchers. Conclusions: These articles, where the co-researcher model represents the contemporary superior level of patient involvement, may indicate that mere collaboration efforts are prioritised at the expense of knowledge outcomes and scientific quality. Collaboration formats other than participation as co-researchers may be necessary for patient involvement in medical research to add to the existing knowledge.

P042 Inflammatory bowel disease is no longer a contraindication for radiation therapy: A systematic review of outcomes with modern RT techniques

BACKGROUND: Inflammatory bowel disease (IBD) continues to be considered a contraindication to the use of Radiation Therapy (RT). Oncologists are often unwilling to deliver RT, due to a perceived risk of severe bowel toxicity, or IBD exacerbation. Modern precision RT techniques allow significant reduction in dose to normal organs, and several studies have reported low toxicity rates. We performed a systematic review of recent studies to summarize the current evidence regarding RT toxicity in cancer patients with IBD. METHODS: MEDLINE and EMBASE databases were searched, using combinations of key terms, for relevant studies published over the past 10 years (2008–2018). Reference lists of eligible articles were also hand-searched. A total of 278 articles were screened, and 9 studies met our search criteria to be included in this review. RESULTS: From the 9 relevant studies, 198 patients with IBD, treated using radiation therapy, and with outcome data available, were included. The reported median follow-up was 55.2 months. The majority of patients (n = 148, 75%) were male; 113 (57%) had Ulcerative Colitis, 81 (41%) had Crohn's Disease, and 4 patients had IBD NOS. Nineteen patients (9.5%) were reported to have active IBD within 6 -12 months prior to starting RT. Colo-rectal carcinoma was the most common malignancy (n = 91, 46%), followed by prostate cancer (n = 83, 42%), anal-canal (n = 10, 5%), and gynecological malignancies (n = 6, 3%). External beam RT was used as part of treatment for 173 patients (87%), while 25 received brachytherapy alone. About 28% (n = 55) also received concurrent chemotherapy. From studies that reported the RT technique used, about 43% of patients were treated with Intensity Modulated RT (IMRT). RT dose ranged from 25 Gy/5 for pre-op rectal cancers to over 70 Gy for prostate cancers. Median BED (a/b = 3, rectum) was calculated to be 83.3 Gy. Acute toxicity data was available for 190 patients: clinically significant acute toxicity, ≥Grade 3, was reported in 29 patients (15.3%). Late RT toxicity data was available for 115 patients: ≥Grade 2 GI toxicity was reported in 21 (10.5%), and ≥Grade 3 in 7 (3.5%) of patients. CONCLUSION(S): With the use of modern RT techniques, GI toxicity is relatively low for patients with IBD, and is not numerically different from that reported for patients without IBD. Patient selection and meticulous RT planning is important, however, evidence does not suggest that IBD in itself is a contraindication for RT.

A Systematic Review of Outcomes After Genital Lymphedema Surgery: Microsurgical Reconstruction Versus Excisional Procedures.

Genital lymphedema (GL) surgery can be either palliative or functional. Palliative procedures involve excision of the affected tissue and reconstruction by either local flaps or skin grafts. Reconstructive procedures aim to restore lymphatic flow through microsurgical lymphaticovenous anastomoses (LVAs). This systematic analysis of outcomes and complication rates aims to compare outcomes between these surgical treatment options for GL. A systematic review of the PubMed database was performed with the following search algorithm: (lymphorrhea or lymphedema) and (genital or scrotal or vulvar) and (microsurgery or "surgical treatment"), evaluating outcomes, and complications after surgical treatment of GL. Twenty studies published between 1980 and 2016 met the inclusion criteria (total, 151 patients). Three main surgical treatments for GL were identified. Surgical resection and primary closure or skin graft was the most common procedure (46.4%) with a total complication rate of 10%. Surgical resection and flap reconstruction accounted for 39.1% of the procedures with an overall complication rate of 54.2%. Lympho venous shunt (LVA) procedures (14.5%) had a total complication rate of 9%. This review demonstrates a lack of consensus in both the preoperative assessment and surgical management of GL. Patients receiving excisional procedures tended to be later stage lymphedema. Patients in the excision and flap reconstruction group seemed to have the highest complication rates. Microsurgical LVAs may represent an alternative approach to GL, either alone or in combination with traditional procedures.

Systematic review of outcomes after total neoadjuvant therapy for locally advanced rectal cancer.

Advances in surgical technique and the development of combined-modality therapy have led to significantly improved local control in rectal cancer. Distant failure rates however, remain high, ranging between 20 and 30 per cent. Additional systemic chemotherapy in the preoperative period has been proposed as a means of eradicating subclinical micrometastases and improving long-term survival. The purpose of this systematic review was to evaluate the current evidence regarding induction chemotherapy in combination with standard neoadjuvant chemoradiotherapy, in terms of oncological outcomes, in patients with rectal cancer. A systematic review of the literature was performed to evaluate oncological outcomes and survival in patients with rectal cancer who underwent induction chemotherapy and neoadjuvant chemoradiotherapy, followed by surgical resection. Four major databases (PubMed, Embase, Scopus and Cochrane) were searched. The review included all original articles published in English reporting long-term outcomes, specifically survival data, and was limited to prospective studies only. A total of 686 studies were identified. After applying inclusion and exclusion criteria, ten studies involving 648 patients were included. Median follow-up was 53·7 (range 26-80) months. Five-year overall and disease-free survival rates were 74·4 and 65·4 per cent respectively. Weighted mean local recurrence and distant failure rates were 3·5 (range 0-7) and 20·6 (range 5-31) per cent respectively. Total neoadjuvant therapy should be considered in patients with high-risk locally advanced rectal cancer owing to improved chemotherapy compliance and disease control. Further prospective studies are required to determine whether this approach translates into improved disease-related survival or increases the proportion of patients suitable for non-operative management.

Meniscal Repair in Pediatric Populations: A Systematic Review of Outcomes.

Background:Loss of meniscal tissue in the pediatric population can have long-term consequences on joint health, highlighting the importance of meniscal preservation in this group.Purpose:To systematically review reported knee outcome measures and complication rates after repair of meniscal tears in children and adolescents.Study Design:Systematic review; Level of evidence, 4.Methods:A review of the literature regarding the existing evidence for pediatric meniscal tear outcomes was performed through use of the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980-present), and MEDLINE (1980-present). Included were articles in English that reported the outcomes of meniscal tears in the pediatric population (<18 years old) with a follow-up of more than 12 months. Clinical outcome scores were reviewed.Results:A total of 1003 total studies were initially retrieved, with 8 meeting the inclusion criteria. The review included 287 patients (165 male, 122 female), mean age 15.1 years (range, 4-18 years), with 301 meniscal tears (reported: 134 medial, 127 lateral, and 32 both medial and lateral, 8 location unspecified). Concomitant anterior cruciate ligament reconstruction was performed in 52% (158/301) of meniscal repairs. The average reported postoperative Lysholm scores ranged from 85.4 to 96.3, and the average reported postoperative Tegner activity scores ranged from 6.2 to 8.Conclusion:Arthroscopic repair of a meniscal tear in the pediatric and adolescent population is an effective treatment option that has a low failure rate, enhances postoperative clinical outcomes, and preserves meniscal tissues.

A systematic review of outcomes after salvage abdominoperineal resection for persistent or recurrent anal squamous cell cancer.

Up to 30% of patients with squamous cell cancer of the anus (SCCA) will require a salvage abdominoperineal resection (APR) for either persistent or recurrent disease. The objective of this study was to assess cancer-related outcomes in patients with (i) persistent or (ii) recurrent SCCA. Embase and MEDLINE were searched. Publications were included if they assessed overall survival (OS), disease-free survival (DFS) and locoregional recurrence or metastatic disease after salvage APR for persistent or recurrent SCCA. A total of 28 retrospective case series (study size ranged from nine to 111) met our inclusion criteria. The median time to salvage APR was 2.6months [interquartile range (IQR) 2.6-5.0months, six studies] for persistent disease and 27.6months (IQR 15.0-32.7months, five studies) for recurrent disease. The median 5-year OS from the time of salvage APR was 45.0% (IQR 32.0%-52.3%, 10 studies) for persistent disease and 51.0% (IQR 36.0%-60.9%, 11 studies) for recurrent disease. The median 5-year DFS following salvage APR was 44.0% (IQR 29.5%-53.0%, 10 studies) for all patients. Following salvage APR, the median locoregional recurrence rate was 23.5% (IQR 15.8%- 46.9%, 19 studies) and 9.0% (IQR 6.4%-13.3%, 16 studies) of patients developed metastatic disease after salvage APR. Our review characterizes the best evidence for outcomes following salvage APR for patients with persistent or recurrent SCCA. The evidence is limited by the quality of included studies, as many were single centre case series.

A systematic review of outcome in intramedullary ependymoma and astrocytoma

The objective was to determine the impact of surgical resection and adjuvant therapies on survival in intramedullary ependymoma and astrocytoma. Secondary goals were to determine predictors of survival in surgical patients including histological grading, age and gender. Searching of Medline, Embase and Clinicaltrials.gov databases were performed. Multivariate analyses were performed for overall survival (OS) and progression-free survival (PFS) through Monte Carlo methods and Maximum Likelihood Estimation. 57 articles detail results for 3022 patients. Meta-analysis revealed the following factors to have a statistically significant effect on OS. Patients undergoing gross-total resection (GTR) are 5.37 times more likely to survive than patients with lesser volumes of tumor resected (HR for OS 1.68, p < 0.01). High-grade tumors were associated with a 14 times risk of death over low-grade tumors (HR for OS 2.64, p < 0.01). Radiation increased the risk of mortality in low-grade tumors (HR for OS 5.20, p < 0.01), but decreased mortality in high-grade lesions (HR for OS 2.46, p < 0.01). Adult patients were more likely to die from disease compared with pediatric patients by a factor of 1.6 (HR for OS 0.47, p < 0.01). In PFS, radiotherapy was associated with a reduced time to recurrence (HR for PFS 1.90, p < 0.01). There was a male predominance of 58%. Gender did not influence survival. 79% of patients demonstrated stable or improved functional neurological outcomes six months post-operatively. Our data indicates GTR improves OS in all tumor grades. Radiation improves OS only in the presence of high-grade histology. Advancing age and high-grade histology are negative prognostic indicators.

Creative Arts Interventions to Address Depression in Older Adults: A Systematic Review of Outcomes, Processes, and Mechanisms.

Depression experienced by older adults is proving an increasing global health burden, with rates generally 7% and as high as 27% in the USA. This is likely to significantly increase in coming years as the number and proportion of older adults in the population rises all around the world. Therefore, it is imperative that the effectiveness of approaches to the prevention and treatment of depression are understood. Creative arts interventions, including art, dance movement, drama, and music modalities, are utilized internationally to target depression and depressive symptoms in older adults. This includes interventions led by trained arts therapists as well as other health and arts professionals. However, to date there has not been a systematic review that reports effects and examines the processes (why) and mechanisms (how) of creative arts interventions are used to address depression in this older age group. This systematic review of studies on creative arts interventions for older adults experiencing depression examined: outcomes of four creative arts modalities (art, dance movement, drama, and music); with particular attention paid to processes documented as contributing to change in each modality; and mechanisms considered to result from these processes. Our analysis of 75 articles (17 art, 13 dance, 4 drama, and 41 music) indicates mostly significant quantitative or positive qualitative findings, particularly for interventions led by creative arts therapists. Mechanisms of change gleaned from the studies that were common across modalities include physical (e.g., increased muscle strength; neurochemical effects, such as endorphin release), intra-personal (e.g., enhanced self-concept, strengthened agency and mastery; processing and communication of emotions), cultural (e.g., creative expression, aesthetic pleasure), cognitive (e.g., stimulation of memory), and social (e.g., increased social skills and connection), that were all considered to contribute to reduced depression and symptoms. Recommendations for future research includes stronger focus on testing of processes and mechanisms.

Mixed Adenoneuroendocrine Carcinoma (MANEC) of the Gallbladder: A Systematic Review of Outcomes Following Surgical Management.

Mixed adenoneuroendocrine carcinomas (MANEC) are uncommon tumors exhibiting both adenocarcinomatous and neuroendocrine differentiation. They most commonly arise in the colon, appendix, rectum or stomach, however, a limited number of MANECs have been reported to originate in the gallbladder (gMANEC). The aim of our systematic review was to accumulate the existing data on gMANEC with special attention to the clinicopathological characteristics, surgical approach, recurrence and survival rates of patients diagnosed with this rare malignancy. A comprehensive search of the literature was undertaken. A total of 15 studies (14 case reports and 1 case series), which comprised 19 patients who successfully underwent surgical treatment for gMANEC were included in our systematic review. During a median follow-up of 8 months (range=2-48 months) the overall survival was 87% and the recurrence rate was 21%. Achievement of complete surgical resection is the mainstay of the therapeutic management. Additionally, the stage of the disease and the histopathological mapping of these tumors affect decision-making for adjuvant chemotherapy and seem to define the prognostic course of each patient.

Systematic review of outcomes following pelvic exenteration for the treatment of primary and recurrent locally advanced rectal cancer.

Pelvic exenteration represents the best treatment option for cure of locally advanced or recurrent rectal cancer. This systematic review sought to evaluate current literature regarding short and long term treatment outcomes and long term survival following pelvic exenteration. A systematic search of the MEDLINE, PubMed and Ovid databases was conducted to identify suitable articles published between 2001 and 2016. The article search was performed in line with Cochrane methodology and reported according to the Preferred Reporting Items for Systematic reviews and Meta-analyses statement. Sixteen studies were included in the final analysis, incorporating 1016 patients. Sixty-three percent of patients were male and median patient age was 59years. Median operating time was 7.2h with median blood loss of 1.9l. Median postoperative stay was 17days with a median 30-day mortality of 0. Complication rates were 31.6-86% with a return to theatre rate of 14.6%. Median R0 resection rate was 74% and was higher for primary cancer (82.6% versus 58% for recurrent cancer). Mean overall survival was 31months and median 5-year survival was 32%. Recurrently identified indicators of adverse outcome included R1/2 resection, preoperative pelvic pain and previous abdominoperineal resection of the rectum. Pelvic exenteration remains a major operation associated with significant morbidity and mortality. Despite advances in preoperative assessment and staging, R1 resection rates remain high. There is also a high degree of variability of reporting outcomes and standardisation of this process would aid comparison of results between centres and drive forward research in this area.

A Systematic Review of Outcomes and Flap Selection Following Lower Extremity Free Tissue Transfer Versus Vascularized Perforator Pedicle Flap Transfer in Lower Limb Reconstruction

The evolution of microsurgery and orthoplastics has expanded our ability as surgeons to manage complex lower extremity soft tissue defects. This evolution relies on the understanding of reconstructive surgical principles for problem solving and analyzing outcomes. The purpose of this review is to determine flap selection with a focus on reliability based on the outcomes of lower extremity free tissue transfer versus vascularized perforator pedicle flap transfer in lower limb reconstruction. A systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the databases PubMed/MEDLINE. Data were compiled by reviewing the number of patients, age, comorbidities, complications, size and location of defect. Outcomes were analyzed by indicated soft tissue defect size, location and cause, as well as subsequent flap size, type, survival, durability and their functional results. Overall, 72 topic related studies from 2014–2017 were reviewed. Sixteen of the 72 met the final inclusion criteria. Patient study sizes from the included articles ranged from 7–428 cases. The current qualitative systematic review of flap transfer in the lower extremity has contributed a summary of reported outcomes in literature thus far. After analyzing existing evidence, our study found no significant differences between reconstructive options with a paucity of evidence to clearly recommend the ideal flap transfer for microsurgical reconstruction of lower extremity soft tissue defects.