Superior mesenteric artery first approach versus standard pancreaticoduodenectomy： a systematic review and meta-analysis

BACKGROUND： The superior mesenteric artery（SMA） first approach was proposed recently as a new modification of the standard pancreaticoduodenectomy. Increasing evidence showed that a periadventiceal dissection of the SMA with early transection of the inflow during pancreaticoduodenectomy associates better early perioperative results, and setup the scene for long-term oncological benefits. The objectives of the current study are to compare the operative results and long-term oncological outcomes of SMA first approach pancreaticoduodenectomy（SMA-PD） with standard pancreaticoduodenectomy（S-PD）.DATA SOURCES： Electronic search of the PubM ed/MEDLINE, EMBASE, Web of Science and Cochrane Library was performed until July 2015. We considered randomized controlled trials（RCTs） and non-randomized comparative studies（NRCSs） comparing SMA-PD with S-PD to be eligible if they included patients with periampullary cancers.RESULTS： A total of one RCT and thirteen NRCSs met the inclusion criteria, involving 640 patients with SMA-PD and 514 patients with S-PD. The SMA-PD was associated with less intraoperative bleeding, less blood transfusions and higher rate of associated venous resections. The pancreatic fistula and delayed gastric emptying had a significantly lower rate in the SMA-PD group. There were no differences between the two approaches regarding overall complications, major complication rates and in-hospital mortality. There was no difference regarding R0 resection rate, and one-, two-or three-year over-all survival. The SMA-PD was associated with a lower local, hepatic and extrahepatic metastatic rate.CONCLUSIONS： The SMA-PD is associated with better perioperative outcomes, such as blood loss, transfusion requirements, pancreatic fistula, and delayed gastric emptying. Although the one-, two-or three-year overall survival rate is not superior, the SMA-PD has a lower local and metastatic recurrence rate.

Laparoscopic vs open complete mesocolic excision with central vascular ligation for colon cancer: A systematic review and meta-analysis

AIM To compare the effectiveness of laparoscopic complete mesocolic excision(CME) with central vascular ligation(L-CME) with its open(O-CME) counterpart. METHODS We conducted an electronic search of the Pub Med/MEDLINE, Excerpta Medica Database, Web of Science Core Collection, Cochrane Center Register of Controlled Trails, Cochrane Database of Systematic Reviews, Sci ELO, and Korean Journal databases from their inception until May 2017. We considered randomized controlled trials(RCTs) and controlled clinical trials(CCTs) that included patients with colonic cancer comparing L-CME and O-CME. Primary outcomes included the quality of the resected specimen(lymph nodes retrieved, complete mesocolic plane excision, tumor to arterial high tie, resected mesocolon surface). Secondary outcomes included the three-year and five-year overall and disease-free survival rates, recurrence of the disease, surgical data, and postoperative morbidity and mortality. Two authors of the review screened the methodological quality of the eligible trials and independently extracted data from individualstudies.RESULTS A total of one RCT and eleven CCTs(four from Europe and seven from Asia) met the inclusion criteria for the current meta-analysis. These studies involved 1619 patients in L-CME and 1477 patients in O-CME. The L-CME was associated with the same quality of the resected specimen, with no differences regarding the retrieved lymphnodes(MD =-1.06, 95%CI:-3.65 to 1.53, P = 0.42), and tumor to high tie distance(MD = 14.26 cm, 95%CI:-4.30 to 32.82, P = 0.13); the surface of the resected mesocolon was higher in the L-CME group(MD = 11.75 cm2, 95%CI: 9.50 to 13.99, P < 0.001). The L-CME was associated with a lower rate of blood transfusions(OR = 0.45, 95%CI: 0.27 to 0.75, P = 0.002), faster recovery of gastrointestinal function, and less postoperative overall complication rate. The L-CME approach was associated with a statistical significant better three-year overall(OR = 2.02, 95%CI: 1.31 to 3.12, P = 0.001, I2 = 28%) and disease-free(OR = 1.45, 95% CI: 1.00 to 2.10, P = 0.05, I2 = 0%) survival. CONCLUSION The laparoscopic approach offers the same quality of the resected specimen as the open approach in complete mesocolic excision with central vascular ligation for colon cancer. The laparoscopic complete mesocolic excision with central vascular ligation is superior in all perioperative results and at least non-inferior in long-term oncological outcomes.

Platelet-to-lymphocyte ratio and CA19-9 are simple and informative prognostic factors in patients with resected pancreatic cancer

We read with great interest the paper “Combined preoperative platelet-to-lymphocyte ratio and serum carbohydrate antigen 19-9 level as a prognostic factor in patients with resected pancreatic cancer” published in Hepatobiliary & Pancreatic Diseases International [1].

The laparoscopic approach in emergency surgery: A review of the literature

The role of laparoscopy in the acute care surgery had significantly increased during the latest years, both as a diagnostic and treatment method of all the upper or lower gastrointestinal pathologies. The objective of the present research is to review the current indications for laparoscopy in abdominal emergencies and to detail the benefits and complications associated with this approach. We have reviewed the relevant literature about this topic published between January 2005 and December 2017, using the PubMed/Medline and Web of Science Core Collection databases. According to the current evidence, we may conclude that the laparoscopic approach is an integral part of the emergency surgery for all the abdominal pathologies. Although laparoscopy requires specialized training and curricula, it brings all the benefits of minimal access in acute care arena.

Overview of clinical forensic services in various countries of the European Union

Examination of a person who has been a victim of a physical or sexual assault may be very important for upcoming legal proceedings.In the context of a clinical forensic examination,physical findings are recorded and biological trace material is gathered and secured.Ideally,all forensic findings are documented in a detailed report combined with photographic docu-mentation,which employs a forensic scale to depict the size of the injuries.However,the integrity of such forensic findings depends particularly on two factors.First,the examination needs to be conducted professionally to ensure that the findings are properly admissible as court evidence.Second,the examination should take place as soon as possible because the opportunity to successfully secure biological samples declines rapidly with time.Access to low-threshold clinical forensic examinations is not evenly provided in all member states of the European Union(EU);in some states,they are not available at all.As part of the JUST_(e)U!(Juridical standards for clinical forensic examinations of victims of violence in Europe)pro-ject,the Ludwig Boltzmann Institute for Clinical Forensic Imaging in Graz,Austria created(in cooperation with its international partner consortium)a questionnaire:the purpose was to collect information about support for victims of physical and/or sexual assault in obtaining a low-threshold clinical forensic examination in various countries of the EU.Our paper pro-vides a summary of the responses and an overview of the current situation concerning pro-vided clinical forensic services.