Background The improvement of renal allograft survival by pre-transplantation transfusions alerted the medical community to the potential detrimental effect of transfusions in patients being treated for cancer. Objectives The present meta-analysis aims to evaluate the role of perioperative blood transfusions (PBT) on colorectal cancer recurrence. This is accomplished by validating the results of a previously published meta-analysis (Amato 1998); and by updating it to December 2004. Search strategy Published papers were retrieved using Medline, EMBASE, the Cochrane Library, controlled trials web-based registries, or the CCG Trial Database. The search strategy used was: {colon OR rectal OR colorectal} WITH {cancer OR tumor OR neoplasm} AND transfusion. The tendency not to publish negative trials was balanced by inspecting the proceedings of international congresses. Selection criteria Patients undergoing curative resection of colorectal cancer (classified either as Dukes stages A-C, Astler-Coller stages A-C2, or TNM stages T1-3a/N0-1/M0) were included if they had received any amount of blood products within one month of surgery. Excluded were patients with distant metastases at surgery, and studies with short follow-up or with no data. Data collection and analysis A specific form was developed for data collection. Data extraction was cross-checked, using the most recent publication in case of repetitive ones. Papers' quality was ranked using the method by Evans and Pollock. Odds ratios (OR, with 95% confidence intervals) were computed for each study, and pooled estimates were generated by RevMan (version 4.2). When available, data were stratified for risk factors of cancer recurrence. Main results The findings of the 1998 meta-analysis were confirmed, with small variations in some estimates. Updating it through December 2004 led to the identification of 237 references. Two-hundred and one of them were excluded because they analyzed survival (n=22), were repetitive (n=26), letters/reviews (n=66) or had no data (n=87). Thirty-six studies on 12,127 patients were included: 23 showed a detrimental effect of PBT; 22 used also multivariable analyses, and 14 found PBT to be an independent prognostic factor. Pooled estimates of PBT effect on colorectal cancer recurrence yielded overall OR of 1.42 (95% CI, 1.20 to 1.67) against transfused patients in randomized controlled studies. Stratified meta-analyses confirmed these findings, also when stratifying patients by site and stage of disease. The PBT effect was observed regardless of timing, type, and in a dose-related fashion, although heterogeneity was detected. Data on surgical techniques was not available for further analysis. Authors' conclusions This updated meta-analysis confirms the previous findings. All analyses support the hypothesis that PBT have a detrimental effect on the recurrence of curable colorectal cancers. However, since heterogeneity was detected and conclusions on the effect of surgical technique could not be drawn, a causal relationship cannot still be claimed. Carefully restricted indications for PBT seems necessary.

Perioperative blood transfusions for the recurrence of colorectal cancer

Background
The improvement of renal allograft survival by pre-transplantation transfusions alerted to the potential detrimental effect of transfusions in cancer treatment.

Objectives
This meta-analysis evaluates the role of perioperative blood transfusions (PBT) on colorectal cancer recurrence. This is accomplished by updating the results of a previously published meta-analysis (Amato 2006) to December 2009.

Search methods
Papers were retrieved using Medline, EMBASE, the Cochrane Library, trials web-based registries, or the CCG Database. The search strategy was: {colon OR rectal OR colorectal} WITH {cancer OR tumor OR neoplasm} AND transfusion. The publication bias was balanced by reviewing the proceedings of international congresses.

Selection criteria
Patients undergoing curative resection of colorectal cancer (classified either as Dukes stages A-C, Astler-Coller stages A-C2, or TNM stages T1-3a/N0-1/M0) were included if they had received blood products within one month of surgery. Excluded were patients with distant metastases and studies with short follow-up or no data.

Data collection and analysis
A specific form was used for data collection. Data was cross-checked, using the most recent publication in case of repetitive ones. Papers' quality was evaluated using the method by Evans and Pollock. Odds ratios (OR, with 95% confidence intervals) were computed for each study, and pooled estimates were generated by RevMan (version 5). When available, data were stratified for risk factors of cancer recurrence.

Main results
Updating the previous review through December 2009 identified 41 additional papers, for a grand total of 278 references. Two-hundred and fourty-two of them were excluded because they analyzed survival (n=27), were repetitive (n=29), letters/reviews (n=71) or had no data (n=115). Thirty-six studies on 12,127 patients remained included: 23 showed a detrimental effect of PBT; 22 used multivariable analyses, and 14 found an independent PBT effect. Pooled estimates of PBT effect on recurrence in randomised studies yielded an OR of 1.42 (95% CI, 1.20 to 1.67) against transfused patients. Stratified meta-analyses confirmed these findings also by site and stage of disease, regardless of timing, type, and in a dose-related fashion, although heterogeneity was detected. Data on surgical techniques was not available for further analysis.

Authors' conclusions
This updated meta-analysis confirms the previous findings and supports the association of PBT on the recurrence of curable colorectal cancers. However, since heterogeneity was detected and the effect of surgical technique could not be assessed, a causal relationship cannot still be claimed. Carefully restricted indications for PBT seems necessary.

Perioperative blood transfusions and recurrence of colorectal cancer

Several studies revealed that gut microbiota are associated with various human diseases, e.g., metabolic diseases, allergies, gastroenterological diseases, and liver diseases. The liver can be greatly affected by changes in gut microbiota due to the entry of gut bacteria or their metabolites into the liver through the portal vein, and the liver-gut axis is important to understand the pathophysiology of several liver diseases, especially non-alcoholic fatty liver disease and hepatic encephalopathy. Moreover, gut microbiota play a significant role in the development of alcoholic liver disease and hepatocarcinogenesis. Based on these previous findings, trials using probiotics have been performed for the prevention or treatment of liver diseases. In this review, we summarize the current understanding of the changes in gut microbiota associated with various liver diseases, and we describe the therapeutic trials of probiotics for those diseases.

Gut microbiota and liver diseases.

Nonalcoholic fatty liver disease (NAFLD) encompasses a broad spectrum of pathological hepatic conditions ranging from simple steatosis to nonalcoholic steatohepatitis (NASH), which may predispose to liver cirrhosis and hepatocellular carcinoma (HCC). Due to the epidemic obesity, NAFLD is representing a global health issue and the leading cause of liver damage worldwide. The pathogenesis of NAFLD is closely related to insulin resistance (IR), adiposity and physical inactivity as well as genetic and epigenetic factors corroborate to the development and progression of hepatic steatosis and liver injury. Emerging evidence has outlined the implication of gut microbiota and gut-derived endotoxins as actively contributors to NAFLD pathophysiology probably due to the tight anatomo-functional crosstalk between the gut and the liver. Obesity, nutrition and environmental factors might alter intestinal permeability producing a favorable micro-environment for bacterial overgrowth, mucosal inflammation and translocation of both invasive pathogens and harmful byproducts, which, in turn, influence hepatic fat composition and exacerbated pro-inflammatory and fibrotic processes. To date, no therapeutic interventions are available for NAFLD prevention and management, except for modifications in lifestyle, diet and physical exercise even though they show discouraging results due to the poor compliance of patients. The premise of this review is to discuss the role of gut–liver axis in NAFLD and emphasize the beneficial effects of probiotics on gut microbiota composition as a novel attractive therapeutic strategy to introduce in clinical practice.

https://www.mdpi.com/2072-6643/11/11/2642/pdf

The Role of Probiotics in Nonalcoholic Fatty Liver Disease: A New Insight into Therapeutic Strategies.

Effects of continuous use of probiotics before liver transplantation: A randomized, double-blind, placebo-controlled trial

Introduction: Hepatic resection is the accepted treatment for various liver tumors. Increasing evidence suggests that two factors significantly influence outcome and successfulness of the hepatic resection in patients with HCC in cirrhosis. There are liver function recovery and the degree of inflammation during early postoperative period. Objective: Aim of this study was to determine whether probiotic use influences on liver function recovery, degree of inflammation during early postoperative period, intraoperative risk, type and frequency of intraoperative and postoperative complications, morbidity, intraoperative and early postoperative mortality and a one-year survival rate in patients who have been used probiotic, and underwent the hepatic resection due to HCC in cirrhosis. Patients and methods : Study was conducted on 120 patients underwent the hepatic resection due to HCC in cirrhosis. This study has been done in University Clinical Centers Tuzla, Maribor and Strasbourg from October 2006 till February 2008. Patients were divided into 2 groups: 1) patients with liver cirrhosis and histologically verified HCC whom underwent liver resection surgery (segmentectomy/ bisegmenctetomy, right and left hemihepatectomy/extended hemihepatectomy) that used preoperatively and postoperatively probiotics (n = 60), 2) a control group of patients with liver cirrhosis and HCC, which did not use preoperative and postoperative probiotics (N = 60). Treatment with probiotics was conducted 3 days preoperatively and postoperatively with 7 day’s oral supplementation. Results: This study have shown next: patients underwent to the hepatic resection due to HCC in cirrhosis who have been used preoperatively and postoperatively probiotic had liver function recovery better and faster, acute immune response better, serum level of tumor markers lower, intraoperative and postoperative complications were less frequent, and morbidity and mortality rates were lower than in those who have not been using probiotic. Conclusion: Probiotic use may make liver function recovery better and increases immune response in early postoperative period and positively influences outcome and successfulness of the hepatic resection in patients with HCC in cirrhosis.

/pdf/effect-of-probiotics-on-liver-function-after-surgery-2rr6tskper.pdf

Effect of probiotics on liver function after surgery resection for malignancy in the liver cirrhotic.

Increasing gap between demand and availability of human kidneys for transplantation has forced a re-evaluation of the limits on donor age acceptability. The present study included 74 patients who underwent kidney transplantation in University Clinical Centre Tuzla. In an observational cohort study we assessed impact of donor age on post transplant renal function by analyzing following parameters: 24 hour urine output, creatinine clearance (Cr Cl) and glomerular filtration rate (GFR). Depending on donor age recipients were allocated in to two groups. Group I included patients who received renal graft from donors age up to 55 years, and Group II encountered recipients who received renal graft from donors older than 55 years. Our goal was to determine whether donor age over 55 years significantly diminishes renal graft function in first seven post transplant days. No statistically significant difference was found between Group I and II regarding 24 hour urine output. From second to fifth postoperative day creatinine clearance values were higher in the group of patients who received kidney from donors older than 55 years (47±19, 1 vs. 44, 4±20, 8). On the fifth, sixth and seventh post operative day GFR was significantly higher in patients who received renal graft from donors age up to 55 years (p 55 years is acceptable and may considerably expand the donor pool.

/pdf/influence-of-donor-age-on-renal-graft-function-in-first-3rx6ceteue.pdf

Influence of donor age on renal graft function in first seven post transplant days.

Primary spontaneous pneumothorax (PSP ) is a benign disease frequently found in younger and healthy-looking persons. It requires a surgical treatment in about 30-40% of cases. Video-assisted thoracoscopic surgery (VATS) has been recently introduced as a reliable alternative method to the classic thoracotomy. The aim of this paper is to establish and compare the length of surgical procedure, pain intensity, number and kind of postsurgical complications during the procedure for the patients with PNTX treated by VATS in relation to the patients with PNTX treated by thoracotomy. This is a retrospective study. The patients are divided into two groups: the first group of 50 patients treated with VATS and the second group of 50 patients treated with thoracotomy. The results obtained show a significantly shorter surgery duration in the group of the patients treated with VATS in relation to the group of patients treated by thoracotomy (p‹0,001). Video-assisted thoracoscopic surgery is characterized by a significantly low intensity of postsurgical pain in relation to thoracotomy (p‹0,001). The number and kind of postsurgical complications are similar in both target groups (p›0,05). Only one relapse occurred in the VATS group. Video-assisted thoracoscopic surgery improves patients’ life quality in relation to the thoracotomy patients. The patients return to work, or to sport activities after a very short time because of minimal sequels. That is why this method represents an obvious socio-economic interest. Today, in the era of a great video-development, VATS method is a treatment of choice for PSP.

Video-assisted thoracoscopic surgery for spontaneous pneumothorax.

UNLABELLED The gallbladder cancer is the most common primary cancer of the hepatobiliary system, and ranks fifth of the cancers of the gastrointestinal system. It is accidentaly found in 1-3 % of patients with gallstone disease, and in 0,5-2,4% on postmortem exam. GOAL Show the incidence, clinical state, and suplement the diagnostic procedure of the patients with the risk factors for gallbladder cancer. Find proper surgical treatment in every stage of the disease according to Nevin-Moran system and the hystological type of the cancer. METHODS Retrospectively we evaluated all cholecystectomies in our hospital in a three year period. We established the incidence of gallbladder cancer and we tried to discover the common characteristics of this group of patients. We analized the histological type of the cancer, and the stage of the disease in correlation with clinical presentation, results of the surgical treatment , and the survival and the quality of life. RESULTS In three years we performed 2553 cholecystectomies, and in 1,7 % of patients -43 patient we discovered the cancer of gallbladder. It is 5 times more common in females. The mean age of the patients with gallbladder cancer is 65 years (55 - 82 years). The etiology of this disease is unknown. In 5 (11,6 %) patients cancer is discovered preoperatively. In 38 (88,4 %) patients it was adenocarcinoma of the gallbladder. Other morphologic types are analplastic cancer, carcinosarcoma, and "squamous cell carcinoma". In 30 patients (69,8 %) we performed cholecystectomy, and in 8 (18,6%) patients extended cholecystectomy with its components. Radical resective procedures on liver were performed in 5 (11,6%) patients. According to the localisation in 60% of cases the cancer was located in fundus, in 30% of cases in corpus,and 10% of cases in the neck of the gallbladder. No patient with stage V survived 1 year after the procedure. CONCLUSION The incidence of the gallbladder cancer in our series is in the slight increase. The quality of life and the survival are inversely correlated with the depth of the invasion and the extent of the spread of the cancer. The extensive surgical procedures in advanced stage of the disease, because of the grim prognosis, does not justify the risk of the operative treatment.

Incidence and surgical treatment of cancer in gallbladder

The aim of this study was to evaluate the incidence, clinical data and patterns of mediastinal lymph node metastasis (pN2) in non-small-cell lung cancer patients who underwent systematic mediastinal lymph node dissection (SMLND). We retrospectively studied 140 consecutive patients [125 male and 15 female, mean ages 54.61 +/- 9.23 years (range, 21-75)], underwent SMLND and major lung resections due to non-small lung cancer (NSCLC), from January 2005 till December 2009. Preoperative clinical staging for mediastinal lymph node metastasis was negative (cN0) in all patients. SMLND was defined as a complete removal of mediastinal lymph nodes. Clinicalpathological data were compared according to the pN stage. Lymph node metastasis to the mediastinum was confirmed in 13 (9.28%) patients. In squamous cell cancer pN2 were in 8 (5.71%) cases out of 82 cases with cN0. On the other side in the adenocarcinomas pN2 were in 5 (3.57%) cases out of 48 with cN0. Unvaried analysis revealed central tumor site as predictive factor for mediastinal lymph node involvement. The upper mediastinal compartment was infiltrated in 12 (8.57%) cases, middle in 8 (5.71%) and lower in 3 (2.14%) cases. Pneumonectomy was the most performed surgical procedure in pN2 patients. We concluded that SMLND improves pTNM staging in lung cancer patients who underwent major lung resections with central location of the tumour.

/pdf/mediastinal-lymph-node-metastasis-pattern-in-clinically-n0-31b6whx3ig.pdf

Mediastinal lymph node metastasis pattern in clinically N0 non-small-cell lung cancer patients who underwent surgical resection.

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