https://www.commed.vcu.edu/Chronic_Disease/2012/cochranrvwrschbias.pdf

The Cochrane Collaboration's tool for assessing risk of bias in randomised trials

Solitary fibrous tumors: Clinical and imaging features from head to toe

PURPOSE Minimally invasive surgery has been universally accepted as a valid option for the treatment of diverticular disease, provided specific expertise is available. Over the last decade, there has been a growing interest in the application of robotic approaches for diverticular disease. We aimed at evaluating whether robotic colectomy may offer some advantages over the laparoscopic approach for surgical treatment of diverticular disease by meta-analyzing the available data from the medical literature. METHODS The PubMed/Medline, EMBASE, and Web Of Sciences electronic databases were searched for literature up to December 2020. Inclusion criteria considered all comparative studies evaluating robotic versus laparoscopic colectomy for diverticulitis eligible. The conversion rate to the open approach was evaluated as the primary outcome. RESULTS The data of 4177 patients from nine studies were included in the analysis. There were no significant differences in the baseline characteristics. Patients undergoing laparoscopic colectomy compared to those who underwent surgery with a robotic approach had a significantly higher risk of conversion into an open procedure (12.5% vs. 7.4%, p < 0.00001) and abbreviated hospital stay (p < 0.0001) at the price of a longer operating time (p < 0.00001). CONCLUSION Compared with conventional laparoscopic surgery, the robotic approach offers significant advantages in terms of conversion rate and shortened hospital stay for the treatment of diverticular disease. However, because of the lack of available evidence, it is impossible to draw definitive conclusions.

/pdf/correction-to-robotic-versus-conventional-laparoscopic-4i13qth1s3.pdf

Correction to: Robotic versus conventional laparoscopic technique for the treatment of left‑sided colonic diverticular disease: a systematic review with meta‑analysis.

Advances in Rectal Cancer Surgery.

Wesentlicher Bestandteil der Therapie des kolorektalen Karzinoms ist die Resektion des tumortragenden Darmsegments. Mit der Entwicklung minimal-invasiver Verfahren stellt sich die Frage nach Anwendbarkeit und Sicherheit derselben im onkologischen kolorektalen Setting. Die breite Studienlage der letzten Jahre zeigt fur das Kolonkarzinom weitgehend konsistent Vorteile in der perioperativen Phase bei Nichtunterlegenheit bez. onkologischer Aspekte im Langzeitverlauf. Die Implementierung der laparoskopischen Rektumresektion erfolgte bedingt durch die Komplexitat des Eingriffs und die unzureichende Studienlage deutlich zogerlicher. Insgesamt erscheint jedoch auch diese bei perioperativen Vorteilen, aber heterogenen Befunden im Hinblick auf die Resektatqualitat langfristig dem offenen Verfahren nicht unterlegen. Dementsprechend hat eine Empfehlung fur eine laparoskopische Resektion bei kolorektalem Karzinom auch in den Grosteil der Leitlinien Einzug gehalten. Dabei tragt die Einschrankung bez. einer erreichbaren onkologischen Gleichwertigkeit nur bei hinreichender Expertise des Operateurs und rationaler Patientenselektion der Komplexitat und den Anforderungen des Eingriffs Rechnung.

Evidence in minimally invasive oncological surgery of the colon and rectum

Background To analyze pathologic and perioperative outcomes of laparoscopic vs. open resections for rectal cancer performed over the last 10 years. Methods A systematic literature search of the following databases was conducted: Cochrane Central Register of Controlled Trials, MEDLINE (through PubMed), EMBASE, and Scopus. Only articles published in English from January 1, 2008 to December 31, 2018 (i.e. the last 10 years), which met inclusion criteria were considered. The review only included articles which compared Laparoscopic rectal resection (LRR) and Open Rectal Resection (ORR) for rectal cancer and reported at least one of the outcomes of interest. The analyses followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement checklist. Only prospective randomized studies were considered. The body of evidence emerging from this study was evaluated using the Grading of Recommendations Assessment Development and Evaluation (GRADE) system. Outcome measures (mean and median values, standard deviations, and interquartile ranges) were extracted for each surgical treatment. Pooled estimates of the mean differences were calculated using random effects models to consider potential inter-study heterogeneity and to adopt a more conservative approach. The pooled effect was considered significant if p <0.05. Results Five clinical trials were found eligible for the analyses. A positive involvement of CRM was found in 49 LRRs (8.5%) out of 574 patients and in 30 ORRs out of 557 patients (5.4%) RR was 1.55 (95% CI, 0.99–2.41; p = 0.05) with no heterogeneity (I2 = 0%). Incorrect mesorectal excision was observed in 56 out of 507 (11%) patients who underwent LRR and in 41 (8.4%) out of 484 patients who underwent ORR; RR was 1.30 (95% CI, 0.89–1.91; p = 0.18) with no heterogeneity (I2 = 0%). Regarding other pathologic outcomes, no significant difference between LRR and ORR was observed in the number of lymph nodes harvested or concerning the distance to the distal margin. As expected, a significant difference was found in the operating time for ORR with a mean difference of 41.99 (95% CI, 24.18, 59.81; p <0.00001; heterogeneity: I2 = 25%). However, no difference was found for blood loss. Additionally, no significant differences were found in postoperative outcomes such as postoperative hospital stay and postoperative complications. The overall quality of the evidence was rated as high. Conclusion Despite the spread of laparoscopy with dedicated surgeons and the development of even more precise surgical tools and technologies, the pathological results of laparoscopic surgery are still comparable to those of open ones. Additionally, concerning the pathological data (and particularly CRM), open surgery guarantees better results as compared to laparoscopic surgery. These results must be a starting point for future evaluations which consider the association between ‘‘successful resection” and long-term oncologic outcomes. The introduction of other minimally invasive techniques for rectal cancer surgery, such as robotic resection or transanal TME (taTME), has revealed new scenarios and made open and even laparoscopic surgery obsolete.

/pdf/laparoscopic-vs-open-mesorectal-excision-for-rectal-cancer-48t1sp0l6d.pdf

Laparoscopic vs. open mesorectal excision for rectal cancer: Are these approaches still comparable? A systematic review and meta-analysis

Doege-Potter syndrome by malignant solitary fibrous tumor of the liver: A case report and review of literature

Pancreatic neuroendocrine tumours (PNETs) are a rare and heterogeneous group of tumours with various clinical manifestations and biological behaviours. They represent approximately 2–4% of all pancreatic tumours, with an incidence of 2–3 cases per million people. PNETs are classified clinically as non-functional or functional, and pancreatic resection is recommended for lesions greater than 2 cm. The surgical approach can involve “typical” and “atypical” resections depending on the number, size and location of the tumour. Typical resections include pancreaticoduodenectomy, distal pancreatectomy enucleation and, rarely, total pancreatectomy. Atypical resections comprise central pancreatectomies or enucleations. Minimally invasive pancreatic resection has been proven to be technically feasible and safe in high-volume and specialized centres with highly skilled laparoscopic surgeons, with consolidated benefits for patients in the postoperative course. However, open and minimally invasive pancreatic surgery remains to have a high rate of complications; there is no specific technical contraindication to minimally invasive pancreatic surgery, but an appropriate patient selection is crucial to obtain satisfactory clinical and oncological outcomes.

The Role of Laparoscopic Surgery in Localized Pancreatic Neuroendocrine Tumours

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Laparoscopic vs. open mesorectal excision for rectal cancer: Are these approaches still comparable? A systematic review and meta-analysis

Doege-Potter syndrome by malignant solitary fibrous tumor of the liver: A case report and review of literature

The Role of Laparoscopic Surgery in Localized Pancreatic Neuroendocrine Tumours