Similarities and differences between study designs in short‐ and long‐term outcomes of laparoscopic versus open low anterior resection for rectal cancer: A systematic review and meta‐analysis of randomized, case‐matched, and cohort studies

[Aim] Randomized controlled trials (RCT) are the gold standard in surgical research, and case-matched studies, such as studies with propensity score matching, are expected to serve as an alternative to RCT. Both study designs have been used to investigate the potential superiority of laparoscopic surgery to open surgery for rectal cancer, but it remains unclear whether there are any differences in the findings obtained using these study designs. We aimed to examine similarities and differences between findings from different study designs regarding laparoscopic surgery for rectal cancer. [Methods] Systematic review and meta-analyses. A comprehensive literature search was conducted using PubMed, Scopus, and Cochrane. RCT, case-matched studies, and cohort studies comparing laparoscopic low anterior resection and open low anterior resection for rectal cancer were included. In total, 8 short-term outcomes and 3 long-term outcomes were assessed. Meta-analysis was conducted stratified by study design using a random-effects model. [Results] Thirty-five studies were included in this review. Findings did not differ between RCT and case-matched studies for most outcomes. However, the estimated treatment effect was largest in cohort studies, intermediate in case-matched studies, and smallest in RCT for overall postoperative complications and 3-year local recurrence. [Conclusion] Findings from case-matched studies were similar to those from RCT in laparoscopic low anterior resection for rectal cancer. However, findings from case-matched studies were sometimes intermediate between those of RCT and unadjusted cohort studies, and case-matched studies and cohort studies have a potential to overestimate the treatment effect compared with RCT

Spontaneous Regression of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus

An 83-year-old man underwent transcatheter arterial chemoembolization (TACE) for a 20-mm hepatocellular carcinoma (HCC) in Couinaud’s segment 4. Computed tomography (CT) 4 months after TACE showed tumor thrombus in the portal vein in addition to diffuse metastases and arterioportal shunts in the left lobe. Although we performed the best supportive care, the tumor thrombus in the portal vein and tumors in the left lobe had completely disappeared on CT 16 months after the TACE. Rapidly grown portal vein tumor thrombus and arterioportal shunt might be the causes of spontaneous regression of HCC, probably associated with tumor hypoxia

Inter-individual differences in working memory improvement after acute mild and moderate aerobic exercise.

Many studies have shown that aerobic exercise improves cognitive function and maintains brain health. In particular, moderate-intensity exercise is effective for improving cognitive performance. However, there is no strong consensus on whether a single exercise session improves working memory (WM) function, as it does inhibitory function. It is possible that these discrepancies involve inter-individual differences in WM function. Therefore, we investigated whether acute mild and moderate aerobic exercise improve WM, and whether there exist inter-individual differences in improvements in WM. Thirty healthy subjects were recruited and participated in three experimental conditions (control, mild-intensity exercise, and moderate-intensity exercise). Subjects performed 10 min of exercise on a cycle ergometer with an individualized load. Their pedaling rate was maintained at 60 rpm. In the control condition, subjects rested on the cycle ergometer instead of performing exercise. The N-back task (2-back and 0-back task) was performed to assess WM function before, 5 min, and 15 min after the 10-min exercise session. In this study, to elucidate the effect of an acute bout of mild or moderate exercise on WM, the "2-back- 0-back" contrast, which is assumed to represent WM function, was calculated. The Two-Dimensional Mood Scale was adopted to measure changes in psychological mood states efficiently. The results revealed that working memory function was not improved by acute mild or moderate exercise. However, baseline working memory function was significantly associated with any change in working memory function following exercise, and this was independent of exercise intensity. Subjects with the lowest working memory function at baseline responded the most favorably. The results revealed that improvements in working memory function after a single session of aerobic exercise depend on baseline working memory function

Symptomatic Liver Cyst Successfully Treated with Transgastric Drainage and Sclerotherapy Using Minocycline Hydrochloride

A liver cyst is hepatic fluid-filled cavities often detected in clinical surveillances such as a health examination. Although the liver cyst is usually asymptomatic and observed without any therapeutic intervention, it can be symptomatic and needs treatment due to its enlargement, hemorrhage, and infection. A 74-year-old woman presented with upper abdominal pain and a huge liver cyst in the left lobe. Several examinations including image findings revealed that the symptom could be derived from the liver cyst. Although there is no definite guideline of treatment for symptomatic liver cysts, percutaneous ultrasound-guided drainage with sclerotherapy or surgery is often selected. Because of anatomical accessibility to the liver cyst and the patient’s wish, we performed endoscopic transgastric drainage with insertion of both an internal stent and an external nasocystic tube. Sclerotherapy with minocycline hydrochloride was performed through the nasocystic tube, and the liver cyst shrunk completely without any complications. This is the first reported method of administering minocycline hydrochloride through a nasocystic tube, which can be a therapeutic option for patients with symptomatic liver cysts

Autoimmune hepatitis complicated by adult‐onset Still's disease during treatment with tocilizumab: A case report from acute onset to recurrence

Key Clinical Message The characteristics of liver dysfunction due to adult‐onset Still's disease are not specific. Differentiating from autoimmune hepatitis is important in deciding whether to continue corticosteroid therapy, and also in terms of management of cirrhosis and surveillance of hepatocellular carcinoma. Liver biopsy is thought to be the most important determinant for differential diagnosis

Clinical-Pathologic Characteristics and Long-term Outcomes of Left Flexure Colonic Cancer: A Retrospective Analysis of an International Multicenter Cohort

BACKGROUND: Colorectal cancer seldom presents at the splenic flexure. Small series on left flexure tumors reported a high occurrence of negative prognostic factors called into question as causes of poor prognosis. However, because of the small number of cases, no definite conclusions can be drawn.OBJECTIVE: The aim of this study was to compare clinical-pathologic characteristics and short- and long-term outcomes of left flexure tumors with other colonic locations.DESIGN: This was a retrospective analysis of consecutive patients who underwent surgery for tumors at the splenic flexure. Each tumor was paired in a 1 to 1 fashion with a right-sided and sigmoid tumor.SETTINGS: The study was conducted in 10 international centers.PATIENTS: A total of 641 patients with left flexure tumors were included in the study.MAIN OUTCOME MEASURES: Overall survival and cancer-specific survival were measured.RESULTS: Left flexure tumors presented more frequently with stenosis (30.5%; p < 0.001), with lesions infiltrating beyond the serosa (21.9%; p = 0.001) and with a high rate of mucinous histology (8.8%; p = 0.001). Looking at long-term prognosis, no differences were observed among the 3 groups, both considering overall and cancer-specific survival. However, left flexure tumors recurred more frequently as peritoneal carcinomatosis (20.6%; p < 0.001).LIMITATIONS: This study was limited because of its retrospective nature.CONCLUSIONS: Although left flexure tumors display several negative prognostic factors, they are not characterized by a worse prognosis compared with other colon cancer locations. See Video Abstract at http://links.lww.com/DCR/B395. CARACTERISTICAS CLINICO-PATOLOGICAS Y RESULTADOS A LARGO PLAZO DEL CANCER DE COLON DE ANGULO IZQUIERDO: UN ANALISIS RETROSPECTIVO DE UNA COHORTE MULTICENTRICA INTERNACIONAL: El cancer colorrectal rara vez se presenta en el angulo esplenico. Pequenas series sobre tumores de angulo izquierdo informaron una alta incidencia de factores pronosticos negativos cuestionados como causas de mal pronostico. Sin embargo, debido al pequeno numero de casos, no se pueden sacar conclusiones definitivas.El objetivo de este estudio fue comparar las caracteristicas clinico-patologicas, los resultados a corto y largo plazo de los tumores de angulo izquierdo con otras ubicaciones de colon.Analisis retrospectivo de pacientes consecutivos que se sometieron a cirugia por tumores en el angulo esplenico. Cada tumor se emparejo de forma individual con un tumor del lado derecho y sigmoide.El estudio se realizo en 10 centros internacionales.Se incluyeron en el estudio un total de 641 pacientes con tumores del angulo izquierdo.Supervivencia general y especifica del cancerLos tumores de angulo izquierda se presentaron con mayor frecuencia con estenosis (30.5%, p <0.001), con lesiones infiltradas mas alla de la serosa (21.9%, p = 0.001), y con una alta tasa de histologia mucinosa (8.8%, p = 0.001). En cuanto al pronostico a largo plazo, no se observaron diferencias entre los tres grupos, considerando la supervivencia general y especifica del cancer. Sin embargo, los tumores de angulo izquierdo recurrieron con mayor frecuencia como carcinomatosis peritoneal (20,6%; p <0,001).Este estudio fue limitado debido a su naturaleza retrospectiva.Aunque los tumores de angulo izquierdo muestran varios factores pronosticos negativos, no se caracterizan por un peor pronostico en comparacion con otras ubicaciones de cancer de colon. Consulte Video Resumen en http://links.lww.com/DCR/B395

Laparoscopic versus open surgery for left flexure colon cancer: A propensity score matched analysis from an international cohort

Aim Surgical treatment of splenic flexure cancer (SFC) still presents some debated issues, including the role of laparoscopic surgery. The literature is based on small single-centre series, while randomized controlled studies comparing open and laparoscopic treatment for colon cancer exclude SFC. This study aimed to determine the role of laparoscopic surgery in the treatment of SFC, comparing short- and long-term outcomes with open surgery. Method This was an international multicentre retrospective cohort study that analysed patients from 10 tertiary referral centres. From a cohort of 641 cases, 484 patients with Stage I-III SFC submitted to elective surgery with curative intent were selected. After 1:1 propensity score matching, 130 patients in the laparoscopic group (LapGroup) were compared with 130 patients in the open surgery group (OpenGroup). Results After propensity score matching, the two groups were comparable for demographic and clinical parameters. OpenGroup presented a higher incidence of overall (P = 0.02) and surgery-related complications (P = 0.05) but a similar rate of severe complications (P = 0.75). Length of stay was notably shorter in the LapGroup (P = 0.001). Overall (P = 0.793) as well as cancer-specific survival (P = 0.63) did not differ between the two groups. Conclusions Elective laparoscopic surgery for Stage I-III SFC is feasible and associated with improved short-term postoperative outcomes compared to open surgery. Moreover, laparoscopic surgery appears to provide excellent long-term cancer outcomes