Publications
334 results found
Kamarajah SK, Phillips AW, Hanna GB, et al., 2022, Is Local Endoscopic Resection a Viable Therapeutic Option for Early Clinical Stage T1a and T1b Esophageal Adenocarcinoma? A Propensity-matched Analysis, ANNALS OF SURGERY, Vol: 275, Pages: 700-705, ISSN: 0003-4932
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- Citations: 10
Sounderajah V, Ashrafian H, Karthikesalingam A, et al., 2022, Developing Specific Reporting Standards in Artificial Intelligence Centred Research, ANNALS OF SURGERY, Vol: 275, Pages: E547-E548, ISSN: 0003-4932
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- Citations: 5
Kroese TE, van Hillegersberg R, Schoppmann S, et al., 2022, Definitions and treatment of oligometastatic oesophagogastric cancer according to multidisciplinary tumour boards in Europe, EUROPEAN JOURNAL OF CANCER, Vol: 164, Pages: 18-29, ISSN: 0959-8049
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- Citations: 14
Chidambaram S, Sounderajah V, Maynard N, et al., 2022, ASO Author Reflections: Applications of Artificial Intelligence in Oesophago-Gastric Malignancies-Present Work and Future Directions, ANNALS OF SURGICAL ONCOLOGY, Vol: 29, Pages: 1991-1992, ISSN: 1068-9265
Chidambaram S, Sounderajah V, Maynard N, et al., 2022, ASO Visual Abstract: Diagnostic Performance of Artificial Intelligence-Centered Systems in the Diagnosis and Postoperative Surveillance of Upper Gastrointestinal Malignancies Using Computed Tomography Imaging: A Systematic Review and Meta-Analysis of Diagnostic Accuracy, ANNALS OF SURGICAL ONCOLOGY, Vol: 29, Pages: 1993-1994, ISSN: 1068-9265
Chidambaram S, Sounderajah V, Maynard N, et al., 2022, Diagnostic Performance of Artificial Intelligence-Centred Systems in the Diagnosis and Postoperative Surveillance of Upper Gastrointestinal Malignancies Using Computed Tomography Imaging: A Systematic Review and Meta-Analysis of Diagnostic Accuracy, ANNALS OF SURGICAL ONCOLOGY, Vol: 29, Pages: 1977-1990, ISSN: 1068-9265
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- Citations: 7
Eyck BM, Klevebro F, Van der Wilk BJ, et al., 2022, Lasting symptoms and long-term health-related quality of life after totally minimally invasive, hybrid and open Ivor Lewis esophagectomy, EJSO, Vol: 48, Pages: 582-588, ISSN: 0748-7983
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- Citations: 6
Kamarajah SK, Phillips AW, Hanna GB, et al., 2022, Definitive Chemoradiotherapy Compared to Neoadjuvant Chemoradiotherapy With Esophagectomy for Locoregional Esophageal Cancer: National Population-based Cohort Study, ANNALS OF SURGERY, Vol: 275, Pages: 526-533, ISSN: 0003-4932
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- Citations: 19
Chidambaram S, Maheswaran Y, Chan C, et al., 2022, Misinformation About the Human Gut Microbiome in YouTube Videos: Cross-sectional Study (Preprint)
<sec> <title>BACKGROUND</title> <p>Social media platforms such as YouTube are integral tools for disseminating information about health and wellness to the public. However, anecdotal reports have cited that the human gut microbiome has been a particular focus of dubious, misleading, and, on occasion, harmful media content. Despite these claims, there have been no published studies investigating this phenomenon within popular social media platforms.</p> </sec> <sec> <title>OBJECTIVE</title> <p>The aim of this study is to (1) evaluate the accuracy and reliability of the content in YouTube videos related to the human gut microbiome and (2) investigate the correlation between content engagement metrics and video quality, as defined by validated criteria.</p> </sec> <sec> <title>METHODS</title> <p>In this cross-sectional study, videos about the human gut microbiome were searched for on the United Kingdom version of YouTube on September 20, 2021. The 600 most-viewed videos were extracted and screened for relevance. The contents and characteristics of the videos were extracted and independently rated using the DISCERN quality criteria by 2 researchers.</p> </sec> <sec> <title>RESULTS</title> <p>Overall, 319 videos accounting for 62,354,628 views were included. Of the 319 videos, 73.4% (n=234) were produced in North America and 78.7% (n=251) were uploaded between 2019 and 2021. A total of 41.1% (131/319) of videos were produced by nonprofit organizations. Of the videos, 16.3% (52/319) included an advertisement for a product or promoted a health
Chidambaram S, Sounderajah V, Maynard N, et al., 2022, Evaluation of postoperative surveillance strategies for esophago-gastric cancers in the UK and Ireland, DISEASES OF THE ESOPHAGUS, Vol: 35, ISSN: 1120-8694
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- Citations: 1
Chidambaram S, Markar SR, 2022, Clinical utility and applicability of circulating tumor DNA testing in esophageal cancer: a systematic review and meta-analysis., Dis Esophagus, Vol: 35
Esophageal cancer is an aggressive malignancy with a relatively poor prognosis even after multimodality therapy. Currently, patients undergo a series of investigations that can be invasive and costly or pose secondary risks to their health. In other malignancies, liquid biopsies of circulating tumor DNA (ctDNA) are used in clinical practice for diagnostic and surveillance purposes. This systematic review summarizes the latest evidence for the clinical applicability of ctDNA technology in esophageal cancer. A systematic review of the literature was performed using MEDLINE, EMBASE, the Cochrane Review and Scopus databases. Articles were evaluated for the use of ctDNA for diagnosis and monitoring of patients with esophageal cancer. Quality assessment of studies was performed using the QUADAS-2 tool. A meta-analysis was performed to assess the diagnostic accuracy of sequencing methodologies. We included 15 studies that described the use of ctDNA technology in the qualitative synthesis and eight studies involving 414 patients in the quantitative analysis. Of these, four studies assessed its utility in cancer diagnosis, while four studies evaluated its use for prognosis and monitoring. The pooled sensitivity and specificity for diagnostic studies were 71.0% (55.7-82.6%) and 98.6% (33.9-99.9%), while the pooled sensitivity and specificity for surveillance purposes were 48.9% (29.4-68.8%) and 95.5% (90.6-97.9%). ctDNA technology is an acceptable method for diagnosis and monitoring with a moderate sensitivity and high specificity that is enhanced in combination with current imaging methods. Further work should demonstrate the practical integration of ctDNA in the diagnostic and surveillance clinical pathway.
Liu Y, Pettersson E, Schandl A, et al., 2022, Psychological distress after esophageal cancer surgery and the predictive effect of dispositional optimism: a nationwide population-based longitudinal study, SUPPORTIVE CARE IN CANCER, Vol: 30, Pages: 1315-1322, ISSN: 0941-4355
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- Citations: 5
Markar SR, Zaninotto G, Castoro C, et al., 2022, Lasting Symptoms After Esophageal Resection (LASER) European Multicenter Cross-sectional Study, ANNALS OF SURGERY, Vol: 275, Pages: E392-E400, ISSN: 0003-4932
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- Citations: 23
Zaninotto G, Markar S, 2022, Management of oesophageal achalasia in POEM (and Google) times, British Journal of Surgery, Vol: 109, Pages: 150-151, ISSN: 0007-1323
Sounderajah V, 2022, Quality assessment standards in artificial intelligence diagnostic accuracy systematic reviews: a meta-research study, npj Digital Medicine, Vol: 5, Pages: 1-13, ISSN: 2398-6352
Artificial intelligence (AI) centred diagnostic systems are increasingly recognized as robust solutions in healthcare delivery pathways. In turn, there has been a concurrent rise in secondary research studies regarding these technologies in order to influence key clinical and policymaking decisions. It is therefore essential that these studies accurately appraise methodological quality and risk of bias within shortlisted trials and reports. In order to assess whether this critical step is performed, we undertook a meta-research study evaluating adherence to the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool within AI diagnostic accuracy systematic reviews. A literature search was conducted on all studies published from 2000 to December 2020. Of 50 included reviews, 36 performed quality assessment, of which 27 utilised the QUADAS-2 tool. Bias was reported across all four domains of QUADAS-2. 243 of 423 studies (57.5%) across all systematic reviews utilising QUADAS-2 reported a high or unclear risk of bias in the patient selection domain, 110 (26%) reported a high or unclear risk of bias in the index test domain, 121 (28.6%) in the reference standard domain and 157 (37.1%) in the flow and timing domain. This study demonstrates incomplete uptake of quality assessment tools in reviews of AI-based diagnostic accuracy studies and highlights inconsistent reporting across all domains of quality assessment. Poor standards of reporting act as barriers to clinical implementation. The creation of an AI specific extension for quality assessment tools of diagnostic accuracy AI studies may facilitate the safe translation of AI tools into clinical practice.
Sounderajah V, Normahani P, Aggarwal R, et al., 2022, Reporting Standards and Quality Assessment Tools in Artificial Intelligence-Centered Healthcare Research, Artificial Intelligence in Medicine, Pages: 385-395, ISBN: 9783030645724
The practice of incomplete study reporting is rife within scientific literature. It hinders the adoption of technologies, introduces considerable “research waste, " and represents a significant moral hazard. In order to combat this issue, there has been a shift towards the use of reporting standards and quality assessment tools, a move that has been endorsed by major biomedical journals as well as other key stakeholders. These instruments help [1] to improve the quality and completeness of study reporting as well as [2] to aid researchers in their assessment of a study’s risk of bias and applicability. These instruments are carefully created through a multistep evidence generation process and are specific to individual study designs or specialties. Recently, it has been noted that many of the existing instruments are poorly suited to aid the reporting and assessment of artificial intelligence (AI)- based studies on account of their niche study considerations. As such, there has been a concerted effort to produce AI-specific extensions to preexisting instruments, such as CONSORT, SPIRIT, STARD, TRIPOD, QUADAS, and PROBAST. This chapter expands upon why AI-specific amendments to these instruments are required in addition to highlighting their contents and proposed scope.
Kamarajah SK, Markar SR, 2022, Esophagectomy or Total Gastrectomy for Siewert 2 Gastroesophageal Junction (GEJ) Adenocarcinoma: An Ongoing Debate., Ann Surg Oncol, Vol: 29
Wiggins T, Jamel S, Hakky S, et al., 2022, Assurance of surgical quality within multicenter randomized controlled trials for bariatric and metabolic surgery: a systematic review, 11th Annual Scientific Meeting of the British-Obesity-and-Metabolic-Surgery-Society (BOMSS), Publisher: ELSEVIER SCIENCE INC, Pages: 124-132, ISSN: 1550-7289
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- Citations: 1
Hagens E, Tukanova K, Jamel S, et al., 2022, Prognostic relevance of lymph node regression on survival in esophageal cancer: a systematic review and meta-analysis, DISEASES OF THE ESOPHAGUS, Vol: 35, ISSN: 1120-8694
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- Citations: 6
Tukanova K, Chidambaram S, Guidozzi N, et al., 2021, Physiotherapy regimens in esophagectomy and gastrectomy: a systematic review and meta-analysis, Annals of Surgical Oncology, Vol: 29, ISSN: 1068-9265
BackgroundEsophageal and gastric cancer surgery are associated with considerable morbidity, specifically postoperative pulmonary complications (PPCs), potentially accentuated by underlying challenges with malnutrition and cachexia affecting respiratory muscle mass. Physiotherapy regimens aim to increase the respiratory muscle strength and may prevent postoperative morbidity.ObjectiveThe aim of this study was to assess the impact of physiotherapy regimens in patients treated with esophagectomy or gastrectomy.MethodsAn electronic database search was performed in the MEDLINE, EMBASE, CENTRAL, CINAHL and Pedro databases. A meta-analysis was performed to assess the impact of physiotherapy on the functional capacity, incidence of PPCs and postoperative morbidity, in-hospital mortality rate, length of hospital stay (LOS) and health-related quality of life (HRQoL).ResultsSeven randomized controlled trials (RCTs) and seven cohort studies assessing prehabilitation totaling 960 patients, and five RCTs and five cohort studies assessing peri- or postoperative physiotherapy with 703 total patients, were included. Prehabilitation resulted in a lower incidence of postoperative pneumonia and morbidity (Clavien–Dindo score ≥ II). No difference was observed in functional exercise capacity and in-hospital mortality following prehabilitation. Meanwhile, peri- or postoperative rehabilitation resulted in a lower incidence of pneumonia, shorter LOS, and better HRQoL scores for dyspnea and physical functioning, while no differences were found for the QoL summary score, global health status, fatigue, and pain scores.ConclusionThis meta-analysis suggests that implementing an exercise intervention may be beneficial in both the preoperative and peri- or postoperative periods. Further investigation is needed to understand the mechanism through which exercise interventions improve clinical outcomes and which patient subgroup will gain the maximal benefit.
Tukanova K, Chidambaram S, Guidozzi N, et al., 2021, ASO author reflections: the role of physiotherapy regimens in esophagectomy and gastrectomy for cancer, Annals of Surgical Oncology, Vol: 29, Pages: 3168-3169, ISSN: 1068-9265
PASTDespite advancements in surgical management, esophageal and gastric cancer surgery is still associated with a significant morbidity. Traditionally, esophagectomy and gastrectomy via an open surgical approach has been the treatment of choice for esophageal and gastric cancer, respectively.1,2 Enhanced recovery after surgery (ERAS) protocols commonly include physiotherapy regimens or early mobilization intervention. These programs are well-established in colorectal cancer surgery and have shown to reduce postoperative complication rates and shortened the length of hospital stay (LOS).3Only a small number of studies have assessed the role of respiratory physiotherapy in gastrointestinal cancer surgery, while this patient group commonly present with pre-existing respiratory disease and is particularly at risk for malnutrition and loss of muscle mass.4 Although there is growing evidence of the benefits of physiotherapy implementation in decreasing the risk for postoperative morbidity, there is currently insufficient strong evidence for routine implementation of standardized respiratory physiotherapy in esophageal and gastric cancer surgery.PRESENTThis is the first meta-analysis assessing the effect of prehabilitation and peri- or postoperative physiotherapy regimens on postoperative mortality and morbidity in esophageal and gastric cancer surgery.5 A lower incidence of pneumonia was observed following both prehabilitation and peri- or postoperative rehabilitation. Furthermore, a lower incidence of postoperative morbidity was seen in patients undergoing prehabilitation, while peri- or postoperative rehabilitation resulted in a shorter LOS and better health-related quality-of-life scores for dyspnea and physical functioning. These results suggest that implementation of a physiotherapy regimen in both the pre- and peri- or postoperative setting may be beneficial. This meta-analysis is however limited by the lack of a standardized physiotherapy protocol for patients unde
Markar S, Santoni G, Maret-Ouda J, et al., 2021, Hospital Volume of Antireflux Surgery in Relation to Endoscopic and Surgical Re-interventions., Ann Surg, Vol: 274, Pages: e1138-e1143
OBJECTIVE: To test the hypothesis that higher hospital volume decreases endoscopic and surgical re-intervention rates after antireflux surgery. BACKGROUND: Antireflux surgery for gastro-esophageal reflux disease is followed by varying rates of re-interventions. Whether hospital volume influences re-intervention rates is uncertain. METHODS: This population-based cohort study used nationwide data from Denmark, Finland, and Sweden for patients having undergone primary antireflux surgery. Hospitals were divided into tertiles based upon annual volume, that is, 3 equal-sized groups. The outcomes were 30-day surgical re-intervention, endoscopic re-intervention, and secondary antireflux surgery. Multivariable Cox regression provided hazard ratios (HRs) with 95% confidence intervals (CIs) for risk of the first outcome occurrence. Incidence rate ratios were calculated to count all outcome occurrences. All risk estimates were adjusted for age, sex, comorbidity, type of antireflux surgery, year of surgery, and country. RESULTS: Among 33,060 patients and a median follow-up of 12 years after antireflux surgery, the frequencies of 30-day re-intervention, endoscopic re-intervention, and secondary antireflux surgery were 1.2%, 4.6%, and 7.0%, respectively. When comparing the highest with the lowest tertiles, higher hospital volume did not decrease HRs of 30-day re-intervention (adjusted HR = 1.14, 95% CI 0.73-1.77), endoscopic re-intervention (HR = 1.21, 95% CI 0.96-1.51), or secondary antireflux surgery (HR = 1.28, 95% CI 1.05-1.54), but rather increased point estimates. The incidence rate ratios showed similar patterns. CONCLUSIONS: Higher hospital volume of primary antireflux surgery may not decrease risk of endoscopic or surgical re-intervention, suggesting that centralization will not decrease rates of postoperative complications or recurrence of gastro-esophageal reflux disease.
Markar SR, Hanna GB, 2021, Response to the Comment on: "Reintervention After Antireflux Surgery for Gastroesophageal Reflux Disease in England'' Markar et al. <i>Ann Surg 2020;271:709-715</i>, ANNALS OF SURGERY, Vol: 274, Pages: E763-E764, ISSN: 0003-4932
Beatty JW, Clarke JM, Sounderajah V, et al., 2021, Impact of the COVID-19 pandemic on emergency adult surgical patients and surgical services: an international multi-center cohort study and department survey., Annals of Surgery, Vol: 274, Pages: 904-912, ISSN: 0003-4932
OBJECTIVES: The PREDICT study aimed to determine how the COVID-19 pandemic affected surgical services and surgical patients and to identify predictors of outcomes in this cohort. BACKGROUND: High mortality rates were reported for surgical patients with COVID-19 in the early stages of the pandemic. However, the indirect impact of the pandemic on this cohort is not understood, and risk predictors are yet to be identified. METHODS: PREDICT is an international longitudinal cohort study comprising surgical patients presenting to hospital between March and August 2020, conducted alongside a survey of staff redeployment and departmental restructuring. A subgroup analysis of 3176 adult emergency patients, recruited by 55 teams across 18 countries is presented. RESULTS: Among adult emergency surgical patients, all-cause in-hospital mortality (IHM) was 3 6%, compared to 15 5% for those with COVID-19. However, only 14 1% received a COVID-19 test on admission in March, increasing to 76 5% by July.Higher Clinical Frailty Scale scores (CFS >7 aOR 18 87), ASA grade above 2 (aOR 4 29), and COVID-19 infection (aOR 5 12) were independently associated with significantly increased IHM.The peak months of the first wave were independently associated with significantly higher IHM (March aOR 4 34; April aOR 4 25; May aOR 3 97), compared to non-peak months.During the study, UK operating theatre capacity decreased by a mean of 63 6% with a concomitant 27 3% reduction in surgical staffing. CONCLUSION: The first wave of the COVID-19 pandemic significantly impacted surgical patients, both directly through co-morbid infection and indirectly as shown by increasing mortality in peak months, irrespective of COVID-19 status.Higher CFS scores and ASA grades strongly predict outcomes in surgical patients and are an important risk assessment tool during the pandemic.
Kamarajah SK, Phillips AW, Markar SR, et al., 2021, ASO Author Reflections: Challenges in the Management of Gastroesophageal Junctional Adenocarcinoma., Ann Surg Oncol, Vol: 28, Pages: 8495-8496
Kamarajah SK, Phillips AW, Griffiths EA, et al., 2021, Esophagectomy or Total Gastrectomy for Siewert 2 Gastroesophageal Junction (GEJ) Adenocarcinoma? A Registry-Based Analysis., Ann Surg Oncol, Vol: 28, Pages: 8485-8494
BACKGROUNDS: Due to a lack of randomized and large studies, the optimal surgical approach for Siewert 2 gastroesophageal junctional (GEJ) adenocarcinoma remains unknown. This population-based cohort study aimed to compare survival between esophagectomy and total gastrectomy for the treatment of Siewert 2 GEJ adenocarcinoma. METHODS: Data from the National Cancer Database (NCDB) from 2010 to 2016 was used to identify patients with non-metastatic Siewert 2 GEJ adenocarcinoma who received either esophagectomy (n = 999) or total gastrectomy (n = 8595). Propensity score-matching (PSM) and multivariable analyses were used to account for treatment selection bias. RESULTS: Comparison of the unmatched cohort's baseline demographics showed that the patients who received esophagectomy were younger, had a lower burden of medical comorbidities, and had fewer clinical positive lymph nodes. The patients in the unmatched cohort who received gastrectomy had a significantly shorter overall survival than those who received esophagectomy (median, 47 vs. 68 months [p < 0.001]; 5-year survival, 45 % vs. 53 %). After matching, gastrectomy was associated with significantly reduced survival compared with esophagectomy (median, 51 vs. 68 months [p < 0.001]; 5-year survival, 47 % vs. 53 %), which remained in the adjusted analyses (hazard ratio [HR], 1.22; 95 % confidence interval [CI], 1.09-1.35; p < 0.001). CONCLUSIONS: In this large-scale population study with propensity-matching to adjust for confounders, esophagectomy was prognostically superior to gastrectomy for the treatment of Siewert 2 GEJ adenocarcinoma despite comparable lymph node harvest, length of stay, and 90-day mortality. Adequately powered randomized controlled trials with robust surgical quality assurance are the next step in evaluating the prognostic outcomes of these surgical strategies for GEJ cancer.
Kamarajah SK, Phillips AW, Griffiths EA, et al., 2021, ASO Visual Abstract: Esophagectomy or Total Gastrectomy for Siewert 2 Gastroesophageal Junction (GEJ) Adenocarcinoma? A Registry-Based Analysis., Ann Surg Oncol, Vol: 28, Pages: 517-518
Kamarajah SK, Markar SR, Phillips AW, et al., 2021, Palliative gastrectomy for metastatic gastric adenocarcinoma: A national population-based cohort study., Surgery, Vol: 170, Pages: 1702-1710
BACKGROUND: The impact of palliative gastrectomy for metastatic gastric adenocarcinoma, especially by site of metastasis remains unclear. METHODS: The National Cancer Database, 2010-2015, was used to identify patients with clinical metastatic (cM1) gastric adenocarcinoma (n = 19,411) at diagnosis. The main variable was index management for cM1 gastric adenocarcinoma (ie, no treatment, palliative chemotherapy, or palliative gastrectomy). Cox multivariable analyses were used to account for treatment selection bias and reported as hazard ratio (HR) and 95% confidence interval. RESULTS: Of 19,411 patients, 10,893 (56%) received palliative chemotherapy, and only 1,101 (6%) received palliative gastrectomy only. The median survival was 6.1 months, and 5-year survival was 4% in the entire cohort. Patients receiving palliative gastrectomy had a significantly longer survival than patients without any treatment or palliative chemotherapy (median: 12.8 vs 1.8 vs 9.5 months, P < .001), which remained after multivariable adjustment (HR: 0.76, 95% confidence interval: 0.71-0.81, P < .001) compared with palliative chemotherapy. Stratified analyses by clinical nodal stage (cN) demonstrated survival benefit with palliative gastrectomy: cN0 (HR: 0.71, 95% confidence interval: 0.62-0.82), cN1 (HR: 0.68, 95% confidence interval: 0.59-0.79), cN2 (HR: 0.86, 95% confidence interval: 0.70-0.94), and cN3 (HR: 0.82, 95% confidence interval: 0.70-0.92) over palliative chemotherapy. Stratified analyses by metastasis site demonstrated that palliative gastrectomy remained superior compared with palliative chemotherapy for metastatic disease limited to liver, bone, and peritoneum, but equivalent to lung metastasis and inferior to brain metastasis. CONCLUSION: Palliative gastrectomy appears to have a modest survival benefit over palliative chemotherapy alone. Differences in outcomes by site of metastasis warrant further research to understand tumor biology and identify specific subgroups
Tarazi M, Jamel S, Mullish BH, et al., 2021, Impact of gastrointestinal surgery upon the gut microbiome: a systematic review, Surgery, Vol: 171, ISSN: 0039-6060
BackgroundThere is evidence from preclinical models that the gut microbiome may impact outcomes from gastrointestinal surgery, and that surgery may alter the gut microbiome. However, the extent to which gastrointestinal surgery modulates the gut microbiome in clinical practice is currently poorly defined. This systematic review aims to evaluate the changes observed in the gut microbiome after gastrointestinal surgery.MethodsA systematic review and meta-analysis were conducted according to the PRISMA guidelines by screening EMBASE, MEDLINE/PubMed, Web of Science, and CENTRAL for comparative studies meeting the predetermined inclusion criteria. The primary outcome was the difference between pre and postoperative bacterial taxonomic composition and diversity metrics among patients receiving gastrointestinal surgery.ResultsIn total, 33 studies were identified including 6 randomized controlled trials and 27 prospective cohort studies reporting a total of 968 patients. Gastrointestinal surgery was associated with an increase in α diversity and a shift in β diversity postoperatively. Multiple bacterial taxa were identified to consistently trend toward an increase or decrease postoperatively. A difference in microbiota across geographic provenance was also observed. There was a distinct lack of studies showing correlation with clinical outcomes or performing microbiome functional analysis. Furthermore, there was a lack of standardization in sampling, analytical methodology, and reporting.ConclusionThis review highlights changes in bacterial taxa associated with gastrointestinal surgery. There is a need for standardization of microbial analysis methods and reporting of results to allow interstudy comparison. Further adequately powered multicenter studies are required to better assess variation in microbial changes and its potential associations with clinical outcomes.
Kalff MC, Gottlieb-Vedi E, Verhoeven RHA, et al., 2021, Presentation, Treatment, and Prognosis of Esophageal Carcinoma in a Nationwide Comparison of Sweden and the Netherlands., Ann Surg, Vol: 274, Pages: 743-750
OBJECTIVE: This population-based study aimed to compare presentation, treatment allocation and survival of potentially curable esophageal cancer patients between Sweden and the Netherlands. SUMMARY OF BACKGROUND DATA: Identification of inter-country differences in treatment allocation and survival may be used for targeted esophageal cancer care improvement. METHODS: Nationwide datasets were acquired from a Swedish cohort study and the Netherlands Cancer Registry. Patients with potentially curable (cT1-T4a/Tx, cN0/+, cM0/x) esophageal adenocarcinoma or squamous cell carcinoma (SCC) diagnosed in 2011-2015 were included. Multivariable logistic regression provided odds ratios (OR) for treatment allocation, and multivariable Cox model provided hazard ratios (HR) for overall survival, all with 95% confidence intervals (CI), adjusted for age, sex, year, tumor sub-location and stage. RESULTS: Among 1980 Swedish and 7829 Dutch esophageal cancer patients, Swedish patients were older (71 vs 69 years, P <0.001) and had higher cT-stage (cT3: 49% vs 46%, P <0.001). After adjustment for confounders, Swedish patients were less frequently allocated to curative treatment (adenocarcinoma: OR=0.31, 95%CI 0.26-0.36; SCC: OR=0.28, 95%CI 0.22-0.36). Overall survival was lower in Swedish patients (adenocarcinoma: HR=1.36, 95%CI 1.27-1.46; SCC: HR=1.38, 95%CI 1.24-1.53), also when allocated to curative treatment (adenocarcinoma: HR=1.12, 95%CI 1.01-1.24; SCC: HR=1.34, 95%CI 1.14-1.59). CONCLUSION: Swedish patients with potentially curable esophageal cancer were less frequently allocated to curative treatment, and showed lower survival compared to Dutch patients. The less pronounced inter-country survival difference after curative treatment suggests that the overall survival difference could at least partly be due to relative undertreatment of Swedish patients. Shared curative treatment thresholds across Europe may help improve survival of esophageal cancer patients.
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