Publications
335 results found
Huddy JR, Markar SR, Ni MZ, et al., 2016, Laparoscopic repair of hiatus hernia: does mesh type influence outcome? A meta-analysis and European survey study, Surgical Endoscopy and Other Interventional Techniques, ISSN: 1432-2218
BACKGROUND: Synthetic mesh (SM) has been used in the laparoscopic repair of hiatus hernia but remains controversial due to reports of complications, most notably esophageal erosion. Biological mesh (BM) has been proposed as an alternative to mitigate this risk. The aim of this study is to establish the incidence of complications, recurrence and revision surgery in patients following suture (SR), SM or BM repair and undertake a survey of surgeons to establish a perspective of current practice. METHODS: An electronic search of EMBASE, MEDLINE and Cochrane database was performed. Pooled odds ratios (PORs) were calculated for discrete variables. To survey current practice an online questionnaire was sent to emails registered to the European Association for Endoscopic Surgery. RESULTS: Nine studies were included, comprising 676 patients (310 with SR, 214 with SM and 152 with BM). There was no significant difference in the incidence of complications with mesh compared to SR (P = 0.993). Mesh significantly reduced overall recurrence rates compared to SR [14.5 vs. 24.5 %; POR = 0.36 (95 % CI 0.17-0.77); P = 0.009]. Overall recurrence rates were reduced in the SM compared to BM groups (12.6 vs. 17.1 %), and similarly compared to the SR group, the POR for recurrence was lower in the SM group than the BM group [0.30 (95 % CI 0.12-0.73); P = 0.008 vs. 0.69 (95 % CI 0.26-1.83); P = 0.457]. Regarding surgical technique 503 survey responses were included. Mesh reinforcement of the crura was undertaken by 67 % of surgeons in all or selected cases with 67 % of these preferring synthetic mesh to absorbable mesh. One-fifth of the respondents had encountered mesh erosion in their career. CONCLUSIONS: Both SM and BM reduce rates of recurrence compared to SR, with SM proving most effective. Surgical practice is varied, and there remains insufficient evidence regarding the optimum technique for the repair
Markar SR, Gronnier C, Duhamel A, et al., 2016, Significance of Microscopically Incomplete Resection Margin After Esophagectomy for Esophageal Cancer., Ann Surg, Vol: 263, Pages: 712-718
OBJECTIVE: The objectives of this study were to establish if R1 resection margin after esophagectomy was (i) a poor prognostic factor independent of patient and tumor characteristics, (ii) a marker of tumor aggressiveness and (iii) to look at the impact of adjuvant treatment in this subpopulation. METHODS: Data were collected from 30 European centers from 2000 to 2010. Patients with an R1 resection margin (n = 242) were compared with those with an R0 margin (n = 2573) in terms of short- and long-term outcomes. Propensity score matching and multivariable analyses were used to compensate for differences in baseline characteristics. RESULTS: Independent factors significantly associated with an R1 resection margin included an upper third esophageal tumor location, preoperative malnutrition, and pathological stage III. There were significant differences between the groups in postoperative histology, with an increase in pathological stage III and TRG 4-5 in the R1 group. Total average lymph node harvests were similar between the groups; however, there was an increase in the number of positive lymph nodes seen in the R1 group. Propensity matched analysis confirmed that R1 resection margin was significantly associated with reduced overall survival and increased overall, locoregional, and mixed tumor recurrence. Similar observations were seen in the subgroup that received neoadjuvant chemoradiation. In R1 patients adjuvant therapy improved survival and reduced distant recurrence however failed to affect locoregional recurrence. CONCLUSIONS: This large multicenter European study provides evidence to support the notion that R1 resection margin is a prognostic indication of aggressive tumor biology with a poor long-term prognosis.
Markar SR, Mackenzie H, Mikhail S, et al., 2016, Surgical resection of hepatic metastases from gastric cancer: outcomes from national series in England, GASTRIC CANCER, Vol: 20, Pages: 379-386, ISSN: 1436-3291
Khanderia E, Markar SR, Acharya A, et al., 2016, The Influence of Gastric Cancer Screening on the Stage at Diagnosis and Survival A Meta-Analysis of Comparative Studies in the Far East, JOURNAL OF CLINICAL GASTROENTEROLOGY, Vol: 50, Pages: 190-197, ISSN: 0192-0790
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- Citations: 33
Markar SR, Gronnier C, Pasquer A, et al., 2016, Role of neoadjuvant treatment in clinical T2N0M0 oesophageal cancer: results from a retrospective multi-center European study., Eur J Cancer, Vol: 56, Pages: 59-68
AIMS: The aims of this study were to compare short- and long-term outcomes for clinical T2N0 oesophageal cancer with analysis of (i) primary surgery (S) versus neoadjuvant therapy plus surgery (NS), (ii) squamous cell carcinoma and adenocarcinoma subsets; and (iii) neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy. METHODS: Data were collected from 30 European centres from 2000 to 2010. Among 2944 included patients, 355 patients (12.1%) had cT2N0 disease; 285 (S) and 70 (NS), were compared in terms of short- and long-term outcomes. Propensity score matching analyses were used to compensate for differences in baseline characteristics. RESULTS: No significant differences between the groups were shown in terms of in hospital morbidity and mortality. Nodal disease was observed in 50% of S-group at the time of surgery, with 20% pN2/N3. Utilisation of neoadjuvant therapy was associated with significant tumour downstaging as reflected by increases in pT0, pN0 and pTNM stage 0 disease, this effect was further enhanced with neoadjuvant chemoradiotherapy. After adjustment on propensity score and confounding factors, for all patients and subset analysis of squamous cell and adenocarcinoma, neoadjuvant therapy had no significant effect upon survival or recurrence (overall, loco-regional, distant or mixed) compared to surgery alone. There were no significant differences between neoadjuvant chemotherapy and chemoradiotherapy in short- or long-term outcomes. CONCLUSION: The results of this study suggest that a surgery alone treatment approach should be recommended as the primary treatment approach for cT2N0 oesophageal cancer despite 50% of patients having nodal disease at the time of surgery.
Markar SR, Lagergren J, Hanna GB, 2016, Research protocol for a diagnostic study of non-invasive exhaled breath analysis for the prediction of oesophago-gastric cancer, BMJ Open, Vol: 6, ISSN: 2044-6055
Introduction Despite improvements in a range of chemo, radio and surgical therapies, the overall survival at 5 years from oesophago-gastric cancer remains poor and ranges from 10% to 30%. Early diagnosis is a key strategy to improve survival but early disease stage has non-specific symptoms that are very common while the warning clinical picture often indicates advanced disease. The aim of this research is to validate a breath test to predict oesophago-gastric cancer therefore allowing earlier diagnosis and introduction of treatment.Methods and analysis The study will include 325 patients and be conducted across four major oesophago-gastric cancer centres in London, UK. This research will utilise selected ion flow-tube mass spectrometry (SIFT-MS) exhaled breath analysis, for comparison of predicted cancer risk based on the previously developed volatile organic compound exhaled breath model, with endoscopic findings and histology biopsies. This will determine the overall diagnostic accuracy for non-invasive breath testing for the diagnosis of oesophago-gastric cancer.Ethics and Dissemination Approval was gained from NRES Committee London, on 16 July 2014 (REC reference 14/LO/1136) for the completion of this study. Different methods of dissemination will be employed including international clinical and patient group presentations, and publication of research outputs in a high-impact clinical journal. This is to ensure that the findings from this research will reach patients, primary care practitioners, scientists, hospital specialists in gastroenterology, oncology and surgery, health policymakers and commissioners as well as NHS regulatory bodies.
Mackenzie H, Markar SR, Askari A, et al., 2016, National proficiency-gain curves for minimally invasive gastrointestinal cancer surgery, British Journal of Surgery, Vol: 103, Pages: 88-96, ISSN: 1365-2168
BackgroundMinimal access surgery for gastrointestinal cancer has short-term benefits but is associated with a proficiency-gain curve. The aim of this study was to define national proficiency-gain curves for minimal access colorectal and oesophagogastric surgery, and to determine the impact on clinical outcomes.MethodsAll adult patients undergoing minimal access oesophageal, colonic and rectal surgery between 2002 and 2012 were identified from the Hospital Episode Statistics database. Proficiency-gain curves were created using risk-adjusted cumulative sum analysis. Change points were identified, and bootstrapping was performed with 1000 iterations to identify a confidence level. The primary outcome was 30-day mortality; secondary outcomes were 90-day mortality, reintervention, conversion and length of hospital stay.ResultsSome 1696, 15 008 and 16 701 minimal access oesophageal, rectal and colonic cancer resections were performed during the study period. The change point in the proficiency-gain curve for 30-day mortality for oesophageal, rectal and colonic surgery was 19 (confidence level 98·4 per cent), 20 (99·2 per cent) and three (99·5 per cent) procedures; the mortality rate fell from 4·0 to 2·0 per cent (relative risk reduction (RRR) 0·50, P = 0·033), from 2·1 to 1·2 per cent (RRR 0·43, P < 0·001) and from 2·4 to 1·8 per cent (RRR 0·25, P = 0·058) respectively. The change point in the proficiency-gain curve for reintervention in oesophageal, rectal and colonic resection was 19 (98·1 per cent), 32 (99·5 per cent) and 26 (99·2 per cent) procedures respectively. There were also significant proficiency-gain curves for 90-day mortality, conversion and length of stay.ConclusionThe introduction of minimal access gastrointestinal cancer surgery has been associated with a proficiency-gain c
group ISOSISOS, Holt P, Rhodes A, et al., 2016, Global patient outcomes after elective surgery: Prospective cohort study in 27 low-, middle- and high-income countries, British Journal of Anaesthesia, ISSN: 0007-0912
Wiggins T, Markar SR, Harris A, 2015, Laparoscopic adhesiolysis for acute small bowel obstruction: systematic review and pooled analysis, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 29, Pages: 3432-3442, ISSN: 0930-2794
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- Citations: 29
Markar S, Gronnier C, Duhamel A, et al., 2015, The Impact of Severe Anastomotic Leak on Long-term Survival and Cancer Recurrence After Surgical Resection for Esophageal Malignancy., Ann Surg, Vol: 262, Pages: 972-980
OBJECTIVE: The aim of this study was to the determine impact of severe esophageal anastomotic leak (SEAL) upon long-term survival and locoregional cancer recurrence. BACKGROUND: The impact of SEAL upon long-term survival after esophageal resection remains inconclusive with a number of studies demonstrating conflicting results. METHODS: A multicenter database for the surgical treatment of esophageal cancer collected data from 30 university hospitals (2000-2010). SEAL was defined as a Clavien-Dindo III or IV leak. Patients with SEAL were compared with those without in terms of demographics, tumor characteristics, surgical technique, morbidity, survival, and recurrence. RESULTS: From a database of 2944 operated on for esophageal cancer between 2000 and 2010, 209 patients who died within 90 days of surgery and 296 patients with a R1/R2 resection were excluded, leaving 2439 included in the final analysis; 208 (8.5%) developed a SEAL and significant independent association was observed with low hospital procedural volume, cervical anastomosis, tumoral stage III/IV, and pulmonary and cardiovascular complications. SEAL was associated with a significant reduction in median overall (35.8 vs 54.8 months; P = 0.002) and disease-free (34 vs 47.9 months; P = 0.005) survivals. After adjustment of confounding factors, SEAL was associated with a 28% greater likelihood of death [hazard ratio = 1.28; 95% confidence interval (CI): 1.04-1.59; P = 0.022], as well as greater overall (OR = 1.35; 95% CI: 1.15-1.73; P = 0.011), locoregional (OR = 1.56; 95% CI: 1.05-2.24; P = 0.030), and mixed (OR = 1.81; 95% CI: 1.20-2.71; P = 0.014) recurrences. CONCLUSIONS: This large multicenter study provides strong evidence that SEAL adversely impacts cancer prognosis. The mechanism through which SEAL increases local recurrence is an important area for future research.
Ngo AT, Markar SR, De Lijster MS, et al., 2015, A Systematic Review of Outcomes Following Percutaneous Transluminal Angioplasty and Stenting in the Treatment of Transplant Renal Artery Stenosis, CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, Vol: 38, Pages: 1573-1588, ISSN: 0174-1551
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- Citations: 43
Antonowicz S, Kumar S, Wiggins T, et al., 2015, Diagnostic metabolomic blood tests for endoluminal gastrointestinal cancer - a systematic review and assessment of quality, Cancer Epidemiology Biomarkers & Prevention, Vol: 25, Pages: 6-15, ISSN: 1538-7755
Advances in analytics have resulted in metabolomic blood tests being developed for the detection of cancer. This systematic review aims to assess the diagnostic accuracy of blood-based metabolomic biomarkers for endoluminal gastrointestinal (GI) cancer. Using endoscopic diagnosis as a reference standard, methodologic and reporting quality was assessed using validated tools, in addition to pathway-based informatics to biologically contextualize discriminant features. Twenty-nine studies (15 colorectal, 9 esophageal, 3 gastric, and 2 mixed) with data from 10,835 participants were included. All reported significant differences in hematologic metabolites. In pooled analysis, 246 metabolites were found to be significantly different after multiplicity correction. Incremental metabolic flux with disease progression was frequently reported. Two promising candidates have been validated in independent populations (both colorectal biomarkers), and one has been approved for clinical use. Networks analysis suggested modulation of elements of up to half of Edinburgh Human Metabolic Network subdivisions, and that the poor clinical applicability of commonly modulated metabolites could be due to extensive molecular interconnectivity. Methodologic and reporting quality was assessed as moderate-to-poor. Serum metabolomics holds promise for GI cancer diagnostics; however, future efforts must adhere to consensus standardization initiatives, utilize high-resolution discovery analytics, and compare candidate biomarkers with peer nonendoscopic alternatives.
Markar S, Gronnier C, Duhamel A, et al., 2015, Salvage Surgery After Chemoradiotherapy in the Management of Esophageal Cancer: Is It a Viable Therapeutic Option?, J Clin Oncol, Vol: 33, Pages: 3866-3873
PURPOSE: The aim of this large multicenter study was to assess the impact of salvage esophagectomy after definitive chemoradiotherapy (SALV) on clinical outcome. PATIENTS AND METHODS: Data from consecutive adult patients undergoing resection for esophageal cancer in 30 European centers from 2000 to 2010 were collected. First, groups undergoing SALV (n = 308) and neoadjuvant chemoradiotherapy followed by planned esophagectomy (NCRS; n = 540) were compared. Second, patients who benefited from SALV for persistent (n = 234) versus recurrent disease (n = 74) were compared. Propensity score matching and multivariable analyses were used to compensate for differences in some baseline characteristics. RESULTS: SALV versus NCRS groups: In-hospital mortality was similar in both groups (8.4% v 9.3%). The only significant differences in complications were seen for anastomotic leak (17.2% v 10.7%; P = .007) and surgical site infection, which were both more frequent in the SALV group. At 3 years, groups had similar overall (43.3% v 40.1%; P = .542) and disease-free survival (39.2% v 32.8%; P = .232) after matching, along with a similar recurrence pattern. Persistent versus recurrent disease groups: There were no significant differences between groups in incidence of in-hospital mortality or major complications. At 3 years, overall (40.9% v 56.2%; P = .046) and disease-free survival (36.6% v 51.6%; P = .095) were lower in the persistent disease group. CONCLUSION: The results of this large multicenter study from the modern era suggest that SALV can offer acceptable short- and long-term outcomes in selected patients at experienced centers. Persistent cancer after definitive chemoradiotherapy seems to be more biologically aggressive, with poorer survival compared with recurrent cancer.
Markar SR, Wiggins T, Antonowicz S, et al., 2015, Minimally invasive esophagectomy: Lateral decubitus vs. prone positioning; systematic review and pooled analysis, SURGICAL ONCOLOGY-OXFORD, Vol: 24, Pages: 212-219, ISSN: 0960-7404
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- Citations: 43
Wiggins T, Markar SR, Arya S, et al., 2015, Anastomotic reinforcement with omentoplasty following gastrointestinal anastomosis: A systematic review and meta-analysis, SURGICAL ONCOLOGY-OXFORD, Vol: 24, Pages: 181-186, ISSN: 0960-7404
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- Citations: 25
Markar S, Gronnier C, Duhamel A, et al., 2015, Pattern of Postoperative Mortality After Esophageal Cancer Resection According to Center Volume: Results from a Large European Multicenter Study., Ann Surg Oncol, Vol: 22, Pages: 2615-2623
BACKGROUND: High center procedural volume has been shown to reduce postoperative mortality (POM); however, the cause of POM has been poorly studied previously. The aim of this study was to define the pattern of POM and major morbidity in relation to center procedural volume. METHODS: Data from 2,944 consecutive adult patients undergoing esophagectomy for esophageal cancer in 30 centers between 2000 and 2010 were retrospectively collected. Data between patients who suffered 30-day POM were compared with those who did not. Factors associated with POM were identified using binary logistic regression, with propensity matching to compare low- (LV) and high-volume (HV) centers. RESULTS: The 30-day and in-hospital POM rates were 5.0 and 7.3 %, respectively. Pulmonary complications were the most common, affecting 38.1 % of patients, followed by surgical site infection (15.5 %), cardiovascular complications (11.2 %), and anastomotic leak (10.2 %). Factors that were independently associated with 30-day POM included American Society of Anesthesiologists grade IV, LV center, anastomotic leak, pulmonary, cardiovascular and neurological complications, and R2 resection margin status. Surgical complications preceded POM in approximately 30 % of patients compared to medically-related causes in 68 %. Propensity-matched analysis demonstrated LV centers were significantly associated with increased 30-day POM, and POM secondary to anastomotic leak, and pulmonary- and cardiac-related causes. CONCLUSIONS: The results of this large, multicenter study provide further evidence to support the centralization of esophagectomy to HV centers, with a lower rate of morbidity and better infrastructure to deal with complications following major surgery preventing further mortality.
Sodergren MH, Markar S, Pucher PH, et al., 2015, Safety of transvaginal hybrid NOTES cholecystectomy: a systematic review and meta-analysis, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 29, Pages: 2077-2090, ISSN: 0930-2794
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- Citations: 23
Munasinghe A, Markar SR, Mamidanna R, et al., 2015, Is It Time to Centralize High-risk Cancer Care in the United States? Comparison of Outcomes of Esophagectomy Between England and the United States, ANNALS OF SURGERY, Vol: 262, Pages: 79-85, ISSN: 0003-4932
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- Citations: 77
Markar SR, Karthikesalingam A, Low DE, 2015, Enhanced recovery pathways lead to an improvement in postoperative outcomes following esophagectomy: systematic review and pooled analysis., Dis Esophagus, Vol: 28, Pages: 468-475
The aim of this systematic review and pooled analysis is to determine the effect of enhanced recovery programs (ERP) on clinical outcome measures following esophagectomy. Medline, Embase, trial registries, conference proceedings, and reference lists were searched for trials comparing clinical outcome from esophagectomy followed by a conventional pathway with esophagectomy followed by an ERP. Primary outcomes were the incidence of postoperative mortality, anastomotic leak and pulmonary complications, and secondary outcomes were length of hospital stay and the incidence of 30-day readmission. Nine studies were included comprising 1240 patients, 661 patients underwent esophagectomy followed conventional pathway, and 579 patients underwent ERP. Utilization of ERP was associated with a reduction in the incidence of anastomotic leak (12.2-8.3%; pooled odds ratios = 0.61; 95% confidence interval = 0.39 to 0.96; P = 0.03) and pulmonary complications (29.1-19.6%; pooled odds ratios = 0.52; 95% confidence interval = 0.36 to 0.77; P = 0.001) and length of hospital stay, and no significant change in postoperative mortality or readmission rate. There was significant variation in the design of enhanced recovery protocols, surgical approach, and utilization of neoadjuvant therapies between the studies that are important confounding variables to be considered. This study suggests a benefit to the utilization of ERP following esophagectomy. The pathways provide a template for all medical personnel interacting with these patients in order to provide incremental changes in all aspects of clinical care that translates into global improvements seen in postoperative outcomes.
Markar SR, Zaninotto G, 2015, Laparoscopic Heller Myotomy for Achalasia: Does the Age of the Patient Affect the Outcome?, WORLD JOURNAL OF SURGERY, Vol: 39, Pages: 1608-1613, ISSN: 0364-2313
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- Citations: 7
Singh M, Harris-Birtill DCC, Markar SR, et al., 2015, Application of Gold Nanoparticles for Gastrointestinal Cancer Theranostics: A Systematic Review., Nanomedicine: Nanotechnology, Biology, and Medicine, Vol: 11, Pages: 2083-2098, ISSN: 1549-9634
Gold nanoparticles (GNPs) are readily synthesised structures that absorb light strongly to generate thermal energy which induces photothermal destruction of malignant tissue. This review examines the efficacy, potential challenges and toxicity from in vitro and in vivo applications of GNPs in oesophageal, gastric and colon cancers. A systematic literature search of Medline, Embase, Web of Science and Cochrane databases was performed using PRISMA guidelines. Two hundred and eighty-four papers were reviewed with sixteen studies meeting the inclusion criteria. The application of GNPs in eleven in vivo rodent studies with GI adenocarcinoma demonstrated excellent therapeutic outcomes but poor corroboration in terms of the cancer cells used, photothermal irradiation regimes, fluorophores and types of nanoparticles. There is compelling evidence of the translational potential of GNPs to be complimentary to surgery and feasible in the photothermal therapy of GI cancer but reproducibility and standardisation require further development prior to GI cancer clinical trials.
Markar SR, Mackenzie H, Wiggins T, et al., 2015, MANAGEMENT AND OUTCOMES OF OESOPHAGEAL PERFORATION: A NATIONAL STUDY OF 2564 PATIENTS IN ENGLAND, GUT, Vol: 64, Pages: A38-A38, ISSN: 0017-5749
Huddy JR, Ni MZ, Markar SR, et al., 2015, Point-of-care testing in the diagnosis of gastrointestinal cancers: Current technology and future directions, WORLD JOURNAL OF GASTROENTEROLOGY, Vol: 21, Pages: 4111-4120, ISSN: 1007-9327
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- Citations: 18
Markar SR, Hanna G, 2015, Minimally Invasive Esophagectomy for Dysplastic Barrett's Esophagus, WORLD JOURNAL OF SURGERY, Vol: 39, Pages: 608-614, ISSN: 0364-2313
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- Citations: 1
Markar SR, Low DE, 2015, The volume-outcome relationship, standardized clinical pathways, and minimally invasive surgery for esophagectomy, Minimally Invasive Foregut Surgery for Malignancy: Principles and Practice, Pages: 1-276, ISBN: 9783319093413
Surgical resection remains the mainstay of treatment of locoregional esophageal cancer. However, it is a highly demanding technical procedure that has historically been associated with a relatively high rate of procedural mortality and morbidity and a prolonged postoperative recovery when compared to other oncological procedures. The centralization of esophagectomy to high-volume institutions has been shown to reduce associated operative mortality; this is a process issue and not just a clinical observation. Management of patients with esophageal cancer at high–volume institutions lends itself towards a true multidisciplinary approach to treatment of these patients typically within standardized clinical pathways or enhanced recovery programs. The use of these standardized pathways facilitates a system–wide approach to the perioperative management of these patients. Furthermore, multidisciplinary standardized clinical pathways as part of enhanced recovery programs have been associated with a progressive improvement in procedural morbidity and length of hospital stay. Evolution in surgical approach including the advent of minimally invasive esophagectomy has been further suggested to improve perioperative outcomes including a reduction in pulmonary complications. There is increasing indications that there are many other perioperative process issues which can lead to measurable improvement in outcomes associated with the surgical treatment of esophageal cancer.
Markar SR, Wiggins T, Ni M, et al., 2015, Assessment of the quality of surgery within randomised controlled trials for the treatment of gastro-oesophageal cancer: a systematic review, The Lancet Oncology, Vol: 16, Pages: E23-E31, ISSN: 1213-9432
Multicentre, randomised, controlled trials (RCTs) provide level 1 evidence for surgery in the treatment of gastro-oesophageal cancer. This systematic review investigated whether standardisation of surgical techniques in RCTs reduces the variation in lymph-node harvest, in-hospital mortality, and locoregional cancer recurrence. The range in the coefficients of variation for lymph-node harvest (0·07–0·61), proportion of patients with locoregional cancer recurrence (1·1–46·2%), and in-hospital mortality (0–10%) was wide. Credentialing of surgeons through assessment of operative reports and monitoring of their performance through data collection were important factors that reduced the variation in lymph-node harvest. Factors that reduced adjusted in-hospital mortality included credentialing surgeons through procedural volume and operative reports, and standardisation of surgical techniques. Future RCTs should include an assessment of surgical performance as an important aspect of study design to reduce variation in clinical outcomes.
Markar SR, Wiggins T, Kumar S, et al., 2015, Exhaled Breath Analysis for the Diagnosis and Assessment of Endoluminal Gastrointestinal Diseases, JOURNAL OF CLINICAL GASTROENTEROLOGY, Vol: 49, Pages: 1-8, ISSN: 0192-0790
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- Citations: 20
Dasari BVM, Baker J, Markar S, et al., 2015, Laparoscopic appendicectomy in obese is associated with improvements in clinical outcome: Systematic review, INTERNATIONAL JOURNAL OF SURGERY, Vol: 13, Pages: 250-256, ISSN: 1743-9191
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- Citations: 13
Wiggins T, Kumar S, Markar SR, et al., 2015, Tyrosine, Phenylalanine, and Tryptophan in Gastroesophageal Malignancy: A Systematic Review, CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION, Vol: 24, Pages: 32-38, ISSN: 1055-9965
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- Citations: 67
Sovova K, Wiggins T, Markar SR, et al., 2015, Quantification of phenol in urine headspace using SIFT-MS and investigation of variability with respect to urinary concentration, ANALYTICAL METHODS, Vol: 7, Pages: 5134-5141, ISSN: 1759-9660
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- Citations: 7
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