PROSPERO registration number CRD42016042347.

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What ' s known on the subject? and What does the study add?The standard treatment for non-muscle invasive bladder (NMIBC) is transurethral resection followed by intravesical therapy. Intravesical agents, e.g. bacille CalmetteGu é rin (BCG) or mitomycin C (MMC), have activity in delaying and reducing the incidence of tumour recurrence after surgery but have signifi cant side-effects and are not effective in all patients. Clinical data suggests that gemcitabine has activity in this disease in terms of tumour response and is less toxic, and warrants further study. This systematic review comprehensively presents the available clinical evidence on intravesical gemcitabine for NMIBC. The limited data from randomised trials suggest that gemcitabine may have role in intermediate-risk patients, as an alternative to MMC, and in high-risk, BCG-refractory patients. Data from observational studies indicate that minimal systemic absorption occurs with intravesical administration and that gemcitabine is active in reducing tumour recurrence.Accepted for publication 1 December 2011• Intravesical immunotherapy or chemotherapy for non-muscle invasive bladder cancer is a well-established treatment for preventing or delaying tumour recurrence after tumour resection. However, up to 70% of patients may fail and new intravesical agents with improved effectiveness are needed. Gemcitabine is a relatively new anticancer drug that has shown activity against bladder cancer.• To systematically review the literature on the effectiveness and toxicity of intravesical gemcitabine for non-muscle invasive bladder cancer (NMIBC).• MEDLINE, EMBASE, CINAHL, the Cochrane database of systematic reviews, LILACS, SCOPUS, BNI, Biomed Central, Web of Science and BIOSIS were searched to identify trials of intravesical gemcitabine for the treatment of NMIBC. Also searched were meeting proceedings, international guidelines and trial registries. Data on authors, study design, patient characteristics, interventions and outcome data relating to tumour recurrence, disease progression, survival and adverse events were extracted from relevant studies.• Six relevant randomised trials were identifi ed with the number of patients randomised in each trial varying from 30 to 341 (total 704). All trials compared gemcitabine to active controls and varied in the reporting of outcomes.• The fi rst was a marker lesion study which reported greater tumour response rates when intravesical gemcitabine (2 g) was given as three bi-weekly doses (36%) or six weekly doses (40%) compared with a single dose (9%).• One study compared a single postoperative instillation of intravesical gemcitabine with a saline placebo in 341 patients and found no signifi cant difference in the rates of tumour recurrence (28% vs 39%, respectively) or recurrence-free survival (hazard ratio 0.95, 95% confi dence interval 0.64 -1.39, P = 0.77). The rate of progression to invasive disease was greater with gemcitabine (2.4% vs 0.8%).• A further trial compared gemcitabine with intravesical mitomycin C (MMC) an...

Partial nephrectomy may be associated with a decreased time-to-death of any cause. With regards to surgery-related mortality, cancer-specific survival and time-to-recurrence, partial nephrectomy appears to result in little to no difference.

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Background Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery. Methods A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far–near–near–far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon’s standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed. Results Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011). Conclusion The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years. Registration number ISRCTN25616490 (http://www.controlled-trials.com).