Surgical resection for HCC remains a major curative treatment option, but it is unclear whether there are differences in outcomes by region and whether outcomes have improved over time. We aimed to estimate pooled overall survival (OS), recurrence‐free survival (RFS), and complication rates in patients with hepatocellular carcinoma (HCC) following curative surgical resection and to compare outcomes by region and by time period. In this systematic review and meta‐analysis, we searched Pubmed, Embase, and Cochrane databases from inception to May 15, 2020. We selected studies reporting OS, RFS, and complications in adult patients with HCC undergoing curative surgical resection. Two authors independently searched the literature and extracted the data. We screened 6983 articles and included 110 eligible studies with 82,392 patients, with study periods spanning from 1980–2017. The global pooled 1‐year and 5‐year survival rates were 88.9% (95% confidence interval [CI] 87.1–90.4) and 56.2% (95% CI 52.8–59.6) for OS and 71.1% (95% CI 67.6–74.3) and 35.2% (95% CI 32.5–38.0) for RFS, respectively. Five‐year OS was higher in Asia (57.03%) than in other regions (Europe 48.3%; North America 48.0%; and South America 49.5%); p = 0.002. Five‐year RFS was higher in patients with hepatitis B virus versus patients with hepatitis C virus (34.8% vs. 24.1%; p = 0.02). There was no significant improvement in 5‐year OS and RFS over time. The pooled rate for complications was 27.6% (95% CI 23.4–32.3), with 9.7% (95% CI 6.3–14.7) classified as major. One‐year OS after surgical resection for HCC is excellent (~90%). However, 5‐year OS (~55%) and RFS (~35%) are still poor, suggesting that long‐term care is suboptimal. Greater efforts are required to improve survival through enhanced surveillance and preventing recurrence through antiviral therapy.
Acute and chronic diarrheal illness secondary to gastrointestinal infection is a significant cause of morbidity and mortality around the world. A cornerstone of management includes prompt diagnosis and appropriate treatment of culprit pathogens. Timely diagnosis can improve patient care, assist in infection control, and prevent disease outbreaks. Historical methods of diagnosis include traditional culture methods and stool analysis. These are limited by long turnaround time and inability to simultaneously assess multiple pathogens. The advent of multiplexed nucleic acid amplification tests first began with the Food and Drug Administration-approved respiratory virus multiplex polymerase chain reaction (PCR) panel in 2009, followed by gastrointestinal infections in 2013, and neurological infections in 2014. We conducted a review of current literature pertaining to the clinical utility of a gastrointestinal multiplex PCR in management of acute and chronic diarrhea in patients. To date, seven platforms approved by the US Food and Drug Administration are used in detection of various bacterial, viral, and parasitic causative organisms for diagnosis of gastrointestinal infections. The sensitivity and specificity of each assay vary depending on the tested organism. Interpretation of a positive result has to be tailored to the clinical context. Further studies are required to establish the utility of gastrointestinal multiplex PCR from a cost-based perspective, whether specific enteropathogens such as Clostridioides difficile are better assessed with toxin gene detection and whether new parameters such as cycle threshold values can improve clinical application of test results.
Background: Guidelines recommend that hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) and/or hepatic vein tumor thrombosis (HVTT) should undergo systemic therapy.However, recent data suggest that surgical resection may be beneficial in selected cases, but outcomes are heterogenous. We aimed to estimate pooled overall survival (OS), recurrence free survival (RFS) and complication rates in HCC patients with macrovascular invasion (MVI) following surgical resection.Methods: In this systematic review and meta-analysis, two investigators independently searched PubMed, Embase, and Cochrane databases from inception to Nov 10, 2020, without language restrictions, for studies reporting outcomes of adult HCC patients with MVI who underwent liver resection with curative intent.Results: We screened 8,598 articles and included 40 studies involving 8,218 patients. Among all patients with MVI, the pooled median OS was 14.39 months [95% confidence interval (
We present a case of a 64-year-old gentleman for whom point of care ultrasound (POCUS) expedited the diagnosis and subsequent early treatment of colon adenocarcinoma. He was referred by his primary provider to our clinic for abdominal bloating. He had no other abdominal symptoms such as abdominal pain, change in bowel habits or rectal bleeding. He had no constitutional symptoms such as weight loss. The patient’s abdominal examination was also unremarkable. However, POCUS identified a 6 cm long hypoechoic circumscribed colon wall thickening around the hyperechoic pattern of bowel lumen (Pseudokidney sign) in the right upper quadrant, which suggested the presence of an ascending colon carcinoma. In view of this prompt bedside diagnosis, we organised a colonoscopy, staging computerised tomographic scan and colorectal surgery consultation the next day. After the locally advanced colorectal carcinoma was confirmed, the patient had curative surgery within 3 weeks of his presentation to the clinic.
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