Correction to: Results of laparoscopic resection in high-risk rectal cancer patients.

The original version of this article unfortunately contained a mistake on the co-author name.

Results of laparoscopic resection in high-risk rectal cancer patients.

PURPOSE: Obesity, neoadjuvant-radiotherapy, tumour proximity to the anal verge and previous abdominal surgery are factors that might increase the intra-operative difficulty of laparoscopic rectal cancer surgery. However, whether patients with these 'high-risk' characteristics are subject to worse short- or long-term outcomes is debated. The aim of this study is to examine the short- and long-term clinical and oncological outcomes of patients receiving laparoscopic rectal surgery with any of these high-risk characteristics and compare them with patients that do not possess any of these high-risk features. METHODS: For the purpose of this study data from consecutive patients receiving laparoscopic rectal cancer resections between 2006 and 2016 from two centres were analysed. High-risk patients were defined as patients with either one of the following characteristics: BMI ≥ 30, neoadjuvant chemoradiotherapy, tumour < 8 cm from the anal verge and previous abdominal surgery. RESULTS: A total of 313 patients were identified (227 high risk, 86 low risk). Short-term outcomes were similar between the two groups with the exception of blood loss and length of stay, which were higher in the high-risk group (10 vs 2.5 ml, p = 0.045; 7 vs 5 days, p = 0.001). There were no statistically significant differences in 5-year overall survival (79.7% vs 79.8%, p = 0.757), disease-free survival (76.8% vs 69.3%, p = 0.175), distant disease-free interval (84.8% vs 79.7%, p = 0.231) and local recurrence-free interval (100%, 97.4%, p = 0.162) between the two groups. CONCLUSION: Similar short- and long-term outcomes can be achieved in high-risk and low-risk patients receiving laparoscopic rectal surgery. The presented data support the suitability of laparoscopic surgery for this group of patients.

Comparison of estimated GFR and measured GFR in prospective living kidney donors.

PURPOSE: The aim of this study was to examine the usefulness of three GFR-estimating equations (eGFR) compared with measured GFR (mGFR) in potential living kidney donors. METHODS: We compared the performance of the MDRD, CKD-Epi and Cockcroft-Gault equations with mGFR measured using (51)Cr-EDTA in 508 consecutive potential living kidney donors. Each equation was assessed for bias, precision and accuracy compared with mGFR, and the sensitivity and specificity for the identification of donors with mGFR<80 mL/min/1.73 m2 was evaluated. RESULTS: Two hundred and forty-four subjects were male, 398 Caucasian, 60 Afro-Caribbean and 50 from other ethnic groups. Median age and mGFR were 44.1 year and 91.7 mL/min/1.73 m2, respectively. Spearman correlation coefficients between eGFR and mGFR were in the range R s=0.520-0.593. Median bias (eGFR-mGFR) for the MDRD, CKD-Epi and Cockcroft-Gault equations were -1.0 (p=0.98), +8.8 (p<0.0001) and +11.1 (p<0.0001) mL/min/1.73 m2, respectively. Significant differences in bias between Afro-Caribbean and Caucasian subjects were found. The sensitivity (specificity) for the MDRD, CKD-Epi and Cockcroft-Gault equations for identifying subjects with mGFR<80 mL/min/1.73 m2 was 60 (83), 39 (95) and 44% (95%), respectively. CONCLUSIONS: The level of agreement between mGFR and all three eGFR values was poor, with the MDRD equation performing best. We conclude that reliance on creatinine-based eGFR values is unsatisfactory for the evaluation of potential living kidney donors.

The relationship between ethnicity and the pain experience of cancer patients: a systematic review.

BACKGROUND: Cancer pain is a complex multidimensional construct. Physicians use a patient-centered approach for its effective management, placing a great emphasis on patient self-reported ratings of pain. In the literature, studies have shown that a patient's ethnicity may influence the experience of pain as there are variations in pain outcomes among different ethnic groups. At present, little is known regarding the effect of ethnicity on the pain experience of cancer patients; currently, there are no systematic reviews examining this relationship. MATERIALS AND METHODS: A systematic search of the literature in October 2013 using the keywords in Group 1 together with Group 2 and Group 3 was conducted in five online databases (1) Medline (1946-2013), (2) Embase (1980-2012), (3) The Cochrane Library, (4) Pubmed, and (5) Psycinfo (1806-2013). The search returned 684 studies. Following screening by inclusion and exclusion criteria, the full text was retrieved for quality assessment. In total, 11 studies were identified for this review. The keywords used for the search were as follows: Group 1-Cancer; Group 2- Pain, Pain measurement, Analgesic, Analgesia; Group 3- Ethnicity, Ethnic Groups, Minority Groups, Migrant, Culture, Cultural background, Ethnic Background. RESULTS: TWO MAIN THEMES WERE IDENTIFIED FROM THE INCLUDED QUANTITATIVE AND QUALITATIVE STUDIES, AND ETHNIC DIFFERENCES WERE FOUND IN: (1) The management of cancer pain and (2) The pain experience. Six studies showed that ethnic groups face barriers to pain treatment and one study did not. Three studies showed ethnic differences in symptom severity and one study showed no difference. Interestingly, two qualitative studies highlighted cultural differences in the perception of cancer pain as Asian patients tended to normalize pain compared to Western patients who engage in active health-seeking behavior. CONCLUSION: There is an evidence to suggest that the cancer pain experience is different between ethnicities. Minority patients face potential barriers for effective pain management due to problems with communication and poor pain assessment. Cultural perceptions of cancer may influence individual conceptualization of pain and affect health-seeking behavior.