ABSTRACT
INTRODUCTION: Surgery (oesophagectomy), with neoadjuvant chemo(radio)therapy, is the main curative treatment for patients with oesophageal cancer. Several surgical approaches can be used to remove an oesophageal tumour. The Ivor Lewis (two-phase procedure) is usually used in the UK. This can be performed as an open oesophagectomy (OO), a laparoscopically assisted oesophagectomy (LAO) or a totally minimally invasive oesophagectomy (TMIO). All three are performed in the National Health Service, with LAO and OO the most common. However, there is limited evidence about which surgical approach is best for patients in terms of survival and postoperative health-related quality of life. METHODS AND ANALYSIS: We will undertake a UK multicentre randomised controlled trial to compare LAO with OO in adult patients with oesophageal cancer. The primary outcome is patient-reported physical function at 3 and 6 weeks postoperatively and 3 months after randomisation. Secondary outcomes include: postoperative complications, survival, disease recurrence, other measures of quality of life, spirometry, success of patient blinding and quality assurance measures. A cost-effectiveness analysis will be performed comparing LAO with OO. We will embed a randomised substudy to evaluate the safety and evolution of the TMIO procedure and a qualitative recruitment intervention to optimise patient recruitment. We will analyse the primary outcome using a multi-level regression model. Patients will be monitored for up to 3 years after their surgery. ETHICS AND DISSEMINATION: This study received ethical approval from the South-West Franchay Research Ethics Committee. We will submit the results for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: ISRCTN10386621.
Subject(s)
Adenocarcinoma/surgery , Carcinoma, Squamous Cell/surgery , Esophageal Neoplasms/surgery , Esophagectomy/methods , Laparoscopy , Adenocarcinoma/economics , Adenocarcinoma/mortality , Adolescent , Adult , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/economics , Carcinoma, Squamous Cell/mortality , Clinical Protocols , Cost-Benefit Analysis , Double-Blind Method , Esophageal Neoplasms/economics , Esophageal Neoplasms/mortality , Esophagectomy/economics , Female , Follow-Up Studies , Humans , Laparoscopy/economics , Male , Middle Aged , Neoplasm Recurrence, Local/economics , Neoplasm Recurrence, Local/epidemiology , Neoplasm Recurrence, Local/etiology , Neoplasm Recurrence, Local/prevention & control , Postoperative Complications/economics , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Quality of Life , Regression Analysis , Treatment Outcome , United Kingdom/epidemiology , Young AdultABSTRACT
The two main histological esophageal cancer types, adenocarcinoma and squamous cell carcinoma, differ in incidence, geographic distribution, ethnic pattern and etiology. This article focuses on epidemiology with particular reference to geographic and temporal variations in incidence, along with a review of the evidence supporting environmental and genetic factors involved in esophageal carcinogenesis. Squamous cell carcinoma of the esophagus remains predominantly a disease of the developing world. In contrast, esophageal adenocarcinoma is mainly a disease of western developed societies, associated with obesity and gastro-esophageal reflux disease. There has been a dramatic increase in the incidence of adenocarcinoma in developed countries in parallel with migration of both esophageal and gastric adenocarcinomas towards the gastro-esophageal junction.
Subject(s)
Fibroma/diagnosis , Intestinal Perforation/diagnosis , Polyps/diagnosis , Stomach Neoplasms/diagnosis , Stomach , Diagnosis, Differential , Fibroma/complications , Fibroma/surgery , Gastrectomy/methods , Humans , Intestinal Perforation/etiology , Intestinal Perforation/surgery , Laparotomy/methods , Male , Middle Aged , Polyps/complications , Polyps/surgery , Rupture, Spontaneous , Stomach Neoplasms/complications , Stomach Neoplasms/surgery , Tomography, X-Ray ComputedABSTRACT
Neste trabalho foi realizado um acompanhamento clínico, por um período de até 14 anos, de implantes de 7 mm de comprimento instalados na mandíbula. Foram avaliados 198 implantes em 99 pacientes. No período de avaliação, obteve-se 96,46% de sucesso dos implantes.
Subject(s)
Humans , Male , Female , Middle Aged , Dental Implantation, Endosseous , Dental Implants , Mandible , Dental Materials/analysis , Dental Prosthesis, Implant-Supported/adverse effects , Dental Prosthesis, Implant-Supported/methodsABSTRACT
Quatro cimentos de ionômero, uma resina composta e dois compômeros: Vidrion N, Vidrion R, Viotremer, Fuji II LC, Tetric Ceram, Dyract e Compoglass foram analisados quanto à sua capacidade de inibiçäo de crescimento bacteriano. Essa capacidade foi avaliada medindo-se o halo de inibiçäo observado no meio de cultura. Para a realizaçäo dos testes, utilizaram-se cinco espécimes bacterianas encontradas na microbiota bucal humana: Streptococos mutans; Streptococcus salivarius; Streptococcus pyogenes; Stafilococcus aureus e Streptococcus sobrinus. Dos materiais analisados, somente o Vitremer apresentou atividade inibidora de crescimento bacteriano contra os microrganismos testados
