Showing papers by "Vincent W. T. Lam published in 2011"

Management of primary symptomatic lymphocele after kidney transplantation: a systematic review.

Abstract: BACKGROUND Management of lymphoceles after kidney transplantation is highly variable. The aim of this study was to evaluate and compare the different approaches of lymphocele management among kidney transplant recipients. METHODS MEDLINE and EMBASE were systematically searched for case studies published between 1954 and 2010. Inclusion criteria were symptomatic lymphoceles developing in recipients of deceased or living donor kidneys with specified intervention and outcome. Primary outcome was the rate of recurrence. Secondary outcomes were the rate of conversion from laparoscopic to open surgery, hospital stay, and complication rates. RESULTS Fifty-two retrospective case series with 1113 cases of primary lymphocele were selected for review. No randomized controlled trials or prospective cohort studies were located. Primary treatment modalities included were as follows: aspiration (n=218), sclerotherapy (n=155), drainage (n=219), laparoscopic surgery (n=333), and open surgery (n=188). Of the 218 cases of lymphocele managed with aspiration alone, 141 recurred with a recurrence rate of 59% (95% confidence interval [CI]: 52-67). Among those who received laparoscopic and open surgery, the recurrence rates were 8% (95% CI: 6-12) and 16% (95% CI: 10-24), respectively. The conversion rate from laparoscopic to open surgery was 12% (95% CI: 8-16). CONCLUSIONS Laparoscopic fenestration of a symptomatic lymphocele is associated with the lowest risk of lymphocele recurrence. However, the evidence base to support a recommendation for laparoscopic surgery as first line treatment is weak and highlights the need for a multicenter prospective cohort study to examine the benefits of incorporating initial simple aspiration into the management of lymphocele after kidney transplantation.

Endoscopic necrosectomy of pancreatic necrosis: a systematic review

Abstract: Aim To review the current status of the novel technique of endoscopic necrosectomy in the management of pancreatic necrosis after acute pancreatitis

Ten-year survival after liver resection for colorectal metastases: systematic review and meta-analysis.

Abstract: Background. Liver resection in metastatic colorectal cancer is proved to result in five-year survival of 25-40%. Several factors have been investigated to look for prognostic factors stratifications such as resection margins, node involvement in the primary disease, and interval between the primary disease and liver metastases. Methods. We searched MEDLINE and EMBASE for studies that reported ten-year survival. Metaanalysis was performed to analyse the effect of recognised prognostic factors on cure rate for colorectal metastases. The meta-analysis was performed according to Ottawa-Newcastle method of analysis for nonrandomised trials and according to the guidelines of the PRISMA. Results. Eleven studies were included in the analysis, which showed a ten-year survival rate of 12-36%. Factors that have favourable impact are clear resection margin, low level of CEA, single metastatic deposit, and node negative disease. The only factor that excluded patients from cure is the positive status of the resection margin. Conclusion. Predicted ten-year survival after liver resection for colorectal metastases varies from 12 to 36%. Only positive resection margins resulted in no 10-year survivors. No patient can be excluded from consideration for liver resection so long the result is negative margins.

Utilization of small pediatric donor kidneys: a decision analysis

Abstract: Background Given the disparity between static supply and increasing demand for organs, the greatest challenge is broadening access to the benefits of kidney transplantation. Organs from small deceased pediatric donors are a potentially underused resource. These may be transplanted as en bloc kidney transplants (EBKTs) to one recipient or as single kidney transplants (SKTs) to two recipients, albeit with an increased risk of graft failure. Methods A systematic literature search identified data on transplant outcomes for recipients of organs from small pediatric deceased donors. A decision analysis model was constructed to allow the outcome in life years (LY) to be predicted for patients with end-stage kidney disease on the transplant waiting list depending on whether they received EBKT or SKT. Results At all recipient ages, the projected LY of both recipients of an SKT was greater than the projected LY of an EBKT recipient. The net estimated gain in LY associated with the SKT technique was greatest for recipients aged 20 to 39 years (14.3 years) and lowest for recipients aged 60 to 74 years (3.36 years). Only for recipients of organs from donors weighing less than 10 kg, there was an estimated net loss of LY associated with the SKT technique across all recipient age groups. Conclusions There is a greater gain in overall life expectancy using SKTs, because this technique yields two recipients per donor, which more than compensates for the increased risk of graft failure.

In Colorectal Liver Metastases, the Presence of Extrahepatic Disease Correlates with the Pathology of the Primary Tumour

Abstract: Background. FDG-PET scan detects extrahepatic metastases in 20% of patients with colorectal liver metastases but it is reported to have approximately 16% false negative rates. Patients and Methods. Patients who had PET scan for metastatic colorectal cancer at Westmead Hospital between March 2006 and March 2010 were reviewed retrospectively. The results of PET scan were correlated with tumour characteristics that were thought to affect the overall prognosis. Results. Degree of tumour differentiation and vascular invasion were significantly predictive for the presence of extrahepatic disease on PET scan, also did the level of CEA. Conclusion. The detection of extrahepatic disease in colorectal liver metastases correlates with the biologic behaviour of the primary tumour. Poorly differentiated tumours and those with lymphovascular invasion behave in aggressive fashion and likely to have wide-spread metastases. This should be considered when contemplating liver resection for colorectal metastases.