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Shrikhande SV, Kunte AR, Chopde AN, Chaudhari VA, Bhandare MS. Big data and RCT's in surgical oncology: Impact on improving hepatopancreatobiliary cancer surgical care on the global stage. J Surg Oncol 2023; 128:1003-1010. [PMID: 37818909 DOI: 10.1002/jso.27467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/13/2023]
Abstract
Randomized controlled clinical trials (RCTs) are at the heart of "evidence-based" medicine. Conducting well-designed RCTs for surgical procedures is often challenged by inadequate recruitment accrual, blinding, or standardization of the surgical procedure, as well as lack of funding and evolution of the treatment strategy during the many years over which such trials are conducted. In addition, most clinical trials are performed in academic high-volume centers with highly selected patients, which may not necessarily reflect a "real-world" practice setting. Large databases provide easy and inexpensive access to data on a large and diverse patient population at a variety of treatment centers. Furthermore, large database studies provide the opportunity to answer questions that would be impossible or very arduous to answer using RCTs, including questions regarding health policy efficacy, trends in surgical practice, access to health care, the impact of hospital volume, and adherence to practice guidelines, as well as research questions regarding rare disease, infrequent surgical outcomes, and specific subpopulations. Prospective data registries may also allow for quality benchmarking and auditing. There are several high-quality RCTs providing evidence to support current practices in hepatopancreatobiliary (HPB) oncology. Evidence from big data bridges the gap in several instances where RCTs are lacking. In this article, we review the evidence from RCTs and big data in HPB oncology identify the existing lacunae, and discuss the future directions of research in HPB oncology.
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Affiliation(s)
- Shailesh V Shrikhande
- Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Aditya R Kunte
- Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Amit N Chopde
- Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vikram A Chaudhari
- Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Manish S Bhandare
- Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Collienne M, Neven A, Caballero C, Kataoka K, Carrion-Alvarez L, Nilsson H, Désolneux G, Rivoire M, Ruers T, Gruenberger T, Protic M, Troisi RI, Primavesi F, Staettner S, Rahbari N, Schnitzbauer A, Malik H, Swijnenburg RJ, Mauer M, Ducreux M, Evrard S. EORTC 1409 GITCG/ESSO 01 - A prospective colorectal liver metastasis database for borderline or initially unresectable diseases (CLIMB): Lessons learnt from real life. From paradigm to unmet need. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107081. [PMID: 37793303 DOI: 10.1016/j.ejso.2023.107081] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/25/2023] [Accepted: 09/13/2023] [Indexed: 10/06/2023]
Abstract
AIM Multidisciplinary management of metastatic colorectal liver metastases (CRLM) is still challenging. To assess postoperative complications in initially unresectable or borderline resectable CRLM, the prospective EORTC-1409 ESSO 01-CLIMB trial capturing 'real-life data' of European centres specialized in liver surgery was initiated. MATERIAL AND METHODS A total of 219 patients were registered between May 2015 and January 2019 from 15 centres in nine countries. Eligible patients had borderline or initially unresectable CRLM assessed by pre-operative multidisciplinary team discussion (MDT). Primary endpoints were postoperative complications, 30-day and 90-days mortality post-surgery, and quality indicators. We report the final results of the 151 eligible patients that underwent at least one liver surgery. RESULTS Perioperative chemotherapy with or without targeted treatment were administered in 100 patients (69.4%). One stage resection (OSR) was performed in 119 patients (78.8%). Two stage resections (TSR, incl. Associating Liver Partition and Portal Vein Ligation for Staged hepatectomy (ALPPS)) were completed in 24 out of 32 patients (75%). Postoperative complications were reported in 55.5% (95% CI: 46.1-64.6%), 64.0% (95% CI: 42.5-82%), and 100% (95% CI: 59-100%) of the patients in OSR, TSR and ALPPS, respectively. Post-hepatectomy liver failure occurred in 6.7%, 20.0%, and 28.6% in OSR, TSR, and ALPPS, respectively. In total, four patients (2.6%) died after surgery. CONCLUSION Across nine countries, OSR was more often performed than TSR and tended to result in less postoperative complications. Despite many efforts to register patients across Europe, it is still challenging to set up a prospective CRLM database.
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Affiliation(s)
- Maike Collienne
- The European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium.
| | - Anouk Neven
- The European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Luxembourg Institute of Health, Competence Center for Methodology and Statistics, Strassen, Luxembourg
| | | | - Kozo Kataoka
- Division of Lower GI, Department of Gastroenterological Surgery, School of Medicine, Hyogo Medical University, Hyogo, Japan
| | | | - Henrik Nilsson
- Karolinska Institutet, Department of Clinical Sciences Danderyd, Stockholm, Sweden
| | | | | | - Theo Ruers
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Thomas Gruenberger
- Clinic Favoriten, HPB Center, Health Network Vienna and Sigmund Freud University, Vienna, Austria
| | - Mladjan Protic
- University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia and Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | - Roberto Ivan Troisi
- Dept. of Human Structure and Repair, Ghent University, Belgium; Division of HPB, Minimally Invasive and Robotic Surgery, Renal Transplantation Service, Dept. of Clinical Medicine and Surgery, Federico II University Hospital Naples, Italy
| | - Florian Primavesi
- Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria; Department of General, Visceral and Vascular Surgery, Salzkammergutklinikum, Austria
| | - Stefan Staettner
- Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria; Department of General, Visceral and Vascular Surgery, Salzkammergutklinikum, Austria
| | - Nuh Rahbari
- Department of Surgery, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Andreas Schnitzbauer
- Universitätsklinikum Frankfurt Goethe-Universität Frankfurt Am Main Klinik für Allgemein- und Viszeralchirurgie, Frankfurt, Germany
| | - Hassan Malik
- Aintree University Hospital NHS Trust, Liverpool, United Kingdom
| | - Rutger-Jan Swijnenburg
- Leiden University Medical Center, Leiden, Netherlands; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Murielle Mauer
- The European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Michel Ducreux
- Gustave Roussy, Université Paris Saclay, Inserm, U1279, France
| | - Serge Evrard
- Institut Bergonié, Université de Bordeaux, INSERM, U1312, France.
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Kirubalingam K, Dzioba A, Chan Y, Graham ME. Trends in otolaryngology publications: a 9-year bibliometric analysis of articles published in Journal of Otolaryngology-Head and Neck Surgery. J Otolaryngol Head Neck Surg 2023; 52:17. [PMID: 36797784 PMCID: PMC9933021 DOI: 10.1186/s40463-022-00619-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/23/2022] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND The advancement of Otolaryngology-Head and Neck Surgery (OHNS) as a specialty relies on excellence in research. The Journal of Otolaryngology-Head and Neck Surgery is an open access, peer-reviewed journal publishing on all aspects and subspecialities of OHNS. It is the official journal of the Canadian Society of Otolaryngology-Head and Neck Surgery. This study aims to analyze bibliometric trends in authorships and institutional contributions within the Journal of Otolaryngology-Head and Neck Surgery over a 9-year period. METHODS All research articles published online in the journal were analyzed from 2013 to the end of 2021. The professional designation of all authors was recorded along with the article type, article category, institutional affiliations and international collaborations. Cochran-Armitage trend tests were used to assess the change in proportion over time between years and groups. RESULTS Of the 603 articles, 20 were excluded as they represented correspondence or corrections, or author identity could not be determined. 583 articles with 3409 total authors were included. Number of first authors with a Doctor of Medicine (MD) degree decreased from 90.2 to 85.3% (P = 0.165). Sub-group analysis of non-MD first authors demonstrated a significant increase in medical students as first authors from 1.6 to 11.8% (P = 0.008). Senior author degree demonstrated a significant increase in MD degree from 96.7 to 98.5% (P = 0.002). Analysis of article categories demonstrated a significant decrease in education and head and neck surgery related articles from 8.2 to 2.9% (P = 0.032) and 44.3 to 29.4% (P = 0.028) respectively. Pediatric otolaryngology articles increased significantly from 0 to 5.9% (P < 0.0001). Systematic and scoping reviews significantly increased, from 3.3 to 10.3% (P = 0.015) and original research significantly decreased from 83.6 to 82.4% (P < 0.0001). There was a significant decrease in Canadian/international collaborations from 14.3 to 4.7% (P = 0.037). There was a significant increase in international first and senior authors, from 23.0 to 36.8% (P = 0.008) and 19.7 to 38.2% (P = 0.002) respectively. CONCLUSION The landscape of the journal is evolving with increased representation of non-MDs and international authors along with content that reflects higher level of scientific evidence. Future studies should characterize trends in other Otolaryngology journals to understand the research trajectory within the field.
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Affiliation(s)
| | - Agnieszka Dzioba
- grid.39381.300000 0004 1936 8884Department of Otolaryngology–Head and Neck Surgery, Children’s Hospital at London Health Sciences Centre, and Schulich School of Medicine and Dentistry, University of Western Ontario, 800 Commissioners Road E, Box 5010, London, ON N6A 5W9 Canada
| | - Yvonne Chan
- grid.17063.330000 0001 2157 2938Department of Otolaryngology–Head and Neck Surgery, St Michael’s Hospital, University of Toronto, Toronto, ON Canada
| | - M. Elise Graham
- grid.39381.300000 0004 1936 8884Department of Otolaryngology–Head and Neck Surgery, Children’s Hospital at London Health Sciences Centre, and Schulich School of Medicine and Dentistry, University of Western Ontario, 800 Commissioners Road E, Box 5010, London, ON N6A 5W9 Canada
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Liatsou E, Tsilimigras DI, Malandrakis P, Gavriatopoulou M, Ntanasis-Stathopoulos I. Current status and novel insights into the role of metastasectomy in the era of immunotherapy. Expert Rev Anticancer Ther 2023; 23:57-66. [PMID: 36527305 DOI: 10.1080/14737140.2023.2160323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION New perspectives on the role of metastasectomy have emerged along with the advances in cancer immunotherapy. Despite accumulating evidence that encourages the use of immunotherapy in the metastatic setting, current data regarding its combination with surgical resection of secondary lesions, as well as the best timeline and sequence of such a therapeutic approach is limited. AREAS COVERED We review the currently available literature on the role of metastasectomy in the era of novel immunotherapeutic agents and provide comprehensive evidence from ongoing trials about the available treatment strategies. In metastatic melanoma, immune checkpoint inhibitors (ICIs) play a key role both in the neoadjuvant and adjuvant setting to achieve long-term disease control. In metastatic renal cell carcinoma, investigation is ongoing regarding the emerging role of ICIs before metastasectomy. ICIs have improved outcomes in patients with metastatic colorectal and head and neck cancer. EXPERT OPINION In the neoadjuvant setting, the high response rates and the durability of responses to immunotherapy may enable the resectability of metastatic lesions. In the adjuvant setting post metastasectomy, immunotherapy constitutes a safe and efficacious approach to support immune tumor surveillance and delay or even prevent disease relapse. Patient participation in relevant clinical trials should be encouraged.
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Affiliation(s)
- Efstathia Liatsou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Diamantis I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, the Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, USA
| | - Panagiotis Malandrakis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Bossi P, De Luca R, Ciani O, D’Angelo E, Caccialanza R. Malnutrition management in oncology: An expert view on controversial issues and future perspectives. Front Oncol 2022; 12:910770. [PMID: 36276153 PMCID: PMC9579941 DOI: 10.3389/fonc.2022.910770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/13/2022] [Indexed: 12/05/2022] Open
Abstract
Cancer and anticancer treatments can lead to several negative side effects, including malnutrition. Despite the recognized need for adequate nutritional support in cancer patients, in daily clinical practice, nutrition is still not considered one of the first aspects to be considered. Malnutrition negatively affects the clinical outcomes, treatment response, and overall survival of cancer patients. In this study, three of the most controversial issues related to malnutrition, which emerged during an Italian Consensus Conference, were addressed specifically for patients with head and neck as well as gastrointestinal cancer. The timing of nutritional evaluation and intervention, extension of the Enhanced Recovery after Surgery (ERAS®) protocols, and cost-effectiveness of nutritional interventions have been considered. This study aimed to illustrate the state-of-the art of each issue and hypothesize future perspectives and actions to be taken, trying to suggest a new nutritional management model for cancer patients in Italy that overcomes the critical issues encountered. Of note, the timely diagnosis of nutritional issue appears to be essential to ensure the correct management of malnourished cancer patients as well as those who are at high risk of malnutrition. Standardized protocols, screening tests, and the inclusion of nutritional parameters in patient medical records would help to achieve good clinical outcomes. Finally, appropriate nutritional support is also associated with cost savings, and it seems necessary to promote its clinical and economic value to obtain improvements in both outcomes and management costs.
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Affiliation(s)
- Paolo Bossi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Università degli Studi di Brescia, Brescia, Italy
| | - Raffaele De Luca
- Department of Surgical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Tumori “Giovanni Paolo II”, Bari, Italy
- *Correspondence: Raffaele De Luca,
| | - Oriana Ciani
- Centre for Research on Health and Social Care Management (CERGAS), Scuola di Direzione Aziendale (SDA) Bocconi School of Management, Bocconi University, Milan, Italy
| | - Elisa D’Angelo
- Radiotherapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
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Kataoka K, Fujita S, Inomata M, Takii Y, Ohue M, Shiozawa M, Akagi T, Ikeda M, Tsukamoto S, Tsukada Y, Ito M, Ikeda S, Ueno H, Shida D, Kanemitsu Y. Challenges needed to be overcome in multi-institutional surgical trials: accumulated experience in the JCOG Colorectal Cancer Study Group (CCSG). Jpn J Clin Oncol 2021; 52:103-107. [PMID: 34865024 DOI: 10.1093/jjco/hyab181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/06/2021] [Indexed: 11/14/2022] Open
Abstract
JCOG-CCSG has been conducting several surgical trials and experienced several challenges. The first point is the appropriate timing of conducting the trial. Once a certain number of surgeons acquire the new technique and its utility is accepted, it suddenly becomes difficult to maintain 'equipoise' between the standard and new treatment, which may lead to poor patient accrual. Smooth preparation and commencement of the trial at an appropriate timing is necessary for its success. Second is the appropriate quality assurance of surgery. High-level quality assurance will strengthen the comparability of randomized control trials and minimize the heterogeneity among hospitals. On the other hand, it may impair the generalizability of the trial. Large observational studies help to bridge the gap of heterogeneity among hospitals. Third is the selection of an appropriate endpoint. Overall survival (OS) is the gold-standard primary endpoint; however, the number of events is much less due to more effective treatment. JCOG0212 and JCOG0404 were unable to demonstrate the non-inferiority of omission of lateral lymph node dissection and laparoscopic surgery partly due to a lack of power. Disease-free survival (DFS) is also a promising candidate for primary endpoint, but as in JCOG0603, special attention must be paid when DFS does not correlate with OS. Although careful discussion is required because the precision of the hazard ratio depends on the number of events, an alternative population-level summary of variables, including restricted mean survival time, can be considered as the primary endpoint. Future surgical trials should be planned considering these points.
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Affiliation(s)
- Kozo Kataoka
- Division of lower GI, Department of Gastroenterological Surgery, Hyogo College of Medicine, Hyogo, Japan.,International Trials Management Section, Clinical Research Support Office, National Cancer Center Hospital, Tokyo, Japan
| | - Shin Fujita
- Department of Surgery, Tochigi Cancer Center, Tochigi, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Hospital, Oita, Japan
| | - Yasumasa Takii
- Department of Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Masayuki Ohue
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Manabu Shiozawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Tomonori Akagi
- Department of Gastroenterological and Pediatric Surgery, Oita University Hospital, Oita, Japan
| | - Masataka Ikeda
- Division of lower GI, Department of Gastroenterological Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Shunsuke Tsukamoto
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yuichiro Tsukada
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Satoshi Ikeda
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Dai Shida
- Division of Frontier Surgery, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
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Persiani R, Lorenzon L, Marincola G, Santocchi P, Tedesco S, Biondi A. Systematic review of transanal total mesorectal excision literature according to the ideal framework: The evolution never ends. Surgery 2021; 170:1054-1060. [PMID: 34020793 DOI: 10.1016/j.surg.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 03/15/2021] [Accepted: 04/05/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Designing studies to assess critically novel procedures can be challenging; thus, the process to achieve robust evidence is frequently problematic. The aim of this systematic review was to evaluate if literature on transanal total mesorectal excision is evolving according to the Idea, Development, Exploration, Assessment, and Long-term results framework. METHODS Literature on transanal total mesorectal excision was searched according to the preferred reporting items for systematic reviews and meta-analyses statement, and these variables were recorded: bibliometric data, design, corresponding author's nationality, number of patients enrolled, and Idea, Development, Exploration, Assessment, and Long-term results stages (stage 0, stage 1, stage 2, stage 3, and stage 4). RESULTS Out of 447 articles retrieved, 247 were selected (76.5% single center and 23.5% multicenter collaborations), including 35 reviews, 15 meta-analyses, 24 other publications, and 173 articles classified according to Idea, Development, Exploration, Assessment, and Long-term results stages (19 stage 0, 27 stage 1, 111 stage 2, 7 stage 3, and 9 stage 4). Overall, impact factor produced was 634.10. Reviewing corresponding authors' nationalities, 32 countries were identified, and the most reported were the United States, China, and the United Kingdom; nearly all were from the Northern Hemisphere. Publication of stage 3 and 4 articles started in 2014, whereas stage 0 and 1 articles were stably published over time. The number of patients increased in correspondence with the Idea, Development, Exploration, Assessment, and Long-term results stages (case series with >51 patients, respectively, 100.0% stage 3, 77.8% stage 4, and 33.3% stage 2, P = .005). CONCLUSION The number of stage 3 and 4 articles is still low; however, the technical innovation of transanal total mesorectal excision is a non-stopping process with preclinical studies stably published over time.
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Affiliation(s)
- Roberto Persiani
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy. https://twitter.com/PersianiRoberto
| | - Laura Lorenzon
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | - Giuseppe Marincola
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy. https://twitter.com/GiuseppeMarinc3
| | - Pietro Santocchi
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy. https://twitter.com/PSantocchi
| | - Silvia Tedesco
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy. https://twitter.com/SilviaTedesco16
| | - Alberto Biondi
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy. https://twitter.com/AlbertoBiondi78
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Sapisochin G, Hibi T, Toso C, Man K, Berenguer M, Heimbach J, Greten TF, Pugh TJ, Dawson LA, Mazzaferro V. Transplant Oncology in Primary and Metastatic Liver Tumors: Principles, Evidence, and Opportunities. Ann Surg 2021; 273:483-493. [PMID: 33065633 DOI: 10.1097/sla.0000000000004071] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Transplant oncology defines any application of transplant medicine and surgery aimed at improving cancer patients' survival and/or quality of life. In practice, liver transplantation for selected hepato-biliary cancers is the only solid organ transplant with demonstrated efficacy in curing cancer. Four are the proposed future contributions of transplant oncology in hepato-biliary cancer (4-e). (1) evolutionary approach to cancer care that includes liver transplantation; (2) elucidation of self and non-self recognition systems, by linking tumor and transplant immunology; (3) exploration of innovative endpoints both in clinical and experimental settings taking advantage from the access to the entire liver explant; (4) extension of surgical limitation in the multidisciplinary approach to hepato-biliary oncology. The aim of this review is to define the principles of transplant oncology that may be applied to hepato-biliary cancer treatment and research, attempting to balance current evidences with future opportunities.
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Affiliation(s)
- Gonzalo Sapisochin
- Multi-Organ Transplant and HPB Surgical Oncology, Division of General Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Christian Toso
- Division of Abdominal Surgery and Hepato-pancreato-biliary Center, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Kwan Man
- Department of Surgery, HKU-SZH and LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Marina Berenguer
- Hepatology and Liver Transplantation Unit, Ciberehd, IISLaFe and Facultad de Medicina, La Fe University Hospital, Valencia, Spain
| | - Julie Heimbach
- Department of Surgery Liver Transplant Program, Mayo Clinic, Rochester, Minnesota
| | - Tim F Greten
- Gastrointestinal Malignancy Section, Thoracic and Gastrointestinal Oncology Branch, Center for Cancer Research and NCI-CCR Liver Cancer Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Trevor J Pugh
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Laura A Dawson
- Radiation Medicine Program, Princess Margaret Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Vincenzo Mazzaferro
- HPB Surgery and Liver Transplantation, Department of Oncology, University of Milan, Milan, Italy and Istituto Nazionale Tumori, Fondazione IRCCS, Milan, Italy
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Reporting quality of surgical randomised controlled trials in head and neck cancer: a systematic review. Eur Arch Otorhinolaryngol 2021; 278:4125-4133. [PMID: 33604748 PMCID: PMC8486722 DOI: 10.1007/s00405-021-06694-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/09/2021] [Indexed: 11/13/2022]
Abstract
Purpose Randomised controlled trials (RCTs) are considered the gold standard for evaluating the efficacy of an intervention. However, previous research has shown that RCTs in several surgical specialities are poorly reported, making it difficult to ascertain if various biases have been appropriately minimised. This systematic review assesses the reporting quality of surgical head and neck cancer RCTs. Methods A literature search of PubMed and Embase was performed. Papers were included if they reported RCTs which assessed a surgical technique used to treat or diagnose head and neck cancer published during or after 2011. The CONSORT 2010 checklist was used to evaluate the reporting quality of these trials. Results 41 papers were included. The mean CONSORT score was 16.5/25 (66% adherence) and the scores ranged from 7.5 (30%) to 25. The most common omissions were full trial protocol (found in 14.6%), participant recruitment method (22%) and effect size with a precision estimate for all outcome measures (29.3%). The full design and implementation of the randomisation methods were reported in 6 (14.6%). Papers published in journals which endorsed CONSORT had significantly higher scores (p = 0.02) and the journal impact factor was significantly correlated with CONSORT score (p = 0.01). Conclusion We have identified several pieces of information that are underreported in surgical head and neck cancer RCTs. These omissions make understanding and comparing the methodologies and conclusions of RCTs more difficult. The endorsement of CONSORT by journals improved adherence, suggesting that wider adoption of the checklist may improve reporting. Supplementary Information The online version contains supplementary material available at 10.1007/s00405-021-06694-9.
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Abstract
Randomized controlled clinical trials (RCTs) are at the heart of "evidence-based" medicine. However, in surgical practice, RCTs remain uncommon. Conducting well-designed RCTs for surgical procedures is often challenged by inadequate recruitment accrual, blinding, or standardization of the surgical procedure, as well as lack of funding and evolution of the treatment strategy during the many years over which such trials are conducted. In addition, most clinical trials are performed in academic high-volume centers in highly selected patients, which may not necessarily reflect a "real-world" practice setting. Over the past decades, surgical outcomes research using nationwide administrative and registry databases has become increasingly common. Large databases provide easy and inexpensive access to data on a large and diverse patient population at a variety of treatment centers. Furthermore, large database studies provide the opportunity to answer questions that would be impossible or very arduous to answer using RCTs, including questions regarding health policy efficacy, trends in surgical practice, access to health care, impact of hospital volume, and adherence to practice guidelines, as well as research questions regarding rare disease, infrequent surgical outcomes, and specific subpopulation. Prospective data registries may also allow for quality benchmarking and auditing. This review outlines the role, advantages, and limitations of RCTs and large database studies in answering important research questions in surgery.
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Affiliation(s)
- Gabriel Liberale
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, 121, Blvd. de Waterloo, 1000 Brussels, Belgium
| | - Lieveke Ameye
- Statistics Department, Data Centre – UGI, Brussels, Belgium
| | - Alain Hendlisz
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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Evrard S, van de Velde C, Noordhoek I, Caballero C, Ceelen W, Polom K, Kolacinska A, Allum W, D'Ugo D, Malik HZ, Rubio IT, Wyld L, Leidenius M, Rivoire M, Zoras O, Polkowski W, Poston GJ, Audisio RA, Kovacs T, González-Moreno S. European Society of Surgical Oncology's strategy for clinical research: Paving the way for a culture of research in cancer surgery. Eur J Surg Oncol 2019; 45:1515-1519. [PMID: 31085024 DOI: 10.1016/j.ejso.2019.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/26/2019] [Accepted: 05/04/2019] [Indexed: 10/26/2022] Open
Abstract
As part of its mission to promote the best surgical care for cancer patients, the European Society of Surgical Oncology (ESSO) has been developing multiple programmes for clinical research along with its educational portfolio. This position paper describes the different research activities of the Society over the past decade and an action plan for the upcoming five years to lead innovative and high quality surgical oncology research. ESSO proposes to consider pragmatic research methodologies as a complement to randomised clinical trials (RCT), advocates for increased funding and operational support in conducting research and aims to enable young surgeons to be active in research and establish partnerships for translational research activities.
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Affiliation(s)
- S Evrard
- Institut Bergonié and Université de Bordeaux, Bordeaux, France.
| | - C van de Velde
- Leiden University Medical Center, Leiden, the Netherlands
| | - I Noordhoek
- Leiden University Medical Center, Leiden, the Netherlands
| | - C Caballero
- European Society of Surgical Oncology Clinical Research Committee, Brussels, Belgium
| | - W Ceelen
- Ghent University Hospital, Ghent, Belgium
| | - K Polom
- University of Siena, Siena, Italy; Medical University of Gdansk, Gdańsk, Poland
| | - A Kolacinska
- Department of Head and Neck Cancer Surgery, Breast Unit, Medical University of Lodz, Cancer Center, Lodz, Poland
| | - W Allum
- Royal Marsden NHS Foundation Trust, London, UK
| | - D D'Ugo
- Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - H Z Malik
- Aintree University Hospital, Liverpool, UK
| | - I T Rubio
- Clinica Universidad de Navarra, Madrid, Spain
| | - L Wyld
- Medical School, University of Sheffield, Sheffield and Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - M Leidenius
- Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - M Rivoire
- Centre Léon Bérard and Université de Lyon, Lyon, France
| | - O Zoras
- Medical School, University of Crete, Heraklion, Greece
| | | | | | - R A Audisio
- Institute of Clinical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden
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Surgical quality assurance in head and neck cancer trials: an EORTC Head and Neck Cancer Group position paper based on the EORTC 1420 ‘Best of’ and 24954 ‘larynx preservation’ study. Eur J Cancer 2018; 103:69-77. [DOI: 10.1016/j.ejca.2018.07.140] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 11/22/2022]
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Impact of mesenteric defect closure technique on complications after gastric bypass. Langenbecks Arch Surg 2018; 403:481-486. [PMID: 29858618 PMCID: PMC6013510 DOI: 10.1007/s00423-018-1684-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 05/24/2018] [Indexed: 01/06/2023]
Abstract
Background Closure of mesenteric defects during laparoscopic gastric bypass surgery markedly reduces the risk for small bowel obstruction due to internal hernia. However, this procedure is associated with an increased risk for early small bowel obstruction and pulmonary complication. The purpose of the present study was to evaluate whether the learning curve and subsequent adaptions made to the technique have had an effect on the risk for complications. Methods The results of patients operated with a primary laparoscopic gastric bypass procedure, including closure of the mesenteric defects with sutures, during a period soon after introduction (January 1, 2010–December 31, 2011) were compared to those of patients operated recently (January 1, 2014–June 30, 2017). Data were retrieved from the Scandinavian Obesity Surgery Registry (SOReg). The main outcome was reoperation for small bowel obstruction within 30 days after surgery. Results A total of 5444 patients were included in the first group (period 1), and 1908 in the second group (period 2). Thirty-day follow-up rates were 97.1 and 97.5% respectively. The risk for early (within 30 days) small bowel obstruction was lower in period 2 than in period 1 (13/1860, 0.7% vs. 67/5285, 1.3%, OR 0.55 (0.30–0.99), p = 0.045). The risk for pulmonary complication was also reduced (5/1860, 0.3%, vs. 41/5285, 0.8%, OR 0.34 (0.14–0.87), p = 0.019). Conclusion Closure of mesenteric defects during laparoscopic gastric bypass surgery can be performed safely and should be viewed as a routine part of that operation.
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Nguyen TK, Nguyen EK, Warner A, Louie AV, Palma DA. Failed Randomized Clinical Trials in Radiation Oncology: What Can We Learn? Int J Radiat Oncol Biol Phys 2018; 101:1018-1024. [PMID: 29859791 DOI: 10.1016/j.ijrobp.2018.04.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 04/05/2018] [Accepted: 04/10/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Randomized clinical trials (RCTs) are essential to evidence-based medicine, yet a significant proportion fail to be completed. In radiation oncology, factors contributing to trial failure are not well understood. We sought to compare completed and incomplete clinical trials involving radiation therapy (RT) to identify predictors of trial failure. METHODS AND MATERIALS We undertook a review of ClinicalTrials.gov to identify RCTs involving RT. Eligible trials mandated external beam RT in ≥1 arm of the study and were registered between September 27, 2007, and December 31, 2010. Univariate and multivariate logistic regression analyses were performed to determine factors predictive of trial failure. RESULTS We included 134 eligible studies, of which 94 (70.1%) were successful and 40 (29.9%) failed. The reasons for trial failure were categorized as follows: lack of accrual (57.5%), inadequate funding (15.0%), drug unavailability (7.5%), interim data-monitoring report recommendations (7.5%), and other (12.5%). Over time, significantly more trials were failing to be completed (P = .010), with rates increasing from 11.8% (before 2007) to 34.0% (2007-2008) to 39.5% (2009-2012). On univariate analysis, predictors of failure were trials with a surgical comparator (odds ratio [OR], 8.12; P = .013), government sponsorship (vs non-government; OR, 3.67; P = .025), inclusion of a safety endpoint (OR, 2.85; P = .022), and studies starting after 2006 (P = .033). On multivariate analysis, surgical trials were strongly predictive of failure (OR, 12.30; P = .025) while behavioral trials were associated with success (OR, 0.11; P = .045). CONCLUSIONS RT RCTs involving ≥1 surgical arms are at a very high risk of failure, with 75% failing to be completed. In contrast, behavioral studies are associated with study completion, with 94% of studies being successful. Future RT trials involving surgical interventions should consider novel methods to reduce the risk of trial failure.
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Affiliation(s)
- Timothy K Nguyen
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Eric K Nguyen
- Department of Radiation Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - David A Palma
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
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Filleron T, Lusque A, Dalenc F, Ferron G, Roche H, Martinez A, Jouve E. Alternative methodological approach to randomized trial for surgical procedures routinely used. Contemp Clin Trials 2018; 68:109-115. [PMID: 29608972 DOI: 10.1016/j.cct.2018.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND In medical oncology, changes in practices are almost always based on randomized trials but medical history shows that it is different in surgical oncology. In the past, many surgical procedures were routinely performed without a rigorous evaluation of the risk-benefit. To highlight the complexity of developing randomized surgical trials, disquisitions on methodology presented in the medical literature. This is particularly true when we consider breast reconstruction after surgical treatment for breast cancer. It is illusory to perform and conduct a randomized clinical trial (RCT) when a surgical procedure is routinely used by most surgeons. METHODS As a case study, we present the scientific rationale and the design of the MAPAM01 trial which evaluates the security of the nipple sparing mastectomy. Other alternative approaches, such as propensity score and CUSUM, are presented. RESULTS In this situation, to design surgical trials using alternative methodological approaches present a particularly important challenge both for surgeons and methodologists. Alternative approach to randomized trials can be useful to evaluate surgical procedures routinely used. CONCLUSION Close collaboration between surgeons and methodologists is needed to propose appropriate and well-designed surgical trials.
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Affiliation(s)
- T Filleron
- Biostatistics Unit, Institut Claudius Regaud, IUCT-O, Toulouse, France.
| | - A Lusque
- Biostatistics Unit, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - F Dalenc
- Oncology Department, Institut Claudius Regaud-IUCT-O, Toulouse, France
| | - G Ferron
- Surgical Department, Institut Claudius Regaud-IUCT-O, Toulouse, France
| | - H Roche
- Oncology Department, Institut Claudius Regaud-IUCT-O, Toulouse, France
| | - A Martinez
- Surgical Department, Institut Claudius Regaud-IUCT-O, Toulouse, France
| | - E Jouve
- Surgical Department, Institut Claudius Regaud-IUCT-O, Toulouse, France
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Re: E Morris, T Treasure, Cancer Epidemiology, 49 (2017) 152–155. Cancer Epidemiol 2018; 52:158-159. [DOI: 10.1016/j.canep.2017.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 12/18/2017] [Indexed: 11/23/2022]
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[Europe and Japan alliance for clinical research in oncology]. Bull Cancer 2018; 105:135-136. [PMID: 29366499 DOI: 10.1016/j.bulcan.2018.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 12/14/2017] [Indexed: 11/21/2022]
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Kataoka K, Nakamura K, Caballero C, Evrard S, Negrouk A, Shiozawa M, Collette L, Fukuda H, Lacombe D. Collaboration between EORTC and JCOG-how to accelerate global clinical research partnership. Jpn J Clin Oncol 2017; 47:164-169. [PMID: 28173055 DOI: 10.1093/jjco/hyw159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 09/28/2016] [Indexed: 11/12/2022] Open
Abstract
The demand for international collaboration in cancer clinical trials has grown stronger to maximize efficiency, avoid duplication of effort and to achieve effective implementation of research results into medical practice. Infrastructures that could facilitate intercontinental collaboration not only between Europe and United States but also between Europe and Asia are urgently needed. The European Organisation for Research and Treatment of Cancer, one of the major cancer clinical research infrastructure in Europe, initiated collaboration with the Japan Clinical Oncology Group, the largest cancer research cooperative group in Japan. Their first pilot trial on unresectable colorectal liver metastasis will commence on fourth quarter of 2016. With similar goals and strategies as well as with similar structures, the two research organizations have a great potential for efficient collaboration that could deliver faster and global therapeutic improvement to cancer patients. However, international collaboration requires careful and structured approach to harmonize activities to ensure success. This article focuses on specific intercontinental differences and the necessary requirements to ensure a successful partnership between European Organisation for Research and Treatment of Cancer and Japan Clinical Oncology Group. This could serve as a model to build more global international academic trials between the East and the West.
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Affiliation(s)
- Kozo Kataoka
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Kenichi Nakamura
- JCOG Data Center/Operations Office, National Cancer Center, Tokyo, Japan
| | - Carmela Caballero
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | | | - Anastassia Negrouk
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | | | - Laurence Collette
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Haruhiko Fukuda
- JCOG Data Center/Operations Office, National Cancer Center, Tokyo, Japan
| | - Denis Lacombe
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
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Sharma RA, Fumi L, Audisio RA, Denys A, Wood BJ, Pignatti F. Commentary: how will interventional oncology navigate the "valleys of death" for new medical devices? Br J Radiol 2017; 91:20170643. [PMID: 29172678 PMCID: PMC5965466 DOI: 10.1259/bjr.20170643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Whereas clinical trials of cancer drugs have methodological standards and conventional primary endpoints, these are not necessarily applicable to the clinical development of loco-regional treatments and new medical devices. The current challenge is to generate high-level clinical evidence for loco-regional treatments to define the benefits for patients. In this article, we argue that, to generate convincing evidence of clinical efficacy and safety, the collective coherence of the entire data package is often more important than the primary endpoint of one clinical trial. We also propose that, when a comprehensive clinical data package is not feasible, limited clinical data can be supplemented with other types of evidence. Emerging life science companies often define the "valley of death" after securing initial investment to translate an early medical device concept to a development stage that is attractive to funders. Unfortunately for this industry, there is a second "valley of death" if the focus and goal is only regulatory approval, to the neglect of clinical acceptance and reimbursement. For the emerging specialism of interventional oncology, it is critical to plan a clear line of sight for each new medical device to avoid the valleys of death and to demonstrate the clinical benefit. Increased international guidance to establish realistic yet convincing standards in this area may avoid attrition of potentially beneficial devices and therapeutic procedures in the valleys of death.
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Affiliation(s)
- Ricky A Sharma
- 1 Department of Oncology, NIHR Oxford Biomedical Research Centre, University of Oxford , Oxford , UK.,2 NIHR University College London Hospitals Biomedical Research Centre, UCL Cancer Institute , London , UK
| | - Lucio Fumi
- 3 Wyfold Medical Consultancy , Wyfold , UK
| | - Riccardo A Audisio
- 4 University of Liverpool, St Helens Teaching Hospital , St. Helens , UK
| | - Alban Denys
- 5 Department of Radiology and Interventional Radiology, CHUV University Hospital , Lausanne , Switzerland
| | - Bradford J Wood
- 6 Center for Interventional Oncology, National Cancer Institute and NIH Clinical Center, National Institutes of Health , Bethesda, MD , USA
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Abstract
OPINION STATEMENT The task of surgical research is to improve the efficacy of available surgical therapeutic modalities, develop new ones, and balance this well with favorable functional outcome. Therefore, surgical research is composed of a translational and a clinical component. In translational surgical research, animal models are used to better understand the biology of head and neck cancers, but even more importantly, the biology of changes to the disease and the microenvironment created by surgical interventions. Animal models additionally allow for the development of image-guided surgery systems, novel strategies of intraoperative adjuvant treatment, and patient "avatars" to test innovative anticancer drug combinations. In clinical surgical research, surgical techniques are validated in clinical trials for effectiveness of tumor control and improvement of functional recovery of the patient. In conclusion, surgical research for head and neck cancer is an active field spanning across the entire breadth of basic and clinical science devoted to a better understanding of what surgery does to the disease and to the patient.
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Affiliation(s)
- Genrich Tolstonog
- Service d'Oto-rhino-laryngologie - Chirurgie cervico-faciale, Centre Hospitalier Universitaire Vaudois (CHUV), Université de Lausanne (UNIL), Rue du Bugnon 21, 1011, Lausanne, Switzerland.
| | - Christian Simon
- Service d'Oto-rhino-laryngologie - Chirurgie cervico-faciale, Centre Hospitalier Universitaire Vaudois (CHUV), Université de Lausanne (UNIL), Rue du Bugnon 21, 1011, Lausanne, Switzerland
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Desjardin M, Desolneux G, Brouste V, Degrandi O, Bonhomme B, Fonck M, Becouarn Y, Béchade D, Evrard S. Parenchymal sparing surgery for colorectal liver metastases: The need for a common definition. Eur J Surg Oncol 2017; 43:2285-2291. [PMID: 29107396 DOI: 10.1016/j.ejso.2017.10.209] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 09/22/2017] [Accepted: 10/03/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The definition of parenchymal sparing surgery (PSS) for colorectal liver metastases (CRLM) diverges requiring a clarification of the concept. METHOD A consecutive series of patients were treated by PSS for their CRLMs, either by resection or intra-operative ablation (IOA), whenever possible a one-stage surgery and minimal usage of portal vein embolization. Post-operative complications were the primary endpoint with a special focus on post-operative liver failure. RESULTS Three hundred and eighty-seven patients underwent a PSS out of which 328 patients received a median of 9 pre-operative cycles of chemotherapy. One hundred and twenty-eight patients had a major resection, combined with IOA in 137 patients and IOA alone in 50 cases. The 5yr-overall survival was 50.3%. There was no difference in post-operative complications between minor and major resections, validating our PSS definition based on the Tumor burden/Healthy liver ratio and not just the retrieved volume. CONCLUSIONS PSS is defined as a high ratio of tumoral burden per specimen retrieved while favoring one-stage surgery approach. Our series, using combined resections and IOAs, matches this definition well. Furthermore, complications were correlated neither to chemotherapy nor to liver-induced toxicities, contrary to extended hepatectomies.
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Affiliation(s)
- Marie Desjardin
- Digestive Tumours Unit, Institut Bergonié, 229 Cours de l'Argonne, 33000 Bordeaux, France
| | - Grégoire Desolneux
- Digestive Tumours Unit, Institut Bergonié, 229 Cours de l'Argonne, 33000 Bordeaux, France
| | - Véronique Brouste
- Department of Clinical Epidemiology Research, Institut Bergonié, 229 Cours de l'Argonne, 33000 Bordeaux, France
| | - Olivier Degrandi
- Department of Digestive Surgery, CHU Bordeaux, Place Amélie Raba Léon, 33000 Bordeaux, France
| | - Benjamin Bonhomme
- Department of Pathology, Institut Bergonié, 229 Cours de l'Argonne, 33000 Bordeaux, France
| | - Marianne Fonck
- Digestive Tumours Unit, Institut Bergonié, 229 Cours de l'Argonne, 33000 Bordeaux, France
| | - Yves Becouarn
- Digestive Tumours Unit, Institut Bergonié, 229 Cours de l'Argonne, 33000 Bordeaux, France
| | - Dominique Béchade
- Digestive Tumours Unit, Institut Bergonié, 229 Cours de l'Argonne, 33000 Bordeaux, France
| | - Serge Evrard
- Digestive Tumours Unit, Institut Bergonié, 229 Cours de l'Argonne, 33000 Bordeaux, France; Université de Bordeaux, 146 rue Léo Saignat, 33000 Bordeaux, France.
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Multidisciplinary quality assurance and control in oncological trials: Perspectives from European Organisation for Research and Treatment of Cancer (EORTC). Eur J Cancer 2017; 86:91-100. [PMID: 28964907 DOI: 10.1016/j.ejca.2017.07.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 07/25/2017] [Indexed: 02/06/2023]
Abstract
Quality assurance (QA) programmes are one of the mainstays of clinical research and constitute the pillars on which European Organisation for Research Treatment of Cancer (EORTC) delivers multidisciplinary therapeutic progress. Changing practice treatments require solid evidence-based data, which can only be achieved if integral QA is part of the infrastructure sustaining research projects. Cancer treatment is a multimodality approach, which is often applied either in sequence and/or in combination. Each modality plays a key role in cancer control. The modalities by which QA is applied varies substantially within and across the disciplines. In addition, translational and diagnostic disciplines take an increasing role in the era of precision medicine. Building on the structuring effect of clinical research with fully integrated multidisciplinary QA programmes associated with the solutions addressing the chain of custody for biological material and data integrity as well as compliance ensure at the same time validity of clinical research output but also have a training effect on health care providers, who are more likely to apply such principles as routine. The principles of QA are therefore critical to be embedded in multidisciplinary infrastructure to guarantee therapeutic progress. These principles also provide the basis for the functioning of multidisciplinary tumour board. However, technical, operational and economic challenges which go with the implementation of such programmes require optimal know-how and the coordination of the multiple expertise and such efforts are best achieved through centralised infrastructure.
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Park YK. Laparoscopic gastric cancer surgery results in reduced wound complication and overall morbidity. Transl Gastroenterol Hepatol 2017; 1:29. [PMID: 28138596 DOI: 10.21037/tgh.2016.03.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 03/22/2016] [Indexed: 11/06/2022] Open
Affiliation(s)
- Young-Kyu Park
- Chonnam National University Hwasun Hospital, Hwasun, Korea
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Evrard S, Audisio R, Poston G, Caballero C, Kataoka K, Fontein D, Collette L, Nakamura K, Fukuda H, Lacombe D. From a Comic Opera to Surcare an Open Letter to Whom Clinical Research in Surgery Is a Concern. Ann Surg 2016; 264:911-912. [DOI: 10.1097/sla.0000000000001700] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Evrard S. [2016 news in oncologic surgery]. Bull Cancer 2016; 103:413-4. [PMID: 26995401 DOI: 10.1016/j.bulcan.2016.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/06/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Serge Evrard
- Institut Bergonié, groupe Digestif, 229, cours de l'Argonne, 33076 Bordeaux, France.
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Balch CM, Nelson H, Niederhuber JE. Limitations of prospective surgical oncology trials — a US view. Nat Rev Clin Oncol 2015; 13:6-8. [DOI: 10.1038/nrclinonc.2015.212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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