Background
Although the value of Rat Sarcoma Oncogene (RAS) mutation status in predicting long‐term outcomes in patients with colorectal liver metastases (CRLM) is widely accepted, the magnitude of its impact has recently been challenged by three large cohort studies. The aim of this meta‐analysis is to reevaluate the impact of RAS mutations on overall survival (OS) and disease‐free survival (DFS) in patients who underwent curative‐intent resection of CRLM.
Methods
A comprehensive literature search was performed for studies reporting outcomes of patients undergoing curative‐intent surgery stratified by RAS mutation status. Exclusion criteria were defined a priori. Subgroup analysis was performed to evaluate the effect of publication date, sample size, and KRAS vs any RAS mutation on overall outcomes.
Results
Ten studies incorporating 3115 patients with known RAS status were identified. Pooled results revealed significantly worse OS (Hazard Ratio 1.5, 95% CI 1.31‐1.71) and DFS (Hazard Ratio 1.36, 95% CI 1.22‐1.52) in RAS‐mutated patients. Subgroup analyses revealed that studies including more than 300 patients or published after 2015 reported lower HR than their counterparts.
Conclusion
The results of this meta‐analysis suggest that the prognostic value of RAS mutation status in patients with CRLM has been previously overestimated.
HighlightsMorgagni hernias represents a rare subtype of diaphragmatic congenital hernias manifesting usually during early childhood.An innocuous or asymptomatic presentation render diagnosis of Morgagni hernias a challenging procedure.In our case, an adult female patient presented with a giant Morgagni hernia, initially diagnosed as a paraesophageal hernia.Early treatment of such cases is advised due to potential fatal complications. Laparoscopic surgery is considered the best approach.
Although the use of laparoscopic surgery is increasing, controversy still surrounds its application for malignant conditions. Gastrointestinal stromal tumours (GISTs) are less demanding in terms of lymphadenectomy, meaning that laparoscopic resection might have a more defined benefit when compared with open resection. To the best of our knowledge, no randomized study exists that compares the laparoscopic and open resection of GISTs. The current study aimed to examine the relevant literature by means of a systematic review. A systematic literature search was performed individually by two authors, in which three independent databases were searched using specific search-terms. Titles, abstracts and full texts were screened, as well as references to relevant articles, in order to comprise a comprehensive list of studies. Data were extracted using a detailed pre-agreed spreadsheet. Studies were evaluated according to the modified MINORS criteria. A total of 10 studies were included in the present review, yielding a total of 14 entries. The majority of studies reported significantly improved perioperative outcomes for the laparoscopic approach, including improved duration of operation, blood loss and length of hospital stay. Only four studies reported long-term outcomes and findings that were controversial, with some studies detecting no statistically significant differences, one reporting improved and one reporting worse disease-free and overall survival for the laparoscopic group. Three studies were deemed to be good quality, two of which had not reported significantly different long-term outcomes, while the third had reported significantly improved outcomes in the open resection group. While there is a clear benefit for performing laparoscopic surgery in patients with GIST with regards to perioperative outcomes, when it comes to long-term oncological outcomes, uncertainty over its application remains. The lack of randomized trials, as well as the poor reporting of retrospective studies, limits the amount of evidence that is currently available. Laparoscopic surgery for GIST is certainly safe, feasible and likely cost-effective; however, further studies are required to inform on whether this technique is superior to open resection.
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