Global surgery in an ecosystem for worldwide health

Søreide, Kjetil; Winter, D. C.

doi:10.1002/bjs.11070

Cited by 13 publications

(11 citation statements)

References 19 publications

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“…Combined with the present results, this suggests that all patients found to have ER+PgR– disease are likely to benefit from adjuvant chemotherapy, regardless of Oncotype score, given the significantly poorer outcomes in this group. With the recent focus on global surgery initiatives, this could particularly aid clinical decision‐making in the context of allocation of scarce healthcare resources. Other authors have argued that using a composite endocrine score comprising both PgR and ER status may be more predictive of outcomes including DFS and OS.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of the impact of progesterone receptor status on oncological outcomes in oestrogen receptor-positive breast cancer

Boland

Ryan

Dunne

et al. 2020

Journal of British Surgery

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Background: Assessment of the oestrogen receptor (ER) provides important prognostic information in breast cancer. The impact of progesterone receptor (PgR) status is less clear. Standardization of immunohistochemical analysis of these receptors has reduced interstudy heterogeneity. The aim of this meta-analysis was to evaluate the impact of PgR negativity on outcomes in ER-positive (ER+) breast cancer.Methods: This study was performed according to PRISMA and MOOSE guidelines. PubMed, Embase and the Cochrane Library were searched systematically to identify studies comparing disease-free survival as the primary outcome and overall survival as secondary outcome between PgR-positive (PgR+) and PgR-negative (PgR-) status in ER+ breast cancer. A meta-analysis of time-to-effect measures from included studies was undertaken.Results: Eight studies including 13 667 patients, 11 838 in the ER+PgR+ group and 1829 in the ER+PgR-group, met the inclusion criteria. Treatment characteristics did not differ significantly between the two groups. Patients in the ER+PgR-group had a higher risk of disease recurrence than those who had ER+PgR+ disease (hazard ratio (HR) 1⋅57, 95 per cent c.i. 1⋅38 to 1⋅79; P < 0⋅001). This hazard was increased in patients with human epidermal growth factor receptor 2-negative tumours (HR 1⋅62, 1⋅37 to 1⋅93; P < 0⋅001). A similar result was observed for overall survival (HR 1⋅69, 1⋅33 to 2⋅14; P < 0⋅001).Conclusion: PgR negativity is associated with significant reductions in disease-free and overall survival in ER+ breast cancer. Treatment and surveillance strategies in these patients should be tailored accordingly.

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Section: Discussionmentioning

confidence: 99%

Meta-analysis of the impact of progesterone receptor status on oncological outcomes in oestrogen receptor-positive breast cancer

Boland

Ryan

Dunne

et al. 2020

Journal of British Surgery

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“…With a long‐lasting lockdown and social distancing in effect, there will be millions of operations cancelled, deferred or simply not done at all over the coming months. Surgery is already recognized as a scarce resource in much of the world, with a global challenge to provide safe surgery and anaesthesia as a recognized area of priority.…”

Section: Preparing Surgical Services For Postpandemic Phasementioning

confidence: 99%

Immediate and long-term impact of the COVID-19 pandemic on delivery of surgical services

Søreide

Hallet

Matthews

et al. 2020

British Journal of Surgery

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598

564

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Background: The ongoing pandemic is having a collateral health effect on delivery of surgical care to millions of patients. Very little is known about pandemic management and effects on other services, including delivery of surgery. Methods: This was a scoping review of all available literature pertaining to COVID-19 and surgery, using electronic databases, society websites, webinars and preprint repositories. Results: Several perioperative guidelines have been issued within a short time. Many suggestions are contradictory and based on anecdotal data at best. As regions with the highest volume of operations per capita are being hit, an unprecedented number of operations are being cancelled or deferred. No major stakeholder seems to have considered how a pandemic deprives patients with a surgical condition of resources, with patients disproportionally affected owing to the nature of treatment (use of anaesthesia, operating rooms, protective equipment, physical invasion and need for perioperative care). No recommendations exist regarding how to reopen surgical delivery. The postpandemic evaluation and future planning should involve surgical services as an essential part to maintain appropriate surgical care for the population during an outbreak. Surgical delivery, owing to its cross-cutting nature and synergistic effects on health systems at large, needs to be built into the WHO agenda for national health planning. Conclusion: Patients are being deprived of surgical access, with uncertain loss of function and risk of adverse prognosis as a collateral effect of the pandemic. Surgical services need a contingency plan for maintaining surgical care in an ongoing or postpandemic phase.

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“…19,22,23 However, it should be noted that the benefit of surgical intervention is most optimal among symptomatic individuals, versus those who have asymptomatic tethering. 24 In an era of expanding global surgical care, 25 a common understanding of the clinical indications, time of intervention, and surgical technique in the management of TCS is fundamental. However, as with the surgical technique for endoscopic closure of the spinal defect, the definition of TCS as a condition that merits surgical intervention has also evolved over time.…”

Section: Introductionmentioning

confidence: 99%

Towards Guideline-Based Management of Tethered Cord Syndrome in Spina Bifida: A Global Health Paradigm Shift in the Era of Prenatal Surgery

et al. 2019

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An estimated 60% of the world's population lives in Asia, where the incidence of neural tube defects is high. Aware that tethered cord syndrome (TCS) is an important comorbidity, the purpose of this systematic review was to explore the treatment of TCS among individuals living with spina bifida (SB) in Asia. MEDLINE and Embase databases were searched for relevant studies published from January 2000 to June 2018. Search terms such as 'spinal dysraphism,' 'spinabifida,' 'diastematomyelia,' 'lipomeningocele,' 'lypomyelomeningocele,' 'meningomyelocele,' and 'tethered cord syndrome' were used in diverse combinations. Of the 1,290 articles that were identified in accordance with PRISMA (Preferred Items for Systematic Reviews and Meta-Analyses) guidelines, 15 Asia-based studies met the inclusion criteria. Significant differences in the diagnostic criteria and management of TCS were documented. As the surgical techniques for prenatal closure of the spinal defect continue to evolve, their adoption internationally is likely to continue. In this setting, a clear and evidence-based approach to the definition and management of TCS is essential. The recent publication by the Spina Bifida Association of America of their updated care guidelines may serve as a tool used to promote a systematized approach to diagnosing and treating TCS among individuals with SB in the region, as well as globally.

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Global surgery in an ecosystem for worldwide health

Abstract: A call for action now

Cited by 13 publications

References 19 publications

Meta-analysis of the impact of progesterone receptor status on oncological outcomes in oestrogen receptor-positive breast cancer

Meta-analysis of the impact of progesterone receptor status on oncological outcomes in oestrogen receptor-positive breast cancer

Immediate and long-term impact of the COVID-19 pandemic on delivery of surgical services

Towards Guideline-Based Management of Tethered Cord Syndrome in Spina Bifida: A Global Health Paradigm Shift in the Era of Prenatal Surgery

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