皇家萨里郡医院

Rapid diagnosis of giant cell arteritis (GCA) is essential to prevent ischemic complications. Color Doppler ultrasound (CDUS) and high-resolution magnetic resonance imaging (MRI) are increasingly used as alternatives or adjuncts to temporal artery biopsy, but their comparative diagnostic performance remains uncertain. We performed a systematic review and bivariate random-effects meta-analysis of diagnostic accuracy studies in adults with suspected GCA. Studies reporting extractable 2×2 data against temporal artery biopsy, or accepted clinical reference standards when biopsy was unavailable, were included. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Pooled sensitivity, specificity, diagnostic odds ratios (DOR), and summary receiver operating characteristic (ROC) curves were calculated, with evaluation of heterogeneity and publication bias. Thirty-nine studies, including 3,619 patients, met the inclusion criteria. Thirty-one studies assessed CDUS (2,766 patients) and 12 evaluated MRI (853 patients). For CDUS, the median sensitivity was 0.83 (range 0.17-1.00) and the median specificity was 0.88 (range 0.59-1.00), with a median DOR of 24.9 and substantial between-study variability. MRI demonstrated a median sensitivity of 0.88 (range 0.61-1.00), a median specificity of 0.92 (range 0.71-1.00), and a higher median DOR of 72.0, with more consistent estimates. Evidence of small-study or publication bias was observed for MRI (p≈0.0004) and was borderline for CDUS (p≈0.055). QUADAS-2 assessments were generally favorable, though common limitations included variable blinding, heterogeneous imaging protocols, and differences in corticosteroid timing. MRI demonstrates higher and more consistent diagnostic performance than CDUS. CDUS can achieve high accuracy in experienced centers but shows notable operator dependence. Both modalities support imaging-based diagnostic pathways for GCA, with the choice influenced by local expertise, resource availability, and corticosteroid exposure.

BACKGROUND:Robot-assisted total mesorectal excision was introduced to overcome several technical constraints associated with conventional laparoscopic total mesorectal excision in rectal cancer surgery. Nevertheless, data on long-term oncological outcomes remain limited. OBJECTIVE:This study compared long-term oncological outcomes between robot-assisted total mesorectal excision and laparoscopic total mesorectal excision for rectal cancer. DESIGN:Retrospective, multicenter, international cohort study using inverse probability of treatment weighting to minimize confounding. SETTINGS:Expert centers specialized in colorectal cancer for their respective surgical approaches across the United Kingdom, the Netherlands, and France. PATIENTS:There were 1077 rectal cancer patients with at least 3 years of follow-up who underwent either laparoscopic or robot-assisted total mesorectal excision from 2014 to 2021. MAIN OUTCOME MEASURES:The primary outcome was 3-year disease-free survival. Secondary outcomes included 3-year local recurrence, 3-year systemic recurrence, and 3-year overall survival. RESULTS:A total of 435.8 laparoscopic and 637.4 robot-assisted cases were analyzed after weighting. More robot-assisted cases were graded as complete total mesorectal excision than in the laparoscopic group (76.5% vs 87.5%, p < 0.001), but without significant differences in circumferential resection margin positivity, conversion rates, or postoperative complications. Robot-assisted surgery led to higher restorative low anterior resection rates (93.2% vs 80.6%, p < 0.001) and less stoma creation (69.1% vs 80.9%, p < 0.001). No significant differences were found in 3-year disease-free survival (75.1% vs 75.2%; HR 1.04; 95% CI, 0.80-1.34), overall survival (81.6% vs 81.7%; HR 1.14; 95% CI, 0.80-1.61), local recurrence (3.7% vs 3.0%; HR 0.89; 95% CI, 0.45-1.80), or systemic recurrence (15.1% vs 15.3%; HR 0.97; 95% CI, 0.69-1.34). LIMITATIONS:Because this is an observational propensity-weighted analysis, these results should be interpreted as an absence of observed differences rather than evidence of equivalence, and residual confounding (including temporal and center-level factors) may remain. CONCLUSIONS:Robot-assisted surgery was associated with improved pathological specimen grade and more restorative procedures, whereas no statistically significant differences were observed in 3-year oncological outcomes. See Video Abstract . CLINICAL STUDY REGISTRY:https://www.isrctn.com/ISRCTN75281193 . RESECCIN ANTERIOR BAJA LAPAROSCPICA VERSUS ASISTIDA POR ROBOT CON ESCISIN MESORRECTAL PARA EL CNCER DE RECTO UN ESTUDIO DE COHORTE MULTICNTRICO PONDERADO POR PROPENSIN SOBRE RESULTADOS ONCOLGICOS A LARGO PLAZO RESOLUTION:ANTECEDENTES:La escisión total del mesorrecto asistida por robot se introdujo para superar varias limitaciones técnicas asociadas con la escisión total del mesorrecto laparoscópica convencional en la cirugía del cáncer rectal. No obstante, los datos sobre los resultados oncológicos a largo plazo siguen siendo limitados.OBJETIVO:Este estudio comparó los resultados oncológicos a largo plazo entre la escisión total del mesorrecto asistida por robot y la escisión total del mesorrecto laparoscópica para el cáncer rectal.DISEÑO:Estudio de cohortes retrospectivo, multicéntrico e internacional, que empleó la ponderación por probabilidad inversa del tratamiento para minimizar los factores de confusión.ÁMBITO:Centros expertos especializados en cáncer colorrectal, según su respectivo enfoque quirúrgico, ubicados en el Reino Unido, los Países Bajos y Francia.PACIENTES:Se incluyeron 1077 pacientes con cáncer rectal, con un seguimiento de al menos 3 años, que se sometieron a una escisión total del mesorrecto (ya fuera laparoscópica o asistida por robot) entre 2014 y 2021.PRINCIPALES MEDIDAS DE RESULTADO:El resultado primario fue la supervivencia libre de enfermedad a los 3 años. Los resultados secundarios incluyeron la recurrencia local a los 3 años, la recurrencia sistémica a los 3 años y la supervivencia global a los 3 años.RESULTADOS:Se analizaron un total de 435,8 casos laparoscópicos y 637,4 casos asistidos por robot tras aplicar la ponderación. Un mayor número de casos asistidos por robot fueron clasificados como escisión total del mesorrecto completa en comparación con el grupo laparoscópico (76,5% frente a 87,5%; p < 0,001), aunque sin diferencias significativas en cuanto a la positividad del margen de resección circunferencial, las tasas de conversión o las complicaciones postoperatorias. La cirugía asistida por robot condujo a tasas más elevadas de resección anterior baja con restauración de la continuidad (93,2% frente a 80,6%; p < 0,001) y a una menor creación de estomas (69,1% frente a 80,9%; p < 0,001). No se hallaron diferencias significativas en la supervivencia libre de enfermedad a 3 años (75,1% frente a 75,2%; HR: 1,04; IC: 0,80-1,34), la supervivencia global (81,6% frente a 81,7%; HR: 1,14; IC: 0,80-1,61), la recurrencia local (3,7% frente a 3,0%; HR: 0,89; IC: 0,45-1,80) ni la recurrencia sistémica (15,1% frente a 15,3%; HR: 0,97; IC: 0,69-1,34).LIMITACIONES:Dado que se trata de un análisis observacional ponderado por puntuación de propensión, estos resultados deben interpretarse como una ausencia de diferencias observadas, más que como evidencia de equivalencia; asimismo, podría persistir un sesgo de confusión residual (incluyendo factores temporales y a nivel de centro).CONCLUSIÓN:La cirugía asistida por robot se asoció con una mejor clasificación patológica de la pieza quirúrgica y con un mayor número de procedimientos restauradores, mientras que no se observaron diferencias estadísticamente significativas en los resultados oncológicos a 3 años. (AI-generated translation )REGISTRO DE ESTUDIOS CLÍNICOS:https://www.isrctn.com/ISRCTN75281193 .

BACKGROUND AND OBJECTIVE:Long-term outcome data for focal therapy using high-intensity focused ultrasound (HIFU) or cryotherapy for nonmetastatic prostate cancer are needed. We report 10-yr cancer control outcomes. METHODS:Patients with nonmetastatic prostate cancer who underwent primary focal HIFU or cryotherapy and had at least 6 mo follow-up were identified from the UK HIFU Evaluation and Assessment of Treatment (HEAT) and International Cryotherapy Evaluation (ICE) prospectively maintained registries. The intervention included up to two focal ablative sessions. The primary outcome was cancer-specific mortality. Secondary outcomes were all-cause mortality, metastasis, local retreatment, radical treatment, and androgen-deprivation therapy (ADT) use. KEY FINDINGS AND LIMITATIONS:A total of 3477 patients (HIFU: n = 2897; cryotherapy: n = 580) were included from 14 UK centres (2004-2024). A total of 48%, 23%, and 25% had European Association of Urology (EAU) 2025-version favourable intermediate-, unfavourable-intermediate-, and high-risk disease, respectively. Ten-yr cancer-specific mortality was 0.13% (95% confidence interval [CI] = 0.027-0.45%). Ten-yr all-cause mortality and metastases were 12% (95% CI = 8.8-15%) and 3.3% (95% CI = 2.1-4.9%), respectively. Ten-yr ADT use was 14% (95% CI = 11-17%). Ten-yr local retreatment and radical treatment were 33% (95% CI = 30-37%) and 30% (95% CI = 27-34%), respectively, on an intention-to-treat basis. In a post hoc per-protocol analysis, undertaken to estimate outcomes under stricter adherence to the two focal ablative session protocol, patients who underwent radical treatment despite being potentially eligible for a further focal ablative session were censored at the time of radical treatment; 10-yr local retreatment and radical treatment were 13% (95% CI = 11-16%) and 8.9% (95% CI = 6.9-11%), respectively. The observational study design is the main limitation. CONCLUSIONS AND CLINICAL IMPLICATIONS:Focal therapy using up to two sessions of focal HIFU or cryotherapy could be considered as a first-line treatment for well-selected patients of nonmetastatic prostate cancer alongside radical treatment. Future research priorities should include the development of a dedicated prognostic risk calculator, further prospective assessment of focal therapy for high-risk disease, and improvements in the detection and management of locally recurrent disease.

Salivary duct carcinoma (SDC) is an aggressive neoplasm that typically involves the major salivary glands. This rapidly growing tumor is known to recur and metastasize to the neck nodes and to distant sites. Given its poor prognosis, researchers have focused on identifying factors and driver genomic alterations that may account for its behavior, ultimately yielding potential therapeutic targets. This review summarizes the growing body of knowledge on SDC since the publication of the latest WHO Classification of Tumors of the Head and Neck. Updates on emerging subtypes, immunohistochemical profiles, molecular alterations, and potential therapeutic targets are succinctly presented. Findings from studies on tumor immune microenvironment (TIME), which may have implications for the treatment and prognosis of SDC, are also discussed in this narrative review.