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  1. Article ; Online: Enhancing endoscopic measurement: validating a quantitative method for polyp size and location estimation in upper gastrointestinal endoscopy.

    Safavian, Nazanin / Toh, Simon K C / Pani, Martino / Lee, Raymond

    Surgical endoscopy

    2024  

    Abstract: Background: Accurate measurement of polyps size is crucial in predicting malignancy, planning relevant intervention strategies and surveillance schedules. Endoscopists' visual estimations can lack precision. This study builds on our prior research, with ...

    Abstract Background: Accurate measurement of polyps size is crucial in predicting malignancy, planning relevant intervention strategies and surveillance schedules. Endoscopists' visual estimations can lack precision. This study builds on our prior research, with the aim to evaluate a recently developed quantitative method to measure the polyp size and location accurately during a simulated endoscopy session.
    Methods: The quantitative method merges information about endoscopic positions obtained from an electromagnetic tracking sensor, with corresponding points on the images of the segmented polyp border. This yields real-scale 3D coordinates of the border of the polyp. By utilising the sensor, positions of any anatomical landmarks are attainable, enabling the estimation of a polyp's location relative to them. To verify the method's reliability and accuracy, simulated endoscopies were conducted in pig stomachs, where polyps were artificially created and assessed in a test-retest manner. The polyp measurements were subsequently compared against clipper measurements.
    Results: The average size of the fifteen polyps evaluated was approximately 12 ± 4.3 mm, ranging from 5 to 20 mm. The test-retest reliability, measured by the Intraclass Correlation Coefficient (ICC) for polyp size estimation, demonstrated an absolute agreement of 0.991 (95% CI 0.973-0.997, p < 0.05). Bland & Altman analysis revealed a mean estimation difference of - 0.17 mm (- 2.03%) for polyp size and, a mean difference of - 0.4 mm (- 0.21%) for polyp location. Both differences were statistically non-significant (p > 0.05). When comparing the proposed method with calliper measurements, the Bland & Altman plots showed 95% of size estimation differences between - 1.4 and 1.8 mm (- 13 to 17.4%) which was not significant (p > 0.05).
    Conclusions: The proposed method of measurements of polyp size and location was found to be highly accurate, offering great potential for clinical implementation to improve polyp assessment. This level of performance represents a notable improvement over visual estimation technique used in clinical practice.
    Language English
    Publishing date 2024-03-11
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 639039-0
    ISSN 1432-2218 ; 0930-2794
    ISSN (online) 1432-2218
    ISSN 0930-2794
    DOI 10.1007/s00464-024-10758-2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Endoscopic measurement of the size of gastrointestinal polyps using an electromagnetic tracking system and computer vision-based algorithm.

    Safavian, Nazanin / Toh, Simon K C / Pani, Martino / Lee, Raymond

    International journal of computer assisted radiology and surgery

    2023  Volume 19, Issue 2, Page(s) 321–329

    Abstract: Purpose: Polyp size is an important factor that may influence diagnosis and clinical management decision, but estimation by visual inspection during endoscopy is often difficult and subject to error. The purpose of this study is to develop a ... ...

    Abstract Purpose: Polyp size is an important factor that may influence diagnosis and clinical management decision, but estimation by visual inspection during endoscopy is often difficult and subject to error. The purpose of this study is to develop a quantitative approach that enables an accurate and objective measurement of polyp size and to study the feasibility of the method.
    Methods: We attempted to estimate polyp size and location relative to the gastro-oesophageal junction by integrating data from an electromagnetic tracking sensor and endoscopic images. This method is based on estimation of the three-dimensional coordinates of the borders of the polyp by combining the endoscope camera position and the corresponding points along the polyp border in endoscopic images using a computer vision-based algorithm. We evaluated the proposed method using a simulated upper gastrointestinal endoscopy model.
    Results: The difference between the mean of ten measurements of one artificial polyp and its actual size (10 mm in diameter) was 0.86 mm. Similarly, the difference between the mean of ten measurements of the polyp distance from the gastroesophageal junction and its actual distance (~ 22 cm) was 1.28 mm. Our results show that the changes in camera positions in which the images were taken and the quality of the polyp segmentation have the most impact on the accuracy of polyp size estimation.
    Conclusion: This study demonstrated an innovative approach to endoscopic measurements using motion tracking technologies and computer vision and demonstrated its accuracy in determining the size and location of the polyp. The observed magnitude of error is clinically acceptable, and the measurements are available immediately after the images captured. To enhance accuracy, it is recommended to avoid identical images and instead utilise control wheels on the endoscope for capturing different views. Future work should further evaluate this innovative method during clinical endoscopic procedures.
    MeSH term(s) Humans ; Endoscopy, Gastrointestinal ; Endoscopes ; Gastrointestinal Neoplasms ; Motion ; Algorithms ; Colonic Polyps/diagnosis ; Colonoscopy/methods
    Language English
    Publishing date 2023-08-19
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 2365628-1
    ISSN 1861-6429 ; 1861-6410
    ISSN (online) 1861-6429
    ISSN 1861-6410
    DOI 10.1007/s11548-023-03011-z
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Digital and paper consent errors.

    Wong, Rohin / Hussain, Mohammad Iqbal / Toh, Simon / Rao, Christopher / St John, Edward R

    The British journal of surgery

    2023  Volume 111, Issue 1

    MeSH term(s) Humans ; Informed Consent
    Language English
    Publishing date 2023-11-09
    Publishing country England
    Document type Journal Article
    ZDB-ID 2985-3
    ISSN 1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
    ISSN (online) 1365-2168
    ISSN 0263-1202 ; 0007-1323 ; 1355-7688
    DOI 10.1093/bjs/znad358
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Informed consent failures: National Health Service Resolution data.

    Ainsworth, Nicholas / Hussain, Mohammad Iqbal / Houten, Rachel / Martin, Antony P / Toh, Simon / Rao, Christopher / St John, Edward Robert

    The British journal of surgery

    2023  Volume 110, Issue 8, Page(s) 993–995

    MeSH term(s) Humans ; State Medicine ; Informed Consent
    Language English
    Publishing date 2023-04-24
    Publishing country England
    Document type Journal Article
    ZDB-ID 2985-3
    ISSN 1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
    ISSN (online) 1365-2168
    ISSN 0263-1202 ; 0007-1323 ; 1355-7688
    DOI 10.1093/bjs/znad131
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Prevalence and Sonographic Detection of Gallbladder Polyps in a Western European Population.

    Pickering, Oliver / Pucher, Philip H / Toale, Conor / Hand, Fiona / Anand, Easan / Cassidy, Sheena / McEntee, Gerry / Toh, Simon K C

    The Journal of surgical research

    2020  Volume 250, Page(s) 226–231

    Abstract: Background: Gallbladder cancer is rare but associated with significant morbidity and mortality necessitating the early identification of premalignant and malignant lesions to improve overall prognosis. Despite limited evidence regarding the ... ...

    Abstract Background: Gallbladder cancer is rare but associated with significant morbidity and mortality necessitating the early identification of premalignant and malignant lesions to improve overall prognosis. Despite limited evidence regarding the effectiveness of transabdominal ultrasound (US) in the detection of gallbladder polyps, it plays a key role in current European guidelines. The aim of this study was to investigate gallbladder polyp prevalence in a western European population and assess the diagnostic accuracy of transabdominal US.
    Methods: Data from patients who underwent cholecystectomy for US detected gallbladder polypoid lesions at four hospitals in Ireland and the United Kingdom between 2010 and 2018 were retrospectively collected. Patient demographics, ultrasonographic, and histopathologic findings were analyzed.
    Results: A total of 134 patients underwent cholecystectomy for US-detected gallbladder polyps. After histopathologic examination, pseudopolyps were found in 75 (56%) specimens with dysplastic or malignant polyps seen in only six (4.5%) specimens. Mean size for neoplastic polyps was 33 mm. The positive predictive value for US in detecting neoplastic polyps in this study was 4.5%, which is significantly lower than the 10%-15% reported previously.
    Conclusions: Although the prevalence of neoplastic polyps in this study is higher than in the previous literature, the distribution of pseudopolyps and true polyps is as expected. With all malignant polyps being >10 mm in diameter, these findings support the current size thresholds stated in European guidelines. The poor diagnostic accuracy of US demonstrated may have led to significant number of patients undergoing unnecessary surgical intervention, further supporting the argument for improved strategies for the investigation of gallbladder polyps.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Cholecystectomy/statistics & numerical data ; Female ; Gallbladder/diagnostic imaging ; Gallbladder/pathology ; Gallbladder/surgery ; Gallbladder Neoplasms/diagnosis ; Gallbladder Neoplasms/epidemiology ; Gallbladder Neoplasms/pathology ; Gallbladder Neoplasms/surgery ; Humans ; Ireland/epidemiology ; Male ; Middle Aged ; Polyps/diagnosis ; Polyps/epidemiology ; Polyps/pathology ; Precancerous Conditions/diagnosis ; Precancerous Conditions/epidemiology ; Precancerous Conditions/pathology ; Precancerous Conditions/surgery ; Predictive Value of Tests ; Prevalence ; Retrospective Studies ; Ultrasonography/statistics & numerical data ; United Kingdom/epidemiology ; Young Adult
    Language English
    Publishing date 2020-02-24
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80170-7
    ISSN 1095-8673 ; 0022-4804
    ISSN (online) 1095-8673
    ISSN 0022-4804
    DOI 10.1016/j.jss.2020.01.003
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Is an involved circumferential resection margin following oesphagectomy for cancer an important prognostic indicator?

    Khan, Omar A / Cruttenden-Wood, David / Toh, Simon K

    Interactive cardiovascular and thoracic surgery

    2010  Volume 11, Issue 5, Page(s) 645–648

    Abstract: A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether an involved circumferential resection margin (CRM) following oesophagectomy for cancer is an independent predictor of poor long- ... ...

    Abstract A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether an involved circumferential resection margin (CRM) following oesophagectomy for cancer is an independent predictor of poor long-term survival. Six hundred and fourteen papers were found using the reported search, of which seven represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group, study type, relevant outcomes and results of these papers are tabulated. Of these studies, four were conducted on patients who predominantly did not receive preoperative chemotherapy and showed conflicting results as to the prognostic significance of CRM involvement. However, three later studies conducted on patients who predominantly did receive preoperative chemotherapy showed that CRM involvement to be an independent predictor of long-term survival. We conclude that for patients who undergo oesophagectomy alone as a treatment for oesophageal cancer, the prognostic importance of CRM involvement is unclear. However, for patients who undergo preoperative chemotherapy prior to surgery, there does appear to be emerging evidence supporting the concept that CRM involvement is an independent predictor of poor long-term outcome.
    MeSH term(s) Benchmarking ; Chemotherapy, Adjuvant ; Esophageal Neoplasms/mortality ; Esophageal Neoplasms/pathology ; Esophageal Neoplasms/surgery ; Esophagectomy/adverse effects ; Esophagectomy/mortality ; Evidence-Based Medicine ; Humans ; Neoadjuvant Therapy ; Neoplasm Recurrence, Local ; Neoplasm, Residual ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome
    Language English
    Publishing date 2010-11
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2095298-3
    ISSN 1569-9285 ; 1569-9293
    ISSN (online) 1569-9285
    ISSN 1569-9293
    DOI 10.1510/icvts.2010.236778
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Open and laparoscopically assisted oesophagectomy: a prospective comparative study.

    Bailey, Lucy / Khan, Omar / Willows, Elizabeth / Somers, Shaw / Mercer, Stuart / Toh, Simon

    European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

    2013  Volume 43, Issue 2, Page(s) 268–273

    Abstract: Objectives: Although a number of studies have examined minimally invasive approaches for oesophagectomy, these procedures have typically been offered only to selected patients with the limited long-term follow-up data. The purpose of this prospective ... ...

    Abstract Objectives: Although a number of studies have examined minimally invasive approaches for oesophagectomy, these procedures have typically been offered only to selected patients with the limited long-term follow-up data. The purpose of this prospective study was to assess the feasibility of performing laparoscopically assisted oesophagectomy (LAO) for all-comers and to compare the short- and long-term clinical outcomes of this surgical strategy with a matched cohort of patients who had undergone open surgery.
    Methods: From November 2009, all patients referred for trans-thoracic resection of an oesophageal cancer underwent a two-stage laparoscopically assisted Ivor-Lewis oesophagectomy. This consisted of laparoscopic mobilization of the stomach and distal oesophagus, followed by open thoracotomy, thoracic lymphadectomy and intrathoracic anastomosis. The clinical and oncological outcomes of the first 39 consecutive LAO patients were compared with those of the preceding 31 consecutive patients who had undergone open surgery.
    Results: Of the 39 LAO cases, 37 cases were completed laparoscopically and 2 were converted to an open surgery. LAO was associated with a decreased incidence of postoperative complications (specifically cardiac and infectious complications) when compared with open surgery (54 vs 77%, P = 0.04). In addition, the initial intensive care unit stay (2 vs 4 days; P = 0.04) and overall length of hospital stay (14 vs 18 days; P = 0.02) were shorter in the LAO group. In terms of pathological outcomes, the lymph node yield and R0 resection rate of the LAO and open groups were comparable, as were the 1-year survival rates (62 vs 61%, P = 0.97).
    Conclusions: LAO can be offered to an unselected cohort of all-comers with a reduced postoperative complication rate and comparable oncological and long-term survival outcomes when compared with open surgery.
    MeSH term(s) Adult ; Aged ; Conversion to Open Surgery/statistics & numerical data ; Esophageal Neoplasms/mortality ; Esophageal Neoplasms/surgery ; Esophagectomy/methods ; Esophagectomy/mortality ; Feasibility Studies ; Female ; Humans ; Laparoscopy/methods ; Laparoscopy/mortality ; Lymph Node Excision ; Lymphatic Metastasis ; Male ; Middle Aged ; Postoperative Complications/etiology ; Postoperative Complications/mortality ; Prospective Studies ; Treatment Outcome
    Language English
    Publishing date 2013-02
    Publishing country Germany
    Document type Comparative Study ; Evaluation Studies ; Journal Article
    ZDB-ID 639293-3
    ISSN 1873-734X ; 1010-7940 ; 1567-4258
    ISSN (online) 1873-734X
    ISSN 1010-7940 ; 1567-4258
    DOI 10.1093/ejcts/ezs314
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Long-term outcomes of extended proximal gastrectomy for oesophagogastric junctional tumours.

    Khan, Omar / Goh, Steven / Byrne, Ben / Somers, Shaw / Mercer, Stuart / Toh, Simon

    World journal of surgery

    2011  Volume 35, Issue 10, Page(s) 2245–2251

    Abstract: Background: There is no consensus on the optimum approach for resection of oesophagogastric junctional (OGJ) tumours. We prospectively evaluated the efficacy of transabdominal radical extended proximal gastrectomy with oesophagogastric anastomosis ( ... ...

    Abstract Background: There is no consensus on the optimum approach for resection of oesophagogastric junctional (OGJ) tumours. We prospectively evaluated the efficacy of transabdominal radical extended proximal gastrectomy with oesophagogastric anastomosis (EPGOG) for selected tumours of the OGJ.
    Methods: Between 1998 and 2007, 66 selected consecutive patients with tumours of the OGJ underwent successful EPGOG. Selection was limited to tumours where the maximal proximal extent was 36 cm ab oral. Pre-, peri-, and postoperative outcomes together with long-term survival data for these patients were prospectively collected.
    Results: Median theatre time was 242 min (range = 120-480), with a median blood loss of 300 ml (range = 50-1720). Eighty-nine percent of patients were extubated in theatre; major complications occurred in 9 (14%) patients, with an overall in-hospital mortality rate of 8%. Thirty-five (53%) patients had nodal disease and the median lymph node yield was 13 (range = 4-36), with an R0 resection rate of 80%. In terms of long-term outcomes, the 2- and 5-year actuarial survival rates were 54 ± 6% and 41 ± 6%.
    Conclusion: Extended radical proximal gastrectomy with oesophagogastric anastomosis for selected junctional tumours is a feasible technique which does not compromise oncological principles as evidenced by an excellent long-term survival rate.
    MeSH term(s) Esophagogastric Junction ; Female ; Gastrectomy/methods ; Humans ; Male ; Middle Aged ; Prospective Studies ; Stomach Neoplasms/surgery ; Time Factors ; Treatment Outcome
    Language English
    Publishing date 2011-08-18
    Publishing country United States
    Document type Journal Article
    ZDB-ID 224043-9
    ISSN 1432-2323 ; 0364-2313
    ISSN (online) 1432-2323
    ISSN 0364-2313
    DOI 10.1007/s00268-011-1235-z
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: A double-blind, randomised, controlled trial to study the effects of an enteral feed supplemented with glutamine, arginine, and omega-3 fatty acid in predicted acute severe pancreatitis.

    Pearce, Callum B / Sadek, Sami A / Walters, A Marisia / Goggin, Patrick M / Somers, Shaw S / Toh, Simon K / Johns, Tim / Duncan, Hamish D

    JOP : Journal of the pancreas

    2006  Volume 7, Issue 4, Page(s) 361–371

    Abstract: Context: Current best evidence is in favour of early institution of enteral feeding in acute severe pancreatitis with promising results from trials in immunonutrition on other patient groups.: Objective: To identify which groups of patients and ... ...

    Abstract Context: Current best evidence is in favour of early institution of enteral feeding in acute severe pancreatitis with promising results from trials in immunonutrition on other patient groups.
    Objective: To identify which groups of patients and products are associated with benefit, we investigated immunonutrition in patients with predicted acute severe pancreatitis.
    Design: A randomised trial of a study feed containing glutamine, arginine, tributyrin and antioxidants versus an isocaloric isonitrogenous control feed was undertaken.
    Patients: Thirty-one patients with a diagnosis of acute pancreatitis predicted to develop severe disease: 15 study feeds and 16 control feeds.
    Interventions: Enteral feeding via nasojejunal tube for 3 days. If patients required further feeding the study was continued up to 15 days.
    Main outcome measures: Reduction in C-reactive protein (CRP) by 40 mg/L after 3 days of enteral feeding was the primary endpoint. Carboxypeptidase B activation peptide (CAPAP) levels were taken at regular intervals.
    Results: After 3 days of feeding, in the study group 2/15 (13%) of patients had reduced their CRP by 40 mg/L or more. In the control group 6/16 (38%) of patients had reduced their CRP by this amount. This difference was found to be near the statistical significant limit (P=0.220).
    Conclusions: The cause of the unexpectedly higher CRP values in the study group is unclear. The rise in CRP was without a commensurate rise in CAPAP or outcome measures so there was no evidence that this represented pancreatic necrosis. The contrast between the CRP and CAPAP results is of interest and we believe that specific pancreatic indices such as CAPAP should be considered in larger future studies.
    MeSH term(s) Acute Disease ; Aged ; Aged, 80 and over ; Antioxidants/administration & dosage ; Antioxidants/therapeutic use ; Arginine/administration & dosage ; Arginine/therapeutic use ; C-Reactive Protein/analysis ; Double-Blind Method ; Enteral Nutrition/methods ; Fatty Acids, Omega-3/administration & dosage ; Fatty Acids, Omega-3/therapeutic use ; Female ; Glutamine/administration & dosage ; Glutamine/therapeutic use ; Humans ; Male ; Middle Aged ; Pancreatitis/blood ; Pancreatitis/diet therapy ; Pancreatitis/physiopathology ; Peptides/blood ; Severity of Illness Index ; Triglycerides/administration & dosage ; Triglycerides/therapeutic use
    Chemical Substances Antioxidants ; Fatty Acids, Omega-3 ; Peptides ; Triglycerides ; carboxypeptidase B activation peptide ; Glutamine (0RH81L854J) ; C-Reactive Protein (9007-41-4) ; Arginine (94ZLA3W45F) ; tributyrin (S05LZ624MF)
    Language English
    Publishing date 2006-07-10
    Publishing country Italy
    Document type Journal Article ; Randomized Controlled Trial
    ZDB-ID 2039637-5
    ISSN 1590-8577 ; 1590-8577
    ISSN (online) 1590-8577
    ISSN 1590-8577
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Capecitabine with radiation is an effective adjuvant therapy in gastric cancers

    Chee Kian Tham, Su Pin Choo, Donald Yew Hee Poon, Han Chong Toh, Simon Yew Kuang Ong, Sze Huey Tan, Michael Lian Chek Wang, Kian Fong Foo

    World Journal of Gastroenterology, Vol 16, Iss 29, Pp 3709-

    2010  Volume 3715

    Abstract: AIM: To analyze the outcome of patients who received concurrent capecitabine (Xeloda) and radiation (XRT) compared to the established concurrent 5-fluorouracil (5-FU) with radiation (5FU-RT) and fluoropyrimidine-based chemotherapy alone as adjuvant ... ...

    Abstract AIM: To analyze the outcome of patients who received concurrent capecitabine (Xeloda) and radiation (XRT) compared to the established concurrent 5-fluorouracil (5-FU) with radiation (5FU-RT) and fluoropyrimidine-based chemotherapy alone as adjuvant treatment in gastric cancers.METHODS: All patients with gastric cancers who received adjuvant treatment at the National Cancer Centre Singapore between 1996 and 2006 were reviewed. Treatment outcomes of patients who received XRT were compared with those who had 5FU-RT or chemotherapy alone as adjuvant therapy for gastric cancers.RESULTS: A total of 108 patients were reviewed. Median age at diagnosis was 60. The majority of the patients (64.8%) had advanced stage III and IV disease (with no distant metastasis). All except 4 patients had D2 gastrectomy. Twenty one patients (19.4%) had positive surgical resection margins. Thirty three patients received XRT compared with 52 who had 5FU-RT and 23 who received chemotherapy alone. For the patients in the chemotherapy-only group, all had fluoropyrimidine-based therapy, with added cisplatin in 7 patients and epirubicin in 2 patients. Median recurrence-free survival was longer for the XRT group (52 mo) compared to the 5FU-RT (35 mo) and chemotherapy-only groups (25 mo) (P = 0.48). The patients in the XRT group achieved similar median overall survival (53 mo) as the 5FU-RT (54 mo) and the chemotherapy-only groups (44 mo) (P = 0.5).CONCLUSION: Capecitabine with concurrent radiation was as effective as concurrent 5FU with radiation or fluoropyrimidine-based chemotherapy alone when used as adjuvant treatment in patients with gastric cancers.
    Keywords Capecitabine ; Radiation ; Gastric cancer ; Adjuvant chemotherapy ; Diseases of the digestive system. Gastroenterology ; RC799-869 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Gastroenterology ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
    Subject code 610
    Language English
    Publishing date 2010-08-01T00:00:00Z
    Publisher Baishideng Publishing Group Co. Limited
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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