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  1. Article ; Online: Evaluation of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis of Colorectal Origin in the Era of Value-Based Medicine.

    Vanounou, Tsafrir / Garfinkle, Richard

    Annals of surgical oncology

    2016  Volume 23, Issue 8, Page(s) 2556–2561

    Abstract: Peritoneal spread from colorectal cancer is second only to the liver as a site for metastasis. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is a well-established treatment option for patients with peritoneal ... ...

    Abstract Peritoneal spread from colorectal cancer is second only to the liver as a site for metastasis. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is a well-established treatment option for patients with peritoneal carcinomatosis (PC) of colorectal origin. However, due to concerns regarding both its clinical benefit and high cost, its universal adoption as the standard of care for patients with limited peritoneal dissemination has been slow. The purpose of this review was to clarify the clinical utility and cost effectiveness of CRS-HIPEC in the treatment of colorectal PC using the framework of value-based medicine, which attempts to combine both benefit and cost into a single quantifiable metric. Our comprehensive review of the clinical outcomes and cost effectiveness of CRS-HIPEC demonstrate that it is a highly valuable oncologic therapy and a good use of healthcare resources.
    MeSH term(s) Colorectal Neoplasms/therapy ; Combined Modality Therapy ; Cytoreduction Surgical Procedures ; Evidence-Based Medicine ; Humans ; Hyperthermia, Induced ; Peritoneal Neoplasms/therapy ; Prognosis
    Language English
    Publishing date 2016-03-08
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1200469-8
    ISSN 1534-4681 ; 1068-9265
    ISSN (online) 1534-4681
    ISSN 1068-9265
    DOI 10.1245/s10434-016-5096-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Preoperative Diagnostic Angiogram and Endovascular Aortic Stent Placement for Appleby Resection Candidates: A Novel Surgical Technique in the Management of Locally Advanced Pancreatic Cancer.

    Trabulsi, N / Pelletier, J S / Abraham, C / Vanounou, T

    HPB surgery : a world journal of hepatic, pancreatic and biliary surgery

    2015  Volume 2015, Page(s) 523273

    Abstract: Background. Pancreatic adenocarcinoma of the body and tail usually presents late and is typically unresectable. The modified Appleby procedure allows resection of pancreatic body carcinoma with celiac axis (CA) invasion. Given that the feasibility of ... ...

    Abstract Background. Pancreatic adenocarcinoma of the body and tail usually presents late and is typically unresectable. The modified Appleby procedure allows resection of pancreatic body carcinoma with celiac axis (CA) invasion. Given that the feasibility of this technique is based on the presence of collateral circulation, it is crucial to confirm the presence of an anatomical and functional collateral system. Methods. We here describe a novel technique used in two patients who were candidates for Appleby resection. We present their clinical scenario, imaging, operative findings, and postoperative course. Results. Both patients had a preoperative angiogram for assessment of anatomical circulation and placement of an endovascular stent to cover the CA. We hypothesize that this new technique allows enhancement of collateral circulation and helps minimize intraoperative blood loss when transecting the CA at its takeoff. Moreover, extra length on the CA margin may be gained, as the artery can be transected at its origin without the need for vascular clamp placement. Conclusion. We propose this novel technique in the preoperative management of patients who are undergoing a modified Appleby procedure. While further experience with this technique is required, we believe that it confers significant advantages to the current standard of care.
    Language English
    Publishing date 2015
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1025964-8
    ISSN 1607-8462 ; 0894-8569
    ISSN (online) 1607-8462
    ISSN 0894-8569
    DOI 10.1155/2015/523273
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Mesalamine in pediatric inflammatory bowel disease: a 10-year experience.

    Dʼagata, I D / Vanounou, T / Seidman, E

    Inflammatory bowel diseases

    2013  Volume 2, Issue 4, Page(s) 229–235

    Abstract: Mesalamine is an enteric-coated 5-aminosalicylic acid formulation effective in the treatment of ulcerative colitis, and in decreasing the relapse rate in Crohn's disease. However, little data are available regarding its use in children and adolescents. ...

    Abstract : Mesalamine is an enteric-coated 5-aminosalicylic acid formulation effective in the treatment of ulcerative colitis, and in decreasing the relapse rate in Crohn's disease. However, little data are available regarding its use in children and adolescents. To determine the modalities of use, safety, and the optimal dose in this age group, charts of 153 pediatric patients with inflammatory bowel disease treated with mesalamine were reviewed, representing >150 patient years of use. Among these, more than half of the children diagnosed with Crohn's disease (120 patients) had ileocolonic involvement, and pancolitis predominated in those with ulcerative colitis (33 patients). Patients with ulcerative colitis were diagnosed at a younger age than those with Crohn's disease, and thus mesalamine therapy was initiated earlier. When used as monotherapy, no difference was noted in the average dose used for the treatment of active disease versus maintenance therapy (36 mg/kg/day). However, the average dose used did increase since 1992, for both the treatment of active disease and relapse prevention (43 mg/kg/ day). Overall, 18 patients (11.8%) were withdrawn from mesalamine therapy; however only 8 (5.2%) had objective side effects. Exacerbation of diarrhea was the most common reason for withdrawal. Although reported rarely, no serious adverse reactions such as pancreatitis or hepatic or renal dysfunction were observed. This study suggests that mesalamine is a safe and well-tolerated medication in the long-term treatment of pediatric patients with ulcerative colitis and Crohn's disease.
    Language English
    Publishing date 2013-01-03
    Publishing country England
    Document type Journal Article
    ZDB-ID 1340971-2
    ISSN 1536-4844 ; 1078-0998
    ISSN (online) 1536-4844
    ISSN 1078-0998
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Morbidity associated with the use of oxaliplatin versus mitomycin C in hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis of colorectal or appendiceal origin: a multi-institutional comparative study.

    Benzaquen, Ella / Wang, Yifan / Wiseman, Stephanie / Rosenfeld, Velka / Sideris, Lucas / Dubé, Pierre / Pelletier, Jean-Sebastien / Vanounou, Tsafrir

    Canadian journal of surgery. Journal canadien de chirurgie

    2021  Volume 64, Issue 2, Page(s) E111–E118

    Abstract: Background: The raw costs of mitomycin C (MMC) and oxaliplatin for hyperthermic intraperitoneal chemotherapy (HIPEC) differ substantially. We sought to compare the morbidity and toxicity profiles associated with the use of oxaliplatin and MMC in ... ...

    Abstract Background: The raw costs of mitomycin C (MMC) and oxaliplatin for hyperthermic intraperitoneal chemotherapy (HIPEC) differ substantially. We sought to compare the morbidity and toxicity profiles associated with the use of oxaliplatin and MMC in patients undergoing cytoreductive surgery (CRS) and HIPEC for peritoneal carcinomatosis (PC) of colorectal or appendiceal origin, to evaluate whether the costeffectiveness of these 2 agents should dictate drug choice.
    Methods: We conducted a retrospective multi-institutional study of all patients with PC of colorectal or appendiceal origin treated with CRS-HIPEC using MMC or oxaliplatin from 2010 to 2015. Demographic, perioperative, morbidity, toxicity and cost data were compared between the 2 treatment groups and between cancer-origin subgroups.
    Results: Forty-two patients treated with MMC and 76 treated with oxaliplatin were included in the study. Baseline demographic and tumour characteristics were comparable in the 2 groups, except that the patients treated with MMC had higher Charlson Comorbidity Index scores. The MMC group had a higher rate of cancer of colorectal origin (76.2% v. 57.9%, p = 0.047) and longer operative times (553 v. 320 min, p < 0.001). In the subgroup of patients whose cancer was of colorectal origin, patients treated with MMC had a higher transfusion rate (50.0% v. 28.6%, p = 0.023) and lower postoperative baseline hemoglobin level (100 v. 119 g/L, p = 0.002) than those treated with oxaliplatin. There was no difference in hematologic toxicity scores after controlling for postoperative anemia. There was no difference in the rates of major complications and 90-day mortality. However, MMC was less costly than oxaliplatin ($724 v. $8928).
    Conclusion: MMC and oxaliplatin are both suitable agents for HIPEC and are associated with comparable morbidity and toxicity profiles, regardless of cancer origin. Thus, we propose that cost-effectiveness should ultimately dictate drug selection.
    MeSH term(s) Adult ; Aged ; Antineoplastic Agents/adverse effects ; Appendiceal Neoplasms/drug therapy ; Colorectal Neoplasms/drug therapy ; Female ; Humans ; Hyperthermic Intraperitoneal Chemotherapy ; Male ; Middle Aged ; Mitomycin/adverse effects ; Morbidity ; Oxaliplatin/adverse effects ; Peritoneal Neoplasms/drug therapy ; Retrospective Studies
    Chemical Substances Antineoplastic Agents ; Oxaliplatin (04ZR38536J) ; Mitomycin (50SG953SK6)
    Language English
    Publishing date 2021-03-02
    Publishing country Canada
    Document type Comparative Study ; Journal Article ; Multicenter Study
    ZDB-ID 410651-9
    ISSN 1488-2310 ; 0008-428X
    ISSN (online) 1488-2310
    ISSN 0008-428X
    DOI 10.1503/cjs.001619
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Biliary mucinous cystic neoplasm mimicking a hydatid cyst: a case report and literature review.

    Tholomier, Côme / Wang, Yifan / Aleynikova, Olga / Vanounou, Tsafrir / Pelletier, Jean-Sebastien

    BMC gastroenterology

    2019  Volume 19, Issue 1, Page(s) 103

    Abstract: Background: Biliary mucinous cystic neoplasms are rare cystic lesions of the liver which carry pre-malignant potential. Given the scarcity of reports in the literature, they pose a considerable challenge to clinical management, particularly with regards ...

    Abstract Background: Biliary mucinous cystic neoplasms are rare cystic lesions of the liver which carry pre-malignant potential. Given the scarcity of reports in the literature, they pose a considerable challenge to clinical management, particularly with regards to accurate pre-operative diagnosis.
    Case presentation: We present the case of a 37-year-old Tunisian woman who presented with subacute right upper quadrant pain and a large multi-loculated cystic lesion, most consistent with a hydatid cyst. She underwent an open right hepatectomy, and pathology surprisingly revealed a biliary mucinous cystadenoma. Herein, we review the current literature on biliary mucinous cystic neoplasms, with a particular emphasis on diagnostic investigations, key radiological features and optimal treatment modalities.
    Conclusion: Biliary mucinous cystic neoplasms require a high index of suspicion and should be managed with complete surgical resection, as conservative techniques are associated with high recurrence rates. Considering the potential for malignant transformation, periodical surveillance imaging is recommended in the post-operative period.
    MeSH term(s) Adult ; Cystadenoma, Mucinous/diagnosis ; Cystadenoma, Mucinous/surgery ; Diagnosis, Differential ; Echinococcosis, Hepatic/diagnostic imaging ; Female ; Humans ; Liver Neoplasms/diagnosis ; Liver Neoplasms/surgery ; Tomography, X-Ray Computed
    Language English
    Publishing date 2019-06-24
    Publishing country England
    Document type Case Reports ; Journal Article ; Review
    ISSN 1471-230X
    ISSN (online) 1471-230X
    DOI 10.1186/s12876-019-1001-5
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Early experience with robotic pancreatic surgery in a Canadian institution.

    Piedimonte, Sabrina / Wang, Yifan / Bergman, Simon / Vanounou, Tsafrir

    Canadian journal of surgery. Journal canadien de chirurgie

    2015  Volume 58, Issue 6, Page(s) 394–401

    Abstract: Background: Pancreatic resections have traditionally been associated with substantial morbidity and mortality. The robotic platform is believed to improve technical aspects of the procedure while offering minimally invasive benefits. We sought to ... ...

    Abstract Background: Pancreatic resections have traditionally been associated with substantial morbidity and mortality. The robotic platform is believed to improve technical aspects of the procedure while offering minimally invasive benefits. We sought to determine the safety and feasibility of the first robotic pancreaticoduodenectomies performed at our institution.
    Methods: We retrospectively reviewed data on all patients who underwent robotic-assisted pancreaticoduodenectomy (RAPD) between July 2010 and June 2014 and compared them to outcomes of patients undergoing hybrid laparoscopic pancreaticoduodenectomies (HLAPD) during the same time period.
    Results: Fifteen patients were scheduled for RAPD; 2 were converted to an open approach and 1 to a mini-laparotomy during the laparoscopic portion of the procedure. Patients who had RAPD (n = 12) had a median duration of surgery of 596.6 (range 509-799) minutes, estimated blood loss of 275 (range 50-1000) mL and median length of stay of 7.5 (range 5-57) days. Mean total opioid use up to postoperative day 7 was 142.599 ± 68.2 versus 176.9 ± 112.7 mg equivalents of intravenous morphine for RAPD and HLAPD, respectively. There was no significant difference between RAPD and HLAPD in any parameters, highlighting the safety and feasibility of a step-wise minimally invasive learning platform. Most patients in the RAPD group had malignant pathology (88.2%). Oncologic outcomes were maintained with no significant difference in ability to resect lymph nodes or achieve negative margins. There were 4 (28.5%) Clavien I-II complications and 3 (29.4%) Clavien III- IV complications, 2 of which required readmission. There were no reported deaths at 90 days. Complication, pancreatic leak and mortality rates did not differ significantly from our laparoscopic experience.
    Conclusion: Outcomes of RAPD and HLAPD were comparable at our centre, even during the early stages of our learning curve. These results also highlight the safety, feasibility and patient benefits of a step-wise transition from open to hybrid to fully robotic pancreaticoduodenectomies in a high-volume academic centre.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/methods ; Feasibility Studies ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Ontario ; Pancreatic Neoplasms/surgery ; Pancreaticoduodenectomy/methods ; Retrospective Studies ; Robotic Surgical Procedures/methods ; Treatment Outcome
    Language English
    Publishing date 2015-11-14
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 410651-9
    ISSN 1488-2310 ; 0008-428X
    ISSN (online) 1488-2310
    ISSN 0008-428X
    DOI 10.1503/cjs.003815
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Molecular Analysis of a Patient With Neurofibromatosis 2 (NF2) and Peritoneal Malignant Mesothelioma.

    Evaristo, Gertruda / Fiset, Pierre-Oliver / Camilleri-Broët, Sophie / Vanounou, Tsafrir / Kavan, Petr / Spatz, Alan / Wang, Hangjun

    The American journal of surgical pathology

    2020  Volume 44, Issue 9, Page(s) 1290–1292

    MeSH term(s) Humans ; Lung Neoplasms ; Mesothelioma ; Neurofibromatosis 2 ; Peritoneal Neoplasms
    Language English
    Publishing date 2020-05-26
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 752964-8
    ISSN 1532-0979 ; 0147-5185
    ISSN (online) 1532-0979
    ISSN 0147-5185
    DOI 10.1097/PAS.0000000000001483
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  8. Article: Diagnostic Laparoscopy with Ultrasound Still Has a Role in the Staging of Pancreatic Cancer: A Systematic Review of the Literature.

    Levy, Jordan / Tahiri, Mehdi / Vanounou, Tsafrir / Maimon, Geva / Bergman, Simon

    HPB surgery : a world journal of hepatic, pancreatic and biliary surgery

    2016  Volume 2016, Page(s) 8092109

    Abstract: Background. The reported incidence of noncurative laparotomies for pancreatic cancer using standard imaging (SI) techniques for staging remains high. The objectives of this study are to determine the diagnostic accuracy of diagnostic laparoscopy with ... ...

    Abstract Background. The reported incidence of noncurative laparotomies for pancreatic cancer using standard imaging (SI) techniques for staging remains high. The objectives of this study are to determine the diagnostic accuracy of diagnostic laparoscopy with ultrasound (DLUS) in assessing resectability of pancreatic tumors. Study Design. We systematically searched the literature for prospective studies investigating the accuracy of DLUS in determining resectability of pancreatic tumors. Results. 104 studies were initially identified and 19 prospective studies (1,573 patients) were included. DLUS correctly predicted resectability in 79% compared to 55% for SI. DLUS prevented noncurative laparotomies in 33%. Of those, the most frequent DLUS findings precluding resection were liver metastases, vascular involvement, and peritoneal metastases. DLUS had a morbidity rate of 0.8% with no mortalities. DLUS remained superior to SI when analyzing studies published only in the last five years (100% versus 81%), enrolling patients after the year 2000 (74% versus 58%), or comparing DLUS to modern multidimensional CT (100% versus 78%). Conclusion. DLUS seems to still have a role in the preoperative staging of pancreatic cancer. With its ability to detect liver metastases, vascular involvement, and peritoneal metastases, the use of DLUS leads to less noncurative laparotomies.
    Language English
    Publishing date 2016
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1025964-8
    ISSN 1607-8462 ; 0894-8569
    ISSN (online) 1607-8462
    ISSN 0894-8569
    DOI 10.1155/2016/8092109
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  9. Article ; Online: Bridging the gap between open and minimally invasive pancreaticoduodenectomy: the hybrid approach.

    Wang, Yifan / Bergman, Simon / Piedimonte, Sabrina / Vanounou, Tsafrir

    Canadian journal of surgery. Journal canadien de chirurgie

    2014  Volume 57, Issue 4, Page(s) 263–270

    Abstract: Background: Minimally invasive pancreatic surgery has evolved rapidly, but total laparoscopic pancreaticoduodenectomy has not been widely adopted owing to its technical complexity. Hybrid laparoscopy-assisted pancreaticoduodenectomy (HLAPD) combines the ...

    Abstract Background: Minimally invasive pancreatic surgery has evolved rapidly, but total laparoscopic pancreaticoduodenectomy has not been widely adopted owing to its technical complexity. Hybrid laparoscopy-assisted pancreaticoduodenectomy (HLAPD) combines the relative ease of open surgery with the benefits of a minimally invasive approach. This study evaluates the safety and effectiveness of the hybrid approach compared with open surgery.
    Methods: We retrospectively analyzed data of consecutive patients undergoing either hybrid or open pancreaticoduodenectomy (OPD) at our institution between September 2009 and December 2013. Demographic, operative and oncologic data were collected to compare outcomes between HLAPD and OPD.
    Results: Our analysis included 33 patients (HLAPD: n = 13; OPD: n = 20). There were no differences in patient demographics, comorbidities or surgical indications. The HLAPD group had significantly lower intraoperative blood loss (450 mL v. 1000 mL, p = 0.023) and shorter length of hospital stay (8 v. 12 d, p = 0.025) than the OPD group. Duration of surgery did not differ significantly between the groups. There were no differences in postoperative analgesic requirements, Clavien grade I/II or grade III/IV complications or 90-day mortality. Oncologic outcomes showed no significant differences in tumour size, R1 resection rate or number of lymph nodes harvested.
    Conclusion: In select patients, HLAPD is a safe and effective procedure with comparable outcomes to conventional open surgery. Wider adoption of the hybrid approach will allow a greater number of patients to benefit from a less invasive procedure while facilitating the transition toward purely minimally invasive pancreaticoduodenectomy.
    MeSH term(s) Adenocarcinoma/surgery ; Adult ; Aged ; Aged, 80 and over ; Feasibility Studies ; Female ; Humans ; Laparoscopy/methods ; Male ; Middle Aged ; Neuroendocrine Tumors/surgery ; Pancreatic Neoplasms/surgery ; Pancreaticoduodenectomy/methods ; Retrospective Studies ; Treatment Outcome
    Language English
    Publishing date 2014-07-30
    Publishing country Canada
    Document type Evaluation Study ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 410651-9
    ISSN 1488-2310 ; 0008-428X
    ISSN (online) 1488-2310
    ISSN 0008-428X
    DOI 10.1503/cjs.026713
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Intra-arterial therapies for unresectable and chemorefractory colorectal cancer liver metastases: a systematic review and meta-analysis.

    Levy, Jordan / Zuckerman, Jesse / Garfinkle, Richard / Acuna, Sergio A / Touchette, Jacynthe / Vanounou, Tsafrir / Pelletier, Jean-Sebastien

    HPB : the official journal of the International Hepato Pancreato Biliary Association

    2018  Volume 20, Issue 10, Page(s) 905–915

    Abstract: Background: A large proportion of patients with colorectal cancer liver metastases (CRCLM) not amenable to curative liver resection will progress on systemic therapy. Intra-arterial therapies (IAT) including conventional transarterial chemoembolization ( ...

    Abstract Background: A large proportion of patients with colorectal cancer liver metastases (CRCLM) not amenable to curative liver resection will progress on systemic therapy. Intra-arterial therapies (IAT) including conventional transarterial chemoembolization (cTACE), drug eluting beads (DEB-TACE) and yttrium-90 radioembolization (Y-90) are indicated to prolong survival and palliate symptoms. The purpose of this systematic review and meta-analysis is to compare the survival benefit and radiologic response of three intra-arterial therapies in patients with chemorefractory and unresectable CRCLM.
    Methods: A systematic search for eligible references in the Cochrane Library and the EMBASE, MEDLINE and TRIP databases from January 2000 to November 2016 was performed in accordance with PRISMA guidelines. Methodological quality of included studies was assessed using the MINORS scale. One-year overall survival rates and RECIST responder rates were pooled using inverse-variance weighted random-effects models. Overall survival outcomes were collected according to transformed pooled median survivals from first IAT with a subgroup analysis of patients with extrahepatic disease.
    Results: Twenty-three prospective studies were included and analyzed: 5 cTACE (n = 746), 5 DEB-TACE (n = 222) and 13 Y-90 (n = 615). All but five were clinical trials. Eleven of 13 Y-90 studies were industry funded. Pooled RECIST response rates with 95% confidence intervals (CI) were: cTACE 23% (9.7, 36), DEB-TACE 36% (0, 73) and Y-90 23% (11, 34). The pooled 1-year survival rates with CI were: cTACE, 70% (49, 87), DEB-TACE, 80% (74, 86) and Y-90, 41% (28, 54). Transformed pooled median survivals from first IAT and ranges for cTACE, DEB-TACE and Y-90 were 16 months (9.0-23), 16 months (7.3-25) and 12 months (7.0-15), respectively. Significant heterogeneity in inclusion criteria and reporting of confounders, including previous therapy, tumor burden and post-IAT therapy, precluded statistical comparisons between the three therapies.
    Conclusion: Methodological and statistical heterogeneity precluded consensus on the optimal treatment strategy. Given the common use and significant cost of radioembolization in this setting, a more robust prospective comparative trial is warranted.
    MeSH term(s) Aged ; Brachytherapy/adverse effects ; Brachytherapy/mortality ; Chemoembolization, Therapeutic/adverse effects ; Chemoembolization, Therapeutic/mortality ; Colorectal Neoplasms/mortality ; Colorectal Neoplasms/pathology ; Drug Resistance, Neoplasm ; Female ; Humans ; Liver Neoplasms/mortality ; Liver Neoplasms/secondary ; Liver Neoplasms/therapy ; Male ; Middle Aged ; Radiopharmaceuticals/administration & dosage ; Radiopharmaceuticals/adverse effects ; Risk Factors ; Time Factors ; Treatment Outcome ; Yttrium Radioisotopes/administration & dosage ; Yttrium Radioisotopes/adverse effects
    Chemical Substances Radiopharmaceuticals ; Yttrium Radioisotopes
    Language English
    Publishing date 2018-06-07
    Publishing country England
    Document type Journal Article ; Meta-Analysis ; Systematic Review
    ZDB-ID 2131251-5
    ISSN 1477-2574 ; 1365-182X
    ISSN (online) 1477-2574
    ISSN 1365-182X
    DOI 10.1016/j.hpb.2018.04.001
    Database MEDical Literature Analysis and Retrieval System OnLINE

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