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Abstract: A best evidence topic in surgery was written according to a structured protocol. The question addressed was whether patients who have undergone chemoradiotherapy (CRT) for locally advanced squamous cell carcinoma of the oesophagus benefit from surgical resection. 505 papers were found using the reported search, of which 5 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 five studies, two were randomised controlled trials. These demonstrated that there was no survival benefit in adding surgery to patients who have undergone CRT for oesophageal cancer. The remaining three observational studies suggest that surgery may have a prognostic benefit for patients who show a partial, but not complete response to CRT. We conclude that for patients who are complete responders to induction CRT, surgery adds no survival benefit. With regard to partial responders there is weak evidence suggesting that there may be some benefit in surgery after CRT, but further trials are needed to clarify the survival benefit (if any) of adding oesophagectomy to CRT for this sub-group. [Copyright &y& Elsevier]

Abstract: A best evidence topic was written according to a structured protocol. The question addressed whether laparoscopic approach confers a difference in functional outcome compared to conventional open resectional surgery for rectal cancer. 246 papers were found using the reported search, of which five represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group, study type, relevant outcomes and key results of these papers are tabulated. Of these five studies, none showed any difference in post-operative urinary function between patients undergoing laparoscopic or open surgery. The two randomised studies reported either a trend or a significant difference in favour of open surgery for sexual outcome in men. Three more recent, case–control studies showed differences in favour of laparoscopic surgery for sexual function in men. We conclude that there is no evidence to suggest that laparoscopic approach makes any difference to post-operative urinary function. The data relating to sexual function in men is contradictory, and as none of the studies available have generated high level evidence and further trials are required to clarify whether laparoscopic approach confers an advantage or disadvantage in terms of sexual function for men post-operatively. In terms of sexual function in women, the available data is far too scarce to satisfactorily determine whether laparoscopy is superior to open surgery. [Copyright &y& Elsevier]