Perioperative morbidity of different operative approaches in early cervical carcinoma: a systematic review and meta-analysis comparing minimally invasive versus open radical hysterectomy

Abstract Purpose Radical hysterectomy and pelvic lymphadenectomy is the standard treatment for early cervical cancer. Studies have shown superior oncological outcome for open versus minimal invasive surgery, but peri- and postoperative complication rates were shown vice versa. This meta-analysis evaluates the peri- and postoperative morbidities and complications of robotic and laparoscopic radical hysterectomy compared to open surgery. Methods Embase and Ovid-Medline databases were systematically searched in June 2020 for studies comparing robotic, laparoscopic and open radical hysterectomy. There was no limitation in publication year. Inclusion criteria were set analogue to the LACC trial. Subgroup analyses were performed regarding the operative technique, the study design and the date of publication for the endpoints intra- and postoperative morbidity, estimated blood loss, hospital stay and operation time. Results 27 studies fulfilled the inclusion criteria. Five prospective, randomized-control trials were included. Meta-analysis showed no significant difference between robotic radical hysterectomy (RH) and laparoscopic hysterectomy (LH) concerning intra- and perioperative complications. Operation time was longer in both RH (mean difference 44.79 min [95% CI 38.16; 51.42]), and LH (mean difference 20.96 min; [95% CI − 1.30; 43.22]) than in open hysterectomy (AH) but did not lead to a rise of intra- and postoperative complications. Intraoperative morbidity was lower in LH than in AH (RR 0.90 [0.80; 1.02]) as well as in RH compared to AH (0.54 [0.33; 0.88]). Intraoperative morbidity showed no difference between LH and RH (RR 1.29 [0.23; 7.29]). Postoperative morbidity was not different in any approach. Estimated blood loss was lower in both LH (mean difference − 114.34 [− 122.97; − 105.71]) and RH (mean difference − 287.14 [− 392.99; − 181.28]) compared to AH, respectively. Duration of hospital stay was shorter for LH (mean difference − 3.06 [− 3.28; − 2.83]) and RH (mean difference − 3.77 [− 5.10; − 2.44]) compared to AH. Conclusion Minimally invasive radical hysterectomy appears to be associated with reduced intraoperative morbidity and blood loss and improved reconvalescence after surgery. Besides oncological and surgical factors these results should be considered when counseling patients for radical hysterectomy and underscore the need for new randomized trials.

Download Full-text

Comparison of Oblique Lateral Interbody Fusion and Transforaminal Lumbar Interbody Fusion for Degenerative Lumbar Disease: A Meta-Analysis

10.21203/rs.3.rs-70799/v1 ◽

2020 ◽

Author(s):

CHEN Tai-bang ◽

HE Xiao-qing ◽

Liang Jing-long

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Interbody Fusion ◽

Meta Analysis ◽

Operation Time ◽

Transforaminal Lumbar Interbody Fusion ◽

Fusion Rate ◽

Disc Height ◽

Estimated Blood Loss ◽

Degenerative Lumbar Disease

Abstract Aim: Both oblique lateral interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) are frequently used to treat degenerative lumbar disease. The purpose of this meta-analysis is to compare the radiologic and clinical outcomes between these two methods.Methods: Electronic databases, including PubMed, Web of Science and MEDLINE, were searched to identify relevant studies that compared OLIF and TLIF up to May 2020. The radiographic outcomes comprised of the disc height (DH), lumbar lordotic angle (LLA), disc angle (DA), fusion rate (FR), and foraminal height (FH). The secondary outcomes were length of hospital stay, operation time, estimated blood loss, visual analog scale (VAS), and Oswestry Disability Index (ODI). Data pooling and a meta-analysis with the random effects model were performed to evaluate the major results and conclusions. Results: A total of nine studies that involved 593 patients (271 patients in the OLIF group and 322 in the TLIF group) were included in the meta-analysis. Similar changes, in terms of disc height and fusion rate of >80%, were observed between the two groups. In comparing OLIF to TLIF, the OLIF group had less estimated blood loss, and a shorter operative time and hospital stay, with statistical difference. However, there was no significant difference in VAS and ODI between OLIF and TLIF.The meta-analysis suggested that TLIF is associated with better postoperative LLA, FH and DA, when compared to OLIF. However, these were not statistically significant (P>005).Conclusion: These results demonstrate that both OLIF and TLIF are similar in terms of the restoration of disc height and intervertebral fusion rate in the treatment of degenerative lumbar diseases. OLIF was superior to TLIF in terms of operation time, hospital stay and estimated blood loss. However, there was no advantage in restoring the sagittal balance and correcting the lordosis.

Download Full-text

Minimally Invasive versus Open Simultaneous Resections of Colorectal Cancer and Synchronous Liver Metastases: A Meta-Analysis

The American Surgeon ◽

10.1177/000313481808400224 ◽

2018 ◽

Vol 84 (2) ◽

pp. 192-200 ◽

Cited By ~ 3

Author(s):

Yulin Guo ◽

Yunhe Gao ◽

Guijin Chen ◽

Chen Li ◽

Guanglong Dong

Keyword(s):

Colorectal Cancer ◽

Blood Loss ◽

Confidence Interval ◽

Minimally Invasive ◽

Liver Metastases ◽

Meta Analysis ◽

Mean Difference ◽

Cochrane Library ◽

Postoperative Stay ◽

Surgical Blood Loss

The aim of this meta-analysis was to compare the efficacy and safety of simultaneous resections between the minimally invasive approach (MIA) and the open approach (OA) for patients with colorectal cancer (CRC) and synchronous colorectal liver metastases (SCRLM). A systematic search was conducted in the Cochrane Library, PubMed, EMBASE and Ovid databases (until May 5, 2016). Studies comparing the perioperative results and long-term outcomes for patients undergoing simultaneous CRC and SCRLM resections between the two approaches were evaluated. Six studies were identified, which included 164 minimally invasive and 213 open simultaneous resections of CRC and SCRLM. MIA was associated with lesser surgical blood loss (mean difference = -155.85 mL; 95% confidence interval: -305.64 to -6.06, P = 0.04) and shorter length of postoperative stay (mean difference = -3.16 days; 95% confidence interval: -4.00 to -2.31, P < 0.00001.). The other perioperative results, including operating time, operative blood transfusion, intestinal function recovery time, and postoperative complications, did not differ significantly. No significant difference in the disease-free survival and overall survival rates between the two approaches was observed. In conclusion, compared with the OA, the MIA for simultaneous CRC and SCRLM resections is safe and effective for the treatment of SCRLM with lesser surgical blood loss and shorter length of postoperative stay. The MIA may be an alternative to the OA for simultaneous CRC and SCRLM resections for appropriately selected patients with resectable SCRLM.

Download Full-text

The Self-Retaining Barbed Suture for Parenchymal Repair in Laparoscopic Partial Nephrectomy: A Systematic Review and Meta-Analysis

Surgical Innovation ◽

10.1177/1553350619856167 ◽

2019 ◽

Vol 26 (6) ◽

pp. 744-752

Author(s):

Hailun Zhan ◽

Chunping Huang ◽

Tengcheng Li ◽

Fei Yang ◽

Jiarong Cai ◽

...

Keyword(s):

Renal Function ◽

Blood Loss ◽

Hospital Stay ◽

Partial Nephrectomy ◽

Operative Time ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

The Self ◽

Barbed Suture ◽

Estimated Blood Loss

Objectives. The warm ischemia time (WIT) is key to successful laparoscopic partial nephrectomy (LPN). The aim of this study was to perform a meta-analysis comparing the self-retaining barbed suture (SRBS) with a non-SRBS for parenchymal repair during LPN. Methods. A systematic search of PubMed, Scopus, and the Cochrane Library was performed up to March 2018. Inclusion criteria for this study were randomized controlled trials (RCTs) and observational comparative studies assessing the SRBS and non-SRBS for parenchymal repair during LPN. Outcomes of interest included WIT, complications, overall operative time, estimated blood loss, length of hospital stay, and change of renal function. Results. One RCT and 7 retrospective studies were identified, which included a total of 461 cases. Compared with the non-SRBS, use of the SRBS for parenchymal repair during LPN was associated with shorter WIT ( P < .00001), shorter overall operative time ( P < .00001), lower estimated blood loss ( P = .02), and better renal function preservation ( P = .001). There was no significant difference between the SRBS and non-SRBS with regard to complications ( P = .08) and length of hospital stay ( P = .25). Conclusions. The SRBS for parenchymal repair during LPN can significantly shorten the WIT and overall operative time, decrease blood loss, and preserve renal function.

Download Full-text

Effect of preoperative biliary drainage in patients with moderately severe obstructive jaundice on the outcomes of pancreatoduodenectomy: A meta-analysis study

10.21203/rs.2.18871/v1 ◽

2019 ◽

Author(s):

Xiaolei Wang ◽

Shanshan Meng ◽

Yaowei Hu ◽

Kehang Duan ◽

Feng Wei

Keyword(s):

Blood Loss ◽

Total Bilirubin ◽

Meta Analysis ◽

Operating Time ◽

Preoperative Biliary Drainage ◽

Postoperative Hospital Stay ◽

Mean Difference ◽

Perioperative Outcomes ◽

Perioperative Mortality ◽

Estimated Blood Loss

Abstract Background The purpose of this meta-analysis was to examine the impact of preoperative biliary drainage (PBD) on the perioperative outcomes of pancreatoduodenectomy (PD) in patients with total bilirubin >100 umol/L.Methods In this meta-analysis, studies that compared the perioperative outcomes of PBD and non-PBD patients with total bilirubin >100 umol/L, and were published in EMBASE, PubMed, the Cochrane library, Web of Science, VIP database, Wanfang data, Chinese biomedical literature and CNKI database from inception up to October 2019 were included. The odds ratios (OR) or mean differences were calculated with 95% confidence intervals (CI).Results Nine trials with 744 patients, which compared PBD (267 patients) with non-PBD (477 patients), were included. There was no significant difference in perioperative mortality between these two groups (OR: 0.51, 95% CI: 0.19 to 1.39; P =0.19). Postoperative hospital stay (mean difference: -2.35, 95% CI: -3.70 to -1.00; P =0.0007), operating time (mean difference: -33.03, 95% CI: -44.14 to 21.93; P <0.00001), estimated blood loss (mean difference: -141.18, 95% CI: -213.25 to -69.11; P =0.0001) and overall morbidity (OR: 0.68, CI: 0.48 to 0.95; P =0.02) were significantly lower in the PBD group than in the non-PBD group.Conclusion Patients who received PBD had similar perioperative mortality, but had decreased postoperative hospital stay, operating time, estimated blood loss and overall morbidity, when compared to patients without PBD. Therefore, PBD should be routinely performed for patients planned for PD with a total bilirubin of >100 umol/L.

Download Full-text

Prognostic Significance of Hyponatremia in Acute Stroke: A Systematic Review and Meta-Analysis

Cerebrovascular Diseases ◽

10.1159/000510751 ◽

2020 ◽

Vol 49 (5) ◽

pp. 531-539

Author(s):

Shogo Shima ◽

Yasunari Niimi ◽

Yosuke Moteki ◽

Osamu Takahashi ◽

Shinsuke Sato ◽

...

Keyword(s):

Systematic Review ◽

Hospital Mortality ◽

Hospital Stay ◽

Acute Stroke ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Mean Difference ◽

Cochrane Library ◽

Inclusion Criteria ◽

Stroke Patients

Objective: Hyponatremia is a common electrolyte disorder in patients with stroke, which leads to various fatal complications. We performed a systematic review and meta-analysis to investigate the outcomes of acute stroke patients with hyponatremia. Methods: We searched MEDLINE, EMBASE, and the Cochrane Library databases for relevant literature in English published up to March 2020. Two review authors independently screened and selected the studies by assessing the eligibility and validity based on the inclusion criteria. Mortality at 90 days was set as the primary end point, and in-hospital mortality and length of hospital stay were set as the secondary end points. We conducted the data synthesis and analyzed the outcomes by calculating the odds ratio (OR) and mean difference. Results: Of 835 studies, 15 studies met the inclusion criteria (n = 10,745). The prevalence rate of stroke patients with hyponatremia was 7.0–59.2%. They had significantly higher 90-day mortality (OR, 1.73; 95% confidence interval (CI), 1.24–2.42) and longer length of hospital stay (mean difference, 10.68 days; 95% CI, 7.14–14.22) than patients without hyponatremia. Patients with hyponatremia had a higher tendency of in-hospital mortality than those without hyponatremia (OR, 1.61; 95% CI, 0.97–2.69). Conclusions: The development of hyponatremia in the clinical course of stroke is associated with higher short-term mortality and a longer hospital stay. Although the causal relationship is unclear, hyponatremia could be a significant predictor of poor outcomes after stroke.

Download Full-text

Feasibility of Endoscopy-Assisted Laparoscopic Full-Thickness Resection for Superficial Duodenal Neoplasms

The Scientific World JOURNAL ◽

10.1155/2014/239627 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 8

Author(s):

Ken Ohata ◽

Masahiko Murakami ◽

Kimiyasu Yamazaki ◽

Kouichi Nonaka ◽

Nobutsugu Misumi ◽

...

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Operation Time ◽

Full Thickness ◽

Duodenal Neoplasms ◽

Invasive Treatment ◽

En Bloc ◽

Estimated Blood Loss ◽

Delayed Perforation ◽

The Mean

Background. Superficial duodenal neoplasms (SDNs) are a challenging target in the digestive tract. Surgical resection is invasive, and it is difficult to determine the site and extent of the lesion from outside the intestine and resect it locally. Endoscopic submucosal dissection (ESD) has scarcely been utilized in the treatment of duodenal tumors because of technical difficulties and possible delayed perforation due to the action of digestive juices. Thus, no standard treatments for SDNs have been established. To challenge this issue, we elaborated endoscopy-assisted laparoscopic full-thickness resection (EALFTR) and analyzed its feasibility and safety.Methods. Twenty-four SDNs in 22 consecutive patients treated by EALFTR between January 2011 and July 2012 were analyzed retrospectively.Results. All lesions were removed en bloc. The lateral and vertical margins of the specimens were negative for tumor cells in all cases. The mean sizes of the resected specimens and lesions were 28.9 mm (SD ± 10.5) and 13.3 mm (SD ± 11.6), respectively. The mean operation time and intraoperative estimated blood loss were 133 min (SD ± 45.2) and 16 ml (SD ± 21.1), respectively. Anastomotic leakage occurred in three patients (13.6%) postoperatively, but all were minor leakage and recovered conservatively. Anastomotic stenosis or bleeding did not occur.Conclusions. EALFTR can be a safe and minimally invasive treatment option for SDNs. However, the number of cases in this study was small, and further accumulations of cases and investigation are necessary.

Download Full-text

Comparison of safety and efficacy of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy in patients with large renal pelvic stones: a meta-analysis

Journal of Investigative Medicine ◽

10.1136/jim-2015-000053 ◽

2016 ◽

Vol 64 (6) ◽

pp. 1134-1142 ◽

Cited By ~ 2

Author(s):

Xuefang Rui ◽

Haiyi Hu ◽

Yanlan Yu ◽

Shicheng Yu ◽

Zhigen Zhang

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Publication Bias ◽

Percutaneous Nephrolithotomy ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Operation Time ◽

Renal Stones ◽

Quality Analysis ◽

Laparoscopic Pyelolithotomy

To compare percutaneous nephrolithotomy (PCNL) and laparoscopic pyelolithotomy (LP) for surgical management for large (>2 cm) renal stones. We searched MEDLINE, Cochrane, and EMBASE databases until March 11, 2015, using the following search terms: renalpelvic stone, percutaneous nephrolithotomy, laparoscopic pyelolithotomy. Randomized controlled and prospective and retrospective two-armed studies were included. Sensitivity analysis and assessment of the quality of the included studies and publication bias were performed. Nine studies were included in the study with a patient population of 622. The studies were homogeneous with respect to the primary end point of stone-free rate, but were heterogeneous with respect to operation time, length of hospital stay, and blood loss. A higher percentage of patients who received LP remained stone-free following surgery compared with patients who were treated with PCNL (p=0.001). However, the mean operation time was longer for patients with LP than for those treated with PCNL (p=0.002). There was no difference between procedures with regard to length of hospital stay or blood loss (p≥0.071). Sensitivity and quality analysis indicated that the data are reliable and the included studies are of good quality. No publication bias was observed. The study suggests that both procedures are effective and safe for removing large renal stones. However, LP may be more efficacious than PCNL in treating large kidney stones.

Download Full-text

Laparoscopic versus open major liver resection for hepatocellular carcinoma: systematic review and meta-analysis of comparative cohort studies

BMC Cancer ◽

10.1186/s12885-019-6240-x ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 7

Author(s):

Zi-Yu Wang ◽

Qing-Lian Chen ◽

Ling-Ling Sun ◽

Shu-Ping He ◽

Xiao-Fen Luo ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Resection ◽

Blood Loss ◽

Hospital Stay ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Disease Free Survival ◽

Operation Time ◽

Cochrane Library ◽

Random Effects Models

Abstract Background The application of laparoscopic liver resection (LLR) has expanded rapidly in recent decades. Although multiple authors have reported LLR shows improved safety and efficacy in treating hepatocellular carcinoma (HCC) compared with open liver resection (OLR), laparoscopic (LMLR) and open (OMLR) major liver resections for HCC treatment remain inadequately evaluated. This work aimed to test the hypothesis that LMLR is safer and more effective than OMLR for HCC. Methods Comparative cohort and registry studies on LMLR and OMLR, searched in PubMed, the Science Citation Index, EMBASE, and the Cochrane Library, and published before March 31, 2018, were collected systematically and meta-analyzed. Fixed- and random-effects models were employed for generating pooled estimates. Heterogeneity was assessed by the Q-statistic. Results Nine studies (1173 patients) were included. Although the pooled data showed operation time was markedly increased for LMLR in comparison with OMLR (weighted mean difference [WMD] 74.1, 95% CI 35.1 to 113.1, P = 0.0002), blood loss was reduced (WMD = − 107.4, 95% CI − 179.0 to − 35.7, P = 0.003), postoperative morbidity was lower (odds ratio [OR] 0.47, 95% CI 0.35 to 0.63, P < 0.0001), and hospital stay was shorter (WMD = − 3.27, 95% CI − 4.72 to − 1.81, P < 0.0001) in the LMLR group. Although 1-year disease-free survival (DFS) was increased in patients administered LMLR (OR = 1.55, 95% CI 1.04 to 2.31, P = 0.03), other 1-, 3-, and 5-year survival outcomes (overall survival [OS] and/or DFS) were comparable in both groups. Conclusions Compared with OMLR, LMLR has short-term clinical advantages, including reduced blood loss, lower postsurgical morbidity, and shorter hospital stay in HCC, despite its longer operative time. Long-term oncological outcomes were comparable in both groups.

Download Full-text

Minimally Invasive Scoliosis Surgery Is a Feasible Option for Management of Idiopathic Scoliosis and Has Equivalent Outcomes to Open Surgery: A Meta-Analysis

Global Spine Journal ◽

10.1177/2192568220988267 ◽

2021 ◽

pp. 219256822098826

Author(s):

Abduljabbar Alhammoud ◽

Yahya Alborno ◽

Abdul Moeen Baco ◽

Yahya Azhar Othman ◽

Yoji Ogura ◽

...

Keyword(s):

Postoperative Pain ◽

Blood Loss ◽

Minimally Invasive ◽

Idiopathic Scoliosis ◽

Operative Time ◽

Meta Analysis ◽

Scoliosis Surgery ◽

Curve Correction ◽

Estimated Blood Loss ◽

Feasible Option

Study Design: Meta-analysis. Objective: To compare outcomes between minimally invasive scoliosis surgery (MISS) and traditional posterior instrumentation and fusion in the correction of adolescent idiopathic scoliosis (AIS). Methods: A literature search was performed using MEDLINE, PubMed, EMBASE, Google scholar and Cochrane databases, including studies reporting outcomes for both MISS and open correction of AIS. Study details, demographics, and outcomes, including curve correction, estimated blood loss (EBL), operative time, postoperative pain, length of stay (LOS), and complications, were collected and analyzed. Results: A total of 4 studies met the selection criteria and were included in the analysis, totaling 107 patients (42 MIS and 65 open) with a mean age of 16 years. Overall there was no difference in curve correction between MISS (73.2%) and open (76.7%) cohorts. EBL was significantly lower in the MISS (271 ml) compared to the open (527 ml) group, but operative time was significantly longer (380 min for MISS versus 302 min for open). There were no significant differences between the approaches in pain, LOS, complications, or reoperations. Conclusion: MISS was associated with less blood loss but longer operative times compared to traditional open fusion for AIS. There was no difference in curve correction, postoperative pain, LOS, or complications/reoperations. While MISS has emerged as a feasible option for the surgical management of AIS, further research is warranted to compare these 2 approaches.

Download Full-text

Meta-analysis of two approaches to Laparoscopic Adrenalectomy: lateral transperitoneal versus posterior retroperitoneal approach

10.21203/rs.3.rs-18722/v1 ◽

2020 ◽

Author(s):

Youyi Lu ◽

Qi Li ◽

Lin Li ◽

Hongtao Wang

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Hospital Stay ◽

Operative Time ◽

Meta Analysis ◽

Oral Intake ◽

Cochrane Collaboration ◽

Systematic Assessment ◽

Conversion Rates ◽

Estimated Blood Loss

Abstract Background:Even though many studies have reported comparisons of the lateral transperitoneal adrenalectomy (LTA)and posterior retroperitoneal adrenalectomy (PRA) approaches,the conclusions were inconsistent.This meta-analysis aims at a systematic assessment of LTA and PRA.Methods:We searched MEDLINE, Pubmed, and Embase database and finally obtained 19 studies published since January 2009.Systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses. RevMan 5.3(Cochrane Collaboration) was used for data analysis.Results:19 studies were included in the meta-analysis.The clinical characteristics of the 2 groups were similar(age, BMI, proportion of right sided, proportion of bilateral lesions,and previous abdominal surgery).There was slightly higher heterogeneity in proportion of male patients (OR 0.87, 95% CI 0.78 to 0.97, P = 0.01) and size of the tumor (MD 0.62, 95% CI 0.16 to 1.08, P = 0.008).The results confirmed that the PRA group was superior to LTA group regarding shorter operative time (MD 17.54, 95% CI 9.67 to 25.40, P < 0.0001),lower estimated blood loss (MD 37.75, 95% CI 18.08 to 57.41, P = 0.0002), shorter hospital stay (MD 1.19, 95% CI 0.76 to 1.63, P < 0.00001) and shorter time to first oral intake(MD 0.48, 95% CI 0.11 to 0.86, P =0.01).There were no statistically significant differences between LTA and PRA regarding overall complication(OR 1.37, 95% CI 0.96 to 1.97, P = 0.08),conversion to open laparotomy (OR 1.16, 95% CI 0.63 to 2.16, P = 0.63) or blood transfusion(OR 2.22, 95% CI 0.51 to 9.57, P = 0.28) .Conclusion:This meta-analysis suggests that PRA has more advantages over LTA,such as shorter operative time,lower estimated blood loss,shorter hospital stay and shorter time to first oral intake.And there were no statistically significance between LTA and PRA in terms of postoperative outcomes(total complications, conversion rates and blood transfusion).

Download Full-text