The impact of mini-invasive right hepatectomy in the setting of living donation: a meta-analysis

AbstractAdult-to-adult living-donor liver transplantation (A2ALDLT) represents a challenging procedure, mainly when the right hepatic lobe is donated. Therefore, especially in Western countries, the medical community still considers it a “risky procedure”. The present meta-analysis investigated the postoperative results reported in donors undergoing right hepatectomy for A2ALDLT through a minimally invasive liver resection (MILR) vs. open liver resection (OLR) approach, with the intent to clarify the hypothesis that the MILR approach should minimize the risks for the donor. A systematic literature search was performed using MEDLINE-PubMed, Cochrane Library, and EMBASE electronic databases. The primary outcome investigated was the complication rate after transplant. Fifteen studies were included (n = 2094; MILR = 553 vs. OLR = 1541). The MILR group only merged the statistical relevance in terms of advantage in terms of a lower number of complications (OR = 0.771, 95% CI 0.578–1.028; P value = 0.077). Investigating the complications ≥ IIIa according to the Dindo-Clavien classification, the estimated blood loss, and the length of hospital stay, no statistical difference was reported between the two groups. MILR represents a novel and promising approach for improving the results in A2ALDLT. However, no benefits have been reported regarding blood loss, length of stay, and postoperative complications. More extensive experiences are needed to re-evaluate the impact of MILR in right lobe live donation.

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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.

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Impact of trainee involvement in esophagectomy on clinical outcomes: a narrative systematic review of the literature

Diseases of the Esophagus ◽

10.1093/dote/doz063 ◽

2019 ◽

Vol 32 (10) ◽

pp. 1-8

Author(s):

P Prasad ◽

M Navidi ◽

A Immanuel ◽

S M Griffin OBE ◽

A W Phillips

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Meta Analysis ◽

Neoadjuvant Treatment ◽

Length Of Hospital Stay ◽

High Volume ◽

Cochrane Library ◽

Published Data ◽

Meta Analyses ◽

The Impact

SUMMARY Changes in the structure of surgical training have affected trainees’ operative experience. Performing an esophagectomy is being increasingly viewed as a complex technical skill attained after completion of the routine training pathway. This systematic review aimed to identify all studies analyzing the impact of trainee involvement in esophagectomy on clinical outcomes. A search of the major reference databases (Cochrane Library, MEDLINE, EMBASE) was performed with no time limits up to the date of the search (November 2017). Results were screened in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and study quality assessed using the MINORS (Methodological Index for Non-Randomized Studies) criteria. Four studies that included a total of 42 trainees and 16 consultants were identified, which assessed trainee involvement in open esophagogastric resectional surgery. A total of 1109 patients underwent upper gastrointestinal procedures, of whom 904 patients underwent an esophagectomy. Preoperative characteristics, histology, neoadjuvant treatment, and overall length of hospital stay were comparable between groups. One study found higher rates of anastomotic leaks in procedures primarily performed by trainees as compared to consultants (P < 0.01)—this did not affect overall morbidity or survival; however, overall anastomotic leak rates from the published data were 10.4% (trainee) versus 6.3% (trainer) (P = 0.10). A meta-analysis could not be performed due to the heterogeneity of data. The median MINORS score for the included studies was 13 (range 11–15). This study demonstrates that training can be achieved with excellent results in high-volume centers. This has important implications on the consent process and training delivered, as patients wish to be aware of the risks involved with surgery and can be reassured that appropriately supervised trainee involvement will not adversely affect outcomes.

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Impact of spontaneous hepatocellular carcinoma rupture on surgical outcome after liver resection: a systemic review and meta-analysis

10.21203/rs.2.19071/v2 ◽

2020 ◽

Author(s):

Wei Zhang ◽

Zhi-Yong Huang ◽

Chang Shu

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Resection ◽

Recurrence Rate ◽

Surgical Outcome ◽

Meta Analysis ◽

Systemic Review ◽

Cochrane Library ◽

Tumor Rupture ◽

Significant Difference ◽

The Impact

Abstract Background Spontaneous tumor rupture is a rare but life-threatening complication of hepatocellular carcinoma (HCC). The impact of spontaneous ruptured HCC on long-term survival after liver resection (LR) remains unclear. Our aim was to compare the surgical outcome in patients who underwent LR with ruptured and non-ruptured HCC . Methods A comprehensive search using PubMed, Embase, Cochrane Library and Science Citation Index Expanded databases was performed. The primary outcomes were the hazard ratio (HR) for overall survival ( OS) and disease free survival (DFS). The secondary outcomes included morbidity, hospital mortality and recurrence rate . Results Ten retrospective studies including 3222 patients met the inclusion criteria. Pooled analysis revealed a significantly poorer OS and DFS for patients with ruptured HCC compared to patients with non-ruptured HCC (HR, 2.02; 95% CI, 1.61-2.54; P< 0.00001 and HR, 1.92; 95% CI, 1.56-2.35; P<0.00001, respectively). In the subgroup analysis, both the propensity score matching (PSM) and non-PSM studies demonstrated a significantly poorer OS in the ruptured HCC group (P=0.02 and P<0.00001, respectively). However, meta-analysis of two PSM studies showed that there was not significant difference in the DFS between the two groups (P=0.50). Patients in the ruptured HCC group had a higher mortality and recurrence rate than the non-ruptured HCC group, but the difference was not significant (P = 0.05 and P = 0.06, respectively) Conclusions Surgical outcomes of the patients with the ruptured or non-ruptured HCC undergoing LR were not only affected by tumor rupture itself, but also by the tumor characteristics and liver functional status. Therefore, classifying all ruptured but resectable HCC as T4 stage is unable to accurately represent their true prognosis.

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Laparoscopic Major Gastrointestinal Surgery Is Safe for Properly Selected Patient with COPD: A Meta-Analysis

BioMed Research International ◽

10.1155/2019/8280358 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8

Author(s):

Yulin Guo ◽

Feng Cao ◽

Yixuan Ding ◽

Haichen Sun ◽

Shuang Liu ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Meta Analysis ◽

Gastrointestinal Surgery ◽

Laparoscopic Approach ◽

Length Of Hospital Stay ◽

Pulmonary Complications ◽

Cochrane Library ◽

Chronic Obstructive ◽

Intraoperative Blood Loss

Background. Laparoscopy has been widely applied in gastrointestinal surgery, with benefits such as less intraoperative blood loss, faster recovery, and shorter length of hospital stay. However, it remains controversial if laparoscopic major gastrointestinal surgery could be conducted for patients with chronic obstructive pulmonary disease (COPD) which was traditionally considered as an important risk factor for postoperative pulmonary complications. The present study was conducted to review and assess the safety and feasibility of laparoscopic major abdominal surgery for patient with COPD. Materials and Methods. Databases including PubMed, EmBase, Cochrane Library, and Wan-fang were searched for all years up to Jul 1, 2018. Studies comparing perioperative results for COPD patients undergoing major gastrointestinal surgery between laparoscopic and open approaches were enrolled. Results. Laparoscopic approach was associated with less intraoperative blood loss (MD = -174.03; 95% CI: −232.16 to -115.91, P < 0.00001; P < 0.00001, I2=93% for heterogeneity) and shorter length of hospital stay (MD = -3.30; 95% CI: −3.75 to -2.86, P < 0.00001; P = 0.99, I2=0% for heterogeneity). As for pulmonary complications, laparoscopic approach was associated with lower overall pulmonary complications rate (OR = 0.58; 95% CI: 0.48 to 0.71, P < 0.00001; P = 0.42, I2=0% for heterogeneity) and lower postoperative pneumonia rate (OR = 0.53; 95% CI: 0.41 to 0.67, P < 0.00001; P = 0.57, I2=0% for heterogeneity). Moreover, laparoscopic approach was associated with lower wound infection (OR = 0.51; 95% CI: 0.42 to 0.63, P < 0.00001; P = 0.99, I2=0% for heterogeneity) and abdominal abscess rates (OR = 0.59; 95% CI: 0.44 to 0.79, P < 0.0004; P = 0.24, I2=30% for heterogeneity). Conclusions. Laparoscopic major gastrointestinal surgery for properly selected COPD patient was safe and feasible, with shorter term benefits.

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Single-Institution Early Experience and Learning Curve with Robotic Liver Resections

The American Surgeon ◽

10.1177/000313481908500143 ◽

2019 ◽

Vol 85 (1) ◽

pp. 115-119 ◽

Cited By ~ 2

Author(s):

Aviad Gravetz ◽

Iswanto Sucandy ◽

Chandler Wilfong ◽

Nirrita Patel ◽

Janelle Spence ◽

...

Keyword(s):

Liver Resection ◽

Blood Loss ◽

Learning Curve ◽

Intraoperative Complications ◽

Length Of Hospital Stay ◽

Early Experience ◽

Robotic Liver Resection ◽

Open Operation ◽

Estimated Blood Loss ◽

Posterosuperior Segment

Robotic liver resection is being introduced with its potential to overcome limitations of conventional laparoscopy. This study was undertaken to document early experience and learning curve of robotic liver resection in our institution. All patients undergoing liver resection between 2013 and 2017 were prospectively followed. Patients were divided into three consecutive tertiles (cohort I–III). Thirty-three patients underwent robotic liver resection within the study period. Twenty-four per cent of patients underwent formal right or left hemihepatectomy, 21 per cent underwent sectionectomy, 6 per cent underwent central hepatectomy, and the remainder underwent non-anatomical liver resection. Formal hemihepatectomy and right posterosuperior segment resection were undertaken in two patients in cohort I, four patients in cohort II, and four patients in cohort III. Two cases were converted to “open” operation. Operative time was 172 (194.5 ± 65.1) minutes in cohort I, 222 (247.8 ± 109.8) minutes in cohort II, and 280 (302.5 ± 84.9) minutes in cohort III, reflecting increasing degree of technical complexity. Estimated blood loss decreased significantly throughout the cohorts, being 400 mL, 200 mL, and 100 mL in cohorts I to III, respectively. Major intraoperative complications were not seen. Three patients experienced postoperative complications, resulting in a single mortality. Length of hospital stay was three days, with two patients being readmitted within 30 days. Robotic technique for liver resection is feasible and safe. It offers good short-term clinical outcomes, including for patients who require major liver resection. As the proficiency developed, a notable improvement in technically ability to undertake more complex resections with decreasing blood loss and minimal morbidity was seen.

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Comparison Between Single-Use Flexible Ureteroscope and Reusable Flexible Ureteroscope for Upper Urinary Calculi: A Systematic Review and Meta-Analysis

Frontiers in Surgery ◽

10.3389/fsurg.2021.691170 ◽

2021 ◽

Vol 8 ◽

Author(s):

Chunyang Meng ◽

Lei Peng ◽

Jinze Li ◽

Yunxiang Li ◽

Jinming Li ◽

...

Keyword(s):

Meta Analysis ◽

Urinary Calculi ◽

Length Of Hospital Stay ◽

Cochrane Library ◽

Flexible Ureteroscope ◽

Estimated Blood Loss ◽

Stone Free Rate ◽

Grade Ii ◽

Single Use ◽

Free Rate

Objective: This article explores the differences in the effectiveness and safety of the treatment of the upper urinary calculi between single-use flexible ureteroscope (su-fURS) and reusable flexible ureteroscope (ru-fURS).Methods: We systematically searched PubMed, Embase, Cochrane Library, Scopus database, and CNKI databases within a period from the date of database establishment to November 2020. Stata 16 was used for calculation and statistical analyses.Results: A total of 1,020 patients were included in the seven studies. The statistical differences were only found in the Clavien–Dindo grade II postoperative complication [odds ratio (OR) 0.47; 95% CI 0.23–0.98; p = 0.04]. No significant statistical differences were observed in operative time (OT), estimated blood loss (EBL), length of hospital stay (LOS), and stone-free rate (SFR).Conclusion: Our meta-analysis results demonstrate that su-fURS, compared with ru-fURS, has similar effectiveness and better security for treating upper urinary calculi.

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The Impact of Delirium On Prognosis In Stroke: A Systematic Review and Meta-Analyses of Observational Studies

10.21203/rs.3.rs-750658/v1 ◽

2021 ◽

Author(s):

jing zhang ◽

xin wang ◽

jie wang ◽

kai liu ◽

tao he ◽

...

Keyword(s):

Hospital Stay ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Length Of Hospital Stay ◽

Clinical Problem ◽

Cochrane Library ◽

Inpatient Mortality ◽

Increased Risk ◽

The Impact

Abstract Background The outcomes of post-stroke delirium are inconsistent. Therefore, we conduct a meta-analysis to provide a comprehensive description of the impact of delirium on the outcomes including including length of hospital stay and inpatient mortality after stroke. Methods We searched electronic databases including PubMed, Google scholar, Web of Science and Cochrane Library databases up to April, 2021. Fixed-effect or random-effect model was used to summary odds ratio (OR) and mean difference (MD ) with 95% confidence interval (CI). Results 13 individual studies with total of 3592 patients met the inclusion criteria. The summary results revealed that stroke patients with delirium increased risk of inpatient mortality (OR = 6.35, 95% CI: 4.35–9.25, p < 0.0001), and had longer length of hospital stay (MD = 5.93, 95% CI: 2.79–9.07, p < 0.0001) compared to non-delirious patients. Conclusions Delirium is associated with unfavorable outcomes in patients with stroke, particularly in higher inpatient mortality and longer length of stay. We should pay more attention to this clinical problem and managed appropriately to prevent poor prognosis.

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Impact of spontaneous hepatocellular carcinoma rupture on surgical outcome after liver resection: a systemic review and meta-analysis

10.21203/rs.2.19071/v1 ◽

2019 ◽

Author(s):

Wei Zhang ◽

Zhi-Yong Huang ◽

Chang Shu

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Resection ◽

Recurrence Rate ◽

Surgical Outcome ◽

Meta Analysis ◽

Systemic Review ◽

Cochrane Library ◽

Tumor Rupture ◽

Significant Difference ◽

The Impact

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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.

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Ankle arthrodesis-Open versus arthroscopic in the Treatment of Ankle Arthritis: A meta-analysis

10.21203/rs.2.18589/v1 ◽

2019 ◽

Author(s):

Tsz Ngai Mok ◽

Qiyu He ◽

Soundarya Panneerselvam ◽

Huige Hou ◽

Huajun Wang ◽

...

Keyword(s):

Blood Loss ◽

Open Surgery ◽

Meta Analysis ◽

Fusion Rate ◽

Functional Improvement ◽

Cochrane Library ◽

Ankle Arthritis ◽

Tourniquet Time ◽

Pooled Data ◽

Estimated Blood Loss

Abstract Background: This study intends in evaluating the comparsion between arthroscopic arthrodesis and open surgery for patients with ankle arthritis by performing a meta-analysis. Methods: A literature search for this meta-analysis was conducted using four English databases (Pubmed, Embase, Medline and the Cochrane Library), up to August 2019. These included two prospective cohort study and 7 retrospective cohort studies, enrolling a total of 507 patients with ankle arthritis. Result: For fusion rate, the pooled data showed significantly higher rate of fusion during the arthroscopic arthrodesis compared with open surgery (odds ratio 0.25, 95% CI 0.11 to 0.57, p = 0.0010). Regarding to the estimated blood loss, the pooled data showed significantly smaller blood losses during arthroscopic arthrodesis as compared with open surgery (WMD 52.04, 95% CI 14.14 to 89.94, p = 0.007). For tourniquet time, the pooled data showed smaller tourniquet time during arthroscopic arthrodesis compared with open surgery (WMD 22.68, 95% CI 1.92 to 43.43, p = 0.03). In the length of stay in the hospital, the pooled data showed less time of hospitalization for patients undergoing arthroscopic arthrodesis compared with open surgery (WMD 1.62, 95% CI 0.97 to 2.26, p < 0.00001). The pooled data showed better recovery for the patients who experienced arthroscopic arthrodesis as compared with open surgery at 1 year (WMD 14.73, 95% CI 6.66 to 22.80, p = 0.0003). Conclusion: For patients with ankle arthritis, arthroscopic arthrodesis seems to be associated with a higher fusion rate, lesser amount of estimated blood loss, shorter tourniquet time, shorter length of hospitalization and better functional improvement at 1 year.

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