Combined Laparoscopic Uterine Artery Occlusion and Myomectomy versus Laparoscopic Myomectomy: A Direct-Comparison Meta-Analysis of Short- and Long-Term Outcomes in Women with Symptomatic Leiomyomas

Abstract Nowadays, there is still no consensus about the benefits of adding neck lymphadenectomy to the traditional two-fields esophagectomy. An extended lymphadenectomy could potentially increase operation time and the risks for postoperative complications. However, extended lymphadenectomy allows resection of cervical nodes at risk for metastases, potentially increasing long-term survival rates. This study aims to estimate whether cervical prophylactic lymphadenectomy for esophageal cancer influences short- and long-term outcomes through a systematic review of literature and meta-analysis. Methods A systematic review was conducted in PubMed, Embase, Cochrane Library Central, and Lilacs (BVS). The inclusion criteria were: (1) studies that compare two-field vs. three-field esophagectomy; (2) adults (>18 years); (3) articles that analyze short- or long-term outcomes; and (4) clinical trials or cohort studies. The results were summarized by forest plots, with effect size (ES) or risk difference (RD) and 95% CI. Results Twenty-five articles were selected, comprising 8,954 patients. Three-field lymphadenectomy was associated to higher operation time (ES: -1.51; 95%CI -1.84, −1.18) and higher blood loss (ES: -0.24; 95%CI: −0.37, −0.11). Also, neck lymphadenectomy inputs additional risk for pulmonary complications (RD: 0.03; 95%CI: 0.01, 0.05). No difference was noted for morbidity (RD: 0.01; 95%CI: −0.01, 0.03); leak (−0.02; 95%CI: −0.07, 0.03); postoperative mortality (RD: 0.00; 95%CI: −0.00, 0.01), and hospital stay (ES: -0.05; 95%CI -0.20, 0.10). Three-field lymphadenectomy allowed higher number of retrieved lymph nodes (MD: -1.51; 95%CI -1.84, −1.18), but did not increase the overall survival (HR: 1.11; 95%CI: 0.96, 1.26). Conclusion Prophylactic neck lymphadenectomy for esophageal cancer should be performed with caution once it is associated with poorer short-term outcomes compared to traditional two-field lymphadenectomy and does not improve long-term survival. Future esophageal cancer studies should determine the subgroup of patients who could benefit from prophylactic neck lymphadenectomy in long-term outcomes.

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A systematic review and meta-analysis comparing the short- and long-term outcomes for laparoscopic and open liver resections for liver metastases from colorectal cancer

Surgical Endoscopy ◽

10.1007/s00464-019-06774-2 ◽

2019 ◽

Vol 34 (1) ◽

pp. 349-360 ◽

Cited By ~ 9

Author(s):

Ruben Ciria ◽

Sira Ocaña ◽

Irene Gomez-Luque ◽

Federica Cipriani ◽

Mark Halls ◽

...

Keyword(s):

Colorectal Cancer ◽

Systematic Review ◽

Liver Metastases ◽

Meta Analysis ◽

Long Term Outcomes ◽

Liver Resections ◽

Short And Long Term

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Short- and long-term outcomes of intracoronary and endogenously mobilized bone marrow stem cells in the treatment of ST-segment elevation myocardial infarction: a meta-analysis of randomized control trials

European Journal of Heart Failure ◽

10.1093/eurjhf/hfr148 ◽

2012 ◽

Vol 14 (1) ◽

pp. 91-105 ◽

Cited By ~ 88

Author(s):

Hendrik Zimmet ◽

Pramote Porapakkham ◽

Pornwalee Porapakkham ◽

Yusuke Sata ◽

Steven Joseph Haas ◽

...

Keyword(s):

Myocardial Infarction ◽

Meta Analysis ◽

Randomized Control Trials ◽

Long Term Outcomes ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Short And Long Term ◽

Randomized Control

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Short- and long-term outcomes of transanal versus laparoscopic total mesorectal excision for mid-to-low rectal cancer: a meta-analysis

Surgical Endoscopy ◽

10.1007/s00464-018-6527-z ◽

2018 ◽

Vol 33 (3) ◽

pp. 972-985 ◽

Cited By ~ 12

Author(s):

Xuan Zhang ◽

Yi Gao ◽

XingLong Dai ◽

HongTao Zhang ◽

ZhongJun Shang ◽

...

Keyword(s):

Rectal Cancer ◽

Total Mesorectal Excision ◽

Meta Analysis ◽

Low Rectal Cancer ◽

Laparoscopic Total Mesorectal Excision ◽

Mesorectal Excision ◽

Long Term Outcomes ◽

Short And Long Term

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Short- and long-term outcomes after laparoscopic and open hepatic resection: systematic review and meta-analysis

HPB ◽

10.1111/j.1477-2574.2011.00295.x ◽

2011 ◽

Vol 13 (5) ◽

pp. 295-308 ◽

Cited By ~ 124

Author(s):

Reza Mirnezami ◽

Alexander H. Mirnezami ◽

Kandiah Chandrakumaran ◽

Mohammad Abu Hilal ◽

Neil W. Pearce ◽

...

Keyword(s):

Systematic Review ◽

Hepatic Resection ◽

Meta Analysis ◽

Long Term Outcomes ◽

Short And Long Term

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Comparison of short- and long-term outcomes after extralevator abdominoperineal excision and standard abdominoperineal excision for rectal cancer: a systematic review and meta-analysis

International Journal of Colorectal Disease ◽

10.1007/s00384-013-1793-7 ◽

2013 ◽

Vol 29 (2) ◽

pp. 183-191 ◽

Cited By ~ 49

Author(s):

Hui-Chuan Yu ◽

Hui Peng ◽

Xiao-Sheng He ◽

Ri-Sheng Zhao

Keyword(s):

Systematic Review ◽

Rectal Cancer ◽

Meta Analysis ◽

Abdominoperineal Excision ◽

Long Term Outcomes ◽

Short And Long Term

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Effect of vascular resection for perihilar cholangiocarcinoma: a systematic review and meta-analysis

PeerJ ◽

10.7717/peerj.12184 ◽

2021 ◽

Vol 9 ◽

pp. e12184

Author(s):

Yong Liu ◽

Guangbing Li ◽

Ziwen Lu ◽

Tao Wang ◽

Yang Yang ◽

...

Keyword(s):

Mortality Rate ◽

Meta Analysis ◽

Postoperative Mortality ◽

Morbidity Rate ◽

R0 Resection ◽

Long Term Outcomes ◽

Term Survival ◽

Long Term Survival ◽

Short And Long Term

Objective To evaluate the effect of vascular resection (VR), including portal vein resection (PVR) and hepatic artery resection (HAR), on short- and long-term outcomes in patients with perihilar cholangiocarcinoma (PHC). Background Resection surgery and transplantation are the main treatment methods for PHC that provide a chance of long-term survival. However, the efficacy and safety of VR, including PVR and HAR, for treating PHC remain controversial. Methods This study was registered at the International Prospective Register of Systematic Reviews (CRD42020223330). The EMBASE, PubMed, and Cochrane Library databases were used to search for eligible studies published through November 28, 2020. Studies comparing short- and long-term outcomes between patients who underwent hepatectomy with or without PVR and/or HAR were included. Random- and fixed-effects models were applied to assess the outcomes, including morbidity, mortality, and R0 resection rate, as well as the impact of PVR and HAR on long-term survival. Results Twenty-two studies including 4,091 patients were deemed eligible and included in this study. The meta-analysis showed that PVR did not increase the postoperative morbidity rate (odds ratio (OR): 1.03, 95% confidenceinterval (CI): [0.74–1.42], P = 0.88) and slightly increased the postoperative mortality rate (OR: 1.61, 95% CI [1.02–2.54], P = 0.04). HAR did not increase the postoperative morbidity rate (OR: 1.32, 95% CI [0.83–2.11], P = 0.24) and significantly increased the postoperative mortality rate (OR: 4.20, 95% CI [1.88–9.39], P = 0.0005). Neither PVR nor HAR improved the R0 resection rate (OR: 0.70, 95% CI [0.47–1.03], P = 0.07; OR: 0.77, 95% CI [0.37–1.61], P = 0.49, respectively) or long-term survival (OR: 0.52, 95% CI [0.35–0.76], P = 0.0008; OR: 0.43, 95% CI [0.32–0.57], P < 0.00001, respectively). Conclusions PVR is relatively safe and might benefit certain patients with advanced PHC in terms of long-term survival, but it is not routinely recommended. HAR results in a higher mortality rate and lower overall survival rate, with no proven benefit.

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