Patient volume and clinical outcome after pancreatic cancer resection: A contemporary systematic review and meta-analysis

e16261 Background: Endoscopic ultrasound-guided ablation therapy (EUS-A) is a minimally invasive technique increasingly used for the management of surgically unresectable pancreatic cancer. The data on the efficacy and clinical outcome of EUS-A for unresectable pancreatic cancer is lacking. We conducted this systematic review and meta-analysis to evaluate the safety, technical and clinical success of EUS-A therapies specifically for unresectable pancreatic cancer. Methods: Studies were identified with a comprehensive search for EUS-A and pancreatic cancer on PubMed, Google Scholar, Web of Science and Embase data search as of October 2020. The technical and clinical success rates of EUS-A were primary outcomes while adverse events (AEs) rate was secondary outcome. We defined technical success as successful placement of probe within tumor and able to perform ablation regardless of tumor outcome. Clinical success was defined as symptomatic improvement and/or any reduction in tumor size or evidence of necrosis on radiological imaging after EUS-A. A compute pooled analysis was performed using the ‘meta’ package by Schwarzer et al. in the R programming language (version 4.0.2) using random effect model. Results: Nineteen studies including 192 patients (54% females) were included. Common pancreatic tumors were nonfunctional neuroendocrine tumor (NNET) 43.5% (97), followed by locally advanced pancreatic ductal adenocarcinoma (LAPDAC) 27.3% (61), insulinoma 17.9% (40), cystic neoplastic lesions 8.5% (19). The pancreatic head was the most common site of tumor 49.8% (111), followed by body, neck and tail 44.8% (100). EUS-RFA was the most commonly used ablative therapy 63% (12/19 studies), followed by EUS-EA (ethanol ablation) 26% (5/19 studies) while EUS-A using laser and lauromacrogol injection was used in one study each. The mean number of ablation sessions per patient was 1.4 based on the total 243 sessions in 176 patients. The pooled technical success rate of EUS-A was 99.5% [95% CI = 0.90-0.97, I2 = 0%]. The pooled clinical success rate calculated out of total number of pancreatic lesions was 91.1% [95% CI = 0.79-0.92, I2 = 16%]. Clinical improvement in symptoms was reported in 11 studies and a complete resolution or decrease in tumor size was reported in 16 studies. The pooled AEs rate was 22.9% [95% CI = 0.17-0.37, I2 = 43%]. Common AEs were abdominal pain 7.8% (15), pancreatitis 5.2% (10) and pancreatic pseudocyst 2.1% (4). The median follow-up was 9.5 months. Conclusions: EUS-A is a safe and promising modality in the management of unresectable pancreatic cancer with a high technical and clinical success rate. Large prospective studies and clinical trials are required for comparison of clinical outcome of different EUS-A therapies and its widespread application for unresectable pancreatic cancer.

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Faculty Opinions recommendation of Effect of pharmaceutical treatment on vasospasm, delayed cerebral ischemia, and clinical outcome in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.722313796.793510609 ◽

2015 ◽

Author(s):

Peter Andrews

Keyword(s):

Systematic Review ◽

Subarachnoid Hemorrhage ◽

Cerebral Ischemia ◽

Clinical Outcome ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Meta Analysis ◽

Delayed Cerebral Ischemia ◽

Pharmaceutical Treatment

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COVID-19 Infection in Medical Staffs versus Patients: A Systematic Review and Meta-analysis of Laboratory Findings, Comorbidities, and Clinical Outcome

SSRN Electronic Journal ◽

10.2139/ssrn.3580517 ◽

2020 ◽

Cited By ~ 1

Author(s):

Mina Ebrahimi ◽

Amal Saki Malehi ◽

Fakher Rahim

Keyword(s):

Systematic Review ◽

Clinical Outcome ◽

Meta Analysis ◽

Laboratory Findings

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Exercise efficacy and prescription during treatment for pancreatic ductal adenocarcinoma: a systematic review

BMC Cancer ◽

10.1186/s12885-020-07733-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Dominic O’Connor ◽

Malcolm Brown ◽

Martin Eatock ◽

Richard C. Turkington ◽

Gillian Prue

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Pancreatic Cancer ◽

Adjuvant Therapy ◽

Physical Function ◽

Meta Analysis ◽

Ductal Adenocarcinoma ◽

Key Stakeholders ◽

The Impact

Abstract Background Surgical resection remains the only curative treatment for pancreatic cancer and is associated with significant post-operative morbidity and mortality. Patients eligible for surgery, increasingly receive neo-adjuvant therapy before surgery or adjuvant therapy afterward, inherently exposing them to toxicity. As such, optimizing physical function through exercise during treatment remains imperative to optimize quality of life either before surgery or during rehabilitation. However, current exercise efficacy and prescription in pancreatic cancer is unknown. Therefore, this study aims to summarise the published literature on exercise studies conducted in patients with pancreatic cancer undergoing treatment with a focus on determining the current prescription and progression patterns being used in this population. Methods A systematic review of four databases identified studies evaluating the effects of exercise on aerobic fitness, muscle strength, physical function, body composition, fatigue and quality of life in participants with pancreatic cancer undergoing treatment, published up to 24 July 2020. Two reviewers independently reviewed and appraised the methodological quality of each study. Results Twelve studies with a total of 300 participants were included. Heterogeneity of the literature prevented meta-analysis. Exercise was associated with improvements in outcomes; however, study quality was variable with the majority of studies receiving a weak rating. Conclusions High quality evidence regarding the efficacy and prescription of exercise in pancreatic cancer is lacking. Well-designed trials, which have received feedback and input from key stakeholders prior to implementation, are required to examine the impact of exercise in pancreatic cancer on key cancer related health outcomes.

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Impact of avoiding cardioplegic arrest on clinical outcome in patients undergoing CABG in Bangladesh: a systematic review and meta-analysis

Indian Journal of Thoracic and Cardiovascular Surgery ◽

10.1007/s12055-020-01054-4 ◽

2021 ◽

Author(s):

Faizus Sazzad ◽

Geetha Ganesh ◽

Prashasth Cheekoty ◽

Muthu Veerappan ◽

Theo Kofidis

Keyword(s):

Systematic Review ◽

Clinical Outcome ◽

Meta Analysis ◽

Cardioplegic Arrest

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Systematic review and meta-analysis of clinical outcome following trainee performed carotid endarterectomy

International Journal of Surgery ◽

10.1016/j.ijsu.2013.06.828 ◽

2013 ◽

Vol 11 (8) ◽

pp. 742

Author(s):

Prashant Singh ◽

Usman Jaffer ◽

Michael Kelly ◽

Kumaran Prabu ◽

Aneel Bhangu

Keyword(s):

Systematic Review ◽

Clinical Outcome ◽

Carotid Endarterectomy ◽

Meta Analysis

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EFFECT OF PROTON PUMP INHIBITORS ON CLINICAL OUTCOME IN PATIENTS TREATED WITH CLOPIDOGREL: A SYSTEMATIC REVIEW AND META-ANALYSIS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(10)61944-4 ◽

2010 ◽

Vol 55 (10) ◽

pp. A206.E1943

Author(s):

Jolanta M. Siller-Matula ◽

Bernd Jilma ◽

Karsten Schrö;r ◽

Guenter Christ ◽

Kurt Huber

Keyword(s):

Systematic Review ◽

Clinical Outcome ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Meta Analysis

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Abstract TMP105: Endovascular Treatment of Severe and Refractory Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage Improves Outcome: A Systematic Review and Meta-analysis of Different Treatment Options Evaluated Since 2006 for Cerebral Vasospasm

Stroke ◽

10.1161/str.47.suppl_1.tmp105 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Gregoire Boulouis ◽

Marc-Antoine Labeyrie ◽

Jean Raymond ◽

Christine Rodriguez-Regent ◽

Anne-Claire Lukaszewicz ◽

...

Keyword(s):

Systematic Review ◽

Subarachnoid Hemorrhage ◽

Clinical Outcome ◽

Endovascular Treatment ◽

Cerebral Vasospasm ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Meta Analysis ◽

Route Of Administration ◽

Unfavorable Outcome ◽

Q Value

Introduction: To report clinical outcome of aneurysmal subarachnoid hemorrhage (aSAH) patients exposed to cerebral vasospasm (CVS) targeted treatments in a systematic review and meta-analysis and compare the efficacy of endovascular and non-endovascular treatments in severe / refractory vasospasm patients. Methods: The literature was searched using PubMed, EMBASE, and The Cochrane Library database. Eligibility criteria were (1) Rated clinical outcome; (2) at least 10 patients; (3) aSAH; (4) study published in English or French (January 2006 - October 2014); and (5) methodological quality score > 10, according to STROBE criteria. Endpoint included unfavorable outcome rate, defined as mRS 3-6, GOS 1-3 or GOSE 1-4 at latest follow-up. Analyses included stratification per route of administration (oral, i.v., intra-arterial or cisternoventricular) and per study inclusion criteria (severe, CVS, refractory CVS or high risk for CVS). Univariate and multivariate subgroup analyses were performed to identify interventions associated with a better outcome. Results: Sixty-two studies, including 26 randomized controlled trials, were included (8976 patients). Overall 2490 patients had unfavorable outcome including death (random-effect weighted average: 33.7%, 99%CI, 28.1-39.7%; Q-value: 806.0, I 2 =92.7%). Clinical outcome was significantly better in severe or refractory patients for whom, on top of best medical treatment, endovascular intervention was performed (RR=0.76, IC95% [0.66-0.89], p <0.00001) whereas other route of administration didn’t show significant differences. RR of unfavorable outcome was significantly lower, vs control groups, in patients treated with Cilostazol (RR=0.46 (IC99% [0.25-0.85], P = 0.001, Q value 1.5, I 2 = 0). Conclusion: In case of CVS following aSAH, endovascular treatment in severe / refractory vasospasm patients. including intra-arterial injection of pharmacological agents or balloon angioplasty, improves outcome as compared to other route of administration.

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