scholarly journals SP1.2.12A meta-analysis of the impact of rectal washout on local recurrence following anterior resection for rectal cancers

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Hena Hidayat ◽  
Tara Connelly ◽  
Anil Agarwal ◽  
Talvinder Gill ◽  
Venkatesh Shanmugam ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Anterior Resection ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Rectal Washout ◽  
Significant Difference ◽  
Rectal Cancers ◽  
The Impact

Abstract Background Standardisation of surgical technique in form of total mesorectal excision (TME) and the use of preoperative radiotherapy have led to improved oncological outcomes in rectal cancer. However, the effectiveness of rectal washout in reducing local recurrence (LR) following anterior resection remains debatable. The aim of this meta-analysis was to evaluate the effectiveness of rectal washout in reducing incidence of LR after anterior resection for rectal cancer. Methods A literature search of electronic databases including PubMed, Embase, Scopus and Cochrane was performed for studies that compared rectal washout to no washout after anterior resection using TME for rectal cancers. The review included all articles reporting oncological outcome of local recurrence. Meta-analysis was carried out using random effect model. Results A total of 5 studies involving 5315 patients were included in meta-analysis. Median follow-up was 60 (range 33–60) months. Overall local recurrence rate was 6.6 % with no significant difference in LR rate between the rectal washout and no washout groups (5.23% vs. 9 %)(P = 0.93; RR 0.97; 95% CI 0.52- 1.83).Similarly in subgroup analysis including prospective studies only no significant difference in LR was seen after washout (P = 0.06) or in group of patients treated with a curative intent(P = 0.50). LR was significantly lower in patients who had a rectal washout with normal saline (P < 0.00001; RR 0.59; 95% CI 0.47-0.74). Conclusion This meta-analysis shows that there is no benefit of rectal washout in reducing incidence of local recurrence after anterior resection for rectal cancers.

scholarly journals The effect of rectal washout on local recurrence following rectal cancer surgery

2018 ◽  
Vol 100 (2) ◽  
pp. 146-151 ◽  
Author(s):  
SR Moosvi ◽  
K Manley ◽  
J Hernon
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Anterior Resection ◽  
High Volume ◽  
Conclusive Evidence ◽  
Rectal Cancer Surgery ◽  
Single Institution ◽  
Recurrence Rates ◽  
Rectal Washout ◽  
Significant Difference

Introduction Local recurrence after surgery for rectal cancer is associated with significant morbidity and debilitating symptoms. Intraoperative rectal washout has been linked to a reduction in local recurrence but there is no conclusive evidence. The aim of this study was to evaluate whether performing rectal washout had any effect on the incidence of local recurrence in patients undergoing anterior resection for rectal cancer in the context of the current surgical management. Methods A total of 395 consecutive patients who underwent anterior resection with or without rectal washout for rectal cancer between January 2003 and July 2009 at a high volume single institution were analysed retrospectively. A standardised process for performing washout was used and all patients had standardised surgery in the form of total mesorectal excision. Neoadjuvant and adjuvant therapy was used on a selected basis. Patients were followed up for five years and local recurrence rates were compared in the two groups. Results Of the 395 patients, 297 had rectal washout and 98 did not. Both groups were well matched with regard to various important clinical, operative and histopathological characteristics. Overall, the local recurrence rate was 5.3%. There was no significant difference in the incidence of local recurrence between the washout group (5.7%) and the no washout group (4.1%). Conclusions Among our cohort of patients, there was no statistical difference in the incidence of local recurrence after anterior resection with or without rectal washout. This suggests that other factors are more significant in the development of local recurrence.

The impact of preoperative sarcopenia on postoperative complications following esophagectomy for esophageal neoplasia: a systematic review and meta-analysis

2020 ◽  
Vol 33 (7) ◽  
Author(s):  
Dimitrios Papaconstantinou ◽  
Konstantina Vretakakou ◽  
Anna Paspala ◽  
Evangelos P Misiakos ◽  
Anestis Charalampopoulos ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Meta Analysis ◽  
Performance Status ◽  
Random Effect ◽  
Random Effect Model ◽  
Cumulative Risk ◽  
Lumbar Vertebra ◽  
Skeletal Muscle Index ◽  
Significant Difference ◽  
The Impact

Summary Esophageal cancer is characterized by profound changes in body composition due to dysphagia and generalized cachexia. Sarcopenia or muscle wasting is a component of cachexia associated with poor postoperative performance status. The skeletal muscle index (SMI) calculated by computed tomography scans at the level of the third lumbar vertebra is an easily quantifiable and reproducible measure of sarcopenia. The aim of this meta-analysis is to investigate the impact of preoperative sarcopenia (low SMI) on postoperative complications after esophagectomy for neoplastic lesions. In this context, a comprehensive literature search was undertaken to identify studies reporting short-term postoperative outcomes in relation to their preoperative SMI values. Cumulative risk ratios (RR) and risk differences (RD) and their respective 95% confidence intervals (CIs) were calculated using a random-effect model. A total of 11 studies incorporating 1,979 total patients (964 patients with sarcopeniaversus 1,015 without sarcopenia) were included in the final analysis. The results demonstrated a significant increase in overall morbidity (RR 1.16, 95% CI 1.01–1.33), respiratory complications (RR 1.64, 95% CI 1.21–2.22) and anastomotic leaks (RR 1.39, 95% CI 1.10–1.76) in patients with sarcopenia. No statistically significant difference was noted in overall mortality (RD 0, 95% CI −0.02–0.02) or Clavien–Dindo grade III or greater complications (RR 1.17, 95% CI 0.96–1.42). The above results demonstrate the validity of the SMI as a predictive factor for post-esophagectomy complications. Although the risk associated with sarcopenia is not prohibitive for surgery, patients with low SMI require closer vigilance during their postoperative course due to the increased propensity for respiratory and anastomotic complications.

scholarly journals Pediatric asthma control during the COVID-19 pandemic: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Ze Yang ◽  
Xiang Wang ◽  
Xigang Wan ◽  
Menglei Wang ◽  
Zonghua Qiu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Asthma Control ◽  
Inhaled Corticosteroids ◽  
Case Reports ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Cochrane Library ◽  
Significant Difference ◽  
The Impact

Background: During the current ongoing COVID-19 pandemic, studies had reported that patients with asthma would experience increased asthma-associated morbidity because of the respiratory virus SARS-CoV-2 infection, based on experience with other respiratory viral infections. However, some studies suggested that there was no apparent increase in asthma related morbidity in children with asthma, it is even possible that due to reduced exposures due to confinement, such children may have improved outcomes. In order to understand the impact of Covid-19 on asthma control in children, we performed this systematic review and meta-analysis. Methods: We searched PubMed, Embase, and Cochrane Library to find literature from December 2019 to June 2021 related to Covid-19 and children’s asthma control, among which results such as abstracts, comments, letters, reviews and case reports were excluded. The level of asthma control during the COVID-19 pandemic was synthesized and discussed. Results: A total of 20456 subjects were included in 7 studies. Random effect model is used to account for the data. Compared to the same period before the COVID-19 pandemic, asthma exacerbation, asthma admission, emergency room visit reduced a lot. The outcome of use of inhaled corticosteroids and Beta-2 agonists shows no significant difference. Conclusion: Compared to the same period before the COVID-19 pandemic and the measures in response to it, the level of asthma control has been significantly improved. We need to understand the exact factors leading to these improvements and find methods to sustain it.

scholarly journals The impact of leptomeningeal collaterals in acute ischemic stroke

2020 ◽  
Author(s):  
Nida Fatima ◽  
Maher Saqqur ◽  
Ashfaq Shuaib
Keyword(s):  
Blood Flow ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Mesh Terms ◽  
Favorable Clinical Outcome ◽  
The Impact

Abstract Objectives: Leptomeningeal collaterals provide an alternate pathway to maintain cerebral blood flow in stroke to prevent ischemia, but their role in predicting outcome is still unclear. So, our study aims at assessing the significance of collateral blood flow (CBF) in acute stroke. Methods: Electronic databases were searched under different MeSH terms from Jan 2000 to Feb 2019. Studies were included if there was available data on good and poor CBF in acute ischemic stroke (AIS). The clinical outcomes included were modified rankin scale (mRS), recanalization, mortality, and symptomatic intracranial hemorrhage (sICH) at 90 days. Data was analyzed using random-effect model.Results: A total of 47 studies with 8,194 patients were included. Pooled meta-analysis revealed that there exist 2-fold higher likelihood of favorable clinical outcome (mRS≤2) at 90 days with good CBF compared with poor CBF (RR: 2.27; 95%CI: 1.94-2.65; p<0.00001) irrespective of the thrombolytic therapy [RR with IVT: 2.90; 95%CI: 2.14-3.94; p<0.00001, and RR with IAT/EVT: 1.99; 95% CI: 1.55-2.55; p<0.00001]. Moreover, there exists 1-fold higher probability of successful recanalization with good CBF (RR: 1.31; 95% CI: 1.15-1.49; p<0.00001). However, there was 54% and 64% lower risk of sICH and mortality respectively in patients with good CBF in AIS (p<0.00001).Conclusions: The relative risk of favorable clinical outcome is more in patients with good pretreatment CBF. This could be explained due to better chances of recanalization, combined with lesser risk of intracerebral hemorrhage in good CBF status.

scholarly journals Effect of maternal birth positions on duration of second stage of labor: systematic review and meta-analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Marta Berta ◽  
Helena Lindgren ◽  
Kyllike Christensson ◽  
Sollomon Mekonnen ◽  
Mulat Adefris
Keyword(s):  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Significant Heterogeneity ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Birth Position ◽  
Study Designs ◽  
The Impact

Abstract Background It is believed that giving birth in an upright position is beneficial for both mother and the infant for several physiologic reasons. An upright positioning helps the uterus to contract more strongly and efficiently, the baby gets in a better position and thus can pass through the pelvis faster. Upright and lateral positions enables flexibility in the pelvis and facilitates the extension of the outlet. Before implementing a change in birthing positions in our clinics we need to review evidences available and context valid related to duration of second stage of labor and birthing positions. Therefore this review aimed to examine the effect of maternal flexible sacrum birth position on duration of second stage of labor. Method The research searched articles using bibliographical Databases: Medline/PUBMED, SCOPUS, Google scholar and Google. All study designs were considered while investigating the impact of maternal flexible sacrum birthing positioning in relation duration of second stage of labor. Studies including laboring mothers with normal labor and delivery. A total of 1985 women were included in the reviewed studies. We included both qualitative and quantitative analysis. Results We identified 1680 potential citations, of which 8 articles assessed the effect of maternal upright birth positioning on the reduction during the duration of second stage of labor. Two studies were excluded because of incomplete reports for meta analysis. The result suggested a reduction in duration of second stage of labor among women in a flexible sacrum birthing position, with a mean duration from 3.2–34.8. The pooled weighted mean difference with random effect model was 21.118(CI: 11.839–30.396) minutes, with the same significant heterogeneity between the studies (I2 = 96.8%, p < 000). Conclusion The second stage duration was reduced in cases of a flexible sacrum birthing position. Even though the reduction in duration varies across studies with considerable heterogeneity, laboring women should be encouraged to choose her comfortable birth position. Researchers who aim to compare different birthing positions should consider study designs which enable women to choose birthing position. Prospero registration number [CRD42019120618]

scholarly journals Prevalence of HTN in Iran: Meta-analysis of Published Studies in 2004-2018

2019 ◽  
Vol 15 (2) ◽  
pp. 113-122
Author(s):  
Mehdi Jafari Oori ◽  
Farahnaz Mohammadi ◽  
Kian Norozi ◽  
Masoud Fallahi-Khoshknab ◽  
Abbas Ebadi ◽  
...  
Keyword(s):  
Sample Size ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Effect Model ◽  
Significant Difference ◽  
Standard Tool ◽  
Egger Test ◽  
Significant Health

Introduction: Prevalence of hypertension (HTN) is increasing in the developing countries like Iran. Various studies have reported different rates of HTN in Iran. The purpose of this study was to estimate an overall prevalence of HTN in Iran. Methodology: Using the English and Persian key derived from Mesh, the databases including MagIran, Iran Medex, SID, Web of Sciences, PubMed, Science Direct and Google Scholar as a searching engine were reviewed: from 2004 to 2018. The overall prevalence of MA was estimated using Random effect model. The I2 test was used to assess the heterogeneity of the studies. Additionally, the quality of studies was evaluated using a standard tool. Publication bias was conducted with the Egger test. Meta-regression and analysis of subgroups were analyzed based on variables such as age, marital status, region and tools. Data were analyzed using STATA 12 software. Results: Analysis of 58 primary articles with a sample size of 902580 showed that the prevalence of HTN in Iran was 25% (with 95% CI of 22-28). The highest prevalence of HTN was related to elderly (42%). The prevalence of HTN was 25% (95% CI: 19-31) in women and 24% (95% CI: 20-28) in men with no significant difference (p = 0.758). The results also indicated that the prevalence of HTN was not related to the year of studies (p = 0.708) or sample size (p = 769). Conclusion: Despite the advancements in science and technology, along with health and prevention of diseases, the overall prevalence of HTN raised in Iran. Since HTN is a silent disease with significant health consequences and economic burden, programs designed to better HTN control seem vital to enhance community health.

scholarly journals The Impact of Dementia on the Clinical Outcome of COVID-19: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 78 (4) ◽  
pp. 1775-1782
Author(s):  
Nanyang Liu ◽  
Jiahui Sun ◽  
Xiyuan Wang ◽  
Ming Zhao ◽  
Qianqian Huang ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Dementia Patients ◽  
Effect Model ◽  
Incidence And Mortality ◽  
High Risk Factor ◽  
The Impact ◽  
Substantial Heterogeneity ◽  
Significant Publication Bias

Background: The emergence of the coronavirus disease 2019 (COVID-19) has brought large challenges to dementia patients. We reviewed the existing literature on COVID-19 to assess the incidence and mortality of dementia comorbidities in COVID-19 patients. Objective: To investigate the impact of pre-existing dementia comorbidities on COVID-19. Methods: We searched the PubMed, Embase, and Web of Science databases for patients with preexisting dementia who were diagnosed with COVID-19. The statistical data on the prevalence and mortality of dementia comorbidities were examined. A fixed-or random-effect model was used to calculate the overall pooled risk estimates. Forest plots were generated to show the summarized results. Results: A total of 265 articles were retrieved from the three databases. After removing duplicates and performing two screenings, 10 articles were selected for meta-analysis, including 119,218 participants. Overall, the meta-analysis of the 10 studies showed that the incidence of dementia in COVID-19 patients was (R: 9%, [95% CI: 6% to 13%]). Moreover, the meta-analysis of 9 studies showed that the mortality rate of individuals with dementia after being infected with COVID-19 was higher than that of individuals with no dementia (OR: 5.17 [95% CI: 2.31 to 11.59]). Substantial heterogeneity was observed in this meta-analysis. Significant publication bias was also found. Conclusion: Emerging literature shows that dementia comorbidities are a high risk factor for the prevalence and mortality of COVID-19. Our results should have an impact on preventive interventions and encourage more targeted approaches to prioritize older people with specific risk factors, such as dementia.

How much is reasonable to expect about overall survival (OS) benefit when designing studies with new drugs for patients affected by castration resistant prostate cancer (CRPC)? Meta-analysis of 23 randomized clinical trials (RCT) including 17,640 patients.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e16053-e16053
Author(s):  
Francesco Massari ◽  
Francesca Maines ◽  
Sara Pilotto ◽  
Camillo Porta ◽  
Paolo Carlini ◽  
...  
Keyword(s):  
Treatment Strategy ◽  
Significant Interaction ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Phase Iii ◽  
Sensitivity Analyses ◽  
Significant Heterogeneity ◽  
Significant Difference

e16053 Background: Treatment decision making in patients affected by CRPC is difficult because the numerous available therapeutic opportunities can significantly affect OS. To demonstrate that comparing results in absence of head-to-head studies may lead to biased survival estimations, a literature-based meta-analysis was conducted. Methods: Hazard Ratios (HR) with 95% confidence intervals (CI) were extracted and cumulated according to a random-effect model from phase III trials. Sensitivity analyses were performed according to: 1) Treatment Strategy (TS, Chemotherapy versus Hormonal versus Immunotherapy versus Other), 2) Comparison (Chemotherapy versus Placebo versus Other), and 3) Disease setting with regard to treatment with Docetaxel (DOC),. Testing for heterogeneity was performed as well. Results: A significant heterogeneity for the 3 sensitivity analyses was found (p<0.0001). The cumulative HR in favor of (any) experimental arm was 0.91 (95% CI 0.84-0.99, p=0.028). We found a significant interaction according to the chosen TS (p<0.0001), in fact a significant difference in OS was more likely to be detected in RCT evaluating hormonal drugs (HR 0.76, 95% CI 0.64-0.92, p=0.005) versus studies testing immunotherapy (HR 1.16, 95% CI 0.86-1.56, p=0.31). With regard to Comparison, a significant interaction (p<0.0001) was found in favor of RCT having placebo as control (HR 0.86, 95% CI 0.76-0.97, p=0.015), versus studies evaluating chemotherapy (HR 1.00, 95% CI 0.84, 1.19, p=0.99). A significant interaction according to DOC-treatment was also detected (p<0.0001), being the Post-DOC the Setting where a significant OS benefit was more likely to be determined (HR 0.77, 95% CI 0.66-0.90, p=0.001). Conclusions: The cross-trials interpretation in absence of formal direct comparisons may drive biased conclusions with regard to OS estimation. When designing trials to evaluate drugs (or strategies) in CRPC, the expected OS benefit must take into account the comparator, the treatment strategy and the (eventual) pre-treatment with DOC.

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