scholarly journals Gastrectomy and D2 Lymphadenectomy for Gastric Cancer: A Meta-Analysis Comparing the Harmonic Scalpel to Conventional Techniques

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Hang Cheng ◽  
Chia-Wen Hsiao ◽  
Jeffrey W. Clymer ◽  
Michael L. Schwiers ◽  
Bryanna N. Tibensky ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Harmonic Scalpel ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Operating Time ◽  
Hospital Length Of Stay ◽  
Sensitivity Analyses ◽  
Continuous Variables ◽  
Complication Risk ◽  
Study Results

The ultrasonic Harmonic scalpel has demonstrated clinical and surgical benefits in dissection and coagulation. To evaluate its use in gastrectomy, we conducted a systematic review and meta-analysis of randomized controlled trials comparing the Harmonic scalpel to conventional techniques in gastrectomy for patients with gastric cancer. International databases were searched without language restrictions for comparisons in open or laparoscopic gastrectomy and lymphadenectomy. The meta-analysis used a random-effects model for all outcomes; continuous variables were analyzed for mean differences and dichotomous variables were analyzed for risk ratios. Sensitivity analyses were conducted for study quality, type of conventional technique, and imputation of study results. Ten studies (N=935) met the inclusion criteria. Compared with conventional hemostatic techniques, the Harmonic scalpel demonstrated significant reductions in operating time (−27.5 min;P<0.001), intraoperative blood loss (−93.2 mL;P<0.001), and drainage volume (−138.8 mL;P<0.001). Results were numerically higher for conventional techniques for hospital length of stay, complication risk, and transfusions but did not reach statistical significance. Results remained robust to sensitivity analyses. This meta-analysis demonstrates the clear advantages of using the Harmonic scalpel compared to conventional techniques, with improvements demonstrated across several outcome measures for patients undergoing gastrectomy and lymphadenectomy.

scholarly journals Meta-analysis of rare adverse events in randomized clinical trials: Bayesian and frequentist methods

2020 ◽  
pp. 174077452096913
Author(s):  
Hwanhee Hong ◽  
Chenguang Wang ◽  
Gary L Rosner
Keyword(s):  
Adverse Events ◽  
Coverage Probability ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Rare Event ◽  
Model Performance ◽  
Study Results ◽  
Wide Range ◽  
Study Heterogeneity

Background/aims: Regulatory approval of a drug or device involves an assessment of not only the benefits but also the risks of adverse events associated with the therapeutic agent. Although randomized controlled trials (RCTs) are the gold standard for evaluating effectiveness, the number of treated patients in a single RCT may not be enough to detect a rare but serious side effect of the treatment. Meta-analysis plays an important role in the evaluation of the safety of medical products and has advantage over analyzing a single RCT when estimating the rate of adverse events. Methods: In this article, we compare 15 widely used meta-analysis models under both Bayesian and frequentist frameworks when outcomes are extremely infrequent or rare. We present extensive simulation study results and then apply these methods to a real meta-analysis that considers RCTs investigating the effect of rosiglitazone on the risks of myocardial infarction and of death from cardiovascular causes. Results: Our simulation studies suggest that the beta hyperprior method modeling treatment group-specific parameters and accounting for heterogeneity performs the best. Most models ignoring between-study heterogeneity give poor coverage probability when such heterogeneity exists. In the data analysis, different methods provide a wide range of log odds ratio estimates between rosiglitazone and control treatments with a mixed conclusion on their statistical significance based on 95% confidence (or credible) intervals. Conclusion: In the rare event setting, treatment effect estimates obtained from traditional meta-analytic methods may be biased and provide poor coverage probability. This trend worsens when the data have large between-study heterogeneity. In general, we recommend methods that first estimate the summaries of treatment-specific risks across studies and then relative treatment effects based on the summaries when appropriate. Furthermore, we recommend fitting various methods, comparing the results and model performance, and investigating any significant discrepancies among them.

scholarly journals A cohort study and meta-analysis of the evidence for consideration of Lauren subtype when prescribing adjuvant or palliative chemotherapy for gastric cancer

2020 ◽  
Vol 12 ◽  
pp. 175883592093035 ◽  
Author(s):  
Kunning Wang ◽  
Enxiao Li ◽  
Rita A. Busuttil ◽  
Joseph C. Kong ◽  
Sharon Pattison ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Systemic Chemotherapy ◽  
Meta Analysis ◽  
Sensitivity Analyses ◽  
Diffuse Gastric Cancer ◽  
Lauren Classification ◽  
Significant Difference ◽  
Laurén Classification ◽  
Better Than

Background: The association between the survival or efficacy of chemotherapy and the Lauren subtype of gastric cancer (GC) remains unclear. We aimed to clarify whether patients with different Lauren subtypes have different survival after treatment with systemic chemotherapy: intestinal gastric cancer (IGC) patients survived better than patients with mixed type gastric cancer (MGC) or diffuse gastric cancer (DGC) after treatment with systemic chemotherapy. Patients & methods: Relevant studies for the meta-analysis were identified through searching Pubmed, Embase, Cochrane and Ovid up to March 2020. We also included our own prospectively collected cohort of patients that were followed over a 10-year period. Sub-group and sensitivity analyses were also performed. Results: In our prospective cohort, the overall survival (OS) of IGC patients receiving systemic chemotherapy (chemoIGC) [median OS 5.01 years, interquartile range (IQR) 2.63–6.71] was significantly higher than that of DGC patients receiving the same chemotherapy (chemoDGC) (median OS 1.33 years, IQR 0.78–3.33, p = 0.0001). After adjusting for age, gender and cancer stage, there was a significant difference in OS in patients treated with chemotherapy based on the Lauren classification of GC {hazard ratio (HR) for OS of the IGC versus DGC 0.33, [95% confidence interval (CI), 0.17–0.65; p < 0.001]}. In the IGC patients, the adjusted HR associated with chemotherapy was 0.26 (95% CI, 0.12–0.56; p = 0.001), whereas the association was 0.64 (95% CI, 0.30–1.33; p = 0.23) in the DGC patient group. In our meta-analysis, 33 studies comprising 10,246 patients treated with systemic chemotherapy (chemoIGC n = 4888, chemoDGC n = 5358) met all the selection criteria. While we accounted for much of the heterogeneity in these studies, we found that chemoIGC patients showed significantly improved OS [HR, 0.76 (95% CI, 0.71–0.82); p < 0.00001] when compared with similarly treated chemoDGC patients. Conclusion: Our results support the consideration of Lauren subtype when prescribing systemic chemotherapy for GC, particularly for MGC or DGC, which may not benefit from chemotherapy. Lauren classification should be considered to stratify chemotherapy regimens to GC patients in future clinical trials, with particular relevance to MGC or DGC, which is more difficult to treat with current regimens.

scholarly journals Reconstruction Methods and Complications of Esophagogastrostomy and Jejunal Interposition in Proximal Gastrectomy for Gastric Cancer: A Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Nan Du ◽  
Pei Wu ◽  
Pengliang Wang ◽  
Yuwei Du ◽  
Kai Li ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lower Risk ◽  
Meta Analysis ◽  
Proximal Gastrectomy ◽  
Operating Time ◽  
Perioperative Period ◽  
Jejunal Interposition ◽  
Cochrane Library ◽  
Reconstruction Methods ◽  
Significant Difference

Background. Proximal gastrectomy is used for the treatment of primary gastric cancer by open or laparoscopic surgery in the upper third of the stomach. Esophagogastrostomy (EG) or jejunal interposition (JI) is widely used in various reconstruction methods after proximal gastrectomy. We conducted a meta-analysis of EG and JI for treatment of gastric cancer. Materials and Methods. A search of PubMed, Embase, MEDLINE, J-STAGE, and Cochrane Library identified retrospective series on EG and JI. Weight mean differences (WMDs), odds ratios (ORs), and 95% confidence intervals (CIs) were used to analyze the operation-related data and postoperative complications. Heterogeneity was evaluated by the I2 test, and potential publication bias was assessed with Egger regression tests and sensitivity analysis. Results. Eight studies were selected, and 496 patients were included. EG group benefits were 44.81 min shorter operating time (P<0.001), 56.58 mL less blood loss (P=0.03), and 7.4 days shorter hospital stay time (P<0.001) than the JI group. Between the two groups, there was no significant difference in anastomotic leakage; otherwise, the EG group had a lower risk of anastomotic stenosis (OR=0.44, 95%CI=0.20 to 0.97, P=0.04), lower risk of intestinal obstruction (OR=0.07, 95%CI=0.01 to 0.43, P=0.004), and higher risk of reflux esophagitis (OR=2.47, 95%CI=1.07 to 5.72, P=0.03). Conclusion. The results of our study indicated that EG has significant advantages during the perioperative period and in short-term outcomes compared to JI.

scholarly journals The Survival Benefit and Safety of Splenectomy for Gastric Cancer With Total Gastrectomy: Updated Results†

2021 ◽  
Vol 10 ◽  
Author(s):  
Kun Yang ◽  
Zhi-Yun Zang ◽  
Kai-Fan Niu ◽  
Li-Fei Sun ◽  
Wei-Han Zhang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Survival Rate ◽  
Lymph Nodes ◽  
Meta Analysis ◽  
Postoperative Mortality ◽  
Sensitivity Analyses ◽  
Cochrane Central Register ◽  
Overall Survival Rate ◽  
Duration Of Surgery

BackgroundSplenectomy was traditionally performed to dissect the splenic hilar lymph nodes. Considering the important functions of spleen, whether splenectomy would bring beneficial to gastric cancer patients is debatable. This meta-analysis aimed to make an updated evaluation on the effectiveness and safety of splenectomy.MethodsLiterature searches were performed to identify eligible RCTs concerning effectiveness or safety of splenectomy with gastrectomy from PubMed, MEDLINE, CBMdisc, EMBASE, and Cochrane Central Register of Controlled Trials. Two reviewers completed the study selection, data extraction, and quality assessment independently. The meta-analyses were performed by RevMan 5.3.ResultsA total of 971 patients from four studies were included (485 in splenectomy group and 486 in spleen preservation group). Splenectomy did not increase 5-year overall survival rate (RR=1.05, 95% CI: 0.96, 1.16) or increase postoperative mortality (RR=1.21, 95% CI: 0.41, 3.54). However, the analysis demonstrated that gastrectomy with splenectomy had significantly higher incidence of postoperative complications (RR=1.80, 95% CI: 1.33, 2.45). No significant differences were found in terms of the number of resected lymph nodes and reoperation rate; however, splenectomy had a tendency to prolong the duration of surgery and hospital stays. Subgroup analyses indicated that splenectomy could not increase overall survival rate for either whole or proximal gastric cancer. Sensitivity analyses also found similar results compared to the primary analyses.ConclusionsSplenectomy cannot benefit the survival of patients with tumor located at lesser curvature, and it could instead increase postoperative morbidity.

Quality of Life After Epilepsy Surgery in Children: A Systematic Review and Meta-Analysis

Neurosurgery ◽  
2018 ◽  
Vol 85 (6) ◽  
pp. 741-749 ◽  
Author(s):  
Georgios A Maragkos ◽  
Georgios Geropoulos ◽  
Konstantinos Kechagias ◽  
Ioannis A Ziogas ◽  
Konstantinos S Mylonas
Keyword(s):  
Quality Of Life ◽  
Epilepsy Surgery ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Life Quality ◽  
Intractable Epilepsy ◽  
Sensitivity Analyses ◽  
Seizure Freedom

Abstract BACKGROUND Pediatric epilepsy surgery is a treatment modality appropriate for select patients with debilitating medication-resistant seizures. Previous publications have studied seizure freedom as the main outcome of epilepsy surgery. However, there has been no systematic assessment of the postoperative life quality for these children. OBJECTIVE To estimate the quality of life (QOL) long-term outcomes after surgery for intractable epilepsy in pediatric patients. METHODS A systematic search of the PubMed and Cochrane databases was performed. Studies reporting questionnaire-assessed QOL at least 12 months postoperatively were included. QOL means and standard deviations were compared between surgically and medically managed patients, between the preoperative and postoperative state of each patient, and were further stratified into patients achieving seizure freedom, and those who did not. Meta-analysis was performed using fixed effects models for weighted mean differences (WMD), 95% confidence intervals (CI) and sensitivity analyses. Funnel plots and Begg's tests were utilized to detect publication bias. RESULTS The search yielded 18 retrospective studies, reporting 890 surgical patients. Following epilepsy surgery, children had significant QOL improvement compared to their preoperative state (WMD: 16.71, 95% CI: 12.19-21.22, P < .001) and better QOL than matched medically treated controls (WMD: 12.42, 95% CI: 6.25-18.58, P < .001). Patients achieving total seizure freedom after surgery had significant postoperative QOL improvement (WMD: 16.12, 95% CI: 7.98-24.25, P < .001), but patients not achieving seizure freedom did not achieve statistical significance (P = .79). CONCLUSION Epilepsy surgery can effectively improve QOL in children with medication-resistant seizures, through seizure freedom, which was associated with the greatest improvement in life quality.

scholarly journals A Meta-Analysis of Association Between the MMP-13 rs2252070 Promoter Polymorphism and Cancer Risk

2021 ◽  
Author(s):  
Peng Yuan ◽  
Yudi Chen ◽  
Youzhao Ma ◽  
Chengjuan Zhang ◽  
Pengfei Ren ◽  
...  
Keyword(s):  
Cancer Risk ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Promoter Polymorphism ◽  
Cochrane Library ◽  
Cancer Tissue ◽  
Cancer Type ◽  
Environment Interaction ◽  
Study Results ◽  
Risk Of Cancer

Abstract Background Originally detected in breast cancer tissue, MMP-13 has been showed to be closely related to cancer development. Increasing evidence has also suggested that rs2252070, one of its SNP, can profoundly influence cancer risk by regulating the expression while the conclusion still remained controversial. Therefore, this meta-analysis was conducted to assess the carcinogenesis effect of this SNP quantitatively. Methods Studies about association between rs2252070 polymorphism and cancer risk by March 15, 2020 had been collected in PubMed, Web of Science, Cochrane Library and CNKI. R scripts and STATA software were applied to calculate estimates. Pooled ORs and corresponding 95% CIs were used to evaluate the strength of association. Results Twenty studies meeting pre-defined criteria were retrieved for the final statistical analysis, including 8,215 cancer patients and 8,480 healthy controls. The pooled estimates revealed no statistical significance for the association between this polymorphism and the risk of cancer in all 5 genetic models. Similarly, no significance had been detected in stratified analyses by region, cancer type, sample size and genotyping method. Conclusion The association between MMP-13 rs2252070 and carcinogenesis was not statistically significant. To elucidate this conclusion, future studies including gene-gene and gene-environment interaction are needed to verify the study results.

scholarly journals Review of Unsafe Changes in the Practice of Cesarean Section with Analysis of Flaws in the Interpretation of Statistics and the Evidence

2021 ◽  
pp. 1-6
Author(s):  
Shashikant L SHOLAPURKAR ◽  
Shashikant L SHOLAPURKAR
Keyword(s):  
Cesarean Section ◽  
Space Shuttle ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Operating Time ◽  
Numerical Data ◽  
Practice Change ◽  
Peritoneal Closure ◽  
Major Operation ◽  
Elective Cesarean

Cesarean section is the commonest major operation. Unfortunately, many recent practice-changes have been rushed based on flawed interpretation limited data that are debated in this review. The discussion includes non-closure of the peritoneum, the 39-week rule for elective cesarean, incorrect implementation of four-category urgency classification, and abdominal entry with excessive blunt force. It took NASA two fatal space-shuttle disasters over 18 years to change its culture of dismissing reasoning and observations in addition to numerical data. Reasoning becomes even more important when there is emerging data, especially in soft sciences like medicine. This review discusses flawed science behind the change to “non-closure of peritoneum” in details (and other changes briefly). This practice change was based on narrow mistaken considerations and solely on statistical significance, studying irrelevant short-term outcomes like increased requirement of analgesia. Several statistical mistakes in interpreting this evidence with wider applications are discussed. This weak/flawed evidence has been subsequently disproven by large randomized controlled trials. Small reduction in operating time should never have been a consideration. The merit of hypothesis favoring peritoneal closure to prevent adhesions is very strong to begin with. More importantly, the meta-analysis of available studies shows that closing peritoneum significantly reduces the formation of adhesions, particularly the severe ones. Extensive adhesion of uterus to the abdominal wall is relatively rare to reach statistical significance in small studies but is clinically highly significant due to operative complications. The rushed mistaken recommendation of non-closure of peritoneum should not have been made. However, reversing these changes is perceived as admitting errors, and there is simply no interest in doing so with detriment of the patients. Guidelines should now change their advice on many important aspects of cesarean, as discussed in this review.

scholarly journals Double-zero-event studies matter: a re-evaluation of physical distancing, face masks, and eye protection for preventing person-to-person transmission of COVID-19 and its policy impact

2020 ◽  
Author(s):  
Mengli Xiao ◽  
Lifeng Lin ◽  
James S. Hodges ◽  
Chang Xu ◽  
Haitao Chu
Keyword(s):  
Linear Mixed Model ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Event Studies ◽  
Sensitivity Analyses ◽  
Prevention Measures ◽  
Double Zero ◽  
Eye Protection ◽  
Meta Analyses ◽  
Zero Event

Objectives: High-quality meta-analyses on COVID-19 are in urgent demand for evidence-based decision making. However, conventional approaches exclude double-zero-event studies (DZS) from meta-analyses. We assessed whether including such studies impacts the conclusions in a recent systematic urgent review on prevention measures for preventing person-to-person transmission of COVID-19. Study designs and settings: We extracted data for meta-analyses containing DZS from a recent review that assessed the effects of physical distancing, face masks, and eye protection for preventing person-to-person transmission. A bivariate generalized linear mixed model was used to re-do the meta-analyses with DZS included. We compared the synthesized relative risks (RRs) of the three prevention measures, their 95% confidence intervals (CI), and significance tests (at the level of 0.05) including and excluding DZS. Results: The re-analyzed COVID-19 data containing DZS involved a total of 1,784 participants who were not considered in the original review. Including DZS noticeably changed the synthesized RRs and 95% CIs of several interventions. For the meta-analysis of the effect of physical distancing, the RR of COVID-19 decreased from 0.15 (95% CI, 0.03 to 0.73) to 0.07 (95% CI, 0.01 to 0.98). For several meta-analyses, the statistical significance of the synthesized RR was changed. The RR of eye protection with a physical distance of 2 m and the RR of physical distancing when using N95 respirators were no longer statistically significant after including DZS. Conclusions: DZS may contain useful information. Sensitivity analyses that include DZS in meta-analysis are recommended.

Does Endovascular Repair for Blunt Traumatic Aortic Injuries Provide Better Outcomes Compared to Its Open Technique? A Systematic Review and Meta-analysis

2021 ◽  
Vol 39 ◽  
Author(s):  
Shekhar Gogna ◽  
◽  
Mahir Gachabayov ◽  
Priya Goyal ◽  
Rifat Latifi ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Meta Analysis ◽  
Operating Time ◽  
Postoperative Mortality ◽  
Reoperation Rate ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Icu Length Of Stay ◽  
Aortic Injuries ◽  
Secondary Endpoints

Introduction: Traumatic aortic injuries are devastating events in terms of high mortality and morbidity in most survivors. We aimed to compare the outcomes of endovascular repair (ER) vs. open repair (OR) in the treatment of traumatic aortic injuries. Methods: PubMed, Embase, and Cochrane Library were systematically searched. Postoperative mortality was the primary endpoint. Secondary endpoints included intensive care unit (ICU) length of stay, hospital length of stay, operating time, paraplegia, stroke, acute renal failure, and reoperation rate. The Mantel-Haenszel method (random-effects model) with odds ratios and 95% confidence intervals (OR (95% CI)), and the inverse variance method with the mean difference (MD (95% CI)), were used to measure the effects of continuous and categorical variables, respectively. Results: A total of 49 studies involving 12,857 patients were included. Postoperative mortality was not significantly different between the two groups (p=0.459). Among secondary outcomes, the paraplegia rate was significantly lower after ER (p=0.032). Other secondary endpoints such as ICU length of stay (p=0.329), hospital length of stay (p=0.192), operating time (p=0.973), stroke rate (p=0.121), ARF rate (p=0.928), and reoperation rate (p=0.643) did not significantly differ between the two groups. Conclusion: This meta-analysis found that ER was associated with a reduced paraplegia rate compared to OR for the management of traumatic aortic injury.

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