scholarly journals Effect of endoscopic resection on short-term surgical outcomes of subsequent laparoscopic gastrectomy: a meta-analysis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Dong Peng ◽  
Yu-Xi Cheng ◽  
Gang Liao
Keyword(s):  
Endoscopic Resection ◽  
Laparoscopic Gastrectomy ◽  
Surgical Outcomes ◽  
Meta Analysis ◽  
Operation Time ◽  
Oral Feeding ◽  
Cochrane Library ◽  
Short Term ◽  
Significant Difference ◽  
Grade Ii

Abstract Background Endoscopic resection (ER) might affect subsequent laparoscopic gastrectomy (LG) because of the electrical coagulation, but the effect remains controversial. The purpose of this meta-analysis was to analyze the effect of ER on the short-term surgical outcomes of subsequent LG. Materials and methods The PubMed, EMBASE, and Cochrane Library databases were searched to find eligible studies published from inception to March 21, 2021. Short-term surgical outcomes were compared between the ER-LG group and the LG-only group. The registration ID of this current meta-analysis on PROSPERO is CRD42021238031. Results Nine studies involving 3611 patients were included in this meta-analysis. The LG-only group had a higher T stage (T1-T2: OR=2.42, 95% CI=1.09 to 5.34, P=0.03; T3-T4: OR=0.41, 95% CI=0.19 to 0.91, P=0.03) than the ER-LG group. The ER-LG group showed a shorter operation time than the LG-only group (MD=−5.98, 95% CI=−10.99 to −0.97, P=0.02). However, no difference was found in operation time after subgroup analysis of propensity score matching studies. No significant difference was found in intraoperative blood loss, time to first oral feeding, or postoperative hospital stay between the ER-LG group and the LG-only group. And no significance was found in overall complications (OR=1.16, 95% CI=0.89 to 1.50, P=0.27), complications of grade ≥ II (OR=1.11, 95% CI=0.71 to 1.73, P=0.64), complications of grade ≥ III b (OR=1.47, 95% CI=0.49 to 4.43, P=0.49) between the ER-LG group and the LG-only group. Conclusions ER did not affect subsequent LG in terms of short-term outcomes, and the ER-LG group might have a shorter operation time than the LG-only group.

scholarly journals “Micro Hand S” Surgical Robot vs Laparoscopic Gastrectomy for Gastric Cancer: Comparison of Short-Term Outcomes

2020 ◽  
Author(s):  
Yuan-Bing Yao ◽  
Guo-Hui Wang ◽  
Yong Liu ◽  
Bo Yi ◽  
Zheng Li ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Laparoscopic Gastrectomy ◽  
Operation Time ◽  
Surgical Robot ◽  
R0 Resection ◽  
Robotic Gastrectomy ◽  
Short Term ◽  
Significant Difference ◽  
Grade Ii ◽  
Comprehensive Complications Index

Abstract Background Expensive cost of surgery has limited the use of surgical robot in China. The emergence of “Micro Hand S” surgical robot provides more choices for surgical treatment. Our study was to evaluate the safety and feasibility of “Micro Hand S” surgical robotic gastrectomy for gastric cancer. Methods Perioperative data of 75 patients who underwent “Micro Hand S” surgical robotic gastrectomy (RG) or laparoscopic gastrectomy (LG) at the Department of General Surgery, Third Xiangya Hospital, Central South University from June 2017 to January 2019 were collected to compare the short-term outcomes between the two groups. Results No statistically significant difference was found in baseline characteristics between the two groups (P > 0.05). RG group had longer operation time (P < 0.01). The harvested lymph nodes were comparable between the two groups (P = 0.084). There were five positive margins in the LG group, and the R0 resection rate was comparable between the two groups (P = 0.247). 16 complications occurred in the RG group according to the Clavien-Dindo classification system, 6 in grade I, and 10 in grade II. 68 complications happened in the LG group, 22 in grade I, 44 in grade II, 1 in grade IIIa and 1 in grade IVa. The comprehensive complications index (CCI) was similar between the two groups (P = 0.895). Intraoperative blood loss, surgical resection, reconstruction of the digestive tract intraoperative blood transfusion, Chemoradiotherapy, pathological type, degree of differentiation, proximal resection margin, time of first flatus, time of liquid diet, time of abdominal drainage tube extraction, and hospital stay for RG and LG were similar too (P > 0.05). Conclusion “Micro Hand S” surgical robotic gastrectomy is safe and feasible. Keywords Surgical robot; Gastric cancer; Gastrectomy; Safety; Feasibility

scholarly journals Roux-en-Y and Billroth II Reconstruction after Pancreaticoduodenectomy: A Meta-Analysis of Complications

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Fulin Ma ◽  
Yong Fan ◽  
Lina Zhang ◽  
Zhiqiang Zhao ◽  
Yuanhua Nie ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Meta Analysis ◽  
Postoperative Bleeding ◽  
Operation Time ◽  
Cochrane Library ◽  
Controlled Clinical Trials ◽  
Billroth Ii ◽  
Billroth Ii Reconstruction ◽  
Significant Difference ◽  
The Cochrane Library

Objective. To evaluate Roux-en-Y and Billroth II reconstruction following pancreaticoduodenectomy (PD). Methods. PubMed, Embase, the Cochrane Library, and the Web of Science were searched to identify randomized controlled trials (RCTs) and controlled clinical trials that compared Roux-en-Y and Billroth II reconstruction following PD up to December 2019. RevMan 5.3 software was used for the statistical analysis. Results. Four RCTs and five controlled clinical trials were included, with a total of 1,072 patients (500 and 572 patients in the Roux-en-Y and Billroth II groups, respectively). No significant differences in delayed gastric emptying (DGE), A-grade DGE, B-grade DGE, or C-grade DGE were observed between the Roux-en-Y and Billroth II reconstruction groups after PD ( odds   ratio   OR = 1.01 , 95% confidence interval [CI]: 0.50–2.03, P = 0.98 ; OR = 0.49 , 95% CI: 0.17–1.45, P = 0.20 ; OR = 0.63 , 95% CI: 0.29–1.38, P = 0.25 ; and OR = 2.13 , 95% CI: 0.38–11.99, P = 0.39 ). No significant difference in the incidence of postoperative pancreatic fistula, abscess, bile leaks, infection, postoperative bleeding, or the length of the postoperative hospital stay was observed between the Roux-en-Y and Billroth II groups ( P > 0.05 ), but the operation time was significantly different ( mean   difference [MD] = 31.65 , 95% CI: 7.14–56.17, P = 0.01 ). Conclusions. Billroth II reconstruction after PD did not significantly reduce the incidence of DGE or other complications but shortened the operation time compared to Roux-en-Y reconstruction. However, the results must be verified by further high-quality, large RCTs or controlled clinical trials.

scholarly journals Robotic Versus Laparoscopic Gastrectomy for Gastric Cancer: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Jianglei Ma ◽  
Xiaoyao Li ◽  
Shifu Zhao ◽  
Ruifu Zhang ◽  
Dejun Yang
Keyword(s):  
Gastric Cancer ◽  
Systematic Review ◽  
Robotic Surgery ◽  
Laparoscopic Gastrectomy ◽  
Resection Margin ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Long Term Outcomes ◽  
Significant Difference

Abstract Background To date, robotic surgery has been widely used worldwide. We conducted a systematic review and meta-analysis to evaluate short- and long-term outcomes of robotic gastrectomy (RG) in gastric cancer patients to determine whether RG can replace laparoscopic gastrectomy (LG).Methods Pubmed, Cochrane Library, WanFang, China National Knowledge Infrastructure (CNKI) and VIP databases were comprehensively searched for studies published before May 2020 that compared RG with LG. Next, two independent reviewers conducted literature screening and data extraction. The quality of the literature was assessed using the Newcastle-Ottawa Scale (NOS),and the data analyzed using the Review Manager 5.3 software. Random effects or fixed effects models were applied according to heterogeneity.Results A total of 19 studies including 7275 patients were included in the meta-analyses, of which 4598 patients were in the LG group and 2677 in the RG group. Compared with LG,RG was associated with longer operative time (WMD=−32.96 min; 95% CI:-42.08~-23.84, P<0.00001),less blood loss (WMD=28.66 ml; 95% CI: 18.59~38.73, P<0.00001),and shorter time to first flatus (WMD=0.16days; 95%CI:0.06~0.27, P=0.003).There was no significant difference between RG and LG in terms of the hospital stay (WMD=0.23days, 95 % CI:-0.53~0.98, P=0.56),overall postoperative complication (OR=1.07, 95 % CI:0.91~1.25, P=0.43),mortality (OR=0.67, 95% CI=0.24~1.90, P=0.45),the number of harvested lymph nodes (WMD=-0.96, 95% CI:-2.12~0.20, P=0.10),proximal resection margin (WMD=-0.10 cm,95% CI:-0.29~0.09, P=0.30),and distal resection margin (WMD=0.15cm,95% CI:-0.21~0.52, P=0.41).No significant differences were found between the two treatments in overall survival(OS) (HR=0.95, 95% CI:0.76~1.18; P=0.64), recurrence-free survival(RFS) (HR=0.91, 95% CI:0.69~1.21;P=0.53), and recurrence rate (OR=0.90, 95% CI:0.67~1.21; P=0.50). Conclusions The results of this study suggested that RG is as acceptable as LG in terms of short-term and long-term outcomes. RG can be performed as effectively and safely as LG. Moreover, more randomized controlled trials comparing the two techniques with rigorous study designs are still essential to evaluate the value of the robotic surgery for gastric cancer.

Short-Term and Long-Term Outcomes of Self-Expanding Metallic Stent Versus Decompressing Stoma as the Bridge of Elective Surgery for Left-Sided Obstructive Colon Cancer A Meta-Analysis

2021 ◽  
Vol 7 (5) ◽  
pp. 1853-1864
Author(s):  
Jin Jing ◽  
Wei Xu ◽  
Haiming Xu ◽  
ZhengHong Yu ◽  
Mengyun zhou ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Elective Surgery ◽  
Meta Analysis ◽  
Complete Analysis ◽  
Cochrane Library ◽  
Metallic Stent ◽  
Sems Placement ◽  
Short Term ◽  
Significant Difference

Background: Compared to emergency resection, elective surgery is a better choice for the people suffering from left-sided obstructive colon cancer (LOSCC). Both are considered as self-expanding decompressing stoma (DS) construction and metallic stent (SEMS) placement are accessible bridges for elective surgery (BTS). We aimed to perform meta-analysis of LOSCC databases to comparethe pros and cons of the two options. Method: LOSCC patients with curative intent were searched in medical databases, including PUBMED, MEDLINE, and the Cochrane Library. Results were expressed as risk ratios. The meta-analysis was performed by Revman5.3. Result: Three comparative studies were selected, including 847 LOSCC patients. The complete analysis showed that there is no statistically significant difference regarding primary anastomosis (0R=1.15, 95% CI 0.30-4.41, P=0.84), There was no significant difference in 90-day recurrence rate post resection (OR=0.90, 95% CI 0.68-1.20, P=0.47), and major complication (OR=1.86, 95% CI 0.98-3.54, P=0.06) between SEMS and DS group. In addition, the permanent stomas (OR=0.82; 95% CI 0.60-1.13, P=0.23), overall recurrence (OR=0.82, 95% CI 0.48-1.40, P=0.46), and overall survival of 3-years (OR=1.24, 95% CI 0.69-2.25, P=0.48) showed no statistical difference between SEMS and DS group. Conclusion: The after-effects of both short-term and long-term in patients who were treated by SEMS or DS as BTS for LSOCC were not statistically significant. Considering of the even complicated surgical interventions, prolonged hospital stays, and worse body image of DS construction, SEMS placement seems to be the preferred option in treating LSOCC patients.

scholarly journals Ultrasonic Dissection versus Conventional Dissection for Pancreatic Surgery: A Meta-Analysis

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Haiming Lei ◽  
Dong Xu ◽  
Xinghua Shi ◽  
Koulan Han
Keyword(s):  
Pancreatic Fistula ◽  
Pancreatic Surgery ◽  
Meta Analysis ◽  
Operation Time ◽  
Perioperative Outcomes ◽  
Cochrane Library ◽  
Ultrasonic Dissection ◽  
Significant Difference ◽  
Fistula Rate ◽  
The Cochrane Library

Background. The role of ultrasonic dissection (UD) in pancreatic surgery remains controversial. The aim of this meta-analysis was to evaluate the clinical effect of UD in pancreatic surgery when compared with conventional dissection (CD).Materials and Methods. A comprehensive literature search was performed to identify eligible studies that compared UD with CD for pancreatic surgery in PubMed, EMBASE, Web of Science, and the Cochrane Library. Risk ratio (RR) or mean difference with 95% confidence interval (CI) was calculated.Results. Six studies were included with a total of 215 patients undergoing UD and 210 undergoing CD. In comparison with CD in distal pancreatectomy, UD was associated with lower rates of pancreatic fistula (RR = 0.46, 95% CI: 0.27–0.76) and abdominal abscess and shorter operation time and hospital stay (P<0.05). In pancreaticoduodenectomy, there was no significant difference in pancreatic fistula rate between two groups (RR = 0.79, 95% CI: 0.48–1.29). However, the significantly less intraoperative blood loss and the transfused blood unit were found in patients receiving UD (P<0.05).Conclusions. The results of this meta-analysis show that, in comparison with CD, UD is associated with better perioperative outcomes in pancreatic surgery.

scholarly journals Microscopic Versus Endoscopic Stapes Surgery: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
JIANNIS HAJIIOANNOU ◽  
Eleni Gkrinia ◽  
Konstantinos Tzimkas-Dakis ◽  
Effrosyni Palla ◽  
Alexandros Brotis ◽  
...  
Keyword(s):  
Success Rate ◽  
Meta Analysis ◽  
Operation Time ◽  
Stapes Surgery ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
Quality Of Evidence ◽  
Randomized Controlled Studies ◽  
Significant Difference

Objectives Endoscopic approaches constitute a newly introduced and promising technique in the field of stapes surgery, presenting favorable outcomes, so far. This study aims to compare endoscopic and microscopic stapes surgery based on current literature evidence, in terms of their efficacy and safety characteristics. Design We conducted a systematic literature search of three medical databases (Pubmed, Cochrane Library, and Scopus). We focused on randomized controlled studies or observational studies comparing microscopic to endoscopic stapes surgery. Data related to the efficacy and safety of each technique were extracted. Outcome data were summarized using the pooled mean differences or pooled odds ratio along with their 95% confidence intervals, according to the available data. The quality of evidence was assessed according to the GRADE recommendations. Results Thirteen studies with 705 patients were included in the meta-analysis. Success rate was evaluated by estimating air-bone gap improvement, resulting in comparable outcomes for the two techniques (mean difference: -0.20; 95% CI: -0.53, 0.14). No statistically significant difference was detected concerning postoperative complications, except for dysgeusia that was in favor of the endoscopic approach (OR: -1.46; 95% CI: -2.45, -.047). The overall quality of evidence was assessed to range from “Low” to “Very Low”. Conclusion Endoscopic stapes surgery is an innovative alternative to the microscopic technique, resulting in commensurate outcomes in terms of success rate and complications. Further high-quality studies are needed, to adequately compare the two approaches, particularly in terms of operation time, learning curve, cost-effectiveness, and otology surgical skills acquisition.

scholarly journals Short-Term Efficacy and Safety of Secukinumab for Ankylosing Spondylitis: A Systematic Review and Meta-Analysis of RCTs

2020 ◽  
Vol 2020 ◽  
pp. 1-12
Author(s):  
Yu Zhou ◽  
Jinhui Ma ◽  
Juncheng Ge ◽  
Bailiang Wang ◽  
Debo Yue ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
Short Term ◽  
Term Efficacy ◽  
Dichotomous Data ◽  
Increased Risk ◽  
Sf 36 ◽  
Significant Difference ◽  
Patient Reported

Secukinumab is a novel IL-17A inhibitor that has been confirmed to be effective for treating PsA and RA. Several studies have demonstrated that secukinumab also provides benefits for AS patients. Thus, we performed a meta-analysis of RCTs to evaluate the short-term efficacy and safety of secukinumab for the management of AS. The PubMed, Medline, Embase, Web of Science, and Cochrane Library databases were searched for RCTs published prior to March 2020 on the treatment of AS with secukinumab. The primary outcome was the ASAS20 response, and the secondary outcomes included the ASAS40 response, ASAS5/6 response, SF-36 PCS score, ASQoL score, and AEs. Dichotomous data were expressed as pooled RRs with 95% CIs, while continuous data were expressed as pooled MDs with 95% CIs. Subgroup analysis was conducted based on whether the AS patients previously underwent treatment with TNFi. A total of 4 RCTs with 1166 patients were included in our meta-analysis. At week 16, secukinumab 150 mg yielded significant improvements in the clinical response and patient-reported outcomes for AS patients. There was no increased risk of AEs. Consistent results were detected in the meta-analysis of secukinumab 75 mg versus a placebo. Furthermore, no significant difference was detected between the secukinumab 75 mg group and secukinumab 150 mg group. We concluded that secukinumab is effective for treating AS and generally well tolerated by AS patients in the short term, regardless of whether they previously underwent TNFi treatment. The superiority of secukinumab 150 mg over secukinumab 75 mg seems to be limited, since no significant difference in any endpoint was detected between the two groups.

Comparative effects on pain arising from injury to the knee meniscus in adults: A systematic review and network meta-analysis

2020 ◽  
pp. 026921552097664
Author(s):  
Yongni Zhang ◽  
Wuting Cao ◽  
Qin Cao ◽  
Yi Zhu
Keyword(s):  
Meta Analysis ◽  
Sufficient Evidence ◽  
Cochrane Library ◽  
Home Exercise ◽  
Short Term ◽  
Total N ◽  
Knee Meniscus ◽  
Supervised Exercise ◽  
Significant Difference ◽  
Meniscus Injuries

Objective: To identify the most effective pain management method for meniscus injuries by comparing pain relief observed with several common interventions including combined different combinations of surgery and exercise, surgery alone, supervised exercise alone and home exercise alone. Methods: PubMed, Embase, CINAHL, Cochrane Library, Web of Science, SportDiscus, and PEDro were searched from database inception through October 15, 2020. Randomized controlled trials investigating the effect of surgery and exercise for meniscus injuries by using the visual analogue scale (VAS) assessment were eligible for inclusion. Primary outcome was mean change in VAS score from baseline. Comparisons between interventions were made through use of random-effects network meta-analysis over the short-term (three months) and mid-term (12 months). Relative ranking of therapies was assessed by the surface-under-the-cumulative ranking possibilities. All reference lists of included studies were hand-searched. Results: We investigated six RCTs (total n = 796 patients). No significant difference was found between different treatments of pain control in three months and 12 months. The surface under the cumulative ranking curves suggested that supervised exercise combined with surgery was considered most likely to overshadow other treatments in reducing short-term pain (surface under cumulative ranking curve (SUCRA) values: 98.1; mean ranks: 1.1) and mid-term pain (SUCRA values: 97.2; mean rank: 1.1). Conclusion: There is not sufficient evidence to identify any preferred or more effective surgical and/or exercise-based treatment program.

Is It Better to Routinely Use Tourniquet for Knee Arthroscopic Surgery: A Systematic Review and Meta-analysis

2019 ◽  
Vol 33 (09) ◽  
pp. 866-874 ◽  
Author(s):  
Jinyou Wang ◽  
Wennan Xu ◽  
Jiayin Lv
Keyword(s):  
Systematic Review ◽  
Randomized Clinical Trials ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Arthroscopic Surgery ◽  
Operation Time ◽  
Current Evidence ◽  
Postoperative Blood Loss ◽  
Cochrane Library ◽  
Significant Difference

AbstractThe use of tourniquet in knee arthroscopic surgery is a routine technique and provides convenience for the operation. However, the adverse effects caused by tourniquet during the operation are noticed by more and more researchers. The purpose of our study was to perform a systematic review and meta-analysis to assess the effects of tourniquet use in knee arthroscopy. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we searched databases like PubMed, Cochrane library, EMBASE, and Web of Science from inception of the database up to November 20, 2018, using the keywords “ anterior cruciate ligament,” “meniscectomy,” “arthrocopy,” etc. to identify randomized clinical trials. A total of 16 randomized controlled trials involving 1,132 participants fulfilled the inclusion criteria with 582 patients in tourniquet group and 550 patients in nontourniquet group. Compared with tourniquet group, nontourniquet group had less postoperative blood loss and less consumption of analgesic. There was no significant difference between the two groups in intraoperatively arthroscopic visualization, postoperative pain score, postoperative quadriceps muscle strength, and operation time. Our study suggested that compared with tourniquet use, arthroscopic surgery of the knee without tourniquet did not appear to have any disadvantage, and the current evidence was more inclined not to use tourniquet as a routine procedure during the knee arthroscopic surgery.

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