Laparoscopic vs. Open Repeat Hepatectomy for Recurrent Liver Tumors: A Propensity Score–Matched Study and Meta-Analysis

Background: It remains unclear whether the short-term benefits of laparoscopic repeat hepatectomy (LRH) accrue to patients with recurrent liver tumors. The present study aimed to report our own center's experience and perform a meta-analysis to evaluate the safety and feasibility of LRH in comparison with open repeat hepatectomy (ORH) for treating recurrent liver tumors.Patients and Methods: A propensity score–matched study was performed including 426 patients receiving LRH or ORH for recurrent hepatocellular carcinoma between January 2017 and December 2018. Surgical outcomes and perioperative inflammation-based markers, including monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune–inflammation index were collected from medical records and analyzed. Additionally, a systematic literature review was performed to identify relevant studies in PubMed, EMBASE, Web of Science, and Cochrane library databases up to October 1, 2020. Information including patient demographics, pathologic characteristics, and short-term outcomes was extracted and analyzed using random- or fixed-effects models.Results: Of 68 LRHs, 57 were matched with an ORH finally. Our study demonstrated that LRH was significantly associated with less intraoperative blood loss (50 vs. 100 mL; P < 0.001), lower rate of hepatic inflow occlusion (10.52 vs. 33.3%; P = 0.003), and shorter postoperative hospital stay (5 vs. 6 days; P = 0.001) after 1:1 propensity score matching. The operation time, rate of blood transfusion, and postoperative complications were similar between the two groups. Moreover, all four inflammation-based markers were significantly lower in LRH group on postoperative day 1. In the meta-analysis, a total of 12 studies comprising 1,315 patients receiving repeat hepatectomy met the selection criteria. Similar to our own study, the meta-analysis showed shorter hospital stay [standard mean difference (SMD) = −0.51, 95% confidence interval (CI) = −0.79 to −0.22, P < 0.001], less intraoperative blood loss (SMD = −0.79, 95% CI = −1.11 to −0.47, P < 0.001), and lower rate of major postoperative complications [odds ratio (OR) = 0.35, 95% CI = 0.19–0.66, P = 0.001] in the LRH group. There was no difference in the field of overall postoperative complication and operation time between LRH and ORH groups.Conclusion: Compared with ORH, LRH results in relatively better surgical outcomes and faster postoperative recovery. It could be considered a feasible and effective option for the treatment of recurrent liver tumors.

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Direct anterior approach (DAA) vs. conventional approaches in total hip arthroplasty: A RCT meta-analysis with an overview of related meta-analyses

PLoS ONE ◽

10.1371/journal.pone.0255888 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0255888 ◽

Cited By ~ 1

Author(s):

Philip Lazaru ◽

Simon Bueschges ◽

Nikolai Ramadanov

Keyword(s):

Total Hip Arthroplasty ◽

Anterior Approach ◽

Meta Analysis ◽

Operation Time ◽

Direct Anterior Approach ◽

Risk Of Bias ◽

Intraoperative Blood Loss ◽

Short Term ◽

Incision Length ◽

Meta Analyses

Objectives Several systematic reviews and meta-analyses on short-term outcomes between total hip arthroplasty (THA) through direct anterior approach (DAA) compared to THA through conventional (including anterior, anterolateral, lateral transgluteal, lateral transtrochanteric, posterior, and posterolateral) approaches (CAs) in treatment of hip diseases and fractures showed contradicting conclusions. Our aim was to draw definitive conclusions by conducting both a fixed and random model meta-analysis of quality randomized controlled trials (RCTs) and by comparison with related meta-analyses. Design We performed a systematic literature search up to May 2020 to identify RCTs, comparing THA through DAA with THA through CAs and related meta-analyses. We conducted risk of bias and level of evidence assessment in accordance with the Cochrane’s Risk of Bias 2 tool and with the guidelines of the Centre for Evidence-Based Medicine. We estimated mean differences (MD) with 95% confidence intervals (CI) through fixed and random effects models, using the DerSimonian and Laird method. Heterogeneity was assessed using tau-square (τ2). Our conclusions take into account the overall results from related meta-analyses. Results Nine studies on THA through DAA met the criteria for final meta-analysis, involving 998 patients. Three studies were blinded RCTs with a level I evidence, the other 6 studies were non-blinded RCTs with a level II evidence. We came to the following results for THA through DAA compared to THA through CAs: operation time (I2 = 92%, p<0.01; fixed: MD = 15.1, 95% CI 13.1 to 17.1; random: MD = 18.1, 95% CI 8.6 to 27.5); incision length (I2 = 100%, p<0.01; fixed: MD = -2.9, 95% CI -3.0 to -2.8; MD = -1.1, 95% CI -4.3 to 2.0); intraoperative blood loss (I2 = 87%, p<0.01; fixed: MD = 51.5, 95% CI 34.1 to 68.8; random: MD = 51.9, 95% CI -89.8 to 193.5); VAS 1 day postoperatively (I2 = 79%, p = 0.03; fixed: MD = -0.8, 95% CI -1.2 to -0.4; random: MD = -0.9, 95% CI -2.0 to 0.15); HHS 3 months postoperatively (I2 = 52%, p = 0.08; fixed: MD = 2.8, 95% CI 1.1 to 4.6; random: MD = 3.0, 95% CI -0.5 to 6.5); HHS 6 months postoperatively (I2 = 0%, p = 0.67; fixed: MD = 0.9, 95% CI -1.1 to 2.9; random: MD = 0.9, 95% CI -1.1 to 2.9); HHS 12 months postoperatively (I2 = 0%, p = 0.79; fixed: MD = 0.7, 95% CI -0.9 to 2.4; random: MD = 0.7, 95% CI -0.9 to 2.4). We compared our findings with 7 related meta-analyses. Conclusions Considering the results of our meta-analysis and the review of related meta-analyses, we can conclude that short-term outcomes of THA through DAA were overall better than THA through CAs. THA through DAA had a shorter incision length, a tendency towards a lower pain VAS 1 day postoperatively and better early postoperative functional outcome than THA through CAs. The intraoperative blood loss showed indifferent results. THA through DAA had a longer operation time than THA through CAs.

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Abstract 14301: Effects of Septal Reduction Therapy on Acute Cardiovascular Events and All-cause Mortality in Patients With Obstructive Hypertrophic Cardiomyopathy: Propensity Score-matched Study

Circulation ◽

10.1161/circ.142.suppl_3.14301 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Sae Morita ◽

Yanling Zhao ◽

Kohei Hasegawa ◽

Muredach P Reilly ◽

Mathew S Maurer ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Propensity Score ◽

New York State ◽

Control Group ◽

Short Term ◽

Alcohol Septal Ablation ◽

Septal Myectomy ◽

All Cause Mortality ◽

Obstructive Hypertrophic Cardiomyopathy ◽

Matched Study

Introduction: Septal reduction therapy (SRT) - i.e., septal myectomy and alcohol septal ablation - has been used to treat medically-refractory obstructive hypertrophic cardiomyopathy (HOCM) for a few decades. However, the effects of SRT on the risk of acute cardiovascular (CV) events and all-cause mortality are largely unknown. Hypothesis: SRT is associated with a long-term decrease in acute CV events and a short-term increase in all-cause mortality in patients with HOCM. Methods: We performed a propensity score (PS)-matched study using all-payer databases that capture all hospitalizations and outpatient visits in New York State. We identified patients with HOCM who underwent SRT between January 1, 2007 and December 31, 2014 (i.e., the SRT group) and those who have never had SRT but had at least one hospitalization for HOCM during the same period (i.e., the control group). We performed 1:1 PS matching using age, sex, race/ethnicity, source of payment, season and year of starting event follow-up (i.e., the day of SRT or the index hospitalization), and Elixhauser comorbidity measures. The primary outcomes were (1) acute CV event (i.e., emergency department visit or unplanned hospitalization for CV disease) during 1-360 days and 361-720 days and (2) 7-, 15-, 30-, 180-, and 360-day all-cause mortality. We compared the risk of the outcome event using logistic regression models. Results: The analytic cohort consisted of 690 patients with HOCM (i.e., 345 PS-matched pairs). The SRT group had a lower risk of acute CV event during 361-720 days (OR 0.44; 95% CI, 0.20-0.97; P=0.04) but a higher risk of 7-day mortality (11 vs. 2 in the control group; P=0.03). The SRT group had a non-significant trend towards lower all-cause mortality in longer terms ( Figure ). Conclusion: In this population-based PS-matched study of patients with HOCM, SRT was associated with a reduced risk of acute CV events in the second post-procedure year at the sacrifice of a short-term increase in all-cause mortality.

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Surgical Loupe at 4.0× Magnification in Pancreaticoduodenectomy—Does It Affect the Surgical Outcomes? A Propensity Score–Matched Study

Surgical Innovation ◽

10.1177/1553350618812322 ◽

2018 ◽

Vol 26 (2) ◽

pp. 201-208

Author(s):

Mohamed El Shobary ◽

Ayman El Nakeeb ◽

Ahmad Sultan ◽

Mahmoud Abd El Wahab Ali ◽

Mohamed El Dosoky ◽

...

Keyword(s):

Postoperative Complications ◽

Propensity Score ◽

Hospital Stay ◽

Pancreatic Fistula ◽

Surgical Outcomes ◽

Operative Time ◽

Postoperative Pancreatic Fistula ◽

Tube Removal ◽

Matched Study ◽

The Impact

Background. There is paucity of data about the impact of using magnification on rate of pancreatic leak after pancreaticoduodenectomy (PD). The aim of this study was to show the impact of using magnifying surgical loupes 4.0× EF (electro-focus) on technical performance and surgical outcomes of PD. Patients and Method. This is a propensity score–matched study. Thirty patients underwent PD using surgical loupes at 4.0× magnification (Group A), and 60 patients underwent PD using the conventional method (Group B). The primary outcome was postoperative pancreatic fistula. Secondary outcomes included operative time, intraoperative blood loss, postoperative complications, mortality, and hospital stay. Results. The total operative time was significantly longer in the loupe group ( P = .0001). The operative time for pancreatic reconstruction was significantly longer in the loupe group ( P = .0001). There were no significant differences between both groups regarding hospital stay, time to oral intake, total amount of drainage, and time of nasogastric tube removal. Univariate and multivariate analyses demonstrated 3 independent factors of development of postoperative pancreatic fistula: pancreatic duct <3 mm, body mass index >25, and soft pancreas. Conclusion. Surgical loupes 4.0× added no advantage in surgical outcomes of PD with regard to improvement of postoperative complications rate or mortality rate.

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Meta-Analysis on the Efficacy and Safety of Laparoscopic Surgery for Large Gastric Gastrointestinal Stromal Tumors

The American Surgeon ◽

10.1177/0003134820951482 ◽

2020 ◽

pp. 000313482095148

Author(s):

Miao Yu ◽

Deng-chao Wang ◽

Jian Wei ◽

Yue-hua Lei ◽

Zhao-jun Fu ◽

...

Keyword(s):

Gastrointestinal Stromal Tumors ◽

Laparoscopic Resection ◽

Meta Analysis ◽

Disease Free Survival ◽

Operation Time ◽

Intraoperative Blood Loss ◽

Open Resection ◽

Free Survival ◽

Stromal Tumors ◽

Disease Free

Background The aim of this study was to conduct a meta-analysis comparing the safety and feasibility of laparoscopic versus open resection for gastric gastrointestinal stromal tumors (GISTs) larger than 5 cm. Method We searched the Cochrane Library, PubMed, and Embase for relevant articles. Randomized and nonrandomized clinical trials were identified and included in this study. Searching for related articles on large GIST (>5 cm) for laparoscopic resection (laparoscopic group [LAPG]) and open resection (open group [OG]), RevMan 5.3 was used for data analysis, comparing 2 groups of operation time, intraoperative blood loss, complications, length of hospital stay, recurrence rate, disease-free survival, and overall survival. Results Seven studies including 440 patients were identified for the meta-analysis. Meta-analysis revealed that LAPG had less bleeding, shorter postoperative hospital stay, and a better 5-year disease-free survival. There was no significant difference between LAPG and OG in operation time, postoperative complications, recurrence rate, and overall survival. Conclusion Laparoscopic resection of large (>5 cm) GIST is safe and feasible and has the advantages of less intraoperative blood loss and fast postoperative recovery, with a good outcome in the recent oncology.

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Intelligent Algorithm-Based Magnetic Resonance Imaging in Radical Gastrectomy under Laparoscope

Contrast Media & Molecular Imaging ◽

10.1155/2021/1701447 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Wenkui Mo ◽

Cansong Zhao

Keyword(s):

Gastric Cancer ◽

Operation Time ◽

Laparoscopic Group ◽

Postoperative Hospital Stay ◽

Intraoperative Blood Loss ◽

Resonance Imaging ◽

Intelligent Algorithm ◽

Short Term ◽

Laparoscopy Group ◽

Significant Difference

The study focused on the influence of intelligent algorithm-based magnetic resonance imaging (MRI) on short-term curative effects of laparoscopic radical gastrectomy for gastric cancer. A convolutional neural network- (CNN-) based algorithm was used to segment MRI images of patients with gastric cancer, and 158 subjects admitted at hospital were selected as research subjects and randomly divided into the 3D laparoscopy group and 2D laparoscopy group, with 79 cases in each group. The two groups were compared for operation time, intraoperative blood loss, number of dissected lymph nodes, exhaust time, time to get out of bed, postoperative hospital stay, and postoperative complications. The results showed that the CNN-based algorithm had high accuracy with clear contours. The similarity coefficient (DSC) was 0.89, the sensitivity was 0.93, and the average time to process an image was 1.1 min. The 3D laparoscopic group had shorter operation time (86.3 ± 21.0 min vs. 98 ± 23.3 min) and less intraoperative blood loss (200 ± 27.6 mL vs. 209 ± 29.8 mL) than the 2D laparoscopic group, and the difference was statistically significant ( P < 0.05 ). The number of dissected lymph nodes was 38.4 ± 8.5 in the 3D group and 36.1 ± 6.0 in the 2D group, showing no statistically significant difference ( P > 0.05 ). At the same time, no statistically significant difference was noted in postoperative exhaust time, time to get out of bed, postoperative hospital stay, and the incidence of complications ( P > 0.05 ). It was concluded that the algorithm in this study can accurately segment the target area, providing a basis for the preoperative examination of gastric cancer, and that 3D laparoscopic surgery can shorten the operation time and reduce intraoperative bleeding, while achieving similar short-term curative effects to 2D laparoscopy.

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Effects of Preoperative Iodine Administration on Thyroidectomy for Hyperthyroidism: A Systematic Review and Meta-analysis

Otolaryngology ◽

10.1177/0194599819829052 ◽

2019 ◽

Vol 160 (6) ◽

pp. 993-1002 ◽

Cited By ~ 1

Author(s):

Chung-Hsin Tsai ◽

Po-Sheng Yang ◽

Jie-Jen Lee ◽

Tsang-Pai Liu ◽

Chi-Yu Kuo ◽

...

Keyword(s):

Postoperative Complications ◽

Blood Loss ◽

Operative Time ◽

Meta Analysis ◽

Thyroid Volume ◽

Vocal Cord Palsy ◽

Significant Heterogeneity ◽

Intraoperative Blood Loss ◽

Significant Difference ◽

And Control

Objective The current guidelines recommend that potassium iodide be given in the immediate preoperative period for patients with Graves’ disease who are undergoing thyroidectomy. Nonetheless, the evidence behind this recommendation is tenuous. The purpose of this study is to clarify the benefits of preoperative iodine administration from published comparative studies. Data Sources We searched PubMed, Embase, Cochrane, and CINAHL from 1980 to June 2018. Review Methods Studies were included that compared preoperative iodine administration and no premedication before thyroidectomy. For the meta-analysis, studies were pooled with the random-effects model. Results A total of 510 patients were divided into the iodine (n = 223) and control (n = 287) groups from 9 selected studies. Preoperative iodine administration was significantly associated with decreased thyroid vascularity and intraoperative blood loss. Significant heterogeneity was present among studies. We found no significant difference in thyroid volume or operative time. Furthermore, the meta-analysis showed no difference in the risk of postoperative complications, including vocal cord palsy, hypoparathyroidism/hypocalcemia, and hemorrhage or hematoma after thyroidectomy. Conclusion Preoperative iodine administration decreases thyroid vascularity and intraoperative blood loss. Nonetheless, it does not translate to more clinically meaningful differences in terms of operative time and postoperative complications.

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Comparison of 27-Gauge and 25-Gauge Microincision Vitrectomy Surgery for the Treatment of Vitreoretinal Disease: A Systematic Review and Meta-Analysis

Journal of Ophthalmology ◽

10.1155/2020/6149692 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Jinlan Ma ◽

Qing Wang ◽

Haoyu Niu

Keyword(s):

Systematic Review ◽

Postoperative Complications ◽

Meta Analysis ◽

Operation Time ◽

Vitreoretinal Disease ◽

Subgroup Analyses ◽

Microincision Vitrectomy Surgery ◽

Anatomical Success ◽

Vitrectomy Surgery ◽

Anatomical Success Rate

Background. We performed a systematic review and meta-analysis to evaluate the safety and effectiveness of 27-gauge (27-G) microincision vitrectomy surgery (MIVS) compared with 25-guage (25-G) MIVS for the treatment of vitreoretinal disease. Methods. A systematic electronic search was conducted in March 2020 in PubMed, Embase, and the Cochrane library. Eligible criteria for including studies were controlled trials comparing 27-G vitrectomy with 25-G vitrectomy in patients with vitreoretinal disease. The main outcomes included operation time; best corrected visual acuity (BCVA) in logMAR; postoperative intraocular pressure (IOP); primary anatomical success rate for rhegmatogenous retinal detachment (RRD) cases and postoperative central macular thickness (CMT) for idiopathic epiretinal membrane (ERM) cases; intraoperative/postoperative complications. Odds ratio (OR) and mean difference (MD) were synthesized under fixed or random effects models. Results. Eleven studies enrolling 940 eyes were identified. Among those 11 studies, six studies were on the treatment of RRD and five studies were on the treatment of ERM, so subgroup analyses were conducted. The total pooled results indicated that 27-G surgery system had obvious advantages in improving BCVA at six months after the vitrectomy (P = 0.004) and reducing intraoperative/postoperative complications (P = 0.03). However, the mean operation time was significantly longer by three minutes for 27-G compared with 25-G vitrectomy (P = 0.002). In subgroup analyses, for the treatment of ERM cases, 27-G group was associated with less complications and longer operation time. However, for the treatment of RRD cases, 27-G groups and 25-G groups were comparable in operation time, postoperative BCVA, postoperative IOP, and primary anatomical success rate. Conclusions. This meta-analysis confirmed that 27-G MIVS was an effective and safe surgical system compared with 25-G MIVS for the treatment of RRD and ERM cases, even though 27-G system needs a longer surgical time.

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A comparative study of the fracture union between long and short proximal femoral intramedullary nails antirotation in the treatment of intertrochanteric femur fractures in the elderly: a multicentric analysis

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20190793 ◽

2019 ◽

Vol 5 (2) ◽

pp. 288

Author(s):

B. Hari Krishnan ◽

S. K. Rai ◽

Rohit Vikas ◽

Manoj Kashid ◽

Pramod Mahender

Keyword(s):

Postoperative Complications ◽

Blood Transfusion ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Operation Time ◽

The Elderly ◽

Intertrochanteric Fractures ◽

Intraoperative Blood Loss ◽

Fracture Union ◽

Femur Fractures

Background: The objective of the study was to compare the fracture union of long vs. short proximal femoral intramedullary nail antirotation (PFNA) in the treatment of intertrochanteric fractures in elderly patients who was more than 60 years old.Methods: A retrospective analysis of 170 cases of intertrochanteric fractures of the femur (AO type A1 and A2) in the elderly was conducted. There were 64 males (37.6%) and 106 females (62.3%) with the age of 60–90 (mean age 75) years. The general demographic data of patients, operation time, intraoperative blood loss, length of hospital stay, blood transfusion rate, anterior thigh pain, postoperative complications like periprosthetic fractures, infections were recorded.Results: The short nail group also had a significantly shorter operation time (41.5±15.3 minutes vs. 62.5±25.3 minutes, p=0.002) and lower rate of postoperative transfusion (31.3% vs. 58.7%, p=0.041). However the length of hospital stay showed no significant differences. After surgery in short group there were 03 cases of periprosthetic fracture with a total incidence of 03%, however there were none in long nail group. At the end of the follow-up, all patients achieved bony union. The average fracture union time of the long nail group was (8.5±3.2) months, and the short nail group was (7.8±4.7) months, revealing no significant differences (p=0.09).Conclusions: Both the proximal femoral intramedullary long and short nail fixation has a good result in the form of fracture union in treating intertrochanteric femur fractures in the elderly. They showed no significant difference in terms of fracture union, hospital stay, and postoperative complications. The incidence of periprosthetic fractures and anterior thigh pain was slightly high in short nail group. In short intramedullary nailing group there was obvious decrease in the intraoperative blood loss, operation time and postoperative blood transfusion.

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Correlation between neutrophil-to-lymphocyte ratio and postoperative mortality in elderly patients with hip fracture: a meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02831-6 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Yu-Hang Chen ◽

Ching-Hsin Chou ◽

Hsin-Hsien Su ◽

Yu-Ting Tsai ◽

Ming-Hsiu Chiang ◽

...

Keyword(s):

Hip Fracture ◽

Elderly Patients ◽

Geriatric Patients ◽

Meta Analysis ◽

Postoperative Mortality ◽

Short Term ◽

Term Survival ◽

Lymphocyte Ratio ◽

Long Term Mortality

Abstract Introduction The neutrophil-to-lymphocyte ratio (NLR) is a crucial prognosis predictor following several major operations. However, the association between NLR and the outcome after hip fracture surgery is unclear. In this meta-analysis, we investigated the correlation between NLR and postoperative mortality in geriatric patients following hip surgery. Method PubMed, Embase, Cochrane library, and Google Scholar were searched for studies up to June 2021 reporting the correlation between NLR and postoperative mortality in elderly patients undergoing surgery for hip fracture. Data from studies reporting the mean of NLR and its 95% confidence interval (CI) were pooled. Both long-term (≥ 1 year) and short-term (≤ 30 days) mortality rates were included for analysis. Result Eight retrospective studies comprising a total of 1563 patients were included. Both preoperative and postoperative NLRs (mean difference [MD]: 2.75, 95% CI: 0.23–5.27; P = 0.03 and MD: 2.36, 95% CI: 0.51–4.21; P = 0.01, respectively) were significantly higher in the long-term mortality group than in the long-term survival group. However, no significant differences in NLR were noted between the short-term mortality and survival groups (MD: − 1.02, 95% CI: − 3.98 to 1.93; P = 0.5). Conclusion Higher preoperative and postoperative NLRs were correlated with a higher risk of long-term mortality following surgery for hip fracture in the geriatric population, suggesting the prognostic value of NLR for long-term survival. Further studies with well-controlled confounders are warranted to clarify the predictive value of NLR in clinical practice in geriatric patients with hip fracture.

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

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02230-5 ◽

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.

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