scholarly journals Comparison Among Endoscopic, Laparoscopic, and Open Resection for Relatively Small Gastric Gastrointestinal Stromal Tumors (<5 cm): A Bayesian Network Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Zhen Liu ◽  
Ziyang Zeng ◽  
Siwen Ouyang ◽  
Zimu Zhang ◽  
Juan Sun ◽  
...  
Keyword(s):  
Bayesian Network ◽  
Gastrointestinal Stromal Tumors ◽  
Meta Analysis ◽  
Random Effect Model ◽  
Positive Margin ◽  
Cochrane Library ◽  
Open Resection ◽  
Stromal Tumors ◽  
Significant Difference

BackgroundEndoscopic resection (ESR) is a novel minimally invasive procedure for superficial tumors. Its safety, efficiency, and outcome for gastric gastrointestinal stromal tumors (gGISTs) less than 5 cm remains unclear compared to laparoscopic resection (LAR) and open resection (ONR). The current network meta-analysis aimed to review and analyze the available evidence of this question.MethodsPubMed, Embase, Cochrane Library, and Web of Science databases were searched to identify eligible studies published up to July 6, 2020. The perioperative and long-term oncological outcomes among ESR, LAR, and ONR for gGIST (&lt;5 cm) were estimated through the Bayesian network meta-analysis with a random-effect model.ResultsFifteen studies with 1,631 patients were included. ESR was associated with a shorter operative time [mean difference, MD: -36; 95% confidence interval, CI (-55, -16)], a higher rate of positive margin [odds ratio, OR: 5.1 × 1010, 95% CI (33, 2.5 × 1032)], and less costs [MD: -1 × 104, 95% CI (-1.6 × 104, -4.4 × 103)] but similar time to resume flatus [MD: 0.52, 95% CI (-0.16, 1.1)] and diet [MD: -3.5, 95% CI (-5.6, -1.6)] compared to LAR. A higher rate of total complications [OR: 11, 95% CI (1.2, 140)] was observed in patients who received ESR compared to patients who received LAR. After excluding perforation from the total complication category, the difference of complication between ESR and LAR disappeared [OR: 0.87, 95% CI (0.22, 2.3)]. The recurrence rate [OR: 1.3, 95% CI (0.40, 4.5)] and disease-free survival [hazard ratio: 1.26, 95% CI (0.60, 2.63)] showed no significant difference between ESR and LAR. ESR was associated with better or equivalent perioperative and long-term outcomes compared to ONR, except for positive margin. A subgroup analysis (&lt;2 and 2–5 cm) showed no significantly different results among these three procedures either.ConclusionESR was shown to be a safe and efficient alternative procedure to both LAR and ONR for gGISTs less than 2 cm and within 2–5 cm, respectively, without worsening the oncologic outcomes. However, preoperative assessment of tumor site is of importance for the determination of procedures regarding the increased incidence of a positive margin related to ESR.

Laparoscopic versus Open Resection for Gastric Gastrointestinal Stromal Tumors: A Meta-analysis

2014 ◽  
Vol 80 (1) ◽  
pp. 48-56 ◽  
Author(s):  
Lijun Zheng ◽  
Weixing Ding ◽  
Donglei Zhou ◽  
Liesheng Lu ◽  
Le Yao
Keyword(s):  
Comparative Studies ◽  
Gastrointestinal Stromal Tumors ◽  
Laparoscopic Resection ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Open Resection ◽  
Stromal Tumors ◽  
Gastric Gists ◽  
Complications Rate

We conducted our meta-analysis to compare outcomes between laparoscopic resection and open resection for gastric gastrointestinal stromal tumors (GISTs) from all published comparative studies in the literature. Databases, including PubMed, Embase, Cochrane Library, Ovid, Web of Science, and CNKI, were searched to identify studies comparing outcomes after laparoscopic resection and open resection for gastric GISTs. The meta-analysis was performed by RevMan 5.1. Eleven comparative studies comprising 495 patients were identified. Patients undergoing laparoscopic resection of gastric GISTs were found to have similar operative time (weighted mean difference [WMD], 2.29; 95% confidence interval [CI], -16.01 to 11.43; P = 0.74) and complications rate (odds ratio [OR], 0.76; 95% CI, 0.36 to 1.58; P = 0.46). Less intraoperative blood loss (WMD, -55.91; 95% CI, -90.26 to -21.56; P = 0.001), earlier passing first flatus (WMD, -0.89, 95% CI, -1.60 to -0.18; P = 0.01), earlier having the first liquid diet (WMD, -1.54; 95% CI, -2.44 to -0.64; P = 0.0008), and shorter hospital stay (WMD, -4.25; 95% CI, -5.63 to -2.88; P < 0.00001) were observed in the laparoscopic resection group. The recurrence rate was higher in the group of open resection compared with the group of laparoscopic resection (OR, 0.26; 95% CI, 0.09 to 0.75; P = 0.01). Laparoscopic resection is safe and efficient in the treatment of patients with gastric GISTs as compared with open resection procedure. Laparoscopic resection may be a preferred treatment for gastric GISTs.

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

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.

scholarly journals Meta-analysis of laparoscopic vs. open resection of gastric gastrointestinal stromal tumors

PLoS ONE ◽  
2017 ◽  
Vol 12 (5) ◽  
pp. e0177193 ◽  
Author(s):  
Liangying Ye ◽  
Xiaojing Wu ◽  
Tongwei Wu ◽  
Qijing Wu ◽  
Zhao Liu ◽  
...  
Keyword(s):  
Gastrointestinal Stromal Tumors ◽  
Meta Analysis ◽  
Open Resection ◽  
Stromal Tumors

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.

Laparoscopy-Assisted versus Open Surgery for Gastrointestinal Stromal Tumors of Jejunum and Ileum: Perioperative Outcomes and Long-Term Follow-Up Experience

2012 ◽  
Vol 78 (12) ◽  
pp. 1399-1404 ◽  
Author(s):  
Ping Wan ◽  
Chen Li ◽  
Min Yan ◽  
Chao Yan ◽  
Zheng Gang Zhu
Keyword(s):  
Gastrointestinal Stromal Tumors ◽  
Open Surgery ◽  
Postoperative Outcomes ◽  
Open Group ◽  
Perioperative Outcomes ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Stromal Tumors ◽  
Significant Difference

Whether laparoscopy-assisted resections for gastrointestinal stromal tumors (GISTs) of small bowel can achieve more benefits on the aspect of postoperative outcomes than open surgery remains a question. The aim of this study is to evaluate the benefits of laparoscopy-assisted surgery for GISTs of jejunum and ileum on the perioperative outcomes and long-term relapse-free survival. From January 2004 to December 2010, 81 patients who underwent either laparoscopy-assisted (LAP group, n = 43) or open surgery (OPEN group, n = 38) were included in final analysis after the eligibility criteria. Clinicopathological characteristics of the selected patients were similar between the two groups. Oral intake was significant earlier ( P < 0.001) and postoperative hospital stay duration was significantly shorter ( P < 0.001) in the LAP group than in the OPEN group. The complication rate of patients in the LAP group and OPEN group was 9.3 and 26.3 per cent, respectively ( P = 0.04). No significant difference was observed in terms of 5-year relapse-free survival between LAP and OPEN groups (91.1 vs 93.8%, P = 0.4). Laparoscopy-assisted surgery for GISTs of jejunum and ileum could get preferable short-term postoperative outcomes and similar long-term relapse-free survival compared with open surgery, so it should be recommended for GISTs of the small intestine.

scholarly journals Intravenous versus inhalational maintenance of anesthesia for quality of recovery in adult patients undergoing non-cardiac surgery: A systematic review with meta-analysis and trial sequential analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254271
Author(s):  
Min Shui ◽  
Ziyi Xue ◽  
Xiaolei Miao ◽  
Changwei Wei ◽  
Anshi Wu
Keyword(s):  
Cardiac Surgery ◽  
Sequential Analysis ◽  
Meta Analysis ◽  
Random Effect Model ◽  
Cochrane Library ◽  
Trial Sequential Analysis ◽  
Type I ◽  
Quality Of Recovery ◽  
Significant Difference

Background Intravenous and inhalational agents are commonly used in general anesthesia. However, it is still controversial which technique is superior for the quality of postoperative recovery. This meta-analysis aimed at comparing impact of total intravenous anesthesia (TIVA) versus inhalational maintenance of anesthesia on the quality of recovery in patients undergoing non-cardiac surgery. Methods We systematically searched EMBASE, PubMed, and Cochrane library for randomized controlled trials (RCTs), with no language or publication status restriction. Two authors independently performed data extraction and assessed risk of bias. The outcomes were expressed as mean difference (MD) with 95% confidence interval (CI) based on a random-effect model. We performed trial sequential analysis (TSA) for total QoR-40 scores and calculated the required information size (RIS) to correct the increased type I error. Results A total of 156 records were identified, and 9 RCTs consisting of 922 patients were reviewed and included in the meta-analysis. It revealed a significant increase in total QoR-40 score on the day of surgery with TIVA (MD, 5.91 points; 95% CI, 2.14 to 9.68 points; P = 0.002; I2 = 0.0%). The main improvement was in four dimensions, including “physical comfort”, “emotional status”, “psychological support” and “physical independence”. There was no significant difference between groups in total QoR-40 score (P = 0.120) or scores of each dimension on POD1. The TSA showed that the estimated required information size for total QoR-40 scores was not surpassed by recovered evidence in our meta-analysis. And the adjusted Z-curves did not cross the conventional boundary and the TSA monitoring boundary. Conclusion Low-certainty evidence suggests that propofol-based TIVA may improve the QoR-40 score on the day of surgery. But more evidence is needed for a firm conclusion and clinical significance.

scholarly journals Evaluating the effect of the temporal intra-oral skeletal anchorage device (TISADs) for facilitating the anchorage reinforcement: A meta-analysis and systematic review

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Ali Amiri ◽  
Setareh Khosravi ◽  
Shiva Torabi ◽  
Hadi Golshekan ◽  
Fan Qi
Keyword(s):  
Systematic Review ◽  
Treatment Time ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Cochrane Collaboration ◽  
Mean Difference ◽  
Cochrane Library ◽  
Significant Difference ◽  
The Mean

Objective: In this meta-analysis and systematic review, we aimed to evaluate the effects of the TISADs to facilitates anchorage reinforcement. Methods:  PubMed, Cochrane Library, Embase, ISI, Scopus, Web of Science, LILACS, BBO, OpenGrey, and Google Scholar, were used from the electronic databases until 2020 perform systematic literature. Two reviewers extracted data blindly and independently from various abstracts as well as full texts of articles they considered for data extraction. Using the Cochrane collaboration's tool, we evaluated the publications' quality. Then, we computed the mean difference of TISADs and conventional anchorage groups with a confidence interval (CI) of 95%, restricted maximum likelihood (REML), and random effect model of the mesial movement of molars and their tipping. Moreover, we employed Stata/MP 16 that has been considered the most rapid version of Stata for evaluating meta-analysis. Results: According to our electronic searches, 134 topics and abstracts with potential relevance were identified according to the research design. Finally, five publications matched the required inclusion criteria of the study. In addition, the Cochrane collaboration instrument exhibited all studies with low to moderate biases. Also, the mean difference of mesial molar movement showed less anchorage loss in the TISADs group vs. the controls, and a significant difference between these two groups (MD= -1.74 with a CI of 95%, -2.76, -0.71. P = 0.00). Conclusions: TISADs can reduce treatment time, and TISADs are more effective in enables the anchorage than other methods and higher tipping in the TISADs.

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