scholarly journals Impact of Prostate Size on the Outcomes of Radical Prostatectomy: A Systematic Review and Meta-Analysis

Cancers ◽  
2021 ◽  
Vol 13 (23) ◽  
pp. 6130
Author(s):  
Omar Fahmy ◽  
Nabil A. Alhakamy ◽  
Osama A. A. Ahmed ◽  
Mohd Ghani Khairul-Asri
Keyword(s):  
Systematic Review ◽  
Radical Prostatectomy ◽  
Blood Loss ◽  
Meta Analysis ◽  
Oncological Outcome ◽  
Estimated Blood Loss ◽  
Prostate Size ◽  
Oncological Results ◽  
Complications Rate ◽  
The Impact

Background: The impact of prostate size on the radical prostatectomy outcome is not clear. Several published reports have shown conflicting results. Objectives: To investigate the effect of prostate size on the surgical, functional and oncological results of radical prostatectomy. Methods: A systematic review and meta-analysis were carried out in accordance with the PRISMA criteria. Finally, we investigated the research that reported on the impact of prostate size on radical prostatectomy outcome. The Review Manager (RevMan) software version 5.4 was utilized for statistical analysis. Results: Eighteen studies including 12,242 patients were included. Estimated blood loss was significantly less with smaller prostates (Z = 3.01; p = 0.003). The complications rate was 17% with larger prostates, compared to 10% for smaller prostates (Z = 5.73; p < 0.00001). Seventy-three percent of patients with a smaller prostate were continent within one month, compared to 64% with a larger prostate (Z = 1.59; p = 0.11). The rate of positive surgical margins was significantly higher with smaller prostates (20.2% vs. 17.8%). (Z = 2.52; p = 0.01). The incidence of biochemical recurrence was higher with smaller prostates (7.8% vs. 4.9%) (Z = 1.87; p = 0.06). Conclusion: Larger prostate size is associated with more blood loss and a higher rate of complications. However, the oncological outcome is better, compared to that in patients with smaller prostates. The impact of the size on the functional outcome is not clear.

scholarly journals Open versus arthroscopic ankle arthrodesis: A systemic review and meta-analysis

2020 ◽  
Author(s):  
Tsz Ngai Mok ◽  
Qiyu He ◽  
SOUNDARYA PANNEERSELVAM ◽  
Huajun Wang ◽  
Huige Hou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Cohort Studies ◽  
Open Surgery ◽  
Meta Analysis ◽  
Fusion Rate ◽  
Ankle Arthritis ◽  
Tourniquet Time ◽  
Pooled Data ◽  
Estimated Blood Loss

Abstract Background: Osteoarthritis (OA) is a growing health concern that affects approximately 27 million people in the USA and is associated with a $185 billion annual cost burden. Choosing between open surgery and arthroscopic arthrodesis for ankle arthritis is still controversial. This study compared arthroscopic arthrodesis and open surgery by performing a systematic review and meta-analysis. Methods: For the systematic review, a literature search was conducted in four English databases (PubMed, Embase, Medline and the Cochrane Library) from inception to February 2020. Two prospective cohort studies and 8 retrospective cohort studies, enrolling a total of 548 patients with ankle arthritis, were included. Result: For fusion rate, the pooled data showed a significantly higher rate of fusion during arthroscopic arthrodesis compared with open surgery (odds ratio 0.25, 95% CI 0.11 to 0.57, p = 0.0010). Regarding estimated blood loss, the pooled data showed significantly less blood loss during arthroscopic arthrodesis compared with open surgery (WMD 52.04, 95% CI 14.14 to 89.94, p = 0.007). For tourniquet time, the pooled data showed a shorter tourniquet time during arthroscopic arthrodesis compared with open surgery (WMD 22.68, 95% CI 1.92 to 43.43, p = 0.03). For length of hospital stay, the pooled data showed less hospitalisation time for patients undergoing arthroscopic arthrodesis compared with open surgery (WMD 1.62, 95% CI 0.97 to 2.26, p < 0.00001). The pooled data showed better recovery for the patients who underwent arthroscopic arthrodesis compared with open surgery at 1 year (WMD 14.73, 95% CI 6.66 to 22.80, p = 0.0003). Conclusion: In conclusion, arthroscopic arthrodesis was associated with a higher fusion rate, smaller estimated blood loss, shorter tourniquet time, shorter length of hospitalisation and better functional improvement at 1 year than open surgery.

scholarly journals Comparison of common perioperative blood loss estimation techniques: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Lara Gerdessen ◽  
Patrick Meybohm ◽  
Suma Choorapoikayil ◽  
Eva Herrmann ◽  
Isabel Taeuber ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Measurement Errors ◽  
Meta Analysis ◽  
Loss Estimation ◽  
Visual Methods ◽  
Mixed Effect ◽  
Estimated Blood Loss ◽  
Blood Loss Estimation ◽  
Colorimetric Methods

Abstract Estimating intraoperative blood loss is one of the daily challenges for clinicians. Despite the knowledge of the inaccuracy of visual estimation by anaesthetists and surgeons, this is still the mainstay to estimate surgical blood loss. This review aims at highlighting the strengths and weaknesses of currently used measurement methods. A systematic review of studies on estimation of blood loss was carried out. Studies were included investigating the accuracy of techniques for quantifying blood loss in vivo and in vitro. We excluded nonhuman trials and studies using only monitoring parameters to estimate blood loss. A meta-analysis was performed to evaluate systematic measurement errors of the different methods. Only studies that were compared with a validated reference e.g. Haemoglobin extraction assay were included. 90 studies met the inclusion criteria for systematic review and were analyzed. Six studies were included in the meta-analysis, as only these were conducted with a validated reference. The mixed effect meta-analysis showed the highest correlation to the reference for colorimetric methods (0.93 95% CI 0.91–0.96), followed by gravimetric (0.77 95% CI 0.61–0.93) and finally visual methods (0.61 95% CI 0.40–0.82). The bias for estimated blood loss (ml) was lowest for colorimetric methods (57.59 95% CI 23.88–91.3) compared to the reference, followed by gravimetric (326.36 95% CI 201.65–450.86) and visual methods (456.51 95% CI 395.19–517.83). Of the many studies included, only a few were compared with a validated reference. The majority of the studies chose known imprecise procedures as the method of comparison. Colorimetric methods offer the highest degree of accuracy in blood loss estimation. Systems that use colorimetric techniques have a significant advantage in the real-time assessment of blood loss.

Open versus arthroscopic ankle arthrodesis: A systematic review and meta-analysis

2020 ◽  
Author(s):  
Tsz Ngai Mok ◽  
Qiyu He ◽  
Soundarya Panneerselvam ◽  
Huajun Wang ◽  
Huige Hou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Cohort Studies ◽  
Open Surgery ◽  
Meta Analysis ◽  
Fusion Rate ◽  
Ankle Arthritis ◽  
Tourniquet Time ◽  
Pooled Data ◽  
Estimated Blood Loss

Abstract Background: Osteoarthritis (OA) is a growing health concern that affects approximately 27 million people in the USA and is associated with a $185 billion annual cost burden . Choosing between open surgery and arthroscopic arthrodesis for ankle arthritis is still controversial. This study compared arthroscopic arthrodesis and open surgery by performing a systematic review and meta-analysis. Methods: For the systematic review, a literature search was conducted in four English databases (PubMed, Embase, Medline and the Cochrane Library) from inception to February 2020. Two prospective cohort studies and 8 retrospective cohort studies, enrolling a total of 548 patients with ankle arthritis, were included. Result: For fusion rate, the pooled data showed a significantly higher rate of fusion during arthroscopic arthrodesis compared with open surgery (odds ratio 0.25, 95% CI 0.11 to 0.57, p = 0.0010). Regarding estimated blood loss, the pooled data showed significantly less blood loss during arthroscopic arthrodesis compared with open surgery (WMD 52.04, 95% CI 14.14 to 89.94, p = 0.007). For tourniquet time, the pooled data showed a shorter tourniquet time during arthroscopic arthrodesis compared with open surgery (WMD 22.68, 95% CI 1.92 to 43.43, p = 0.03). For length of hospital stay, the pooled data showed less hospitalisation time for patients undergoing arthroscopic arthrodesis compared with open surgery (WMD 1.62, 95% CI 0.97 to 2.26, p < 0.00001). The pooled data showed better recovery for the patients who underwent arthroscopic arthrodesis compared with open surgery at 1 year (WMD 14.73, 95% CI 6.66 to 22.80, p = 0.0003). Conclusion: In conclusion, arthroscopic arthrodesis was associated with a higher fusion rate, smaller estimated blood loss, shorter tourniquet time, shorter length of hospitalisation and better functional improvement at 1 year than open surgery.

scholarly journals Comparing robotic, laparoscopic and open cystectomy: a systematic review and meta-analysis

2015 ◽  
Vol 87 (1) ◽  
pp. 41 ◽  
Author(s):  
Thomas Fonseka ◽  
Kamran Ahmed ◽  
Saied Froghi ◽  
Shahid A. Khan ◽  
Prokar Dasgupta ◽  
...  
Keyword(s):  
Systematic Review ◽  
Radical Cystectomy ◽  
Meta Analysis ◽  
Oncological Outcome ◽  
Outcome Data ◽  
Lymph Node Yield ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
Lower Complication ◽  
Open Radical Cystectomy

Objective: To conduct a systematic review and meta-analysis comparing outcomes between Open Radical Cystectomy (ORC), Laparoscopic Radical Cystectomy (LRC) and Robot-assisted Radical Cystectomy (RARC). RARC is to be compared to LRC and ORC and LRC compared to ORC. Material and methods: A systematic review of the literature was conducted, collating studies comparing RARC, LRC and ORC. Surgical and oncological outcome data were extracted and a meta-analysis was performed. Results: Twenty-four studies were selected with total of 2,104 cases analyzed. RARC had a longer operative time (OPT) compared to LRC with no statistical difference between length of stay (LOS) and estimated blood loss (EBL). RARC had a significantly shorter LOS, reduced EBL, lower complication rate and longer OPT compared to ORC. There were no significant differences regarding lymph node yield (LNY) and positive surgical margins (PSM.) LRC had a reduced EBL, shorter LOS and increased OPT compared to ORC. There was no significant difference regarding LNY. Conclusion: RARC is comparable to LRC with better surgical results than ORC. LRC has better surgical outcomes than ORC. With the unique technological features of the robotic surgical system and increasing trend of intra-corporeal reconstruction it is likely that RARC will become the surgical option of choice.

scholarly journals A systematic review and meta-analysis of endoscopic versus open treatment of craniosynostosis. Part 1: the sagittal suture

2018 ◽  
Vol 22 (4) ◽  
pp. 352-360 ◽  
Author(s):  
Han Yan ◽  
Taylor J. Abel ◽  
Naif M. Alotaibi ◽  
Melanie Anderson ◽  
Toba N. Niazi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Blood Loss ◽  
Open Surgery ◽  
Meta Analysis ◽  
Operating Time ◽  
Transfusion Rate ◽  
Endoscopic Procedures ◽  
Estimated Blood Loss ◽  
Cosmetic Outcomes

OBJECTIVEIn this systematic review and meta-analysis the authors aimed to directly compare open surgical and endoscope-assisted techniques for the treatment of sagittal craniosynostosis, focusing on the outcomes of blood loss, transfusion rate, length of stay, operating time, complication rate, cost, and cosmetic outcome.METHODSA literature search was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant articles were identified from 3 electronic databases (MEDLINE, EMBASE, and CENTRAL [Cochrane Central Register of Controlled Trials]) from their inception to August 2017. The quality of methodology and bias risk were assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Effect estimates between groups were calculated as standardized mean differences with 95% CIs. Random and fixed effects models were used to estimate the overall effect.RESULTSOf 316 screened records, 10 met the inclusion criteria, of which 3 were included in the meta-analysis. These studies reported on 303 patients treated endoscopically and 385 patients treated with open surgery. Endoscopic surgery was associated with lower estimated blood loss (p < 0.001), shorter length of stay (p < 0.001), and shorter operating time (p < 0.001). From the literature review of the 10 studies, transfusion rates for endoscopic procedures were consistently lower, with significant differences in 4 of 6 studies; the cost was lower, with differences ranging from $11,603 to $31,744 in 3 of 3 studies; and the cosmetic outcomes were equivocal (p > 0.05) in 3 of 3 studies. Finally, endoscopic techniques demonstrated complication rates similar to or lower than those of open surgery in 8 of 8 studies.CONCLUSIONSEndoscopic procedures are associated with lower estimated blood loss, operating time, and days in hospital. Future long-term prospective registries may establish advantages with respect to complications and cost, with equivalent cosmetic outcomes. Larger studies evaluating patient- or parent-reported satisfaction and optimal timing of intervention as well as heterogeneity in outcomes are indicated.

The role of bedside assistant during robot assisted radical prostatectomy: Is more experience better? Analysis on perioperative and clinical outcomes

2020 ◽  
pp. 039156032095108
Author(s):  
Mario Salvatore Mangano ◽  
Claudio Lamon ◽  
Francesco Beniamin ◽  
Alberto De Gobbi ◽  
Matteo Ciaccia ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Blood Loss ◽  
Clinical Outcomes ◽  
Operative Time ◽  
Surgical Margin ◽  
Positive Surgical Margin ◽  
Robot Assisted ◽  
Estimated Blood Loss ◽  
Bedside Assistant ◽  
The Impact

Objectives: To analyze the impact of the bedside assistant’s experience during RARP. It is believed that the outcome of robotic surgery during Robot Assisted Radical Prostatectomy (RARP) for prostate cancer depends not only on the console surgeon’s experience. Materials and Methods: All consecutive RARPs from January 2017 to March 2018 were sourced from a prospectively maintained database. All cases were performed by the same surgeon. He was supported by three bedside assistants: one with bedside and console experience, one only with relevant bedside experience, one basically inexperienced. The patient’s parameters analyzed: age, Body Mass Index (BMI), previous abdominal surgery, prostate volume (by TRUS), pre-operative PSA, bioptic grading. Surgical outcomes analyzed included skin-to-skin operative time and estimated blood loss; clinical outcomes included length of hospital stay and time to catheter removal; the oncological outcome was represented by positive surgical margin rate. Results: A total of 116 RARPs were identified: 38 RARPs were performed with the console experienced bedside assistant, 38 with the experienced one, 40 with the novice one. The variables were similar between the three groups. As far as outcomes are concerned, there were no statistically significant differences between the three bedside assistants in terms of operative time, estimated blood loss, length of stay, days of catheterization, positive surgical margin rate.

scholarly journals The impact of mini-invasive right hepatectomy in the setting of living donation: a meta-analysis

2021 ◽  
Author(s):  
Quirino Lai ◽  
Francesco Giovanardi ◽  
Gianluca Mennini ◽  
Giammauro Berardi ◽  
Massimo Rossi
Keyword(s):  
Liver Resection ◽  
Blood Loss ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Medical Community ◽  
Cochrane Library ◽  
Right Hepatectomy ◽  
Donor Liver Transplantation ◽  
Estimated Blood Loss ◽  
The Impact

AbstractAdult-to-adult living-donor liver transplantation (A2ALDLT) represents a challenging procedure, mainly when the right hepatic lobe is donated. Therefore, especially in Western countries, the medical community still considers it a “risky procedure”. The present meta-analysis investigated the postoperative results reported in donors undergoing right hepatectomy for A2ALDLT through a minimally invasive liver resection (MILR) vs. open liver resection (OLR) approach, with the intent to clarify the hypothesis that the MILR approach should minimize the risks for the donor. A systematic literature search was performed using MEDLINE-PubMed, Cochrane Library, and EMBASE electronic databases. The primary outcome investigated was the complication rate after transplant. Fifteen studies were included (n = 2094; MILR = 553 vs. OLR = 1541). The MILR group only merged the statistical relevance in terms of advantage in terms of a lower number of complications (OR = 0.771, 95% CI 0.578–1.028; P value = 0.077). Investigating the complications ≥ IIIa according to the Dindo-Clavien classification, the estimated blood loss, and the length of hospital stay, no statistical difference was reported between the two groups. MILR represents a novel and promising approach for improving the results in A2ALDLT. However, no benefits have been reported regarding blood loss, length of stay, and postoperative complications. More extensive experiences are needed to re-evaluate the impact of MILR in right lobe live donation.

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