Impact of Lymphadenectomy on the Oncologic Outcome of Patients with Adrenocortical Carcinoma—A Systematic Review and Meta-Analysis

(1) Background: Locoregional lymphadenectomy (LND) in adrenocortical carcinoma (ACC) may impact oncological outcome, but the findings from individual studies are conflicting. The aim of this systematic review and meta-analysis was to determine the oncological value of LND in ACC by summarizing the available literature. (2) Methods: A systematic search on studies published until December 2020 was performed according to the PRISMA statement. The primary outcome was the impact of lymphadenectomy on overall survival (OS). Two separate meta-analyses were performed for studies including patients with localized ACC (stage I–III) and those including all tumor stages (I–IV). Secondary endpoints included postoperative mortality and length of hospital stay (LOS). (3) Results: 11 publications were identified for inclusion. All studies were retrospective studies, published between 2001–2020, and 5 were included in the meta-analysis. Three studies (N = 807 patients) reported the impact of LND on disease-specific survival in patients with stage I–III ACC and revealed a survival benefit of LND (hazard ratio (HR) = 0.42, 95% confidence interval (95% CI): 0.26–0.68). Based on results of studies including patients with ACC stage I–IV (2 studies, N = 3934 patients), LND was not associated with a survival benefit (HR = 1.00, 95% CI: 0.70–1.42). None of the included studies showed an association between LND and postoperative mortality or LOS. (4) Conclusion: Locoregional lymphadenectomy seems to offer an oncologic benefit in patients undergoing curative-intended surgery for localized ACC (stage I–III).

Download Full-text

Impact of BRAF mutations on prognosis and immunotherapy response in microsatellite instability/mismatch repair deficient metastatic colorectal cancer: A systematic review and meta-analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.3557 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 3557-3557

Author(s):

Robin Park ◽

Laércio Lopes da Silva ◽

Sunggon Lee ◽

Anwaar Saeed

Keyword(s):

Colorectal Cancer ◽

Systematic Review ◽

Braf Mutation ◽

Meta Analysis ◽

Stage Iv ◽

Stage I ◽

Prognostic Impact ◽

Braf Mutations ◽

Mutation Status ◽

The Impact

3557 Background: Mismatch repair deficient/microsatellite instability high (dMMR/MSI-H) colorectal cancer (CRC) defines a molecular subtype with distinct clinicopathologic characteristics including an excellent response to immunotherapy. Although BRAF mutations are established as a negative prognostic marker in CRC, whether they retain their negative prognostic impact in or alter the response to immunotherapy in dMMR/MSI-H CRC remains unknown. Herein, we present a systematic review and meta-analysis of the impact of BRAF mutations on the overall survival (OS) and immune checkpoint inhibitor (ICI) response in dMMR/MSI-H CRC. Methods: Studies published from inception to 26 January 2021 were searched in PubMed, Embase, and major conference proceedings (AACR, ASCO, and ESMO). Eligible studies included the following: 1) observational studies reporting outcomes based on BRAF mutation status in dMMR/MSI-H CRC patients and 2) experimental studies of ICI reporting outcomes based on BRAF mutation status in dMMR/MSI-H CRC patients. A summary hazard ratio (HR) was calculated for OS in BRAF mutated ( BRAFmut) vs. BRAF wild type ( BRAFwt) patients (pts) with the random effects meta-analysis (REM). A summary odds ratio (OR) was calculated for objective response rate (ORR) in BRAFmut vs. BRAFwt pts treated with ICI with the REM. Results: Database search conducted according to PRISMA guidelines found 4221 studies in total. Initial screening identified 30 studies and after full-text review, 9 studies (N = 4158 pts) were included for the meta-analysis of prognosis (analysis A) and 3 studies (N = 178 pts) were included for the meta-analysis of ICI response (analysis B). The outcome measures are summarized in the table below. Analysis A showed that in stage I-IV dMMR/MSI-H CRC pts, BRAFmut was associated with worse OS than BRAFwt (HR 1.57, 1.23-1.99). The heterogeneity was low (I2 = 21%). Subgroup analysis showed no significant difference in the prognostic impact of BRAF mutation status between stage IV only and stage I-IV CRC pts. Analysis B showed no difference in ORR (OR 1.04, 0.48-2.25) between BRAFmut vs. BRAFwt dMMR/MSI-H pts who received ICI. The heterogeneity was low (I2 = 0%). Conclusions: BRAF mutations retain their negative prognostic impact in dMMR/MSI-H stage I-IV and stage IV CRC but are not associated with differential ICI response. Limitations include the following: analysis A was based on retrospective studies; also, the impact of BRAF status on the survival outcome of ICI could not be assessed due to limited number of studies.[Table: see text]

Download Full-text

Impact of trainee involvement in esophagectomy on clinical outcomes: a narrative systematic review of the literature

Diseases of the Esophagus ◽

10.1093/dote/doz063 ◽

2019 ◽

Vol 32 (10) ◽

pp. 1-8

Author(s):

P Prasad ◽

M Navidi ◽

A Immanuel ◽

S M Griffin OBE ◽

A W Phillips

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Meta Analysis ◽

Neoadjuvant Treatment ◽

Length Of Hospital Stay ◽

High Volume ◽

Cochrane Library ◽

Published Data ◽

Meta Analyses ◽

The Impact

SUMMARY Changes in the structure of surgical training have affected trainees’ operative experience. Performing an esophagectomy is being increasingly viewed as a complex technical skill attained after completion of the routine training pathway. This systematic review aimed to identify all studies analyzing the impact of trainee involvement in esophagectomy on clinical outcomes. A search of the major reference databases (Cochrane Library, MEDLINE, EMBASE) was performed with no time limits up to the date of the search (November 2017). Results were screened in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and study quality assessed using the MINORS (Methodological Index for Non-Randomized Studies) criteria. Four studies that included a total of 42 trainees and 16 consultants were identified, which assessed trainee involvement in open esophagogastric resectional surgery. A total of 1109 patients underwent upper gastrointestinal procedures, of whom 904 patients underwent an esophagectomy. Preoperative characteristics, histology, neoadjuvant treatment, and overall length of hospital stay were comparable between groups. One study found higher rates of anastomotic leaks in procedures primarily performed by trainees as compared to consultants (P < 0.01)—this did not affect overall morbidity or survival; however, overall anastomotic leak rates from the published data were 10.4% (trainee) versus 6.3% (trainer) (P = 0.10). A meta-analysis could not be performed due to the heterogeneity of data. The median MINORS score for the included studies was 13 (range 11–15). This study demonstrates that training can be achieved with excellent results in high-volume centers. This has important implications on the consent process and training delivered, as patients wish to be aware of the risks involved with surgery and can be reassured that appropriately supervised trainee involvement will not adversely affect outcomes.

Download Full-text

Pneumonia Is Associated with Increased Mortality in Hospitalized COPD Patients: A Systematic Review and Meta-Analysis

Respiration ◽

10.1159/000510615 ◽

2021 ◽

Vol 100 (1) ◽

pp. 64-76

Author(s):

Yan Yu ◽

Wei Liu ◽

Hong-Li Jiang ◽

Bing Mao

Keyword(s):

Systematic Review ◽

Mechanical Ventilation ◽

Hospital Stay ◽

Readmission Rate ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Mortality And Morbidity ◽

Icu Stay ◽

Copd Patients ◽

The Impact

Background: Patients with chronic obstructive pulmonary disease (COPD) are at a heightened risk of pneumonia. Whether coexisting community-acquired pneumonia (CAP) can predict increased mortality in hospitalized COPD patients is still controversial. Objective: This systematic review and meta-analysis aims to assess the association between CAP and mortality and morbidity in COPD patients hospitalized for acute worsening of respiratory symptoms. Methods: In this review, cohort studies and case-control studies investigating the impact of CAP in hospitalized COPD patients were retrieved from 4 electronic databases from inception until December 2019. Methodological quality of included studies was assessed using Newcastle-Ottawa Quality Assessment Scale. The primary outcome was mortality. The secondary outcomes included length of hospital stay, need for mechanical ventilation, intensive care unit (ICU) admission, length of ICU stay, and readmission rate. The Mantel-Haenszel method and inverse variance method were used to calculate pooled relative risk (RR) and mean difference (MD), respectively. Results: A total of 18 studies were included. The presence of CAP was associated with higher mortality (RR = 1.85; 95% CI: 1.50–2.30; p < 0.00001), longer length of hospital stay (MD = 1.89; 95% CI: 1.19–2.59; p < 0.00001), more need for mechanical ventilation (RR = 1.48; 95% CI: 1.32–1.67; p < 0.00001), and more ICU admissions (RR = 1.58; 95% CI: 1.24–2.03; p = 0.0002) in hospitalized COPD patients. CAP was not associated with longer ICU stay (MD = 5.2; 95% CI: −2.35 to 12.74; p = 0.18) or higher readmission rate (RR = 1.02; 95% CI: 0.96–1.09; p = 0.47). Conclusion: Coexisting CAP may be associated with increased mortality and morbidity in hospitalized COPD patients, so radiological confirmation of CAP should be required and more attention should be paid to these patients.

Download Full-text

907 THE IMPACT OF POST-SURGICAL COMPLICATIONS ON LONG TERM ONCOLOGICAL OUTCOMES FOLLOWING CURATIVE RESECTION OF COLORECTAL CANCER (STAGE I-III). A SYSTEMATIC REVIEW AND META-ANALYSIS.

Gastroenterology ◽

10.1016/s0016-5085(20)34532-7 ◽

2020 ◽

Vol 158 (6) ◽

pp. S-1542

Author(s):

Noor Mualla ◽

Maryam R Hussain ◽

Muhammad Akrmah

Keyword(s):

Colorectal Cancer ◽

Systematic Review ◽

Surgical Complications ◽

Curative Resection ◽

Meta Analysis ◽

Stage I ◽

Cancer Stage ◽

Oncological Outcomes ◽

The Impact

Download Full-text

Association of adjuvant chemoradiotherapy with survival in patients with resected gallbladder carcinoma: A systematic review and meta-analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.477 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 477-477 ◽

Cited By ~ 1

Author(s):

Eui Kyu Chie ◽

Byoung Hyuck Kim ◽

Jeanny Kwon ◽

Kyubo Kim

Keyword(s):

Systematic Review ◽

Lymph Node ◽

Gallbladder Carcinoma ◽

Survival Benefit ◽

Meta Analysis ◽

Convincing Evidence ◽

Adjuvant Chemoradiotherapy ◽

Curative Surgery ◽

Risk Of Death ◽

The Impact

477 Background: The impact of adjuvant radiotherapy (ART) on survival in gallbladder carcinoma (GBC) remains underexplored, and conflicting results have been reported. We conducted a systematic review and meta-analysis to clarify the impact of ART in GBC. Methods: Systematic literature search was performed in the several databases following the PRISMA guidelines from inception to August 2016. We included the studies which reported survival outcome in the patients with or without ART following curative surgery. Results: Fourteen retrospective studies including 9364 analyzable patients met all inclusion criteria, but most of them had a moderate risk of bias. Generally, ART group had more patients with unfavorable characteristics than the surgery alone group. Nevertheless, pooled results showed that ART significantly reduced the risk of death (HR, 0.54; 95% CI, 0.44-0.67; p < 0.001) and recurrence (HR, 0.61; 95% CI, 0.38-0.98; p = 0.04) compared to the surgery alone group. Exploratory analyses demonstrated that subgroup of patients with lymph node positive disease (HR, 0.61; p < 0.001) and R1 resection (HR, 0.55; p < 0.001) had survival benefit from ART, while those with lymph node negative disease did not (HR 1.06; p = 0.78). No evidence of publication bias was found (p = 0.663). Conclusions: This work is the first meta-analysis evaluating the role of ART and provides convincing evidence that ART may offer survival benefit, especially in high risk patients. However, further confirmation with a randomized prospective study is needed to clarify the subgroup of GBC patients who would most benefit from ART.

Download Full-text

637 ANALYSIS OF THE OUTCOMES OF HAND-SEWN COMPARED TO THE STAPLED ANASTOMOSIS AFTER TOTAL GASTRECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS.

Diseases of the Esophagus ◽

10.1093/dote/doab052.637 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Fernanda Honório ◽

João Emílio Pinheiro Filho ◽

Luca Tristão ◽

Clara Santos ◽

Letícia Datrino ◽

...

Keyword(s):

Systematic Review ◽

Total Gastrectomy ◽

Surgical Outcomes ◽

Meta Analysis ◽

Postoperative Mortality ◽

Length Of Hospital Stay ◽

Operation Time ◽

Mean Difference ◽

Stapled Anastomosis ◽

Esophageal Anastomosis

Abstract The complications related to esophagojejunal anastomosis are among the leading issues in the postoperative period of total gastrectomy. This review aims to evaluate the surgical outcomes of hand-sewn esophageal anastomosis compared to mechanical anastomosis for the reconstruction of total gastrectomy. Methods A systematic review and meta-analysis of comparative studies evaluating hand-sewn and stapled anastomosis was performed. Results A total of 12 studies were selected, comprising 1761 individuals. The operation time was higher in the hand-sewn anastomosis group (mean difference [MD] = 22.13 minutes; 95%CI: 3.97, 40.29). However, the risk for anastomotic fistula was not different between the groups (difference risk [DR] = 0.00; 95%CI: −0.03, 0.03). Also, the rate of intracavitary abscess (DR = -0.02; 95%CI: −0.07, 0.02); the reoperation rate (DR = -0.00; 95%CI: −0.01, 0.01); postoperative complications (DR = 0.12; 95%CI: −0.01, 0.25); postoperative mortality (DR = 0.02; 95%CI: −0.02, 0.06); anastomotic stenosis (DR = -0.01; 95%CI: −0.03, 0.00); and length of hospital stay (mean difference [MD] = 3.52 days; 95%CI: −0.49, 7.53) were no different between groups. Conclusion The results indicate that the hand-sewn and stapled esophageal anastomosis have similar surgical outcomes. Stapled anastomosis has a shorter operation time being.

Download Full-text

Effects of Enteral Immunonutrition in Patients Undergoing Pancreaticoduodenectomy: A Meta-Analysis of Randomized Controlled Trials

Annals of Nutrition and Metabolism ◽

10.1159/000495468 ◽

2018 ◽

Vol 74 (1) ◽

pp. 53-61 ◽

Cited By ~ 10

Author(s):

Haonan Guan ◽

Sanwei Chen ◽

Qiang Huang

Keyword(s):

Hospital Stay ◽

Randomized Controlled Trials ◽

Fixed Effects ◽

Meta Analysis ◽

Postoperative Mortality ◽

Length Of Hospital Stay ◽

Infectious Complications ◽

Controlled Trials ◽

Randomized Controlled ◽

The Impact

Background: The effect of enteral immunonutrition (EIN) in patients undergoing pancreaticoduodenectomy (PD) is still doubtful. This meta-analysis aimed to assess the impact of EIN on postoperative clinical outcomes for patients undergoing PD. Methods: A literature search was carried out to identify all of the randomized controlled trials (RCTs) concerning the use of EIN for PD. Data collection ended on April 1, 2018. Pooled risk ratios (RRs) and the mean difference (MD) with a 95% CI were calculated using fixed effects or random effects models. The analyses were performed with RevMan 5.3.5. Results: Four RCTs with a total of 299 patients were included. Immunonutrition reduced the incidence of postoperative infectious complications (RR 0.58, 95% CI 0.37–0.92; p = 0.02) and shortened the length of hospital stay (MD –1.79, 95% CI –3.40 to 0.18; p = 0.03). Conversely, there were no significant differences in the incidence of overall postoperative complications (RR 0.81, 95% CI 0.62–1.05; p = 0.11), non-infectious complications (RR 0.94, 95% CI 0.69–1.28; p = 0.70) and postoperative mortality (RR 2.43, 95% CI 0.37–16.10; p = 0.36). Conclusions: EIN reduced postoperative infectious complications and shortened the length of the hospital stay; immunonutrition should be encouraged in patients undergoing PD.

Download Full-text