Objective To evaluate the effectiveness and safety of microsurgical varicocelectomy (MV) compared with Palomo surgery for male varicocele. Methods MEDLINE (1985-October 2008), EMbase (1990-October 2008), China Biology Medicine Literature Disc Database (1979-October 2008), CMCC (1979-October 2008) and CNKI (1990-October 2008) were searched electronically by computer. Addtionally, four relevant journals were searched manually to get randomized controlled clinical trials about the comparison of MV and Palomo in the treatment of varicocele. Two reviewers screened the literature, evaluated the document quality, extracted the data independently, and checked the result together. RevMan software version 4.3.1 developed by the Cochrane Collaborative was used for meta-analysis. Results Seven RCTs reporting data on effectiveness and safety of MV versus palomo surgery were included. Meta-analyses showed that MV was superior to palomo surgery in improving sperm motility [RR= 1.21, 95%CI (1.09, 1.34), P=0.000 5], concentration [RR= 1.35, 95%CI (1.20, 1.51), Plt;0.000 01] and also postoperation natural pregnancy rate [RR= 1.34，95%CI (1.08, 1.66), P=0.008]. While the MV group had a longer operation time in unilateral [WMD= 23.01 min, 95%CI (16.86, 29.16), Plt;0.000 01] or bilateral varicocele [WMD= 34.05 min, 95%CI (4.9, 63.21), P=0.02] than Palomo surgery. The recovery time difference in the two groups was not significant. The incidence of varicocele recurrence was significantly lower in the MV group than in the Palomo group [RR= 0.17, 95%CI (0.10, 0.31), Plt;0.000 01], and the incidence of postoperative hydrocele was also significantly lower in the MV group than in the Palomo group [RR= 0.10, 95%CI (0.05, 0.23), Plt;0.000 01]. The incidences of wound infection, scrotal hematoma and scrotal pain were similar in both groups. Conclusion The evidence shows that MV is superior to Palomo surgery because of the higher sperm improvement rate, higher natural pregnancy rate and lower incidence of recurrence and hydrocele. But the operation time is longer. The long-term effect and overall effectiveness of MV need more high-quality RCTs to confirm.
Objective To evaluate the strategy of chemoradiotherapy following endoscopic R0 resection for esophageal cancer in M3-T1b stage. Methods There were 45 esophageal cancer patients with M3-T1b stage with endoscopic R0 resection followed by additional chemoradiotherapy from ECETC (Esophageal Cancer Endoscopic Therapy Consortium) as a trial group with 34 males and 11 females at age of 61.37±7.14 years. There were 90 patients with esophagectomy from Fudan University Shanghai Cancer Center as a control group with 63 males and 27 females at age of 61.04±8.17 years. Propensity score match (1:2) was used to balance the factors: gender, age, position, depth of invasion and lymphovascular invasion (LVI), which may influence the outcomes. Overall survival (OS) rate, relapse free survival (RFS) rate, and local recurrence rate were compared between the two groups. Result There was no statistical difference (HR=2.66 with 95%CI 0.87 to 8.11, P=0.179) in terms of OS rate between the two groups. One, two and three years overall survival rate of patients in the control group was 93%, 86%, and 84%, respectively. Nobody died in the trial group within 3 years after surgery. The RFS rate between the two groups didn’t significantly differ (HR=1.48, 95% CI 0.66 to 3.33, P=0.389). One, two and three years RFS rate of patients in the contorl group was 87%, 78%, and 76%, respectively, while 97%, 93%, and 73% in the trial group, respectively. The local recurrence rates between the two groups didn’t significantly differ either ( HR=0.53, 95%CI 0.13 to 2.18, P=0.314). One, two and three years local recurrence rate of patients in the control group was 5%, 6% and 6%, respectively, while 0%, 0% and 21% in the trial group, respectively. Conclusion Similar outcomes are found regarding OS, RFS and local recurrence rates between the two groups. The strategy of endoscopic R0 resection followed by additional chemoradiotherapy has prospect for the treatment of esophageal cancer in M3-T1b stage. And this kind of therapy may be provided for those with risk factors or can not tolerate surgery.