ObjectiveTo systematically evaluate the influence of posterior mediastinal and retrosternal route on the incidence of complications in patients with esophageal carcinoma after esophagectomy. MethodsA systematic literature search for studies which were published on PubMed, EMbase, CBM, VIP was performed from database establishment to April 2014. We included randomized controlled trials and case control studies related to the influence of two routes on the incidence of complications of patients with esophagectomy. We assessed the methodology quality of included researches, and extracted data. RevMan 5.2 was used for meta-analysis. ResultsA total of 23 studies including 7 randomized controlled trials and 16 case control studies were included in this study. Meta-analysis showed that there was statistically significant difference in case control studies related to anastomotic leakage between two groups[OR=0.39, 95%CI (0.30, 0.50), P < 0.01]. However, no statistical difference in anastomotic stricture was observed between the two groups[randomized controlled trials:RR=0.80, 95%CI (0.49, 1.30), P=0.36; case control studies:OR=0.64, 95%CI (0.40, 1.03), P=0.07]. And there was no statistical difference in cardiac complications[randomized controlled trials:RR=0.70, 95%CI (0.46, 1.06), P=0.09; case control studies:OR=1.13, 95%CI (0.70, 1.81), P=0.62]. There was also no statistical difference in pulmonary complications[randomized controlled trials:RR=1.27, 95%CI(0.92, 1.75), P=0.14; case control studies:OR=0.91, 95%CI (0.66, 1.27), P=0.59]. Besides, there was also no statistical difference in postoperative mortality[randomized controlled trials:RR=0.47, 95%CI (0.19, 1.16), P=0.10; case control studies:OR=0.18, 95%CI (0.03, 1.01), P=0.05]. ConclusionFor patients with esophageal carcinoma undergoing esophagectomy and reconstruction, the incidence of anastomotic leakage was significantly lower with posterior mediastinal route than that of retrosternal route.
ObjectiveTo compare the complication morbidity of mechanical and hand-sewn esophagogastric anastomosis systemically. MethodsMedline (January 1960 to June 2015), EMbase (January 1980 to June 2015), Cochrane Library (January 1996 to June 2015), Web of Science (January 1980 to June 2015) and other databases were searched to identify randomized controlled trials (RCTs) about comparing the complication morbidity of hand-sewn and mechanical anastomosis. Moreover, the references were searched by search engines such as Google Scholar. Papers were screened according to the inclusion and exclusion criteria. And then the data were extracted. The quality of current meta-analysis was assessed by GRADE profiler 3.6 software. The meta-analysis was conducted using Stata 12.0 software. ResultsA total of 1 611 patients in 14 RCTs were reviewed. The results suggested that the anastomatic leakage rate of mechanical method showed no significant difference from that of hand-sewn method[RR=1.07, 95%CI (0.76, 1.51), P=0.699]. While the anastomatic stenosis rate was even higher[RR=1.59, 95%CI (1.21, 2.09), P=0.001]. ConclusionMechanical method can't reduce the anastomotic leakage rate following esophagogastrostomy, while it maybe increase the risk of anastomotic stenosis on the contrary. The patients' physical condition should be considered when surgeons make the choice.
ObjectiveTo explore the impact of the preoperative nutritional status on quality of life of colorectal cancer patients. MethodsIn this study, patients diagnosed definitely as colorectal cancer were enrolled from September 2012 to December 2012 in this hospital.NRS-2002 was used to assess the preoperative nutritional status, and QLQ-C30 was used to assess the quality of life. ResultsForty-four patients were enrolled in this study and divided into two groups based on NRS-2002 preoperative nutritional status evaluation scores:mild nutritional risk group had 27 patients who got 1 point, and moderate-severe nutritional risk group had 17 patients who got 2 point or over it.Patients in moderate-severe nutritional risk group were significantly older than the mild nutritional risk group (P=0.001), but there were no statistical differences between the two groups in gender (P=0.718), TNM stage (P=0.302), differentiation degree (P=0.564), preoperative medical complications (P=0.070), postoperative complications[NS (not significant)], and stoma (P=0.786).There were no statistical differences between the two groups in quality of life, too (P > 0.05). ConclusionsThis study don't get the conclusion that there is any relationship between nutritional status and quality of life of the colorectal cancer patients.And maybe it is effected by the too small sample size and single time of accessing.Therefore, the further research by expanding sample size, using more kinds of assessment tools, and selecting different time to explore the impact of the preoperative nutritional status on quality of life of colorectal cancer patients are necessary.
ObjectiveTo investigate the influence of semi-mechanical and hand-sewn esophagogastric anastomoses on postoperative anastomostic complications in patients undergoing esophagectomy. MethodsA systematic, computer-aided literature search was performed in PubMed, OVID, CNKI and BioMed databases for studies which were published from database establishment to December 2013. A manual literature search was also performed. We included randomized controlled trials (RCT)and observational studies which investigated the influence of semi-mechanical and conventional hand-sewn esophagogastric anastomoses on postoperative anastomostic complications. Quality assessment and data extraction were performed, and RevMan 5.2 was used for meta-analysis. ResultsTwelve relevant studies with 1 271 patients were included (3 RCTs and 9 observational studies).No significant heterogeneity among the 12 trials was found, so fixed effects model was used for meta-analysis.There was statistical difference in the incidence of postoperative anastomotic leak between hand-sewn and semi-mechanical esophagogastric anastomoses[RCT RR=0.34, 95%CI (0.12, 0.97), P < 0.05;observational studies OR=0.40, 95%CI (0.26, 0.62), P < 0.05]. Postoperative incidence of anastomostic stricture was reported in all 12 studies. There was statistical difference in the incidence of postoperative anastomotic stricture between hand-sewn and semi-mechanical esophagogastric anastomoses[RCT RR=0.14, 95%CI (0.04, 0.47), P < 0.05;observational studies OR=0.22, 95%CI (0.15, 0.34), P < 0.000 1]. ConclusionsCompared with conventional hand-sewn anastomosis, semi-mechanical esophagogastric anastomosis can significantly reduce the incidence of postoperative anastomostic leak and stricture. Due to limited quantity and quality of included studies, more high-quality studies with larger sample size including RCT and non-randomized studies are needed to confirm these findings.
ObjectiveTo evaluate the methodological quality and impacts on outcomes for systematic reviews (SRs) of radiofrequency ablation (RFA) versus hepatic resection (HR) for early hepatocellular carcinoma (HCC). MethodsWe comprehensively searched six databases and five official websites for health technology assessment (HTA), to collect HTAs, SRs, or meta-analyses from inception to Nov. 11th, 2012. The Overview Quality Assessment Questionnaire (OQAQ) was applied for quality assessment of included studies, the tools recommended by the Cochrane Collaboration was applied for quality assessment for randomized controlled trials (RCTs), and the modified MINORS score was applied to assess non-randomized controlled trials (NRCTs). The odds ratios (ORs) and 95% confidence intervals (CIs) were integrated using Stata 10.0 software. ResultsOne HTA, 3 SRs and 15 meta-analyses were included in total. The mean OQAQ score was 3.3 with 95%CI 2.6 to 4.1. Only five (26.3%) SRs were assessed as good quality. Seven studies misused statistical models, and 3 of them changed outcome direction after modification. Five studies (5/19) included retrospective controlled studies as RCTs. A total of 39 primary studies referenced by SRs were included, of which, 3 RCTs were levelled grade B, 35 NRCTs were of moderate quality, with an estimated mean MINORS score of 15.0 (totally, scored 18) with 95%CI 14.6 to 15.4, and only 13 studies (37.1%) scored more than 16. Seventeen primary studies (43.6%) did not meet inclusion criteria of the SRs, of which, 9 (23.1%) studies were mixed with other effective interventions in both groups (TACE, PEI, etc.). Four studies included patients with non-primary HCC. ConclusionCurrently, the overall quality of HTAs, SRs and meta-analyses about comparing the effects between RFA and HR for early HCC is fairly poor (high heterogeneity exists, and the evidence level is low. Physicians should apply the evidence with caution in clinical practice.