Gastroesophageal Cancer After Gastric Bypass Surgeries: a Systematic Review and Meta-analysis

Obesity Surgery - Data comparing the occurrence of gastroesophageal cancer after gastric bypass procedures are lacking and are only available in the form of case reports. We perform in this study a...     

64排螺旋CT对Ⅳ期胃癌术前分期的价值

目的 评价64排螺旋CT对Ⅳ期胃癌术前分期的准确性.方法 收集2007年7月至2008年4月期间我院胃肠外科收治的49例Ⅳ期胃癌患者的临床资料,对其中术前行64排螺旋CT(64 MDCT)检查的29例患者进行回顾性分析并按日本胃癌规约对肿瘤进行分期. 将CT术前分期结果与临床-手术-病理分期结果进行对照分析.结果 本组病例经64 MDCT术前分期,其中65.2%(15/23)T分期准确,47.8%(11/23)N分期准确,70.8%(17/24)M分期准确,58.6%TNM分期准确(17/29). 而腹膜转移患者中6/9未能经术前64 MDCT检出. 结论 64 MDCT可以对Ⅳ期胃癌进行较准确的分期,其分期准确率降低的主要原因为腹膜转移的漏诊,但64 MDCT分期降低并不增加剖腹探查率.     

Extranodal Extension of Nodal Metastases Is a Poor Prognostic Indicator in Gastric Cancer: a Systematic Review and Meta-analysis

Introduction

The extranodal extension (ENE) of nodal metastases (the extension of neoplastic cells through the nodal capsule into the perinodal soft tissue) is a histological feature that has been considered a prognostic factor in several cancers, but the role in gastric cancer was not yet investigated. We aimed to investigate the prognostic role of ENE in patients affected by gastric cancer through a systematic review and meta-analysis.

Material and Methods

Two independent authors searched major databases until 09/30/2015 to identify studies providing data on gastric cancer patients’ prognostic parameters and comparing patients with ENE (ENE+) vs intra-nodal extension (ENE?). The data were summarized using risk ratios (RRs) for the number of deaths/recurrences and hazard ratios (HRs) with 95 % confidence intervals (CI), adjusted for potential confounders.

Results

Nine studies followed up 3250 patients with gastric cancer (1064 ENE+ and 2186 ENE?). ENE+ was associated with a significantly higher risk of all-cause mortality (RR?=?1.70; 95 % CI: 1.43–2.03, I ²?=?66 %; HR?=?2.14; 95 % CI: 1.66–2.75, I ²?=?0 %), cancer-specific mortality (RR?=?1.59; 95 % CI: 1.42–1.79; HR?=?1.52; 95 % CI: 1.19–1.96), and disease recurrence (RR?=?3.43, 95 % CI: 1.80–6.54, I ²?=?0 %).

Discussion

Judging from our results, ENE in gastric cancer patients should be considered for prognostic purposes from the gross sample to the pathology report.

     

Effect of Preoperative Radio(chemo)therapy on Long-term Functional Outcome in Rectal Cancer Patients: A Systematic Review and Meta-analysis

Background

Preoperative radio(chemo)therapy (pR(C)T) significantly reduces the local recurrence risk and is therefore recommended in stage II/III rectal cancer. However, this multimodal treatment approach may be associated with late adverse effects. To determine the impact of pR(C)T on long-term anorectal, sexual, and urinary function, we performed a systematic review and meta-analysis.

Methods

PubMed, Embase, and the Cochrane Library were systematically searched for studies reporting on long-term functional outcome after rectal cancer resection with pR(C)T. Only studies that reported anorectal, sexual, and/or urinary function after rectal cancer resection in TME-technique with pR(C)T were eligible for inclusion.

Results

Twenty-five studies, including 6,548 patients, were identified. Methodological quality of the eligible studies was low. The majority of studies reported higher rates of anorectal (14/18 studies) and male sexual dysfunction (9/10 studies) after pR(C)T. Few studies examined female sexual dysfunction (n = 4). Meta-analysis revealed that stool incontinence occurred more often in irradiated patients (risk ratio (RR) = 1.67; 95 % confidence interval (CI), 1.36, 2.05; p < 0.0001) and manometric results were significantly worse after pR(C)T (mean resting pressures (weighted mean difference (WMD) = 15.04; 95 % CI, 0.77, 29.31; p = 0.04) and maximum squeeze pressures (WMD = 30.39; 95 % CI, 21.48, 39.3; p < 0.0001)). Meta-analysis of erectile dysfunction revealed no statistical significance (RR = 1.41; 95 % CI, 0.74, 2.72; p = 0.3). Six of eight studies and meta-analysis demonstrated no negative effect of pR(C)T on urinary function (RR = 1.05; 95 % CI, 0.67, 1.65; p = 0.82).

Conclusions

Although quality of studies on long-term functional outcome is limited, current evidence demonstrates that pR(C)T negatively affects anorectal function after TME.     

The Prognostic Impact of Occult Lymph Node Metastasis in Node-negative Gastric Cancer: A Systematic Review and Meta-analysis

Purpose

To conduct a meta-analysis to clarify whether occult lymph node metastasis (OLNM), which is identified by molecular detection techniques but is not detected by routine histological examination within regional lymph nodes, represents a prognostic factor for patients with node-negative gastric cancer.

Methods

PubMed, Embase, and the Cochrane Library were searched from their inception to November 2012. The published studies that investigated the association between OLNM and the prognosis of patients with node-negative gastric cancer were included. We extracted hazard ratios (HRs) and associated standard errors from the identified studies and performed random-effects model meta-analyses on overall survival and disease-specific survival. Subgroup analyses were also conducted.

Results

A total of 14 eligible studies that included 1,478 patients were identified. Meta-analyses revealed that OLNM was associated with poor overall survival [HR 2.72; 95 % confidence interval (CI) 1.61–4.60], and disease-specific survival (HR 2.91; 95 % CI 1.25–6.79). Subgroup analyses suggested that OLNM was associated with poor survival in early gastric cancer (HR 3.57; 95 % CI 1.23–10.33). However, subgroup analyses of studies that exclusively enrolled patients with D2 lymph node dissection demonstrated that OLNM did not have an influence on the prognosis (HR 1.97; 95 % CI 0.82–4.70).

Conclusions

OLNM correlates with poor prognosis for patients with node-negative gastric cancer, and D2 lymph node dissection could eliminate this correlation. For OLNM-positive patients with node-negative gastric cancer, D2 lymph node dissection is necessary.     

Primary Tumor Resection in Patients with Incurable Localized or Metastatic Colorectal Cancer: A Systematic Review and Meta-analysis

World Journal of Surgery - To assess the impact of primary tumor resection (PTR) on survival and morbidity in incurable colorectal cancer. Systematic literature review and meta-analysis to compare...     

Value of Preoperative Inflammation-Based Prognostic Scores in Predicting Overall Survival and Disease-Free Survival in Patients with Gastric Cancer

Background

This study was designed to identify which are the best preoperative inflammation-based prognostic scores in terms of overall survival (OS) and disease-free survival (DFS) in patients with gastric cancer.

Methods

Between January 2004 and January 2013, 102 consecutive patients underwent resection for gastric cancer at S. Andrea Hospital, "La Sapienza", University of Rome. Their records were retrospectively reviewed.

Results

After a median follow up of 40.8 months (8–107 months), patients’ 1-, 3-, and 5-year OS rates were 88, 72, and 59 %, respectively. After R0 resection, the 1-, 3-, and 5-year DFS rates were 93, 74, and 56 %, respectively. A multivariate analysis of the significant variables showed that only the modified Glasgow prognostic scores (p < 0.001) and PI (p < 0.001) were independently associated with OS. Regarding DFS, multivariate analysis of the significant variables showed that the modified Glasgow prognostic score (p = 0.002) and prognostic index (p < 0.001) were independently associated with DFS.

Conclusions

The results of this study show that modified Glasgow prognostic score and prognostic index are independent predictors of OS and DFS in patients with gastric cancer.     

Oncologic Effectiveness and Safety of Bursectomy in Patients with Advanced Gastric Cancer: A Systematic Review and Updated Meta-Analysis

ABSTRACT

Purpose/Aim: In the past few decades some researchers have questioned whether bursectomy for gastric cancer is essential from an oncological point of view and no consistent recommendations have been proposed. The aim of this systematic review with meta-analysis is to investigate the oncologic effectiveness and safety of bursectomy for the treatment of advanced gastric cancer patients. Materials and Methods: We planned and performed this systematic review and meta-analysis in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement and Cochrane Handbook for Systematic Reviews of Intervention. Results: Overall, four studies with a total of 1,340 patients met inclusion criteria. The pooled hazard ratio for overall survival between the bursectomy versus nonbursectomy groups was [HR = 0.85, 95% CI 0.66–1.11, p =.252]. Interestingly, the pooled HR between the two groups in serosa-positive cases subgroup, showed a significant improvement of overall survival rate in favor of bursectomy [HR = 0.72, 95% CI 0.73–0.99, p <.05]. Conclusions: Bursectomy represents a surgical procedure that might be able to improve overall survival in serosa positive gastric cancer patients. However, a definitive conclusion could not be made because of the studies’ methodological limitations. This meta-analysis points to the urgent need of high quality, large-scaled, clinical trials with short- as well as long-term evaluation comparing bursectomy with non bursectomy procedures, in a controlled randomized manner, helping future researches and establishing a modern and tailored approach to gastric cancer.     

Incidence of Cancer Following Bariatric Surgery: Systematic Review and Meta-analysis

Obesity is linked to the development of cancer. Previous studies have suggested that there is a relationship between bariatric surgery and reduced cancer risk. Data sources were from Medline, Embase, and Cochrane Library. From 951 references, 13 studies met the inclusion criteria (54,257 participants). In controlled studies, bariatric surgery was associated with a reduction in the risk of cancer. The cancer incidence density rate was 1.06 cases per 1000 person-years within the surgery groups. In the meta-regression, we found an inverse relationship between the presurgical body mass index and cancer incidence after surgery (beta coefficient ?0.2, P?相似文献   

Outcomes of Parathyroidectomy in Patients with Primary Hyperparathyroidism: A Systematic Review and Meta-analysis

Background

Parathyroidectomy is a definitive treatment for primary hyperparathyroidism. Patients contemplating this intervention will benefit from knowledge regarding the expected outcomes and potential risks of the currently available surgical options.

Purpose

To appraise and summarize the available evidence regarding benefits and harms of minimally invasive parathyroidectomy (MIP) and bilateral neck exploration (BNE).

Data sources

A comprehensive search of multiple databases (MEDLINE, EMBASE, and Scopus) from each database’s inception to September 2014 was performed.

Study selection

Eligible studies evaluated patients with primary hyperparathyroidism undergoing MIP or BNE.

Data extraction

Reviewers working independently and in duplicate extracted data and assessed the risk of bias.

Data synthesis

We identified 82 observational studies and 6 randomized trials at moderate risk of bias. Most of them reported outcomes after MIP (n = 71). Using random-effects models to pool results across studies, the cure rate was 98 % (95 % CI 97–98 %, I ² = 10 %) with BNE and 97 % (95 % CI 96–98 %, I ² = 86 %) with MIP. Hypocalcemia occurred in 14 % (95 % CI 10–17 % I ² = 93 %) of the BNE cases and in 2.3 % (95 % CI 1.6–3.1 %, I ² = 87 %) with MIP (P < 0.001). There was a statistically significant lower risk of laryngeal nerve injury with MIP (0.3 %) than with BNE (0.9 %), but similar risk of infection (0.5 vs. 0.5 %) and mortality (0.1 vs. 0.5 %).

Limitations

The available evidence, mostly observational, is at moderate risk of bias, and limited by indirect comparisons and inconsistency for some outcomes (cure rate, hypocalcemia).

Conclusion

MIP and BNE are both effective surgical techniques for the treatment of primary hyperparathyroidism. The safety profile of MIP appears superior to BNE (lower rate of hypocalcemia and recurrent laryngeal nerve injury).

     

High-Dose versus Low-Dose Corticosteroids in COVID-19 Patients: a Systematic Review and Meta-analysis

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Preoperative Antisepsis with Chlorhexidine Versus Povidone-Iodine for the Prevention of Surgical Site Infection: a Systematic Review and Meta-analysis

World Journal of Surgery - Chlorhexidine (CH) and povidone-iodine (PI) are the most commonly used preoperative skin antiseptics at present. However, the prevention of the surgical site infection...     

One-Anastomosis Gastric Bypass Versus Roux-en-Y Gastric Bypass as Revisional Surgery After Sleeve Gastrectomy: a Systematic Review and Meta-analysis

The demand for revisional bariatric surgery after sleeve gastrectomy (SG) has increased, but the ideal procedure remains unclear. A systematic review and meta-analysis were performed to compare the outcomes of weight loss and safety of one-anastomosis gastric bypass (OAGB) and Roux-en-Y gastric bypass (RYGB) as revisional procedures for failed SG. Four retrospective comparative studies were included, comprising 499 individuals. Patients submitted to OAGB had a more significant total weight loss (TWL) (MD =  − 5.89%; 95% CI − 6.80 to − 4.97) after revisional surgery. Overall early complication rate was similar between procedures (RD = 0.04; 95% CI: − 0.05 to 0.12). Limited and heterogeneous data prevent meaningful conclusions, but the present analysis suggests that OAGB has a better TWL after revisional surgery.

Graphical abstract

     

Preoperative Hematocrit (HCT) is a Novel and Simple Predictive Marker for Gastric Cancer Patients Who Underwent Radical Gastrectomy

Annals of Surgical Oncology - Previous studies have suggested that preoperative anemia negatively influences survival in patients with gastric cancer (GC). We sought to investigate which anemic...     

Chemotherapy-Associated Liver Injury in Patients with Colorectal Liver Metastases: A Systematic Review and Meta-analysis

Background

Chemotherapy-associated liver injury is a major cause for concern when treating patients with colorectal liver metastases. The aim of this review was to determine the pathological effect of specific chemotherapy regimens on the hepatic parenchyma as well as on surgical morbidity, mortality and overall survival.

Methods

A systematic review of the published literature and a meta-analysis were performed. For each of the variables under consideration, the effects of different chemotherapy regimens were determined by calculation of relative risks by a random-effects model.

Results

Hepatic parenchymal injury is regimen specific, with oxaliplatin-based regimens being associated with grade 2 or greater sinusoidal injury (number needed to harm 8; 95?% confidence interval [CI] 6.4?C13.6), whereas irinotecan-based regimens associated with steatohepatitis (number needed to harm 12; 95?% CI 7.8?C26). The use of bevacizumab alongside FOLFOX reduces the risk of grade 2 or greater sinusoidal injury (relative risk 0.34; 95?% CI 0.15?C0.75).

Conclusions

Chemotherapy before resection of colorectal liver metastases is associated with an increased risk of regimen-specific liver injury. This liver injury may have implications for the functional reserve of the liver for patients undergoing major hepatectomy for colorectal liver metastases.     

Systematic Review and Meta-analysis of Medium-Term Outcomes After Banded Roux-en-Y Gastric Bypass

This is the first systematic review and meta-analysis focused exclusively on intermediate-term outcomes for the banded Roux-en-Y gastric bypass (B-RYGB). B-RYGB articles published from 1990 to 2013 were identified through MEDLINE, ScienceDirect, and SpringerLink databases augmented by manual reference review. Articles were assigned an evidence level (Centre for Evidence-Based Medicine [Oxford UK] criteria) and Jadad quality score (randomized controlled trials). Simple and weighted means (95 % confidence interval (CI)) for excess weight loss (EWL) at follow-up (1–10+ years) were calculated. At 5 years, a pooled estimate for BMI (kg/m²) change (weighted mean difference and 95 % CI) for banded bypass patients was computed. Rates for weighted mean complications, non-band- and band-related reoperations, and overall comorbidity resolution were calculated. Three hundred twenty-one articles were identified: 286 failed inclusion criteria (i.e., non-English, B-RYGB unrelated, <10 per arm, <3-year follow-up), leaving 35 articles. Manual review added 10 potentially relevant articles; 30 that failed inclusion criteria were excluded, leaving 15 for analysis. B-RYGB was performed on 8,707 patients: 79.0 % female, mean age 38.7, and BMI 47.6 (41.0–59.4). Overall BMI weighted mean difference (reduction) at 5 years was 17.8 (95 % CI 12.8, 22.7; p?相似文献   

A Systematic Review and Meta-analysis of the Randomized Controlled Trials on Adjuvant Intraperitoneal Chemotherapy for Resectable Gastric Cancer

Background The purpose of this systematic review and meta-analysis was to determine the effectiveness and safety of adjuvant intraperitoneal chemotherapy for patients with locally advanced resectable gastric cancer. Methods Studies eligible for this systematic review included those in which patients with gastric cancer were randomly assigned to receive surgery combined with intraperitoneal chemotherapy versus surgery without intraperitoneal chemotherapy. There were no language restrictions. After independent quality assessment and data extraction, data were pooled for meta-analysis. Results Thirteen reports of randomized controlled trials (RCTs) were included for quality appraisal and data extraction. Ten reports were judged to be of fair quality and subjected to meta-analysis. A significant improvement in survival was associated with hyperthermic intraoperative intraperitoneal chemotherapy (HIIC) alone (hazard ratio [HR] = 0.60; 95% CI = 0.43 to 0.83; p = 0.002) or HIIC combined with early postoperative intraperitoneal chemotherapy (EPIC) (HR = 0.45; 95% CI = 0.29 to 0.68; p = 0.0002). There was a trend towards survival improvement with normothermic intraoperative intraperitoneal chemotherapy (p = 0.06), but this was not significant with either EPIC alone or delayed postoperative intraperitoneal chemotherapy. Intraperitoneal chemotherapy was also found to be associated with higher risks of intra-abdominal abscess (RR = 2.37; 95% CI = 1.32 to 4.26; p = 0.003) and neutropenia (RR = 4.33; 95% CI = 1.49 to 12.61; p = 0.007). Conclusions The present meta-analysis indicates that HIIC with or without EPIC after resection of advanced gastric primary cancer is associated with improved overall survival. However, increased risk of intra-abdominal abscess and neutropenia are also demonstrated.     

Bariatric Surgery Is Effective and Safe in Patients Over 55: a Systematic Review and Meta-analysis

Effective weight loss and reduction in comorbidities has been convincingly demonstrated with bariatric surgery. Concerns regarding increased perioperative complications and poor results have led to a reluctance to offer such surgery to older patients. We performed a systematic review and meta-analysis of the published evidence for those in the ≥55-year age group. An electronic search was conducted of MEDLINE, EMBASE, and the Cochrane Library databases from 1990 to December 2010. We included laparoscopic studies published in English where the results were broken down by surgical procedure, reporting a minimum 6-month follow-up for ≥10 patients aged ≥55. After an initial screen of 2,543 titles, 298 abstracts were reviewed. Eighteen studies were included in the analysis. Of these, 10 included patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) (663 patients), and 11 included patients undergoing laparoscopic adjustable gastric banding (LAGB) (543 patients). Meta-analyses of body mass index (BMI) reductions indicated sustained and clinically significant BMI reductions for both RYGB (mean percentage of excess weight loss at 1?year, 72.6?%) and LAGB (mean percentage of excess weight loss at 1?year, 39.1?%). The 30-day mortality was 0.30 and 0.18?% for LRYGB and LAGB, respectively. Meta-analysis of old versus young patients revealed better comorbidity and mortality outcomes for younger patients. Bariatric surgery for patients ≥55?years achieves weight loss and reduction in comorbidities and mortality comparable to the general bariatric surgery population. Based on the above findings, patients should not be denied bariatric surgery on the basis of age alone.