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1.
Percutaneous endoscopic gastrostomy prior to esophagectomy for esophageal cancer - a systematic review and meta-analysis.
Fang, HC, Farah, MH, Shiue, SJ, Cheng, SW, Shiue, HS, Cheng, CL, Chan, TS, Liao, AH, Wu, MS
Expert review of gastroenterology & hepatology. 2022;(2):155-162
Abstract
BACKGROUND For resectable esophageal cancer (EC), it remains controversial whether to place percutaneous endoscopic gastrostomy (PEG) before the curative surgery to provide nutritional support during the neoadjuvant therapy. OBJECTIVE To compare surgical outcomes for patients who received preoperative PEG and those without PEG placement (No-PEG) insertion prior to surgery in a potentially operable EC. METHODS A comprehensive literature search was conducted to identify randomized and non-randomized studies comparing PEG and No-PEG groups. RESULTS Four retrospective studies with a total number of 1,027 patients were identified and included in this meta-analysis. The differences in anastomotic leakage, anastomotic stricture, morbidity, pulmonary complications, wound infection, and hospital stay were not statistically significant between the two groups. Operation time was significantly shorter in the PEG group. There was no PEG-related gastric conduit failure and no leak from the PEG site in the PEG group. CONCLUSION We conclude preoperative PEG for resectable EC is a safe procedure with no adverse effect on the gastric tube construction and anastomosis, it can be selectively inserted for EC patients with marked weight loss and malnutrition or those at risk of developing malnutrition during neoadjuvant therapy.
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2.
Impact of Early Oral Feeding on Anastomotic Leakage Rate After Esophagectomy: A Systematic Review and Meta-analysis.
Li, X, Yan, S, Ma, Y, Li, S, Wang, Y, Wang, X, Wang, Y, Wang, J, Lv, C, Yang, Y, et al
World journal of surgery. 2020;(8):2709-2718
Abstract
BACKGROUND Esophageal cancer occupies a vital position in fatal cancer-related disease, with esophagectomy procedures helping to improve patient survival. The timing when oral intake should be resumed after esophagectomy and whether early oral feeding (EOF) or delayed oral feeding (DOF) should be the optimal regimen are controversial. METHODS Databases (PubMed, Embase, Cochrane library) were searched. All records were screened by two authors through full-text reading. Data on the anastomotic leakage rate were extracted and synthesized in meta-analyses. Postoperative pneumonia rate and length of hospital stay were also assessed. RESULTS Seven studies from 49 records were included after full-text reading; 1595 patients were totally included in the analysis. No significant difference was observed between the EOF and DOF groups (odds ratio [OR] 1.68; 95% confidence interval [CI] 0.70-4.03; p = 0.2495; I2 = 70%). Higher anastomotic leakage rate was observed in EOF compared with DOF (OR 2.89; 95% CI 1.56-5.34; p = 0.0007; I2 = 10%) in the open subgroup. No significant difference was observed in the MIE (OR 0.48; 95% CI 0.22-1.02; p = 0.0564; I2 = 0%). Patients performed similarly in pneumonia (OR 1.12; 95% CI 0.57-2.21; p = 0.745; I2 = 34%). In cervical subgroup, anastomosis leakage may be less in DOF (OR 2.42 95% CI 1.26-4.64; p = 0.0651; I2 = 58%), while in thoracic subgroup, there is no obvious difference (OR 0.86 95% CI 0.46-1.61; p = 0.01; I2 = 84.9%). CONCLUSIONS Anastomotic leakage related to the timing of oral feeding after open esophagectomy, which is more favorable to the DOF regimen. However, timing of oral feeding did not impair anastomotic healing in patients undergoing MIE.
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Meta-analysis of the relationship between Dietary Inflammatory Index and esophageal cancer risk.
Chen, QJ, Ou, L, Li, K, Ou, FR
Medicine. 2020;(49):e23539
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Abstract
INTRODUCTION Diet is closely related to the occurrence of esophageal cancer (EC). Dietary Inflammatory Index (DII), as a novel index that describes the inflammatory potential of diet, was widely used in many diseases. OBJECTIVE To systematically analyze the relationship between DII and the risk of esophageal cancer. METHODS We mainly searched relative studies in PubMed, Cochrane library, Web of Science, and other literature database. The random-effect model was used for meta-analysis, and subgroup analysis and sensitivity analysis were used to detect the origin of heterogeneity. RESULTS We finally obtained 6 articles (8 studies). All studies were case-control studies which consisted of 1961 cases and 3577 controls. In this study, compared with the lowest DII category, the highest DII category had a higher risk of esophageal cancer, and the pooled odds ratio (OR) of the 8 studies were 2.54 (95% confidence interval (CI): 1.90-3.40; I = 65.7%, P = .005). Furthermore, regardless of the differences in published year, DII components, geographic location, and study quality, there was still an increased risk of esophageal cancer in the highest DII category compared with the lowest DII category. CONCLUSIONS Our results inferred that DII was positively correlated with esophageal cancer risk and it could be used as a tool to predict the esophageal cancer risk and evaluate human health.
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Systematic review and network meta-analysis comparing Chinese herbal injections with chemotherapy for treating patients with esophageal cancer.
Zhang, D, Wu, J, Wang, H, Zhou, W, Ni, M, Liu, X, Zhang, X
The Journal of international medical research. 2020;(1):300060519898336
Abstract
OBJECTIVE This study compared Chinese herbal injections (CHIs) plus chemotherapy with chemotherapy alone in terms of clinical efficacy and safety for treating patients with esophageal cancer (EC). METHODS Randomized controlled trials (RCTs) of CHIs combined with chemotherapy for treating EC published in English and Chinese databases were identified. The main outcomes were clinical efficacy, performance status, and adverse reactions. Random-effects models were fitted to calculate the odds ratios and 95% confidence intervals for all pair-wise comparisons. RESULTS In total, 29 RCTs of eight CHIs were included in this study. The results of cluster analysis demonstrated that Compound Kushen injection plus chemotherapy was the optimal choice for improving the clinical efficacy rate. Shenfu injection was associated with a relatively high performance status. Compound Kushen injection and Shenfu injection were inferior to other CHIs in terms of preventing leukopenia and gastrointestinal side effects. CONCLUSIONS The combination of Compound Kushen injection with chemotherapy could improve efficacy and reduce adverse drug reactions versus chemotherapy alone in patients with EC.
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Enteral immunonutrition versus enteral nutrition for patients undergoing oesophagectomy: a systematic review and meta-analysis.
Li, XK, Zhou, H, Xu, Y, Cong, ZZ, Wu, WJ, Luo, J, Jiang, ZS, Shen, Y
Interactive cardiovascular and thoracic surgery. 2020;(6):854-862
Abstract
OBJECTIVES According to retrospective studies, oesophageal carcinoma is the second deadliest gastrointestinal cancer after gastric cancer. Enteral immunonutrition (EIN) has been increasingly used to enhance host immunity and relieve the inflammatory response of patients undergoing oesophagectomy; however, conclusions across studies remain unclear. We aimed to evaluate the effect of EIN on the clinical and immunological outcomes of patients undergoing oesophagectomy. METHODS Four electronic databases (MEDLINE, Embase, Web of Science and Cochrane Library) were used to search articles in peer-reviewed, English-language journals. The mean difference, relative risk or standard mean difference with 95% confidence interval were calculated. Heterogeneity was assessed by the Cochran's Q test and I2 statistic combined with the corresponding P-value. The analysis was carried out with RevMan 5.3. RESULTS Six articles were finally included, with a total of 320 patients with oesophageal cancer. The meta-analysis results showed that EIN did not improve clinical outcomes (such as infectious complications, pneumonia, surgical site infection, anastomotic leak and postoperative hospital stay) or immune indices [referring to C-reactive protein, interleukin (IL)-6, IL-8, tumour necrosis factor-α]. Descriptive analysis suggested that EIN also increased the serum concentrations of IgG and the percentage of the B-cell fraction. Thus, its impact on IL-8 and IL-6 remains inconsistent. CONCLUSIONS The early-stage impact of EIN on immunological status in patients undergoing oesophagectomy is still unclear. According to the results of this meta-analysis, whether EIN could improve the clinical outcomes or biological status after oesophagectomy compared to standard enteral nutrition is uncertain. Since the impact of EIN is unclear, current guidelines that strongly advise the use of EIN should be changed, as the utility of EIN is very uncertain. More appropriately powered clinical studies are warranted to confirm its effectiveness.
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Red and processed meat consumption and esophageal cancer risk: a systematic review and meta-analysis.
Zhao, Z, Wang, F, Chen, D, Zhang, C
Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico. 2020;(4):532-545
Abstract
BACKGROUND The associations between red and processed meat consumption and esophageal cancer risk remain inconclusive. We performed a systematic review and meta-analysis to analyze these associations. METHODS We searched PubMed and EMBASE to identify studies published between the databases' dates of inception and May 2019. RESULTS We ultimately selected 33 eligible studies for analysis. We found that the summary relative risks for the associations between meat consumption and esophageal cancer risk were positive for the case-control studies (P < 0.05), but negative for the cohort studies included in the analysis (P > 0.05). Subtype analysis indicated that red and processed meat consumption was not associated with the risks of esophageal adenocarcinoma (P > 0.05) and esophageal squamous cell carcinoma (P > 0.05) in the cohort studies. CONCLUSIONS We found case-control but not cohort studies to associate consumption of red and processed meat with the risk of esophageal cancer. Further large prospective studies are needed to validate these findings.
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Alcohol, Alcoholic Beverages and Risk of Esophageal Cancer by Histological Type: A Dose-Response Meta-Analysis of Observational Studies.
Yu, X, Chen, J, Jiang, W, Zhang, D
Alcohol and alcoholism (Oxford, Oxfordshire). 2020;(5):457-467
Abstract
AIMS: We conducted a dose-response meta-analysis to explore the association between alcohol and particular alcoholic beverages with risk of esophageal cancer (EC) by histological type [esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC)] and whether the association differs according to gender. METHODS PubMed and Web of Science databases were searched for relevant articles published between January 1960 and December 2019. The pooled relative ratios (RRs) and 95% confidence interval (CI) were calculated with the fixed or random effect model. The dose-response relationship was assessed by restricted cubic spline. RESULTS A total of 74 published articles involving 31,105 cases among 3,369,024 participants were included in this meta-analysis. The pooled RRs of the highest versus lowest alcohol intake were 3.67 (95% CI, 2.89,4.67) for EC, 5.11 (95% CI, 3.60,7.25) for ESCC and 0.96 (95% CI, 0.79,1.16) for EAC. The above-mentioned associations were observed in cohort design, for different alcoholic beverages (beer, wine and liquor/spirits) and gender. Evidence of a nonlinear dose-response relationship for EC risk with alcohol intake was found (Pnon-linearity < 0.001), and a linear relationship (Pnon-linearity = 0.216) suggested that the risk of ESCC increased by 33% for every 12.5 g/day increment of alcohol intake. CONCLUSIONS This meta-analysis suggests that alcohol intake might significantly increase the incidence of EC, especially for ESCC.
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Perioperative immunonutrition in esophageal cancer patients undergoing esophagectomy: the first meta-analysis of randomized clinical trials.
Mingliang, W, Zhangyan, K, Fangfang, F, Huizhen, W, Yongxiang, L
Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus. 2020;(4)
Abstract
Although several randomized controlled trials have been published in recent years, the effect of perioperative immunonutrition in esophageal cancer (EC) patients remains unclear. This initial meta-analysis was conducted to assess whether perioperative enteral immunonutrition reduces postoperative complications in patients undergoing esophagectomy for EC. Relevant randomized controlled trials published before 1st September 2019 were retrieved from the Cochrane Library, PubMed, and EMBASE databases. After the literature was screened, two researchers extracted the information and data from eligible studies according to predefined selection criteria. Obtained data were pooled and analyzed by RevMan 5.3 software. The results were presented as risk ratios (RRs) with 95% confidence intervals (CIs). The heterogeneity among studies was tested by I2 test. Seven high-quality randomized controlled trials were included, with a total of 606 patients, 311 of whom received immunonutrition before and after surgery, while 295 received perioperative standard nutrition. No significant difference was observed between the two groups in the incidence of postoperative infection complications, including total infection complications (RR = 0.97, CI: 0.78-1.20, P = 0.76), pneumonia (RR = 0.97, CI: 0.71-1.33, P = 0.84), wound infection (RR = 0.80, CI: 0.46-1.40, P = 0.44), sepsis (RR = 1.35, CI: 0.67-2.71, P = 0.40), and urinary tract infection (RR = 0.87, CI: 0.54-1.40, P = 0.56). The prevalence of anastomotic leakage in the two groups was 9.4 and 5.4%, but the difference was not statistically significant (RR = 0.59, CI: 0.33-1.04, P = 0.07). Perioperative enteral immunonutrition provided no benefit in terms of the incidence of infection complications and anastomotic leakage in EC patients undergoing esophagectomy. Further large-scale randomized controlled trials are needed to confirm this conclusion.
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Systematic review and meta-analysis of docetaxel perioperative chemotherapy regimens in gastric and esophagogastric tumors.
Uson Junior, PLS, Santos, VM, Bugano, DDG, Victor, EDS, Rother, ET, Maluf, FC
Scientific reports. 2019;(1):15806
Abstract
FLOT regimen became the standard perioperative treatment in several centers around the world for esophagogastric tumors despite concerns about toxicity. In addition, FLOT has never been compared with other docetaxel-based regimens. To address this question, we conducted a systematic review of PubMed, Embase and Web of Science including prospective or retrospective studies of docetaxel based perioperative regimen in gastric and esophagogastric tumors. Data regarding chemotherapy regimens, efficacy and toxicity were extracted. Outcomes were compared using a random effects model. Of 548 abstracts, 16 were considered eligible. Comparing the studies with meta-analysis we can see that the regimens are similar in terms of pathological complete response, resection rate, progression free survival and overall survival in one year, without significant heterogeneity. The meta-regression of docetaxel dose failed to show any association with dose ranging between 120-450 mg/m². Regarding the toxicity of the regimens it is noted that the regimens are quite toxic (up to 50-70% of grade 3-4 neutropenia). The results of this meta-analysis with a combined sample size of more than 1,000 patients suggest that docetaxel perioperative regimens are equivalent in outcomes. Prospective trials addressing modified regimens should be performed to provide less toxic strategies and be applicable to all patients.
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Effect of dietary cholesterol intake on the risk of esophageal cancer: a meta-analysis.
Jin, Y, Yang, T, Li, D, Ding, W
The Journal of international medical research. 2019;(9):4059-4068
Abstract
OBJECTIVE This systematic review aimed to explore the potential association between dietary cholesterol intake and esophageal cancer risk. METHODS A literature search was conducted using PubMed, Embase, and Web of Science databases from inception to March 2019 according to specific inclusion and exclusion criteria. Pooled estimates with odds ratio (ORs) and 95% confidence intervals (CIs) were obtained using random effects models. RESULTS Nine articles of 12 independent studies were included in the final meta-analysis. Pooled analysis suggested that dietary cholesterol intake may increase the risk of esophageal cancer (summarized OR = 1.424, 95% CI = 1.191–1.704). Consistent results were found in American (summarized OR = 1.410, 95% CI = 1.130–1.758) and European populations (summarized OR = 1.556, 95% CI = 1.021–2.373). Subgroup analysis by disease type showed that dietary cholesterol intake had a significant association with the development of esophageal adenocarcinoma and esophageal squamous cell carcinoma. CONCLUSION Our findings indicated that dietary cholesterol intake could significantly increase the risk of developing esophageal cancer in both European and American populations. Further high-quality studies are necessary to confirm the effects of cholesterol intake.