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Meta-analysis of retroperitoneal vs transperitoneal laparoscopic and robot-assisted pyeloplasty for the management of pelvi-ureteric junction obstruction.
Chua, ME, Ming, JM, Kim, JK, Milford, KL, Silangcruz, JM, Ren, L, Rickard, M, Lorenzo, AJ
BJU international. 2021;(6):687-702
Abstract
OBJECTIVE To determine differences in perioperative outcomes between retroperitoneal and transperitoneal approaches for laparoscopic pyeloplasty (LP) to manage pelvi-ureteric junction obstruction (PUJO) through a meta-analysis of comparative studies. METHODS A systematic search was performed in January 2020. Comparative studies were evaluated according to Cochrane Collaboration recommendations. Assessed outcomes included success and complication rates, conversion to open surgery, operative time (OT), length of hospital stay (LOS), estimated blood loss (EBL), analgesic requirements, regular diet resumption, and drain duration. Relative risk (RR) and standardised mean difference (SMD) with 95% confidence intervals (CIs) were extrapolated. Subgroup analyses were performed according to study design and techniques. International Prospective Register of Systematic Reviews (PROSPERO) number: CRD42020163303. RESULTS A total of 18 studies describing 2007 cases were included. Overall pooled effect estimates did not show statistically significant differences between the approaches with regards to success rate (RR 0.99; 95% CI 0.97, 1.01), complications (RR 1.09; 95% CI 0.82, 1.45), OT (SMD 0.61; 95% CI -0.04, 1.26), LOS (SMD -0.30; 95% CI -0.63, 0.04), EBL (SMD -0.53; 95% CI -1.26, 0.21), or analgesic requirements (SMD -0.51; 95% CI -1.23, 0.21). Compared to the transperitoneal approach, retroperitoneal LP had a higher conversion rate (RR 2.40; 95% CI 1.23, 4.66); however, patients resumed diets earlier (SMD -2.49; 95% CI -4.17, -0.82) and had shorter drain duration (SMD -0.31; 95% CI -0.57, -0.05). CONCLUSION The evidence suggests that there are no significant differences in success rate, OT and complications between transperitoneal and retroperitoneal LP. Conversion rates are higher with the retroperitoneal approach; however, return to diet occurs faster and drain duration is shorter when compared to the transperitoneal approach.
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Comparative effectiveness of open, laparoscopic and robot-assisted radical cystectomy for bladder cancer: a systematic review and network meta-analysis.
Feng, D, Li, A, Hu, X, Lin, T, Tang, Y, Han, P
Minerva urologica e nefrologica = The Italian journal of urology and nephrology. 2020;(3):251-264
Abstract
INTRODUCTION Our aim is to compare feasibility and safety of open radical cystectomy (ORC), laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) for the treatment of bladder cancer through network meta-analysis. EVIDENCE ACQUISITION Eligible articles were identified from electronic databases including PubMed/Medline, Embase, the Cochrane Library and Web of Science up to August 2019 with no language limitations. Studies selection, quality assessment, data extraction and analysis were accomplished by two independent reviewers (DCF and AL) using Cochrane Collaboration's tools. EVIDENCE SYNTHESIS After screening 2528 articles, 27 studies were included in the final meta-analysis. In the network meta-analysis, both RARC (MD:83.09, 95% CI: 61.06 to 105.11) and LRC (MD: 49.68, 95% CI: 21.75 to 77.62) showed a longer operative time compared with ORC. Besides, RARC had a longer operative time than LRC (MD: 33.40, 95% CI: 1.35 to 65.45). RARC (MD:-591.86, 95% CI: -879.46 to -304.27) and LRC (MD: -435.28, 95% CI: -854.98 to -15.58) showed a less estimated blood loss (EBL) than ORC; however, the difference in EBL for RARC versus LRC was not significant. RARC (OR: 0.26, 95% CI: 0.14 to 0.50) and LRC (OR: 0.23, 95% CI: 0.13 to 0.43) had a higher blood transfusion rate than ORC; however, the OR between RARC and LRC was not significant. RARC (MD: -1.34, 95% CI: -2.55 to -0.12) and LRC (MD: -1.35, 95% CI: -2.38 to -0.32) took a shorter time to regular diet compared with ORC; however, there was no significant difference between RARC and LRC. Compared with ORC, RARC (MD: -2.37, 95% CI: -3.57 to -1.17) and LRC (MD: -2.22, 95% CI: -4.04 to -0.40) showed a shorter length of stay (LOS); however, the difference in LOS for RARC versus LRC was not significant. RARC, LRC and ORC were comparable with regard to minor complications, major complications, positive surgical margin and lymph node yields. CONCLUSIONS Current evidence indicates that minimally invasive approaches could be considered as a feasible and safe alternative to ORC when performed by experienced surgeons in selected patients. Notably, RARC may be more suitable for RC with extracorporeal urinary diversion. Larger well-designed trials are still needed to confirm these findings due to the observational nature of most studies.
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Laparoscopic versus open distal gastrectomy for advanced gastric cancer: A meta-analysis of randomized controlled trials and high-quality nonrandomized comparative studies.
Chen, X, Feng, X, Wang, M, Yao, X
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2020;(11):1998-2010
Abstract
BACKGROUND Controversy persists about the effects of laparoscopic distal gastrectomy (LDG) versus open distal gastrectomy (ODG) on short-term surgical outcomes and long-term survival within the field of advanced gastric cancer (AGC). METHODS Studies published from January 1994 to February 2020 that compare LDG and ODG for AGC were identified. All randomized controlled trials (RCTs) were included. The selection of high-quality nonrandomized comparative studies (NRCTs) was based on a validated tool (Methodological Index for Nonrandomized Studies, MINORS). The short- and long-term outcomes of both procedures were compared. RESULTS Overall, 30 studies were included in this meta-analysis, which comprised of 8 RCTs and 22 NRCTs involving 16,029 patients (7864 LDGs, 8165 ODGs). The recurrence, 3-year disease-free survival (DFS), 3-year overall survival (OS), and 5-year OS rates for LDG and ODG were comparable. LDG was associated with a lower postoperative complication rate (OR 0.79; P < 0.00001), lower estimated volume of blood loss (WMD -102.21 mL; P < 0.00001), shorter postoperative hospital stay (WMD -1.96 days; P < 0.0001), shorter time to first flatus (WMD -0.54 day; P = 0.0007) and shorter time to first liquid diet (WMD -0.66 day; P = 0.001). The number of lymph nodes retrieved, mortality, intraoperative complications, intraoperative blood transfusion, and time to ambulation were similar. However, LDG was associated with a longer surgical time (WMD 33.57 min; P < 0.00001). CONCLUSIONS LDG with D2 lymphadenectomy is a safe and effective technique for patients with AGC when performed by experienced surgeons at high-volume specialized centers.
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Comparing the safety, efficacy, and oncological outcomes of laparoscopic and open colectomy in transverse colon cancer: a meta-analysis.
Baloyiannis, I, Perivoliotis, K, Ntellas, P, Dadouli, K, Tzovaras, G
International journal of colorectal disease. 2020;(3):373-386
Abstract
INTRODUCTION In order to compare the safety, efficacy, and oncological outcomes of laparoscopic (LC) and open colectomy (OC) for transverse colon cancer (TCC) patients, the present systematic review of the literature and meta-analysis was designed. METHODS This study was conducted following the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. A systematic screening of the electronic databases was performed (Medline, Web of Science and Scopus). The validity of the pooled results was verified through the performance of trial sequential analysis (TSA). The level of evidence was estimated using the GRADE approach. RESULTS Overall, 21 studies and 2498 patients were included in our study. Pooled comparisons and TSA analyses reported a superiority of LC over OC in terms of postoperative complications (OR 0.64, p = 0.0003), blood loss (WMD - 86.84, p < 0.00001), time to first flatus (WMD - 0.94, p < 0.00001) and oral diet (WMD - 1.25, p < 0.00001), and LOS (WMD - 2.39, p < 0.00001). Moreover, OC displayed a lower operation duration (p < 0.00001). A higher rate of complete mesocolic excision (p = 0.001) was related to OC. Although inconclusive in TSA, the recurrence rate in LC group was lower. LC and OC were equivalent in terms of postoperative survival outcomes. CONCLUSIONS Considering several limitations of the eligible studies and the subsequent low level of evidence, further RCTs of a higher quality and methodological level are required to verify the findings of our meta-analysis.
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Safety and efficiency of endoscopic resection versus laparoscopic resection in gastric gastrointestinal stromal tumours: A systematic review and meta-analysis.
Wang, C, Gao, Z, Shen, K, Cao, J, Shen, Z, Jiang, K, Wang, S, Ye, Y
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2020;(4 Pt A):667-674
Abstract
The application of endoscopic resection (ER) in gastric gastrointestinal stromal tumours (GIST) is controversial. We carried out a meta-analysis to compare the safety and efficiency of ER with laparoscopic resection (LR) in patients with gastric GISTs. We searched PubMed to identify studies comparing ER with LR in GIST. The outcomes focused on two areas: safety, including operation time, blood loss, length of hospital stay, time to flatus, time to liquid, time to soft diet, and postoperative complications; and efficiency, including positive margin, recurrence, and long-term survival. A total of 1292 patients from 12 studies were included in the meta-analysis. Patients undergoing ER had a shorter operation time (standardised mean difference [SMD] -1.48, 95% confidence interval [CI] -2.18 to -0.78) and shorter time to soft diet (SMD -1.02, 95% CI -1.52 to -0.52) than those undergoing LR. No significant differences were observed between the groups in terms of blood loss, length of hospital stay, time to flatus, time to liquid, and postoperative complications. ER was also associated with greater positive margins compared with LR (relative risk 6.32, 95% CI 1.41-28.26). There were no significant differences between ER and LR for recurrence and 5-year disease-free survival. The limited evidence suggests that ER is a more effective strategy for improving postoperative recovery without increasing the risk of surgery and recurrence in gastric GIST. However, close attention should be paid to margin status after ER.
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Laparoscopic adrenalectomy (LA) vs open adrenalectomy (OA) for pheochromocytoma (PHEO): A systematic review and meta-analysis.
Li, J, Wang, Y, Chang, X, Han, Z
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2020;(6):991-998
Abstract
PURPOSE To evaluate the efficacy and safety of laparoscopic adrenalectomy (LA) vs open adrenalectomy (OA) for pheochromocytoma (PHEO). METHODS A systematic literature research of PubMed, Ovid, Scopus, and citation lists were performed to identify eligible studies. All studies comparing LA versus OA for PHEO were included. RESULTS Overall, fourteen studies including 743 patients (LA 391; OA 352) were included. LA might have smaller tumor size (WMD -0.92 cm, 95% CI -1.09 to -0.76; p < 0.001) and higher body mass index (BMI) (WMD 0.31 kg/m2, 95% CI 0.04 to 0.58; p = 0.02). Compared to OA, LA showed lower estimated blood loss (EBL) (WMD -207.72 ml, 95% CI -311.26, -104.19; p < 0.001), lower transfusion rate (OR 0.25, 95% CI 0.16 to 0.38; p < 0.001), lower hemodynamic instability (HI) (OR 0.61, 95% CI 0.42 to 0.88; p = 0.009), less postoperative complications (OR 0.55, 95% CI 0.34 to 0.89; p = 0.02), less Clavien Dindo score ≥3 complications (OR 0.51, 95% CI 0.27 to 0.97; p = 0.04), shorter return to diet time (WMD -0.76 days, 95% CI -1.27 to -0.25; p = 0.003), and shorter length of hospital stay (WMD -1.76 days, 95% CI -2.94 to -0.58; p < 0.001). The subgroup analysis of studies since 2008 showed consistent results. CONCLUSION LA shows a feasible, safe and superior treatment option for PHEO, because it provides superior perioperative and recovery outcomes without increasing complications.
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Comparison of endoscopic versus laparoscopic resection for gastric gastrointestinal stromal tumors: A preliminary meta-analysis.
Zhu, H, Zhao, S, Jiao, R, Zhou, J, Zhang, C, Miao, L
Journal of gastroenterology and hepatology. 2020;(11):1858-1868
Abstract
BACKGROUND AND AIM For localized disease, complete surgical resection is regarded as the "gold standard" therapeutic modality. With the rapid development of endoscopic techniques, endoscopic resection (ESR) has been confirmed as an efficient and safe alternative for the treatment of gastrointestinal stromal tumors (GISTs) in the stomach. Nevertheless, the management of gastric GISTs remains poorly defined. The purpose of this study is to evaluate the security and effectiveness of ESR with laparoscopic resection (LAR) for gastric GISTs. METHODS A literature search of online databases was conducted to identify relevant comparative studies of ESR and LAR procedures for gastric GISTs published before April 10, 2020. The cumulative data analysis was also performed utilizing the software STATA. RESULTS In total, 10 studies involving 1165 patients met the inclusion criteria for analysis (651 for ESR and 514 for LAR). From the results of meta-analysis, patients who underwent ESR experienced decreased operative time (P = 0.000), less intraoperative blood loss (P = 0.002), earlier time to diet (P = 0.000), shorter hospital stay (P = 0.000), and lower total charges (P = 0.000) compared with LAR. Moreover, there were no significant differences between these two approaches concerning tumor rupture, conversion rate to other procedure, complete resection rate, postoperative complication rate, recurrence rate, and disease-free survival. CONCLUSIONS Endoscopic resection, as an effective alternative treatment strategy with satisfactory outcomes, is acceptable for selective patients with gastric GISTs compared with LAR. Further well-designed randomized controlled trials with large samples are warranted to corroborate our observations.
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The effects of intravenous lidocaine on wound pain and gastrointestinal function recovery after laparoscopic colorectal surgery.
Wei, S, Yu-Han, Z, Wei-Wei, J, Hai, Y
International wound journal. 2020;(2):351-362
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Abstract
To evaluate the efficacy of intravenous lidocaine in relieving postoperative pain and promoting rehabilitation in laparoscopic colorectal surgery, we conducted this meta-analysis. The systematic search strategy was performed on PubMed, EMBASE, Chinese databases, and Cochrane Library before September 2019. As a result, 10 randomised clinical trials were included in this meta-analysis (n = 527 patients). Intravenous lidocaine significantly reduced pain scores at 2, 4, 12, 24, and 48 hours on movement and 2, 4, and 12 hours on resting-state and reduced opioid requirement in first 24 hours postoperatively (weighted mean difference [WMD] = -5.02 [-9.34, -0.70]; P = .02). It also decreased the first flatus time (WMD: -10.15 [-11.20, -9.10]; P < .00001), first defecation time (WMD: -10.27 [-17.62, -2.92]; P = .006), length of hospital stay (WMD: -1.05 [-1.89, -0.21]; P = .01), and reduced the incidence of postoperative nausea and vomiting (risk ratio: 0.53 [0.30, 0.93]; P = .03) when compared with control group. However, it had no effect on pain scores at 24 and 48 hours at rest, the normal dietary time, and the level of serum C-reactive protein. In summary, perioperative intravenous lidocaine could alleviate acute pain, reduce postoperative analgesic requirements, and accelerate recovery of gastrointestinal function in patients undergoing laparoscopic colorectal surgery.
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Meta-analysis and systematic review on laparoscopic-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) for gastric cancer: Preliminary study for a multicenter prospective KLASS07 trial.
Jin, HE, Kim, MS, Lee, CM, Park, JH, Choi, CI, Lee, HH, Min, JS, Jee, YS, Oh, J, Chae, H, et al
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2019;(12):2231-2240
Abstract
BACKGROUND The curative surgical treatment of gastric cancer in the current laparoscopic surgical era relies on the surgeon's preference, technical difficulties, and concerns regarding outcome have led to the availability of totally laparoscopic distal gastrectomy (TLDG) and laparoscopic-assisted distal gastrectomy (LADG). A consensus on which of the two procedures is preferable is necessary. Therefore, the aim of this study was to evaluate the differences between LADG and TLDG in terms of surgical outcomes, postoperative recovery, pain, and complications. METHODS PubMed, Google Scholar, Medline, Embase, and Cochrane databases were explored up to 2017 to evaluate TLDG and LADG. Parameters including surgical outcomes, postoperative recovery, and postoperative complications were subjected to meta-analysis to calculate the odds ratio and weighted mean difference with 95% confidence intervals (c.i.). RESULTS Twenty-five studies (24 non-RCT and 1 RCT) with a total of 4562 gastric cancer patients were included in the meta-analysis. Under reconstruction-matched analysis, overall complications and anastomotic complications were similar for TLDG and LADG. Nevertheless, short-term outcomes such as blood loss, time to first soft diet, hospital stay, analgesic use, and CRP level were favourable for TLDG, while all other surgical outcomes showed no difference. CONCLUSIONS TLDG and LADG did not show significant differences in surgical outcomes and postoperative complications, including anastomotic-related morbidity. Therefore, decisive factors in selecting surgical procedures, which previously consisted of surgical outcomes, have been superseded by extra-surgical values such as cosmesis, economics, and patient's quality of life. These factors will be explored in a future multicentre prospective study (KLASS07 trial).
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Comparison of totally laparoscopic total gastrectomy and laparoscopic-assisted total gastrectomy: A systematic review and meta-analysis.
Zhao, S, Zheng, K, Zheng, JC, Hou, TT, Wang, ZN, Xu, HM, Jiang, CG
International journal of surgery (London, England). 2019;:1-10
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BACKGROUND Laparoscopic-assisted total gastrectomy (LATG) has been extensively employed for the removal of gastric tumors, although it has several limitations. Totally laparoscopic total gastrectomy (TLTG) is a new technique that has rapidly been gaining popularity, and may help overcome the limitations of LATG; however, its safety and therapeutic effect remain controversial. In the present study, we aimed to assess the safety and efficacy of TLTG, and compare the short-term outcomes of TLTG and LATG. METHODS We searched for studies comparing TLTG and LATG published up to April 2018 from databases such as PubMed and Embase. The study results, including time of surgery, blood loss, anastomosis time, retrieved lymphatic nodes, proximal and distal resection edges, incision length, time to first fluid and soft diet, hospitalization duration, time to first flatus, and postsurgical and anastomotic complications, were compared between the procedures. RESULTS A total of 10 studies were included. TLTG led to reduced intraoperative blood loss (P < 0.01), greater number of retrieved lymphatic nodes (P < 0.01), decreased hospitalization duration (P < 0.01), reduced incision length (P = 0.05), and shorter time to first fluid diet (P < 0.05), as compared to LATG. The surgery and anastomosis times, time to first soft diet, resection edge, time to first flatus, overall postsurgical complications, and anastomosis-related complications were similar between TLTG and LATG (P > 0.05). CONCLUSIONS TLTG is a safe procedure that yields better cosmesis lower invasiveness, and faster recovery as compared to LATG.