Haiyang Zhou

Systematic Review and Meta-Analysis of Somatostatin Analogues in the Prevention of Postoperative Complication after Pancreaticoduodenectomy

Background: The use of somatostatin analogues (SAs) following pancreaticoduodenectomy (PD) is controversial. Method: Literature databases were searched systematically for relevant articles. A meta-analysis of all randomized controlled trials (RCTs) evaluating prophylactic SAs in PD was performed. Results: Fifteen RCTs involving 1,352 patients were included. There was a towards reduced incidences of pancreatic fistulas (p = 0.26), clinically significant pancreatic fistulas (p = 0.08), and bleeding (p = 0.05) in prophylactic SAs group. In subgroup analyses, prophylactic somatostatin significantly reduced the incidence of pancreatic fistulas (p = 0.02), with a nonsignificant trend toward reduced incidence of clinically significantly pancreatic fistulas (p = 0.06). Pasireotide significantly reduced the incidence of clinically significantly pancreatic fistulas (p = 0.03). Octreotide had no influence on the incidence of pancreatic fistulas. Conclusion: The current best evidence suggests prophylactic treatment with somatostatin or pasireotide has a potential role in reducing the incidence of pancreatic fistulas, while octreotide had no influence on the incidence of pancreatic fistulas. High-quality RCTs assessing the role of somatostatin and pasireotide are required for further verification.

Association of perioperative allogeneic blood transfusions and prognosis of patients with gastric cancer after curative gastrectomy

BACKGROUND The relationship between perioperative allogeneic blood transfusions (PABTs) and prognosis in patients with gastric cancer remains controversial. METHODS Six hundred five consecutive patients with gastric cancer who underwent curative gastrectomy from a single center were enrolled in this retrospective study. Clinical and pathologic variables were prospectively collected. The effect of PABT on the long-term survival of patients with gastric cancer after curative gastrectomy was evaluated by univariate and multivariate analyses. RESULTS The overall 5-year survival rate was 65.0%. On univariate analyses, PABT had a statistically significant negative impact on 3-year and 5-year survival rates (66.3% vs 80.5% [P = .005] and 38.7% vs 76.4% [P < .001], respectively). However, multivariate analyses revealed that duration of operation (P = .009), tumor size (P = .001), and tumor stage (P < .001), instead of PABT, were independent prognostic factors. CONCLUSIONS Our study indicates that PABT is not an independent prognostic factor for long-term survival in patients with gastric cancer after curative gastrectomy.

Single Incision versus Conventional Multiport Laparoscopic Appendectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: The efficacy of single incision laparoscopic appendectomy (SILA) in comparison with conventional multiport laparoscopic appendectomy (CMLA) has not been conclusively determined. Methods: A systematic literature review (Medline, EMBASE, Science Citation Index, and Cochrane Central Register of Controlled Trials) was performed. Meta-analyses of randomized controlled trials (RCTs) comparing SILA with CMLA were carried out by RevMan 5.0 software. Results: Eleven RCTs comparing SILA and CMLA were included. Overall, 1,216 patients were operated on: 611 cases by SILA versus 605 cases by CMLA. Compared with CMLA, SILA was associated with increased procedural difficulty, prolonged procedural duration, shorter length of hospital stay, earlier return to normal activity and better cosmesis. There were no significant differences in postoperative pain scores and complication rates between SILA and CMLA. Conclusion: The current best evidence shows SILA holds the promise of improving postoperative recovery and cosmetic result with equal efficacy and safety, whereas it is associated with higher surgical difficulty with longer surgical time when compared with CMLA.

Retrograde vs Conventional Dissection Technique in Pancreaticoduodenectomy A Pilot Study

IMPORTANCE A retrograde dissection technique of pancreaticoduodenectomy in a caudocranial direction has been described recently. OBSERVATIONS Fifteen consecutive patients who underwent retrograde pancreaticoduodenectomy were compared with 15 consecutive patients operated on through a conventional approach. The mean (SD) intraoperative blood loss was 407 (202) mL in the retrograde group compared with 423 (253) mL in the conventional group (P = .84). The mean (SD) operative duration was 255 (57) minutes in the retrograde group compared with 264 (54) minutes in the conventional group (P = .66). The overall morbidity was 7 of 15 patients (47%) in the retrograde group and 6 of 15 (40%) in the conventional group (P > .99). Neither group had a positive resection margin or a perioperative death. CONCLUSIONS AND RELEVANCE The retrograde dissection technique had no significant difference in perioperative outcomes compared with the conventional dissection technique and could serve as an alternative dissection approach in pancreaticoduodenectomy.

Does preoperative biliary drainage associated time delay harm? From trial design to conclusion.

TAPP versus 24 patients for TEP.2 Only length of stay was significantly shorter for TEP. No differences between TAPP and TEP were seen in terms of length of operation, hematomas, time to return to usual activities and hernia recurrence. Data about complications were obtained from additional non-RCT studies and these results appear to be broadly consistent. The non-RCT studies suggest that an increased number of port-site hernias and visceral injuries are associated with TAPP rather than TEP. These non-RCT studies consisted of 5 studies with concurrent comparators and 3 case series. These were mainly large studies: Lepere with 1290 TAPP versus 692 TEP procedures,3 and Felix with 733 TAPP versus 382 TEP procedures.4 The case series varied from 2500 to 5707 procedures.5–7 Therefore, although the learning curve for TAPP is shorter and the conversion rate is higher for TEP,8 the Dutch guideline on inguinal hernia repair prefers TEP over TAPP.9 However, well-randomized controlled multicenter trials comparing TAPP versus TEP are lacking indeed. For the future, more research on this subject is encouraged.