Jiarong Wang

Laparoscopic versus Open Hepatectomy with or without Synchronous Colectomy for Colorectal Liver Metastasis: A Meta-Analysis

Background To compare short-term and long-term results of colorectal patients undergoing laparoscopic and open hepatectomy. Moreover, outcomes of laparoscopic versus open procedures for simultaneous primary colorectal tumor and liver metastasis resection were compared. Methods A systematic search was conducted in the PubMed and EmBase databases (until Oct. 22. 2013) with no limits. Bibliographic citation management software (EndNote X6) was used for extracted literature management. Quality assessment was performed according to a modification of the Newcastle-Ottawa Scale. The data were analyzed using Review Manager (Version 5.1), and sensitivity analysis was performed by sequentially omitting each study. Results Finally, 14 studies, including a total of 975 CLM (colorectal liver metastasis) patients, compared laparoscopic with open hepatectomy. 3 studies of them, including a total of 107 CLM patients, compared laparoscopic with open procedures for synchronous hepatectomy and colectomy. Laparoscopic hepatectomy was associated with a significantly less blood loss, shorter hospitalization time, and less operative transfusion rate. In addition, lower hospital morbidity rate (OR = 0.57, 95%CI:0.42–0.78, P = 0.0005) and better R0 resection (OR = 2.44, 95%CI:1.21–4.94, P = 0.01) were observed in laparoscopic hepatectomy. For long-term outcomes, there were no significant differences between two surgical procedures on recurrence and overall survival. In comparison of synchronous hepatectomy and colectomy, laparoscopic procedure displayed shorter hospitalization (MD = −3.40, 95%CI:−4.37–2.44, P<0.00001) than open procedure. Other outcomes, including surgical time, estimated blood loss, hospital morbidity, and overall survival did not differ significantly in the comparison. Conclusions Laparoscopic hepatectomy with or without synchronous colectomy are acceptable for selective CLM patients. We suggest standard inclusion criteria of CLM patients be formulated.

BMI as a Predictor for Perioperative Outcome of Laparoscopic Colorectal Surgery: a Pooled Analysis of Comparative Studies.

BACKGROUND: There has been a long-lasting controversy about whether higher BMI is associated with worse perioperative outcomes of laparoscopic colorectal surgery. Recently, a number of newly published investigations have made it possible to draw a quantitative conclusion. OBJECTIVE: We conducted this comprehensive meta-analysis to clarify the exact effect that BMI imposes on perioperative outcome of laparoscopic colorectal surgery. DATA SOURCES: We systematically searched MEDLINE, Embase, and Cochrane Library databases to identify all relevant studies. STUDY SELECTION: Comparative studies in English that investigated perioperative outcome of laparoscopic colorectal surgery for patients with different BMIs were included. Quality of studies was evaluated by using the Newcastle-Ottawa Scale. INTERVENTION: The risk factor of interest was BMI. MAIN OUTCOME MEASURES: Effective sizes were pooled under a random-effects model to evaluate preoperative, intraoperative, and postoperative outcomes. RESULTS: A total of 43 studies were included. We found that higher BMI was associated with significantly longer operative time (p < 0.001), greater blood loss (p = 0.01), and higher incidence of conversion to open surgery (p < 0.001). Moreover, BMI was a risk factor for overall complication rates (p < 0.001), especially for ileus (p = 0.02) and events of the urinary system (p = 0.03). Significant association was identified between higher BMI and risk of surgical site infection (p < 0.001) and anastomotic leakage (p = 0.02). Higher BMI might also led to a reduced number of harvest lymph nodes for patients with colorectal cancer (p = 0.02). The heterogeneity test identified no significant cross-study heterogeneity, and the results of cumulative meta-analysis, sensitivity analysis, and the publication bias test verified the reliability of our study. LIMITATIONS: Most studies included were retrospectively designed. CONCLUSIONS: Body mass index is a practical and valuable measurement for the prediction of the perioperative outcome of laparoscopic colorectal surgery. Higher BMI is associated with worse perioperative outcome. More accurate conclusions, with more precise cutoff values, can be achieved by future well-designed prospective investigations.

Association between the plasminogen activator inhibitor-1 4G/5G polymorphism and risk of venous thromboembolism: a meta-analysis.

INTRODUCTION The plasminogen activator inhibitor-1 (PAI-1) 4G/5G polymorphism was considered to be associated with risk of venous thromboembolism (VTE), while evidence remains inadequate. To provide a more accurate estimation of this relationship, we performed an updated meta-analysis of all eligible studies. MATERIALS AND METHODS A systematical search was performed in PubMed, EMBASE, Wanfang, China National Knowledge Infrastructure (CNKI) and Cqvip databases to identify relevant studies published before March 6(th) 2014. The odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using the fixed/random-effects model using Review Manager 5.1 and STATA 12.0. RESULTS A total of 34 studies with 3561 cases and 5693 controls were analyzed. Overall, significant association between the PAI-1 4G/5G variant and VTE risk in total population (dominant model: OR=1.32, 95%CI: 1.13-1.54) was observed. And this variant was also related to the deep vein thrombosis risk (dominant model: OR=1.60, 95%CI: 1.24-2.06, P=0.0003). In the subgroup analyses on ethnicity, significant results were obtained in both Asians (dominant model: OR=2.08, 95%CI: 1.29-3.35, P=0.003) and Caucasians (dominant model: OR=1.31, 95%CI: 1.10-1.56, P=0.003). However, no significant association was found in patients with provoked VTE. In terms of subgroup analyses on co-existence of other thrombotic risk factors, the PAI-1 4G/5G polymorphism was significantly associated with VTE risk in patients with factor V Leiden mutation (dominant model: OR=1.72, 95%CI: 1.17-2.53), but not in patients with cancer or surgery. CONCLUSION Our findings demonstrate the role of PAI-1 4G/5G polymorphism being a risk candidate locus for VTE susceptibility, especially in patients with other genetic thrombophilic disorders.

NBS1 Glu185Gln polymorphism and cancer risk: update on current evidence

A number of studies have investigated the association between NBS1 Glu185Gln (rs1805794, E185Q) polymorphism and cancer risk, but the results remained controversial. Previous meta-analysis found a borderline significant impact of this polymorphism on cancer risk; however, the result might be relatively unreliable due to absence of numerous newly published studies. Thus, we conducted an updated meta-analysis. A systematic search was performed in PubMed and Embase databases until April 9, 2013. The odds ratios were pooled by the fixed-effects/random-effects model in STATA 12.0 software. As a result, a total of 48 case–control studies with 17,159 cases and 22,002 controls were included. No significant association was detected between the Glu185Gln polymorphism and overall cancer risk. As to subgroup analysis by cancer site, the results showed that this polymorphism could increase the risk for leukemia and nasopharyngeal cancer. Notably, the Glu185Gln polymorphism was found to be related to increased risk for urinary system cancer, but decreased risk for digestive system cancer. No significant associations were obtained for other subgroup analyses such as ethnicity, sample size and smoking status. In conclusion, current evidence did not suggest that the NBS1 Glu185Gln polymorphism was associated with overall cancer risk, but this polymorphism might contribute to the risk for some specific cancer sites due to potential different mechanisms. More well-designed studies are imperative to identify the exact function of this polymorphism in carcinogenesis.

Angiotensin-converting enzyme insertion/deletion polymorphism and gastric cancer: A systematic review and meta-analysis

BACKGROUND AND OBJECTIVE Several studies were launched to investigate the potential function of ACE I/D polymorphism in gastric cancer development and prognosis, but no conclusive results have been obtained. We conducted a systematic review and meta-analysis to evaluate the association between ACE I/D polymorphism and gastric cancer. METHODS A systemic search was performed in PubMed, Embase, China National Knowledge Infrastructure (CNKI), Wanfang and Weipu databases (until October 15,2013) to identify all published records on association between the ACE I/D polymorphism and gastric cancer. We adopted the odds ratio (OR) and 95% confidence interval (95%CI) as measure of effect. Meta-analysis was conducted using fixed/random-effects model in STATA 12.0. RESULTS Eventually a total of seven studies with 1392 cases and 2951 controls were included in our meta-analysis. No association was detected between ACE I/D polymorphism and gastric cancer susceptibility (DI+DD vs II: OR=1.06, 95%CI=0.92-1.21, P=0.443). However, we found that the DD genotype was significantly associated with increased lymph node metastasis (DD vs DI+II: OR=3.48, CI=1.77-6.85, P<0.001), and more advanced clinical stage (DD vs DI+II: OR=2.43, CI=1.34-4.39, P=0.003) of gastric cancer. CONCLUSION Our results indicated that ACE I/D polymorphism could not be directly associated with gastric cancer susceptibility, but might play important role in gastric cancer prognosis. Future studies with larger sample size are warranted for further evaluation.

Impact of CYP1A1 Polymorphisms on Susceptibility to Chronic Obstructive Pulmonary Disease: A Meta-Analysis

Objective. Several studies have evaluated the association between CYP1A1 polymorphisms and the susceptibility of chronic obstructive pulmonary disease (COPD) with inconclusive results. We performed the first comprehensive meta-analysis to summarize the association between CYP1A1 polymorphisms and COPD risk. Method. A systematic literature search was conducted (up to April 2015) in five online databases: PubMed, EMBASE, China National Knowledge Infrastructure (CNKI), WeiPu, and WanFang databases. The strength of association was calculated by odds ratio (OR) and corresponding 95% confidence interval (CI). Results. Seven case-control studies with 1050 cases and 1202 controls were included. Our study suggested a significant association between the MspI polymorphism and COPD risk (CC versus TC + TT: OR = 1.57, CI: 1.09–2.26, P = 0.02; CC versus TT: OR = 1.73, CI: 1.18–2.55, P = 0.005). For the Ile/Val polymorphism, a significant association with COPD risk was observed (GG versus AG + AA: OR = 2.75, CI: 1.29–5.84, P = 0.009; GG versus AA: OR = 3.23, CI: 1.50–6.93, P = 0.003; AG versus AA: OR = 1.39, CI: 1.01–1.90, P = 0.04). Subgroup analysis indicated a significant association between the MspI variation and COPD risk among Asians (CC versus TC + TT: OR = 1.70, CI: 1.06–2.71, P = 0.03; CC versus TT: OR = 1.84, CI: 1.11–3.06, P = 0.02). Conclusion. The MspI and Ile/Val polymorphisms might alter the susceptibility of COPD, and MspI polymorphism might play a role in COPD risk among Asian population.

Systematic review and meta-analysis of current evidence in spontaneous isolated celiac and superior mesenteric artery dissection

Objective: Spontaneous isolated celiac artery dissection (SICAD) and spontaneous isolated superior mesenteric artery dissection (SISMAD) represent the major types of spontaneous visceral artery dissection. However, no quantitative meta‐analysis of SICAD and SISMAD is available. The aim of our study was to pool current evidence concerning basic profiles, treatment strategies, long‐term adverse events, and morphologic changes of lesioned vessels in SICAD and SISMAD patients. Methods: We searched the MEDLINE, Embase, Scopus, and Cochrane Databases (January 1, 1946‐September 21, 2017) for studies of SICAD and SISMAD. Related cohort studies or case series with sample size larger than 10 were included. Two reviewers independently extracted and summarized the data. A random‐effects model was used to calculate pooled estimates. Results: In total, 43 studies were included. An estimated 8% (95% confidence interval [CI], 0.01‐0.21) symptomatic SICAD and 12% (95% CI, 0.06‐0.19) symptomatic SISMAD patients with initial conservative management required secondary intervention during follow‐up, whereas none of the asymptomatic patients treated conservatively required secondary intervention. As for morphologic changes during follow‐up, a higher proportion of SICAD patients (64%; 95% CI, 0.47‐0.80) achieved complete remodeling compared with SISMAD patients (25%; 95% CI, 0.19‐0.32), and an estimated 6% (95% CI, 0.00‐0.16) of SICAD and 12% (95% CI, 0.05‐0.20) of SISMAD patients had morphologic progression. Overall, the pooled estimate of long‐term all‐cause mortality was 0% (95% CI, 0.00‐0.03) in SICAD and 1% (95% CI, 0.00‐0.02) in SISMAD. When stratified by symptoms, symptomatic patients were associated with a significantly increased probability of accomplishing complete remodeling (odds ratio, 3.95; 95% CI, 1.31‐11.85) compared with asymptomatic patients. Conclusions: Initial conservative treatment is safe for asymptomatic SICAD or SISMAD patients. Symptomatic patients managed conservatively have relatively high occurrence of late secondary intervention, which may require closer surveillance, especially in SISMAD because of a lower rate of remodeling.

The Effect of Gender on Outcomes After Lower Extremity Revascularization

Objective: The effect of gender on outcomes after lower extremity revascularization is controversial. The aim of our systemic review and meta‐analysis was to evaluate the gender‐related outcomes after peripheral vascular interventions. Methods: We systematically searched MEDLINE, Embase, Cochrane Database, and Scopus to identify studies comparing outcomes after revascularization according to gender. A random‐effects model was used to pool outcomes. Time‐to‐event data were reported using hazard ratios (HRs) and dichotomous data were presented using odds ratios (ORs). Results: Included were 40 studies. Pooling of short‐term outcomes after intervention showed that women had significantly increased risks of 30‐day mortality (OR, 1.31; 95% confidence interval [CI], 1.11–1.55; P = .001), amputation (OR, 1.07; 95% CI, 1.02–1.12; P = .002), early graft thrombosis (OR, 1.56; 95% CI, 1.28–1.90; P < .0001), embolization (OR, 1.64; 95% CI, 1.24–2.17; P = .0005), incisional site complication (OR, 1.56; 95% CI, 1.34–1.80; P < .0001), cardiac events (OR, 1.21; 95% CI, 1.16–1.26; P < .0001), stroke (OR, 1.35; 95% CI, 1.19–1.53; P < .0001), and pulmonary complication (OR, 1.07; 95% CI, 1.03–1.12; P = .0006). No significant differences were found between women and men for short‐term reinterventions (OR, 1.06; 95% CI, 0.73–1.54; P = .74) and renal complications (OR, 1.03; 95% CI, 0.76–1.39; P = .86). No significant differences in long‐term outcomes between women and men were found, with similar rates of cumulative survival (HR, 1.10; 95% CI, 0.97–1.24; P = .12), primary patency (HR, 1.14; 95% CI, 1.00–1.30; P = .06), secondary patency (HR, 1.07; 95% CI, 0.86–1.34; P = .54), and limb salvage (HR, 0.93; 95% CI, 0.70–1.24; P = .63). However, in the open surgery subgroup, women had significantly reduced survival compared with men (HR, 1.21; 95% CI, 1.01–1.44; P = .04). Conclusions: Women have inferior short‐term outcomes but similar long‐term outcomes compared with men after lower limb revascularization. A higher treatment threshold may be warranted when considering intervening on women with symptomatic peripheral arterial disease owing to the increased risks of postprocedural mortality and complications.

Significant association of alpha-methylacyl-CoA racemase gene polymorphisms with susceptibility to prostate cancer: a meta-analysis.

BACKGROUND Alpha-methylacyl-CoA racemase(AMACR) is thought to play key roles in diagnosis and prognosis of prostate cancer. However, studies of associations between AMACR gene polymorphisms and prostate cancer risk reported inconsistent results. Therefore, we conducted the present meta-analysis to clarify the link between AMACR gene polymorphisms and prostate cancer risk. MATERIALS AND METHODS A literature search was performed in PubMed, Embase, China National Knowledge Infrastructure (CNKI), Wanfang and Weipu databases. Odds ratios (ORs) and 95% confidence intervals (95%CIs) were calculated to assess the strength of any association between AMACR polymorphisms and prostate cancer risk. Subgroup analyses by ethnicity, source of controls, quality control and sample size were also conducted. RESULTS Five studies covering 3,313 cases and 3,676 controls on five polymorphisms (D175G, M9V, S201L, K277E and Q239H) were included in this meta-analysis. Significant associations were detected between prostate cancer and D175G (dominant model: OR=0.89, 95%CI=0.80-0.99, P=0.04) and M9V (dominant model: OR=0.87, 95%CI=0.78-0.97, P=0.01) polymorphisms as well as that in subgroup analyses. We also observed significant decreased prostate cancer risk in the dominant model (OR=0.90, 95%CI=0.81-0.99, P=0.04) for the S201L polymorphism. However, K277E and Q239H polymorphisms did not appear to be related to prostate cancer risk. CONCLUSIONS The current meta- analysis indicated that D175G and M9V polymorphisms of the AMACR gene are related to prostate cancer. The S201L polymorphism might also be linked with prostate cancer risk to some extent. However, no association was observed between K277E or Q239H polymorphisms and susceptibility to prostate cancer.