Lupeng Wu

Outcome of laparoscopic colorectal surgery in obese and nonobese patients: a meta-analysis.

BackgroundObese patients are generally believed to be at increased risk for surgery compared with those who are not obese. A meta-analysis was performed to assess the outcomes of laparoscopic colorectal surgery in obese and nonobese patients.MethodsA systematic literature search from inception to June 2011 was performed. Pooled odds ratios (OR) and weighted mean differences (WMD) with 95% confidence intervals (95% CI) were calculated using the fixed effects model or random effects model.ResultsEight observational studies identified and matched the selection criteria. Conversion rates (OR: 2.31, 95% CI: 1.74–3.08), operating time (WMD: 15.33, 95% CI: 1.81–28.85), and postoperative morbidity (OR: 2.11; 95% CI: 1.3–3.42) were all significantly increased in the obese group. Length of hospital stay and mortality were similar in both groups. For patients with cancer, there was no difference between groups for the number of harvested nodes and length of specimen.ConclusionsObesity is associated with increased conversion rate, operating time, and postoperative morbidity of laparoscopic colorectal surgery but does not affect surgical safety or oncological security.

Hepatitis viruses infection and risk of intrahepatic cholangiocarcinoma: evidence from a meta-analysis

BackgroundStudies investigating the association between Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections and intrahepatic cholangiocarcinoma (ICC) have reported inconsistent findings. We conducted a meta-analysis of epidemiological studies to explore this relationship.MethodsA comprehensive search was conducted to identify the eligible studies of hepatitis infections and ICC risk up to September 2011. Summary odds ratios (OR) with their 95% confidence intervals (95% CI) were calculated with random-effects models using Review Manager version 5.0.ResultsThirteen case–control studies and 3 cohort studies were included in the final analysis. The combined risk estimate of all studies showed statistically significant increased risk of ICC incidence with HBV and HCV infection (OR = 3.17, 95% CI, 1.88-5.34, and OR = 3.42, 95% CI, 1.96-5.99, respectively). For case–control studies alone, the combined OR of infection with HBV and HCV were 2.86 (95% CI, 1.60-5.11) and 3.63 (95% CI, 1.86-7.05), respectively, and for cohort studies alone, the OR of HBV and HCV infection were 5.39 (95% CI, 2.34-12.44) and 2.60 (95% CI, 1.36-4.97), respectively.ConclusionsThis study suggests that both HBV and HCV infection are associated with an increased risk of ICC.

Laparoscopic liver resection as a safe and efficacious alternative to open resection for colorectal liver metastasis: a meta-analysis

BackgroundThe safety and efficacy of laparoscopic liver resection (LLR) for colorectal liver metastasis (CLM) remain to be established. A meta-analysis was undertaken to compare LLR and open liver resection (OLR) for CLM with respect to surgical and oncologic outcomes.MethodsAn electronic search was performed to retrieve all relevant articles published in the English language by the end of March 2013. Data were analyzed using Review Manager version 5.0.ResultsA total of 8 nonrandomized controlled studies with 695 subjects were analyzsed. Intra-operative blood loss, the proportion of patients requiring blood transfusion, morbidity and the length of hospital stay were all significantly reduced after LLR. Postoperative recurrence, 5-year overall and disease-free survivals were comparable between two groups.ConclusionsLLR for CLM is safe and efficacious. It improves surgical outcomes and uncompromises oncologic outcomes as compared with OLR.

Perioperative blood transfusion adversely affects prognosis after resection of lung cancer: a systematic review and a meta-analysis

BackgroundIt is speculated that blood transfusion may induce adverse consequences after cancer surgery due to immunosuppression. This study was intended to assess the impact of perioperative blood transfusion on the prognosis of patients who underwent lung cancer resection.MethodsEligible studies were identified through a computerized literature search. The pooled relative risk ratio (RR) with 95% confidence interval (CI) was calculated using Review Manager 5.1 Software.ResultsEighteen studies with a total of 5915 participants were included for this meta-analysis. Pooled analysis showed that perioperative blood transfusion was associated with worse overall survival (RR: 1.25, 95% CI: 1.13-1.38; P <0.001) and recurrence-free survival (RR: 1.42, 95% CI: 1.20-1.67; P <0.001) in patients with resected lung cancer.ConclusionsPerioperative blood transfusion appears be associated with a worse prognosis in patients undergoing lung cancer resection. These data highlight the importance of minimizing blood transfusion during surgery.

Single-Incision Versus Conventional Laparoscopy for Colorectal Disease: A Meta-Analysis

BackgroundSingle-incision laparoscopic surgery (SILS) was developed as a novel minimally invasive surgical approach.AimsThe aim of this meta-analysis was to compare SILS and conventional laparoscopy (CL) for colorectal diseases with respect to perioperative and oncologic outcomes.MethodsAn electronic search was performed to retrieve all relevant articles published in the English language between 2008 and 2012 comparing SILS and CL for colorectal diseases. The data were analyzed with fixed-effect or random-effects models using review manager version 5.0.ResultsA total of 14 studies (one randomized controlled trial and 13 nonrandomized controlled trials) were found to be eligible and reported on 1,155 subjects, of whom 521 underwent SILS and 634 underwent CL for colorectal diseases. Concerning the perioperative outcomes, no differences were observed in conversion rate, operating time, and postoperative adverse events; however, patients who underwent SILS had lower blood loss, decreased blood transfusion requirement, shorter time to flatus, shorter hospital stay, and smaller incision. Concerning the oncologic outcomes, length of resected specimens, number of harvested lymph nodes, proximal margin, and distal margin, were comparable between two groups.ConclusionsSingle-incision laparoscopic surgery (SILS) is a safe, feasible, and oncological efficient alternative to CL for colorectal diseases. Further larger, multi-centred, randomised controlled trial is indicated.

Influence of viral hepatitis status on prognosis in patients undergoing hepatic resection for hepatocellular carcinoma: a meta-analysis of observational studies

BackgroundThe influence of viral hepatitis status on prognosis in patients undergoing hepatic resection for hepatocellular carcinoma (HCC) remains a matter of debate. This study is a meta-analysis of the available evidence.MethodsA literature search was performed to identify comparative studies reporting postoperative survival of HCC in different types of viral hepatitis. Pooled odds ratios (OR) and weighted mean differences (WMD with 95% confidence intervals (95% CI) were calculated using either the fixed effects model or random effects model.ResultsTwenty studies matched the selection criteria and reported on 4744 subjects, of whom 2008 in the HBV-positive (B-HCC) group, 2222 in the HCV-positive (C-HCC) group, and 514 in the hepatitis B- and C-negative (NBNC-HCC). Meta-analysis showed that patients with HBV or HCV infection had a worse 5-year disease-free survival when compared to patients with NBNC-HCC (respectively: OR: 0.39, 95% CI: 0.28 to 0.53, P < 0.001; WMD: 0.37, 95% CI: 0.22 to 0.64, P < 0.001). There was a tendency toward higher 5-year overall survival rates in the NBNC-HCC group compared to those in the other two groups, although these differences were not statistically significant. Both the 5-year overall survival and disease-free survival were not different among the B-HCC and C-HCC groups.ConclusionsPatients with positive serology for hepatitis B or C undergoing resection for HCC had a poor prognosis compared to patients with negative serology.

Meta-analysis: preoperative transcatheter arterial chemoembolization does not improve prognosis of patients with resectable hepatocellular carcinoma

BackgroundLong-term outcomes of partial liver resection of hepatocellular carcinoma (HCC) remain satisfactory due to high incidences of recurrence. This study was intended to see whether preoperative transcatheter arterial chemoembolization (TACE) reduces postoperative tumor recurrences and prolongs survival of patients with resectable HCC.MethodsA computerized literature search was performed to identify relevant articles. The quality of nonrandomized comparative studies (NRCTs) was assessed using the methodological index for nonrandomized studies (MINORS). Data synthesis was performed using Review Manager 5.0 software.ResultsTwenty-one studies (4 randomized controlled trials and 17 NRCTs) with a total of 3,210 participants were suitable for analysis. There was no significant difference in disease-free and overall survival at 5-year (32.1% vs. 30.0% and 40.2% vs. 45.2%), and intra- and extra-hepatic recurrence (51.2% vs.53.6% and 12.9% vs.10.3%) between patients with and without preoperative TACE. Postoperative morbidity (28.9% vs. 26.8%) and in-hospital mortality (4.1% vs. 3.1%) were also similar between the two groups.ConclusionsPreoperative TACE does not seem to improve prognosis and therefore it is prudent to recommend it as a preoperative routine procedure for resectable HCC.

Distal pancreatectomy with en bloc celiac axis resection for pancreatic body-tail cancer: Is it justified?

Background The aim of this study was to evaluate the safety and efficacy of distal pancreatectomy with en bloc celiac axis resection (DP-CAR) for pancreatic body-tail cancer. Material/Methods The medical records of 12 patients who underwent DP-CAR for pancreatic body-tail cancer were retrospectively studied, together with a literature review of studies including at least 3 cases of DP-CAR. Results There were no deaths among our 12 cases. Postoperative morbidity developed in 9 cases and was successfully managed by non-surgical treatment. No patients developed ischemic complications. Median overall survival was 10 months. A total of 19 studies involving 203 patients who underwent DP-CAR were included in the literature review. The overall morbidity and mortality rates were 50.2% and 3.0%, respectively. The overall median survival after surgery ranged from 9.3 to 26 months. Conclusions DP-CAR is a safe and effective treatment for patients with locally advanced pancreatic body-tail cancer.

Risk factors for combined hepatocellular-cholangiocarcinoma: A hospital-based case-control study

AIM To identify risk factors contributing to the development of combined hepatocellular-cholangiocarcinoma (CHC) in China. METHODS One hundred and twenty-six patients with CHC and 4:1 matched healthy controls were interviewed during the period from February 2000 to October 2012. Logistic regression analysis was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for each risk factor. RESULTS Univariate analysis showed that the significant risk factors for CHC development were hepatitis B virus (HBV) infection, heavy alcohol consumption, a family history of liver cancer, and diabetes mellitus. Multivariate stepwise logistic regression analysis showed that HBV infection (OR = 19.245, 95%CI: 13.260-27.931) and heavy alcohol consumption (OR = 2.186, 95%CI: 1.070-4.466) were independent factors contributing to the development of CHC. CONCLUSION HBV infection and heavy alcohol consumption may play a role in the development of CHC in China.

Survival after surgical resection of distal cholangiocarcinoma: A systematic review and meta-analysis of prognostic factors

BACKGROUND/OBJECTIVE This study aimed to assess the available evidence on the survival of distal cholangiocarcinoma (DCC) patients following resection with curative intent and analyze the prognostic factors. METHODS Relevant studies published between January 2000 and January 2015 were identified by searching PubMed and Embase and reviewed systematically. Summary relative risks (RR) and 95% confidence intervals (95% CI) were estimated using random-effects models. RESULTS A total of 39 observational studies involving 3258 patients were included in the review. R0 resection was achieved in 84% (range, 46-100%) of patients. The median 5-year overall survival rate after resection was 37% (range, 13-54%), with corresponding rate of 44% (range, 27-63%) in R0 resection. The meta-analysis for 25 studies showed that R1 resection (RR 2.36, 95% CI 1.89-2.93), lymph node metastasis (RR 2.35, 95% CI 1.89-2.93), perineural invasion (RR 1.96, 95% CI 1.64-2.34), lymphatic invasion (RR 1.84, 95% CI 1.47-2.31), vascular invasion (RR 1.99, 95% CI 1.40-2.82), pancreatic invasion (RR 2.13, 95% CI 1.39-3.27), and pathological tumor stage ≥ T3 (RR 1.56, 95% CI 1.25-1.93) were associated with shorter survival. CONCLUSION In general, prognosis of DCC after resection is poor. R0 resection results in a substantially improved survival and represents one of the most important prognostic variables.