scholarly journals Effect of vascular resection for perihilar cholangiocarcinoma: a systematic review and meta-analysis

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e12184
Author(s):  
Yong Liu ◽  
Guangbing Li ◽  
Ziwen Lu ◽  
Tao Wang ◽  
Yang Yang ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Meta Analysis ◽  
Postoperative Mortality ◽  
Morbidity Rate ◽  
R0 Resection ◽  
Long Term Outcomes ◽  
Term Survival ◽  
Long Term Survival ◽  
Short And Long Term

Objective To evaluate the effect of vascular resection (VR), including portal vein resection (PVR) and hepatic artery resection (HAR), on short- and long-term outcomes in patients with perihilar cholangiocarcinoma (PHC). Background Resection surgery and transplantation are the main treatment methods for PHC that provide a chance of long-term survival. However, the efficacy and safety of VR, including PVR and HAR, for treating PHC remain controversial. Methods This study was registered at the International Prospective Register of Systematic Reviews (CRD42020223330). The EMBASE, PubMed, and Cochrane Library databases were used to search for eligible studies published through November 28, 2020. Studies comparing short- and long-term outcomes between patients who underwent hepatectomy with or without PVR and/or HAR were included. Random- and fixed-effects models were applied to assess the outcomes, including morbidity, mortality, and R0 resection rate, as well as the impact of PVR and HAR on long-term survival. Results Twenty-two studies including 4,091 patients were deemed eligible and included in this study. The meta-analysis showed that PVR did not increase the postoperative morbidity rate (odds ratio (OR): 1.03, 95% confidenceinterval (CI): [0.74–1.42], P = 0.88) and slightly increased the postoperative mortality rate (OR: 1.61, 95% CI [1.02–2.54], P = 0.04). HAR did not increase the postoperative morbidity rate (OR: 1.32, 95% CI [0.83–2.11], P = 0.24) and significantly increased the postoperative mortality rate (OR: 4.20, 95% CI [1.88–9.39], P = 0.0005). Neither PVR nor HAR improved the R0 resection rate (OR: 0.70, 95% CI [0.47–1.03], P = 0.07; OR: 0.77, 95% CI [0.37–1.61], P = 0.49, respectively) or long-term survival (OR: 0.52, 95% CI [0.35–0.76], P = 0.0008; OR: 0.43, 95% CI [0.32–0.57], P < 0.00001, respectively). Conclusions PVR is relatively safe and might benefit certain patients with advanced PHC in terms of long-term survival, but it is not routinely recommended. HAR results in a higher mortality rate and lower overall survival rate, with no proven benefit.

723 TWO- VS. THREE-FIELD LYMPHADENECTOMY FOR ESOPHAGEAL CANCER. A SYSTEMATIC REVIEW AND META-ANALYSIS OF SHORT- AND LONG-TERM OUTCOMES.

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Letícia Nogueira Datrino ◽  
Clara Lucato Santos ◽  
Guilherme Tavares ◽  
Luca Schiliró Tristão ◽  
Maria Carolina Andrade Serafim ◽  
...  
Keyword(s):  
Systematic Review ◽  
Esophageal Cancer ◽  
Meta Analysis ◽  
Operation Time ◽  
Extended Lymphadenectomy ◽  
Long Term Outcomes ◽  
Term Survival ◽  
Long Term Survival ◽  
Short And Long Term

Abstract   Nowadays, there is still no consensus about the benefits of adding neck lymphadenectomy to the traditional two-fields esophagectomy. An extended lymphadenectomy could potentially increase operation time and the risks for postoperative complications. However, extended lymphadenectomy allows resection of cervical nodes at risk for metastases, potentially increasing long-term survival rates. This study aims to estimate whether cervical prophylactic lymphadenectomy for esophageal cancer influences short- and long-term outcomes through a systematic review of literature and meta-analysis. Methods A systematic review was conducted in PubMed, Embase, Cochrane Library Central, and Lilacs (BVS). The inclusion criteria were: (1) studies that compare two-field vs. three-field esophagectomy; (2) adults (&gt;18 years); (3) articles that analyze short- or long-term outcomes; and (4) clinical trials or cohort studies. The results were summarized by forest plots, with effect size (ES) or risk difference (RD) and 95% CI. Results Twenty-five articles were selected, comprising 8,954 patients. Three-field lymphadenectomy was associated to higher operation time (ES: -1.51; 95%CI -1.84, −1.18) and higher blood loss (ES: -0.24; 95%CI: −0.37, −0.11). Also, neck lymphadenectomy inputs additional risk for pulmonary complications (RD: 0.03; 95%CI: 0.01, 0.05). No difference was noted for morbidity (RD: 0.01; 95%CI: −0.01, 0.03); leak (−0.02; 95%CI: −0.07, 0.03); postoperative mortality (RD: 0.00; 95%CI: −0.00, 0.01), and hospital stay (ES: -0.05; 95%CI -0.20, 0.10). Three-field lymphadenectomy allowed higher number of retrieved lymph nodes (MD: -1.51; 95%CI -1.84, −1.18), but did not increase the overall survival (HR: 1.11; 95%CI: 0.96, 1.26). Conclusion Prophylactic neck lymphadenectomy for esophageal cancer should be performed with caution once it is associated with poorer short-term outcomes compared to traditional two-field lymphadenectomy and does not improve long-term survival. Future esophageal cancer studies should determine the subgroup of patients who could benefit from prophylactic neck lymphadenectomy in long-term outcomes.

Gender-based 30-day and long-term outcomes after carotid endarterectomy

VASA ◽  
2015 ◽  
Vol 44 (4) ◽  
pp. 289-295
Author(s):  
Thomas Lübke ◽  
Wael Ahmad ◽  
Bijan Koushk Jalali ◽  
Jan Brunkwall
Keyword(s):  
Carotid Endarterectomy ◽  
Female Group ◽  
Long Term Outcomes ◽  
Term Survival ◽  
Long Term Survival ◽  
Significant Difference ◽  
Short And Long Term ◽  
Independent Risk Factors ◽  
Ica Stenosis

Abstract. Background: We analyses the effect of gender on short and long-term morbidity and mortality in carotid endarterectomy (CEA) under loco-regional anesthesia. Patients and methods: Patients who were entered into a prospectively compiled computerized database of unilateral, consecutive CEAs performed at our hospital from January 2000 to December 2010 were analysed. Endpoints were perioperative stroke and death, and overall long-term survival rates. Statistical analysis was used to determine the relationships between gender and outcomes after CEA. A Cox proportional hazard model was applied to determine independent risk factors for long term survival. Results: A total of 1880 CEA procedures were performed in the period between 2000 and 2010. Overall, there were 28 (1.48 %) neurological deficits according to the ipsilateral carotid supply territory, including minor and major strokes. 7 occurred in the female group (1.19 %), and 21 in the male group (1.62 %) with no significant difference between the genders (p = 0.60). No significant difference emerged between female and male patients when postoperative neurological events according to the ipsilateral carotid supply territory were stratified by linical presentation (asymptomatic ICA stenosis: p = 0.75; symptomatic ICA stenosis: p = 0.66). The late overall mortality rate was 4.1% (n = 78) and 26/78 of these late deaths occurred in the female group (33 %). Log rank analysis of Kaplan Meier curves showed no statistically significant difference in long-term survival between the groups (p = 0.74). The multivariate risk factor analysis with the Cox proportinal hazard model revealed age (p < 0.00), and smoking (p = 0,02) as independent risk factors for decreased long term survival. Conclusions: When considering short and long-term outcomes in patients receiving carotid endarterectomy in local anaesthesia gender should not be regarded as a factor on decision-making for carotid interventions in both symptomatic and asymptomatic patients.

Abstract 16046: Conventional versus Right Mini-thoracotomy versus Robotic Mitral Valve Replacement/repair; Insights From a Network Meta-analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yujiro Yokoyama ◽  
Hisato Takagi ◽  
Toshiki Kuno
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Meta Analysis ◽  
Mitral Valve Surgery ◽  
Valve Repair ◽  
Long Term Outcomes ◽  
Term Survival ◽  
Long Term Survival ◽  
Mini Thoracotomy

Background: Benefits and risks of minimally invasive cardiac surgery (MICS) through right mini-thoracotomy and robotic surgery for mitral valve are not fully understood. We conducted a network meta-analysis comparing the perioperative and long-term outcomes of mitral valve surgery via conventional sternotomy, MICS and robot. Methods: MEDLINE and EMBASE were searched through March 15th, 2020 to identify randomized controlled trials (RCTs) and propensity-score matched (PSM) trials that investigated perioperative and long-term outcomes after mitral surgery via conventional sternotomy, MICS and robot. Subanalyses were conducted by restricting trials, in which mitral valve repair was tried first for all patients. Results: Our systematic literature search identified 2 RCTs and 21 PSM trials. MICS was related to significant decrease in PM ([RR] [95% confidence interval [CI] =0.56 [0.40-0.78]] and SSI (RR [95%CI] =0.53 [0.33-0.85) compared to conventional sternatomy. Re-exploration for bleeding was significantly higher in robot compared to sternotomy (RR [95% CI] =1.56 [1.03-2.37]), and transfusion was higher in sternotomy compared to MICS (RR [95%CI] =1.63 [1.27-2.08]). No significant differences were observed in perioperative mortality, MI, stroke, and LCOS among there procedures. Similarly, there were no significant differences in long-term survival and mitral valve reoperation. Suanalyses by restricting trials in which mitral valve repair tried first for all patients showed MICS was related to significant increase in mitral valve reoperation compared to conventional sternotomy (hazard ratio [95%CI] =7.33 [1.54-34.97]) (Figure). Conclusion: Our network meta-analysis demonstrated similar long-term survival and mitral valve reoperation. However, MICS was related to significant increase in mitral valve reoperation after mitral valve repair compared to conventional sternotomy.

scholarly journals Rubin H. Flocks and Colloidal Gold Treatments for Prostate Cancer

2011 ◽  
Vol 11 ◽  
pp. 1560-1567 ◽  
Author(s):  
Henry M. Rosevear ◽  
Andrew J. Lightfoot ◽  
Michael A. O'Donnell ◽  
Charles E. Platz ◽  
Stefan A. Loening ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Colloidal Gold ◽  
Long Term Outcomes ◽  
University Of Iowa ◽  
Term Survival ◽  
Long Term Survival ◽  
Short And Long Term ◽  
The University

In the early 1950s, Rubin H. Flocks of the University of Iowa began to treat prostate cancer patients with colloidal gold (Au198) therapy, evolving his technique over nearly 25 years in 1515 patients. We reviewed the long-term outcomes of Flocks' prostate cancer patients as compared to those patients treated by other methods at the University of Iowa before Flocks' chairmanship. We reviewed archived patient records, Flocks' published data, and long-term survival data from the Iowa Tumor Registry to determine short- and long-term outcomes of Flocks' work with colloidal gold. We also reviewed the literature of Flocks' time to compare his outcomes against those of his contemporaries. The use of colloidal gold, either as primary or adjunctive therapy, provided short- and long-term survival benefit for the majority of Flocks' patients as compared to historical treatment options (p< 0.001). Flocks' use of colloidal gold for the treatment of locally advanced prostate cancer offered short- and long-term survival benefits compared to other contemporary treatments.

scholarly journals The Anti-PD-1/PD-L1 Immunotherapy for Gastric Esophageal Cancer: A Systematic Review and Meta-Analysis and Literature Review

2021 ◽  
Vol 28 ◽  
pp. 107327482199743
Author(s):  
Ke Chen ◽  
Xiao Wang ◽  
Liu Yang ◽  
Zheling Chen
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Survival Rate ◽  
Meta Analysis ◽  
Response Rates ◽  
Control Group ◽  
Term Survival ◽  
Long Term Survival ◽  
And Control

Background: Treatment options for advanced gastric esophageal cancer are quite limited. Chemotherapy is unavoidable at certain stages, and research on targeted therapies has mostly failed. The advent of immunotherapy has brought hope for the treatment of advanced gastric esophageal cancer. The aim of the study was to analyze the safety of anti-PD-1/PD-L1 immunotherapy and the long-term survival of patients who were diagnosed as gastric esophageal cancer and received anti-PD-1/PD-L1 immunotherapy. Method: Studies on anti-PD-1/PD-L1 immunotherapy of advanced gastric esophageal cancer published before February 1, 2020 were searched online. The survival (e.g. 6-month overall survival, 12-month overall survival (OS), progression-free survival (PFS), objective response rates (ORR)) and adverse effects of immunotherapy were compared to that of control therapy (physician’s choice of therapy). Results: After screening 185 studies, 4 comparative cohort studies which reported the long-term survival of patients receiving immunotherapy were included. Compared to control group, the 12-month survival (OR = 1.67, 95% CI: 1.31 to 2.12, P < 0.0001) and 18-month survival (OR = 1.98, 95% CI: 1.39 to 2.81, P = 0.0001) were significantly longer in immunotherapy group. The 3-month survival rate (OR = 1.05, 95% CI: 0.36 to 3.06, P = 0.92) and 18-month survival rate (OR = 1.44, 95% CI: 0.98 to 2.12, P = 0.07) were not significantly different between immunotherapy group and control group. The ORR were not significantly different between immunotherapy group and control group (OR = 1.54, 95% CI: 0.65 to 3.66, P = 0.01). Meta-analysis pointed out that in the PD-L1 CPS ≥10 sub group population, the immunotherapy could obviously benefit the patients in tumor response rates (OR = 3.80, 95% CI: 1.89 to 7.61, P = 0.0002). Conclusion: For the treatment of advanced gastric esophageal cancer, the therapeutic efficacy of anti-PD-1/PD-L1 immunotherapy was superior to that of chemotherapy or palliative care.

scholarly journals The Prospects of Secondary Moderate Mitral Regurgitation after Aortic Valve Replacement —Meta-Analysis

2020 ◽  
Vol 17 (19) ◽  
pp. 7335
Author(s):  
Ilija Bilbija ◽  
Milos Matkovic ◽  
Marko Cubrilo ◽  
Nemanja Aleksic ◽  
Jelena Milin Lazovic ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Meta Analysis ◽  
Reverse Remodeling ◽  
Term Survival ◽  
Long Term Survival

Aortic valve replacement for aortic stenosis represents one of the most frequent surgical procedures on heart valves. These patients often have concomitant mitral regurgitation. To reveal whether the moderate mitral regurgitation will improve after aortic valve replacement alone, we performed a systematic review and meta-analysis. We identified 27 studies with 4452 patients that underwent aortic valve replacement for aortic stenosis and had co-existent mitral regurgitation. Primary end point was the impact of aortic valve replacement on the concomitant mitral regurgitation. Secondary end points were the analysis of the left ventricle reverse remodeling and long-term survival. Our results showed that there was significant improvement in mitral regurgitation postoperatively (RR, 1.65; 95% CI 1.36–2.00; p < 0.00001) with the average decrease of 0.46 (WMD; 95% CI 0.35–0.57; p < 0.00001). The effect is more pronounced in the elderly population. Perioperative mortality was higher (p < 0.0001) and long-term survival significantly worse (p < 0.00001) in patients that had moderate/severe mitral regurgitation preoperatively. We conclude that after aortic valve replacement alone there are fair chances but for only slight improvement in concomitant mitral regurgitation. The secondary moderate mitral regurgitation should be addressed at the time of aortic valve replacement. A more conservative approach should be followed for elderly and high-risk patients.

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