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Clinical and Translational... Dec 2020Colorectal cancer (CRC) is a leading cause of morbidity and mortality. Post-CRC resection complications and lower quality of life (QoL) are associated with a lower... (Meta-Analysis)
Meta-Analysis
Colorectal cancer (CRC) is a leading cause of morbidity and mortality. Post-CRC resection complications and lower quality of life (QoL) are associated with a lower long-term survival. Perioperative administration of probiotics/synbiotics might lower prevalence of side effects and improve QoL and survival among CRC patients. Medline, Web of Science, Cochrane database, Embase, and clinical trials registries were searched in January 2020. Altogether, 16 randomized placebo-controlled probiotic/synbiotic clinical trials that included patients undergoing CRC surgery and investigated postoperative complications and QoL side effects were found. Meta-analyses using random-effects model were performed on data from 11 studies to calculate the effects of probiotics/synbiotics on common CRC resection postoperative side effects and complications. Perioperative probiotics/synbiotics administration was associated with lower infection incidence (odds ratio [OR] = 0.34, P < 0.001), lower diarrheal incidence (OR = 0.38, P < 0.001), faster return to normal gut function (mean difference [MD] -0.66 days, P < 0.001), shorter postoperative antibiotics use (MD -0.64 days, P < 0.001), lower incidence of septicemia (OR = 0.31, P < 0.001), and shorter length of hospital stay (MD -0.41 days, P = 0.110). The results support the hypothesis that short-term perioperative administration of probiotics/synbiotics, which are easy to administer, have few side-effects, and are low cost compared with alternatives, might help to alleviate gastrointestinal symptoms and postoperative complications among CRC patients.
Topics: Colectomy; Colorectal Neoplasms; Humans; Incidence; Perioperative Care; Postoperative Complications; Probiotics; Proctectomy; Quality of Life; Randomized Controlled Trials as Topic; Synbiotics; Treatment Outcome
PubMed: 33512803
DOI: 10.14309/ctg.0000000000000268 -
Surgical Endoscopy Jan 2021Surgical resection is crucial for curative treatment of rectal cancer. Through multidisciplinary treatment, including radiochemotherapy and total mesorectal excision,... (Comparative Study)
Comparative Study Meta-Analysis
Surgical resection is crucial for curative treatment of rectal cancer. Through multidisciplinary treatment, including radiochemotherapy and total mesorectal excision, survival has improved substantially. Consequently, more patients have to deal with side effects of treatment. The most recently introduced surgical technique is robotic-assisted surgery (RAS) which seems equally effective in terms of oncological control compared to laparoscopy. However, RAS enables further advantages which maximize the precision of surgery, thus providing better functional outcomes such as sexual function or contience without compromising oncological results. This review was done according to the PRISMA and AMSTAR-II guidelines and registered with PROSPERO (CRD42018104519). The search was planned with PICO criteria and conducted on Medline, Web of Science and CENTRAL. All screening steps were performed by two independent reviewers. Inclusion criteria were original, comparative studies for laparoscopy vs. RAS for rectal cancer and reporting of functional outcomes. Quality was assessed with the Newcastle-Ottawa scale. The search retrieved 9703 hits, of which 51 studies with 24,319 patients were included. There was a lower rate of urinary retention (non-RCTs: Odds ratio (OR) [95% Confidence Interval (CI)] 0.65 [0.46, 0.92]; RCTs: OR[CI] 1.29[0.08, 21.47]), ileus (non-RCTs: OR[CI] 0.86[0.75, 0.98]; RCTs: OR[CI] 0.80[0.33, 1.93]), less urinary symptoms (non-RCTs mean difference (MD) [CI] - 0.60 [- 1.17, - 0.03]; RCTs: - 1.37 [- 4.18, 1.44]), and higher quality of life for RAS (only non-RCTs: MD[CI]: 2.99 [2.02, 3.95]). No significant differences were found for sexual function (non-RCTs: standardized MD[CI]: 0.46[- 0.13, 1.04]; RCTs: SMD[CI]: 0.09[- 0.14, 0.31]). The current meta-analysis suggests potential benefits for RAS over laparoscopy in terms of functional outcomes after rectal cancer resection. The current evidence is limited due to non-randomized controlled trials and reporting of functional outcomes as secondary endpoints.
Topics: Adult; Aged; Aged, 80 and over; Databases, Factual; Female; Humans; Laparoscopy; Male; Middle Aged; Odds Ratio; Postoperative Complications; Proctectomy; Quality of Life; Rectal Neoplasms; Rectum; Robotic Surgical Procedures; Treatment Outcome
PubMed: 32025924
DOI: 10.1007/s00464-019-07361-1 -
The Permanente Journal 2020Abdominoperineal resection is associated with a high rate of wound complications. A high degree of wound tension, a common contributor to wound breakdown and...
INTRODUCTION
Abdominoperineal resection is associated with a high rate of wound complications. A high degree of wound tension, a common contributor to wound breakdown and complications, may be mitigated by incisional negative-pressure wound therapy (NPWT). Although NPWT has been shown to reduce complications associated with open and complex wounds, there is a paucity of data regarding its prophylactic use for incisional wounds.
OBJECTIVE
To determine the effect of NPWT use on surgical wound complications of abdominoperineal resection for malignancy.
METHODS
We performed a systematic review by querying the PubMed database for studies from 1990 to 2019 and included English-language studies that used incisional NPWT for closed wounds from abdominoperineal resection in malignancy cases.
RESULTS
Five studies with a total of 76 patients were included. Their findings showed reduced rates of surgical site complications with the use of incisional NPWT. Another 2 studies describing the use of prophylactic NPWT to expedite secondary closure of the surgical wound followed by incisional wound therapy were separately categorized and included 8 patients, none of whom experienced wound wound complications.
DISCUSSION
Additional, prospective research is needed to confirm the benefit of prophylactic incisional NPWT.
Topics: Age Factors; Humans; Negative-Pressure Wound Therapy; Proctectomy; Prospective Studies; Rectal Neoplasms; Risk Factors; Severity of Illness Index; Sex Factors; Surgical Wound Infection
PubMed: 32069209
DOI: 10.7812/TPP/19.173 -
World Journal of Surgical Oncology Mar 2022To assess the efficacy of extraperitoneal colostomy (EPC) in preventing stoma-related complications. (Meta-Analysis)
Meta-Analysis
AIM
To assess the efficacy of extraperitoneal colostomy (EPC) in preventing stoma-related complications.
BACKGROUND
Transperitoneal colostomy (TPC) is a widely used surgical approach. However, TPCs have been reported to have increased risks of stoma-related complications, such as parastomal hernias, stomal retraction, and stomal prolapse. The purpose of EPC is to reduce these complications. However, there is still a lack of evidence-based studies.
MATERIALS AND METHODS
MEDLINE, EMBASE, Web of Science, Scopus, MOOSE, PubMed, Google Scholar, Baidu Scholar, and the Cochrane Library were searched to conduct a systematic review and meta-analysis with RCTs. The meta-analysis was performed with RevMan 5.4 software.
RESULTS
This study included 5 eligible RCTs. Compared with the TPC group, the EPC group had lower incidence rates of parastomal hernias (RR, 0.14; 95% CI, 0.04-0.52, P = 0.003, I = 0%) and stomatal prolapse (RR, 0.27; 95% CI, 0.08-0.95, P = 0.04, I = 0%), but a higher rate of defecation sensation (RR, 3.51; 95% CI, 2.47-5.0, P < 0.00001, I = 37%). No statistically significant differences were observed in stoma retraction, colostomy construction time, stoma ischemia, or stoma necrosis.
CONCLUSION
Extraperitoneal colostomies are associated with lower rates of postoperative complications than transperitoneal colostomies. A randomized controlled trial meta-analysis found that permanent colostomies after abdominoperineal resection resulted in better outcomes.
Topics: Colostomy; Humans; Postoperative Complications; Proctectomy; Randomized Controlled Trials as Topic; Software; Surgical Stomas
PubMed: 35279174
DOI: 10.1186/s12957-022-02547-9 -
International Journal of Colorectal... Jan 2021Closed perineal wounds often fail to heal by primary intention after abdomino-perineal resection (APR) and are often complicated by surgical site infection (SSI) and/or... (Review)
Review
The role of perineal application of prophylactic negative-pressure wound therapy for prevention of wound-related complications after abdomino-perineal resection: a systematic review.
BACKGROUND
Closed perineal wounds often fail to heal by primary intention after abdomino-perineal resection (APR) and are often complicated by surgical site infection (SSI) and/or wound dehiscence. Recent evidence showed encouraging results of prophylactic negative-pressure wound therapy (pNPWT) for prevention of wound-related complications in surgery. Our objective was to gather and discuss the early existing literature regarding the use of pNPWT to prevent wound-related complications on perineal wounds after APR.
METHODS
Medline, Embase, and Web of Science were searched for original publications and congress abstracts reporting the use of pNPWT after APR on closed perineal wounds.
RESULTS
Seven publications were included for analysis. Two publications reported significantly lower incidence of SSI in pNPWT patients than in controls with a risk reduction of about 25-30%. Two other publications described similar incidences of SSI between the two groups of patients but described SSI in pNPWT patients to be less severe. One study reported significantly lower incidence of wound dehiscence in pNPWT patients than in controls.
CONCLUSION
The largest non-randomized studies investigating the effect of pNPWT on the prevention of wound-related complications after APR showed encouraging results in terms of reduction of SSI and wound dehiscence that deserve further investigation and confirmation.
Topics: Humans; Negative-Pressure Wound Therapy; Perineum; Proctectomy; Rectal Neoplasms; Surgical Wound Infection; Wound Healing
PubMed: 32886194
DOI: 10.1007/s00384-020-03732-6 -
Langenbeck's Archives of Surgery May 2024Transanal minimally invasive surgery has theoretical advantages for ileal pouch-anal anastomosis surgery. We performed a systematic review assessing technical approaches... (Meta-Analysis)
Meta-Analysis
PURPOSE
Transanal minimally invasive surgery has theoretical advantages for ileal pouch-anal anastomosis surgery. We performed a systematic review assessing technical approaches to transanal IPAA (Ta-IPAA) and meta-analysis comparing outcomes to transabdominal (abd-IPAA) approaches.
METHODS
Three databases were searched for articles investigating Ta-IPAA outcomes. Primary outcome was anastomotic leak rate. Secondary outcomes included conversion rate, post operative morbidity, and length of stay (LoS). Staging, plane of dissection, anastomosis, extraction site, operative time, and functional outcomes were also assessed.
RESULTS
Searches identified 13 studies with 404 unique Ta-IPAA and 563 abd-IPAA patients. Anastomotic leak rates were 6.3% and 8.4% (RD 0, 95% CI -0.066 to 0.065, p = 0.989) and conversion rates 2.5% and 12.5% (RD -0.106, 95% CI -0.155 to -0.057, p = 0.104) for Ta-IPAA and abd-IPAA. Average LoS was one day shorter (MD -1, 95% CI -1.876 to 0.302, p = 0.007). A three-stage approach was most common (47.6%), operative time was 261(± 60) mins, and total mesorectal excision and close rectal dissection were equally used (49.5% vs 50.5%). Functional outcomes were similar. Lack of randomised control trials, case-matched series, and significant study heterogeneity limited analysis, resulting in low to very low certainty of evidence.
CONCLUSIONS
Analysis demonstrated the feasibility and safety of Ta-IPAA with reduced LoS, trend towards less conversions, and comparable anastomotic leak rates and post operative morbidity. Though results are encouraging, they need to be interpreted with heterogeneity and selection bias in mind. Robust randomised clinical trials are warranted to adequately compare ta-IPAA to transabdominal approaches.
Topics: Humans; Proctocolectomy, Restorative; Anastomotic Leak; Transanal Endoscopic Surgery; Treatment Outcome; Length of Stay; Colonic Pouches; Operative Time; Anastomosis, Surgical
PubMed: 38705912
DOI: 10.1007/s00423-024-03343-7 -
The Incidence and Definition of Crohn's Disease of the Pouch: A Systematic Review and Meta-analysis.Inflammatory Bowel Diseases Aug 2019A subset of patients who undergo total proctocolectomy with ileal pouch-anal anastomosis (IPAA) creation for ulcerative colitis (UC) will later develop Crohn's disease... (Meta-Analysis)
Meta-Analysis
BACKGROUND
A subset of patients who undergo total proctocolectomy with ileal pouch-anal anastomosis (IPAA) creation for ulcerative colitis (UC) will later develop Crohn's disease (CD) of the pouch, which has been associated with significant morbidity. We aimed to analyze the incidence of CD of the pouch and to review the existing diagnostic criteria utilized.
METHODS
A systematic search performed through March 1, 2018, identified 12 studies that reported the incidence of CD of the pouch after IPAA for UC or indeterminate colitis (IC). We compiled all diagnostic criteria utilized in these studies and then performed a meta-analysis using random effects modeling to estimate the overall incidence of CD of the pouch in this population.
RESULTS
Among 4843 patients with an IPAA for UC or IC, 10.3% of patients were ultimately diagnosed with CD of the pouch (95% confidence interval [CI], 6.1%-15.4%). The most commonly reported diagnostic criteria were (1) presence of fistula/fistulae, (2) stricture involving the pouch or prepouch ileum, and (3) presence of prepouch ileitis. In a secondary analysis, excluding those studies that included patients with a preoperative diagnosis of IC, the incidence of CD of the pouch was 12.4% (95% CI, 9.0%-16.1%).
CONCLUSIONS
The estimated incidence of 10.3% will assist gastroenterologists and surgeons in preoperative counseling regarding the potential to develop CD of the pouch. There is an unmet need for common diagnostic criteria for a more standardized approach to the diagnosis of CD of the pouch.
Topics: Colitis, Ulcerative; Crohn Disease; Humans; Incidence; Pouchitis; Proctocolectomy, Restorative; Prognosis; United States
PubMed: 30698715
DOI: 10.1093/ibd/izz005 -
PloS One 2022Neoadjuvant chemoradiotherapy (nCRT) before total mesorectal excision (TME) and followed systemic chemotherapy is widely accepted as the standard therapy for locally... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
Neoadjuvant chemoradiotherapy (nCRT) before total mesorectal excision (TME) and followed systemic chemotherapy is widely accepted as the standard therapy for locally advanced rectal cancer (LARC). This meta-analysis was to evaluate the current evidence regarding nCRT in combination with induction or consolidation chemotherapy for rectal cancer in terms of oncological outcomes.
METHODS
A systematic search of medical databases (PubMed, EMBASE and Cochrane Library) was conducted up to the end of July 1, 2021. This meta-analysis was performed to evaluate the efficacy of TNT in terms of pathological complete remission (pCR), nCRT or surgical complications, R0 resection, local recurrence, distant metastasis, disease-free survival (DFS) and overall survival (OS) in LARC.
RESULTS
Eight nRCTs and 7 RCTs, including 3579 patients were included in the meta-analysis. The rate of pCR was significantly higher in the TNT group than in the nCRT group, (OR 1.85, 95% CI 1.39-2.46, p < 0.0001), DFS (HR 0.80, 95% CI 0.69-0.92, p = 0.001), OS (HR 0.75, 95% CI 0.62-0.89, p = 0.002), nCRT complications (OR 1.05, 95% CI 0.77-1.44, p = 0.75), surgical complications (OR 1.02, 95% CI 0.83-1.26, p = 0.83), local recurrence (OR 1.82, 95% CI 0.95-3.49, p = 0.07), distant metastasis (OR 0.77, 95% CI 0.58-1.03, p = 0.08) did not differ significantly between the TNT and nCRT groups.
CONCLUSION
TNT appears to have advantages over standard therapy for LARC in terms of pCR, R0 resection, DFS, and OS, with comparable nCRT and postoperative complications, and no increase in local recurrence and distant metastasis.
Topics: Humans; Chemoradiotherapy; Neoadjuvant Therapy; Neoplasms, Second Primary; Rectal Neoplasms; Retrospective Studies; Treatment Outcome; Standard of Care; Proctectomy; Mesentery; Antineoplastic Agents
PubMed: 36331947
DOI: 10.1371/journal.pone.0276599 -
International Journal of Colorectal... Oct 2020Restorative proctocolectomy (RPC) is performed for patients with refractory ulcerative colitis (UC). This operation is performed in 2 or 3 stages and involves forming a... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Restorative proctocolectomy (RPC) is performed for patients with refractory ulcerative colitis (UC). This operation is performed in 2 or 3 stages and involves forming a diverting loop ileostomy thought to protect patients from complications related to anastomotic leak. However, some advocate for a modified 2-stage approach, consisting of subtotal colectomy followed by completion proctectomy and ileal pouch anal anastomosis without diverting ileostomy. We present a systematic review and meta-analysis comparing postoperative complication rates between modified 2-stage and traditional RPC with ileal pouch anal anastomosis.
METHODS
Records were sourced from PubMed/Embase databases. Studies comparing postoperative complications following RPC for ulcerative colitis (UC) were selected according to PRISMA guidelines comparing modified 2-stage (exposure), classic 2-stage, and 3-stage approaches (comparators). The primary outcome measure was safety as measured by postoperative complication rates. We employed random effects meta-analysis.
RESULTS
We included ten observational studies including 1727 patients (38% modified 2-stage). Among pediatric patients, modified 2-stage approaches had higher rates of anastomotic leak than 3-stage approaches (p = 0.03). Among adult cohorts with lower preoperative biologic use rates, modified 2-stage approaches had lower leak rates than classic 2-stage approaches (p < 0.001).
CONCLUSIONS
The modified 2-stage approach may be safe for adult patients who otherwise require a 3-stage approach while reducing costs and length of stay. Pediatric patients may benefit from lower leak rates when receiving 3-stage compared with modified 2-stage approaches, especially when on biologics. The modified 2-stage approach may be safer than the classic 2-stage approach for adult patients with lower biologic exposure.
Topics: Adult; Anastomosis, Surgical; Child; Colitis, Ulcerative; Colonic Pouches; Humans; Ileostomy; Postoperative Complications; Proctocolectomy, Restorative; Retrospective Studies; Treatment Outcome
PubMed: 32715346
DOI: 10.1007/s00384-020-03696-7 -
PloS One 2020To analyze pathologic and perioperative outcomes of laparoscopic vs. open resections for rectal cancer performed over the last 10 years. (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
To analyze pathologic and perioperative outcomes of laparoscopic vs. open resections for rectal cancer performed over the last 10 years.
METHODS
A systematic literature search of the following databases was conducted: Cochrane Central Register of Controlled Trials, MEDLINE (through PubMed), EMBASE, and Scopus. Only articles published in English from January 1, 2008 to December 31, 2018 (i.e. the last 10 years), which met inclusion criteria were considered. The review only included articles which compared Laparoscopic rectal resection (LRR) and Open Rectal Resection (ORR) for rectal cancer and reported at least one of the outcomes of interest. The analyses followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement checklist. Only prospective randomized studies were considered. The body of evidence emerging from this study was evaluated using the Grading of Recommendations Assessment Development and Evaluation (GRADE) system. Outcome measures (mean and median values, standard deviations, and interquartile ranges) were extracted for each surgical treatment. Pooled estimates of the mean differences were calculated using random effects models to consider potential inter-study heterogeneity and to adopt a more conservative approach. The pooled effect was considered significant if p <0.05.
RESULTS
Five clinical trials were found eligible for the analyses. A positive involvement of CRM was found in 49 LRRs (8.5%) out of 574 patients and in 30 ORRs out of 557 patients (5.4%) RR was 1.55 (95% CI, 0.99-2.41; p = 0.05) with no heterogeneity (I2 = 0%). Incorrect mesorectal excision was observed in 56 out of 507 (11%) patients who underwent LRR and in 41 (8.4%) out of 484 patients who underwent ORR; RR was 1.30 (95% CI, 0.89-1.91; p = 0.18) with no heterogeneity (I2 = 0%). Regarding other pathologic outcomes, no significant difference between LRR and ORR was observed in the number of lymph nodes harvested or concerning the distance to the distal margin. As expected, a significant difference was found in the operating time for ORR with a mean difference of 41.99 (95% CI, 24.18, 59.81; p <0.00001; heterogeneity: I2 = 25%). However, no difference was found for blood loss. Additionally, no significant differences were found in postoperative outcomes such as postoperative hospital stay and postoperative complications. The overall quality of the evidence was rated as high.
CONCLUSION
Despite the spread of laparoscopy with dedicated surgeons and the development of even more precise surgical tools and technologies, the pathological results of laparoscopic surgery are still comparable to those of open ones. Additionally, concerning the pathological data (and particularly CRM), open surgery guarantees better results as compared to laparoscopic surgery. These results must be a starting point for future evaluations which consider the association between ''successful resection" and long-term oncologic outcomes. The introduction of other minimally invasive techniques for rectal cancer surgery, such as robotic resection or transanal TME (taTME), has revealed new scenarios and made open and even laparoscopic surgery obsolete.
Topics: Adult; Aged; Female; Humans; Laparoscopy; Male; Middle Aged; Postoperative Complications; Proctectomy; Randomized Controlled Trials as Topic; Rectal Neoplasms
PubMed: 32722694
DOI: 10.1371/journal.pone.0235887