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Transthoracic resection versus non-transthoracic resection for gastroesophageal junction cancer: a meta-analysis.

Yang K, Chen HN, Chen XZ, Lu QC, Pan L, Liu J, Dai B, Zhang B, Chen ZX, Chen JP, Hu JK - PLoS ONE (2012)

Bottom Line: The postoperative morbidity (RR = 0.69, 95% CI 0.48- 1.00 and OR = 0.55, 95% CI 0.25- 1.22) and mortality (RD = -0.03, 95% CI -0.06- 0.00 and RD = 0.00, 95% CI -0.05- 0.05) of RCTs and non-RCTs did not suggest any significant differences between the two groups.The results of sensitivity analyses were similar to the primary analyses.However, the results should be interpreted cautiously since the qualities of included studies were suboptimal.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China.

ABSTRACT

Background: The aim of this meta-analysis is to evaluate the impact of transthoracic resection on long-term survival of patients with GEJ cancer and to compare the postoperative morbidity and mortality of patients undergoing transthoracic resection with those of patients who were not undergoing transthoracic resection.

Method: Searches of electronic databases identifying studies from Medline, Cochrane Library trials register, and WHO Trial Registration etc were performed. Outcome measures were survival, postoperative morbidity and mortality, and operation related events.

Results: Twelve studies (including 5 RCTs and 7 non-RCTs) comprising 1105 patients were included in this meta-analysis, with 591 patients assigned treatment with transthoracic resection. Transthoracic resection did not increase the 5-y overall survival rate for RCTs and non-RCTs (HR = 1.01, 95% CI 0.80- 1.29 and HR = 0.89, 95% CI 0.70- 1.14, respectively). Stratified by the Siewert classification, our result showed no obvious differences were observed between the group with transthoracic resection and group without transthoracic resection (P>0.05). The postoperative morbidity (RR = 0.69, 95% CI 0.48- 1.00 and OR = 0.55, 95% CI 0.25- 1.22) and mortality (RD = -0.03, 95% CI -0.06- 0.00 and RD = 0.00, 95% CI -0.05- 0.05) of RCTs and non-RCTs did not suggest any significant differences between the two groups. Hospital stay was long with thransthoracic resection (WMD = -5.80, 95% CI -10.38- -1.23) but did not seem to differ in number of harvested lymph nodes, operation time, blood loss, numbers of patients needing transfusion, and reoperation rate. The results of sensitivity analyses were similar to the primary analyses.

Conclusions: There were no significant differences of survival rate and postoperative morbidity and mortality between transthoracic resection group and non-transthoracic resection group. Both surgical approaches are acceptable, and that one offers no clear advantage over the other. However, the results should be interpreted cautiously since the qualities of included studies were suboptimal.

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Related in: MedlinePlus

Forest plot of 5-year overall survival rates for RCTs and non-RCTs.a: RCTs; b: non-RCTs. The 95% confidence interval (CI) for the hazard ratio for each study is represented by a horizontal line and the point estimate is represented by a square. The size of the square corresponds to the weight of the study in the meta-analysis. The 95% CI for pooled estimates is represented by a diamond. Data for a fixed-effects model are shown as there was no statistical heterogeneity. df = degrees of freedom; I2 = percentage of the total variation across studies due to heterogeneity; IV = Inverse Variance; SE = standard error; Z = test of overall treatment effect.
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pone-0037698-g002: Forest plot of 5-year overall survival rates for RCTs and non-RCTs.a: RCTs; b: non-RCTs. The 95% confidence interval (CI) for the hazard ratio for each study is represented by a horizontal line and the point estimate is represented by a square. The size of the square corresponds to the weight of the study in the meta-analysis. The 95% CI for pooled estimates is represented by a diamond. Data for a fixed-effects model are shown as there was no statistical heterogeneity. df = degrees of freedom; I2 = percentage of the total variation across studies due to heterogeneity; IV = Inverse Variance; SE = standard error; Z = test of overall treatment effect.

Mentions: The meta-analysis of RCTs and non-RCTs showed there were no significant survival benefits for the group with transthoracic resection (HR = 1.01, P = 0.92 and HR = 0.89, P = 0.35 respectively). However, the pooled result of non-RCTs proned to favor the group with transthoracic resection (HR = 0.89, 95% CI: 0.70- 1.14), which could not be observed from the result of RCTs (Table 3, Figure 2). As the Siewert classification of GEJ cancer has a major effect on the choice of operation procedure [37], we performed the subgroup analysis stratified by the Siewert classification.


Transthoracic resection versus non-transthoracic resection for gastroesophageal junction cancer: a meta-analysis.

Yang K, Chen HN, Chen XZ, Lu QC, Pan L, Liu J, Dai B, Zhang B, Chen ZX, Chen JP, Hu JK - PLoS ONE (2012)

Forest plot of 5-year overall survival rates for RCTs and non-RCTs.a: RCTs; b: non-RCTs. The 95% confidence interval (CI) for the hazard ratio for each study is represented by a horizontal line and the point estimate is represented by a square. The size of the square corresponds to the weight of the study in the meta-analysis. The 95% CI for pooled estimates is represented by a diamond. Data for a fixed-effects model are shown as there was no statistical heterogeneity. df = degrees of freedom; I2 = percentage of the total variation across studies due to heterogeneity; IV = Inverse Variance; SE = standard error; Z = test of overall treatment effect.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3366974&req=5

pone-0037698-g002: Forest plot of 5-year overall survival rates for RCTs and non-RCTs.a: RCTs; b: non-RCTs. The 95% confidence interval (CI) for the hazard ratio for each study is represented by a horizontal line and the point estimate is represented by a square. The size of the square corresponds to the weight of the study in the meta-analysis. The 95% CI for pooled estimates is represented by a diamond. Data for a fixed-effects model are shown as there was no statistical heterogeneity. df = degrees of freedom; I2 = percentage of the total variation across studies due to heterogeneity; IV = Inverse Variance; SE = standard error; Z = test of overall treatment effect.
Mentions: The meta-analysis of RCTs and non-RCTs showed there were no significant survival benefits for the group with transthoracic resection (HR = 1.01, P = 0.92 and HR = 0.89, P = 0.35 respectively). However, the pooled result of non-RCTs proned to favor the group with transthoracic resection (HR = 0.89, 95% CI: 0.70- 1.14), which could not be observed from the result of RCTs (Table 3, Figure 2). As the Siewert classification of GEJ cancer has a major effect on the choice of operation procedure [37], we performed the subgroup analysis stratified by the Siewert classification.

Bottom Line: The postoperative morbidity (RR = 0.69, 95% CI 0.48- 1.00 and OR = 0.55, 95% CI 0.25- 1.22) and mortality (RD = -0.03, 95% CI -0.06- 0.00 and RD = 0.00, 95% CI -0.05- 0.05) of RCTs and non-RCTs did not suggest any significant differences between the two groups.The results of sensitivity analyses were similar to the primary analyses.However, the results should be interpreted cautiously since the qualities of included studies were suboptimal.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China.

ABSTRACT

Background: The aim of this meta-analysis is to evaluate the impact of transthoracic resection on long-term survival of patients with GEJ cancer and to compare the postoperative morbidity and mortality of patients undergoing transthoracic resection with those of patients who were not undergoing transthoracic resection.

Method: Searches of electronic databases identifying studies from Medline, Cochrane Library trials register, and WHO Trial Registration etc were performed. Outcome measures were survival, postoperative morbidity and mortality, and operation related events.

Results: Twelve studies (including 5 RCTs and 7 non-RCTs) comprising 1105 patients were included in this meta-analysis, with 591 patients assigned treatment with transthoracic resection. Transthoracic resection did not increase the 5-y overall survival rate for RCTs and non-RCTs (HR = 1.01, 95% CI 0.80- 1.29 and HR = 0.89, 95% CI 0.70- 1.14, respectively). Stratified by the Siewert classification, our result showed no obvious differences were observed between the group with transthoracic resection and group without transthoracic resection (P>0.05). The postoperative morbidity (RR = 0.69, 95% CI 0.48- 1.00 and OR = 0.55, 95% CI 0.25- 1.22) and mortality (RD = -0.03, 95% CI -0.06- 0.00 and RD = 0.00, 95% CI -0.05- 0.05) of RCTs and non-RCTs did not suggest any significant differences between the two groups. Hospital stay was long with thransthoracic resection (WMD = -5.80, 95% CI -10.38- -1.23) but did not seem to differ in number of harvested lymph nodes, operation time, blood loss, numbers of patients needing transfusion, and reoperation rate. The results of sensitivity analyses were similar to the primary analyses.

Conclusions: There were no significant differences of survival rate and postoperative morbidity and mortality between transthoracic resection group and non-transthoracic resection group. Both surgical approaches are acceptable, and that one offers no clear advantage over the other. However, the results should be interpreted cautiously since the qualities of included studies were suboptimal.

Show MeSH
Related in: MedlinePlus