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Comparison of ultrasonic scalpel versus conventional techniques in open gastrectomy for gastric carcinoma patients: a systematic review and meta-analysis.

Chen XL, Chen XZ, Lu ZH, Wang L, Yang K, Hu JK, Zhang B, Chen ZX, Chen JP, Zhou ZG - PLoS ONE (2014)

Bottom Line: Comparative meta-analysis showed perioperative outcomes were significantly improved using USS compared with conventional surgical instrumentation.OT was reduced from a weighted mean of 185.3 min in the conventional group to 151.0 min in the USS group (MD = -33.30, 95% CI [-41.75, -24.86], p<0.001) and intraoperative BL was decreased from a weighted mean of 217.9 ml in the conventional group to 111.6 ml in the USS group (MD = -113.42, 95% CI [-142.05, -84.79], p<0.001).Pooled estimated results from nRCTs (OR = 0.54, 95% CI [0.27, 1.06], p = 0.07) and RCTs (RR = 0.75, 95% CI [0.44, 1.26], p = 0.27) showed no significant difference between the USS and control groups.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.

ABSTRACT

Objectives: To compare surgical efficacy and postoperative recovery of ultrasonic scalpel (USS) with conventional techniques for the resection of gastric carcinoma.

Methods: A systematic search of major medical databases (PubMed, Embase, CCRT and CNKI) was conducted. Both randomized and non-randomized controlled trials (RCTs and nRCTs) were considered eligible. Operation time (OT), intraoperative blood loss (BL) and postoperative complications (POC) rates as well as postoperative hospitalization days, number of dissected lymph nodes, abdominal drainage volume and time for recovery of gastrointestinal functions were synthesized and compared.

Results: Nineteen studies were included (7 RCTs and 12 nRCTs), in which 1930 patients were enrolled totally (946 in the USS group and 984 in the conventional group). Monopolar electrocautery and ligation were used as the conventional methods. Comparative meta-analysis showed perioperative outcomes were significantly improved using USS compared with conventional surgical instrumentation. OT was reduced from a weighted mean of 185.3 min in the conventional group to 151.0 min in the USS group (MD = -33.30, 95% CI [-41.75, -24.86], p<0.001) and intraoperative BL was decreased from a weighted mean of 217.9 ml in the conventional group to 111.6 ml in the USS group (MD = -113.42, 95% CI [-142.05, -84.79], p<0.001). Results from RCTs subgroup were consistent with those from nRCTs subgroup. The weighted cumulative risk of POC accounted for 8.9% (0%-25%) and 12.9% (5.5%-45%) in the USS and conventional groups, respectively. Pooled estimated results from nRCTs (OR = 0.54, 95% CI [0.27, 1.06], p = 0.07) and RCTs (RR = 0.75, 95% CI [0.44, 1.26], p = 0.27) showed no significant difference between the USS and control groups. Analysis of secondary outcomes showed the improvements of the USS group over control group regarding the number of dissected lymph nodes, postoperative hospitalization days, abdominal drainage volume and time for recovery of gastrointestinal functions.

Conclusion: Compared with conventional electrosurgery, the USS is a safe and effective technique with more short-term advantages in open surgery for gastric cancer.

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Related in: MedlinePlus

Forest plot of blood loss in operation.
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pone-0103330-g006: Forest plot of blood loss in operation.

Mentions: In total, 15 studies (5 RCTs and 10 nRCTs) reported BL from a mean of 50 to 287.5 ml in the USS group and 72 to 686.1 ml in the conventional group [19]–[23], [25]–[29], [31], [33]–[36]. The WCM was 111.6 ml in the USS group and 217.9 ml in the control group. BL was significantly less in the USS group than in the control group in both RCT (MD = −106.34, 95% CI [−150.96, −61.71], p<0.001) and nRCT (MD = −117.06, 95% CI [−154.46, −79.66], p<0.001) subgroup sensitivity analysis. Generally, compared with the control group, the USS group could diminish by approximately 100 ml of hemorrhagic volume (MD = −113.42, 95% CI [−142.05, −84.79], p<0.001) (Figure 6). Additionally, some studies reported blood loss using different criteria (“gram” or “milliliter”). Because blood density was close to 1 g/ml [38], we simply changed the unit “gram” into “milliliter” without changing the value. Although the funnel plot showed an asymmetrical distribution with more studies located at the right part of the middle line, the difference was still significant. Therefore, the results were proved to be reliable on the contrary (Figure 7).


Comparison of ultrasonic scalpel versus conventional techniques in open gastrectomy for gastric carcinoma patients: a systematic review and meta-analysis.

Chen XL, Chen XZ, Lu ZH, Wang L, Yang K, Hu JK, Zhang B, Chen ZX, Chen JP, Zhou ZG - PLoS ONE (2014)

Forest plot of blood loss in operation.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4117513&req=5

pone-0103330-g006: Forest plot of blood loss in operation.
Mentions: In total, 15 studies (5 RCTs and 10 nRCTs) reported BL from a mean of 50 to 287.5 ml in the USS group and 72 to 686.1 ml in the conventional group [19]–[23], [25]–[29], [31], [33]–[36]. The WCM was 111.6 ml in the USS group and 217.9 ml in the control group. BL was significantly less in the USS group than in the control group in both RCT (MD = −106.34, 95% CI [−150.96, −61.71], p<0.001) and nRCT (MD = −117.06, 95% CI [−154.46, −79.66], p<0.001) subgroup sensitivity analysis. Generally, compared with the control group, the USS group could diminish by approximately 100 ml of hemorrhagic volume (MD = −113.42, 95% CI [−142.05, −84.79], p<0.001) (Figure 6). Additionally, some studies reported blood loss using different criteria (“gram” or “milliliter”). Because blood density was close to 1 g/ml [38], we simply changed the unit “gram” into “milliliter” without changing the value. Although the funnel plot showed an asymmetrical distribution with more studies located at the right part of the middle line, the difference was still significant. Therefore, the results were proved to be reliable on the contrary (Figure 7).

Bottom Line: Comparative meta-analysis showed perioperative outcomes were significantly improved using USS compared with conventional surgical instrumentation.OT was reduced from a weighted mean of 185.3 min in the conventional group to 151.0 min in the USS group (MD = -33.30, 95% CI [-41.75, -24.86], p<0.001) and intraoperative BL was decreased from a weighted mean of 217.9 ml in the conventional group to 111.6 ml in the USS group (MD = -113.42, 95% CI [-142.05, -84.79], p<0.001).Pooled estimated results from nRCTs (OR = 0.54, 95% CI [0.27, 1.06], p = 0.07) and RCTs (RR = 0.75, 95% CI [0.44, 1.26], p = 0.27) showed no significant difference between the USS and control groups.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.

ABSTRACT

Objectives: To compare surgical efficacy and postoperative recovery of ultrasonic scalpel (USS) with conventional techniques for the resection of gastric carcinoma.

Methods: A systematic search of major medical databases (PubMed, Embase, CCRT and CNKI) was conducted. Both randomized and non-randomized controlled trials (RCTs and nRCTs) were considered eligible. Operation time (OT), intraoperative blood loss (BL) and postoperative complications (POC) rates as well as postoperative hospitalization days, number of dissected lymph nodes, abdominal drainage volume and time for recovery of gastrointestinal functions were synthesized and compared.

Results: Nineteen studies were included (7 RCTs and 12 nRCTs), in which 1930 patients were enrolled totally (946 in the USS group and 984 in the conventional group). Monopolar electrocautery and ligation were used as the conventional methods. Comparative meta-analysis showed perioperative outcomes were significantly improved using USS compared with conventional surgical instrumentation. OT was reduced from a weighted mean of 185.3 min in the conventional group to 151.0 min in the USS group (MD = -33.30, 95% CI [-41.75, -24.86], p<0.001) and intraoperative BL was decreased from a weighted mean of 217.9 ml in the conventional group to 111.6 ml in the USS group (MD = -113.42, 95% CI [-142.05, -84.79], p<0.001). Results from RCTs subgroup were consistent with those from nRCTs subgroup. The weighted cumulative risk of POC accounted for 8.9% (0%-25%) and 12.9% (5.5%-45%) in the USS and conventional groups, respectively. Pooled estimated results from nRCTs (OR = 0.54, 95% CI [0.27, 1.06], p = 0.07) and RCTs (RR = 0.75, 95% CI [0.44, 1.26], p = 0.27) showed no significant difference between the USS and control groups. Analysis of secondary outcomes showed the improvements of the USS group over control group regarding the number of dissected lymph nodes, postoperative hospitalization days, abdominal drainage volume and time for recovery of gastrointestinal functions.

Conclusion: Compared with conventional electrosurgery, the USS is a safe and effective technique with more short-term advantages in open surgery for gastric cancer.

Show MeSH
Related in: MedlinePlus