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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 abdominal drainage.
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pone-0103330-g012: Forest plot of abdominal drainage.

Mentions: Seven studies (2 RCTs and 5 nRCTs) reported the total abdominal drainage within postoperative 3 days from 105 to 591.9 ml [22]–[24], [26]–[27], [32]–[33]. The WCM of the USS group was 199.2 ml compared with 302.8 ml in the control group. Meta-analysis showed that obviously less volume of abdominal drainage was found in the USS group than in the control group in both RCT (MD = −74.62, 95% CI [−95.20, −54.04], p<0.001) and nRCT subgroups (MD = −107.12, 95% CI [−139.85, −74.39], p<0.001). Taken together, patients in the USS group had approximately 100 ml drainage less than those in the conventional group within postoperative 3 days (MD = −96.67, 95% CI [−119.26, −74.09], p<0.001) (Figure 12). The funnel plot showed a symmetrical distribution of included studies (Figure 13).


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 abdominal drainage.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0103330-g012: Forest plot of abdominal drainage.
Mentions: Seven studies (2 RCTs and 5 nRCTs) reported the total abdominal drainage within postoperative 3 days from 105 to 591.9 ml [22]–[24], [26]–[27], [32]–[33]. The WCM of the USS group was 199.2 ml compared with 302.8 ml in the control group. Meta-analysis showed that obviously less volume of abdominal drainage was found in the USS group than in the control group in both RCT (MD = −74.62, 95% CI [−95.20, −54.04], p<0.001) and nRCT subgroups (MD = −107.12, 95% CI [−139.85, −74.39], p<0.001). Taken together, patients in the USS group had approximately 100 ml drainage less than those in the conventional group within postoperative 3 days (MD = −96.67, 95% CI [−119.26, −74.09], p<0.001) (Figure 12). The funnel plot showed a symmetrical distribution of included studies (Figure 13).

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