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Gastrectomy and D2 Lymphadenectomy for Gastric Cancer: A Meta-Analysis Comparing the Harmonic Scalpel to Conventional Techniques.

Cheng H, Hsiao CW, Clymer JW, Schwiers ML, Tibensky BN, Patel L, Ferko NC, Chekan E - Int J Surg Oncol (2015)

Bottom Line: The ultrasonic Harmonic scalpel has demonstrated clinical and surgical benefits in dissection and coagulation.Compared with conventional hemostatic techniques, the Harmonic scalpel demonstrated significant reductions in operating time (-27.5 min; P < 0.001), intraoperative blood loss (-93.2 mL; P < 0.001), and drainage volume (-138.8 mL; P < 0.001).Results were numerically higher for conventional techniques for hospital length of stay, complication risk, and transfusions but did not reach statistical significance.

View Article: PubMed Central - PubMed

Affiliation: Ethicon Inc., 4545 Creek Road, Cincinnati, OH 45242, USA.

ABSTRACT
The ultrasonic Harmonic scalpel has demonstrated clinical and surgical benefits in dissection and coagulation. To evaluate its use in gastrectomy, we conducted a systematic review and meta-analysis of randomized controlled trials comparing the Harmonic scalpel to conventional techniques in gastrectomy for patients with gastric cancer. International databases were searched without language restrictions for comparisons in open or laparoscopic gastrectomy and lymphadenectomy. The meta-analysis used a random-effects model for all outcomes; continuous variables were analyzed for mean differences and dichotomous variables were analyzed for risk ratios. Sensitivity analyses were conducted for study quality, type of conventional technique, and imputation of study results. Ten studies (N = 935) met the inclusion criteria. Compared with conventional hemostatic techniques, the Harmonic scalpel demonstrated significant reductions in operating time (-27.5 min; P < 0.001), intraoperative blood loss (-93.2 mL; P < 0.001), and drainage volume (-138.8 mL; P < 0.001). Results were numerically higher for conventional techniques for hospital length of stay, complication risk, and transfusions but did not reach statistical significance. Results remained robust to sensitivity analyses. This meta-analysis demonstrates the clear advantages of using the Harmonic scalpel compared to conventional techniques, with improvements demonstrated across several outcome measures for patients undergoing gastrectomy and lymphadenectomy.

No MeSH data available.


Related in: MedlinePlus

Risk of bias assessment for studies meeting inclusion criteria.
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Related In: Results  -  Collection


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fig2: Risk of bias assessment for studies meeting inclusion criteria.

Mentions: Overall, the risk of bias varied across studies. The overall results of the risk of bias assessments are presented in Figure 2 and the results of the individual study quality assessments are summarized in Table 3. Randomization method was reported in four studies: two studies used a random permuted block design [21, 23], one reported the use of a random number table [31], and one described the use of a lottery system [29]. Only one study [23] described concealment of the randomization sequence. One study [23] reported blinding of patients to the surgical technique. Of the nine studies that did not report blinding, risk of performance bias was deemed low in six studies [20, 21, 24, 29, 30, 32], where nonblinding was assumed to have no impact on the outcomes assessed. Nine studies reported all prespecified study outcomes; however, selective reporting remained unclear in one study [20]. Attritions or exclusions were reported in two studies [21, 23] but were assumed to have no clinical impact on the observed effect size. In three studies, reporting of attritions or exclusions was insufficient [24, 29, 30]. There were no patient withdrawals in five studies [20, 26, 28, 31, 32]. Additional bias was unclear in one study, as there was a reported difference in surgeon status between treatment groups (Harmonic group: 40% residents versus conventional group: 56.7% residents) [26]. Studies generally reported positive results which could result from a publication selection bias; however, funnel plots did not indicate any clear omission of negative studies.


Gastrectomy and D2 Lymphadenectomy for Gastric Cancer: A Meta-Analysis Comparing the Harmonic Scalpel to Conventional Techniques.

Cheng H, Hsiao CW, Clymer JW, Schwiers ML, Tibensky BN, Patel L, Ferko NC, Chekan E - Int J Surg Oncol (2015)

Risk of bias assessment for studies meeting inclusion criteria.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4446499&req=5

fig2: Risk of bias assessment for studies meeting inclusion criteria.
Mentions: Overall, the risk of bias varied across studies. The overall results of the risk of bias assessments are presented in Figure 2 and the results of the individual study quality assessments are summarized in Table 3. Randomization method was reported in four studies: two studies used a random permuted block design [21, 23], one reported the use of a random number table [31], and one described the use of a lottery system [29]. Only one study [23] described concealment of the randomization sequence. One study [23] reported blinding of patients to the surgical technique. Of the nine studies that did not report blinding, risk of performance bias was deemed low in six studies [20, 21, 24, 29, 30, 32], where nonblinding was assumed to have no impact on the outcomes assessed. Nine studies reported all prespecified study outcomes; however, selective reporting remained unclear in one study [20]. Attritions or exclusions were reported in two studies [21, 23] but were assumed to have no clinical impact on the observed effect size. In three studies, reporting of attritions or exclusions was insufficient [24, 29, 30]. There were no patient withdrawals in five studies [20, 26, 28, 31, 32]. Additional bias was unclear in one study, as there was a reported difference in surgeon status between treatment groups (Harmonic group: 40% residents versus conventional group: 56.7% residents) [26]. Studies generally reported positive results which could result from a publication selection bias; however, funnel plots did not indicate any clear omission of negative studies.

Bottom Line: The ultrasonic Harmonic scalpel has demonstrated clinical and surgical benefits in dissection and coagulation.Compared with conventional hemostatic techniques, the Harmonic scalpel demonstrated significant reductions in operating time (-27.5 min; P < 0.001), intraoperative blood loss (-93.2 mL; P < 0.001), and drainage volume (-138.8 mL; P < 0.001).Results were numerically higher for conventional techniques for hospital length of stay, complication risk, and transfusions but did not reach statistical significance.

View Article: PubMed Central - PubMed

Affiliation: Ethicon Inc., 4545 Creek Road, Cincinnati, OH 45242, USA.

ABSTRACT
The ultrasonic Harmonic scalpel has demonstrated clinical and surgical benefits in dissection and coagulation. To evaluate its use in gastrectomy, we conducted a systematic review and meta-analysis of randomized controlled trials comparing the Harmonic scalpel to conventional techniques in gastrectomy for patients with gastric cancer. International databases were searched without language restrictions for comparisons in open or laparoscopic gastrectomy and lymphadenectomy. The meta-analysis used a random-effects model for all outcomes; continuous variables were analyzed for mean differences and dichotomous variables were analyzed for risk ratios. Sensitivity analyses were conducted for study quality, type of conventional technique, and imputation of study results. Ten studies (N = 935) met the inclusion criteria. Compared with conventional hemostatic techniques, the Harmonic scalpel demonstrated significant reductions in operating time (-27.5 min; P < 0.001), intraoperative blood loss (-93.2 mL; P < 0.001), and drainage volume (-138.8 mL; P < 0.001). Results were numerically higher for conventional techniques for hospital length of stay, complication risk, and transfusions but did not reach statistical significance. Results remained robust to sensitivity analyses. This meta-analysis demonstrates the clear advantages of using the Harmonic scalpel compared to conventional techniques, with improvements demonstrated across several outcome measures for patients undergoing gastrectomy and lymphadenectomy.

No MeSH data available.


Related in: MedlinePlus