Effects of preoperative nutrition on postoperative outcomes in esophageal cancer: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Yuqin Cao ◽  
Dingpei Han ◽  
Xiang Zhou ◽  
Yu Han ◽  
Yajie Zhang ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Hospital Mortality ◽  
Complication Rate ◽  
Nutritional Support ◽  
Infectious Complication ◽  
Meta Analysis ◽  
Feeding Tube ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Preoperative Nutrition

Summary Postoperative enteral nutrition has been widely implemented in esophageal cancer, but the efficacy and safety of preoperative nutrition, particularly immune-enhancing nutrition (IEN), remain controversial. This meta-analysis aims to provide a quantitative synthesis of whether preoperative nutrition improves postoperative morbidity and mortality in patients with resectable esophageal cancer. A systematic search was conducted in Medline, Embase, Cochrane, and databases of clinical trials dated up to December 2019. Randomized controlled trials and observational studies comparing postoperative outcomes between esophageal cancer patients with and without preoperative nutritional support were included. Random-effects model was applied in the meta-analysis of primary outcomes (overall complication rate, in-hospital mortality) and secondary outcomes (infectious complication rate, anastomotic leak rate, length of postoperative hospital stay). Complications of feeding tube access and perioperative weight loss were evaluated by qualitative synthesis. Subgroup analyses were performed by stratifying immunonutrition and standard nutrition before surgery. Subgroup analysis of randomized controlled trials alone was also done. A total of 15 studies enrolling 1864 participants were included. The overall meta-analysis found that preoperative nutrition could reduce infectious complications (odds ratio [OR] = 0.51, 95% confidence interval [CI] [0.26, 0.98]; I2 = 48%) and length of hospital stay (mean difference = −2.10 day, 95% CI [−3.72, −0.47]; I2 = 78%) after esophagectomy, whereas no significant difference was revealed in the incidence of overall complications (OR = 0.76, 95% CI [0.52, 1.11]; I2 = 32%), in-hospital mortality (OR = 1.03, 95% CI [0.41, 2.61]; I2 = 12%), and anastomotic leak (OR = 1.05, 95% CI [0.69, 1.58]; I2 = 0%). Subgroup of preoperative immunonutrition showed more prominent benefits. The complication rate of feeding tube access was low (1.6–16%). In conclusion, preoperative nutrition is safe in esophageal cancer, but benefits are observed in infectious complication rate and length of stay on a limited scale. IEN holds more advantages over standard nutrition. Randomized trials in the context of nutritional support during neoadjuvant therapy are in demand.

scholarly journals Does Intraoperative Ulinastatin Improve Postoperative Clinical Outcomes in Patients Undergoing Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials

2014 ◽  
Vol 2014 ◽  
pp. 1-15 ◽  
Author(s):  
Qiu-Lan He ◽  
Fei Zhong ◽  
Fang Ye ◽  
Ming Wei ◽  
Wei-Feng Liu ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Postoperative Complication ◽  
Complication Rate ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Postoperative Complication Rate ◽  
Randomized Controlled ◽  
Extubation Time

Introduction. The systematic meta-analysis of randomized controlled trials (RCTs) evaluated the effects of intraoperative ulinastatin on early-postoperative recovery in patients undergoing cardiac surgery.Methods.RCTs comparing intraoperative ulinastatin with placebo in cardiac surgery were searched through PubMed, Cochrane databases, Medline, SinoMed, and the China National Knowledge Infrastructure (1966 to May 20th, 2013). The primary endpoints included hospital mortality, postoperative complication rate, length of stay in intensive care unit, and extubation time. The physiological and biochemical parameters illustrating postoperative cardiac and pulmonary function as well as inflammation response were considered as secondary endpoints.Results.Fifteen RCTs (509 patients) met the inclusion criteria. Ulinastatin did not affect hospital mortality, postoperative complication rate, or ICU length of stay but reduced extubation time. Ulinastatin also increased the oxygenation index on postoperative day 1 and reduced the plasma level of cardiac troponin-I. Additionally, ulinastatin inhibited the increased level of tumor necrosis factor-alpha, polymorphonuclear neutrophil elastase, interleukin-6, and interleukin-8 associated with cardiac surgery.Conclusion.Ulinastatin may be of value for the inhibition of postoperative increased inflammatory agents and most likely provided pulmonary protective effects in cardiac surgery. However, larger adequately powered RCTs are required to define the clinical effect of ulinastatin on postoperative outcomes in cardiac surgery.

scholarly journals Comparing Surgical and Conservative Treatment on Achilles Tendon Rupture: A Comprehensive Meta-Analysis of RCTs

2020 ◽  
Author(s):  
Guorong She ◽  
Qiang Teng ◽  
Jieruo Li ◽  
Xiaofei Zheng ◽  
Lin Chen ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Achilles Tendon ◽  
Randomized Controlled Trials ◽  
Complication Rate ◽  
Tendon Rupture ◽  
Meta Analysis ◽  
Achilles Tendon Rupture ◽  
Controlled Trials ◽  
Randomized Controlled

Abstract Background Achilles tendon is the strongest tendon in human and frequently injured mainly in young to middle age active population. Increasing incidence of Achilles tendon rupture (ATR) is still reported in several studies. Surgical repair and conservative treatment are two major management strategy widely adopted in ATR patients but the consensus of optimal treatment strategy is still debated. We aimed at fully reviewing the ATR topic with additional assessments and performed a most comprehensive meta-analysis of randomized controlled trials (RCTs).Method We comprehensively searched database of PubMed, Embase, Cochrane and ClinicalTrial.gov and retrieved all randomized controlled trials comparing surgical and conservative treatment on achilles tendon rupture for further analysis. Data extraction was performed by two independent reviewer and random effect model was adopted when I2 > 50%, with data presentation of risk ratio, risk difference or mean difference and 95% confidence interval. Results A total of 13 randomized control trials were included in this meta-analysis. Significant difference was observed in events of re-rupture, complication rate, adhesion to underlying tendon, sural nerve injury and superficial infection. For surgical treatment, significant reduction in re-rupture rate could be observed while complication rate was higher compared with conservative treatment. Conclusion Surgical treatment was revealed significance in reduction of re-rupture rate but associated with higher complication rate while conservative treatment showed similar outcomes with lower complication rate. Collectively, we recommend conservative treatment if patients’ status and expectation are suitable, but surgeon as well as physician’s discretion is also important in decision making.

scholarly journals Higher Versus Lower Positive End-Expiratory Pressure in Patients Without Acute Respiratory Distress Syndrome: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Tommaso Pettenuzzo ◽  
Annalisa Boscolo ◽  
Alessandro De Cassai ◽  
Nicolò Sella ◽  
Francesco Zarantonello ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Hospital Mortality ◽  
Distress Syndrome ◽  
Meta Analysis ◽  
Invasive Mechanical Ventilation ◽  
Controlled Trials ◽  
Positive End Expiratory Pressure ◽  
Randomized Controlled ◽  
Duration Of Ventilation

Abstract Background: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the association of higher positive end-expiratory pressure (PEEP), as opposed to lower PEEP, with hospital mortality in adult intensive care unit (ICU) patients undergoing invasive mechanical ventilation for reasons other than acute respiratory distress syndrome (ARDS). Methods: We performed an electronic search of MEDLINE, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science from inception until December 18, 2020 with no language restrictions. In addition, a research-in-progress database and grey literature were searched. Results: We identified 22 RCTs (2225 patients) comparing higher PEEP (1007 patients) with lower PEEP (991 patients). No statistically significant association between higher PEEP and hospital mortality was observed (risk ratio 1.02, 95% confidence interval 0.89-1.16; I2 = 0%, p = 0.62; low certainty of evidence). Among secondary outcomes, higher PEEP was associated with better oxygenation, higher respiratory system compliance, and lower risk of hypoxemia and ARDS occurrence. Furthermore, barotrauma, hypotension, duration of ventilation, lengths of stay, and ICU mortality were similar between the two groups. Conclusions: In our meta-analysis of RCTs, higher PEEP, compared with lower PEEP, was not associated with mortality or duration of ventilation in patients without ARDS receiving invasive mechanical ventilation, despite being associated with improved oxygenation and lower occurrence of ARDS.

scholarly journals Prognostic and Predictive Factors for the Curative Treatment of Esophageal and Gastric Cancer in Randomized Controlled Trials: A Systematic Review and Meta-Analysis

Cancers ◽  
2019 ◽  
Vol 11 (4) ◽  
pp. 530 ◽  
Author(s):  
van den Ende ◽  
ter Veer ◽  
Mali ◽  
van Berge Henegouwen ◽  
Hulshof ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Systematic Review ◽  
Esophageal Cancer ◽  
Prognostic Factors ◽  
Predictive Factors ◽  
Meta Analysis ◽  
Curative Treatment ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Prognostic And Predictive Factors

Background: An overview of promising prognostic variables and predictive subgroups concerning the curative treatment of esophageal and gastric cancer from randomized controlled trials (RCTs) is lacking. Therefore, we conducted a systematic review and meta-analysis. Methods: PubMed, EMBASE, CENTRAL, and ASCO/ESMO conferences were searched up to March 2019 for RCTs on the curative treatment of esophageal or gastric cancer with data on prognostic and/or predictive factors for overall survival. Prognostic factors were deemed potentially clinically relevant according to the following criteria; (1) statistically significant (p < 0.05) in a multivariate analysis, (2) reported in at least 250 patients, and (3) p < 0.05, in ≥ 33% of the total number of patients in RCTs reporting this factor. Predictive factors were potentially clinically-relevant if (1) the p-value for interaction between subgroups was <0.20 and (2) the hazard ratio in one of the subgroups was significant (p < 0.05). Results: For gastric cancer, 39 RCTs were identified (n = 13,530 patients) and, for esophageal cancer, 33 RCTs were identified (n = 8618 patients). In total, we identified 23 potentially clinically relevant prognostic factors for gastric cancer and 16 for esophageal cancer. There were 15 potentially clinically relevant predictive factors for gastric cancer and 10 for esophageal cancer. Conclusion: The identified prognostic and predictive factors can be included and analyzed in future RCTs and be of guidance for nomograms. Further validation should be performed in large patient cohorts.

scholarly journals Comparison of 1L Adjuvant Auxiliary Preparations with 2L Solely Polyethylene Glycol plus Ascorbic Acid Regime for Bowel Cleaning: A Meta-analysis of Randomized, Controlled Trials

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Xin Yuan ◽  
Zhixin Zhang ◽  
Jiarong Xie ◽  
Yu Zhang ◽  
Lu Xu ◽  
...  
Keyword(s):  
Ascorbic Acid ◽  
Polyethylene Glycol ◽  
Bowel Preparation ◽  
Complication Rate ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Lower Volume

The effectiveness of additional usage of adjuvants for bowel preparation is still unclear. This study compared 1L polyethylene glycol plus ascorbic acid with adjuvant drug regimens (1L PEG-AA, lower volume) with 2L polyethylene glycol plus ascorbic acid (2L PEG-A, low volume) to evaluate whether the adjuvants can be used to reduce the standard dosage of purgative further. The PubMed/MEDLINE, EMBASE, Cochrane Library, and Web of Science database were searched for randomized controlled trials (RCTs). The primary outcome was the efficacy of bowel preparation, and the secondary outcomes were patients’ tolerability and complication rate. The overall quality of evidence was assessed using the GRADEpro guideline development tool. Five RCTs with a total of 1013 patients from Korea were included. The majority of patients were outpatients from different hospitals. The pooled data showed no significant difference in the adequate bowel preparation rate (89.3% versus 89.4%, RR 1, 95% CI 0.95-1.05, I 2 = 47 % ) as well as in the complication rate (RR for nausea 1.22, 95% CI 0.89-1.65, I 2 = 49 % ; RR for bloating 0.96, 95% CI 0.73-1.28, I 2 = 0 % ; RR for vomiting 0.69, 95% CI 0.32-1.50, I 2 = 33 % ; RR for abdominal pain 1.01, 95% CI 0.61-1.69, I 2 = 0 % ). But a significantly higher willingness rate was observed in the lower volume (85.1% versus 67.9%, RR 1.25, 95% CI 1.14-1.38, I 2 = 46 % ). The quality of primary outcome evidence was moderate. The findings of this meta-analysis revealed that 1L PEG-AA may be a viable alternative to 2L PEG-A, with comparable effectiveness, better patient preference, and no statistically significant adverse event occurrence.

scholarly journals Meta-analysis Comparing Celecoxib with Diclofenac Sodium in Patients with Knee Osteoarthritis

Pain Medicine ◽  
2020 ◽  
Author(s):  
Hetao Huang ◽  
Minghui Luo ◽  
Haodong Liang ◽  
Jianke Pan ◽  
Weiyi Yang ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Complication Rate ◽  
Meta Analysis ◽  
Diclofenac Sodium ◽  
Controlled Trials ◽  
Reactive Protein ◽  
Randomized Controlled ◽  
Vas Score ◽  
Online Databases ◽  
Review Manager

Abstract Objective To compare the efficacy and safety of celecoxib and diclofenac sodium in patients with knee osteoarthritis (KOA). Methods Clinical controlled trials (CCTs) and randomized controlled trials (RCTs) from online databases comparing the efficacy of celecoxib and diclofenac sodium in the treatment of KOA were retrieved. The main outcomes included the treatment effect, C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), visual analog scale (VAS) score, and complication rate. The Cochrane risk of bias (ROB) tool in Review Manager 5.3.5 was used to assess methodological quality. Results Twelve studies (N = 2,350) were included in this meta-analysis. The meta-analysis indicated that celecoxib reduced pain more effectively than diclofenac sodium in patients with KOA, as evaluated by the VAS score. In addition, celecoxib has certain advantages in terms of better treatment effects and greater reductions in the ESR, CRP level, and complication rate. Conclusions Celecoxib is superior to diclofenac sodium in the treatment of KOA. However, well-designed and high-quality RCTs are still needed.

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