Title: Journal of Gastrointestinal and Liver Diseases

Title: Journal of Gastrointestinal Surgery

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? Mazaki, T. and Ebisawa, K. (2008), Enteral versus parenteral nutrition after gastrointestinal surgery: A systematic review and meta-analysis of randomized controlled trials in the English literature. Journal of Gastrointestinal Surgery, 12 (4), 739-755.

Full Text: 2008 Gas Sur12, 739.pdf

Abstract: Background Although previous studies recommend the use of enteral nutrition (EN), the benefit of EN after elective gastrointestinal surgery has not been comprehensively demonstrated as through a meta-analysis. Our aim is to determine whether enteral nutrition is more beneficial than parenteral nutrition. Methods A search was conducted on MEDLINE, Web of Science, the Cochrane Library electronic databases, and bibliographic reviews. The trials were based on randomization, gastrointestinal surgery, and the reporting of at least one of the following end points: Any complication, any infectious complication, mortality, wound infection and dehiscence, anastomotic leak, intraabdominal abscess, pneumonia, respiratory failure, urinary tract infection, renal failure, any adverse effect, and duration of hospital stay. Results Twenty-nine trials, which included 2,552 patients, met the criteria. EN was beneficial in the reduction of any complication (relative risk (RR), 0.85; 95% confidence interval (CI), 0.74-0.99; P=0.04), any infectious complication (RR, 0.69; 95% CI, 0.56-0.86; P=0.001), anastomotic leak (RR, 0.67; 95% CI, 0.47-0.95; P=0.03), intraabdominal abscess (RR, 0.63; 95% CI, 0.41-0.95; P=0.03), and duration of hospital stay (weighted mean difference, -0.81; 95% CI, -1.25-0.38; P=0.02). There were no clear benefits in any of the other complications. Conclusion The present findings would lead us to recommend the use of EN rather than PN when possible and indicated.

Keywords: Bacterial Translocation, Bibliographic, Cochrane, Controlled Clinical-Trials, Critically Ill Patients, Databases, Elective Colorectal Surgery, Enteral Nutrition, Future-Research Directions, Gastrointestinal, Gastrointestinal Surgery, Gut-Barrier Function, Hospital, Infection, Infectious Complication, Lead, Literature, Major Abdominal-Surgery, Meta-Analysis, Methods, Mortality, Nutrition, Oral Dietary-Supplements, Parenteral Nutrition, Points, Postoperative Complications, Randomized Controlled Trials, Relative Risk, Review, Risk, Science, Septic Complications, Surgery, Surgical-Patients, Systematic, Systematic Review, Tract, Web of Science

? Ohtani, H., Tamamori, Y., Noguchi, K., Azuma, T., Fujimoto, S., Oba, H., Aoki, T., Minami, M. and Hirakawa, K. (2010), A meta analysis of randomized controlled trials that compared laparoscopy-assisted and open distal gastrectomy for early gastric cancer. Journal of Gastrointestinal Surgery, 14 (6), 958-964.

Full Text: 2010\J Gas Sur14, 958.pdf

Abstract: We conducted a meta-analysis to evaluate and compare the advantages of laparoscopy-assisted distal gastrectomy (LADG) over open distal gastrectomy (ODG) for treating early gastric cancer (EGC). We searched MEDLINE, EMBASE, Science Citation Index, and Cochrane Controlled Trial Register for relevant papers published between January 1990 and January 2010 by using the following search terms: laparoscopy-assisted gastrectomy, laparoscopic gastrectomy, and early gastric cancer. The following data were analyzed: operative time, estimated blood loss, number of harvested lymph nodes, time required for resumption of oral intake, duration of hospital stay, frequency of analgesic administration, complications, tumor recurrence, and mortality. We selected four papers reporting randomized control studies (RCTs) that compared LADG with ODG for EGC. Our meta-analysis included 267 patients with EGC; of these, 134 and 133 had undergone LADG and ODG, respectively. The volume of intraoperative blood loss, frequency of analgesic administration, and rate of complications were significantly lesser for LADG than for ODG. However, the time required for resumption of oral intake and duration of hospital stay did not significantly differ between LADG and ODG. The operative time for LADG was significantly longer than that for ODG; further, the number of harvested lymph nodes was significantly lesser in the LADG group than in the ODG group. LADG is advantageous over ODG because it results in lesser blood loss, is less painful, and is associated with a low risk of complications. Additional RCTs that compare LADG and ODG and investigate the long-term oncological outcomes of LADG are required to determine the advantages of LADG over ODG.

Keywords: Billroth-I Gastrectomy, Cancer, Citation, Early Gastric Cancer, Experience, Gastrectomy, Gastric Cancer, Laparoscopy-Assisted Distal Gastrectomy (LADG), Lymph-Node Dissection, Medline, Meta-Analysis, Mortality, Outcomes, Quality-of-Life, Recurrence, Resection, Risk, Science, Science Citation Index

? Ohtani, H., Tamamori, Y., Azuma, T., Mori, Y., Nishiguchi, Y., Maeda, K. and Hirakawa, K. (2011), A meta-analysis of the short- and long-term results of randomized controlled trials that compared laparoscopy-assisted and conventional open surgery for rectal cancer. Journal of Gastrointestinal Surgery, 15 (8), 1375-1385.

Full Text: 2011\J Gas Sur15, 1375.pdf

Abstract: We conducted a meta-analysis to evaluate and compare the short- and long-term results of laparoscopy-assisted and open rectal surgery for the treatment of patients with rectal cancer. We searched MEDLINE, EMBASE, Science Citation Index, and the Cochrane Controlled Trial Register for relevant papers published between January 1990 and April 2011 by using the search terms “laparoscopy,” “laparoscopy assisted,” “surgery,” “rectal cancer,” and “randomized controlled trials.” We analyzed outcomes over short- and long-term periods. We identified 12 papers reporting results from randomized controlled trials that compared laparoscopic surgery with open surgery for rectal cancer. Our meta-analysis included 2,095 patients with rectal cancer; 1,096 had undergone laparoscopic surgery, and 999 had undergone open surgery. In the short-term period, 13 outcome variables were examined. In the long-term period, eight oncologic variables, as well as late morbidity, urinary function, and sexual function were analyzed. Laparoscopic surgery for rectal cancer was associated with a reduction in intraoperative blood loss and the number of transfused patients, earlier resumption of oral intake, and a shorter duration of hospital stay over the short-term, but with similar short-term and long-term oncologic outcomes compared to conventional open surgery. Laparoscopic surgery may be an acceptable alternative treatment option to conventional open surgery for rectal cancer.

Keywords: Bladder, Cancer, Chemoradiation, Citation, Clinical-Trials, Colorectal-Cancer, Embase, Hospital, Laparoscopy-Assisted Rectal Surgery, Medline, Meta-Analysis, Mrc Clasicc Trial, Nerve-Preserving Surgery, Open Resection, Outcomes, Papers, Randomized Controlled Trials, Rectal Cancer, Science, Science Citation Index, Sexual Function, Total Mesorectal Excision