Bin Li

Delayed gastric emptying (DGE) is one of the most frequent complications after pancreaticoduodenectomy (PD). This meta-analysis aimed to evaluate the effect of antecolic versus retrocolic reconstruction of gastro/duodenojejunostomy on DGE after PD. Randomized controlled trials (RCTs) comparing antecolic versus retrocolic reconstruction of gastro/duodenojejunostomy on DGE after PD were eligible for inclusion. Pooled estimates of treatment effect were calculated using either the fixed effects model or random effects model. Five RCTs involving 534 randomized patients were eligible. The comparison of DGE showed no significant difference (odds ratio, 0.66; 95 % confidence interval, 0.32 to 1.33; P = 0.24). The antecolic and retrocolic groups also had comparable outcomes for clinical parameters related to DGE, other complications, hospital mortality, and length of hospital stay. The route of gastro/duodenojejunostomy reconstruction has no impact on DGE after PD. Therefore, the choice of reconstruction route should be selected according to the surgeon’s preference.

The safety and efficacy of laparoscopic liver resection (LLR) for colorectal liver metastasis (CLM) remain to be established. A meta-analysis was undertaken to compare LLR and open liver resection (OLR) for CLM with respect to surgical and oncologic outcomes.

Background: With the increase in average life expectancy in recent decades, the proportion of elderly patients requiring liver surgery is rising. The aim of the meta‐analysis reported here was to evaluate the safety and efficacy of hepatectomy in elderly patients.Methods: An extensive electronic search was performed for relevant articles that compare the outcomes of hepatectomy in patients ≥70 years of age with those in younger patients prior to October 2012. Analysis of pooled data was performed with RevMan 5.0.Results: Twenty‐eight observational studies involving 15,480 patients were included in the analysis. Compared with the younger patients, elderly patients experienced more complications (31.8 vs 28.7 %; P = 0.002), mainly as a result of increased cardiac complications (7.5 vs 1.9 %; P < 0.001) and delirium (11.7 vs 4.5 %; P < 0.001). Postoperative major surgical complications (12.6 vs 11.3 %; P = 0.55) and mortality (3.6 vs 3.3 %; P = 0.68) were comparable between elderly and younger patients. For patients with malignancies, both the 5‐year disease‐free survival (26.5 vs 26.3 %; P = 0.60) and overall survival (39.5 vs 40.7 %; P = 0.29) did not differ significantly between the two groups.Conclusions: Postoperative major surgical complications, mortality, and long‐term results in elderly patients seem to be comparable with those in younger patients, suggesting that age alone should not be considered a contraindication for hepatectomy.

Background: Long-term outcomes of partial liver resection of hepatocellular carcinoma (HCC) remain satisfactory due to high incidences of recurrence. This study was intended to see whether preoperative transcatheter arterial chemoembolization (TACE) reduces postoperative tumor recurrences and prolongs survival of patients with resectable HCC. Methods: A computerized literature search was performed to identify relevant articles. The quality of nonrandomized comparative studies (NRCTs) was assessed using the methodological index for nonrandomized studies (MINORS). Data synthesis was performed using Review Manager 5.0 software. Results: Twenty-one studies (4 randomized controlled trials and 17 NRCTs) with a total of 3,210 participants were suitable for analysis. There was no significant difference in disease-free and overall survival at 5-year (32.1% vs. 30.0% and 40.2% vs. 45.2%), and intra- and extra-hepatic recurrence (51.2% vs.53.6% and 12.9% vs.10.3%) between patients with and without preoperative TACE. Postoperative morbidity (28.9% vs. 26.8%) and in-hospital mortality (4.1% vs. 3.1%) were also similar between the two groups. Conclusions: Preoperative TACE does not seem to improve prognosis and therefore it is prudent to recommend it as a preoperative routine procedure for resectable HCC.

Background Caudate resection for hepatocellular carcinoma (HCC) remains a challenging procedure. This study aimed to assess the surgical outcomes of HCC originating from caudate lobe. Methods Twenty-three patients with HCC in the caudate lobe who received surgical treatment were retrospectively reviewed. Results Surgical procedures included 13 isolated caudatectomy (56.5%) and 10 combined caudatectomy (43.5%). Eight patients (34.7%) experienced post-operative complications. Mortality was nil. The 1-, 3- and 5-year overall survival rates after surgery were 90.1%, 60% and 37%, respectively. Isolated caudatectomy was associated with less frequent tumours located in paracaval portion, longer operative time, longer vascular occlusion time and more blood loss than combined caudatectomy (P < 0.05). Conclusion Surgical resection is feasible and beneficial for patients with HCC in the caudate lobe. If liver functional reserve is sufficient, combined caudatectomy is preferred.

Background: Studies investigating the association between Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections and intrahepatic cholangiocarcinoma (ICC) have reported inconsistent findings. We conducted a meta-analysis of epidemiological studies to explore this relationship. Methods: A comprehensive search was conducted to identify the eligible studies of hepatitis infections and ICC risk up to September 2011. Summary odds ratios (OR) with their 95% confidence intervals (95% CI) were calculated with random-effects models using Review Manager version 5.0. Results: Thirteen case–control studies and 3 cohort studies were included in the final analysis. The combined risk estimate of all studies showed statistically significant increased risk of ICC incidence with HBV and HCV infection (OR = 3.17, 95% CI, 1.88-5.34, and OR = 3.42, 95% CI, 1.96-5.99, respectively). For case–control studies alone, the combined OR of infection with HBV and HCV were 2.86 (95% CI, 1.60-5.11) and 3.63 (95% CI, 1.86-7.05), respectively, and for cohort studies alone, the OR of HBV and HCV infection were 5.39 (95% CI, 2.34-12.44) and 2.60 (95% CI, 1.36-4.97), respectively. Conclusions: This study suggests that both HBV and HCV infection are associated with an increased risk of ICC.

Single-incision laparoscopic surgery (SILS) was developed as a novel minimally invasive surgical approach. The aim of this meta-analysis was to compare SILS and conventional laparoscopy (CL) for colorectal diseases with respect to perioperative and oncologic outcomes. An electronic search was performed to retrieve all relevant articles published in the English language between 2008 and 2012 comparing SILS and CL for colorectal diseases. The data were analyzed with fixed-effect or random-effects models using review manager version 5.0. A total of 14 studies (one randomized controlled trial and 13 nonrandomized controlled trials) were found to be eligible and reported on 1,155 subjects, of whom 521 underwent SILS and 634 underwent CL for colorectal diseases. Concerning the perioperative outcomes, no differences were observed in conversion rate, operating time, and postoperative adverse events; however, patients who underwent SILS had lower blood loss, decreased blood transfusion requirement, shorter time to flatus, shorter hospital stay, and smaller incision. Concerning the oncologic outcomes, length of resected specimens, number of harvested lymph nodes, proximal margin, and distal margin, were comparable between two groups. Single-incision laparoscopic surgery (SILS) is a safe, feasible, and oncological efficient alternative to CL for colorectal diseases. Further larger, multi-centred, randomised controlled trial is indicated.

Background: Pancreatectomy combined with superior mesenteric vein–portal vein resection (VR) for pancreatic cancer remains a matter of debate. The present study is a meta‐analysis of the available evidence.Methods: Articles published until end of March 2011, comparing the results of pancreatic resections with VR versus without VR, were searched. Pooled odds ratios (OR) and weighted mean differences (WMD; with 95% Confidence Intervals [95% CI]) were calculated using either the fixed effects model or the random effects model.Results: Nineteen nonrandomized studies met the inclusion criteria, comprising 2,247 patients. There was no difference in perioperative morbidity (OR: 0.95; 95% CI: 0.74–1.21; P = 0.67), mortality (OR: 1.19; 95% CI: 0.73–1.96; P = 0.48), or 5‐year overall survival (OR: 0.57; 95% CI: 0.32–1.02; P = 0.06) between patients with VR and those without VR.Conclusions: Pancreatectomy combined with VR resection for pancreatic cancer is justified because it can result in good perioperative outcome and long‐term survival comparable to that obtained with standard resection. Owing to the selection bias and low level of clinical evidence available so far, the results should be interpreted with caution.

Obese patients are generally believed to be at increased risk for surgery compared with those who are not obese. A meta-analysis was performed to assess the outcomes of laparoscopic colorectal surgery in obese and nonobese patients. A systematic literature search from inception to June 2011 was performed. Pooled odds ratios (OR) and weighted mean differences (WMD) with 95% confidence intervals (95% CI) were calculated using the fixed effects model or random effects model. Eight observational studies identified and matched the selection criteria. Conversion rates (OR: 2.31, 95% CI: 1.74–3.08), operating time (WMD: 15.33, 95% CI: 1.81–28.85), and postoperative morbidity (OR: 2.11; 95% CI: 1.3–3.42) were all significantly increased in the obese group. Length of hospital stay and mortality were similar in both groups. For patients with cancer, there was no difference between groups for the number of harvested nodes and length of specimen. Obesity is associated with increased conversion rate, operating time, and postoperative morbidity of laparoscopic colorectal surgery but does not affect surgical safety or oncological security.

Background: The influence of viral hepatitis status on prognosis in patients undergoing hepatic resection for hepatocellular carcinoma (HCC) remains a matter of debate. This study is a meta-analysis of the available evidence. Methods: A literature search was performed to identify comparative studies reporting postoperative survival of HCC in different types of viral hepatitis. Pooled odds ratios (OR) and weighted mean differences (WMD with 95% confidence intervals (95% CI) were calculated using either the fixed effects model or random effects model. Results: Twenty studies matched the selection criteria and reported on 4744 subjects, of whom 2008 in the HBV-positive (B-HCC) group, 2222 in the HCV-positive (C-HCC) group, and 514 in the hepatitis B- and C-negative (NBNC-HCC). Meta-analysis showed that patients with HBV or HCV infection had a worse 5-year disease-free survival when compared to patients with NBNC-HCC (respectively: OR: 0.39, 95% CI: 0.28 to 0.53, P < 0.001; WMD: 0.37, 95% CI: 0.22 to 0.64, P < 0.001). There was a tendency toward higher 5-year overall survival rates in the NBNC-HCC group compared to those in the other two groups, although these differences were not statistically significant. Both the 5-year overall survival and disease-free survival were not different among the B-HCC and C-HCC groups. Conclusions: Patients with positive serology for hepatitis B or C undergoing resection for HCC had a poor prognosis compared to patients with negative serology.