Qi J.,Lanzhou University |
Qi J.,Key Laboratory of Digestive System Tumors of Gansu Province |
Qi J.,Key Laboratory of Orthopedics of Gansu Province |
Zhang P.,Key Laboratory of Digestive System Tumors of Gansu Province |
And 5 more authors.
PLoS ONE | Year: 2016
Background/Aims: Total gastrectomy (TG) has shown to be superior regarding low risk of recurrence and readmission to distal subtotal gastrectomy (DG) for treatment of distal stomach cancer, but the incidence of postoperative morbidity and mortality in TG cannot be ignored. Therefore, we performed a meta-analysis to compare the effectiveness between TG and DG for distal stomach cancer. Methodology: A search in PubMed, EMBASE, the Cochrane Library, Web of Science, Chinese Biomedical Database through January 2016 was performed. Eligible studies in comparing of TG and DG for distal gastric cancer were included in this meta-analysis. Review Manager 5.2 software from the Cochrane Collaboration was used for the performance of meta-analysis and STATA 12.0 software for meta-regression analysis. Results: Ten retrospective cohort studies and one randomized control trial involving 5447 patients were included. The meta-analysis showed no significant difference of postoperative mortality (RR = 1.48, 95%CI = 0. 90-2.44,p = 0.12), intraoperative blood loss (MD = 24.34, 95%CI = -3.31-51.99, p = 0.08) and length of hospital stay(MD = 0.76, 95%CI:-0.26-1.79, p = 0.15). TG procedure could retrieve more lymph nodes than DG(MD = 4.33, 95% CI = 2.34-6.31, p<0.0001). According to different postoperative complications, we performed subgroup analysis, subgroup analysis revealed that patients in TG group tended to have a higher rate of postoperative intra-abdominal abscess than DG procedure (RR = 3.41, 95% CI = 1.21-9.63, p<0.05). No statistical differences were found in leakage, intestinal obstruction, postoperative bleeding, anastomotic stricture and wound infection between the two groups (p>0.05). We pooled the data together, the accumulated 5-year Overall Survival rates of TG and DG groups were 49.6% (919/1852) vs.55.9%(721/1290) respectively. Meta-analysis revealed a favoring trend to DG procedure and there was a statistical difference between the two groups (RR = 0.91,95% CI = 0.85-0.97,p = 0.006). Conclusion: Based on current retrospective evidences, we found that in spite of similar postoperative mortality, TG for distal gastric cancer provided a high risk of five-year Overall Survival rate. DG procedure can be a recommendation for distal gastric cancer, whereas due to lack of high quality RCTs in multicenter and the relatively small sample size of long-term outcomes, further comparative studies are still needed. © 2016 Qi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Yun X.-D.,Key Laboratory of Orthopedics of Gansu Province |
Yun X.-D.,Lanzhou University |
An L.-P.,Key Laboratory of Orthopedics of Gansu Province |
Jiang J.,Key Laboratory of Orthopedics of Gansu Province |
And 7 more authors.
International Journal of Clinical and Experimental Medicine | Year: 2015
Component position and good fixation are important factors determining the success of a primary or revision total knee arthroplasty (TKA). The aim of this study was to measure the anatomic features of the tibial plateau and to assess variations in the offset of the tibial shaft from the tibial plateau in osteoarthritis (OA) patients. Computed tomography (CT) scan results were obtained from 126 knees of 121 OA patients (72 female, 49 male) with an average age of 65 ± 7 years. The anatomic features of the tibial plateau were measured and analyzed using three-dimensional reconstruction information derived from a 64-slice spiral CT. The results showed signifi cant variations in proximal tibial anatomy among the subjects. The mean offset was 7.61 ± 3.04 mm at the resection just distal to the subchondral bone. The mean anteroposterior and mediolateral dimensions of the tibial plateau were 53.05 ± 4.82 mm and 70.42 ± 8.33 mm, respectively, at the resection just distal to the subchondral bone. The tibial shaft axis was located anterolateral to the center of the tibial plateau in 62% of knees, while in 36% of these knees, it was located anterior medial to the center of the tibial plateau at the resection just distal to the subchondral bone. Our study shows that anatomic variations should be fully evaluated before performing TKA. A wide range of implant sizes is thus necessary for optimum replacement. © 2015, E-Century Publishing Corporation. All rights reserved.