BACKGROUND The effect of low ligation(LL)vs high ligation(HL)of the inferior mesenteric artery(IMA)on functional outcomes during sigmoid colon and rectal cancer surgery,including urinary,sexual,and bowel function,is s...BACKGROUND The effect of low ligation(LL)vs high ligation(HL)of the inferior mesenteric artery(IMA)on functional outcomes during sigmoid colon and rectal cancer surgery,including urinary,sexual,and bowel function,is still controversial.AIM To assess the effect of LL of the IMA on genitourinary function and defecation after colorectal cancer(CRC)surgery.METHODS EMBASE,PubMed,Web of Science,and the Cochrane Library were systematically searched to retrieve studies describing sigmoid colon and rectal cancer surgery in order to compare outcomes following LL and HL.A total of 14 articles,including 4750 patients,were analyzed using Review Manager 5.3 software.Dichotomous results are expressed as odds ratios(ORs)with 95%confidence intervals(CIs)and continuous outcomes are expressed as weighted mean differences(WMDs)with 95%CIs.RESULTS LL resulted in a significantly lower incidence of nocturnal bowel movement(OR=0.73,95%CI:0.55 to 0.97,P=0.03)and anastomotic stenosis(OR=0.31,95%CI:0.16 to 0.62,P=0.0009)compared with HL.The risk of postoperative urinary dysfunction,however,did not differ significantly between the two techniques.The meta-analysis also showed no significant differences between LL and HL in terms of anastomotic leakage,postoperative complications,total lymph nodes harvested,blood loss,operation time,tumor recurrence,mortality,5-year overall survival rate,or 5-year disease-free survival rate.CONCLUSION Since LL may result in better bowel function and a reduced rate of anastomotic stenosis following CRC surgeries,we suggest that LL be preferred over HL.展开更多
BACKGROUND It remains controversial as to which pathological classification is most valuable in predicting the overall survival(OS)of patients with gastric cancer(GC).AIM To assess the prognostic performances of three...BACKGROUND It remains controversial as to which pathological classification is most valuable in predicting the overall survival(OS)of patients with gastric cancer(GC).AIM To assess the prognostic performances of three pathological classifications in GC and develop a novel prognostic nomogram for individually predicting OS.METHODS Patients were identified from the Surveillance,Epidemiology,and End Results program.Univariate and multivariate analyses were performed to identify the independent prognostic factors.Model discrimination and model fitting were evaluated by receiver operating characteristic curves and Akaike information criteria.Decision curve analysis was performed to assess clinical usefulness.The independent prognostic factors identified by multivariate analysis were further applied to develop a novel prognostic nomogram.RESULTS A total of 2718 eligible GC patients were identified.The modified Lauren classification was identified as one of the independent prognostic factors for OS.It showed superior model discriminative ability and model-fitting performance over the other pathological classifications,and similar results were obtained in various patient settings.In addition,it showed superior net benefits over the Lauren classification and tumor differentiation grade in predicting 3-and 5-year OS.A novel prognostic nomogram incorporating the modified Lauren classification showed superior model discriminative ability,model-fitting performance,and net benefits over the American Joint Committee on Cancer 8th edition tumor-nodemetastasis classification.CONCLUSION The modified Lauren classification shows superior net benefits over the Lauren classification and tumor differentiation grade in predicting OS.A novel prognostic nomogram incorporating the modified Lauren classification shows good model discriminative ability,model-fitting performance,and net benefits.展开更多
文摘BACKGROUND The effect of low ligation(LL)vs high ligation(HL)of the inferior mesenteric artery(IMA)on functional outcomes during sigmoid colon and rectal cancer surgery,including urinary,sexual,and bowel function,is still controversial.AIM To assess the effect of LL of the IMA on genitourinary function and defecation after colorectal cancer(CRC)surgery.METHODS EMBASE,PubMed,Web of Science,and the Cochrane Library were systematically searched to retrieve studies describing sigmoid colon and rectal cancer surgery in order to compare outcomes following LL and HL.A total of 14 articles,including 4750 patients,were analyzed using Review Manager 5.3 software.Dichotomous results are expressed as odds ratios(ORs)with 95%confidence intervals(CIs)and continuous outcomes are expressed as weighted mean differences(WMDs)with 95%CIs.RESULTS LL resulted in a significantly lower incidence of nocturnal bowel movement(OR=0.73,95%CI:0.55 to 0.97,P=0.03)and anastomotic stenosis(OR=0.31,95%CI:0.16 to 0.62,P=0.0009)compared with HL.The risk of postoperative urinary dysfunction,however,did not differ significantly between the two techniques.The meta-analysis also showed no significant differences between LL and HL in terms of anastomotic leakage,postoperative complications,total lymph nodes harvested,blood loss,operation time,tumor recurrence,mortality,5-year overall survival rate,or 5-year disease-free survival rate.CONCLUSION Since LL may result in better bowel function and a reduced rate of anastomotic stenosis following CRC surgeries,we suggest that LL be preferred over HL.
基金Supported by The China Scholarship Council,No.201908050148.
文摘BACKGROUND It remains controversial as to which pathological classification is most valuable in predicting the overall survival(OS)of patients with gastric cancer(GC).AIM To assess the prognostic performances of three pathological classifications in GC and develop a novel prognostic nomogram for individually predicting OS.METHODS Patients were identified from the Surveillance,Epidemiology,and End Results program.Univariate and multivariate analyses were performed to identify the independent prognostic factors.Model discrimination and model fitting were evaluated by receiver operating characteristic curves and Akaike information criteria.Decision curve analysis was performed to assess clinical usefulness.The independent prognostic factors identified by multivariate analysis were further applied to develop a novel prognostic nomogram.RESULTS A total of 2718 eligible GC patients were identified.The modified Lauren classification was identified as one of the independent prognostic factors for OS.It showed superior model discriminative ability and model-fitting performance over the other pathological classifications,and similar results were obtained in various patient settings.In addition,it showed superior net benefits over the Lauren classification and tumor differentiation grade in predicting 3-and 5-year OS.A novel prognostic nomogram incorporating the modified Lauren classification showed superior model discriminative ability,model-fitting performance,and net benefits over the American Joint Committee on Cancer 8th edition tumor-nodemetastasis classification.CONCLUSION The modified Lauren classification shows superior net benefits over the Lauren classification and tumor differentiation grade in predicting OS.A novel prognostic nomogram incorporating the modified Lauren classification shows good model discriminative ability,model-fitting performance,and net benefits.
