Objectives: To evaluate comparative outcomes of routine abdominal drainage (RAD) and non-routine abdominal drainage (NRAD) during elective hepatic resection for hepatic neoplasms. Materials and Methods: We systematically searched MEDLINE, EMBASE, The Cochrane Library, Web of Science. The searching phrases included “liver resection,” “hepatic resection,” “hepatectomy,” “abdominal drainage,” “surgical drainage,” “prophylactic drainage,” “intraperitoneal drainage,” “drainage tube,” “hepatectomy,” “abdominal drainage” and “drainage tube.” Two independent reviewers critically screened literature, extracted data and assessed the risk of bias. Post-operative morbidity and mortality were the outcome parameters. Combined overall effect sizes were calculated using fixed-effect or random-effect model. Results: We have identified 9 RCTs and 3 comparative studies reporting total of 5726 patients undergoing elective hepatectomy under RAD (n = 3084) or NRAD (NRAD group, n = 2642). RAD was associated with significantly higher overall complication rate [odds risk = 1.79, 95% CI (1.10, 2.93), P = .02] and biliary leakage rate [odds risk = 2.41, 95% CI (1.48, 3.91), P = .0004] compared with NRAD. Moreover, it significantly increased hospital stays [mean difference = 0.95, 95% CI (0.02, 1.87), P = .04] compared with NRAD. RAD showed no difference regarding intra-abdominal hemorrhage, wound complications, liver failure, subphrenic complications, pulmonary complications, infectious complications, reoperation and mortality compared with NRAD. Conclusions: Although routine abdominal drainage may help surgeons to observe post-operative complication, it seems to be associated with increased post-operative morbidity and longer hospital stays. Non-routine abdominal drainage may be an appropriate option in selected patients undergoing hepatic resection. Higher level of evidence is needed.
Aim: To assess the safety, feasibility and efficacy of 125 I seeds irradiation stents compared with conventional selfexpandable metal stents (SEMS) to treat malignant obstructive jaundice (MOJ). Methods:A systematic search of English and Chinese databases, from January 1980 to December 2017, was conducted. All prospective random trials comparing SEMS and the various form of irradiation stent with 125 I seeds to treat MOJ were included. Results:Overall, six studies with 276 patients were eligible in current analysis. Of reported 276 patients, 138 patients were subjected to irradiation stents while 138 patients to SEMS. The irradiation stents are associated with a longer survival (hazard ratio (HR) 0.46, IV, random, 95% confidence interval (CI) 0.34-0.63; p<0.001, I 2 =0%) and stent patency (HR 0.45, IV, random, 95% CI 0.25-0.80; p=0.007, I 2 =59%) than conventional SEMS. Conclusions:According to limited source data, the current meta-analysis suggests that the irradiation stent is a feasible, safe treatment of MOJ, with longer survival and stent patency. Application of irradiation stent with antitumor effect does not add extra adverse events compared to SEMS stent.
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