ObjectiveTo compare the clinical efficacy of endoscopic minimally invasive surgery and median sternotomy thoracotomy in the treatment of atrial myxoma by meta-analysis.MethodsWe searched CBM, CNKI, Wanfang Data, VIP, PubMed, the Cochrane Library and EMbase to collect relevant researches on atrial myxoma and endoscopic minimally invasive surgery. The retrieval time was from the establishment of the database to September 2020. Two reviewers independently screened the literature, extracted data and evaluated the bias risk of included studies by the Newcastle-Ottawa scale (NOS). Then, the meta-analysis was performed by Stata 16.0.ResultsTen articles were included in the study, all of which were case-control studies. The quality of literature was grade B in 5 articles and grade A in 5 articles. The sample size of surgery was 938 patients, including 480 patients in the endoscopic minimally invasive group, 458 patients in the median thoracotomy group, and 595 patients in follow-up. A total of 18 outcome indexes were included in the meta-analysis. The combined results of 9 outcome indicators were statistically significant: cardiopulmonary bypass time (SMD=0.32, 95%CI 0.00 to 0.63, P=0.048); ventilator assisted ventilation time (SMD=−0.35, 95%CI −0.56 to −0.15, P=0.001), ICU stay time (SMD=–0.42, 95%CI −0.62 to −0.21, P<0.001); postoperative hospitalization time (SMD=−0.91, 95%CI −1.22 to −0.60, P<0.001); postoperative drainage volume (SMD=−2.48, 95%CI −5.24 to 0.28, P<0.001); postoperative new onset atrial fibrillation (OR=0.29, 95%CI 0.12 to 0.67, P= 0.005); postoperative pneumonia (OR=0.09, 95%CI 0.02 to 0.36, P=0.001); postoperative blood transfusion (OR=0.22, 95%CI 0.11 to 0.45, P<0.001); incision satisfaction (OR=83.15, 95%CI 1.24 to 5563.29, P=0.039).ConclusionAvailable evidence suggests that median thoracotomy requires shorter cardiopulmonary bypass time than endoscopic minimally invasive surgery; during the 5-year follow-up after surgery and discharge, ICU stay time, postoperative hospital stay, postoperative drainage, new atrial fibrillation after surgery, postoperative pneumonia, postoperative blood transfusion, satisfactory incision, endoscopic minimally invasive surgery showed better results than median sternotomy thoracotomy.
ObjectiveTo systematically review the clinical utilization of robotic bronchoscopes in diagnosis of pulmonary nodules, including MonarchTM and IonTM platforms, and then evaluate the efficacy and safety of the procedure. MethodsPubMed, EMbase, Web of Science and Cochrane Central Register of Controlled Trials databases were searched by computer for literature about the biopsy of pulmonary nodules with robotic bronchoscope from January 2018 to February 14, 2022. The quality of research was evaluated with Newcastle-Ottawa Scale. RevMan 5.4 software was used to conduct the meta-analysis. ResultsFinally, 19 clinical studies with 1 542 patients and 1 697 targeted pulmonary nodules were included, of which 13 studies used the IonTM platform and 6 studies used the MonarchTM platform. The overall diagnostic rate of the two systems was 84.96% (95%CI 62.00%-95.00%), sensitivity for malignancy was 81.79% (95%CI 43.00%-96.00%), the mean maximum diameter of the nodules was 16.22 mm (95%CI 10.98-21.47), the mean procedure time was 61.86 min (95%CI 46.18-77.54) and the rate of complications occurred was 4.76% (95%CI 2.00%-15.00%). There was no statistical difference in the outcomes between the two systems. Conclusion Robotic bronchoscope provides a high efficacy and safety in biopsy of pulmonary nodules, and has a broad application prospect for pulmonary nodules diagnosis.
ObjectiveThrough comparing the therapeutic efficacy of robot-assisted surgery (RS) and conventional surgery (CS) for mitral valve disease by meta-analysis to guide the choice of clinical operation.MethodsDatabases including The Cochrane Library, PubMed, EMbase, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBMdisc) and Wanfang Database were searched by computer from inception to June 2020. The literature of efficacy comparison between RS and CS was collected. Two reviewers independently screened the literature according to inclusion and exclusion criteria, extracted the data, and evaluated the quality of the literature. Meta-analysis was performed using RevMan 5.4 software.ResultsWe identified 11 studies of RS versus CS with 4 330 patients. Among them, 2 212 patients underwent RS and 2 118 underwent CS. Meta-analysis demonstrated that compared with the CS, RS had longer cross-clamp time (MD=25.00, 95%CI 15.04 to 34.95, P<0.000 01), cardiopulmonary bypass time (MD=44.11, 95%CI 29.26 to 58.96, P<0.000 01) and operation time (MD=46.40, 95%CI 31.55 to 61.26, P<0.000 01). However, ICU stay (MD=–22.13, 95%CI –31.88 to –12.38, P<0.000 01) and hospital stay (MD=–1.81, 95%CI –2.69 to –0.92, P<0.000 01) were significantly shorter in the RS group; and the incidences of blood transfusion (OR=0.38, 95%CI 0.16 to 0.89, P=0.03) and complications (OR=0.73, 95%CI 0.57 to 0.94, P=0.01) were significantly lower in the RS group.ConclusionAlthough RS has a longer operation time than CS, it has less damage, less bleeding, faster recovery and better curative efficacy.
ObjectiveTo evaluate the effectiveness and safety of proximal aortic repair (PAR) versus total arch replacement (TAR) for treatment of acute type A aortic dissection (ATAAD). Methods An electronic search was conducted for clinical controlled studies on PAR versus TAR for patients with ATAAD published in Medline via PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang Database and CNKI since their inception up to April 30, 2022. The quality of each study included was assessed by 2 evaluators and the necessary data were extracted. STATA 16 software was used to perform statistical analysis of the available data. ResultsA total of 28 cohort studies involving 7 923 patients with ATAAD were included in this meta-analysis, of whom 5 710 patients received PAR and 2 213 patients underwent TAR, and 96.43% of the studies (27/28) were rated as high quality. The meta-analysis results showed that: (1) patients who underwent PAR had lower incidences of 30 d mortality [RR=0.62, 95%CI (0.50, 0.77), P＜0.001], in-hospital mortality [RR=0.64, 95%CI (0.54, 0.77), P＜0.001], and neurologic deficiency after surgery [RR=0.84, 95%CI (0.72, 0.98), P=0.032] than those who received TAR; (2) the cardiopulmonary bypass time [WMD=–52.07, 95%CI (–74.19, –29.94), P＜0.001], circulatory arrest time [WMD=–10.14, 95%CI (–15.02, –5.26), P＜0.001], and operation time [WMD=–101.68, 95%CI (–178.63, –24.73), P＜0.001] were significantly shorter in PAR than those in TAR; (3) there was no statistical difference in mortality after discharge, rate of over 5-year survival, renal failure after surgery and re-intervention, volume of red blood cells transfusion and fresh-frozen plasma transfusion, or hospital stay between two surgical procedures. Conclusion Compared with TAR, PAR has a shorter operation time and lower early and in-hospital mortality, but there is no difference in long-term outcomes or complications between the two procedures for patients with ATAAD.
Objective To systematically evaluate the impact of pulmonary hypertension (PH) on the prognosis of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Methods A computerized search was conducted in CNKI, Wanfang Data, VIP, CBM, PubMed, The Cochrane Library, EMbase, and Web of Science databases from inception to June 2023 for cohort studies on the prognostic impact of PH in severe AS patients undergoing TAVR. Two researchers independently screened the literature, extracted data, and assessed the quality of included studies. Stata 17.0 software was used for meta-analysis. Results A total of 16 cohort studies were included, all with Newcastle-Ottawa Scale scores≥7. Meta-analysis results showed that, compared with AS patients without PH, those with PH had significantly higher 1-year all-cause mortality after TAVR [OR=2.10, 95%CI (1.60, 2.75), P<0.01], 30-day all-cause mortality [OR=2.09, 95%CI (1.54, 2.83), P<0.01], and cardiovascular mortality [OR=1.49, 95%CI (1.18, 1.90), P<0.01]. The differences between the two groups in major bleeding events, stroke, myocardial infarction, pacemaker implantation, and postoperative renal failure were not statistically significant. For outcome indicators with significant heterogeneity, subgroup analyses were performed based on PH measurement methods, diagnostic criteria, and different types of PH. The results showed that most subgroup combined results were consistent with the overall findings and that heterogeneity was significantly reduced. Conclusion PH significantly increases the 30-day all-cause mortality, 1-year all-cause mortality, and cardiovascular mortality in patients with severe AS undergoing TAVR.
ObjectiveTo systematically evaluate the risk factors for postoperative pulmonary infection in patients with esophageal cancer. MethodsCNKI, Wangfang Data, VIP, CBM, PubMed, EMbase, The Cochrane Library were searched from inception to January 2021 to collect case-control studies, cohort studies and cross-sectional studies about risk factors for postoperative pulmonary infection in patients with esophageal cancer. Two researchers independently conducted literature screening, data extraction and quality assessment. RevMan 5.3 software and Stata 15.0 software were used for meta-analysis. ResultsA total of 20 articles were included, covering 5 409 patients of esophageal cancer. The quality score of included studies was 6-8 points. Meta-analysis results showed that age (MD=1.99, 95%CI 0.10 to 3.88, P=0.04), age≥60 years (OR=2.68, 95%CI 1.46 to 4.91, P=0.001), smoking history (OR=2.41, 95%CI 1.77 to 3.28, P<0.001), diabetes (OR=2.30, 95%CI 1.90 to 2.77, P<0.001), chronic obstructive pulmonary disease (OR=3.69, 95%CI 2.09 to 6.52, P<0.001), pulmonary disease (OR=2.22, 95%CI 1.16 to 4.26, P=0.02), thoracotomy (OR=1.77, 95%CI 1.32 to 2.37, P<0.001), operation time (MD=14.08, 95%CI 9.64 to 18.52, P<0.001), operation time>4 h (OR=3.09, 95%CI 1.46 to 6.55, P=0.003), single lung ventilation (OR=3.46, 95%CI 1.61 to 7.44, P=0.001), recurrent laryngeal nerve injury (OR=5.66, 95%CI 1.63 to 19.71, P=0.006), and no use of patient-controlled epidural analgesia (PCEA) (OR=2.81, 95%CI 1.71 to 4.61, P<0.001) were risk factors for postoperative pulmonary infection in patients with esophageal cancer. ConclusionThe existing evidence shows that age, age≥60 years, smoking history, diabetes, chronic obstructive pulmonary disease, pulmonary disease, thoracotomy, operation time, operation time>4 h, single lung ventilation, recurrent laryngeal nerve injury, and no use of PCEA are risk factors for postoperative pulmonary infection in patients with esophageal cancer. Due to the limitation of the quantity and quality of included literature, the conclusion of this study still needs to be confirmed by more high-quality studies.
ObjectiveTo evaluate the diagnostic value of artificial intelligence (AI)-assisted diagnostic system for pulmonary cancer based on CT images.MethodsDatabases including PubMed, The Cochrane Library, EMbase, CNKI, WanFang Data and Chinese BioMedical Literature Database (CBM) were electronically searched to collect relevant studies on AI-assisted diagnostic system in the diagnosis of pulmonary cancer from 2010 to 2019. The eligible studies were selected according to inclusion and exclusion criteria, and the quality of included studies was assessed and the special information was identified. Then, meta-analysis was performed using RevMan 5.3, Stata 12.0 and SAS 9.4 softwares. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio were pooled and the summary receiver operating characteristic (SROC) curve was drawn. Meta-regression analysis was used to explore the sources of heterogeneity.ResultsTotally 18 studies were included with 4 771 patients. Random effect model was used for the analysis due to the heterogeneity among studies. The results of meta-analysis showed that the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnosis odds ratio and area under the SROC curve were 0.87 [95%CI (0.84, 0.90)], 0.89 [95%CI (0.84, 0.92)], 7.70 [95%CI (5.32, 11.15)], 0.14 [95%CI (0.11, 0.19)], 53.54 [95%CI (30.68, 93.42)] and 0.94 [95%CI (0.91, 0.95)], respectively.ConclusionAI-assisted diagnostic system based on CT images has high diagnostic value for pulmonary cancer, and thus it is worthy of clinical application. However, due to the limited quality and quantity of included studies, above results should be validated by more studies.
ObjectiveTo compare the clinical outcomes of transcatheter aortic valve implantation (TAVI) in oncology and non-oncology patients with severe aortic stenosis (AS).MethodsA computer-based search in PubMed, The Cochrane Library, EMbase, CBM, CNKI and Wanfang databases from their date of inception to December 2021 was performed, together with reference screening, to identify eligible clinical trials. Two investigators screened the articles, extracted data, and evaluated quality independently. RevMan 5.3 and Stata 12.0 softwares were used for meta-analysis.ResultsThe selected 8 cohort studies contained 57 988 patients, including 12 335 cancer patients and 45 653 non-cancer patients. The results of meta-analysis showed that in patients with cancer, the 30-day mortality [OR=0.74, 95%CI (0.65, 0.84), I2=0%, P<0.000 01], stroke [OR=0.87, 95%CI (0.76, 0.99), I2=0%, P=0.04] and acute kidney injury [OR=0.81, 95%CI (0.76, 0.85), I2=49%, P<0.000 01] were lower than those in patients without cancer. The 1-year mortality [OR=1.46, 95%CI (1.15, 1.86), I2=62%, P=0.002] and late mortality [OR=1.51, 95%CI (1.24, 1.85), I2=61%, P<0.000 1] were higher in patients with cancer.ConclusionIt is effective and safe in cancer patients with severe AS undergoing TAVI. However, compared with patients without cancer, it is still high in long-term mortality, and further study of the role of TAVI in cancer patients with AS is necessary.
Objective To compare the perioperative results between uniportal and three-portal thoracoscopic lobectomy for non-small cell lung cancer (NSCLC). Methods Electronic databases including PubMed, Web of Science, EMbase, CNKI, Wanfang were systematically searched from the establishment of each database until April 2022. Literature screening, data extraction and bias risk assessment were independently conducted by two researchers. All combined results were performed by RevMan 5.3 and Stata 16.0. The quality of the literature and the risk of bias were evaluated using the Cochrane Bias Risk Assessment Tool. Results Eighteen eligible randomized controlled trials (1 597 patients) were identified eventually, including 800 patients undergoing uniportal thoracoscopic lobectomy and 797 patients undergoing three-portal thoracoscopic lobectomy. Meta-analysis results showed that compared to the three-portal approach, uniportal lobectomy took longer operation time (WMD=7.63, 95%CI 2.36 to 12.91, P=0.005) with less intraoperative blood loss (WMD=–28.81, 95%CI –42.54 to –15.08, P<0.001). Furthermore, patients undergoing uniportal lobectomy achieved lower visual analogue score within 24 hours after the operation (WMD=–1.60, 95%CI –2.26 to –0.94, P<0.001), less volume of drainage after the operation (WMD=–25.30, 95%CI –46.22 to –4.37, P=0.020), as well as shorter drainage duration (WMD=–0.36, 95%CI –0.72 to –0.01, P=0.040). Besides, patients undergoing uniportal lobectomy were also observed with shorter length of hospital stay (WMD=–2.28, 95%CI –2.68 to –1.88, P<0.001) and lower incidence of postoperative complications (RR=0.49, 95%CI 0.38 to 0.63, P<0.001). However, the number of lymph nodes harvested during the operation (WMD=–0.01, 95%CI –0.24 to 0.21, P=0.930) was similar between the two groups. Conclusion Both uniportal and three-portal thoracoscopic lobectomy for NSCLC are safe and feasible. The uniportal approach is superior in reducing short-term postoperative pain, postoperative complications and shortening the length of hospital stay.
ObjectiveTo investigate effectiveness and safety of transcatheter aortic valve replacement in the treatment of aortic regurgitation. Methods PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, Wanfang Data and VIP were searched from inception to August 2021. According to the criteria of inclusion and exclusion, two reviewers independently screened the literature, extracted the data and evaluated the quality of the included studies. Then, Stata 16.0 software was used for meta-analysis. Subgroup meta-analysis of valve type used and study type was performed. ResultsTwenty-five studies (12 cohort studies and 13 single-arm studies) were included with 4 370 patients. Meta-analysis results showed that an incidence of device success was 87% (95%CI 0.81-0.92). The success rate of the new generation valve subgroup was 93% (95%CI 0.89-0.96), and the early generation valve subgroup was 66% (95%CI 0.56-0.75). In addition, the 30-day all-cause mortality was 7% (95%CI 0.05-0.10), the 30-day cardiac mortality was 4% (95%CI 0.01-0.07), the incidence of pacemaker implantation was 10% (95%CI 0.08-0.13), and the incidence of conversion to thoracotomy was 2% (95%CI 0.01-0.04). The incidence of moderate or higher paravalvular aortic regurgitation was 6% (95%CI 0.03-0.09). Conclusion Transcatheter aortic valve replacement for aortic regurgitation is safe and yields good results, but some limitations can not be overcome. Therefore, multicenter randomized controlled trials are needed to confirm our results.