Background
Methods
Search strategy
Eligibility criteria and data extraction
Assessing methodological quality and certainty in evidence
Results
Characteristics of included reviews and overall results
Review (year) | Search period | Intervention | Comparisons | Surgical procedure | Outcomes | No. of RCTs | Methodological quality of RCTs† |
---|---|---|---|---|---|---|---|
Population: gastric cancer patients | |||||||
Sun (2015) [24] | June 2014 | Ultrasonic dissection | Conventional electrocautery | Gastrectomy with D1/D2 LND | OR time; blood loss; post-op abdominal drainage; morbidity and mortality; post-op hospital stay; total cost | 5 | Low RoB |
Cheng (2015) [12] | September 2013 | Harmonic surgical devices | Conventional techniques | OR time; blood loss; post-op drainage volume; post-op hospital stay; blood transfusion; post-op complications | 10 | Moderate to low RoB | |
Chen (2014) [23] | September 2012 | Ultrasonic scalpel | Conventional techniques | OR time; post-op complications; blood loss; abdominal drainage; post-op hospital stay; blood transfusion; GI function recovery days; no. dissected lymph nodes | 7 | Low quality‡ | |
Population: breast cancer patients | |||||||
Huang (2015) [13] | June 2015 | Harmonic scalpel | Electrocautery dissection | Modified radical mastectomy | Post-op drainage; seroma formation; blood loss; OR time; wound complications | 7* | Low to moderate quality‡ |
Cheng (2016) [21] | January 1998 to May 2014 | Harmonic technology | Conventional techniques | Mastectomy and BCS with LND | OR time; blood loss; chest wall drainage; post-op hospital stay; total complications; seroma and hematoma formation; wound infection; necrosis; ecchymosis | 12 | Moderate to low RoB |
Currie (2012) [22] | 2011 | Ultrasonic dissection | Electrocautery dissection | Mastectomy ± LND | Total post-op drainage; seroma formation; blood loss; OR time; wound complications | 6 | Low to moderate quality‡ |
Population: oral, head, and neck cancer patients | |||||||
Ren (2015) [14] | 2014 | Harmonic scalpel | Conventional hemostasis | Neck dissection with LND | OR time; blood loss; post-op drainage; hospital stay | 7 | Moderate to low RoB |
Population: colon cancer patients | |||||||
Allaix (2016) [28] | January 1999 to January 2016 | Energy sources | Conventional electrosurgery | Laparoscopic colorectal resection | Quantitative analysis not performed | 4** | Not assessed |
Di Lorenzo (2012) [29] | 1990 to June 2011 | Ultrasonic energy | Radiofrequency | Quantitative analysis for comparison of Harmonic devices vs. conventional techniques not performed | 5*** | Not assessed | |
Tou (2011) [30] | March 2010 | Energy sources | Conventional electrosurgery | OR time; blood loss; complications; conversion to open surgery; post-op hospital stay; total cost | 6 | Low RoB |
Gastric cancer surgeries
Review (year) | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | Rating |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Population: gastric cancer patients | ||||||||||||
Sun (2015) [24] | No | Yes | Yes | No | No | Yes | Yes | Yes | Yes | Yes | Yes | 8 |
Cheng (2015) [12] | No | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | Yes | 9 |
Chen (2014) [23] | No | Yes | Yes | No | No | Yes | Yes | No | Yes | Yes | Yes | 7 |
Population: breast cancer patients | ||||||||||||
Huang (2015) [13] | No | CA | Yes | No | No | Yes | Yes | Yes | Yes | Yes | Yes | 7 |
Cheng (2016) [21] | No | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | No | Yes | 8 |
Currie (2012) [22] | No | CA | Yes | Yes | No | Yes | Yes | Yes | Yes | No | Yes | 7 |
Population: oral, head, and neck cancer patients | ||||||||||||
Ren (2015) [14] | No | No | Yes | No | No | Yes | Yes | Yes | Yes | Yes | Yes | 7 |
Population: colon cancer patients | ||||||||||||
Allaix (2016) [28] | No | Yes | No | No | No | Yes | No | NA | NA | No | Yes | 3 |
Di Lorenzo (2012) [29] | No | Yes | No | No | No | Yes | No | NA | Yes | No | Yes | 4 |
Tou (2011) [30] | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | No | Yes | 10 |
Review (year) | Population | Effect size (95% CI) | P value for difference | No. of participant (HS/CT) | Heterogeneity (I2) | Publication bias†† | GRADE Certainty in evidence‡ |
---|---|---|---|---|---|---|---|
Operative time (min) | |||||||
Sun (2015) [24] | Gastric cancer | MD − 24.5 (− 46.0 to − 3.0) | 0.026 | 199/198 | 95% | Asymmetric funnel plot | Low1, 2, 3 |
Cheng (2015) [12] | MD − 27.5 (− 42.2 to − 12.8) | < 0.001 | 399/382 | 91% | Symmetric funnel plot | Moderate1 | |
Chen (2014) [23] | MD − 27.1 (−45.2 to − 9.1) | 0.003 | 172/168 | 91% | Symmetric funnel plot | Very low1, 2, 4 | |
Huang (2015) [13] | Breast cancer | MD − 1.4 (− 4.2 to 1.4) † | 0.85 | 333/327 | 74% | NS Egger’s and Begg’s tests | Very low1, 2, 5 |
Cheng (2016) [21] | MD − 5.1 (− 11.0 to 0.8) | 0.09 | 390/391 | 83% | Not assessed | Moderate1, 6 | |
Currie (2012) [22] | MD 1.7 (− 3.8 to 7.3) † | 0.81 | 125/120 | 42% | Not assessed | Low1, 2 | |
Ren (2015)[14] | Oral, head, and neck cancer | MD − 29.3 (− 44.3 to − 4.3) | < 0.001 | 201/205 | 92% | Symmetric funnel plot | Moderate1, 7 |
Tou (2011) [30] | Colon cancer | MD − 26.2 (− 62.0 to 9.6) * | 0.15 | 94/92 | 87% | Not assessed | Low1, 2, 8 |
Intraoperative blood loss (mL) | |||||||
Sun (2015) [24] | Gastric cancer | MD − 137.5 (− 224.9 to − 50.2) | 0.002 | 195/196 | 91% | Asymmetric funnel plot | Low1, 2, 3 |
Cheng (2015) [12] | MD − 93.2 (− 125.3 to − 61.0) | < 0.001 | 349/336 | 86% | Symmetric funnel plot | Moderate1 | |
Chen (2014) [23] | MD − 106.3 (− 151.0 to − 61.7) | < 0.001 | 172/168 | 93% | Symmetric funnel plot | Very low1, 2, 4 | |
Huang (2015) [13] | Breast cancer | MD − 87.5 (− 130.1 to − 45.0)† | < 0.001 | 226/237 | 92% | NS Egger’s and Begg’s tests | Low1, 5 |
Cheng (2016) [21] | MD − 87.5 (− 137.1 to − 38.0) | < 0.001 | 323/321 | 99% | Not assessed | Moderate1 | |
Currie (2012) [22] | MD − 127.4 (− 227.5 to − 27.3)† | 0.013 | 126/137 | 91% | Not assessed | Very Low1, 2, 9 | |
Ren (2015) [14] | Oral, head, and neck cancer | MD − 141.1 (− 315.0 to 6.4) | 0.112 | 153/151 | 100% | Symmetric funnel plot | Moderate 2, 10 |
Tou (2011) [30] | Colon cancer | MD − 42.1 (− 62.0 to − 21.2) | < 0.001 | 94/92 | 0.0% | Not assessed | Moderate2 |
Drainage volume (mL) | |||||||
Sun (2015) [24] | Gastric cancer | MD − 292.3 (− 708.3 to 123.7) | 0.168 | 148/145 | 77% | Asymmetric funnel plot | Low1, 2, 3 |
Cheng (2015) [12] | MD − 138.8 (− 177.6 to − 100.1) | < 0.001 | 375/359 | 94% | Symmetric funnel plot | Moderate1 | |
Chen (2014) [23] | MD − 74.6 (− 95.2 to − 54.0) | < 0.001 | 69/69 | 84% | Symmetric funnel plot | Very low1, 2, 4 | |
Huang (2015) [13] | Breast cancer | MD − 211.6 (− 353.9 to − 69.2)† | 0.004 | 258/269 | 91% | NS Egger’s and Begg’s tests | Moderate1 |
Cheng (2016) [21] | MD − 42.1 (− 65.9 to − 18.9) | < 0.001 | 127/129 | 87% | Not assessed | Low1, 2 | |
Currie (2012) [22] | MD − 141.5 (− 335.9 to 53.0)† | 0.154 | 138/149 | 81% | Not assessed | Low1, 2 | |
Ren (2015) [14] | Oral, head, and neck cancer | MD − 64.9 (− 110.4 to − 19.3) | 0.005 | 191/195 | 97% | Symmetric funnel plot | Low1, 2 |
Duration of hospitalization (days) | |||||||
Sun (2015) [24] | Gastric cancer | MD − 2.1 (− 4.0 to − 0.2) | 0.027 | 50/50 | 0.0% | Asymmetric funnel plot | Moderate2 |
Cheng (2015) [12] | MD − 0.6 (− 2.5 to 1.2) | 0.509 | 81/81 | 65% | Symmetric funnel plot | Low1, 2 | |
Chen (2014) [23] | MD − 3.2 (− 6.3 to − 0.1) | 0.040 | 20/20 | – | Symmetric funnel plot | -** | |
Cheng (2016) [21] | Breast cancer | MD − 1.4 (− 2.4 to − 0.4) | 0.007 | 184/186 | 98% | Not assessed | Low1, 2 |
Ren (2015) [14] | Oral, head, and neck cancer | MD − 0.21 (− 0.48 to 0.07) | 0.142 | 79/81 | 0.0% | Symmetric funnel plot | Moderate2 |
Tou (2011) [30] | Colon cancer | MD − 0.42 (− 0.84 to 0.00) | 0.051 | 94/92 | 0.0% | Not assessed | Moderate2 |
Overall perioperative complications | |||||||
Cheng (2015) [12] | Gastric cancer | RR 0.58 (0.3 to 1.0) | 0.059 | 235/229 | 12.0% | Symmetric funnel plot | High |
Chen (2014) [23] | RR 0.75 (0.4 to 1.3) | 0.276 | 126/121 | 0.0% | Symmetric funnel plot | Moderate2 | |
Huang (2015) [13] | Breast cancer | RR 0.38 (0.2 to 0.6) | 0.01 | 199/209 | 23.0% | NS Egger’s and Begg’s tests | High |
Cheng (2016) [21] | RR 0.5 (0.3 to 0.8) | 0.002 | NR | 0.0% | Not assessed | Moderate2 | |
Currie (2012) [22] | OR 1.6 (0.7 to 3.7) | 0.3 | NR | 35.0% | Not assessed | Very low1, 2, 9 | |
Tou (2011) [30] | Colon cancer | RR 1.28 (0.7 to 2.3) | 0.395 | 106/103 | 0.0% | Not assessed | Moderate2 |
Seroma development | |||||||
Huang (2015) [13] | Breast cancer | RR 0.5 (0.3 to 0.7) | < 0.001 | 82/125 | 0.0% | NS Egger’s and Begg’s tests | Moderate2 |
Cheng (2016) [21] | RR 0.5 (0.4 to 0.7) | < 0.001 | 410/411 | 25.0% | Not assessed | High | |
Currie (2012) [22] | OR: 0.8 (0.4 to 1.4) | 0.368 | 45/49 | 0.0% | Not assessed | Low2, 9 |