Network meta-analysis of protocol-driven care and laparoscopic surgery for colorectal cancer

Background Laparoscopic approaches and standardized recovery protocols have reduced morbidity following colorectal cancer surgery. As the optimal regimen remains inconclusive, a network meta‐analysis was undertaken of treatments for the development of postoperative complications and mortality. Metho...

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Veröffentlicht in:British journal of surgery 2016-12, Vol.103 (13), p.1783-1794
Hauptverfasser: Currie, A. C., Malietzis, G., Jenkins, J. T., Yamada, T., Ashrafian, H., Athanasiou, T., Okabayashi, K., Kennedy, R. H.
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container_end_page 1794
container_issue 13
container_start_page 1783
container_title British journal of surgery
container_volume 103
creator Currie, A. C.
Malietzis, G.
Jenkins, J. T.
Yamada, T.
Ashrafian, H.
Athanasiou, T.
Okabayashi, K.
Kennedy, R. H.
description Background Laparoscopic approaches and standardized recovery protocols have reduced morbidity following colorectal cancer surgery. As the optimal regimen remains inconclusive, a network meta‐analysis was undertaken of treatments for the development of postoperative complications and mortality. Methods MEDLINE, Embase, trial registries and related reviews were searched for randomized trials comparing laparoscopic and open surgery within protocol‐driven or conventional perioperative care for colorectal cancer resection, with complications as a defined endpoint. Relative odds ratios (ORs) for postoperative complications and mortality were estimated for aggregated data. Results Forty trials reporting on 11 516 randomized patients were included with the network. Open surgery within conventional perioperative care was the index for comparison. The OR relating to complications was 0·77 (95 per cent c.i. 0·65 to 0·91) for laparoscopic surgery within conventional care, 0·69 (0·48 to 0·99) for open surgery within protocol‐driven care, and 0·43 (0·28 to 0·67) for laparoscopic surgery within protocol‐driven care. Sensitivity analyses excluding trials of low rectal cancer and those with a high risk of bias did not affect the treatment estimates. Meta‐analyses demonstrated that mortality risk was unaffected by perioperative strategy. Conclusion Laparoscopic surgery combined with protocol‐driven care reduces colorectal cancer surgery complications, but not mortality. The reduction in complications with protocol‐driven care is greater for open surgery than for laparoscopic approaches. Registration number: CRD42015017850 (https://www.crd.york.ac.uk/PROSPERO) Protocols improve outcomes
doi_str_mv 10.1002/bjs.10306
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C. ; Malietzis, G. ; Jenkins, J. T. ; Yamada, T. ; Ashrafian, H. ; Athanasiou, T. ; Okabayashi, K. ; Kennedy, R. H.</creator><creatorcontrib>Currie, A. C. ; Malietzis, G. ; Jenkins, J. T. ; Yamada, T. ; Ashrafian, H. ; Athanasiou, T. ; Okabayashi, K. ; Kennedy, R. H.</creatorcontrib><description>Background Laparoscopic approaches and standardized recovery protocols have reduced morbidity following colorectal cancer surgery. As the optimal regimen remains inconclusive, a network meta‐analysis was undertaken of treatments for the development of postoperative complications and mortality. Methods MEDLINE, Embase, trial registries and related reviews were searched for randomized trials comparing laparoscopic and open surgery within protocol‐driven or conventional perioperative care for colorectal cancer resection, with complications as a defined endpoint. Relative odds ratios (ORs) for postoperative complications and mortality were estimated for aggregated data. Results Forty trials reporting on 11 516 randomized patients were included with the network. Open surgery within conventional perioperative care was the index for comparison. The OR relating to complications was 0·77 (95 per cent c.i. 0·65 to 0·91) for laparoscopic surgery within conventional care, 0·69 (0·48 to 0·99) for open surgery within protocol‐driven care, and 0·43 (0·28 to 0·67) for laparoscopic surgery within protocol‐driven care. Sensitivity analyses excluding trials of low rectal cancer and those with a high risk of bias did not affect the treatment estimates. Meta‐analyses demonstrated that mortality risk was unaffected by perioperative strategy. Conclusion Laparoscopic surgery combined with protocol‐driven care reduces colorectal cancer surgery complications, but not mortality. The reduction in complications with protocol‐driven care is greater for open surgery than for laparoscopic approaches. 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T.</creatorcontrib><creatorcontrib>Yamada, T.</creatorcontrib><creatorcontrib>Ashrafian, H.</creatorcontrib><creatorcontrib>Athanasiou, T.</creatorcontrib><creatorcontrib>Okabayashi, K.</creatorcontrib><creatorcontrib>Kennedy, R. H.</creatorcontrib><title>Network meta-analysis of protocol-driven care and laparoscopic surgery for colorectal cancer</title><title>British journal of surgery</title><addtitle>Br J Surg</addtitle><description>Background Laparoscopic approaches and standardized recovery protocols have reduced morbidity following colorectal cancer surgery. As the optimal regimen remains inconclusive, a network meta‐analysis was undertaken of treatments for the development of postoperative complications and mortality. Methods MEDLINE, Embase, trial registries and related reviews were searched for randomized trials comparing laparoscopic and open surgery within protocol‐driven or conventional perioperative care for colorectal cancer resection, with complications as a defined endpoint. Relative odds ratios (ORs) for postoperative complications and mortality were estimated for aggregated data. Results Forty trials reporting on 11 516 randomized patients were included with the network. Open surgery within conventional perioperative care was the index for comparison. The OR relating to complications was 0·77 (95 per cent c.i. 0·65 to 0·91) for laparoscopic surgery within conventional care, 0·69 (0·48 to 0·99) for open surgery within protocol‐driven care, and 0·43 (0·28 to 0·67) for laparoscopic surgery within protocol‐driven care. Sensitivity analyses excluding trials of low rectal cancer and those with a high risk of bias did not affect the treatment estimates. Meta‐analyses demonstrated that mortality risk was unaffected by perioperative strategy. Conclusion Laparoscopic surgery combined with protocol‐driven care reduces colorectal cancer surgery complications, but not mortality. The reduction in complications with protocol‐driven care is greater for open surgery than for laparoscopic approaches. 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source MEDLINE; Wiley Online Library; Oxford Journals
subjects Cancer surgery
Clinical Protocols
Colorectal cancer
Colorectal Neoplasms - mortality
Colorectal Neoplasms - surgery
Feasibility Studies
Humans
Laparoscopy
Laparoscopy - methods
Laparoscopy - mortality
Meta-analysis
Mortality
Network Meta-Analysis
Patient Safety
title Network meta-analysis of protocol-driven care and laparoscopic surgery for colorectal cancer
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