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Meta-analysis of ischemic preconditioning (IP) on postoperative outcomes after liver resections
BACKGROUND: The protective role (decrease ischemia-reperfusion injury) of ischemic preconditioning (IP) before continuous vascular occlusion in liver resection is controversial. This meta-analysis aimed to compare the advantages and any potential disadvantages of IP maneuver. METHODS: A systematic s...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5728726/ https://www.ncbi.nlm.nih.gov/pubmed/29310325 http://dx.doi.org/10.1097/MD.0000000000008217 |
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author | Guo, Xingjun Liu, Gongpan Zhang, Xiaobin |
author_facet | Guo, Xingjun Liu, Gongpan Zhang, Xiaobin |
author_sort | Guo, Xingjun |
collection | PubMed |
description | BACKGROUND: The protective role (decrease ischemia-reperfusion injury) of ischemic preconditioning (IP) before continuous vascular occlusion in liver resection is controversial. This meta-analysis aimed to compare the advantages and any potential disadvantages of IP maneuver. METHODS: A systematic search in the Embase, Medline, PubMed databases, and the Cochrane Library was performed using both medical subject headings (MeSH) and truncated word searches to identify all randomized controlled trials (RCTs) published on this topic. The primary outcomes were postoperative morbidity, mortality, postoperative aspartate aminotransferase (AST) level, alanine aminotransferase (ALT) level, and total bilirubin (TB) level. Pooled odds ratios (ORs) and weighted mean differences (WMDs) with 95% confidence intervals (95% CIs) were calculated using either the random effects model or fixed effects model. RESULTS: Thirteen RCTs involving 918 patients were analyzed to achieve a summated outcome. The patients have been divided into IP group (n = 455) and no IP group (n = 463) before continuous vascular occlusion. No significant difference was found in postoperative mortality between both groups (P = .30). Subgroup analysis revealed that the postoperative morbidity in the cirrhosis subgroup was significantly less for the IP group compared with the control group (P = .01). In the cirrhosis subgroup, the result was stable (P = .04), without heterogeneity (P = .59; I(2) = 0%). Meta-analysis of AST level on postoperative day (POD) 1 indicated lower postoperative AST level in the IP group (P = .04). The analysis of ALT level showed lower ALT level in the IP group versus control group (P = .02). However, there was no difference in postoperative AST and ALT level after excluding 1 study with statistical heterogeneity (all P > .05). With respect to postoperative TB level, there was no significant difference between 2 groups. CONCLUSION: IP cannot decrease the hospital mortality for patients undergoing hepatectomy. IP may be beneficial for patients with cirrhosis due to less morbidity in patients with liver cirrhosis. However, we cannot conclude that IP can decrease ischemia-reperfusion injury because it did not significantly decrease postoperative AST, ALT, and TB levels. |
format | Online Article Text |
id | pubmed-5728726 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-57287262017-12-20 Meta-analysis of ischemic preconditioning (IP) on postoperative outcomes after liver resections Guo, Xingjun Liu, Gongpan Zhang, Xiaobin Medicine (Baltimore) 7100 BACKGROUND: The protective role (decrease ischemia-reperfusion injury) of ischemic preconditioning (IP) before continuous vascular occlusion in liver resection is controversial. This meta-analysis aimed to compare the advantages and any potential disadvantages of IP maneuver. METHODS: A systematic search in the Embase, Medline, PubMed databases, and the Cochrane Library was performed using both medical subject headings (MeSH) and truncated word searches to identify all randomized controlled trials (RCTs) published on this topic. The primary outcomes were postoperative morbidity, mortality, postoperative aspartate aminotransferase (AST) level, alanine aminotransferase (ALT) level, and total bilirubin (TB) level. Pooled odds ratios (ORs) and weighted mean differences (WMDs) with 95% confidence intervals (95% CIs) were calculated using either the random effects model or fixed effects model. RESULTS: Thirteen RCTs involving 918 patients were analyzed to achieve a summated outcome. The patients have been divided into IP group (n = 455) and no IP group (n = 463) before continuous vascular occlusion. No significant difference was found in postoperative mortality between both groups (P = .30). Subgroup analysis revealed that the postoperative morbidity in the cirrhosis subgroup was significantly less for the IP group compared with the control group (P = .01). In the cirrhosis subgroup, the result was stable (P = .04), without heterogeneity (P = .59; I(2) = 0%). Meta-analysis of AST level on postoperative day (POD) 1 indicated lower postoperative AST level in the IP group (P = .04). The analysis of ALT level showed lower ALT level in the IP group versus control group (P = .02). However, there was no difference in postoperative AST and ALT level after excluding 1 study with statistical heterogeneity (all P > .05). With respect to postoperative TB level, there was no significant difference between 2 groups. CONCLUSION: IP cannot decrease the hospital mortality for patients undergoing hepatectomy. IP may be beneficial for patients with cirrhosis due to less morbidity in patients with liver cirrhosis. However, we cannot conclude that IP can decrease ischemia-reperfusion injury because it did not significantly decrease postoperative AST, ALT, and TB levels. Wolters Kluwer Health 2017-12-01 /pmc/articles/PMC5728726/ /pubmed/29310325 http://dx.doi.org/10.1097/MD.0000000000008217 Text en Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0 |
spellingShingle | 7100 Guo, Xingjun Liu, Gongpan Zhang, Xiaobin Meta-analysis of ischemic preconditioning (IP) on postoperative outcomes after liver resections |
title | Meta-analysis of ischemic preconditioning (IP) on postoperative outcomes after liver resections |
title_full | Meta-analysis of ischemic preconditioning (IP) on postoperative outcomes after liver resections |
title_fullStr | Meta-analysis of ischemic preconditioning (IP) on postoperative outcomes after liver resections |
title_full_unstemmed | Meta-analysis of ischemic preconditioning (IP) on postoperative outcomes after liver resections |
title_short | Meta-analysis of ischemic preconditioning (IP) on postoperative outcomes after liver resections |
title_sort | meta-analysis of ischemic preconditioning (ip) on postoperative outcomes after liver resections |
topic | 7100 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5728726/ https://www.ncbi.nlm.nih.gov/pubmed/29310325 http://dx.doi.org/10.1097/MD.0000000000008217 |
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