Metaanálisis: una forma básica de entender e interpretar su evidencia / Meta-Analysis: A Basic Way To Understand And Interpret Your Evidence

El metaanálisis es un método sistemático para sintetizar resultados de diferentes estudios empíricos sobre el efecto de una variable independiente, sea de intervención o tratamiento, en un resultado final preciso. Desarrollado principalmente en la investigación médica y psicológica como una herramienta para sintetizar información empírica sobre los resultados de un tratamiento, ahora el metaanálisis se usa cada vez más en las ciencias de la salud, formando parte de las revisiones sistemáticas, como una herramienta de inferencia estadística. Sin embargo, a pesar de sus indiscutibles propiedades para la síntesis de la información dispersa en la literatura y para la resolución de controversias con un alto grado de evidencia, adolece de distintos problemas en la consecución de estos objetivos. Es necesario conocer su entramado metodológico, aunque sea a un nivel básico, para valorar su validez en el logro de dichos objetivos. (AU)

Meta-analysis is a systematic method to synthesise results from different empirical studies on the effect of an independent variable, whether an intervention or treatment, on a precise outcome. These studies were mainly developed in medical and psychological research as a tool to synthesise empirical information on the results of treatment. They are currently increasingly used in health sciences, forming part of systematic reviews, as a tool for statistical inference. However, despite their undoubted usefulness for synthesising information scattered in the literature and for resolving controversies with a high grade of evidence, these studies also show various problems in achieving their aims. Familiarity with their methodological framework is essential, even at a basic level, to assess their validity in achieving their objectives. (AU)

Outcome quality standards for surgery of colorectal liver metastasis.

PURPOSE: Liver metastases are the most common malignant solid liver lesions, approximately 40% of which stem from colorectal tumors. Liver resection is currently the only curative treatment for colorectal cancer liver metastases (CRLM). However, there is a lack of consensus criteria to assess the results of this treatment. In order to evaluate the quality of surgical outcomes, it is necessary to identify quality indicators (QIs) and their corresponding quality standards (QS). We propose a simple method to determine QI and QS in CRLM surgery (CRLMS) and establish acceptable quality limits (AQL) for each QI. MATERIAL AND METHODS: A systematic review of CRLMS results published from 2006 to 2016. Clinical guidelines, consensus conferences, and publications related to the CRLMS were reviewed to identify and select QIs. Once selected, a new review of the papers including the results of at least one of the QIs was performed. Statistical process control (SPC) method was applied to calculate the QS and AQL of each QI. The limits of variability were established from mean and confidence intervals at 95% and 99.8%. RESULTS: The most relevant QIs and its AQLs were postoperative mortality (2%, < 4.5%), overall postoperative morbidity (33%, < 41%), liver failure (5%, < 8%), postoperative hemorrhage (1%, < 3%), biliary fistula (6%, < 10%), reoperation (3%, < 6%), R1 resection margins (18%, < 25%), and overall survival at 12 and 60 months (84%, > 77%; and 34%, > 25%, respectively). CONCLUSIONS: Despite its limitations, the present study constitutes the most extensive scientific evidence to date on QI and AQL in CRLMS and may constitute a reference in future studies.

Tumor fibroso quístico calcificante. Una extraña forma de carcinomatosis peritoneal benigna / No disponible

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Estudio de casos y controles entre anastomosis intra y extracorpórea en pacientes intervenidos de hemicolectomía derecha laparoscópica / A case-control study of extracorporeal versus intracorporeal anastomosis in patients subjected to right laparoscopic hemicolectomy

IntroducciónEn la actualidad no existe suficiente evidencia científica sobre cuál es la mejor técnica para realizar la anastomosis -intracorpórea (IC) o extracorpórea (EC)- en la hemicolectomía derecha laparoscópica. El objetivo del presente estudio es determinar si existen diferencias al comparar ambas técnicas.Material y métodosSe realiza un estudio sobre una serie prospectiva de pacientes intervenidos en nuestro Centro mediante hemicolectomía derecha laparoscópica. Se comparan las variables preoperatorias, intraoperatorias y relacionadas con complicaciones recogidas en función del tipo de anastomosis.ResultadosDesde junio de 2004 hasta junio de 2010 se intervinieron 60 pacientes (35 IC; 25 EC). No existieron diferencias significativas entre ambos grupos en cuanto a características basales preoperatorias ni comorbilidades asociadas. La mediana de tiempo operatorio fue de 212 minutos (142-305min), sin diferencias significativas entre ambas técnicas. El número de ganglios extraídos resultó mayor en el grupo IC (21 versus 14; p=0,03). Tanto el inicio de la tolerancia oral como la primera deposición resultaron significativamente más precoces en el grupo IC. La tasa de complicaciones postoperatorias fue similar para ambos grupos (14% IC; 16% EC; p=0,89). Tres pacientes presentaron dehiscencia de anastomosis en las IC. La tasa de mortalidad fue del 2,8% (un paciente en cada grupo).ConclusiónLa anastomosis intracorpórea frente a la extracorpórea en la hemicolectomía derecha laparoscópica permite obtener un mayor número de ganglios resecados y un inicio más precoz de la tolerancia oral y del tránsito intestinal (AU)

IntroductionThere is still insufficient scientific evidence on which is the best technique to perform the anastomosis -intracorporeal (IC) or extracorporeal (EC)- in right laparoscopic hemicolectomy. The objective of the present study is to determine whether there are differences to compare in both techniques.Material and methodsA study was performed on a prospective patient series subjected to right laparoscopic hemicolectomy in our Hospital. The preoperative and the postoperative variables associated with complications recorded depending on the type of anastomosis.ResultsA total of 60 patients were intervened form June 2004 to June 2010 (35 IC; 25 EC). There were no significant differences between both groups as regards baseline preoperative characteristics or associated comorbidities. The median operation time was 212minutes (142-305min), with no significant difference between both techniques. The number of lymph nodes removed was higher in the IC group (21 versus 14; p=0.03). The beginning of oral tolerance and the first bowel movement were significantly earlier in the IC group. The complications rate was similar for both groups (14% IC; 16% EC; p=0.89). Three patients in the IC group had anastomosis dehiscence. The mortality rate was 2.8% (one patient in each group).ConclusionIntracorporeal versus extracorporeal anastomosis in right laparoscopic hemicolectomy can obtain a higher number of resected lymph nodes and an earlier oral tolerance and intestinal transit (AU)