Blood salvage and autotransfusion during orthotopic liver transplantation for hepatocellular carcinoma: A systematic review and meta-analysis.

BACKGROUND: Hepatocellular carcinoma (HCC) is a significant cause of oncologic mortality worldwide. Liver transplantation represents a curative option for patients with significant liver dysfunction and absence of metastases. However, this therapeutic option is associated with significant blood loss and frequently requires various transfusions and intraoperative blood salvage for autotransfusion (IBS-AT) with or without a leukocyte reduction filter. This study aimed to analyze available evidence on long-term oncologic outcomes of patients undergoing liver transplantation for HCC with and without IBS-AT. METHODS: Per PRISMA guidelines, a systematic review of keywords "Blood Salvage," "Auto-transfusion," "Hepatocellular carcinoma," and "Liver-transplant" was conducted in PubMed, EMBASE, and SCOPUS. Studies comparing operative and postoperative outcomes were screened and analyzed for review. RESULTS: Twelve studies totaling 1704 participants were included for analysis. Length of stay, recurrence rates, and overall survival were not different between IBS-AT group and non IBS-AT group. CONCLUSION: IBS-AT use is not associated with increased risk of recurrence in liver transplant for HCC even without leukocyte filtration. Both operative and postoperative outcomes are similar between groups. Comparison of analyzed studies suggest that IBS-AT is safe for use during liver transplant for HCC.

A Network Meta-Analysis on the Surgical Management of Thoracolumbar Burst Fractures: Anterior, Posterior, and Combined.

Background: Thoracolumbar burst fractures (BFs) are traumatic lesions instigated by compression forces. Canal compression and compromise may lead to neurological deficits. Optimal surgical management is yet to be fully defined since various approaches such as anterior, posterior, or combined exist. This study aims to determine the operative performance of these three treatment modalities. Methods: In accordance with the PRISMA guidelines, a systematic review was performed, identifying studies comparing anterior, posterior, and/or combined surgical approaches in patients with thoracolumbar BFs. To analyze available evidence, a Bayesian network meta-analysis framework was utilized. Results: In this study, 16 studies were included. The shortest operative times and lowest operative blood losses were found for a posterior approach. The length of stay (LoS) was shorter with the posterior approach compared with the other two modalities. Return to work, postoperative kyphotic angle (PKA), and complications all favored the posterior approach. The visual analog scale score was similar between groups. Conclusions: This study suggests that the posterior approach has significant advantages in terms of operative time, blood loss, LoS, PKA, return to work, and complication rates when compared to the other approaches. Treatment should remain an individualized process, and before choosing an approach, factors such as patient characteristics, surgeon experience, and hospital settings should be considered.

Intraoperative and postoperative impact of pretransplantation transjugular intrahepatic portosystemic shunts in orthotopic liver transplantations: A systematic review and meta-analysis.

Objectives: Orthotopic liver transplantation (OLT) remains the definitive treatment for patients afflicted with end-stage liver disease (ESLD). Transjugular intrahepatic portosystemic shunts (TIPS) have been adapted as a bridge to transplantation, allowing partial normalization of portal pressure and associated symptom improvement. Conflicting evidence exists on TIPS' impact on operative procedures. This study aimed to analyze available evidence on patients who underwent OLT with prior TIPS compared to OLT alone with the intent to determine TIPS' impact on surgical outcomes. Material and Methods: Following PRISMA guidelines, a systematic review was conducted, identifying studies comparing TIPS + OLT versus OLT alone in patients with ESLD. Data were analyzed using Review Manager 5.3. Results: Thirteen studies were included. Operative time, packed red blood cells transfusions, intensive care unit admission, length of stay, dialysis, serum creatinine levels, ascites, vascular complications, bleeding revisions, reintervention, and other complications rates were similar between both groups. Fresh frozen plasma transfusion -2.88 units (-5.42, -0.35; p= 0.03), was lower in the TIPS + OLT group. Conclusion: Our study found TIPS can be safely employed without having detrimental impacts on OLT outcomes, furthermore, these findings also suggest TIPS does not increase bleeding or complications.

Thoracolumbar Burst Fractures: A Systematic Review and Meta-Analysis on the Anterior and Posterior Approaches.

Background: A thoracolumbar burst fracture (BF) is a severe type of compression fracture, which is the most common type of traumatic spine fractures. Generally, surgery is the preferred treatment, but whether the optimal approach is either an anterior or a posterior approach remains unclear. This study aims to determine whether either method provides an advantage. Methods: Following PRISMA guidelines, a systematic review was conducted, identifying studies comparing anterior versus posterior surgical approaches in patients with thoracolumbar BFs. Data were analyzed using Review Manager 5.3. Seven studies were included. Results: An operative time of 87.97 min (53.91, 122.03; p<0.0001) and blood loss of 497.04 mL (281.8, 712.28; p<0.0001) were lower in the posterior approach. Length of hospital stay, complications, reintervention rate, neurological outcomes, postoperative kyphotic angle, and costs were similar between both groups. Conclusions: Surgical intervention is usually selected to rehabilitate patients with BFs. The data obtained from this study suggest that a posterior approach represents a viable alternative to an anterior approach, with various advantages such as a shorter operative time and decreased bleeding.

Minimally Invasive versus Open Surgery for Spinal Metastasis: A Systematic Review and Meta-Analysis.

Bones are the third most common location for solid tumor metastasis affecting up to 10% of patients with solid tumors. When the spine is involved, thoracic and lumbar vertebrae are frequently affected. Access to spinal lesions can be through minimally invasive surgery (MIS) or traditional open surgery (OS). This study aims to determine which method provides an advantage. Following the PRISMA (Preferred Inventory for Systematic Reviews and Meta-Analysis) guidelines, a systematic review was conducted to identify studies that compare MIS with OS in patients with spinal metastatic disease. Data were analyzed using Review Manager ver. 5.3 (RevMan; Cochrane, London, UK). Ten studies were included. Operative time was similar among groups at -35.23 minutes (95% confidence interval [CI], -73.36 to 2.91 minutes; p=0.07). Intraoperative bleeding was lower in MIS at -562.59 mL (95% CI, -776.97 to -348.20 mL; p<0.00001). OS procedures had higher odds of requiring blood transfusions at 0.26 (95% CI, 0.15 to 0.45; p<0.00001). Both approaches instrumented similar numbers of levels at -0.05 levels (95% CI, -0.75 to 0.66 levels; p=0.89). We observed a decreased need for postoperative bed rest at -1.60 days (95% CI, -2.46 to -0.74 days; p=0.0003), a shorter length of stay at -3.08 days (95% CI, -4.50 to -1.66 days; p=0.001), and decreased odds of complications at 0.60 (95% CI, 0.37 to 0.96; p=0.03) in the MIS group. Both approaches revealed similar reintervention rates at 0.65 (95% CI, 0.15 to 2.84; p=0.57), effective rates of reducing metastasis-related pain at -0.74 (95% CI, -2.41 to 0.94; p=0.39), and comparable scores of the Tokuhashi scale at -0.52 (95% CI, -2.08 to 1.05; p=0.41), Frankel scale at 1.00 (95% CI, 0.60 to 1.68; p=1.0), and American Spinal Injury Association Scale at 0.53 (95% CI, 0.21 to 1.37; p=0.19). MIS appears to provide advantages over OS. Larger and prospective studies should fully detail the role of MIS as a treatment for spine metastasis.

Endovascular Treatment of Transplant Renal Artery Stenosis: A Systematic Review and Meta-analysis.

OBJECTIVE: Endovascular treatment through either percutaneous transluminal angioplasty (PTA) alone or stenting has been previously used as a treatment for transplant renal artery stenosis (TRAS). This review aimed to investigate the results of endovascular treatment for renal artery stenosis in transplanted kidneys as compared with the outcomes of interventions, medical management, and graft survival in non-TRAS patients. METHODS: A systematic review of PubMed, Google Scholar, Cochrane, and Scopus was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in which studies that reported outcomes of the treatment of TRAS via the endoluminal approach were identified, and their results were meta-analyzed. RESULTS: Fifty-four studies with a total of 1522 patients were included. A significant reduction of serum creatinine level was found, favoring the stenting group, with a mean difference of 0.68 mg/dL (95% confidence interval (CI), 0.17-1.19; Z=2.60, p=0.0009). Comparison of pre- and post-intervention values of any intervention revealed a significant decrease in overall serum creatinine level (0.65 mg/dL; 95% CI, 0.40-0.90; Z=5.09, p=0.00001), overall blood pressure, with a mean difference of 11.12 mmHg (95% CI, 7.29-14.95; Z=5.59, p=0.00001), mean difference in the use of medications (0.77; 95% CI, 0.29-1.24; p=0.002), and peak systolic velocity (190.05; 95% CI, 128.41-251.69; p<0.00001). The comparison of serum creatinine level between endovascular interventions and best medical therapy favored endovascular intervention, with a mean difference of 0.23 mg/dL (95% CI, 0.14-0.32; Z=5.07, p<0.00001). Graft survival was similar between the treated patients and those without TRAS (hazard ratio, 0.98; 95% CI, 0.75-1.28; p=0.091). The overall pooled success rate was 89%, and the overall complication rate was 10.4%, with the most prevalent complication being arterial dissection. CONCLUSION: The endovascular treatment of TRAS improves graft preservation and renal function and hemodynamic parameters. PTA + stenting appears to be a more effective option to PTA alone in the stabilization of renal function, with additional benefits from decreased restenosis rates. Further high-quality studies could expand on these findings.