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Lymphadenectomy for primary ovarian cancer: a systematic review and meta-analysis
Tatsuyuki Chiyoda,Manabu Sakurai,Toyomi Satoh,Satoru Nagase,Mikio Mikami,Hidetaka Katabuchi,Daisuke Aoki 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.5
Objective: To assess the effectiveness of lymphadenectomy at primary debulking surgery(PDS) on the survival of patients with epithelial ovarian cancer (EOC). Methods: We searched PubMed, Ichushi, and the Cochrane Library. Randomized controlledtrials (RCTs) and retrospective cohort studies comparing survival of women with EOCundergoing lymphadenectomy at PDS with that of women without lymphadenectomy wereincluded. We performed a meta-analysis of overall survival (OS), progression-free survival(PFS), and adverse events. Results: For advanced-stage EOC, 2 RCTs including 1,074 women and 7 cohort studiescomprising 3,161 women were evaluated. Meta-analysis revealed that lymphadenectomy wasassociated with improved OS (hazard ratio [HR]=0.80; 95% confidence interval [CI]=0.70–0.90). However, meta-analysis of 2 RCTs revealed no significant difference in OS betweenthe lymphadenectomy and no-lymphadenectomy groups (OS: HR=1.02; 95% CI=0.85–1.22). For early-stage EOC, 1 RCT comprising 268 women and 4 cohort studies comprising 14,228women were evaluated. Meta-analysis showed that lymphadenectomy was associatedwith improved OS (HR=0.75; 95% CI=0.68–0.82). A RCT of early-stage EOC reported thatlymphadenectomy was not associated with improved OS (HR=0.85; 95% CI=0.49–1.47). Surgery-related deaths were similar in both groups (risk ratio [RR]=1.00; 95% CI=0.99–1.01);however, blood transfusion was required less frequently in the no-lymphadenectomy group(RR=0.74; 95% CI=0.63–0.86). Conclusions: Meta-analysis of RCTs and observational studies suggest thatlymphadenectomy was associated with improved OS in advanced- and early-stage EOC. However, results from RCTs demonstrate that lymphadenectomy was not associated withimproved OS in advanced- and early-stage EOC.
( Goki Kamei ),( Shigeki Ishibashi ),( Koki Yoshioka ),( Satoru Sakurai ),( Hiroyuki Inoue ),( Yu Mochizuki ),( Masakazu Ishikawa ),( Nobuo Adachi ) 대한슬관절학회 2022 대한슬관절학회지 Vol.34 No.-
Purpose: A distal femoral trial component was manufactured, and flexion gap size and inclination were evaluated with or without the distal femoral trial component in total knee arthroplasty (TKA). This study aimed to evaluate the effect of the distal femoral trial component on flexion gap size and joint inclination in posterior-stabilized (PS)-TKA. Materials and methods: A total of 84 patients with medial osteoarthritis who underwent mobile-bearing PSTKA using modified gap techniques were included in this retrospective study. The flexion gap size and inclination before and after setting the distal femoral trial component were evaluated and compared with the final gap size and inclination. Results: The joint gap size and inclination were significantly lower in those with than in those without the distal femoral trial component (P = 0.005, P < 0.001). The final gap size and inclination were similar to the gap size and inclination with the distal trial component (P = 0.468, P = 0.158). Conclusions: The joint gap size and medial tension in PS-TKA were significantly reduced after setting the distal femoral trial component. The flexion gap measured using the distal femoral trial component was similar to that when the final trial component was set. To more accurately perform the gap technique TKA, the flexion gap should be measured using the distal femoral trial component.