Laparoscopic and open liver resection : a literature review with meta-analysis

Introduction: In recent years laparoscopic approach to liver resections has gained important attention from surgeons worldwide. The aim of this review was to compare the results of laparoscopic and open liver resections. Material and methods: We have performed a search in Medline, Embase and the Cochrane Library databases. Studies comparing laparoscopic and open liver resections were included. Results: No randomized clinical trial were identified. In the 16 observational studies included in the analysis there were 927 laparoscopic and 1049 open liver resections. The laparoscopy group had lower blood loss (MD = 244.93 ml, p < 0.00001), lower odds of transfusion (OR = 0.35, p = 0.0002), lower odds of positive margins on pathology report (OR = 0.22, p < 0.00001), lower odds of readmission (OR = 0.36, p = 0.04), lower odds of pulmonary (OR = 0.38, p = 0.003) and cardiac complications (OR = 0.30, p = 0.02) and lower odds of postoperative liver failure (OR = 0.24, p = 0.001), but in many cases the results were based on a low number of events reported in included studies. Conclusions: Laparoscopic resection of liver yields complications rates comparable to open resection, but the results are based on low quality evidence from nonrandomised studies

Mortality in patients after acute myocardial infarction managed by cardiologists and primary care physicians : a systematic review

Introduction Mortality following acute myocardial infarction (AMI) remains high despite of progress in invasive and noninvasive treatments. Objectives This study aimed to compare the outcomes of ambulatory treatment provided by cardiologists versus general practitioners (GPs) in post‑AMI patients. Patients and methods We conducted a systematic search in 3 electronic databases for interventional and observational studies that reported all‑cause mortality, mortality from cardiovascular causes, stroke, and myocardial infarction at long‑term follow‑up following AMI. We assessed the risk of bias of the included studies using the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS‑I) tool. For randomized trials, we used the revised Cochrane risk of bias tool (RoB 2.0). Results Two nonrandomized studies fulfilled the inclusion criteria. We assessed these studies as having a moderate risk of bias. We did not pool the results owing to significant heterogeneity between the studies. Patients consulted by both a cardiologist and a GP were at lower risk of all‑cause death as compared with patients consulted by a cardiologist only (risk ratio [RR], 0.92; 95% CI, 0.85–0.99). Patients consulted by a cardiologist with or without GP consultation were at lower risk of all‑cause death compared with those consulted by a GP only in both studies (RR, 0.8; 95% CI, 0.75–0.85 and RR, 0.44; 95% CI, 0.41–0.47). Conclusions Patients after AMI consulted by both a cardiologist and a GP may beat lower risk of death compared with patients consulted by a GP or a cardiologist only. However, these findings are based on moderate‑quality nonrandomized studies. We found no evidence on the relation between the specialization of the physician and the risk of cardiovascular death, stroke, or myocardial infarction in AMI survivors