- Email: [email protected]
The devil hides in the details
International Journal of Surgery xxx (2016) 1
Contents lists available at ScienceDirect
International Journal of Surgery journal homepage: www.journal-surgery.net
Letter to the Editor
The devil hides in the details become apparent. Otherwise their conclusions on the value of ERAS protocols remain in doubt. Keywords: Gastric cancer Enhanced recovery programs
Dear Editor We read in your Journal the article of Beamish et al. [1] with much interest. Enhanced recovery programs in gastric cancer surgery seem a fascinating alternative in these times of financial constrain. Unfortunately, when we examined the secondary outcome measures of the meta-analysis, we noted a discrepancy between the included morbidity data and the actual ones. In their series Wang et al. [2] reported 7 cases (14.9%) of the conventional group with complications versus 9 cases (20%) of the fast track group. Beamish et al. performed their meta-analysis reversing the data i.e. 7 cases (14.9%) with complications in the ERP group versus 9 cases (20%) in the control group. This discrepancy can be detected in all the three relative tables of the paper (2.1.1, 2.1.2, 2.1.3), and questions the reliability of the authors' conclusion. The noninferiority of ERAS protocols as compared to conventional ones has been supported by others [3,4,5]. Beamish et al. [1] reported a statistically significant superiority of ERAS when they limited their analysis in six “high quality” studies including the series of Wang et al. [2]. We are not sure that this significance will still exist after the correction of the data. Consequently we believe that the authors should reanalyze their data, especially if superiority is to
References [1] A.J. Beamish, D.S. Chan, P.A. Blake, A. Karran, W.G. Lewis, Systematic review and meta-analysis of enhanced recovery programmes in gastric cancer surgery, Int. J. Surg. 19 (2015 Jul) 46e54, http://dx.doi.org/10.1016/j.ijsu.2015.05.021. Epub 2015 May 21. Review. PubMed PMID: 26004350. [2] D. Wang, Y. Kong, B. Zhong, X. Zhou, Y. Zhou, Fast-track surgery improves postoperative recovery in patients with gastric cancer: a randomized comparison with conventional postoperative care, J. Gastrointest. Surg. 14 (4) (2010 Apr) 620e627, http://dx.doi.org/10.1007/s11605-009-1139-5. Epub 2010 Jan 28. PubMed PMID: 20108171. [3] Y.J. Li, T.T. Huo, J. Xing, J.Z. An, Z.Y. Han, X.N. Liu, Q.C. Zhao, Meta-analysis of efficacy and safety of fast-track surgery in gastrectomy for gastric cancer, World J. Surg. 38 (12) (2014 Dec) 3142e3151, http://dx.doi.org/10.1007/s00268-0142690-0. Review. PubMed PMID: 25228170. [4] Z. Yu, C.L. Zhuang, X.Z. Ye, C.J. Zhang, Q.T. Dong, B.C. Chen, Fast-track surgery in gastrectomy for gastric cancer: a systematic review and meta-analysis, Langenbecks Arch. Surg. 399 (1) (2014 Jan) 85e92, http://dx.doi.org/10.1007/s00423013-1148-4. Epub 2013 Dec 15. Review. PubMed PMID: 24337792. [5] S. Chen, Z. Zou, F. Chen, Z. Huang, G. Li, A meta-analysis of fast track surgery for patients with gastric cancer undergoing gastrectomy, Ann. R. Coll. Surg. Engl. 97 (1) (2015 Jan) 3e10, http://dx.doi.org/10.1308/003588414X13946184903649. Review. PubMed PMID: 25519256.
Ioannis Karavokyros, Anastasios Angelou*, Emmanouil Pikoulis First Department of Surgery, “Laikon” General Hospital, University of Athens, Medical School, Athens, Greece * Corresponding author. E-mail address: [email protected] (A. Angelou).
8 March 2016 Available online xxx
http://dx.doi.org/10.1016/j.ijsu.2016.03.067 1743-9191/© 2016 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: I. Karavokyros, et al., The devil hides in the details, International Journal of Surgery (2016), http://dx.doi.org/ 10.1016/j.ijsu.2016.03.067
Contents lists available at ScienceDirect
International Journal of Surgery journal homepage: www.journal-surgery.net
Letter to the Editor
The devil hides in the details become apparent. Otherwise their conclusions on the value of ERAS protocols remain in doubt. Keywords: Gastric cancer Enhanced recovery programs
Dear Editor We read in your Journal the article of Beamish et al. [1] with much interest. Enhanced recovery programs in gastric cancer surgery seem a fascinating alternative in these times of financial constrain. Unfortunately, when we examined the secondary outcome measures of the meta-analysis, we noted a discrepancy between the included morbidity data and the actual ones. In their series Wang et al. [2] reported 7 cases (14.9%) of the conventional group with complications versus 9 cases (20%) of the fast track group. Beamish et al. performed their meta-analysis reversing the data i.e. 7 cases (14.9%) with complications in the ERP group versus 9 cases (20%) in the control group. This discrepancy can be detected in all the three relative tables of the paper (2.1.1, 2.1.2, 2.1.3), and questions the reliability of the authors' conclusion. The noninferiority of ERAS protocols as compared to conventional ones has been supported by others [3,4,5]. Beamish et al. [1] reported a statistically significant superiority of ERAS when they limited their analysis in six “high quality” studies including the series of Wang et al. [2]. We are not sure that this significance will still exist after the correction of the data. Consequently we believe that the authors should reanalyze their data, especially if superiority is to
References [1] A.J. Beamish, D.S. Chan, P.A. Blake, A. Karran, W.G. Lewis, Systematic review and meta-analysis of enhanced recovery programmes in gastric cancer surgery, Int. J. Surg. 19 (2015 Jul) 46e54, http://dx.doi.org/10.1016/j.ijsu.2015.05.021. Epub 2015 May 21. Review. PubMed PMID: 26004350. [2] D. Wang, Y. Kong, B. Zhong, X. Zhou, Y. Zhou, Fast-track surgery improves postoperative recovery in patients with gastric cancer: a randomized comparison with conventional postoperative care, J. Gastrointest. Surg. 14 (4) (2010 Apr) 620e627, http://dx.doi.org/10.1007/s11605-009-1139-5. Epub 2010 Jan 28. PubMed PMID: 20108171. [3] Y.J. Li, T.T. Huo, J. Xing, J.Z. An, Z.Y. Han, X.N. Liu, Q.C. Zhao, Meta-analysis of efficacy and safety of fast-track surgery in gastrectomy for gastric cancer, World J. Surg. 38 (12) (2014 Dec) 3142e3151, http://dx.doi.org/10.1007/s00268-0142690-0. Review. PubMed PMID: 25228170. [4] Z. Yu, C.L. Zhuang, X.Z. Ye, C.J. Zhang, Q.T. Dong, B.C. Chen, Fast-track surgery in gastrectomy for gastric cancer: a systematic review and meta-analysis, Langenbecks Arch. Surg. 399 (1) (2014 Jan) 85e92, http://dx.doi.org/10.1007/s00423013-1148-4. Epub 2013 Dec 15. Review. PubMed PMID: 24337792. [5] S. Chen, Z. Zou, F. Chen, Z. Huang, G. Li, A meta-analysis of fast track surgery for patients with gastric cancer undergoing gastrectomy, Ann. R. Coll. Surg. Engl. 97 (1) (2015 Jan) 3e10, http://dx.doi.org/10.1308/003588414X13946184903649. Review. PubMed PMID: 25519256.
Ioannis Karavokyros, Anastasios Angelou*, Emmanouil Pikoulis First Department of Surgery, “Laikon” General Hospital, University of Athens, Medical School, Athens, Greece * Corresponding author. E-mail address: [email protected] (A. Angelou).
8 March 2016 Available online xxx
http://dx.doi.org/10.1016/j.ijsu.2016.03.067 1743-9191/© 2016 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: I. Karavokyros, et al., The devil hides in the details, International Journal of Surgery (2016), http://dx.doi.org/ 10.1016/j.ijsu.2016.03.067