[Transanal drainage tube for prevention of anastomotic leak after anterior resection for rectal cancer: a meta-analysis].

Objective: To assess the effectiveness of transanal drainage tube (TDT) in reducing the incidence of anastomotic leak following anterior resection in patients with rectal cancer. Methods: We conducted a systematic search for relevant studies published from inception to October 2022 across multiple databases, including PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, and VIP. Meta-analysis was performed using Review Manager 5.4 software. The primary outcomes included total incidence of anastomotic leak, grade B and C anastomotic leak rates, reoperation rate, anastomotic bleeding rate, and overall complication rate. Results: Three randomized controlled trials involving 1115 patients (559 patients in the TDT group and 556 in the non-TDT group) were included. Meta-analysis showed that the total incidences of anastomotic leak and of grade B anastomotic leak were 5.5% (31/559) and 4.5% (25/559), respectively, in the TDT group and 7.9% (44/556) and 3.8% (21/556), respectively, in the non-TDT group. These differences are not statistically significant (P=0.120, P=0.560, respectively). Compared with the non-TDT group, the TDT group had a lower incidence of grade C anastomotic leak (1.6% [7/559] vs. 4.5% [25/556]) and reoperation rate (0.9% [5/559] vs. 4.3% [24/556]), but a higher incidence of anastomotic bleeding (8.2% [23/279] vs. 3.6% [10/276]). These differences were statistically significant (P=0.003, P=0.001, P=0.030, respectively). The overall complication rate was 26.5%(74/279) in the TDT group and 27.2% (75/276) in the non-TDT group. These differences are not statistically significant (P=0.860). Conclusions: TDT did not significantly reduce the total incidence of anastomotic leak but may have potential clinical benefits in preventing grade C anastomotic leak. Notably, placement of TDT may increase the anastomotic bleeding rate.

Correlation between the BRAF V600E mutation status and the clinicopathologic features of papillary thyroid carcinoma.

This study sought to investigate the correlations of V-raf murine sarcoma viral oncogene homolog B1 (BRAF) gene mutations with the clinicopathologic features of papillary thyroid carcinoma and central lymph node metastasis. We retrospectively analyzed the 2-year medical records of patients who underwent surgery for papillary thyroid carcinoma. After screening, the records of 126 patients who met the study requirements were used to assess the characteristics associated with the BRAF V600E gene mutation. The BRAF mutation incidence rate among patients with papillary thyroid carcinoma was 69.0% (87/126). Univariate analysis revealed that the BRAF mutation status was correlated significantly with both tumor size and lymph node metastasis (P < 0.05). Multivariate analysis revealed a significant correlation between lymph node metastasis and BRAF mutation status (P < 0.05). When the tumor diameter was ≤10 mm, the BRAF mutation status had no effect on lymph node metastasis (P > 0.05). When the tumor diameter was >10 mm, the incidence of lymph node metastasis was significantly higher among BRAF mutation-positive patients than among BRAF mutation-negative patients (P < 0.05). BRAF gene mutations independently predicted central lymph node metastasis in patients with papillary thyroid carcinoma. For patients preoperatively diagnosed to be BRAF mutation-positive, the importance of central lymph node dissection should be emphasized because the tumor diameter increases; regional lymphatic and adipose tissue dissection should be routinely conducted. However, in mutation-negative patients with tumor diameters of ≤5 mm, the need for central lymph node dissection should be re-examined.