Datasheet1_Comparison of efficiency and safety of open surgery, hybrid surgery and endovascular repair for the treatment of thoracoabdominal aneurysms: a systemic review and network meta-analysis.pdf

ObjectiveThe objective of this study was to perform a network meta-analysis (NMA) to assess the efficacy and safety of three different surgical interventions- open surgical repair (OSR), hybrid surgical repair (HSR), and endovascular repair (EVAR)- for the treatment of thoracoabdominal aortic aneurysms (TAAAs).
MethodsElectronic repositories like PubMed, Embase, Web of Science, Scopus, ScienceDirect, the Cochrane library, Clinical trial, and China National Knowledge Infrastructure (CNKI) were systematically searched to identify studies that compared the efficacy of OSR, HSR, and EVAR with endografts for the treatment of TAAAs until December 24th, 2022. Random-effects and fixed-effects models were employed to analyze the data gathered in a network meta-analysis. The study's primary outcomes of interest encompassed in-hospital mortality, long-term survival rate, and postoperative complications.
ResultsEleven comparative studies meet inclusion criterias. There were 2,222 patients in OSR, 1,574 patients in EVAR and 537 patients in HSR. EVAR has lower one-month mortality than OSR (RR: 0.31; 95% CI: 0.17–0.70) and HSR (RR: 0.37; 95% CI: 0.22–0.71), and lower incident rate of renal complications than HSR (RR: 0.20; 95% CI: 0.08–0.43) and OSR (RR: 0.34; 95% CI: 0.16–0.65). Nonetheless, there was no noteworthy discrepancy identified in the long-term survival rates of these procedures.
ConclusionsAs compared with OSR, HSR, and EVAR, EVER has lower one-month mortality, and lower incident rates of complications.
Systematic review registrationPROSPERO (CRD42022313829).

研究目的：本研究旨在开展一项网络Meta分析（network meta-analysis, NMA），评估开放手术修复（open surgical repair, OSR）、杂交手术修复（hybrid surgical repair, HSR）以及血管内修复（endovascular repair, EVAR）三种不同手术干预方式治疗胸腹主动脉瘤（thoracoabdominal aortic aneurysms, TAAAs）的有效性与安全性。
研究方法：本研究系统性检索了PubMed、Embase、Web of Science、Scopus、ScienceDirect、Cochrane图书馆、Clinical trial以及中国知网（China National Knowledge Infrastructure, CNKI）等电子数据库，检索时限截至2022年12月24日，以筛选对比OSR、HSR、EVAR联合血管内移植物治疗胸腹主动脉瘤的相关研究。本研究采用随机效应模型与固定效应模型对网络Meta分析纳入的数据进行分析，预设的主要结局指标包括住院死亡率、长期生存率以及术后并发症发生率。
研究结果：共计11项对比研究符合纳入标准。其中OSR组纳入2222例患者，EVAR组1574例，HSR组537例。EVAR组的1个月死亡率低于OSR组（相对风险RR=0.31；95%置信区间CI：0.17~0.70）与HSR组（RR=0.37；95%CI：0.22~0.71），且肾脏并发症发生率低于HSR组（RR=0.20；95%CI：0.08~0.43）与OSR组（RR=0.34；95%CI：0.16~0.65）。不过，三种手术方式的长期生存率未发现显著差异。
研究结论：相较于OSR、HSR与EVAR，EVAR的1个月死亡率更低，并发症发生率也更低。
系统评价注册信息：PROSPERO（CRD42022313829）。