Effect of ω-3 fatty acids on complications in patients undergoing hepatectomy: A meta-analysis

doi:10.3877/cma.j.issn.1674-0785.2017.22.005

Abstract

Abstract:

Objective

To compare postoperative outcomes between patients undergoing hepatectomy who received perioperative ω-3 fatty acids and those who did not.

Methods

PubMed, Embase, and Cochrane Central Register of Controlled Trials database were searched to retrieve all of the randomized controlled trials (RCTs) evaluating the value of perioperative ω-3 fatty acids in patients undergoing hepatectomy until the end of September 2016. Data extraction and quality assessment of RCTs were performed in accordance with PRISMA guidelines. The quality of evidence for each postoperative outcome was assessed using the GRADEpro analysis. A random-effects model was used to conduct this meta-analysis with RevMan 5.3.5 software.

Results

Six RCTs were identified. ω-3 fatty acids significantly reduced the incidence of overall postoperative complications (Risk ratio [RR]=0.60, 95% confidence interval [CI]: 0.46-0.76, Z=4.11, P<0.001) and infectious complications (RR=0.49, 95%CI: 0.33~0.73, Z=3.54, P<0.001), and shortened the length of hospital stay (standardized mean difference=-0.49, 95%CI: ?0.81-?0.16, Z=2.89, P=0.004). There was no significant between-group difference in postoperative mortality (RR=0.46, 95%CI: 0.16-1.31, Z=1.45, P=0.15).

Conclusion

ω-3 fatty acids are potentially beneficial in reducing overall and infectious postoperative complications and in shortening the hospital stay for patients undergoing hepatectomy.

Key words: Hepatectomy, ω-3 fatty acids, Randomized controlled trials, Meta-analysis

Yanli Na, Chengshuo Zhang, Baomin Chen, Feng Li, Ao Jiao, Ning Sun, Jialin Zhang. Effect of ω-3 fatty acids on complications in patients undergoing hepatectomy: A meta-analysis[J]. Chinese Journal of Clinicians(Electronic Edition), 2017, 11(22): 2407-2413.

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Figures/Tables 8

References 13

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作者[序]	年份	国家	干预时机	干预时间（d）	干预途径	例数（例）		失访（例）
作者[序]	年份	国家	干预时机	干预时间（d）	干预途径	IM	Con	IM	Con
Gong et al^[5]	2016	中国	术后	5	PN/CVC	59	60	0	0
Zhang et al^[6]	2016	中国	术后	5	PN/CVC	160	160	3	5
Cockbain et al^[7]	2014	英国	术前	12~65	EN/Oral	43	45	7	10
Wu et al^[8]	2012	中国	术后	5~7	PN/CVC	31	32	0	0
Wang et al^[9]	2011	中国	术后	6	PN	41	41	0	0
Lai et al^[10]	2012	中国	术后	5	PN	40	40	8	6
作者[序]	年龄（±s，岁）		性别（男/女，例）		BMI（±s，kg/m²）		手术时间（±s，min）
作者[序]	IM	Con	IM	Con	IM	Con	IM	Con
Gong et al^[5]	51.37±11.75	49.63±11.21	44/15	46/14	R^b	R^b	267.9±112.0	289.4±147.5
Zhang et al^[6]	47.59±11.69	49.62±11.85	115/42	112/43	63.14±8.51^c	63.52±10.39^c	271.92±112.07	282.04±89.28
Cockbain et al^[7]	68（44-82）^a	71（35-87）^a	26/17	35/10	-	-	-	-
Wu et al^[8]	52.00±7.90	52.16±8.31	25/6	25/7	22.47±1.80	22.64±1.63	214.2±58.8	218.4±55.8
Wang et al^[9]	51.93±10.18	55.83±8.11	26/15	29/12	-	-	-	-
Lai et al^[10]	50.3±10.2	53.0±15.6	34/6	32/8	20.8±2.60	21.3±2.60	164±39	171±42
作者[序]	术中失血量（±s，ml）		肝门阻断时间（±s，min）		原发疾病情况
作者[序]	IM	Con	IM	Con	原发疾病情况
Gong et al^[5]	423.3±395.8	451.4±243.3	18.6±12.0	16.7±9.2	原发性肝癌，转移性肝癌，良性肝肿瘤
Zhang et al^[6]	2.74±0.42^d	2.73±0.42^d	1.14±0.24^d	1.20±0.22^d	肝细胞癌，胆管细胞癌，结肠癌肝转移
Cockbain et al^[7]	-	-	-	-	结肠癌肝转移
Wu et al^[8]	344±146	341±137	11.52±4.86	11.56±4.09	肝细胞癌
Wang et al^[9]	-	-	-	-	-
Lai et al^[10]	293±157	312±162	18.2±10.7	17.1±6.7	肝细胞癌

作者[序]	年份	国家	干预时机	干预时间（d）	干预途径	例数（例）		失访（例）
作者[序]	年份	国家	干预时机	干预时间（d）	干预途径	IM	Con	IM	Con
Gong et al^[5]	2016	中国	术后	5	PN/CVC	59	60	0	0
Zhang et al^[6]	2016	中国	术后	5	PN/CVC	160	160	3	5
Cockbain et al^[7]	2014	英国	术前	12~65	EN/Oral	43	45	7	10
Wu et al^[8]	2012	中国	术后	5~7	PN/CVC	31	32	0	0
Wang et al^[9]	2011	中国	术后	6	PN	41	41	0	0
Lai et al^[10]	2012	中国	术后	5	PN	40	40	8	6
作者[序]	年龄（±s，岁）		性别（男/女，例）		BMI（±s，kg/m²）		手术时间（±s，min）
作者[序]	IM	Con	IM	Con	IM	Con	IM	Con
Gong et al^[5]	51.37±11.75	49.63±11.21	44/15	46/14	R^b	R^b	267.9±112.0	289.4±147.5
Zhang et al^[6]	47.59±11.69	49.62±11.85	115/42	112/43	63.14±8.51^c	63.52±10.39^c	271.92±112.07	282.04±89.28
Cockbain et al^[7]	68（44-82）^a	71（35-87）^a	26/17	35/10	-	-	-	-
Wu et al^[8]	52.00±7.90	52.16±8.31	25/6	25/7	22.47±1.80	22.64±1.63	214.2±58.8	218.4±55.8
Wang et al^[9]	51.93±10.18	55.83±8.11	26/15	29/12	-	-	-	-
Lai et al^[10]	50.3±10.2	53.0±15.6	34/6	32/8	20.8±2.60	21.3±2.60	164±39	171±42
作者[序]	术中失血量（±s，ml）		肝门阻断时间（±s，min）		原发疾病情况
作者[序]	IM	Con	IM	Con	原发疾病情况
Gong et al^[5]	423.3±395.8	451.4±243.3	18.6±12.0	16.7±9.2	原发性肝癌，转移性肝癌，良性肝肿瘤
Zhang et al^[6]	2.74±0.42^d	2.73±0.42^d	1.14±0.24^d	1.20±0.22^d	肝细胞癌，胆管细胞癌，结肠癌肝转移
Cockbain et al^[7]	-	-	-	-	结肠癌肝转移
Wu et al^[8]	344±146	341±137	11.52±4.86	11.56±4.09	肝细胞癌
Wang et al^[9]	-	-	-	-	-
Lai et al^[10]	293±157	312±162	18.2±10.7	17.1±6.7	肝细胞癌

结局指标	质量评价					结果摘要
	偏倚风险	不一致性	间接性	不精确性	发表偏倚	样本量		效应量（95%可信区间）	证据质量
	偏倚风险	不一致性	间接性	不精确性	发表偏倚	ω-3脂肪酸组	对照组（平均值，中位数）	效应量（95%可信区间）	证据质量
术后总并发症	严重^a	无	无	无	无	66/259（25.5%）	111/260（42.7%），43.3%	风险比0.6（0.46~0.76）	????中
术后感染并发症	严重^a	无	无	无	无	30/290（10.3%）	62/292（21.2%），22.7%	风险比0.49（0.33~0.73）	????中
住院时间	严重^a,b	无	无	无	无	331	333	均数差-0.49（-0.81~-0.16）	????中
术后病死率	严重^a,b	无	无	无	无	4/333（1.2%）	11/337（3.3%），2.2%	风险比0.46（0.16~1.31）	????中

结局指标	质量评价					结果摘要
	偏倚风险	不一致性	间接性	不精确性	发表偏倚	样本量		效应量（95%可信区间）	证据质量
	偏倚风险	不一致性	间接性	不精确性	发表偏倚	ω-3脂肪酸组	对照组（平均值，中位数）	效应量（95%可信区间）	证据质量
术后总并发症	严重^a	无	无	无	无	66/259（25.5%）	111/260（42.7%），43.3%	风险比0.6（0.46~0.76）	????中
术后感染并发症	严重^a	无	无	无	无	30/290（10.3%）	62/292（21.2%），22.7%	风险比0.49（0.33~0.73）	????中
住院时间	严重^a,b	无	无	无	无	331	333	均数差-0.49（-0.81~-0.16）	????中
术后病死率	严重^a,b	无	无	无	无	4/333（1.2%）	11/337（3.3%），2.2%	风险比0.46（0.16~1.31）	????中

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