Several other RCTs are now available, along with numerous meta-analyses to further evaluate the literature on pathologic outcomes with robotic compared to laparoscopic rectal cancer resections, which are discussed in this review. To date, the largest RCT available to compare laparoscopic and robotic rectal resections is the ROLARR trial. Examining the pathologic outcomes is important to ensure appropriate care is provided when introducing new technologies. Surgical innovation continues to play a vital role in the multimodal treatment of rectal cancer. Although this technology has gained widespread popularity, it is not without its own set of challenges, including higher cost, longer operative time, and loss of tactile sensation. The theoretical technical advantages of robotic TME include a stable camera platform, three-dimensional view, and better articulation of the surgical instruments. Robotic TME was introduced to overcome some of these challenges. Performing a laparoscopic TME is not without its challenges, especially in a deep narrow pelvis with the two-dimensional view and limited dexterity. Since that time, laparoscopic TME was introduced and has now become standard of care after several large randomized controlled trials (RCTs) assessed oncologic outcomes and early postoperative recovery. This landmark discovery changed the trajectory of rectal cancer resections and greatly improved patient outcomes by reducing pelvic recurrences. During this time, surgical innovations continued to revolutionize treatment and improve patient outcomes, most notably the introduction of total mesorectal excision (TME) by Heald et al.
© Copyright 2010 Physicians Postgraduate Press, Inc.The treatment of rectal cancer has evolved during the last several decades into a multidisciplinary model of care. Data presented may be helpful for a more accurate treatment selection in patients at risk of obesity or related medical illness. However, the effect of each antidepressant may vary greatly depending on an individual's characteristics and generally became more evident in the long term to a variable degree across compounds.ĭespite the fact that some analyses were done on only a few studies due to the difficulty of finding reliable information in literature, to our knowledge, this is the first comprehensive meta-analysis to allow comparison of different antidepressants as regards their impact on body weight. Other compounds have no transient or negligible effect on body weight in the short term. In contrast, some weight loss occurs with fluoxetine and bupropion, although the effect of fluoxetine appears to be limited to the acute phase of treatment. Quantitative results evidenced that amitriptyline, mirtazapine, and paroxetine were associated with a greater risk of weight gain. Methodological quality of studies, heterogeneity, publication bias, and effect of treatment duration were systematically controlled. Non-placebo-controlled studies were compared to a virtual placebo sample, whose mean and standard deviation were derived by the weighted mean of means and standard deviations of all placebo samples. Missing means and standard deviations were directly calculated by using information available in the article when possible.
Weight change mean and standard deviation and size of each group were recorded. Finally, 116 studies were included in the analysis. Studies reporting body weight changes during treatment with different antidepressants were selected for eligibility. We used the following keywords: antidepressant, psychotropic drugs, body weight, weight gain, obesity, overweight, adverse event, side effects, SSRIs, tricyclic antidepressants, and the name of each antidepressant active compound together with body weight or other keywords. We performed a literature search using the MEDLINE, ISI Web of Knowledge, and Cochrane research databases for all publications available to January 2009. There is evidence that antidepressant drugs may induce a variable amount of weight gain, but results are sparse and often contradictory. Psychotropic drugs often induce weight gain, leading to discomfort and discontinuation of treatment and, more importantly, increasing the risk of obesity-related illnesses such as diabetes mellitus, hypertension, and coronary heart disease.
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