Copyright ©2013 Baishideng Publishing Group Co.
World J Gastroenterol. Apr 7, 2013; 19(13): 2104-2109
Published online Apr 7, 2013. doi: 10.3748/wjg.v19.i13.2104
Table 1 Primary characteristics of the randomized controlled trails included in the meta-analysis
Ref.CountrySample sizeMaleMedian age (yr)Body mass index (kg/m2)Operation time (min)Blood loss (mL)Median follow-up time (d)
Schardey et al[7]Germany1026063.7 ± 11.4NM301.6 ± 87.7NM42
1035962.6 ± 11.9NM314.8 ± 107NM
P > 0.05P > 0.05NMP > 0.05NM
Farran et al[8]Spain223357(31-87)NMNMNM> 22
Imamura et al[9]Japan1791256522.5 (12.4-32.9)200 (64-415)210 (1-1700)30
1761156622.3 (16.3-33.0)209 (58-428)200 (1-880)
P = 0.536P = 0.429P = 0.190P = 0.499P = 0.903
Mohri et al[10]Japan24317468 (22-91)21.6 (13.4-31.6)232 (43-70)338.0 (10-2811)30
24316468 (23-90)21.4 (13.6-34.0)234 (70-492)405.7 (10-2917)
P = 0.375P = 0.642P = 0.446P = 0.798P = 0.028
Table 2 Secondary characteristics of the randomized controlled trails included in the meta-analysis
Schardey et al[7]205 patients August 1991-March 1994 Germany, multi-centre, ≥ 18 yr, total gastrectomy102 vs 103Polymyxin B 0.1 g, tobramycin 0.08 g, vancomycin 0.125 g and amphotericin B 0.5 g four times per day orally from the day before operation until 7th postoperative day plus perioperative intravenous prophylaxis: cefotaxime 2 × 2 g vs placebo plus perioperative intravenous prophylaxis: cefotaxime 2 × 2 gInfections: Pulmonary, urinary tract; abscess; Insufficiency: Pancreatic, esophagointestinal; miscellaneous; pancreatic fistula
Farran et al[8]49 patients January 2000-March 2005, single centre, ≥ 18 yr, total gastrectomy22 vs 2720 mL oral suspension of erythromycin 0.5 g + gentamicine 0.08 g + nystatin sulfate 0.1 g vs 20 mL placebo solution. Both groups started treatment 12 h before surgery and continued until the 5th postoperative dayDehiscence; sepsis; abscess;pulmonary infection;pulmonary distress syndrome
Imamura et al[9]355 patients June 2005-December 2007, Japan, multi-centre, ≥ 35 yr, distal gastrectomy179 vs 176Intraoperative administration plus cefazolin 1 g once after closure and twice daily for 2 postoperative days vs intraoperative administration: cefazolin 1 g before surgical incision and every 3 h as intraoperative supplementsAnastomotic leakage; remote infections; surgical site infections
Mohri et al[10]486 patients May 2001-December 2004 Japan, single-centre, ≥ 20 yr, elective gastrectomy243 vs 243Intraoperative schedule: cefazolin 1 g or ampicillin-sulbactam 1.5 g by intravenous infusion > 15 min and an additional dose was administrated if operation > 3 h vs intraoperative schedule plus further treatment at 12-h intervals, a total of 7 dosesSurgical site infection: incision or organ or space; abscess
Table 3 Basic data of the comparisons included in the randomized controlled trails
Ref.Total complicationSurgical site infectionIncision infectionOrgan/space infectionRemote site infectionAnastomotic leakage/dehiscenceMortality
Schardey et al[7]31/102NMNMNM16/102NM5/102
Farran et al[8]2/22NMNMNM1/221/222/22
Imamura et al[9]22/17916/1795/17911/1796/1794/179NM
Mohri et al[10]NM23/24314/24312/243NMNMNM
Table 4 Quality assessment of the randomized controlled trails included based on the Cochrane Risk of Bias Tool
Ref.RandomizationAllocation concealmentBlindWithdrawal and dropoutPresence of selective reporting bias
Schardey et al[7]Without detailsEnvelopeDouble-blindWell reportedUnclear
Farran et al[8]Well reportedEnvelopeDouble-blindWell reportedNo
Imamura et al[9]Well reportedEnvelopeNoWell reportedNo
Mohri et al[10]Well reportedWithout detailsNoWell reportedUnclear
Table 5 Summary of comparisons between extended antimicrobial prophylaxis and intraoperative antimicrobial prophylaxis
Analysis modelOverall effect
RR (95%CI)Ref.
Total complications42%0.18Fixed0.990.320.86 (0.63-1.16)[7-9]
Surgical site infectionsNPNPFixed1.610.111.97 (0.86-4.48)[9]
Incision infectionsNPNPFixed1.460.144.92 (0.58-41.66)[9]
Organ/space infectionsNPNPFixed0.920.361.55 (0.61-3.89)[9]
Remote site infections0%0.90Fixed2.580.010.54 (0.34-0.86)[7-9]
Anastomotic leakage/dehiscence0%0.97Fixed1.470.143.85 (0.64-23.17)[8,9]
Mortality62%0.10Random0.100.921.14 (0.1-13.12)[8,9]