Table 2.
Summary of pooled results and overall quality of evidence.
| Outcomes | Relative effect (95% CI) | P-value | Studies | Patients | Heterogeneity | Publication bias |
Quality
of evidence |
|||
|---|---|---|---|---|---|---|---|---|---|---|
| χ2 | P-value | I2(%) | Begg | Egger | ||||||
| Nutritional outcomes 1 month | ||||||||||
| BMI (kg/m2) | WMD 0.70 (0.09, 1.30) | 0.02 | 3 | 252 | 3.29 | 0.193 | 39.1 | 1 | 0.88 | ++++, high |
| Albumin (g/dL) | WMD 0.05 (−0.03, 0.13) | 0.20 | 2 | 190 | 1.49 | 0.223 | 32.7 | 1 | 0.55 | ++++, high |
| Weight (kg) POD30–Preop | WMD 0.39 (−0.01, 0.79) | 0.06 | 2 | 112 | 2.02 | 0.156 | 50.4 | ++++, high | ||
| LBM (kg) POD30–Preop | WMD 0.76 (0.04, 1.48) | 0.04 | 2 | 101 | 0.20 | 0.652 | 0 | ++++, high | ||
| ASMI (kg/m2) POD30–Preop | WMD 0.30 (0.02, 0.58) | 0.03 | 2 | 101 | 2.03 | 0.154 | 50.8 | ++++, high | ||
| EORTC QLQ-C30 1 month | ||||||||||
| Physical function | WMD 5.90 (2.27, 9.53) | 0.001 | 3 | 250 | 7.42 | 0.025 | 73 | 1 | 0.46 | +++-a, moderate |
| Role function | WMD 10.32 (−6.08, 26.72) | 0.22 | 3 | 250 | 130.21 | <0.001 | 98.5 | 1 | 0.37 | ++-b, low |
| Social function | WMD 3.29 (−8.12, 14.69) | 0.57 | 3 | 250 | 65.56 | <0.001 | 96.9 | 1 | 0.21 | ++- b, low |
| Emotional function | WMD 1.41 (−8.34, 11.16) | 0.78 | 3 | 250 | 47.33 | <0.001 | 95.8 | 1 | 0.36 | ++- b, low |
| Cognitive function | WMD 2.88 (−3.78, 9.53) | 0.40 | 2 | 190 | 2.73 | 0.099 | 63.3 | ++++, high | ||
| Fatigue | WMD −10.82 (−18.76, −2.88) | 0.008 | 3 | 250 | 20.87 | <0.001 | 90.4 | 1 | 0.13 | +++- c, moderate |
| Diarrhea | WMD −9.24 (−31.08, 12.60) | 0.41 | 3 | 250 | 87.07 | <0.001 | 97.7 | 1 | 0.27 | ++- b, low |
| Pain | WMD −8.85 (−23.92, 6.21) | 0.25 | 3 | 250 | 72.45 | <0.001 | 97.2 | 1 | 0.81 | ++- b, low |
| Dyspnea | WMD −1.09 (−7.22, 5.05) | 0.73 | 2 | 190 | <0.01 | 0.975 | 0 | ++++, high | ||
| Insomnia | WMD −10.83 (−24.76, 3.10) | 0.13 | 2 | 190 | 3.22 | 0.073 | 68.9 | ++++, high | ||
| Nausea and vomiting | WMD −2.14 (−4.58, 0.30) | 0.09 | 2 | 190 | 0.01 | 0.925 | 0 | ++++, high | ||
| Appetite loss | WMD −2.28 (−8.74, 4.19) | 0.49 | 2 | 190 | 0.59 | 0.444 | 0 | ++++, high | ||
| Constipation | WMD 1.83 (−5.61, 9.28) | 0.63 | 2 | 190 | 0.02 | 0.878 | 0 | ++++, high | ||
| Financial difficulties | WMD 6.72 (−0.37, 13.81) | 0.06 | 2 | 190 | 0.03 | 0.859 | 0 | ++++, high | ||
| Global health status | WMD 1.26 (−1.06, 3.58) | 0.29 | 2 | 190 | 0.03 | 0.859 | 0 | ++++, high | ||
| EORTC QLQ-C30 3 months | ||||||||||
| Physical function | WMD 9.26 (8.00, 10.53) | <0.001 | 2 | 200 | 0.04 | 0.85 | 0 | ++++, high | ||
| Role function | WMD 9.96 (8.11, 11.82) | <0.001 | 2 | 200 | 1.37 | 0.241 | 27.1 | ++++, high | ||
| Social function | WMD 8.51 (3.48, 13.54) | 0.001 | 2 | 200 | 4.87 | 0.027 | 79.5 | +++- a, moderate | ||
| Emotional function | WMD 0.37 (−9.22, 9.96) | 0.94 | 2 | 200 | 18.22 | <0.001 | 94.5 | ++- b, low | ||
| Fatigue | WMD −12.73 (−14.80, −10.66) | <0.001 | 2 | 200 | 1.30 | 0.253 | 23.3 | ++++, high | ||
| Diarrhea | WMD 12.75 (−17.04, 42.54) | 0.40 | 2 | 200 | 90.69 | <0.001 | 98.9 | ++- b, low | ||
| Pain | WMD −4.28 (−19.76, 11.20) | 0.59 | 2 | 200 | 61.05 | <0.001 | 98.4 | ++- b, low | ||
| Postoperative outcomes | ||||||||||
| Hospital stay (days) | WMD −0.29 (−1.76, 1.18) | 0.70 | 3 | 254 | 1.47 | 0.481 | 0 | 1 | 0.99 | ++++, high |
| Postoperative complications | RR 1.09 (0.61, 1.94) | 0.81 | 2 | 112 | 0.20 | 0.656 | 0 | ++++, high | ||
| Anastomotic leakage | RR 0.71 (0.12, 4.22) | 0.70 | 2 | 194 | 0.07 | 0.797 | 0 | ++++, high | ||
| Pneumonia | RR 0.53 (0.34, 0.81) | 0.004 | 2 | 192 | 0.57 | 0.449 | 0 | ++++, high | ||
CI, confidence interval; BMI, body mass index; POD30, postoperative day 30; Preop, preoperative; LBM, lean body mass; ASMI, appendicular skeletal muscle mass index; QLQ-C30, quality of life questionnaire-core 30; WMD, weighted mean difference; RR, risk ratios.
a
Downgraded by one level for moderate statistical heterogeneity.
b
Downgraded by two levels for severe statistical heterogeneity.
c
Downgraded by one level because despite severe statistical heterogeneity, visual inspection of forest plots indicated a consistent direction in study-level treatment effects.