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- W2897792568 abstract "I read with interest the systematic review and meta-analysis by Chan et al.(1), and wish to congratulate them for the comprehensive review comparing central versus extended hepatectomy. However, I wish to highlight a few methodological issues that could potentially impair the overall quality and validity of findings. The authors have opted to analyse dichotomous data with a fixed-effects model. This may be an inaccurate method given substantial heterogeneity (I2 > 50%) in a few of their outcomes, including pre-operative portal vein embolization, and post-operative complications.1Chan J. Perini M. Fink M. Nikfarjam M. The outcomes of central hepatectomy versus extended hepatectomy: a systematic review and meta-analysis.HPB – Offic J Int Hepato Pancreato Biliary Assoc. 2018; 20: 487-496Google Scholar Did the authors consider performing these analyses with a random-effects model to account for the substantial heterogeneity?.2Higgins J.P.T.G.S. Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration, 2011Google Scholar Two major reasons for the substantial heterogeneity in the analysis of post-operative complications could be that, firstly, different types of complications were pooled and analysed and or, secondly, different time periods of post-operative complications were reported. On this basis the authors should perhaps have considered performing a meta-analysis of hepatectomy-specific post-operative complications. In addition, specific time periods should have been considered in their analysis, such as 30 days post-operatively. Lastly, all studies included were retrospective in nature, which raises significant biases given the inherent limitations of non-randomised studies. This includes confounding bias, selection bias, and even publication bias. To better rate the overall quality of evidence, the authors should have considered performing a risk of bias (ROB) assessment using one of the widely-validated tools, including the Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) tool,3Sterne J.A. Hernan M.A. Reeves B.C. Savovic J. Berkman N.D. Viswanathan M. et al.ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions.BMJ (Clin Res Ed). 2016; 355: i4919Crossref PubMed Scopus (6096) Google Scholar and the Newcastle-Ottawa Scale.4Wells G.A. O'Connell D. Peterson J. Welch V. Losos M. The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses.2014http://www.ohri.ca/programs/clinical_epidemiology/oxford.htmGoogle Scholar Furthermore, a sensitivity analysis of good quality studies can be performed subsequently to ensure consistency in their findings. None declared." @default.
- W2897792568 created "2018-10-26" @default.
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- W2897792568 date "2019-02-01" @default.
- W2897792568 modified "2023-09-27" @default.
- W2897792568 title "Reply to “The outcomes of central hepatectomy versus extended hepatectomy: a systematic review and meta-analysis”" @default.
- W2897792568 doi "https://doi.org/10.1016/j.hpb.2018.09.010" @default.
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