Extended antimicrobial prophylaxis after gastric cancer surgery: A systematic review and meta-analysis

Table 1 Primary characteristics of the randomized controlled trails included in the meta-analysis

Ref.	Country	Sample size	Male	Median age (yr)	Body mass index (kg/m2)	Operation time (min)	Blood loss (mL)	Median follow-up time (d)
Schardey et al[7]	Germany	102	60	63.7 ± 11.4	NM	301.6 ± 87.7	NM	42
		103	59	62.6 ± 11.9	NM	314.8 ± 107	NM
			P > 0.05	P > 0.05	NM	P > 0.05	NM
Farran et al[8]	Spain	22	33	57(31-87)	NM	NM	NM	> 22
		27			NM	NM	NM
Imamura et al[9]	Japan	179	125	65	22.5 (12.4-32.9)	200 (64-415)	210 (1-1700)	30
		176	115	66	22.3 (16.3-33.0)	209 (58-428)	200 (1-880)
			P = 0.536	P = 0.429	P = 0.190	P = 0.499	P = 0.903
Mohri et al[10]	Japan	243	174	68 (22-91)	21.6 (13.4-31.6)	232 (43-70)	338.0 (10-2811)	30
		243	164	68 (23-90)	21.4 (13.6-34.0)	234 (70-492)	405.7 (10-2917)
			P = 0.375	P = 0.642	P = 0.446	P = 0.798	P = 0.028

NM: Not mentioned.

Table 2 Secondary characteristics of the randomized controlled trails included in the meta-analysis

Ref.	Participants	n	Interventions	Complications
Schardey et al[7]	205 patients August 1991-March 1994 Germany, multi-centre, ≥ 18 yr, total gastrectomy	102 vs 103	Polymyxin 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 g	Infections: 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 gastrectomy	22 vs 27	20 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 day	Dehiscence; sepsis; abscess;pulmonary infection;pulmonary distress syndrome
Imamura et al[9]	355 patients June 2005-December 2007, Japan, multi-centre, ≥ 35 yr, distal gastrectomy	179 vs 176	Intraoperative 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 supplements	Anastomotic leakage; remote infections; surgical site infections
Mohri et al[10]	486 patients May 2001-December 2004 Japan, single-centre, ≥ 20 yr, elective gastrectomy	243 vs 243	Intraoperative 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 doses	Surgical site infection: incision or organ or space; abscess

Table 3 Basic data of the comparisons included in the randomized controlled trails

Ref.	Total complication	Surgical site infection	Incision infection	Organ/space infection	Remote site infection	Anastomotic leakage/dehiscence	Mortality
Schardey et al[7]	31/102	NM	NM	NM	16/102	NM	5/102
	46/103	NM	NM	NM	31/103	NM	11/103
Farran et al[8]	2/22	NM	NM	NM	1/22	1/22	2/22
	3/27	NM	NM	NM	3/27	0/27	0/27
Imamura et al[9]	22/179	16/179	5/179	11/179	6/179	4/179	NM
	17/176	8/176	1/176	7/176	9/176	1/176	NM
Mohri et al[10]	NM	23/243	14/243	12/243	NM	NM	NM
	NM	21/243	11/243	10/243	NM	NM	NM

NM: Not mentioned.

Table 4 Quality assessment of the randomized controlled trails included based on the Cochrane Risk of Bias Tool

Ref.	Randomization	Allocation concealment	Blind	Withdrawal and dropout	Presence of selective reporting bias
Schardey et al[7]	Without details	Envelope	Double-blind	Well reported	Unclear
Farran et al[8]	Well reported	Envelope	Double-blind	Well reported	No
Imamura et al[9]	Well reported	Envelope	No	Well reported	No
Mohri et al[10]	Well reported	Without details	No	Well reported	Unclear

Table 5 Summary of comparisons between extended antimicrobial prophylaxis and intraoperative antimicrobial prophylaxis

Items	Heterogeneity		Analysis model	Overall effect		RR (95%CI)	Ref.
	I2	P		Z	P
Total complications	42%	0.18	Fixed	0.99	0.32	0.86 (0.63-1.16)	[7-9]
Surgical site infections	NP	NP	Fixed	1.61	0.11	1.97 (0.86-4.48)	[9]
Incision infections	NP	NP	Fixed	1.46	0.14	4.92 (0.58-41.66)	[9]
Organ/space infections	NP	NP	Fixed	0.92	0.36	1.55 (0.61-3.89)	[9]
Remote site infections	0%	0.90	Fixed	2.58	0.01	0.54 (0.34-0.86)	[7-9]
Anastomotic leakage/dehiscence	0%	0.97	Fixed	1.47	0.14	3.85 (0.64-23.17)	[8,9]
Mortality	62%	0.10	Random	0.10	0.92	1.14 (0.1-13.12)	[8,9]

NP: Not applicable; RR: Risk ratio.