Meta-analysis of clinical effects of abdominal aortic balloon occlusion in resection of pelvic and sacral tumors

Objective To systematically evaluate the clinical effects of abdominal aortic balloon occlusion in resection of pelvic and sacral tumors. Methods All the randomized controlled trials (RCT) and cohort studies about abdominal aortic balloon occlusion in resection of pelvic and sacral tumors were electronically collected by searching databases, including China National Knowledge Infrastructure (CNKI), Wanfang Database, China Biology Medicine disc (CBMdisc), PubMed, Embase, Cochrane Library Database. Search time interval period was from construction of databases to December 31, 2018. Cochrane bias risk assessment table was used to evaluate the quality of RCT, and New Castle-Ottawa Scale (NOS) was used to evaluate the quality of cohort studies. Two researchers independently screened the literatures according to the inclusion and exclusion criteria, evaluated the quality of the included literatures and risk of bias, and extracted relevant research data. Meta-analysis of the clinical effects of abdominal aortic balloon occlusion for pelvic and sacral tumor resection was performed by RevMan5.3 software. Outcome observation indicators included intraoperative blood loss, intraoperative blood transfusion volume, operation duration time and incidences of postoperative complications. Results ① A total of 219 related literatures were screened out in this study. Six of them met the inclusion and exclusion criteria of literatures, which included 1 RCT and 5 retrospective cohort studies. A total of 609 patients with pelvic and sacral tumor resection were involved in these 6 literatures. Among them, 258 patients underwent abdominal aortic balloon occlusion, and 351 did not receive abdominal aortic balloon occlusion. ② Cochrane bias risk assessment results of 1 RCT were uncertain, and NOS scores of 5 retrospective cohort studies were 7 scores. According to the results of literature quality evaluation, 5 high-quality cohort studies were included in the Meta-analysis. ③ Meta-analysis of this study showed that the intraoperative blood loss, intraoperative blood transfusion volume, operation duration time (excluded clinical heterogeneity) of patients undergoing abdominal aortic balloon occlusion for pelvic and sacral tumors resection were significantly lower than those of patients without abdominal aortic balloon occlusion (SMD=-917.12, 95%CI: -1 239.61 to -594.62, P 0.05). Conclusions Abdominal aortic balloon occlusion can reduce the amount of bleeding and blood transfusion during pelvic and sacral tumor resection without increasing the incidence of complications, including nerve injury, wound infection, urethral injury and vaginal injury. Key words: Balloon occlusion; Aortic, abdominal; Sacrum; Pelvic tumor; Blood loss, surgical; Blood transfusion; Postoperative complications