2 Methods
2.1 Literature search
This present analysis was conducted according to the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses statement6. Two of the authors (YCL and LJH) searched PubMed,
EMBASE, and the Cochrane Library independently and extensively for
articles of interest published before March 2020. The keywords used in
the search process included “stapler” or “stapling” or
“mechanical” and “laryngectomy”. Moreover, reference lists of the
included studies were also reviewed to identify additional studies.
2.2 Study selection and data extraction
The inclusion criteria were studies including only patients with
laryngeal cancer who underwent TL, articles published in English, and
studies comparing the outcomes of TL between the SC and MC techniques.
The exclusion criteria were based primarily on the absence of one of the
inclusion criteria. Studies without a control group, studies using the
same database, articles not published in English, duplicate studies,
case reports, abstracts, letters to the editor, and articles pending
publication of the full text were excluded from the present analysis.
Data were independently extracted by the 2 researchers (YCL and LJH).
The bias in the studies was assessed independently by two researchers
(YCL and LJH) using the Newcastle-Ottawa Scale and the Cochrane
Collaboration’s risk of bias tool (RoB 1.0) for nonrandomized and
randomized studies, respectively 7,8. Discrepancies in
study bias classification were discussed between the two authors until
consensus was achieved.
2.3 Outcomes
The main outcomes of this study included operative time,
pharyngocutaneous fistula (PCF), length of hospitalization and
postoperative surgical site infection.
2.4 Data analysis
The results were analyzed using Comprehensive Meta-Analysis software
(Version 3; Biostat, Englewood, NJ). Mean differences (MDs) were
calculated to compare the operative time and the length of
hospitalization between the SC and MC groups. Odds ratios (ORs) were
calculated to compare the PCF rate and postoperative surgical site
infection rate between the SC and MC groups. The overall effect was
pooled using a random-effects model. Statistical heterogeneity among
studies was measured using the I2 statistic,
which calculated the proportion of overall variation attributable to
between-study heterogeneity. An I2 statistic
exceeding 50% indicated moderate heterogeneity, and anI2 statistic exceeding 75% indicated high
heterogeneity 9. Potential publication bias was
assessed using a funnel plot and the Egger intercept test9. A 2-sided P value < 0.05 was
considered statistically significant.