Systematic Review and Meta-analysis of Complications Following Mastectomy and Prosthetic Reconstruction in Patients With and Without Prior Breast Augmentation

2021 ◽  
Author(s):  
Maria Chicco ◽  
Ali R Ahmadi ◽  
Hsu-Tang Cheng
Keyword(s):  
Systematic Review ◽  
Postoperative Complications ◽  
Meta Analysis ◽  
Skin Flap ◽  
Prosthetic Reconstruction ◽  
Hematoma Formation ◽  
Significant Difference ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing ◽  
Early Late

Abstract Background There is limited evidence available in literature with regard to the complication profile of mastectomy and immediate prosthetic reconstruction in augmented patients. Objectives The purpose of this systematic review and meta-analysis is to compare postoperative complications between women with versus without prior augmentation undergoing skin- or nipple-sparing mastectomy and immediate prosthetic reconstruction. Methods A systematic search was conducted in February 2020 for studies comparing women with versus without prior augmentation undergoing skin- or nipple-sparing mastectomy and immediate prosthetic reconstruction with documentation of postoperative complications. Outcomes analyzed included early, late and overall complications. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were obtained through meta-analysis. Results Our meta-analysis, which included six studies comparing 241 breasts with prior augmentation and 1441 without, demonstrated no significant difference between the two groups in rates of early (36.7% vs. 24.8%; OR=1.57, 95% CI 0.94 to 2.64; P=0.09), late (10.1% vs. 19.9%; OR=0.53, 95% CI 0.06 to 4.89; P=0.57) and overall complications (36.5% vs. 31.2%; OR=1.23, 95% CI 0.76 to 2.00; P=0.40). Subgroup analysis showed a significantly higher rate of hematoma formation in the augmented group (3.39% versus 2.15%; OR=2.68, 95% CI 1.00 to 7.16; P=0.05), but no difference in rates of seroma, infection, mastectomy skin flap necrosis and prosthesis loss. Conclusions Our meta-analysis suggests that prior augmentation does not significantly increase overall postoperative complications in women undergoing skin- or nipple-sparing mastectomy and immediate prosthetic reconstruction. However, the significantly higher rate of hematoma formation in augmented patients warrants further investigation and preoperative discussion.

scholarly journals Surgery vs. Biopsy in the Treatment of Butterfly Glioblastoma: A Systematic Review and Meta-Analysis

Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 314
Author(s):  
Shreya Chawla ◽  
Vasileios K. Kavouridis ◽  
Alessandro Boaro ◽  
Rasika Korde ◽  
Sofia Amaral Medeiros ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Complications ◽  
Surgical Resection ◽  
Meta Analysis ◽  
Case Series ◽  
Extent Of Resection ◽  
Random Effects Model ◽  
Review Of The Literature ◽  
Hazard Ratios ◽  
Significant Difference

Butterfly glioblastomas (bGBM) are grade IV gliomas that spread to bilateral hemispheres by infiltrating the corpus callosum. Data on the effect of surgery are limited to small case series. The aim of this meta-analysis was to compare resection vs. biopsy in terms of survival outcomes and postoperative complications. A systematic review of the literature was conducted using PubMed, EMBASE, and Cochrane databases through March 2021 in accordance with the PRISMA checklist. Pooled hazard ratios were calculated and meta-analyzed in a random-effects model including assessment of heterogeneity. Out of 3367 articles, seven studies were included with 293 patients. Surgical resection was significantly associated with longer overall survival (HR 0.39, 95%CI 0.2–0.55) than biopsy. Low heterogeneity was observed (I2: 0%). In further analysis, the effect persisted in extent of resection subgroups of both ≥80% and <80%. No statistically significant difference between surgery and biopsy was detected in terms of postoperative complications, although these were numerically larger for surgery. In patients with bGBM, surgical resection was associated with longer survival prospects compared with biopsy.

scholarly journals Postoperative complications following simultaneous therapeutic and contralateral prophylactic nipple-sparing mastectomy: a retrospective study

Mastology ◽  
2021 ◽  
Author(s):  
Marina Sonagli ◽  
Eduardo Bertolli ◽  
Alexandre Katalinic Dutra ◽  
Hirofumi Iyeyasu ◽  
Fabiana Baroni Alves Makdissi
Keyword(s):  
Retrospective Study ◽  
Postoperative Complications ◽  
Wound Infection ◽  
Skin Flap ◽  
Cancer Center ◽  
Flap Necrosis ◽  
Areola Complex ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing ◽  
Skin Flap Necrosis

Introduction: Nipple-Sparing Mastectomy (NSM) is increasingly indicated for therapeutic and prophylactic purposes due to better cosmetic results with nipple maintenance. Postoperative complications have not been compared among patients who have undergone simultaneous therapeutic and contralateral prophylactic NSM. The aim of the present study was to evaluate the incidence and risk factors for postoperative complications in bilateral/unilateral NSMs, and therapeutic and/or prophylactic NSMs. Methods: Retrospective study of patients who underwent NSM between 2007 and 2017 at A.C. Camargo Cancer Center. Results: Among 290 patients, 367 NSMs were performed, 64 simultaneous therapeutic and contralateral prophylactic NSM. The latter were associated with more postoperative complications (OR=3.42; p=0.002), mainly skin flap necrosis (OR=3.79; p=0.004), hematoma (OR=7.1; p=0.002), wound infection (OR=3.45; p=0.012), and nipple-areola complex (NAC) loss (OR=9.63; p=0.003). Of the 367 NSMs, 213 were unilateral NSMs, which were associated with lower rates of postoperative complications (OR=0.44; p=0.003), especially skin flap necrosis (OR=0.32; p=0.001), hematoma (OR=0.29; p=0.008), wound infection (OR=0.22; p=0.0001), and reoperation (OR=0.38; p=0.008). Obesity was related to more postoperative complications (OR=2.55; p=0.01), mainly hematoma (OR=3.54; p=0.016), reoperation (OR=2.68; p=0.023), and NAC loss (OR=3.54; p=0.016). Patients’ age (p=0.169), their smoking status (p=0.138), breast ptosis (0.189), previous chest radiotherapy (p 1), or previous breast surgery (p=0.338) were not related to higher chances of postoperative complications. Conclusions: Results suggest that performing therapeutic and contralateral prophylactic NSM as separated procedures may represent a good strategy for minimizing postoperative complications.

OPEN, LAPAROSCOPIC AND TRANSANAL TOTAL MESORECTAL EXCISION: A SYSTEMATIC LITERATURE REVIEW AND NETWORK META ANALYSIS

2019 ◽  
Vol 18 (4) ◽  
pp. 37-85
Author(s):  
Yu. S. Khilkov ◽  
A. A. Ponomarenko ◽  
E. G. Rybakov ◽  
Yu. A. Shelygin
Keyword(s):  
Systematic Review ◽  
Postoperative Complications ◽  
Resection Margin ◽  
Meta Analysis ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Short Term ◽  
Significant Difference ◽  
Grade 3

AIM: to compare the effectiveness of different methods of total mesorectumectomy (TME).MATERIALS AND METHODS: the systematic review performed in accordance with PRISMA practice and recommendations.RESULTS: Forty-one papers were included in the analysis. Fourteen studies were for transanal total mesorectumectomy (TA TME) (n=480) compared with laparoscopic (LA TME), 26 – for LA TME vs open (n=6820), 1 – for open vs TA TME. There was no significant difference between open TME, LA TME and TA TME in grade 3 quality of mesorectumectomy by Quirke. The positive circular resection margin (CRM) is less often in TA TME group, then LA TME (OR=2.58, CI 1.34-4.97, p=0.005). There was significantly lower positive CRM rate in LA TME then open TME (OR=0.73, CI 0.63-0.85, p<0.0001). There were no significant differences in postoperative complications rates between LA TME and TA TME (p=0.72). Network meta-analysis showed less postoperative complications followed LA TME than open TME (OR=0.75, CI 0.65-0.84).CONCLUSION: TA TME is comparable with laparoscopic and open TME in short term results. Rates of positive CRM, the quality of Grade 1 mesorectal excision, the conversion rate, the postoperative urinary dysfunction, may have better results in TA TME.

scholarly journals The choice of dissection or preservation of the inferior pulmonary ligament after an upper lobectomy: a systematic review and meta-analysis

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Hao Lv ◽  
Rui Zhou ◽  
Xianghong Zhan ◽  
Dongmei Di ◽  
Yongxian Qian ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Complications ◽  
Meta Analysis ◽  
The Other ◽  
Cochrane Library ◽  
Drainage Time ◽  
Significant Difference ◽  
The Right ◽  
Group D ◽  
Review Manager

Abstract Background The necessity of the inferior pulmonary ligament (IPL) dissection after an upper lobectomy remains controversial. This meta-analysis aimed to evaluate whether this accessional procedure could reduce the postoperative complications and improve outcomes. Methods PubMed, Embase, Ovid, Cochrane Library, CBM, and CNKI databases were searched for the relevant studies which compared the dissection with preservation of IPL during the upper lobectomy. The Review Manager 5.3 software was used for this meta-analysis. Results Three RCTs and five CCTs were included in this meta-analysis. These studies contained a total of 610 patients, in which 315 patients received a pulmonary ligament dissection (group D) after the upper lobectomy, while the other 295 patients preserved the pulmonary ligament (group P). No significant difference was demonstrated between the group D and group P in terms of drainage time after surgery (MD 0.14, 95%CI − 0.05 to 0.33, P = 0.15), rate of postoperative dead space (OR 1.33, 95%CI 0.72 to 2.46, P = 0.36), rate of postoperative complications (OR 1.20, 95%CI 0.66 to 2.19, P = 0.56). However, the pooled comparison revealed a greater change of the right main bronchial angle (MD 5.00, 95%CI 1.68 to 8.33, P = 0.003) in group D compared with group P, indicated that the dissection of IPL may lead to a greater distortion of bronchus. Conclusions This meta-analysis confirmed that the dissection of IPL do not effectively reduce the postoperative complications and improve the prognosis. Therefore, it is not necessary to dissect the IPL after an upper lobectomy.

Is There a Preferred Incision Location for Nipple-Sparing Mastectomy? A Systematic Review and Meta-Analysis

2019 ◽  
Vol 143 (5) ◽  
pp. 906e-919e ◽  
Author(s):  
David A. Daar ◽  
Salma A. Abdou ◽  
Lauren Rosario ◽  
William J. Rifkin ◽  
Pauline J. Santos ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Incision Location ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

scholarly journals The effectiveness and safety of D2 plus para-aortic lymphadenectomy for resectable gastric cancer: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Shi-Hui Zou ◽  
Xi Zhong ◽  
Jia-Le Zhang ◽  
Bao-Jun Huang ◽  
Hui-Mian Xu ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Systematic Review ◽  
Lymph Node ◽  
Postoperative Complications ◽  
Malignant Tumors ◽  
Meta Analysis ◽  
Perioperative Outcomes ◽  
Cochrane Library ◽  
Term Survival ◽  
Significant Difference

Abstract Background: Gastric cancer (GC) is among the malignant tumors of highest morbidity and mortality in the world, and has a profile of high lymph node metastasis rate. Lymph node clearance is a critical part of gastric cancer surgery, however, the extent of lymph node clearance, for example, whether to perform abdominal aortic lymph node dissection, remains considerably controversial. In this study, we performed a systematic review and meta-analysis to assess the effects of D2 plus para-aortic lymphadenectomy (PALD) on survival and postoperative complications in patients with GC.Methods: An electronic search was conducted through PubMed, Embase and cochrane library. The Q test and I2 were used to assess heterogeneity. The publication bias was evaluated via funnel plots. All statistical analyses were performed using STATA 14.0 (STATA, College Station, TX).Results: 908 studies were retrieved via literature search and eight studies were finally included. There was no significant difference between D2 and D2+PALD in the 5-year survival rate after surgery (HR: 1.00, 95% CI: 0.97-1.03, P = 0.897; I2 = 64.9%). Besides, the 30-day mortality (RR: 1.17, 95% CI: 0.66-2.10, P = 0.590; I2 = 0.0%) and the overall risk of postoperative complications (RR: 1.15, 95% CI: 0.83-1.59, P = 0.411; I2 = 35.5%) were comparable between D2 and D2+PALD.Conclusion: Based on current literature body, compared with D2, D2+PALD does not prevail in terms of long-term survival or perioperative outcomes.

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