SP8.1.1 Ultrasonic versus electrocautery dissection in modified radical mastectomy for breast cancer: A Systematic Review and Meta-analysis

Abstract Aims Electrocautery (EC) remains the dominant dissection tool in modified radical mastectomy (MRM) for breast cancer. However, ultrasonic dissection devices (UDD) have emerged as popular alternatives on the basis that their mechanism of action limits tissue damage resulting in decreased blood loss, seroma formation and post-operative drainage. A systematic review and meta-analysis was performed to compare surgical outcomes for EC versus UDD in MRM surgery. Methods MEDLINE, EMBASE, PubMed and the Cochrane Database were searched and a comprehensive systematic review and meta-analysis performed according to PRISMA guidelines, comparing EC versus UDD in MRM for breast cancer. Outcomes of interest were post-operative drainage, incidence of seroma, intra-operative blood loss and operative time. Meta-analysis was performed using a random effects model to aggregate the data. Odds ratios (OR) were used as the summary statistic for dichotomous data and mean difference (MD) for continuous data. Data heterogeneity was assessed using the I2 statistic. Results Nineteen eligible peer-reviewed studies were analysed involving 1501 patients, UDD:744 EC:757. We demonstrated that in MRM, UDD significantly reduced post-operative drainage (MD = 312.26, 95% confidence interval (CI): 102.59-521.93, p = 0.004); seroma (OR = 0.51, 95% CI: 0.39-0.68, p < 0.00001) and intra-operative blood loss (MD = 111.68, 95% CI: 84.56-138.8, p < 0.00001) with no significant difference in operative time between the two techniques (MD = 0.32 (11.3-11.94), p = 0.96. Conclusion Using UDD in MRM for breast cancer presents significant advantages in decreasing post-operative drainage, seroma and intra-operative blood loss, without lengthening operating time compared to EC. It therefore appears favourable, however further cost-effectiveness analysis would be beneficial to guide selection.

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Coblation versus cold dissection in paediatric tonsillectomy: a systematic review and meta-analysis

The Journal of Laryngology & Otology ◽

10.1017/s0022215120000377 ◽

2020 ◽

Vol 134 (3) ◽

pp. 197-204

Author(s):

M U Ahmad ◽

A N Wardak ◽

T Hampton ◽

M R S Siddiqui ◽

I Street

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Operative Time ◽

Meta Analysis ◽

Alternative Technique ◽

Operative Blood Loss ◽

Operative Outcomes ◽

Significant Difference ◽

Dissection Techniques ◽

Cold Dissection

AbstractBackgroundCold dissection is the most commonly used tonsillectomy technique, with low post-operative haemorrhage rates. Coblation is an alternative technique that may cause less pain, but could have higher post-operative haemorrhage rates.ObjectiveThis study evaluated the peri-operative outcomes in paediatric tonsillectomy patients by comparing coblation and cold dissection techniques.MethodsA systematic review was conducted of all comparative studies of paediatric coblation and cold dissection tonsillectomy, up to December 2018. Any studies with adults were excluded. Outcomes such as pain, operative time, and intra-operative, primary and secondary haemorrhages were recorded.ResultsSeven studies contributed to the summative outcome. Coblation tonsillectomy appeared to result in less pain, less intra-operative blood loss (p < 0.01) and a shorter operative time (p < 0.01). There was no significant difference between the two groups for post-operative haemorrhage (p > 0.05).ConclusionThe coblation tonsillectomy technique may offer better peri-operative outcomes when compared to cold dissection, and should therefore be offered in paediatric cases, before cold dissection tonsillectomy.

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Active versus passive drainage after modified radical mastectomy in breast cancer

International Surgery Journal ◽

10.18203/2349-2902.isj20182784 ◽

2018 ◽

Vol 5 (7) ◽

pp. 2616

Author(s):

Alex Oommen ◽

Thara Augustine ◽

E. V. Gopi

Keyword(s):

Breast Cancer ◽

Hospital Stay ◽

Radical Mastectomy ◽

Breast Cancer Patients ◽

Modified Radical Mastectomy ◽

Suction Drain ◽

Drain Removal ◽

Significant Difference ◽

Operative Drainage ◽

Negative Suction

Background: Active drains are routinely used after Modified Radical Mastectomy (MRM) and is an important factor contributing to increased hospital stay as the patients are often discharged only after their removal. Amongst various factors that influence the amount of post operative drainage, the negative suction pressure applied to the drain has been reported to be of great significance. Against this background a study was conducted to compare the amount and duration of drainage between suction and dependent drainage in patients following Modified Radical Mastectomy.Methods: Patients were randomised using randomly ordered sealed envelopes, which were opened immediately before the closure of the wound, to decide on whether suction or dependent drain was to be given. Drains were removed when output was less than 30 ml per day. Patients were followed up from the day of surgery till the day of drain removal. Statistical analysis was performed with SPSS.Results: There is significant increase in the drain per day in post MRM patients with active suction drain. But, there is no relation between the type of drain and either total drain output or the total number of days of drain. The study also revealed that there is no significant difference in the number of days of hospital stay in both groups of patients.Conclusions: Suction drains do not have any significant advantage over dependent drains after Modified Radical Mastectomy in breast cancer patients.

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Copper Concentrations in Breast Cancer: A Systematic Review and Meta-Analysis

Current Medicinal Chemistry ◽

10.2174/0929867326666190918120209 ◽

2020 ◽

Vol 27 (37) ◽

pp. 6373-6383 ◽

Cited By ~ 1

Author(s):

Leila Jouybari ◽

Faezeh Kiani ◽

Farhad Islami ◽

Akram Sanagoo ◽

Fatemeh Sayehmiri ◽

...

Keyword(s):

Breast Cancer ◽

Systematic Review ◽

Breast Tissue ◽

Reference Lists ◽

Meta Analysis ◽

Cancer Risks ◽

Hair Samples ◽

Significant Difference ◽

Mean Differences ◽

Very High

: Breast cancer is the most common neoplasm, comprising 16% of all women's cancers worldwide. Research of Copper (Cu) concentrations in various body specimens have suggested an association between Cu levels and breast cancer risks. This systematic review and meta-analysis summarize the results of published studies and examine this association. We searched the databases PubMed, Scopus, Web of Science, and Google Scholar and the reference lists of relevant publications. The Standardized Mean Differences (SMDs) between Cu levels in cancer cases and controls and corresponding Confidence Intervals (CIs), as well as I2 statistics, were calculated to examine heterogeneity. Following the specimens used in the original studies, the Cu concentrations were examined in three subgroups: serum or plasma, breast tissue, and scalp hair. We identified 1711 relevant studies published from 1984 to 2017. There was no statistically significant difference between breast cancer cases and controls for Cu levels assayed in any studied specimen; the SMD (95% CI) was -0.01 (-1.06 - 1.03; P = 0.98) for blood or serum, 0.51 (-0.70 - 1.73; P = 0.41) for breast tissue, and -0.88 (-3.42 - 1.65; P = 0.50) for hair samples. However, the heterogeneity between studies was very high (P < 0.001) in all subgroups. We did not find evidence for publication bias (P = 0.91). The results of this meta-analysis do not support an association between Cu levels and breast cancer. However, due to high heterogeneity in the results of original studies, this conclusion needs to be confirmed by well-designed prospective studies.

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Haemostatic devices in parotid surgery: a systematic review

The Journal of Laryngology & Otology ◽

10.1017/s0022215121001973 ◽

2021 ◽

pp. 1-7

Author(s):

L Allen ◽

C MacKay ◽

M H Rigby ◽

J Trites ◽

S M Taylor

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Facial Nerve ◽

Hospital Stay ◽

Outcome Measures ◽

Meta Analysis ◽

Operating Time ◽

Length Of Hospital Stay ◽

Operative Blood Loss ◽

Parotid Surgery

Abstract Objective The Harmonic Scalpel and Ligasure (Covidien) devices are commonly used in head and neck surgery. Parotidectomy is a complex and intricate surgery that requires careful dissection of the facial nerve. This study aimed to compare surgical outcomes in parotidectomy using these haemostatic devices with traditional scalpel and cautery. Method A systematic review of the literature was performed with subsequent meta-analysis of seven studies that compared the use of haemostatic devices to traditional scalpel and cautery in parotidectomy. Outcome measures included: temporary facial paresis, operating time, intra-operative blood loss, post-operative drain output and length of hospital stay. Results A total of 7 studies representing 675 patients were identified: 372 patients were treated with haemostatic devices, and 303 patients were treated with scalpel and cautery. Statistically significant outcomes favouring the use of haemostatic devices included operating time, intra-operative blood loss and post-operative drain output. Outcome measures that did not favour either treatment included facial nerve paresis and length of hospital stay. Conclusion Overall, haemostatic devices were found to reduce operating time, intra-operative blood loss and post-operative drain output.

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Comparison of the Effectiveness of Full Negative Pressure with Half Negative Pressure on Suction Drain in Reducing Post-Modified Radical Mastectomy Seroma

Sriwijaya Journal of Surgery ◽

10.37275/sjs.v2i2.18 ◽

2019 ◽

Vol 2 (2) ◽

pp. 24-31

Author(s):

Gulraj Singh ◽

Mulawan Umar ◽

Nur Qodir

Keyword(s):

Breast Cancer ◽

Negative Pressure ◽

Radical Mastectomy ◽

Control Group ◽

Breast Cancer Patients ◽

Modified Radical Mastectomy ◽

Pressure Groups ◽

Suction Drain ◽

Significant Difference ◽

June July

Abstract Introduction: Modified radical mastectomy (MRM) is a breast cancer treatment option that is still operable. One of the postoperative complications that can be found is the formation of seroma. High negative suction drain is done to treat seroma after surgery but it can contribute to increase the length of stay in hospital. Methods: This study was a clinical randomized control trial (cRCT) conducted on 30 breast cancer patients in June - July 2019 at Moehammad Hoesin Hospital in Palembang. This study divided the two sample groups, each group consisting of 15 patients. One group was given half negative pressure on suction drain (experimental group) and the other used full negative pressure on suction drain (control group). Results: There was a significant difference (p <0.005) between the full and half negative pressure groups where there were more seroma events in the full vacuum group in 9 (60%) cases and half vacuum in 2 (30%) but there were no significant differences in long period of stay (p> 0.005). Conclusion: Half negative pressure is more effective in treating seroma than full negative pressure.

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Effects of Preoperative Iodine Administration on Thyroidectomy for Hyperthyroidism: A Systematic Review and Meta-analysis

Otolaryngology ◽

10.1177/0194599819829052 ◽

2019 ◽

Vol 160 (6) ◽

pp. 993-1002 ◽

Cited By ~ 1

Author(s):

Chung-Hsin Tsai ◽

Po-Sheng Yang ◽

Jie-Jen Lee ◽

Tsang-Pai Liu ◽

Chi-Yu Kuo ◽

...

Keyword(s):

Postoperative Complications ◽

Blood Loss ◽

Operative Time ◽

Meta Analysis ◽

Thyroid Volume ◽

Vocal Cord Palsy ◽

Significant Heterogeneity ◽

Intraoperative Blood Loss ◽

Significant Difference ◽

And Control

Objective The current guidelines recommend that potassium iodide be given in the immediate preoperative period for patients with Graves’ disease who are undergoing thyroidectomy. Nonetheless, the evidence behind this recommendation is tenuous. The purpose of this study is to clarify the benefits of preoperative iodine administration from published comparative studies. Data Sources We searched PubMed, Embase, Cochrane, and CINAHL from 1980 to June 2018. Review Methods Studies were included that compared preoperative iodine administration and no premedication before thyroidectomy. For the meta-analysis, studies were pooled with the random-effects model. Results A total of 510 patients were divided into the iodine (n = 223) and control (n = 287) groups from 9 selected studies. Preoperative iodine administration was significantly associated with decreased thyroid vascularity and intraoperative blood loss. Significant heterogeneity was present among studies. We found no significant difference in thyroid volume or operative time. Furthermore, the meta-analysis showed no difference in the risk of postoperative complications, including vocal cord palsy, hypoparathyroidism/hypocalcemia, and hemorrhage or hematoma after thyroidectomy. Conclusion Preoperative iodine administration decreases thyroid vascularity and intraoperative blood loss. Nonetheless, it does not translate to more clinically meaningful differences in terms of operative time and postoperative complications.

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Transverse Versus Longitudinal Uterine Incision in Abdominal Myomectomy: A Randomized Controlled trial

QJM ◽

10.1093/qjmed/hcaa056.025 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

A Elguindy ◽

H Hemeda ◽

M Esmat ◽

M Nawara ◽

A M F Metwally

Keyword(s):

Blood Loss ◽

Operative Time ◽

Controlled Trial ◽

Demographic Data ◽

Operative Blood Loss ◽

Postoperative Fever ◽

Abdominal Myomectomy ◽

Randomized Controlled ◽

Uterine Incision ◽

Significant Difference

Abstract Objective The Aim of the study is to compare between transverse and longitudinal uterine incision in abdominal myomectomy regarding intraoperative blood loss Design: A randomized Controlled interventional study. Setting Ain Shams Maternity teaching hospital. Patients and methods 52 patients undergoing abdominal myomectomy for single myoma were involved The patients were randomized into two groups that showed no significant difference in demographic data, characters of myoma or indication of surgery Results Our results proved that there was no significant difference between both incisions regarding intra-operative blood loss, need for blood transfusion, post-operative Hgb drop, operative time or incidence of postoperative fever. Conclusion Transverse uterine incision for myomectomy does not cause more blood loss than longitudinal incision. There is no difference between both incisions in operative time or postoperative complications Trial identifier: NCT03009812, MY-789

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Rehabilitation interventions to support return to work for women with breast cancer: a systematic review and meta-analysis

10.21203/rs.3.rs-250979/v1 ◽

2021 ◽

Author(s):

Naomi Algeo ◽

Kathleen Bennett ◽

Deirdre Connolly

Keyword(s):

Breast Cancer ◽

Systematic Review ◽

Return To Work ◽

Usual Care ◽

Breast Cancer Survivors ◽

Meta Analysis ◽

Work Outcomes ◽

Cochrane Central Register ◽

Specific Content ◽

Significant Difference

Abstract Background Research recommends the development and evaluation of interventions to support women with breast cancer in returning to, or managing, work. Despite this, there has historically been a paucity of rehabilitation interventions to support women with breast cancer to maintain or return to their work role. The aim of this systematic review was to examine key characteristics of rehabilitation interventions, and their effectiveness on work outcomes for women with breast cancer, compared to usual care. Methods A systematic review was conducted of controlled studies of rehabilitation interventions with work outcomes for women with breast cancer. Six databases were systematically searched: EMBASE, Web of Science, MEDLINE (OVID), CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials (CENTRAL). Results are presented either as pooled odds ratio (OR) or pooled effect size (hedges g) between groups, with 95% confidence intervals (CI). Narrative synthesis was conducted on intervention outcomes not suitable for meta-analysis. Results Five thousand, five hundred and thirty-five studies were identified. Nine out of 28 abstracts met inclusion criteria. Heterogeneity of interventions and outcomes precluded meta-analysis for most outcomes. Of the interventions included in meta-analysis, no significant differences compared to usual care were found for sick leave (2 studies (12 months); OR 1.11 (95% CI: 0.66 to 1.87), number of sick days taken (2 studies (six months); difference in effect: -0.08, (95% CI: -0.48 to 0.38) or working hours (2 studies (12 months); 0.19, (95% CI: -0.20 to 0.64). Only one study, with a multidisciplinary intervention, showed a significant difference for work outcomes when compared to usual care. Work-specific content featured in three interventions only, none of which provided conclusive evidence for improvement in work outcomes. Enhanced physical and psychological sequalae, and quality of life was observed in some studies. Conclusion There remains a lack of effective and methodologically rigorous rehabilitation intervention studies for breast cancer survivors. The development and evaluation of effective rehabilitation interventions to support return to work is warranted.

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Comparison of nephroscopy and cystoscopy used in the treatment of bladder stones: a systematic review and meta-analysis of randomized controlled trials

BMC Surgery ◽

10.1186/s12893-021-01461-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Liping Gou ◽

Zhenghao Wang ◽

Ye Zhou ◽

Xiaofeng Zheng

Keyword(s):

Systematic Review ◽

Randomized Controlled Trials ◽

Operative Time ◽

Meta Analysis ◽

Cochrane Library ◽

Controlled Trials ◽

Significant Heterogeneity ◽

Bladder Stones ◽

Randomized Controlled ◽

Significant Difference

Abstract Background A systematic review and meta-analysis was conducted to compare the safety and efficiency of nephroscopy and cystoscopy in transurethral cystolithotripsy (TUCL) for bladder stones (BS). Methods The PubMed, Web of Science, Embase, EBSCO, and Cochrane Library databases were searched up to January 2021 for studies assessing the effect of different types of endoscopes among patients who underwent TUCL. The search strategy and study selection process were in accordance with the PRISMA statement. Results Five randomized controlled trials were included in the meta-analysis. The results showed no difference in stone-free rate (RR = 1.00, CI = 0.98–1.02, p = 1.00) between the two groups and nonsignificant heterogeneity (I2 = 0%, p = 1.00), and all patients were rendered stone free. Use of the nephroscope significantly shortened the operative time compared with the cystoscope group (RR= − 26.26, CI = − 35.84 to − 16.68, p < 0.00001), and there was significant heterogeneity (I2= 87%, p < 0.00001). There was no significant difference in mean urethral entries (RR = 0.66, CI = − 0.71 to − 2.04, p = 0.35), hospitalization (MD = 0.08, 95% CI = − 0.07 to 0.23, p = 0.31) or total complication rate (RR=1.37, 95% CI = 0.47–4.00, p = 0.56) between the two groups. Conclusions In conclusion, this systematic review demonstrates that both nephroscopy and cystoscopy have high stone clearance efficiency, low rates of complications and short hospitalizations. The mean urethral entries depend on the treatment method for large stone fragments. However, the use of nephroscopy can significantly reduce the operative time.

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Risk Factors of Venous Thromboembolic Events after Breast Cancer Surgeries; A Meta-Analysis of 166929 Patients

Tumori Journal ◽

10.1177/0300891620914126 ◽

2020 ◽

Vol 106 (1_suppl) ◽

pp. 6-6

Author(s):

A.M.E. Elkholy ◽

A. Awadeen ◽

I.H. Kabeil ◽

A. Sokar

Keyword(s):

Breast Cancer ◽

Diabetes Mellitus ◽

Risk Factors ◽

Health Care Providers ◽

Meta Analysis ◽

Radical Mastectomy ◽

Care Providers ◽

Primary Reconstruction ◽

Significant Difference ◽

Venous Thromboembolic Events

Introduction: Venous thromboembolism (VTE) is the second most common cause of death among patients with breast cancer. In particular, VTE accounted for 20% of deaths after radical mastectomy. Owing to the devastating sequels associated with VTE and its financial impact, the current study was conducted to reveal the possible risk factors of VTE after breast cancer surgeries. Materials and Methods: Extensive systematic literature review, from inception up to 1 October 2019, was performed throughout 12 databases to reveal all clinical studies reported the risk factors of VTE after breast cancer surgeries. Pooled analysis was implemented using Review Manager. Results: This meta-analysis included 8 articles that encompassed an overall 166929 patients. There was no statistically significant difference between patients developed VTE and those not developed such condition regarding Caprini total score (SMD0.5;95%CI-0.58,1.57; P=0.36). Subsequently, patients developed VTE were elder than patients did not develop such complications (MD1.21;95%CI 1.06,1.35; P<0.001). Patients had pre-operative diabetes mellitus (OR 0.69;95%CI0.49,0.98; P=0.04) or pulmonary disease (OR1.43;95%CI1.09,1.88; P=0.01) were more susceptible to experience post-operative VTE, relative to other patients. Besides that, post-operative hospitalization stays were significantly longer among patients experienced VTE, relative to patients did not experience such complications (MD 2.6;95%CI 2.54,2.66; P<0.001). Patients subjected to radical mastectomy and primary reconstruction were more vulnerable to have VTE post-operatively (OR 2.66;95%CI 1.90,3.71; P<0.001). Similarly, patients received concurrent venous catheterization were more susceptible to develop VTE post-operatively (OR 2.13;95%CI 1.22,3.73; P<0.00=0.008). On the contrary, post-operative hormonal therapy, radiotherapy, or chemotherapy were not statistically significant risk factors of VTE after breast cancer surgeries. Conclusions: Elderly patients and those with pre-operative diabetes mellitus or pulmonary diseases and patients subordinated to primary reconstruction after radical mastectomy were more susceptible to develop VTE. Understanding these factors will aid health care providers to optimize the optimal preventive strategies of VTE after breast cancer surgeries.

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