The impact of tumor-to-nipple distance and multicentricity on occult nipple-areola complex involvement and local recurrence in the setting of nipple-sparing mastectomy: A meta-analysis and systematic review.

2016 ◽  
Vol 34 (15_suppl) ◽  
pp. 1041-1041
Author(s):  
Hai-Tong Lyu ◽  
Sheng-Li An ◽  
Guo-Chun Zhang ◽  
Chong-Yang Ren ◽  
Ling-Zhu Wen ◽  
...  
Author(s):  
Maria Chicco ◽  
Ali R Ahmadi ◽  
Hsu-Tang Cheng

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.


2018 ◽  
Vol 6 (4) ◽  
pp. e1716 ◽  
Author(s):  
Prakasit Chirappapha ◽  
Pongsakorn Srichan ◽  
Panuwat Lertsithichai ◽  
Panya Thaweepworadej ◽  
Thongchai Sukarayothin ◽  
...  

2018 ◽  
Vol 06 (08) ◽  
pp. E998-E1007 ◽  
Author(s):  
Enrique Pérez-Cuadrado-Robles ◽  
Lucille Quénéhervé ◽  
Walter Margos ◽  
Tom G. Moreels ◽  
Ralph Yeung ◽  
...  

Abstract Background and study aims Endoscopic submucosal dissection (ESD) has been developed as an option for treatment of esophageal, gastric and colorectal lesions. However, there is no consensus on the role of ESD in duodenal tumors. Methods This systematic review and meta-analysis compared ESD and endoscopic mucosal resection (EMR) in sporadic non-ampullary superficial duodenal tumors (NASDTs), including local experience. We conducted a search in PubMed, Scopus and the Cochrane library up to August 2017 to identify studies that compared both techniques reporting at least one main outcome (en-bloc/complete resection, local recurrence). Pooled outcomes were calculated under fixed and random-effect models. Subgroup analyses were conducted. Results A total of 753 patients presenting with 784 NASDTs (242 ESD, 542 EMR) in 14 studies were included. Tumor size (MD: 5.88, [CI95 %: 2.15, 9.62], P = 0.002, I2 = 79 %) and procedure time (MD: 65.65, [CI95 %: 40.39, 90.92], P < 0.00001, I2 = 88 %) were greater in the ESD group. En-bloc resection rate was significantly higher in Asian studies (OR: 2.16 [CI95 %: 1.15, 4.08], P = 0.02, I2: 46 %). ESD provided a higher complete resection rate (OR: 1.63 [I95 %: 1.06, 2.50], P = 0.03, I2: 59 %), but there was no risk difference in the risk of local recurrence (RD: – 0.03 [CI95 %: – 0.07, 0.01], P = 0.15, I2: 0 %) or delayed bleeding. ESD was associated with an increased number of intraoperative perforations [RD: 0.12 (CI95 %: 0.04, 0.20), P = 0.002, I2: 56 %] and emergency surgery for delayed perforations. The inclusion of eligible studies was limited to retrospective series with inequalities in comparative groups. Conclusions Duodenal ESD for NASDTs may achieve higher en-bloc and complete resections at the expense of a greater perforation rate compared to EMR. The impact on local recurrence remains uncertain.


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