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Interactive Cardiovascular and Thoracic... Mar 2022This study aims to systematically review published literature on male-female differences in presentation, management and outcomes in patients diagnosed with acute... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
This study aims to systematically review published literature on male-female differences in presentation, management and outcomes in patients diagnosed with acute thoracic aortic dissection (AD).
METHODS
A systematic literature search was conducted for studies published between 1 January 1999 and 19 October 2020 investigating mortality and morbidity in adult patients diagnosed with AD. Patient and treatment characteristics were compared with odds ratios (ORs) and standardized mean differences and a meta-analysis using a random-effects model was performed for early mortality. Overall survival and reoperation were visualized by pooled Kaplan-Meier curves.
RESULTS
Nine studies investigating type A dissections (AD-A), 1 investigating type B dissections (AD-B) and 3 investigating both AD-A and AD-B were included encompassing 18 659 patients. Males were younger in both AD-A (P < 0.001) and AD-B (P < 0.001), and in AD-A patients males had more distally extended dissections [OR 0.57, 95% confidence interval (CI) 0.46-0.70; P < 0.001]. Longer operation times were observed for males in AD-A (standardized mean difference 0.29, 95% CI 0.17-0.41; P < 0.001) while male patients were less often treated conservatively in AD-B (OR 0.65, 95% CI 0.58-0.72; P < 0.001). The pooled early mortality risk ratio for males versus females was 0.94 (95% CI 0.84-1.06, P = 0.308) in AD-A and 0.92 (95% CI 0.83-1.03, P = 0.143) in AD-B. Pooled overall mortality in AD-A showed no male-female difference, whereas male patients had more reinterventions during follow-up.
CONCLUSIONS
This systematic review shows male-female differences in AD patient and treatment characteristics, comparable early and overall mortality and inconsistent outcome reporting. As published literature is scarce and heterogeneous, large prospective studies with standardized reporting of male-female characteristics and outcomes are clearly warranted. Improved knowledge of male-female differences in AD will help shape optimal individualized care for both males and females.
CLINICAL REGISTRATION NUMBER
PROSPERO, ID number: CRD42020155926.
Topics: Adult; Aortic Dissection; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Female; Humans; Male; Prospective Studies; Retrospective Studies; Risk Factors; Treatment Outcome
PubMed: 34664071
DOI: 10.1093/icvts/ivab270 -
Frontiers in Cardiovascular Medicine 2023The evolution of the false lumen after the repair of acute aortic dissection has been linked to numerous adverse clinical outcomes, including increased late mortality... (Review)
Review
BACKGROUND AND AIM
The evolution of the false lumen after the repair of acute aortic dissection has been linked to numerous adverse clinical outcomes, including increased late mortality and a higher risk of reoperation. Despite the widespread use of chronic anticoagulation in patients who have undergone repair for acute aortic dissection, the effects of this therapy on false lumen evolution and its subsequent consequences are yet to be fully understood. This meta-analysis aimed to investigate the impact of postoperative anticoagulation on patients with acute aortic dissection.
METHODS
In PubMed, Cochrane Libraries, Embase, and Web of Science, we performed a systematic review of nonrandomized studies, comparing outcomes with postoperative anticoagulation vs. non-anticoagulation on aortic dissection. We investigated the status of false lumen (FL), aorta-related death, aortic reintervention, and perioperative stroke in aortic dissection patients with anticoagulation and non-anticoagulation.
RESULTS
After screening 527 articles, seven non-randomized studies were selected, including a total of 2,122 patients with aortic dissection. Out of these patients, 496 received postoperative anticoagulation while 1,626 served as controls. Meta-analyses of 7 studies revealed significantly higher FL patency in Stanford type A aortic dissection (TAAD) postoperative anticoagulation with an OR of 1.82 (95% CI: 1.22 to 2.71; = 2.95; ²=0%; =0.93). Moreover, there was no statistically significant difference between the two groups in aorta-related death, aortic reintervention, and perioperative stroke with an OR of 1.31 (95% CI: 0.56 to 3.04; = 0.62; ² = 0%; = 0.40), 0.98 (95% CI: 0.66 to 1.47; = 0.09; ² = 23%; = 0.26), 1.73 (95% CI: 0.48 to 6.31; = 0.83; ² = 8%; = 0.35), respectively.
CONCLUSIONS
Postoperative anticoagulation was associated with higher FL patency in Stanford type A aortic dissection patients. However, there was no significant difference between the anticoagulation and non-anticoagulation groups in terms of aorta-related death, aortic reintervention, and perioperative stroke.
PubMed: 37234372
DOI: 10.3389/fcvm.2023.1173945 -
Head & Neck Feb 2022We defined the occult nodal metastasis (ONM) rate of clinical node-negative salivary gland malignancies and examined the role of elective neck dissection (END).... (Meta-Analysis)
Meta-Analysis Review
We defined the occult nodal metastasis (ONM) rate of clinical node-negative salivary gland malignancies and examined the role of elective neck dissection (END). Meta-analysis querying four databases, from inception of databases to March 25th, 2020. Fifty-one studies with 11 698 patients were included. ONM rates were 64% for salivary ductal carcinoma (SDC), 51% for undifferentiated carcinoma, 34% for carcinoma ex-pleomorphic adenoma (CXPA), 32% for adenocarcinoma not otherwise specified (ANOS), 31% for lymphoepithelial carcinoma (LE), 20% for mucoepidermoid carcinoma, 17% for acinic cell carcinoma, and 17% for adenoid cystic carcinoma. T3/T4 tumors had a 2.3 times increased risk of ONM than T1/T2 tumors. High-grade tumors had a 3.8 times increased risk of ONM than low/intermediate-grade tumors. ONM rates were exceedingly high for T3/T4, high-grade, and undifferentiated, SDC, ANOS, CXPA, and LE tumors, indicating the potential role of END.
Topics: Carcinoma, Acinar Cell; Carcinoma, Adenoid Cystic; Carcinoma, Squamous Cell; Humans; Neck Dissection; Salivary Gland Neoplasms
PubMed: 34862810
DOI: 10.1002/hed.26923 -
Journal of Pediatric Surgery Apr 2022Laparoscopic orchiopexy (LO) was recently described as superior to open orchiopexy (OO) for palpable undescended testes (UDT). We aimed to investigate the outcomes of LO... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND/PURPOSE
Laparoscopic orchiopexy (LO) was recently described as superior to open orchiopexy (OO) for palpable undescended testes (UDT). We aimed to investigate the outcomes of LO of palpable UDT in relation to high retroperitoneal dissection, Prentiss maneuver and intrascrotal testis fixation; also, to identify evidence for the safety, efficacy and cost of LO compared with OO in palpable UDT.
METHODS
Systematic search was performed for all studies on LO for palpable UDT, and for all comparative studies between LO and OO in palpable UDT. Fisher's test was used to assess associations between success/complications rates and different LO approaches and meta-analysis to compare LO and OO.
RESULTS
In LO, success rates were not affected by regular high dissection (p = 1.0), Prentiss maneuver (p = 1.0) or intrascrotal fixation (p = 1.0); in fact, higher complications rates were noticed with regular high dissection (p = 0.002) and Prentiss maneuver (p = 0.01). Meta-analysis showed no significant differences between LO and OO in success (p = 0.17) and complications (p = 0.14) rates, while LO cost was higher in all comparative studies.
CONCLUSIONS
Evidence shows higher benefit-cost ratio for OO and, therefore, the latter should remain the procedure of choice. LO can be alternatively used, as it shows comparable safety/efficacy, but it should not include high dissection, Prentiss maneuver and testis fixation, when unnecessary.
TYPE OF STUDY
Systematic review and meta-analysis LEVEL OF EVIDENCE: III.
Topics: Cryptorchidism; Dissection; Humans; Infant; Laparoscopy; Male; Orchiopexy
PubMed: 34304904
DOI: 10.1016/j.jpedsurg.2021.07.003 -
Techniques in Coloproctology Jan 2016Endoscopic submucosal dissection (ESD) and local excision (LE) are minimally invasive procedures that can be used to treat early rectal cancer. There are no current... (Comparative Study)
Comparative Study Meta-Analysis Review
Endoscopic submucosal dissection (ESD) and local excision (LE) are minimally invasive procedures that can be used to treat early rectal cancer. There are no current guidelines or consensus on the optimal treatment strategy for these lesions. A systematic review was conducted to compare the efficacy and safety of ESD and LE. A meta-analysis was conducted following all aspects of the Cochrane Handbook for systematic reviews and preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement. To perform the statistical analysis, the odds ratio (OR) was used for categorical variables and the weighted mean difference (WMD) for continuous variables. Four studies, involving a total of 307 patients, were identified. The length of hospital stay was longer in the group of patients undergoing LE [weighted mean difference (WMD) -1.94; 95% CI -2.85 to -1.02; p < 0.0001]. The combined results of the individual studies showed no significant differences as regards en-bloc resection rate (OR 0.82; 95% CI 0.25-2.70; p = 0.74), R0 resection rate (OR 1.53; 95% CI 0.62-3.73; p = 0.35), overall complication rate (OR 0.67; 95% CI 0.26-1.69; p = 0.40), and tumor size (WMD 0.57; 95% CI -3.64 to 4.78; p = 0.79) between ESD and LE. When adopting the fixed effect model which takes into account the study size, ESD was associated with a lower recurrence rate than LE (OR 0.15; 95% CI 0.03-0.87; p = 0.03), while with the random-effect model the difference was not significant (OR 0.18; 95% CI 0.02-2.04; p = 0.17). Over the last decade improvements in technology have improved the technical feasibility of rectal ESD. In specialized centers with highly experienced endoscopists, ESD can provide high-quality en-bloc excision of rectal neoplasms equivalent to traditional local excision.
Topics: Aged; Colectomy; Dissection; Endoscopy, Gastrointestinal; Female; Humans; Intestinal Mucosa; Length of Stay; Male; Middle Aged; Neoplasm Recurrence, Local; Odds Ratio; Rectal Neoplasms; Rectum; Treatment Outcome
PubMed: 26519288
DOI: 10.1007/s10151-015-1383-5 -
The Laryngoscope Jul 2019The aim of this systematic review is to compare the perioperative outcomes of robotic versus conventional neck dissection in patients with head and neck malignancy. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The aim of this systematic review is to compare the perioperative outcomes of robotic versus conventional neck dissection in patients with head and neck malignancy.
METHODS
An electronic search of PubMed, Web of Science, and EMBASE databases was conducted. We included studies with direct comparisons of robotic and open neck dissections and performed dual, independent data extraction for primary outcomes of nodal yield, recurrence rate, subjective cosmetic assessment, operative time, length of stay, and rates of perioperative complications. Data were pooled using random effects meta-analysis to determine the standardized mean difference (SMD), absolute risk difference (RD), and 95% confidence intervals (CI).
RESULTS
Eleven comparative studies comprising 225 robotic and 430 open neck dissections met the final selection criteria. All studies had low to moderate risk of bias. Robotic surgery improved cosmesis (SMD 1.15, 95% CI 0.73 to 1.56) but also increased operative time (SMD 1.94, 95% CI 1.25 to 2.63). Total nodal yield, pathological nodal yield, recurrence rate, rates of perioperative complications, and length of stay were not significantly different between the two groups, and the 95% CIs suggested that false negative results were unlikely. The results remained consistent after stratification by pathology and robotic technique.
CONCLUSION
Although robotic neck dissection may offer similar perioperative outcomes compared to conventional neck dissection, it requires significantly more operative time. Whereas cosmesis was found to be superior among the robotic cohort, this must be viewed cautiously given the nonvalidated measurement tool that was used and the inherent reporting bias associated with it. Laryngoscope, 129:1587-1596, 2019.
Topics: Head and Neck Neoplasms; Humans; Neck Dissection; Robotic Surgical Procedures
PubMed: 30325513
DOI: 10.1002/lary.27533 -
Journal of the American Heart... Sep 2017Retrograde type A aortic dissection (RTAD) is a potentially lethal complication after thoracic endovascular aortic repair (TEVAR). However, data are limited regarding... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Retrograde type A aortic dissection (RTAD) is a potentially lethal complication after thoracic endovascular aortic repair (TEVAR). However, data are limited regarding the development of RTAD post-TEVAR. This systematic review aims to define the incidence, mortality, and potential risk factors of RTAD post-TEVAR.
METHODS AND RESULTS
Multiple electronic searches were performed. Fifty publications with a total of 8969 patients were analyzed. Pooled estimates for incidence and mortality of RTAD were 2.5% (95% confidence interval [CI], 2.0-3.1) and 37.1% (95% CI, 23.7-51.6), respectively. Metaregression analysis evidenced that RTAD rate was associated with hypertension (=0.043), history of vascular surgery (=0.042), and American Surgical Association (=0.044). The relative risk of RTAD was 1.81 (95% CI, 1.04-3.14) for acute dissection (relative to chronic dissection) and 5.33 (95% CI, 2.70-10.51) for aortic dissection (relative to a degenerative aneurysm). Incidence of RTAD was significantly different in patients with proximal bare stent and nonbare stent endografts (relative risk [RR]=2.06; 95% CI, 1.22-3.50). RTAD occurrence rate in zone 0 was higher than other landing zones.
CONCLUSIONS
The pooled RTAD rate after TEVAR was calculated at 2.5% with a high mortality rate (37.1%). Incidence of RTAD is significantly more frequent in patients treated for dissection than those with an aneurysm (especially for acute dissection), and when the proximal bare stent was used. Rate of RTAD after TEVAR varied significantly according to the proximal Ishimaru landing zone. The more-experienced centers tend to have lower RTAD incidences.
Topics: Aged; Aortic Dissection; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Female; Humans; Incidence; Male; Metals; Middle Aged; Odds Ratio; Prosthesis Design; Risk Factors; Stents; Treatment Outcome
PubMed: 28939705
DOI: 10.1161/JAHA.116.004649 -
Plastic and Reconstructive Surgery May 2023Supermicrosurgical simulators and experimental models promote test viability, a faster learning curve, technical innovations, and improvements of the surgical... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Supermicrosurgical simulators and experimental models promote test viability, a faster learning curve, technical innovations, and improvements of the surgical dexterities. The authors aimed to present a systematic review and meta-analysis of preclinical experimental models and simulation platforms used for supermicrosurgery.
METHODS
An electronic search was conducted across the PubMed MEDLINE, Embase, Web of Science, and Scopus databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data collection included the types of experimental models and outcomes. Pooled estimates were calculated with a random-effect meta-analysis using the DerSimonian-Laird model.
RESULTS
Thirty-eight articles were incorporated in the qualitative synthesis. Twenty-three articles reported the use of in vivo models (60.5%), 12 used ex vivo models (31.5%), and three used synthetic models (7.9%). The superficial inferior epigastric system of rats was the most common in vivo model, whereas chicken wings and hindlimbs were the most common methods used in ex vivo models. The most common methods to evaluate patency of anastomoses were gross inspection, passage of nylon thread into the lumen, and intravascular flow of an injected dye. Nineteen studies were incorporated in the meta-analysis. The overall rate of a successful anastomosis was 94.9% (95% CI, 92.3 to 97.5%). The success rate of in vivo models using rats was 92.5% (95% CI, 88.8 to 96.3%). The success rate of ex vivo models was 97.7% (95% CI, 94.6 to >99%).
CONCLUSION
Simulators that have high fidelity concerning the dissection of the vascular pedicle, flap elevation, supermicrovascular anastomosis, and adequate assessment of a successful anastomosis possess adequate predictive validation to evaluate and simulate the supermicrosurgical technique.
CLINICAL RELEVANCE STATEMENT
Supermicrosurgical simulators are designed to reproduce specific clinical scenarios; therefore, these should be implemented sequentially to develop specific competencies. Supermicrosurgical models must be regarded as mutually inclusive learning platforms to optimize the learning curve.
Topics: Rats; Animals; Microsurgery; Surgical Flaps; Anastomosis, Surgical; Dissection; Models, Theoretical
PubMed: 36729403
DOI: 10.1097/PRS.0000000000010084 -
Obstetrical & Gynecological Survey Feb 2017Abdominal wall endometriosis (AWE) is a rare but easily treated cause of pain in women, especially those who have undergone cesarean deliveries. (Review)
Review
IMPORTANCE
Abdominal wall endometriosis (AWE) is a rare but easily treated cause of pain in women, especially those who have undergone cesarean deliveries.
OBJECTIVE
This article reviews the diagnosis and management of AWE, a condition that generally develops after surgery but may arise spontaneously. We present a systematic review of the existing literature on AWE, as well as our clinical recommendations for medical and surgical management.
EVIDENCE ACQUISITION
We searched PubMed and other databases using the search criteria "abdominal wall endometriosis," "abdominal wall endometriomas," and "abdominal wall mass." The references of those articles were then reviewed, and additional publications were evaluated.
RESULTS
Many case reports and case series have been published describing AWE. The overall quality of evidence is poor due to the lack of prospective studies and heterogeneous descriptions of AWE lesions and treatment options. Based on the available literature, it appears that AWE may arise spontaneously but is generally associated with prior pelvic surgery. Abdominal wall endometriosis can be diagnosed with a careful history and physical examination. Imaging including ultrasound and magnetic resonance imaging can assist with localization of the lesions, and aid in surgical excision and management. Lesions that have been removed in their entirety are unlikely to reoccur.
CONCLUSIONS AND RELEVANCE
Although limited, the body of literature describing management of AWE suggests that it can be successfully treated in most patients with careful surgical planning.
Topics: Abdominal Wall; Disease Management; Dissection; Endometriosis; Female; Humans; Medical History Taking; Physical Examination
PubMed: 28218772
DOI: 10.1097/OGX.0000000000000399 -
Management and Outcomes of Aortic Dissection in Pregnancy with Marfan Syndrome: A Systematic Review.Current Vascular Pharmacology 2020In Marfan Syndrome (MFS), aortic dilatation is one of the main cardiovascular manifestations which deteriorate due to the physiological changes during pregnancy. We...
BACKGROUND
In Marfan Syndrome (MFS), aortic dilatation is one of the main cardiovascular manifestations which deteriorate due to the physiological changes during pregnancy. We aimed to assess the up-to-date management and outcomes of aortic root dilation and dissection (AoD) in pregnancy with MFS.
PATIENTS AND METHODS
A systematic review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Original studies published between January 1, 2001 and December 31, 2018 and which described the management and/or outcomes of AoD during or after pregnancy in women with MFS were included. Literature searches were conducted. The PubMed search was performed using terms "Marfan Syndrome" [Mesh] and "Pregnancy" [Mesh] whereas the Google Scholar search was for "Marfan" and "Pregnancy", all words anywhere in the article.
RESULTS
The literature search yielded 177 articles on PubMed and 13,900 articles on Google Scholar. Assessment of full-text articles for eligibility after removal of duplicates from both databases yielded 12 eligible studies to be included in the final review.
CONCLUSION
Women with MFS are at high risk of aortic dissection during pregnancy and women with aortic root 41-45 mm should consider avoiding pregnancy. Guideline-specific management of aortic aneurysms in pregnancy will reduce the risk of dissection. Diagnosis and Management of MFS need a multidisciplinary approach and team that should start working early in pregnancy. Further studies are needed to optimize medical and surgical approaches in addition to preconception counselling in highrisk subjects.
Topics: Aortic Dissection; Aortic Aneurysm; Blood Vessel Prosthesis Implantation; Female; Heart Valve Prosthesis Implantation; Humans; Marfan Syndrome; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 30963974
DOI: 10.2174/1570161117666190408164612