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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 -
International Journal of Surgery... Sep 2023To compare the safety and efficacy of robotic-assisted retroperitoneal lymph node dissection (RA-RPLND) versus non-robotic retroperitoneal lymph node dissection in... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To compare the safety and efficacy of robotic-assisted retroperitoneal lymph node dissection (RA-RPLND) versus non-robotic retroperitoneal lymph node dissection in testicular cancer.
METHODS
The statistical analysis software used Stata 17. The weighted mean difference (WMD) represents the continuous variable, and the dichotomous variable chooses the odds ratio, and calculates the 95% CI. This systematic review and cumulative meta-analysis was performed according to PRISMA criteria, and AMSTAR guidelines (assessing the methodological quality of systematic reviews). The Embase, PubMed, Cochrane Library, Web of Science, and Scopus databases were searched. The upper limit of the search time frame was February 2023, and no lower limit was set.
RESULTS
Seven studies involving 862 patients. Compared with open retroperitoneal lymph node dissection, RA-RPLND appears to have a shorter length of stay [WMD=-1.21, 95% CI (-1.66, -0.76), P <0.05], less estimated blood loss [WMD=-0.69, 95% CI (-1.07, -0.32), P <0.05], and lower overall complications [odds ratio=0.45, 95% CI (0.28, 0.73), P <0.05]. RA-RPLND appears to have more lymph node yields than laparoscopic retroperitoneal lymph node dissection [WMD=5.73, 95% CI (1.06, 10.40), P <0.05]. However, robotic versus open/laparoscopic retroperitoneal lymph node dissection had similar results in operation time, lymph node positivity rate, recurrence during follow-up, and postoperative ejaculation disorders.
CONCLUSION
RA-RPLND appears to be safe and effective for testicular cancer, but longer follow-up and more studies are needed to confirm this.
Topics: Male; Humans; Testicular Neoplasms; Robotic Surgical Procedures; Retroperitoneal Space; Retrospective Studies; Lymph Node Excision; Treatment Outcome; Laparoscopy
PubMed: 37222676
DOI: 10.1097/JS9.0000000000000520 -
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 -
The Neuroradiology Journal Aug 2015Flow-diverter devices (FDDs) are new-generation stents placed in the parent artery at the level of the aneurysm neck to disrupt the intra-aneurysmal flow thus favoring... (Review)
Review
BACKGROUND
Flow-diverter devices (FDDs) are new-generation stents placed in the parent artery at the level of the aneurysm neck to disrupt the intra-aneurysmal flow thus favoring intra-aneurysmal thrombosis.
OBJECTIVE
The objective of this review article is to define the indication and results of the treatment of intracranial aneurysms by FDD, reviewing 18 studies of endovascular treatment by FDDs for a total of 1704 aneurysms in 1483 patients.
METHODS
The medical literature on FDDs for intracranial aneurysms was reviewed from 2009 to December 2014. The keywords used were: "intracranial aneurysms," "brain aneurysms," "flow diverter," "pipeline embolization device," "silk flow diverter," "surpass flow diverter" and "FRED flow diverter."
RESULTS
The use of these stents is advisable mainly for unruptured aneurysms, particularly those located at the internal carotid artery or vertebral and basilar arteries, for fusiform and dissecting aneurysms and for saccular aneurysms with large necks and low dome-to-neck ratio. The rate of aneurysm occlusion progressively increases during follow-up (81.5% overall rate in this review). The non-negligible rate of ischemic (mean 4.1%) and hemorrhagic (mean 2.9%) complications, the neurological morbidity (mean 3.5%) and the reported mortality (mean 3.4%) are the main limits of this technique.
CONCLUSION
Treatment with FDDs is a feasible and effective technique for unruptured aneurysms with complex anatomy (fusiform, dissecting, large neck, bifurcation with side branches) where coiling and clipping are difficult or impossible. Patient selection is very important to avoid complications and reduce the risk of morbidity and mortality. Further studies with longer follow-up are necessary to define the rate of complete occlusion.
Topics: Cerebral Angiography; Embolization, Therapeutic; Endovascular Procedures; Equipment Design; Humans; Intracranial Aneurysm; Stents
PubMed: 26314872
DOI: 10.1177/1971400915602803 -
Journal of Vascular Surgery Dec 2019Isolated abdominal aortic dissection (IAAD) has remained poorly understood because of its rarity. We explored the prevalence, clinical characteristics, risk factors,... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Isolated abdominal aortic dissection (IAAD) has remained poorly understood because of its rarity. We explored the prevalence, clinical characteristics, risk factors, imaging characteristics, and treatment strategy of IAAD to facilitate its diagnosis and treatment.
METHODS
We performed a meta-analysis of 17 studies, with single-arm-based and network meta-analysis as the main data synthesis method. The Medline, Embase, and Cochrane library were searched from their inception to July 2018. A total of 9163 patients with aortic disease were enrolled, with IAAD identified in 491 patients.
RESULTS
The pooled prevalence of IAAD among cases of aortic dissection overall, type B aortic dissection, and type A aortic dissection was 1.7% (95% confidence interval [CI], 0.9%-3.4%), 4.1% (95% CI, 2.5%-6.6%), and 2.0% (95% CI, 0.7%-3.9%), respectively. Abdominal pain was the most common symptom (50.8%), followed by back pain (30.5%), and chest pain (21.7%). Up to 41.0% of the patients with IAAD did not present with any clinical symptoms, and up to 71.0% of these patients had negative findings on physical examination. The top three most prevalent risk factors for IAAD were hypertension, hyperlipidemia, and smoking. Most cases of IAAD were limited to the aorta inferior to the renal arteries (81.7%), and the average aortic diameter was 4 cm. No statistically significant difference was observed between open surgery, endovascular aortic repair, and conservative management for both early and late mortality.
CONCLUSIONS
The results from the present meta-analysis regarding IAAD support the following conclusions and recommendations. First, IAAD is rare and predominantly affects males. Second, symptoms (pain) might or might not be present, and physical findings will rarely be found on abdominal examination. Third, hypertension is the most prevalent risk factor. Fourth, most cases IAAD will be infrarenal. Finally, a complication-specific approach, similar to that for type B aortic dissection, would be appropriate.
Topics: Aortic Dissection; Aortic Aneurysm, Abdominal; Humans; Prevalence; Risk Factors
PubMed: 31204217
DOI: 10.1016/j.jvs.2019.04.467 -
BMC Veterinary Research Apr 2017The optimisation of trypanosomosis control programs warrants a good knowledge of the main vector of animal and human trypanosomes in sub-Saharan Africa, the tsetse fly.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The optimisation of trypanosomosis control programs warrants a good knowledge of the main vector of animal and human trypanosomes in sub-Saharan Africa, the tsetse fly. An important aspect of the tsetse fly population is its trypanosome infection prevalence, as it determines the intensity of the transmission of the parasite by the vector. We therefore conducted a systematic review of published studies documenting trypanosome infection prevalence from field surveys or from laboratory experiments under controlled conditions. Publications were screened in the Web of Science, PubMed and Google Scholar databases. Using the four-stage (identification, screening, eligibility and inclusion) process in the PRISMA statement the initial screened total of 605 studies were reduced to 72 studies. The microscopic examination of dissected flies (dissection method) remains the most used method to detect trypanosomes and thus constituted the main focus of this analysis. Meta-regression was performed to identify factors responsible for high trypanosome prevalence in the vectors and a random effects meta-analysis was used to report the sensitivity of molecular and serological tests using the dissection method as gold standard.
RESULTS
The overall pooled prevalence was 10.3% (95% confidence interval [CI] = 8.1%, 12.4%) and 31.0% (95% CI = 20.0%, 42.0%) for the field survey and laboratory experiment data respectively. The country and the year of publication were found to be significantly factors associated with the prevalence of trypanosome infection in tsetse flies. The alternative diagnostic tools applied to dissection positive samples were characterised by low sensitivity, and no information on the specificity was available at all.
CONCLUSION
Both temporal and spatial variation in trypanosome infection prevalence of field collected tsetse flies exists, but further investigation on real risk factors is needed how this variation can be explained. Improving the sensitivity and determining the specificity of these alternative diagnostic tools should be a priority and will allow to estimate the prevalence of trypanosome infection in tsetse flies in high-throughput.
Topics: Animals; Insect Vectors; Prevalence; Trypanosoma; Tsetse Flies
PubMed: 28403841
DOI: 10.1186/s12917-017-1012-9 -
Gynecologic Oncology Mar 2023The purpose of this systematic review and meta-analysis was to evaluate the proportion and risk factors of lymphoceles and symptomatic lymphoceles after PLND in... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The purpose of this systematic review and meta-analysis was to evaluate the proportion and risk factors of lymphoceles and symptomatic lymphoceles after PLND in early-stage cervical and early-stage high or high-intermediate risk endometrial cancer.
METHODS
Studies reporting on the proportion of lymphocele after PLND were conducted in PubMed, Embase and Cochrane Library. Retrieved studies were screened on title/abstract and full text by two reviewers independently. Quality assessment was conducted using the Newcastle Ottowa Scale and the Cochrane risk-of-bias tool. Proportion of lymphocele and possible risk factors were pooled through random-effects meta-analyses.
RESULTS
From the 233 studies retrieved, 24 studies were included. The pooled proportion of lymphocele was 14% and of symptomatic lymphocele was 3%. Routinely performing diagnostics was associated with a significantly higher proportion of lymphocele compared to diagnostics performed on indication (21% versus 4%, p < 0.01). Laparotomic surgical approach led to a significantly higher proportion of lymphoceles than laparoscopic surgical approach (18% versus 7%, p = 0.05). The proportion of lymphocele was significantly higher when >15% of the study population underwent additional paraaortic lymph node dissection (PAOLND) opposed to <15% (15% versus 3%, p < 0.01). A mean number of lymph nodes dissected of <21 resulted in a significantly higher pooled proportion of lymphoceles opposed to when the mean number was 21 or higher (19% versus 5%, p = 0.02). Other risk factors analysed were BMI, lymph node metastasis, adjuvant radiotherapy and follow up. There was no sufficient data to detect significant risk factors for the development of symptomatic lymphoceles.
CONCLUSION
The pooled proportion of lymphocele was 14% of which symptomatic lymphoceles occurred in 3%. Significant risk factors for the total proportion of lymphoceles were laparotomic approach, decreased number of lymph nodes dissected and additional PAOLND.
Topics: Female; Humans; Lymphocele; Lymph Node Excision; Lymph Nodes; Laparoscopy; Endometrial Neoplasms; Pelvis; Postoperative Complications
PubMed: 36738486
DOI: 10.1016/j.ygyno.2023.01.022 -
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 -
Annals of Cardiothoracic Surgery May 2014The management of acute type B dissection represents a clinical challenge. We undertook a systematic review of the available literature regarding medical, surgical and... (Review)
Review
BACKGROUND
The management of acute type B dissection represents a clinical challenge. We undertook a systematic review of the available literature regarding medical, surgical and endovascular treatments of acute type B aortic dissection and combined the eligible studies into a meta-analysis.
METHODS
An extensive electronic health database search was performed on all articles published from January 2006 up to November 2013 describing the management of acute type B aortic dissection. Studies including less than 15 patients were excluded.
RESULTS
ACUTE COMPLICATED TYPE B DISSECTION: overall, 2,531 patients were treated with endovascular repair (TEVAR) and the pooled rate for 30-day/in-hospital mortality was 7.3%. The pooled estimates for cerebrovascular events, spinal cord ischemia (SCI) and total neurologic events were 3.9%, 3.1% and 7.3%, respectively. A total of 1,276 patients underwent open surgical repair and the pooled rate for 30-day/in-hospital mortality was 19.0%. The pooled rate for cerebrovascular events was 6.8%, for SCI 3.3% and for total neurologic complications 9.8%. Acute uncomplicated type B dissection: outcome of 2,347 patients who underwent conservative medical management were analyzed. The pooled 30-day/in-hospital mortality rate was 2.4%. The pooled rate for cerebrovascular events was 1%, for SCI 0.8% and for overall neurologic complications 2%.
CONCLUSIONS
Endovascular repair provides a superior 30-day/in-hospital survival for acute complicated type B aortic dissection compared to surgical aortic reconstruction. However, open repair still has a significant role as endovascular repair is not applicable in all patients and there remains concerns regarding the durability of this technique. TEVAR seems to have a more favorable outcome regarding aortic remodeling and the aortic-specific survival rate when compared with medical therapy alone. Randomized controlled trials focusing on the prognostic factors of early and late complications in uncomplicated type B dissections are needed.
PubMed: 24967162
DOI: 10.3978/j.issn.2225-319X.2014.05.08 -
Catheterization and Cardiovascular... Jun 2021Iatrogenic aorto-coronary dissection (ICD) is one of the most feared complications of interventional cardiology. Although rare, it is characterized by anterograde...
OBJECTIVES AND BACKGROUND
Iatrogenic aorto-coronary dissection (ICD) is one of the most feared complications of interventional cardiology. Although rare, it is characterized by anterograde coronary ischemia and a concomitant aortic dissection, with potentially fatal consequences.
METHODS
We present an example case of IACD and an accurate case-series review of the literature including 125 published cases.
RESULTS
There were no significant predisposing factors and the IACD occurred equally in elective and urgent procedures. A significant number of IACDs were associated with CTO procedures. The factors associated with a worse outcome were hemodynamic instability, the presence of anterograde ischemia, and the extent of dissection according to the Dunning classification. Bail-out stenting was the most used strategy and its failure was associated with mortality.
CONCLUSION
The main features of IACD are anterograde ischemia, retrograde dissection, and hemodynamic instability, each of them should be addressed with no time delay, possibly with bailout stenting, the most employed exit-strategy. According to our proposed algorithm, a shock team approach is required to coordinate the interdisciplinary skills and enabled patients to receive the best treatment.
Topics: Humans; Aorta; Aortic Dissection; Coronary Angiography; Coronary Vessels; Dissection; Iatrogenic Disease; Treatment Outcome
PubMed: 33201611
DOI: 10.1002/ccd.29367