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Neurosurgical Review Apr 2024Brain Arteriovenous Malformations (bAVMs) are rare but high-risk developmental anomalies of the vascular system. Microsurgery through craniotomy is believed to be the... (Review)
Review
Enhancing the quality of evidence, comparability, and reproducibility in brain arteriovenous malformations treated with open surgery research: a systematic review and proposal of a reporting guideline for surgical and clinical outcomes.
Brain Arteriovenous Malformations (bAVMs) are rare but high-risk developmental anomalies of the vascular system. Microsurgery through craniotomy is believed to be the mainstay standard treatment for many grades of bAVMs. However, a significant challenge emerges in the existing body of clinical studies on open surgery for bAVMs: the lack of reproducibility and comparability. This study aims to assess the quality of studies reporting clinical and surgical outcomes for bAVMs treated by open surgery and develop a reporting guideline checklist focusing on essential elements to ensure comparability and reproducibility. This is a systematic literature review that followed the PRISMA guidelines with the search in Medline, Embase, and Web of Science databases, for studies published between January 1, 2018, and December 1, 2023. Included studies were scrutinized focusing on seven domains: (1) Assessment of How Studies Reported on the Baseline Characteristics of the Patient Sample; (2) Assessment and reporting on bAVMs grading, anatomical characteristics, and radiological aspects; (3) Angioarchitecture Assessment and Reporting; (4) Reporting on Pivotal Concepts Definitions; (5) Reporting on Neurosurgeon(s) and Staff Characteristics; (6) Reporting on Surgical Details; (7) Assessing and Reporting Clinical and Surgical Outcomes and AEs. A total of 47 studies comprising 5,884 patients were included. The scrutiny of the studies identified that the current literature in bAVM open surgery is deficient in many aspects, ranging from fundamental pieces of information of methodology to baseline characteristics of included patients and data reporting. Included studies demonstrated a lack of reproducibility that hinders building cumulative evidence. A bAVM Open Surgery Reporting Guideline with 65 items distributed across eight domains was developed and is proposed in this study aiming to address these shortcomings. This systematic review identified that the available literature regarding microsurgery for bAVM treatment, particularly in studies reporting clinical and surgical outcomes, lacks rigorous scientific methodology and quality in reporting. The proposed bAVM Open Surgery Reporting Guideline covers all essential aspects and is a potential solution to address these shortcomings and increase transparency, comparability, and reproducibility in this scenario. This proposal aims to advance the level of evidence and enhance knowledge regarding the Open Surgery treatment for bAVMs.
Topics: Humans; Reproducibility of Results; Intracranial Arteriovenous Malformations; Brain; Microsurgery; Neurosurgical Procedures
PubMed: 38643293
DOI: 10.1007/s10143-024-02422-z -
American Journal of Otolaryngology 2024In early glottic squamous cell carcinoma, similar results have been described in terms of disease control between transoral laser microsurgery (TLM) and radiation... (Meta-Analysis)
Meta-Analysis Comparative Study Review
PURPOSE
In early glottic squamous cell carcinoma, similar results have been described in terms of disease control between transoral laser microsurgery (TLM) and radiation therapy (RT). During the past two decades, several studies compared subjective vocal outcomes of exclusive RT with those of TLM, showing a trend towards improving results for TLM over time. However, the objective differences in terms of spectro-acoustic voice parameters between exclusive RT and TLM have been less frequently investigated. The aim of this systematic review with meta-analysis was to evaluate voice quality after TLM and RT treatment for early glottic carcinoma, based on acoustic analysis parameters including jitter, shimmer, noise to harmonic ratio, fundamental frequency and maximum phonation time.
MATERIAL AND METHODS
A search of the English published literature was conducted on the Pubmed, Scopus and Cochrane databases following PRISMA guidelines.
RESULTS
A total of 441 titles were retrieved from the search. After full-text screening and application of inclusion/exclusion criteria, 12 articles were included. We found no significant differences between TLM and RT treatment in the considered acoustic analysis parameters, except for Shimmer, with more favorable values reported in the RT group.
CONCLUSIONS
Considering the spread of the disease and expecting an improvement in long-term survival over time, well-designed and multicentric studies involving larger populations with a long-term follow up are mandatory to better assess objective voice outcomes in terms of spectro-acoustic voice parameters.
Topics: Humans; Laryngeal Neoplasms; Microsurgery; Glottis; Laser Therapy; Voice Quality; Neoplasm Staging; Treatment Outcome; Carcinoma, Squamous Cell; Speech Acoustics; Male
PubMed: 38579506
DOI: 10.1016/j.amjoto.2024.104272 -
Journal of Stomatology, Oral and... Jun 2024The aim of this study is to compare the outcomes of vascular anastomosis using loupes magnification versus operative microscope magnification in reconstructive surgery. (Meta-Analysis)
Meta-Analysis Review
Can Loupe magnification be a viable alternative to Operative Microscope magnification for vascular anastomosis in reconstructive surgery? A systematic review and meta-analysis.
PURPOSE
The aim of this study is to compare the outcomes of vascular anastomosis using loupes magnification versus operative microscope magnification in reconstructive surgery.
METHODS
We performed a systematic review of MEDLINE (via PubMed), Scopus and Cochrane Library database according to the PRISMA guidelines. Comparative studies between the two techniques and single arm studies reporting on loupes reconstruction were included. Random-effects model meta-analyses were performed.
RESULTS
Twelve studies, reporting a total of 3908 of flaps, 3409 of which were performed under loupes magnification and 499 under the operative microscope magnification were selected for analysis. No statistically significant differences were observed regarding total flap loss and vascular complication between the two arms. In the Loupes group the rate of total flap loss was 2.65% (95% CI: 1.15-4.63) and the rate of vascular complications 4.49% (95% CI: 2.58-6.84).
CONCLUSION
Loupes magnification under circumstances can provide a safe and effective alternative to microvascular reconstruction in reconstructive surgery. With respect to flap failure and vascular complication rates, there appear to be no statistically significant differences between the anastomoses conducted under Loupes magnification and the standard operative microscope.
Topics: Humans; Anastomosis, Surgical; Plastic Surgery Procedures; Microscopy; Microsurgery; Vascular Surgical Procedures; Surgical Flaps
PubMed: 38575496
DOI: 10.1016/j.jormas.2024.101845 -
European Archives of... Apr 2024In laryngeal squamous cell carcinoma (LSCC) treated with transoral laser microsurgery (TOLMS), the status of margins significantly affected local control. When a... (Review)
Review
PURPOSE
In laryngeal squamous cell carcinoma (LSCC) treated with transoral laser microsurgery (TOLMS), the status of margins significantly affected local control. When a positive or close margin is present, there is no ubiquitous consensus regarding further treatments. The rationale of the present systematic review and meta-analysis is to investigate the survival impact of the status of the margins in patients affected by LSCC treated with TOLMS.
DATA SOURCES
PubMed, EMBASE, and Cochrane Library.
METHODS
We performed a systematic search, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria were: patients affected by LSCC, staged according to the American Joint Committee on Cancer Staging System and treated by TOLMS without any previous treatment; margins status (close, positive, negative) and the adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) of overall survival, disease-specific survival, and disease-free survival has to be reported.
RESULTS
Nine studies were deemed eligible for the qualitative analysis, and 3 for the quantitative analysis to investigate the association between margin status and OS. The cumulative number of patients was 3130. The sample size ranged from 96 to 747 patients. The follow-up period ranged from 0 to 201 months. The meta-analysis results show that positive margins have an aHR of 1.30 yet with CI range (0.56 to 2.97).
CONCLUSIONS
Our current meta-analysis results are unable to definitively assess the real impact of resection margins on OS. Few authors provide accurate data regarding position and types of margins. Further prospective or high-quality studies are required.
PubMed: 38564009
DOI: 10.1007/s00405-024-08610-3 -
Aesthetic Plastic Surgery Apr 2024Keloid scars are a particularly challenging fibroproliferative wound healing disorder with a variety of proposed management approaches including concurrent surgery and... (Review)
Review
Keloid scars are a particularly challenging fibroproliferative wound healing disorder with a variety of proposed management approaches including concurrent surgery and intralesional steroid injection. We aimed to identify the optimum time for triamcinolone injection of keloids, by comparing the recurrence and complication occurrence in patients who received pre-, intra- or post-operative injection. Studies reporting on the rate of recurrence and complication occurrence following treatment of keloid scarring with concurrent surgical excision and intralesional steroid injection were identified from the PubMed, Web of science and Embase databases. The I-squared (I) statistic was used to quantify the variability in study estimates due to heterogeneity and to determine whether the fixed or random effect models will be employed. Publication bias was visualized through funnel plots and tested with the Egger's test. We found that the recurrence rate was significantly lower with post-operative injection compared to intra-operative injection (p < 0.001) and pre-operative injection (p = 0.009). A significant difference between intra-operative and pre-operative injection was not found (p = 0.46). In conclusion, post-operative steroid injection after surgical excision results in lower keloid recurrence compared to pre- and intra-operative injection.Level of Evidence IV "This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ."
PubMed: 38561576
DOI: 10.1007/s00266-024-03935-0 -
Microsurgery May 2024
Comments on "Comparison of the outcomes of split thickness skin graft versus thickness skin graft for closure of the radial forearm free flap donor site: A systematic review".
Topics: Humans; Skin Transplantation; Free Tissue Flaps; Plastic Surgery Procedures; Skin
PubMed: 38549401
DOI: 10.1002/micr.31170 -
Dermatologic Surgery : Official... Jul 2024Mohs micrographic surgery (MMS) is increasingly used to treat cutaneous melanoma. However, it is unclear whether intraoperative immunohistochemistry (IHC) improves... (Meta-Analysis)
Meta-Analysis
Intraoperative Immunohistochemistry During Mohs Micrographic Surgery and Staged Excision Decreases Local Recurrence Rates for Invasive Cutaneous Melanoma: A Systematic Review and Meta-Analysis.
BACKGROUND
Mohs micrographic surgery (MMS) is increasingly used to treat cutaneous melanoma. However, it is unclear whether intraoperative immunohistochemistry (IHC) improves surgical outcomes.
OBJECTIVE
To determine whether intraoperative IHC during MMS and staged excision is associated with a decreased risk of poor surgical outcomes.
MATERIALS AND METHODS
Search of 6 databases identified comparative and noncomparative studies that reported local recurrence after MMS or staged excision with or without IHC for melanoma. Random-effects meta-analysis was used to estimate pooled local recurrence rates, nodal recurrence, distant recurrence, and disease-specific mortality.
RESULTS
Overall, 57 studies representing 12,043 patients with cutaneous melanoma and 12,590 tumors met inclusion criteria. Combined MMS and staged excision with IHC was associated with decreased local recurrence in patients with invasive melanoma (0.3%, 95% CI: 0-0.6) versus hematoxylin and eosin alone (1.8%, 95% CI: 0.8%-2.8%) [ p < .001]. Secondary outcomes including nodal recurrence, distant recurrence, and disease-specific mortality were not significantly different between these 2 groups. Study heterogeneity was moderately-high.
CONCLUSION
Local recurrence of invasive melanoma is significantly lower after MMS and staged excision with IHC as opposed to without IHC. These findings suggest that the use of intraoperative IHC during MMS or staged excision should strongly be considered, particularly for invasive melanoma.Trial Registration PROSPERO Identifier: CRD42023435630.
Topics: Humans; Skin Neoplasms; Melanoma; Mohs Surgery; Neoplasm Recurrence, Local; Immunohistochemistry; Neoplasm Invasiveness; Intraoperative Care
PubMed: 38530980
DOI: 10.1097/DSS.0000000000004164 -
Otolaryngology--head and Neck Surgery :... Mar 2024We aim to systematically review the literature addressing perioperative practices for optimal use of the CO laser in laryngeal transoral laser microsurgery (TOLMS), with... (Review)
Review
OBJECTIVE
We aim to systematically review the literature addressing perioperative practices for optimal use of the CO laser in laryngeal transoral laser microsurgery (TOLMS), with a focus on safety.
DATA SOURCES
A systematic review of publications indexed in Medline, Embase, and EBM reviews-Cochrane Central Register of Controlled Trials which evaluated perioperative strategies for the use of CO laser in laryngeal TOLMS was conducted.
REVIEW METHODS
Records obtained from the search strategy were assessed for eligibility in a 2-step process by 2 independent researchers using the Covidence software.
RESULTS
Among 2143 identified records, 103 were included in this study. The majority of studies (n = 25) focused on the use of the CO laser in oncologic resection, while 20 addressed the treatment of vocal cord paralysis, 16 discussed the treatment of pediatric or congenital pathologies, 11 detailed the management of benign lesions, and 31 studies tackled other surgical indications. Strategies for safe CO TOLMS were highly heterogeneous across studies and included preoperative measures (ie, related to the environment, staff preparation, patient protection, and ventilation), intraoperative precautions (ie, protection of nontarget structures, technical considerations, topical and systemic medications), and postoperative strategies (ie, related to airway protection, oral intake, vocal rest, hospitalization duration, drug regimen, and consultant follow-up).
CONCLUSION
The results provided in this study can be used as a framework to guide the creation of laser safety protocols across institutions, guide quality improvement initiatives, the development of simulation training activities, and as a tool to facilitate resident teaching and skill assessment.
PubMed: 38529664
DOI: 10.1002/ohn.734 -
Arquivos de Gastroenterologia 2024Colorectal cancer is the third most common cancer, and prevention relies on screening programs with resection complete resection of neoplastic lesions. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Colorectal cancer is the third most common cancer, and prevention relies on screening programs with resection complete resection of neoplastic lesions.
OBJECTIVE
We aimed to evaluate the best snare polypectomy technique for colorectal lesions up to 10 mm, focusing on complete resection rate, and adverse events.
METHODS
A comprehensive search using electronic databases was conducted to identify randomized controlled trials comparing hot versus cold snare resection for polyps sized up to 10 mm, and following PRISMA guidelines, a meta-analysis was performed. Outcomes included complete resection rate, en bloc resection rate, polypectomy, procedure times, immediate, delayed bleeding, and perforation.
RESULTS
Nineteen RCTs involving 8720 patients and 17588 polyps were included. Hot snare polypectomy showed a higher complete resection rate (RD, 0.02; 95%CI [+0.00,0.04]; P=0.03; I 2=63%), but also a higher rate of delayed bleeding (RD 0.00; 95%CI [0.00, 0.01]; P=0.01; I 2=0%), and severe delayed bleeding (RD 0.00; 95%CI [0.00, 0.00]; P=0.04; I 2=0%). Cold Snare was associated with shorter polypectomy time (MD -46.89 seconds; 95%CI [-62.99, -30.79]; P<0.00001; I 2=90%) and shorter total colonoscopy time (MD -7.17 minutes; 95%CI [-9.10, -5.25]; P<0.00001; I 2=41%). No significant differences were observed in en bloc resection rate or immediate bleeding.
CONCLUSION
Hot snare polypectomy presents a slightly higher complete resection rate, but, as it is associated with a longer procedure time and a higher rate of delayed bleeding compared to Cold Snare, it cannot be recommended as the gold standard approach. Individual analysis and personal experience should be considered when selecting the best approach.
Topics: Humans; Colonoscopy; Colonic Polyps; Colorectal Neoplasms; Randomized Controlled Trials as Topic; Microsurgery
PubMed: 38511795
DOI: 10.1590/S0004-2803.246102023-143 -
Journal of Plastic, Reconstructive &... Apr 2024Plastic surgery (PS) in Africa is a relatively young surgery specialty, and the number of available plastic surgeons on average is one or two surgeons per country in... (Review)
Review
BACKGROUND
Plastic surgery (PS) in Africa is a relatively young surgery specialty, and the number of available plastic surgeons on average is one or two surgeons per country in many African low-income countries. This systematic review aims to geographically map the research activities through scientific publications of African PS centres, between February 2012-February 2023.
METHODS
We searched four literature databases (Medline, Embase, Google Scholar and African Journal Online) and did a manual search. We included case reports, randomised controlled trials, and clinical, comparative, observational and multicentre studies conducted in Africa and published in English and French. In the Google Scholar database, we analysed the first 200 references (scientific articles) selected per relevance according to the Boolean terms. In the African Journals Online database, we analysed the references from the first five pages. The selected keywords were: burns, trauma reconstruction, pressure injuries, wound, cleft lip and palate, breast reconstruction, microsurgery, aesthetic surgery, face surgery, head and neck surgery, hand surgery, open fracture surgery, oculoplastic surgery, skin surgery, and soft tissue surgery.
RESULTS
We retrieved a total of 228 articles. Out of the 73 African centres we identified, 27 were in the North, 22 in the West, 8 in the East, 3 in the Centre, and 14 in the South. Most of the retrieved 228 articles involved burns (60, 26.31%), congenital abnormalities (52, 22.80%) and reconstruction (28,12.80%); however, other conditions, such as breast or skin cancer, hand surgery, microsurgery or aesthetics are emerging. The studies were case reports/case series (93, 40.78%), retrospective (78, 34.21%), prospective (36, 15.78%), randomised controlled studies (10, 4.38%), cross-sectional (5, 2,19%) and cohort (2, 0.87%).
CONCLUSIONS
Beyond burns, congenital abnormalities, or reconstructions, other PS indications are emerging, such as skin cancer, breast reconstruction, hand surgery, microsurgery, and aesthetics.
Topics: Humans; Surgery, Plastic; Cleft Lip; Retrospective Studies; Cross-Sectional Studies; Prospective Studies; Cleft Palate; Burns; Skin Neoplasms
PubMed: 38479124
DOI: 10.1016/j.bjps.2024.01.058