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Zheng X, Wang F, Su YC, Xu CY, Wang MZ. Efficacy and safety of fibrin sealant application in patients undergoing thyroidectomy: a systematic review and meta-analysis. BMC Surg 2024; 24:122. [PMID: 38658932 PMCID: PMC11041004 DOI: 10.1186/s12893-024-02414-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
Various studies have focused on the application of fibrin sealants (FS) in thyroid surgery. Utilizing a meta-analysis, this systematic review analyzed the findings of recent randomized controlled trials on the safety and efficacy of FS in patients who underwent thyroidectomy. The Cochrane Library, Web of Science, Embase, PubMed, and Medline databases were searched for relevant studies, without any language restrictions. Seven randomized controlled trials were included in the originally identified 69 studies. Overall, 652 patients received FS during thyroid surgery; their outcomes were compared with those of conventionally treated patients. The primary outcomes were total volume of wound drainage, length of hospitalization, and operative time. Significant differences were observed in the total volume of wound drainage (mean deviation (MD): -29.75, 95% confidence interval (CI): -55.39 to -4.11, P = 0.02), length of hospitalization (MD: -0.84, 95% CI: -1.02 to -0.66, P < 0.00001), and surgery duration (MD: -7.60, 95% CI: -14.75 to -0.45, P = 0.04). Secondary outcomes were seroma and hypoparathyroidism development. The risk of hypoparathyroidism did not differ between the FS and conventional groups (I = 0%, relative risk = 1.31, P = 0.38). Analysis of "seroma formation that required invasive treatment" indicated that FS showed some benefit (I2 = 8%, relative risk 0.44, P = 0.15). Heterogeneity among the different trials limited their conclusions. The meta-analysis showed that although FS use did not significantly reduce seroma or hypoparathyroidism incidence in patients after thyroidectomy, it significantly reduced the total drainage volume, length of hospitalization, and duration of surgery.
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Affiliation(s)
- XiaoGang Zheng
- Jinhua Maternity and Child Health Care Hospital, Surgery, Xia man University, Jinhua City, 324100, China
| | - Fan Wang
- Jinhua Central Hospital, Surgery, Zhejiang University, Jinhua City, 324100, China
| | - Yong Cheng Su
- Xiamen Key Laboratory for Tumor Metastasis, Cancer Research Center, School of Medicine, Xiamen University, Xiamen, 361102, China
| | - Chao Yang Xu
- Jinhua Central Hospital, Surgery, Zhejiang University, Jinhua City, 324100, China.
| | - Ming Zheng Wang
- Jinhua Central Hospital, Surgery, Shandong University, Jinhua City, 324100, China
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López Gordo S, Ruiz-Edo N, Fernández-Planas MT, Viscaya-Martín S, Serra-Serra C. Seroma control in axillary lymphadenectomy with Glubran 2® without drain. Multicenter, prospective, randomized, clinical trial. GALA-ND study (Glubran, Axillary Lymphadenectomy, Ambulatory, No Drain). Trials 2024; 25:142. [PMID: 38388444 PMCID: PMC10885511 DOI: 10.1186/s13063-023-07840-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 11/30/2023] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Seroma after breast cancer surgery is a frequent entity; therefore, different products have been described in literature with the aim to reduce it. The most studied ones have been the sealants products, being tested with aspirative drains. Symptomatic seroma represents the 19% after axillary lymphadenectomy without drains. The aim of this study is to analyze the effect of a sealant in the seroma control after axillary lymphadenectomy without drains and identify the risk factors related to symptomatic seroma. METHODS This is a prospective, multicenter, international, and randomized clinical trial. Patients undergoing conservative surgery and axillary lymphadenectomy for breast cancer will be randomized to control group (lymphadenectomy without sealant) or interventional group (lymphadenectomy with sealant Glubran 2®). In any of the study groups, drains are placed. Patients who received neoadjuvant treatment are included. Measurements of the study outcomes will take place at baseline; at 7, 14, and 30 days post-surgery; and at 6-12 months. The primary outcome is symptomatic seroma. Secondary outcomes are seroma volume, morbidity, quality of life, and lymphedema. DISCUSSION Several studies compare the use of sealant products in axillary lymphadenectomy but generally with drains. We would like to demonstrate that patients who underwent axillary lymphadenectomy could benefit from an axillary sealant without drains and reduce axillary discomfort while maintaining a good quality of life. Assessing the relationship between axillary volume, symptoms, and related risk factors can be of great help in the control of seroma in patients who received breast cancer surgery. TRIAL REGISTRATION ClinicalTrials.gov, NCT05280353. Registration date 02 August 2022.
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Affiliation(s)
- Sandra López Gordo
- General Surgeon, Breast Cancer Unit of Maresme Health Consortium (Mataró Hospital), Carr. de Cirera, 230, 08304 Mataró, Barcelona, Spain.
- Associated professor at the Autonomous University of Barcelona (UAB), Bellaterra 08193, Barcelona, Spain.
| | - Neus Ruiz-Edo
- General Surgeon, Breast Cancer Unit of Maresme Health Consortium (Mataró Hospital), Carr. de Cirera, 230, 08304 Mataró, Barcelona, Spain
| | - Maria Teresa Fernández-Planas
- General Surgeon, Breast Cancer Unit of Maresme Health Consortium (Mataró Hospital), Carr. de Cirera, 230, 08304 Mataró, Barcelona, Spain
- Radiologist, Breast Cancer Unit of Maresme Health Consortium (Mataró Hospital), Carr. de Cirera, 230, 08304 Mataró, España
| | - Sara Viscaya-Martín
- General Surgeon, Breast Cancer Unit of Maresme Health Consortium (Mataró Hospital), Carr. de Cirera, 230, 08304 Mataró, Barcelona, Spain
| | - Cristina Serra-Serra
- General Surgeon, Breast Cancer Unit of Maresme Health Consortium (Mataró Hospital), Carr. de Cirera, 230, 08304 Mataró, Barcelona, Spain
- Gynecologist, Breast Cancer Unit of Maresme Health Consortium (Mataró Hospital), Carr. de Cirera, 230, 08304 Mataró, España
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Li G, Cai J, Xie J, Dai Y. Extracellular fibrin promotes non-small cell lung cancer progression through integrin β1/PTEN/AKT signaling. Open Life Sci 2023; 18:20220716. [PMID: 37744455 PMCID: PMC10512450 DOI: 10.1515/biol-2022-0716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 09/26/2023] Open
Abstract
The extracellular matrix (ECM) has been strongly correlated with cancer progression in various tumor types. However, the specific mechanisms underlying ECM-associated tumor behaviors remain unclear. In this study, we found an enriched distribution of fibrin in tumor tissues obtained from high-grade non-small cell lung cancer (NSCLC) patients. For further investigation, we established an in vitro 3D culture system using fibrin gel and found that NSCLC cells grown in this system exhibited increased stemness and tumorigenesis. Mechanistically, we demonstrated that fibrin facilitated the activation of the phosphatase and tensin homolog (PTEN)/protein kinase B (AKT) signaling pathway through integrin β1. Furthermore, we found that blocking integrin β1 signals enhanced the tumor suppressive effects of chemotherapy, providing a novel approach for clinical therapy for NSCLC.
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Affiliation(s)
- Guilong Li
- Department of Cardiothoracic Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian 363000, The People’s Republic of China
| | - Jiaying Cai
- Department of Pathology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian 363000, The People’s Republic of China
| | - Jianjun Xie
- Department of Radiotherapy, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian 363000, The People’s Republic of China
| | - Yizhi Dai
- Department of Cardiothoracic Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian 363000, The People’s Republic of China
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Buch-Villa E, Castañer-Puga C, Delgado-Garcia S, Fuster-Diana C, Vidal-Herrador B, Ripoll-Orts F, Galeote-Quecedo T, Prat A, Andrés-Matias M, Jimeno-Fraile J, Muñoz-Sorsona E, Vento G, Gumbau-Puchol V, Adrianzen M, López-Flor V, Ortega J. Clinical and cost outcomes of a polyethylene glycol (PEG)-coated patch versus drainage after axillary lymph node dissection in breast cancer: results from a multicentre randomized clinical trial. Br J Surg 2023; 110:1180-1188. [PMID: 37311694 PMCID: PMC10416686 DOI: 10.1093/bjs/znad150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/29/2023] [Accepted: 05/01/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND The aim of this study was to compare the clinical outcomes between breast cancer patients who underwent axillary lymph node dissection with postoperative management using a polyethylene glycol-coated patch versus axillary drainage. The direct costs associated with both postoperative management strategies were also evaluated. METHODS This was a multicentre RCT in women with breast cancer who underwent axillary lymph node dissection (ClinicalTrials.gov identifier: NCT04487561). Patients were randomly assigned (1 : 1) to receive either drainage or a polyethylene glycol-coated patch as postoperative management. The primary endpoints were the need for an emergency department visit for any event related to the surgery and the rate of seroma development. RESULTS A total of 227 patients were included , 115 in the patch group (50.7 per cent) and 112 (29.4 per cent ) in the drainage group. The incidence of emergency department visits was significantly greater for patients with drainage versus a polyethylene glycol-coated patch (incidence rate difference 26.1 per cent, 95 per cent c.i. 14.5 to 37.7 per cent; P < 0.001). Conversely, the seroma rate was significantly higher in the polyethylene glycol-coated patch group (incidence rate difference 22.8 per cent, 95 per cent c.i. 6.7 to 38.9 per cent; P < 0.0055). Compared with drainage, using a polyethylene glycol-coated patch resulted in cost savings of €100.41 per patient. An incremental cost-effectiveness ratio analysis found that drainage was associated with an incremental cost-effectiveness ratio of €7594.4 for no need for hospital admission and €491.7 for no need for an emergency department visit. CONCLUSION Compared with patients who received drainage after axillary lymph node dissection, the use of a polyethylene glycol-coated patch resulted in a higher rate of seroma, but a lower number of postoperative outpatient or emergency department visits and thus a reduction in overall costs.
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Affiliation(s)
- Elvira Buch-Villa
- Department of Surgery, University Clinical Hospital of Valencia, Valencia, Spain
- INCLIVA Biomedical Research Institute, Valencia, Spain
| | | | | | - Carlos Fuster-Diana
- Department of Surgery, Valencian Institute of Oncology (IVO), Valencia, Spain
| | - Beatriz Vidal-Herrador
- Department of Surgery, University Clinical Hospital of Santiago de Compostela, A Coruña, Spain
| | | | | | - Antonio Prat
- Department of Surgery, General Hospital of Requena, Valencia, Spain
| | | | - Jaime Jimeno-Fraile
- Department of Surgery, University Clinical Hospital of Marques de Valdecilla, Santander, Spain
| | - Ernesto Muñoz-Sorsona
- Department of Surgery, University Clinical Hospital of Valencia, Valencia, Spain
- INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Giovani Vento
- Department of Surgery, Valencian Institute of Oncology (IVO), Valencia, Spain
| | | | - Marcos Adrianzen
- Department of Surgery, University Clinical Hospital of Valencia, Valencia, Spain
- INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Vicente López-Flor
- Department of Surgery, University Clinical Hospital of Valencia, Valencia, Spain
- INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Joaquín Ortega
- Department of Surgery, University Clinical Hospital of Valencia, Valencia, Spain
- INCLIVA Biomedical Research Institute, Valencia, Spain
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Daniel B, Schmid K, Zajonc H, Eisenhardt S, Dragu A, Alawi SA. Application of fibrin glue for hematoma prophylaxis in selective aponeurectomy in Dupuytren's disease. J Plast Reconstr Aesthet Surg 2023; 77:291-297. [PMID: 36610274 DOI: 10.1016/j.bjps.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 09/18/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Fibrin glue (FG) can be applied in several surgical procedures at wound closure to reduce postoperative complications such as hematoma formation and wound impairment. The purpose of this study is to assess these preventive surgical benefits in Dupuytren's disease of the hand. PATIENTS AND METHODS We performed a monocentric retrospective cohort study. All patients who underwent selective aponeurectomy for Dupuytren's disease between 2010 and 2020 were included. Patients were divided into two groups: either receiving or not receiving FG. The primary outcome variables were postoperative bleeding, wound healing impairment, and further pooled postoperative complications. RESULTS One hundred and thirty-three patients were included in the analysis of which 108 patients were treated with FG, while 24 did not. There was no statistically significant difference in outcomes regarding postoperative bleeding, infections, or revision surgery. However, in the group receiving FG, there was a tendency toward higher wound healing impairment (13%, p = 0.07). The FG group showed a significantly higher pooled complication rate (18.5%, p < 0.02). Complication in general increased with higher Tubiana classification and number of resected cords. Smoking tripled the risk of impaired wound, while cardiovascular comorbidities increased postoperative bleeding by the factor of 11. CONCLUSION FG did not show a preventive outcome regarding bleeding. The FG group had a tendency for a higher wound healing incidence. Smoking and arterial hypertension correlated with a higher postoperative complication rate. The overall incidence of complications was higher in the FG group. The quality of the surgical intervention as well as accurate hemostasis cannot be corrected by the application of FG.
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Affiliation(s)
- Bassem Daniel
- Department of Plastic and Hand Surgery, Faculty of Medicine, University Medical Center Freiburg, Medical Center - University of Freiburg, University of Freiburg, Breisgau, Germany
| | - Kim Schmid
- Department of Plastic and Hand Surgery, Faculty of Medicine, University Medical Center Freiburg, Medical Center - University of Freiburg, University of Freiburg, Breisgau, Germany
| | - Horst Zajonc
- Department of Plastic and Hand Surgery, Faculty of Medicine, University Medical Center Freiburg, Medical Center - University of Freiburg, University of Freiburg, Breisgau, Germany
| | - Steffen Eisenhardt
- Department of Plastic and Hand Surgery, Faculty of Medicine, University Medical Center Freiburg, Medical Center - University of Freiburg, University of Freiburg, Breisgau, Germany
| | - Adrian Dragu
- Department of Plastic and Hand Surgery, University Center of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at the TU Dresden, Germany
| | - Seyed Arash Alawi
- Department of Plastic and Hand Surgery, University Center of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at the TU Dresden, Germany.
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Long Q, Zhang J, Qi J, Fan Y, Li H. Analysis of factors influencing postoperative drainage time in breast cancer. Gland Surg 2021; 10:3272-3282. [PMID: 35070887 PMCID: PMC8749090 DOI: 10.21037/gs-21-697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/04/2021] [Indexed: 01/03/2024]
Abstract
BACKGROUND To investigate the related factors affecting the postoperative indwelling time of drainage tubes (hereinafter referred to as drainage time) in breast cancer (BC) and evaluate the effect of Pseudomonas aeruginosa-mannose-sensitive hemagglutinin (PA-MSHA) preparation on reducing postoperative drainage time. METHODS The clinical data of 165 BC patients in our hospital, including the postoperative drainage time and occurrence of seroma and related complications (such as fever, incision infection, and flap necrosis) after extubation, were retrospectively analyzed. Univariate, multivariate, and stratified analyses were used to determine the correlations between 15 factors including age, body weight, body mass index (BMI), and PA-MSHA preparation, and the postoperative total drainage volume and drainage time. RESULTS Age, BMI, and PA-MSHA preparation were independent factors affecting the postoperative drainage volume and drainage time of BC patients. Age and BMI were positively correlated with postoperative drainage volume and drainage time (P≤0.004, P≤0.037). PA-MSHA preparation significantly reduced the postoperative total drainage volume and drainage time (P<0.001), decreased the incidence of seroma after extubation (P=0.024), and did not increase complications (P>0.05). CONCLUSIONS Obese and elderly patients were at a significantly high risk of a high drainage volume and long drainage time. Local treatment with PA-MSHA preparation had the advantages of reducing postoperative drainage volume, reducing drainage time, preventing seroma, and not increasing complications, and was a safe and effective treatment. For BC patients aged over 60 years and with a BMI ≥25, the intraoperative local spraying of wounds with PA-MSHA preparation to reduce postoperative drainage times is a valuable option.
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Affiliation(s)
- Quanyi Long
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jia Zhang
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jiahao Qi
- Linzi District Center for Disease Control and Prevention, Zibo, China
| | - Yuan Fan
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hongjiang Li
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
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Chen YS, Loh EW, Shen SC, Su YH, Tam KW. Efficacy of Fibrin Sealant in Reducing Complication Risk After Bariatric Surgery: a Systematic Review and Meta-analysis. Obes Surg 2020; 31:1158-1167. [PMID: 33145716 DOI: 10.1007/s11695-020-05098-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Complications including staple-line leakage and bleeding may occur after sleeve gastrectomy and Roux-en-Y gastric bypass. In this meta-analysis, the efficacy of fibrin sealant in strengthening the staple line and reducing complication risk after bariatric surgery was evaluated. METHODS We searched PubMed, Embase, and Cochrane Library databases for randomized controlled trials (RCTs) published up to October 2020. Pooled estimates of the outcomes were computed using a random effects model. The primary outcomes were bleeding and leakage; secondary outcomes were gastric stricture, length of hospital stay, reoperation rate, and total operation time. RESULTS In total, 9 RCTs including 2136 patients were reviewed. Our meta-analysis revealed that compared with controls, fibrin sealants decreased incidence of bleeding significantly (risk ratio [RR] = 0.42; 95% confidence interval [CI], 0.18-0.97), but did not demonstrate significant differences in reducing the incidence of leakage (RR = 0.62; 95% CI, 0.23-1.73), gastric stricture (RR = 1.16; 95% CI, 0.46-2.91), reoperation rate (RR = 0.85; CI, 0.14-5.14), or length of hospital stay (weighted mean difference = 0.62; 95% CI, - 0.31 to 1.55). Compared with oversewing, fibrin sealant use reduced the operation time; however, their efficacies in reducing the incidence of postoperative bleeding and leakage did not differ significantly. CONCLUSIONS Although applying fibrin sealants to the staple line in bariatric surgery may provide favorable results, but it may not reduce postoperative leakage and stricture incidence significantly. Nevertheless, the application of fibrin sealants as a method for reducing risks of complications after bariatric surgery warrant further investigation.
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Affiliation(s)
- Yi-Shyue Chen
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - El-Wui Loh
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
| | - Shih-Chiang Shen
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan
| | - Yen-Hao Su
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan
- Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Ka-Wai Tam
- Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan.
- Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan.
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