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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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Chaves N, Broekhuis JM, Fligor SC, Collins RA, Modest AM, Kaul S, James BC. Delay in Surgery and Papillary Thyroid Cancer Survival in the United States: A SEER-Medicare Analysis. J Clin Endocrinol Metab 2023; 108:2589-2596. [PMID: 36987566 DOI: 10.1210/clinem/dgad163] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/03/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION Delays in surgery and their impact on survival in papillary thyroid cancer (PTC) is unclear. We sought to investigate the association between time to surgery and survival in patients with PTC. METHODS A total of 8170 Medicare beneficiaries with PTC who underwent thyroidectomy were identified within the Surveillance, Epidemiology, and End Results-Medicare linked data files between 1999 and 2018. Disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meir analysis, and Cox proportional hazards models were specified to estimate the association between time to surgery and survival. RESULTS Among 8170 patients with PTC, mean age 69.3 (SD+/- 11.4), 89.8% had surgery within the first 90 days, 7.8% had surgery 91 to 180 days from diagnosis, and 2.4% had surgery after 180 days. Increasing time to surgery was associated with increased mortality for OS in the >180-day group [adjusted hazard ratio (aHR) 1.24; 95% CI, 1.01-1.53]. Moreover, on stratification by summary stage, those with localized disease in the 91- to 180-day group increased risk by 25% (aHR 1.25; 95%CI, 1.05-1.51), and delaying over 180 days increased risk by 61% (aHR 1.61; 95%CI, 1.19-2.18) in OS. Those with localized disease in the >180-day group had almost 4 times the estimated rate of DSS mortality (aHR3.51; 95%CI, 1.68-7.32). When stratified by T stage, those with T2 disease in the >180 days group had double the estimated rate of all-cause mortality (aHR 2.0; 95% CI, 1.1-3.3) and almost triple the estimated rate of disease-specific mortality (aHR 2.7; 95% CI, 1.05-6.8). CONCLUSIONS Delays in surgery for PTC may impact OS and DSS in localized disease, prior to nodal metastasis.
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Affiliation(s)
- Natalia Chaves
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Jordan M Broekhuis
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA 02215, USA
| | - Scott C Fligor
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA 02215, USA
| | - Reagan A Collins
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA 02214, USA
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA 02214, USA
| | - Anna M Modest
- Harvard Medical School, Boston, MA 02215, USA
- Department of Obstetrics Gynecology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Sumedh Kaul
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Benjamin C James
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA 02215, USA
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Xia L, Lai J, Liu X, Kong F, Qiu S, Hu H, Zhu S, Cao J. Epidemiological and survival outcomes of neuroendocrine carcinoma of the breast: a SEER data analysis. Transl Cancer Res 2023; 12:1951-1962. [PMID: 37701099 PMCID: PMC10493786 DOI: 10.21037/tcr-23-368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/01/2023] [Indexed: 09/14/2023]
Abstract
Background Neuroendocrine carcinoma of the breast (NECB) is a rare subtype of breast cancer, comprising only 0.1% to 5% of all breast cancer cases. Despite its rarity, it is important to gain a better understanding of the epidemiological, clinical, and prognostic features of NECB. The purpose of the study was to obtain population-based evaluations of the epidemiological and survival outcomes of NECB. Methods The data of patients with neuroendocrine carcinoma diagnosed and enrolled between 2000 and 2017 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Descriptive statistical analyses were used to assess the distribution and tumor-related characteristics of these patients. Kaplan-Meier curves and univariate and multivariate Cox proportional risk models were used to analyze variables that might be associated with prognosis. Results This study included 7,856 patients with neuroendocrine carcinoma. The median age of the patients was 64 years, and most of them were female, White, and diagnosed at ≥60 years old. The most common pathological type was neoplasm. Survival analysis indicated that there were significant differences in age, marital status, registration location, American Joint Committee on Cancer (AJCC) stage, breast subtype, surgery of primary tumor, and no cancer cause surgery patients with NECB. The results also indicated that treatment with surgery, including surgery of primary tumor, surgery combined with radiation, and no cancer cause surgery, were all effective in improving the prognosis compared with not providing surgical treatment. Conclusions In conclusion, NECB is a very rare lesion for which age, marital status, registration location, and surgery, AJCC stage, breast subtype were found to be independent prognostic factors.
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Affiliation(s)
- Longjie Xia
- Department of General Surgery, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
- Department of General Surgery, Guangzhou First People’s Hospital, Guangzhou, China
| | - Jianqin Lai
- Department of General Surgery, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
- Department of General Surgery, Guangzhou First People’s Hospital, Guangzhou, China
| | - Xiangxia Liu
- Department of Plastic Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Fanbiao Kong
- Department of General Surgery, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
- Department of Colorectal and Anal Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
- Institute of Minimally Invasive Technology and Applications Guangxi Academy of Medical Science, Nanning, China
| | - Shenghui Qiu
- Department of General Surgery, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
- Department of General Surgery, Guangzhou First People’s Hospital, Guangzhou, China
| | - Huiqiong Hu
- Department of General Surgery, Guangzhou First People’s Hospital, Guangzhou, China
| | - Shaoliang Zhu
- Department of Hepatobiliary, Pancreas and Spleen Surgery, Guangxi Academy of Medical Sciences, Nanning, China
| | - Jie Cao
- Department of General Surgery, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
- Department of General Surgery, Guangzhou First People’s Hospital, Guangzhou, China
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Beer M, Allison H, Fisher C, Fan B. Second Opinions in Breast Cancer Surgery: What Have We Learned? Cureus 2022; 14:e30180. [PMID: 36397917 PMCID: PMC9648675 DOI: 10.7759/cureus.30180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Second-opinion consultations (SOCs) provide many benefits. However, duplicate office visits and the logistics of transferring medical records may be concerning for delaying treatment. There is currently no clear understanding regarding the characteristics of patients with breast cancer who desire second surgical opinions or if this contributes to delays in care. Methods A review of our institutional database from July 1, 2019, to December 31, 2019, identified breast cancer patients who were documented to be SOCs or primary consultations (PC). Neoadjuvant chemotherapy patients were excluded. Comparisons of patient characteristics, tumor characteristics, and surgery factors were performed using chi-square analysis. All analyses were two-tailed and statistical significance was assigned at p <0.05. This study was deemed IRB-exempt. Results In our review, 158 breast cancer patients were identified, 21 (13.3%) SOCs and 137 (86.7%) PCs. Of the SOCs, 90% (19/21) underwent surgery at our institution. The study revealed an increased incidence of SOCs in those patients who ultimately underwent mastectomy (p=0.039) as well as those with lower pathologic T stage (p=0.021). There were no other differences in demographics, surgery, or tumor characteristics. No delay was seen in time for treatment. Conclusions Patients who sought second opinions were more likely to undergo mastectomy and had lower pathologic tumor size. The time from biopsy to surgery appointment was longer in patients who sought second opinions but there were no differences in the time from biopsy or surgery appointment. It is encouraging that those who sought second opinions did not face any delay in care once established.
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