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Harmonic Scalpel versus Electrocautery Dissection in Modified Radical Mastectomy for Breast Cancer: A Meta-Analysis.

Huang J, Yu Y, Wei C, Qin Q, Mo Q, Yang W - PLoS ONE (2015)

Bottom Line: We used odds ratios (ORs) with 95% confidence intervals (CIs) to evaluate the effect size for categorical outcomes and standardised mean differences (SMDs) for continuous outcomes.A total of 11 studies with 702 patients were included for this meta-analysis.No difference was found as for operative time between harmonic scalpel dissection and standard electrocautery (SMD: 0.04 [95%CI: -0.41, 0.50]; P = 0.85).

View Article: PubMed Central - PubMed

Affiliation: The Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China.

ABSTRACT

Background: Despite the common use of conventional electrocautery in modified radical mastectomy for breast cancer, the harmonic scalpel is recently emerging as a dominant surgical instrument for dissection and haemostasis, which is thought to reduce the morbidity, such as seroma and blood loss. But the results of published trials are inconsistent. So we made the meta-analysis to assess the intraoperative and postoperative endpoints among women undergoing modified radical mastectomy with harmonic scalpel or electrocautery.

Methods: A comprehensive literature search of case-control studies from PubMed, MEDLINE, EMBASE and Cochrane Library databases involving modified radical mastectomy with harmonic scalpel or electrocautery was performed. We carried out a meta-analysis of primary endpoints including postoperative drainage, seroma development, intraoperative blood loss and secondly endpoints including operative time and wound complications. We used odds ratios (ORs) with 95% confidence intervals (CIs) to evaluate the effect size for categorical outcomes and standardised mean differences (SMDs) for continuous outcomes.

Results: A total of 11 studies with 702 patients were included for this meta-analysis. There was significant difference in total postoperative drainage (SMD: -0.74 [95%CI: -1.31, -0.16]; P< 0.01), seroma development[OR: 0.49 (0.34, 0.70); P < 0.01], intraoperative blood loss(SMD: -1.14 [95%CI: -1.81,-0.47]; P < 0.01) and wound complications [OR: 0.38 (0.24, 0.59); P < 0.01] between harmonic scalpel dissection and standard electrocautery in modified radical mastectomy for breast cancer. No difference was found as for operative time between harmonic scalpel dissection and standard electrocautery (SMD: 0.04 [95%CI: -0.41, 0.50]; P = 0.85).

Conclusion: Compared to standard electrocautery, harmonic scalpel dissection presents significant advantages in decreasing postoperative drainage, seroma development, intraoperative blood loss and wound complications in modified radical mastectomy for breast cancer, without increasing operative time. Harmonic scalpel can be recommended as a preferential surgical instrument in modified radical mastectomy.

No MeSH data available.


Related in: MedlinePlus

Forest plot for weighted mean difference in intraoperative blood loss between harmonic scalpel dissection and electrocautery in mastectomy used by random-effect model.
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pone.0142271.g004: Forest plot for weighted mean difference in intraoperative blood loss between harmonic scalpel dissection and electrocautery in mastectomy used by random-effect model.

Mentions: Nine studies[7–9,12,14,15,17–19] reported intraoperative blood loss as an endpoint. Two of them[17,19] did not mention the data of standard deviation and we could not get the results. So, a total of seven studies[7–9,12,14,15,18] wered included for this meta-analysis. The mean blood loss volume was 300 mls and 399 mls for harmonic scalpel dissection and electrocautery, respectively. There was significant difference in terms of intraoperative blood loss between the two groups after pooling the included studies (SMD: -1.14 [95%CI: -1.81, -0.47]; P< 0.01) (Fig 4). There was significant statistical heterogeneity among the included studies (Chi2 = 61.26; P < 0.01; I2 = 90%).


Harmonic Scalpel versus Electrocautery Dissection in Modified Radical Mastectomy for Breast Cancer: A Meta-Analysis.

Huang J, Yu Y, Wei C, Qin Q, Mo Q, Yang W - PLoS ONE (2015)

Forest plot for weighted mean difference in intraoperative blood loss between harmonic scalpel dissection and electrocautery in mastectomy used by random-effect model.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4636213&req=5

pone.0142271.g004: Forest plot for weighted mean difference in intraoperative blood loss between harmonic scalpel dissection and electrocautery in mastectomy used by random-effect model.
Mentions: Nine studies[7–9,12,14,15,17–19] reported intraoperative blood loss as an endpoint. Two of them[17,19] did not mention the data of standard deviation and we could not get the results. So, a total of seven studies[7–9,12,14,15,18] wered included for this meta-analysis. The mean blood loss volume was 300 mls and 399 mls for harmonic scalpel dissection and electrocautery, respectively. There was significant difference in terms of intraoperative blood loss between the two groups after pooling the included studies (SMD: -1.14 [95%CI: -1.81, -0.47]; P< 0.01) (Fig 4). There was significant statistical heterogeneity among the included studies (Chi2 = 61.26; P < 0.01; I2 = 90%).

Bottom Line: We used odds ratios (ORs) with 95% confidence intervals (CIs) to evaluate the effect size for categorical outcomes and standardised mean differences (SMDs) for continuous outcomes.A total of 11 studies with 702 patients were included for this meta-analysis.No difference was found as for operative time between harmonic scalpel dissection and standard electrocautery (SMD: 0.04 [95%CI: -0.41, 0.50]; P = 0.85).

View Article: PubMed Central - PubMed

Affiliation: The Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China.

ABSTRACT

Background: Despite the common use of conventional electrocautery in modified radical mastectomy for breast cancer, the harmonic scalpel is recently emerging as a dominant surgical instrument for dissection and haemostasis, which is thought to reduce the morbidity, such as seroma and blood loss. But the results of published trials are inconsistent. So we made the meta-analysis to assess the intraoperative and postoperative endpoints among women undergoing modified radical mastectomy with harmonic scalpel or electrocautery.

Methods: A comprehensive literature search of case-control studies from PubMed, MEDLINE, EMBASE and Cochrane Library databases involving modified radical mastectomy with harmonic scalpel or electrocautery was performed. We carried out a meta-analysis of primary endpoints including postoperative drainage, seroma development, intraoperative blood loss and secondly endpoints including operative time and wound complications. We used odds ratios (ORs) with 95% confidence intervals (CIs) to evaluate the effect size for categorical outcomes and standardised mean differences (SMDs) for continuous outcomes.

Results: A total of 11 studies with 702 patients were included for this meta-analysis. There was significant difference in total postoperative drainage (SMD: -0.74 [95%CI: -1.31, -0.16]; P< 0.01), seroma development[OR: 0.49 (0.34, 0.70); P < 0.01], intraoperative blood loss(SMD: -1.14 [95%CI: -1.81,-0.47]; P < 0.01) and wound complications [OR: 0.38 (0.24, 0.59); P < 0.01] between harmonic scalpel dissection and standard electrocautery in modified radical mastectomy for breast cancer. No difference was found as for operative time between harmonic scalpel dissection and standard electrocautery (SMD: 0.04 [95%CI: -0.41, 0.50]; P = 0.85).

Conclusion: Compared to standard electrocautery, harmonic scalpel dissection presents significant advantages in decreasing postoperative drainage, seroma development, intraoperative blood loss and wound complications in modified radical mastectomy for breast cancer, without increasing operative time. Harmonic scalpel can be recommended as a preferential surgical instrument in modified radical mastectomy.

No MeSH data available.


Related in: MedlinePlus