Optimal primary wound closure methods after thyroid and parathyroid surgery: network meta-analysis of randomized clinical trials.

BACKGROUND: At present, there is no consensus on optimal neck wound closure methods after thyroid and parathyroid surgery. The aim of this study was to perform a systematic review and network meta-analysis of RCTs evaluating the optimal neck closure method after thyroid and parathyroid surgery. METHODS: A frequentist random-effects network meta-analysis was performed for RCTs comparing at least two closure methods according to PRISMA-network meta-analysis guidelines. Analysis was performed using R packages and Shiny. RESULTS: Eighteen RCTs evaluating six closure methods (that is adhesive (28.5 per cent, 404 patients), absorbable subcuticular suture (18.1 per cent, 257 patients), non-absorbable subcuticular suture (16.8 per cent, 238 patients), staples (26.3 per cent, 372 patients), steristrips (8.1 per cent, 115 patients), and conventional suture (2.1 per cent, 30 patients)) in 1416 patients were included. At network meta-analysis, there was no difference in complication, infection, dehiscence, or haematoma rates irrespective of closure method used. Staples reduced closure duration versus absorbable subcuticular suture (mean difference (MD) 8.50, 95 per cent c.i. 6.90 to 10.10) and non-absorbable subcuticular suture (MD 0.30, 95 per cent c.i. 0.23 to 0.37), whereas adhesives (MD -1.05, 95 per cent c.i. -1.31 to -0.79) reduced closure time relative to staples. Cosmesis was improved after non-absorbable subcuticular suture (odds ratio (OR) 3.41, 95 per cent c.i. 1.66 to 7.00) relative to staples. Staples reduced patient satisfaction (OR 0.04, 95 per cent c.i. 0.00 to 0.33) and ability to shower (OR 0.04, 95 per cent c.i. 0.00 to 0.33) relative to adhesives. CONCLUSION: Despite staples decreasing closure times, this advantage is offset by reduced patient satisfaction, ability to shower, and cosmesis compared with patients with wounds closed using adhesives, absorbable subcuticular suture, and non-absorbable subcuticular suture. Therefore, these closure methods are favourable for closing neck wounds due to more acceptable patient-reported outcomes, without compromising the safety of the procedure.

The impact of liver resection on survival for patients with metastatic breast cancer - A systematic review and meta-analysis.

INTRODUCTION: There is uncertainty surrounding the role of resection as an option for curative treatment of breast cancer with liver metastases (BCLM). AIM: To perform a systematic review and meta-analysis evaluating the role of liver resection for BCLM. METHODS: A systematic review was performed as per PRISMA guidelines. Hazard ratio (HR) for overall survival (OS) and standard error was obtained from each study and expressed using the generic inverse variance method, with a corresponding 95% confidence interval (CI). OS outcomes at 1- 3- and 5-years were expressed as dichotomous variables and pooled as odds ratios (OR) using the Mantel-Haenszel method. RESULTS: Nine studies with 1732 patients were included. Of these, 24.5% underwent surgical resection of BCLM (424/1732) and 75.5% did not (1308/1732). Overall, OS was significantly better among those who underwent surgery versus controls (HR: 0.69, 95% CI: 0.59-0.80, P < 0.00001). Mortality rates were significantly reduced at 1-year (7.5% (10/134) vs 20.3% (79/390), OR: 0.25, 95% CI: 0.08-0.74, P = 0.010) and 5-years (54.0% (190/352) vs 75.3% (940/1249), OR: 0.46, 95% CI: 0.25-0.87, P = 0.020) respectively for those undergoing surgery versus controls. Mortality rates at 3 years after surgery were lower than the control group (19.1% (29/152) vs 53.0% (222/419)), however this failed to achieve statistical significance at meta-analysis (OR: 0.32, 95% CI: 0.09-1.12, P = 0.070). CONCLUSION: Liver resection may be considered at multidisciplinary meetings for those with BCLM and offers a potentially curative option. However, judicious patient selection is crucial prior to making decisions in relation to resection of BCLM.

Pathological complete response as a surrogate to improved survival in human epidermal growth factor receptor-2-positive breast cancer: systematic review and meta-analysis.

BACKGROUND: Achieving a pathological complete response (pCR) is believed to correlate with oncological outcomes in human epidermal growth factor receptor-2-positive (HER2+) breast cancer. However, informed estimation of this survival advantage is often difficult to quantify. The aim of this study was to evaluate the role of pCR as a biomarker of survival in patients treated with neoadjuvant therapies for HER2+ breast cancer. METHODS: A systematic review was performed in accordance with the PRISMA checklist. Data specific to pCR and survival with respect to event-free survival (EFS), recurrence-free survival (RFS) and overall survival (OS) were expressed as hazard ratio (HR) and 95 per cent confidence intervals (c.i.). pCR and survival at yearly intervals after resection were expressed as dichotomous variables using the Mantel-Haenszel method. RESULTS: Overall, 78 clinical studies with 25 150 patients were included in this study. pCR predicted better EFS (HR 0.67, 95 per cent c.i. 0.60 to 0.74; 41 studies), RFS (HR 0.69, 95 per cent c.i. 0.57 to 0.83; 18 studies) and OS (HR 0.63, 95 per cent c.i. 0.56 to 0.70; 29 studies) for patients with HER2+ breast cancer. At 5 years, pCR predicted better EFS (HR 0.37, 95 per cent c.i. 0.30 to 0.48; 19 studies), RFS (HR 0.28, 95 per cent c.i. 0.21 to 0.39; 8 studies) and OS (HR 0.26, 95 per cent c.i. 0.20 to 0.33; 10 studies). CONCLUSION: This study confirms pCR as an informative surrogate biomarker for enhanced survival and suggests that it may be used as an appropriate endpoint for clinical research.