ObjectiveTo explore the clinical efficacy of volume displacement techniques for breast defects following breast conserving surgery. MethodsAfter inclusion and exclusion, the patients with breast defects following breast conserving surgery in the Minda Hospital of Hubei Minzu University from February 2013 to March 2020 were retrospectively enrolled, and were assigned into a volume displacement group and volume replacement group according to different surgical techniques. Then the outcomes were compared between the two groups, including short-term efficacy (incision length, operation time, intraoperative blood loss, volume of resected specimen, cosmetic effect, patients’ subjective satisfaction, total postoperative complications, and total hospitalization time) and long-term efficacy (local recurrence rate, 3-year tumor-free survival, and 3-year overall survival). ResultsA total of 208 eligible patients were included in this study, including 105 in the volume displacement group and 103 in the volume replacement group before propensity score matching (PSM); after PMS, a total of 62 patients were enrolled, including 33 in the volume displacement group and 29 in the volume replacement group. No statistical difference was reported in the baseline data between two groups (P>0.05), except that the maximum diameter of lesion in the volume displacement group was smaller than that in the volume replacement group (P<0.05). The incision length, operation time, total hospitalization time, total postoperative complication rate, local recurrence rate, 3-year tumor-free survival rate, and 3-year overall survival rate had no statistical differences between the two groups (P>0.05), whereas the intraoperative blood loss was less (t=3.294, P=0.002) and the volume of resected specimen was smaller (t=2.030, P=0.047) in the volume displacement group as compared with the volume replacement group, and the cosmetic effect and patients’ subjective satisfaction were better in the volume displacement group as compared with the volume replacement group (Z=2.297, P=0.022; Z=2.256, P=0.024). ConclusionThe study analysis with small size samples reveals that volume displacement technique for breast defects following breast conserving surgery can achieve a good cosmetic effect and high patients’ subjective satisfaction without increasing risk of postoperative complications and tumour recurrence, which demonstrates a good long-term efficacy profile.
ObjectiveTo evaluate the effectiveness and safety of proximal aortic repair (PAR) versus total arch replacement (TAR) for treatment of acute type A aortic dissection (ATAAD). Methods An electronic search was conducted for clinical controlled studies on PAR versus TAR for patients with ATAAD published in Medline via PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang Database and CNKI since their inception up to April 30, 2022. The quality of each study included was assessed by 2 evaluators and the necessary data were extracted. STATA 16 software was used to perform statistical analysis of the available data. ResultsA total of 28 cohort studies involving 7 923 patients with ATAAD were included in this meta-analysis, of whom 5 710 patients received PAR and 2 213 patients underwent TAR, and 96.43% of the studies (27/28) were rated as high quality. The meta-analysis results showed that: (1) patients who underwent PAR had lower incidences of 30 d mortality [RR=0.62, 95%CI (0.50, 0.77), P＜0.001], in-hospital mortality [RR=0.64, 95%CI (0.54, 0.77), P＜0.001], and neurologic deficiency after surgery [RR=0.84, 95%CI (0.72, 0.98), P=0.032] than those who received TAR; (2) the cardiopulmonary bypass time [WMD=–52.07, 95%CI (–74.19, –29.94), P＜0.001], circulatory arrest time [WMD=–10.14, 95%CI (–15.02, –5.26), P＜0.001], and operation time [WMD=–101.68, 95%CI (–178.63, –24.73), P＜0.001] were significantly shorter in PAR than those in TAR; (3) there was no statistical difference in mortality after discharge, rate of over 5-year survival, renal failure after surgery and re-intervention, volume of red blood cells transfusion and fresh-frozen plasma transfusion, or hospital stay between two surgical procedures. Conclusion Compared with TAR, PAR has a shorter operation time and lower early and in-hospital mortality, but there is no difference in long-term outcomes or complications between the two procedures for patients with ATAAD.