Ultrasonic dissection versus electrocautery in mastectomy for breast cancer - a meta-analysis.
BACKGROUND
Electrocautery has advanced the practice of mastectomy but significant morbidity, such as seroma and blood loss, remains a concern. This has led to newer forms of dissection being introduced including the ultrasonic dissection devices, which are thought to reduce tissue damage. The aim of this systematic review was to compare the outcomes after mastectomy using novel ultrasonic dissection or standard electrocautery in published trials.


METHODS
Medline, Embase, trial registries, conference proceedings and reference lists were searched for comparative trials of ultrasonic dissection versus electrocautery for mastectomy. The primary outcomes were total postoperative drainage, seroma development and intra-operative blood loss. Secondary outcomes were operative time and wound complications. Odds ratios were calculated for categorical outcomes and standardised mean differences for continuous outcomes.


RESULTS
Six trials were included in the analysis of 287 mastectomies. There was no effect in total postoperative drainage (pooled analysis weight mean difference: -0.21 (95% CI: -0.70-0.29); p = 0.41) or seroma development (pooled analysis odds ratio: 0.77 (95% CIs 0.43-1.37); p = 0.37). Intra-operative blood was slightly less for ultrasonic dissection compared to standard electrocautery (pooled analysis weight mean difference: -1.04 (95% CI: -2.00 to -0.08); p = 0.03). Ultrasonic dissection and standard electrocautery had similar outcomes with regard to operative time and wound complications.


CONCLUSIONS
Ultrasonic dissection and standard electrocautery appear to deliver similar results in the mastectomy setting. Further cost-effectiveness analysis may guide surgeon selection in the use of new technologies for mastectomy.
Department of Breast Surgery, Kingston Hospital, Galsworthy Road, Kingston-upon-Thames, Surrey KT2 7QB, UK. a.currie@imperial.ac.uk
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Currie
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Chong
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Davies
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Cummins
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001943:Breast Neoplasms / Q000601:surgery*; D004210:Dissection / Q000009:adverse effects / Q000379:methods; D004322:Drainage / Q000379:methods; D004564:Electrocoagulation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control / Q000601:surgery; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D049291:Seroma / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome; D059708:Ultrasonic Surgical Procedures / Q000009:adverse effects / Q000379:methods*