A systematic review and meta-analysis of Harmonic technology compared with conventional techniques in mastectomy and breast-conserving surgery with lymphadenectomy for breast cancer
Identifieur interne : 008648 ( Ncbi/Merge ); précédent : 008647; suivant : 008649A systematic review and meta-analysis of Harmonic technology compared with conventional techniques in mastectomy and breast-conserving surgery with lymphadenectomy for breast cancer
Auteurs : Hang Cheng [États-Unis] ; Jeffrey W. Clymer [États-Unis] ; Nicole C. Ferko [Canada] ; Leena Patel [Canada] ; Ireena M. Soleas [Canada] ; Chris G. Cameron [Canada] ; Piet Hinoul [États-Unis]Source :
- Breast Cancer : Targets and Therapy [ 1179-1314 ] ; 2016.
Abstract
Mastectomy and breast-conserving surgery (BCS) are important treatment options for breast cancer patients. A previous meta-analysis demonstrated that the risk of certain complications can be reduced with the Harmonic technology compared with conventional methods in mastectomy. However, the meta-analysis did not include studies of BCS patients and focused on a subset of surgical complications. The objective of this study was to compare Harmonic technology and conventional techniques for a range of clinical outcomes and complications in both mastectomy and BCS patients, including axillary lymph node dissection.
A comprehensive literature search was performed for randomized controlled trials comparing Harmonic technology and conventional methods in breast cancer surgery. Outcome measures included blood loss, drainage volume, total complications, seroma, necrosis, wound infections, ecchymosis, hematoma, hospital length of stay, and operating time. Risk of bias was analyzed for all studies. Meta-analysis was performed using random-effects models for mean differences of continuous variables and a fixed-effects model for risk ratios of dichotomous variables.
Twelve studies met the inclusion criteria. Across surgery types, compared to conventional techniques, Harmonic technology reduced total complications by 52% (
In this meta-analysis of both mastectomy and BCS procedures, the use of Harmonic technology reduced the risk of most complications by about half across breast cancer surgery patients. These benefits may be due to superior hemostatic capabilities of Harmonic technology and better dissection, particularly lymph node dissection. Reduction in complications and other resource outcomes may engender lower downstream health care costs.
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DOI: 10.2147/BCTT.S110461
PubMed: 27486342
PubMed Central: 4958357
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Clymer</name><affiliation wicri:level="1"><nlm:aff id="af1-bctt-8-125">Ethicon Inc., Cincinnati, OH, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Ethicon Inc., Cincinnati, OH</wicri:regionArea><wicri:noRegion>OH</wicri:noRegion></affiliation></author><author><name sortKey="Ferko, Nicole C" sort="Ferko, Nicole C" uniqKey="Ferko N" first="Nicole C" last="Ferko">Nicole C. Ferko</name><affiliation wicri:level="1"><nlm:aff id="af2-bctt-8-125">Cornerstone Research Group, Burlington, ON, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Cornerstone Research Group, Burlington, ON</wicri:regionArea><wicri:noRegion>ON</wicri:noRegion></affiliation></author><author><name sortKey="Patel, Leena" sort="Patel, Leena" uniqKey="Patel L" first="Leena" last="Patel">Leena Patel</name><affiliation wicri:level="1"><nlm:aff id="af2-bctt-8-125">Cornerstone Research Group, Burlington, ON, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Cornerstone Research Group, Burlington, ON</wicri:regionArea><wicri:noRegion>ON</wicri:noRegion></affiliation></author><author><name sortKey="Soleas, Ireena M" sort="Soleas, Ireena M" uniqKey="Soleas I" first="Ireena M" last="Soleas">Ireena M. Soleas</name><affiliation wicri:level="1"><nlm:aff id="af2-bctt-8-125">Cornerstone Research Group, Burlington, ON, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Cornerstone Research Group, Burlington, ON</wicri:regionArea><wicri:noRegion>ON</wicri:noRegion></affiliation></author><author><name sortKey="Cameron, Chris G" sort="Cameron, Chris G" uniqKey="Cameron C" first="Chris G" last="Cameron">Chris G. Cameron</name><affiliation wicri:level="1"><nlm:aff id="af2-bctt-8-125">Cornerstone Research Group, Burlington, ON, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Cornerstone Research Group, Burlington, ON</wicri:regionArea><wicri:noRegion>ON</wicri:noRegion></affiliation></author><author><name sortKey="Hinoul, Piet" sort="Hinoul, Piet" uniqKey="Hinoul P" first="Piet" last="Hinoul">Piet Hinoul</name><affiliation wicri:level="1"><nlm:aff id="af1-bctt-8-125">Ethicon Inc., Cincinnati, OH, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Ethicon Inc., Cincinnati, OH</wicri:regionArea><wicri:noRegion>OH</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27486342</idno><idno type="pmc">4958357</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4958357</idno><idno type="RBID">PMC:4958357</idno><idno type="doi">10.2147/BCTT.S110461</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000876</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000876</idno><idno type="wicri:Area/Pmc/Curation">000876</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000876</idno><idno type="wicri:Area/Pmc/Checkpoint">000C52</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000C52</idno><idno type="wicri:Area/Ncbi/Merge">008648</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">A systematic review and meta-analysis of Harmonic technology compared with conventional techniques in mastectomy and breast-conserving surgery with lymphadenectomy for breast cancer</title><author><name sortKey="Cheng, Hang" sort="Cheng, Hang" uniqKey="Cheng H" first="Hang" last="Cheng">Hang Cheng</name><affiliation wicri:level="1"><nlm:aff id="af1-bctt-8-125">Ethicon Inc., Cincinnati, OH, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Ethicon Inc., Cincinnati, OH</wicri:regionArea><wicri:noRegion>OH</wicri:noRegion></affiliation></author><author><name sortKey="Clymer, Jeffrey W" sort="Clymer, Jeffrey W" uniqKey="Clymer J" first="Jeffrey W" last="Clymer">Jeffrey W. Clymer</name><affiliation wicri:level="1"><nlm:aff id="af1-bctt-8-125">Ethicon Inc., Cincinnati, OH, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Ethicon Inc., Cincinnati, OH</wicri:regionArea><wicri:noRegion>OH</wicri:noRegion></affiliation></author><author><name sortKey="Ferko, Nicole C" sort="Ferko, Nicole C" uniqKey="Ferko N" first="Nicole C" last="Ferko">Nicole C. Ferko</name><affiliation wicri:level="1"><nlm:aff id="af2-bctt-8-125">Cornerstone Research Group, Burlington, ON, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Cornerstone Research Group, Burlington, ON</wicri:regionArea><wicri:noRegion>ON</wicri:noRegion></affiliation></author><author><name sortKey="Patel, Leena" sort="Patel, Leena" uniqKey="Patel L" first="Leena" last="Patel">Leena Patel</name><affiliation wicri:level="1"><nlm:aff id="af2-bctt-8-125">Cornerstone Research Group, Burlington, ON, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Cornerstone Research Group, Burlington, ON</wicri:regionArea><wicri:noRegion>ON</wicri:noRegion></affiliation></author><author><name sortKey="Soleas, Ireena M" sort="Soleas, Ireena M" uniqKey="Soleas I" first="Ireena M" last="Soleas">Ireena M. Soleas</name><affiliation wicri:level="1"><nlm:aff id="af2-bctt-8-125">Cornerstone Research Group, Burlington, ON, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Cornerstone Research Group, Burlington, ON</wicri:regionArea><wicri:noRegion>ON</wicri:noRegion></affiliation></author><author><name sortKey="Cameron, Chris G" sort="Cameron, Chris G" uniqKey="Cameron C" first="Chris G" last="Cameron">Chris G. Cameron</name><affiliation wicri:level="1"><nlm:aff id="af2-bctt-8-125">Cornerstone Research Group, Burlington, ON, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Cornerstone Research Group, Burlington, ON</wicri:regionArea><wicri:noRegion>ON</wicri:noRegion></affiliation></author><author><name sortKey="Hinoul, Piet" sort="Hinoul, Piet" uniqKey="Hinoul P" first="Piet" last="Hinoul">Piet Hinoul</name><affiliation wicri:level="1"><nlm:aff id="af1-bctt-8-125">Ethicon Inc., Cincinnati, OH, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Ethicon Inc., Cincinnati, OH</wicri:regionArea><wicri:noRegion>OH</wicri:noRegion></affiliation></author></analytic><series><title level="j">Breast Cancer : Targets and Therapy</title><idno type="eISSN">1179-1314</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Mastectomy and breast-conserving surgery (BCS) are important treatment options for breast cancer patients. A previous meta-analysis demonstrated that the risk of certain complications can be reduced with the Harmonic technology compared with conventional methods in mastectomy. However, the meta-analysis did not include studies of BCS patients and focused on a subset of surgical complications. The objective of this study was to compare Harmonic technology and conventional techniques for a range of clinical outcomes and complications in both mastectomy and BCS patients, including axillary lymph node dissection.</p></sec><sec><title>Methods</title><p>A comprehensive literature search was performed for randomized controlled trials comparing Harmonic technology and conventional methods in breast cancer surgery. Outcome measures included blood loss, drainage volume, total complications, seroma, necrosis, wound infections, ecchymosis, hematoma, hospital length of stay, and operating time. Risk of bias was analyzed for all studies. Meta-analysis was performed using random-effects models for mean differences of continuous variables and a fixed-effects model for risk ratios of dichotomous variables.</p></sec><sec><title>Results</title><p>Twelve studies met the inclusion criteria. Across surgery types, compared to conventional techniques, Harmonic technology reduced total complications by 52% (<italic>P</italic>=0.002), seroma by 46% (<italic>P</italic><0.0001), necrosis by 49% (<italic>P</italic>=0.04), postoperative chest wall drainage by 46% (<italic>P</italic>=0.0005), blood loss by 38% (<italic>P</italic>=0.0005), and length of stay by 22% (<italic>P</italic>=0.007). Although benefits generally appeared greatest in mastectomy patients with lymph node dissection, Harmonic technology showed significant reductions in complications in the BCS study subgroup.</p></sec><sec><title>Conclusion</title><p>In this meta-analysis of both mastectomy and BCS procedures, the use of Harmonic technology reduced the risk of most complications by about half across breast cancer surgery patients. These benefits may be due to superior hemostatic capabilities of Harmonic technology and better dissection, particularly lymph node dissection. Reduction in complications and other resource outcomes may engender lower downstream health care costs.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Torre, La" uniqKey="Torre L">LA Torre</name></author><author><name sortKey="Siegel, Rl" uniqKey="Siegel R">RL Siegel</name></author><author><name sortKey="Ward, Em" uniqKey="Ward E">EM Ward</name></author><author><name sortKey="Jemal, A" uniqKey="Jemal A">A Jemal</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Franceschini, G" uniqKey="Franceschini G">G Franceschini</name></author><author><name sortKey="Martin Sanchez, A" uniqKey="Martin Sanchez A">A Martin Sanchez</name></author><author><name sortKey="Di Leone, A" uniqKey="Di Leone A">A Di Leone</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Veronesi, U" uniqKey="Veronesi U">U Veronesi</name></author><author><name sortKey="Paganelli, G" uniqKey="Paganelli G">G Paganelli</name></author><author><name sortKey="Galimberti, V" uniqKey="Galimberti V">V Galimberti</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bohm, D" uniqKey="Bohm D">D Bohm</name></author><author><name sortKey="Kubitza, A" uniqKey="Kubitza A">A Kubitza</name></author><author><name sortKey="Lebrecht, A" uniqKey="Lebrecht A">A Lebrecht</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Anlar, B" uniqKey="Anlar B">B Anlar</name></author><author><name sortKey="Karaman, N" uniqKey="Karaman N">N Karaman</name></author><author><name sortKey="Dogan, L" uniqKey="Dogan L">L Dogan</name></author><author><name sortKey="Ozaslan, C" uniqKey="Ozaslan C">C Ozaslan</name></author><author><name sortKey="Atalay, C" uniqKey="Atalay C">C Atalay</name></author><author><name sortKey="Altinok, M" uniqKey="Altinok M">M Altinok</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="He, Q" uniqKey="He Q">Q He</name></author><author><name sortKey="Zhuang, D" uniqKey="Zhuang D">D Zhuang</name></author><author><name sortKey="Zheng, L" uniqKey="Zheng L">L Zheng</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Iovino, F" uniqKey="Iovino F">F Iovino</name></author><author><name sortKey="Auriemma, Pp" uniqKey="Auriemma P">PP Auriemma</name></author><author><name sortKey="Ferraraccio, F" uniqKey="Ferraraccio F">F Ferraraccio</name></author><author><name sortKey="Antoniol, G" uniqKey="Antoniol G">G Antoniol</name></author><author><name sortKey="Barbarisi, A" uniqKey="Barbarisi A">A Barbarisi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rohaizak, M" uniqKey="Rohaizak M">M Rohaizak</name></author><author><name sortKey="Khan, Fj" uniqKey="Khan F">FJ Khan</name></author><author><name sortKey="Jasmin, Js" uniqKey="Jasmin J">JS Jasmin</name></author><author><name sortKey="Mohd Latar, Nh" uniqKey="Mohd Latar N">NH Mohd Latar</name></author><author><name sortKey="Abdullah, Ss" uniqKey="Abdullah S">SS Abdullah</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Miller, E" uniqKey="Miller E">E Miller</name></author><author><name sortKey="Paull, De" uniqKey="Paull D">DE Paull</name></author><author><name sortKey="Morrissey, K" uniqKey="Morrissey K">K Morrissey</name></author><author><name sortKey="Cortese, A" uniqKey="Cortese A">A Cortese</name></author><author><name sortKey="Nowak, E" uniqKey="Nowak E">E Nowak</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Banerjee, D" uniqKey="Banerjee D">D Banerjee</name></author><author><name sortKey="Williams, Ev" uniqKey="Williams E">EV Williams</name></author><author><name sortKey="Ilott, J" uniqKey="Ilott J">J Ilott</name></author><author><name sortKey="Monypenny, Ij" uniqKey="Monypenny I">IJ Monypenny</name></author><author><name sortKey="Webster, Dj" uniqKey="Webster D">DJ Webster</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Morrow, M" uniqKey="Morrow M">M Morrow</name></author><author><name sortKey="Jagsi, R" uniqKey="Jagsi R">R Jagsi</name></author><author><name sortKey="Alderman, Ak" uniqKey="Alderman A">AK Alderman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Vinton, Al" uniqKey="Vinton A">AL Vinton</name></author><author><name sortKey="Traverso, Lw" uniqKey="Traverso L">LW Traverso</name></author><author><name sortKey="Jolly, Pc" uniqKey="Jolly P">PC Jolly</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Woodworth, Pa" uniqKey="Woodworth P">PA Woodworth</name></author><author><name sortKey="Mcboyle, Mf" uniqKey="Mcboyle M">MF McBoyle</name></author><author><name sortKey="Helmer, Sd" uniqKey="Helmer S">SD Helmer</name></author><author><name sortKey="Beamer, Rl" uniqKey="Beamer R">RL Beamer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sheen Chen, Sm" uniqKey="Sheen Chen S">SM Sheen-Chen</name></author><author><name sortKey="Chou, Ff" uniqKey="Chou F">FF Chou</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Porter, Ka" uniqKey="Porter K">KA Porter</name></author><author><name sortKey="O Onnor, S" uniqKey="O Onnor S">S O’Connor</name></author><author><name sortKey="Rimm, E" uniqKey="Rimm E">E Rimm</name></author><author><name sortKey="Lopez, M" uniqKey="Lopez M">M Lopez</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Deo, Sv" uniqKey="Deo S">SV Deo</name></author><author><name sortKey="Shukla, Nk" uniqKey="Shukla N">NK Shukla</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Carlander, J" uniqKey="Carlander J">J Carlander</name></author><author><name sortKey="Johansson, K" uniqKey="Johansson K">K Johansson</name></author><author><name sortKey="Lindstrom, S" uniqKey="Lindstrom S">S Lindström</name></author><author><name sortKey="Velin, Ak" uniqKey="Velin A">AK Velin</name></author><author><name sortKey="Jiang, Ch" uniqKey="Jiang C">CH Jiang</name></author><author><name sortKey="Nor Dborg, C" uniqKey="Nor Dborg C">C Nor-dborg</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bandi, G" uniqKey="Bandi G">G Bandi</name></author><author><name sortKey="Wen, Cc" uniqKey="Wen C">CC Wen</name></author><author><name sortKey="Wilkinson, Ea" uniqKey="Wilkinson E">EA Wilkinson</name></author><author><name sortKey="Hedican, Sp" uniqKey="Hedican S">SP Hedican</name></author><author><name sortKey="Moon, Td" uniqKey="Moon T">TD Moon</name></author><author><name sortKey="Nakada, Sy" uniqKey="Nakada S">SY Nakada</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zhang, Zj" uniqKey="Zhang Z">ZJ Zhang</name></author><author><name sortKey="Zhang, P" uniqKey="Zhang P">P Zhang</name></author><author><name sortKey="Tian, Jh" uniqKey="Tian J">JH Tian</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cheng, H" uniqKey="Cheng H">H Cheng</name></author><author><name sortKey="Hsiao, Cw" uniqKey="Hsiao C">CW Hsiao</name></author><author><name sortKey="Clymer, Jw" uniqKey="Clymer J">JW Clymer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cheng, H" uniqKey="Cheng H">H Cheng</name></author><author><name sortKey="Soleas, I" uniqKey="Soleas I">I Soleas</name></author><author><name sortKey="Ferko, Nc" uniqKey="Ferko N">NC Ferko</name></author><author><name sortKey="Clymer, Jw" uniqKey="Clymer J">JW Clymer</name></author><author><name sortKey="Amaral, Jf" uniqKey="Amaral J">JF Amaral</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Huang, J" uniqKey="Huang J">J Huang</name></author><author><name sortKey="Yu, Y" uniqKey="Yu Y">Y Yu</name></author><author><name sortKey="Wei, C" uniqKey="Wei C">C Wei</name></author><author><name sortKey="Qin, Q" uniqKey="Qin Q">Q Qin</name></author><author><name sortKey="Mo, Q" uniqKey="Mo Q">Q Mo</name></author><author><name sortKey="Yang, W" uniqKey="Yang W">W Yang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Deeks, J" uniqKey="Deeks J">J Deeks</name></author><author><name sortKey="Higgins, J" uniqKey="Higgins J">J Higgins</name></author><author><name sortKey="Altman, D" uniqKey="Altman D">D Altman</name></author><author><name sortKey="Green, S" uniqKey="Green S">S Green</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hozo, Sp" uniqKey="Hozo S">SP Hozo</name></author><author><name sortKey="Djulbegovic, B" uniqKey="Djulbegovic B">B Djulbegovic</name></author><author><name sortKey="Hozo, I" uniqKey="Hozo I">I Hozo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kontos, M" uniqKey="Kontos M">M Kontos</name></author><author><name sortKey="Kothari, A" uniqKey="Kothari A">A Kothari</name></author><author><name sortKey="Hamed, H" uniqKey="Hamed H">H Hamed</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sweeting, Mj" uniqKey="Sweeting M">MJ Sweeting</name></author><author><name sortKey="Sutton, Aj" uniqKey="Sutton A">AJ Sutton</name></author><author><name sortKey="Lambert, Pc" uniqKey="Lambert P">PC Lambert</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lumachi, F" uniqKey="Lumachi F">F Lumachi</name></author><author><name sortKey="Burelli, P" uniqKey="Burelli P">P Burelli</name></author><author><name sortKey="Basso, Sm" uniqKey="Basso S">SM Basso</name></author><author><name sortKey="Iacobone, M" uniqKey="Iacobone M">M Iacobone</name></author><author><name sortKey="Ermani, M" uniqKey="Ermani M">M Ermani</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yilmaz, Kb" uniqKey="Yilmaz K">KB Yilmaz</name></author><author><name sortKey="Dogan, L" uniqKey="Dogan L">L Dogan</name></author><author><name sortKey="Nalbant, H" uniqKey="Nalbant H">H Nalbant</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Khan, S" uniqKey="Khan S">S Khan</name></author><author><name sortKey="Khan, S" uniqKey="Khan S">S Khan</name></author><author><name sortKey="Chawla, T" uniqKey="Chawla T">T Chawla</name></author><author><name sortKey="Murtaza, G" uniqKey="Murtaza G">G Murtaza</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Khater, A" uniqKey="Khater A">A Khater</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Damani, Sr" uniqKey="Damani S">SR Damani</name></author><author><name sortKey="Haider, S" uniqKey="Haider S">S Haider</name></author><author><name sortKey="Shah, Ssh" uniqKey="Shah S">SSH Shah</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kozomara, D" uniqKey="Kozomara D">D Kozomara</name></author><author><name sortKey="Gali, G" uniqKey="Gali G">G Galić</name></author><author><name sortKey="Brekalo, Z" uniqKey="Brekalo Z">Z Brekalo</name></author><author><name sortKey="Sutalo, N" uniqKey="Sutalo N">N Sutalo</name></author><author><name sortKey="Kvesi, A" uniqKey="Kvesi A">A Kvesić</name></author><author><name sortKey="Solji, M" uniqKey="Solji M">M Soljić</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kumar, S" uniqKey="Kumar S">S Kumar</name></author><author><name sortKey="Lal, B" uniqKey="Lal B">B Lal</name></author><author><name sortKey="Misra, Mc" uniqKey="Misra M">MC Misra</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ecker, T" uniqKey="Ecker T">T Ecker</name></author><author><name sortKey="Carvalho, Al" uniqKey="Carvalho A">AL Carvalho</name></author><author><name sortKey="Choe, Jh" uniqKey="Choe J">JH Choe</name></author><author><name sortKey="Walosek, G" uniqKey="Walosek G">G Walosek</name></author><author><name sortKey="Preuss, Kj" uniqKey="Preuss K">KJ Preuss</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Adwani, A" uniqKey="Adwani A">A Adwani</name></author><author><name sortKey="Ebbs, Sr" uniqKey="Ebbs S">SR Ebbs</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ribeiro, Gh" uniqKey="Ribeiro G">GH Ribeiro</name></author><author><name sortKey="Kerr, Lm" uniqKey="Kerr L">LM Kerr</name></author><author><name sortKey="Haikel, Rl" uniqKey="Haikel R">RL Haikel</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Galatius, H" uniqKey="Galatius H">H Galatius</name></author><author><name sortKey="Okholm, M" uniqKey="Okholm M">M Okholm</name></author><author><name sortKey="Hoffmann, J" uniqKey="Hoffmann J">J Hoffmann</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Deo, Sv" uniqKey="Deo S">SV Deo</name></author><author><name sortKey="Shukla, Nk" uniqKey="Shukla N">NK Shukla</name></author><author><name sortKey="Asthana, S" uniqKey="Asthana S">S Asthana</name></author><author><name sortKey="Niranjan, B" uniqKey="Niranjan B">B Niranjan</name></author><author><name sortKey="Srinivas, G" uniqKey="Srinivas G">G Srinivas</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cheng, H" uniqKey="Cheng H">H Cheng</name></author><author><name sortKey="Soleas, Im" uniqKey="Soleas I">IM Soleas</name></author><author><name sortKey="Ferko, Nc" uniqKey="Ferko N">NC Ferko</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tejler, G" uniqKey="Tejler G">G Tejler</name></author><author><name sortKey="Aspegren, K" uniqKey="Aspegren K">K Aspegren</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lumachi, F" uniqKey="Lumachi F">F Lumachi</name></author><author><name sortKey="Brandes, Aa" uniqKey="Brandes A">AA Brandes</name></author><author><name sortKey="Burelli, P" uniqKey="Burelli P">P Burelli</name></author><author><name sortKey="Basso, Sm" uniqKey="Basso S">SM Basso</name></author><author><name sortKey="Iacobone, M" uniqKey="Iacobone M">M Iacobone</name></author><author><name sortKey="Ermani, M" uniqKey="Ermani M">M Ermani</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lane, Pw" uniqKey="Lane P">PW Lane</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Huang, Y" uniqKey="Huang Y">Y Huang</name></author><author><name sortKey="Mu, Gc" uniqKey="Mu G">GC Mu</name></author><author><name sortKey="Qin, Xg" uniqKey="Qin X">XG Qin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Huang, Y" uniqKey="Huang Y">Y Huang</name></author><author><name sortKey="Mu, Gc" uniqKey="Mu G">GC Mu</name></author><author><name sortKey="Qin, Xg" uniqKey="Qin X">XG Qin</name></author><author><name sortKey="Chen, Zb" uniqKey="Chen Z">ZB Chen</name></author><author><name sortKey="Lin, Jl" uniqKey="Lin J">JL Lin</name></author><author><name sortKey="Zeng, Yj" uniqKey="Zeng Y">YJ Zeng</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hung, Sh" uniqKey="Hung S">SH Hung</name></author><author><name sortKey="Chu, D" uniqKey="Chu D">D Chu</name></author><author><name sortKey="Chen, Fm" uniqKey="Chen F">FM Chen</name></author><author><name sortKey="Chen, T" uniqKey="Chen T">T Chen</name></author><author><name sortKey="Chen, Rc" uniqKey="Chen R">RC Chen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Salvia, R" uniqKey="Salvia R">R Salvia</name></author><author><name sortKey="Malleo, G" uniqKey="Malleo G">G Malleo</name></author><author><name sortKey="Marchegiani, G" uniqKey="Marchegiani G">G Marchegiani</name></author><author><name sortKey="Butturini, G" uniqKey="Butturini G">G Butturini</name></author><author><name sortKey="Esposito, A" uniqKey="Esposito A">A Esposito</name></author><author><name sortKey="Bassi, C" uniqKey="Bassi C">C Bassi</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="review-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Breast Cancer (Dove Med Press)</journal-id><journal-id journal-id-type="iso-abbrev">Breast Cancer (Dove Med Press)</journal-id><journal-id journal-id-type="publisher-id">Breast Cancer: Targets and Therapy</journal-id><journal-title-group><journal-title>Breast Cancer : Targets and Therapy</journal-title></journal-title-group><issn pub-type="epub">1179-1314</issn><publisher><publisher-name>Dove Medical Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27486342</article-id><article-id pub-id-type="pmc">4958357</article-id><article-id pub-id-type="doi">10.2147/BCTT.S110461</article-id><article-id pub-id-type="publisher-id">bctt-8-125</article-id><article-categories><subj-group subj-group-type="heading"><subject>Review</subject></subj-group></article-categories><title-group><article-title>A systematic review and meta-analysis of Harmonic technology compared with conventional techniques in mastectomy and breast-conserving surgery with lymphadenectomy for breast cancer</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Cheng</surname><given-names>Hang</given-names></name><xref ref-type="aff" rid="af1-bctt-8-125">1</xref></contrib><contrib contrib-type="author"><name><surname>Clymer</surname><given-names>Jeffrey W</given-names></name><xref ref-type="aff" rid="af1-bctt-8-125">1</xref><xref ref-type="corresp" rid="c1-bctt-8-125"></xref></contrib><contrib contrib-type="author"><name><surname>Ferko</surname><given-names>Nicole C</given-names></name><xref ref-type="aff" rid="af2-bctt-8-125">2</xref></contrib><contrib contrib-type="author"><name><surname>Patel</surname><given-names>Leena</given-names></name><xref ref-type="aff" rid="af2-bctt-8-125">2</xref></contrib><contrib contrib-type="author"><name><surname>Soleas</surname><given-names>Ireena M</given-names></name><xref ref-type="aff" rid="af2-bctt-8-125">2</xref></contrib><contrib contrib-type="author"><name><surname>Cameron</surname><given-names>Chris G</given-names></name><xref ref-type="aff" rid="af2-bctt-8-125">2</xref></contrib><contrib contrib-type="author"><name><surname>Hinoul</surname><given-names>Piet</given-names></name><xref ref-type="aff" rid="af1-bctt-8-125">1</xref></contrib></contrib-group><aff id="af1-bctt-8-125"><label>1</label>Ethicon Inc., Cincinnati, OH, USA</aff><aff id="af2-bctt-8-125"><label>2</label>Cornerstone Research Group, Burlington, ON, Canada</aff><author-notes><corresp id="c1-bctt-8-125">Correspondence: Jeffrey W Clymer, Ethicon Inc., 4545 Creek Road, Cincinnati, OH 45242, USA, Tel +1 513 337 3318, Email <email>jclymer@its.jnj.com</email></corresp></author-notes><pub-date pub-type="collection"><year>2016</year></pub-date><pub-date pub-type="epub"><day>18</day><month>7</month><year>2016</year></pub-date><volume>8</volume><fpage>125</fpage><lpage>140</lpage><permissions><copyright-statement>© 2016 Cheng et al. This work is published and licensed by Dove Medical Press Limited</copyright-statement><copyright-year>2016</copyright-year><license><license-p>The full terms of this license are available at <ext-link ext-link-type="uri" xlink:href="https://www.dovepress.com/terms.php">https://www.dovepress.com/terms.php</ext-link> and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.</license-p></license></permissions><abstract><sec><title>Background</title><p>Mastectomy and breast-conserving surgery (BCS) are important treatment options for breast cancer patients. A previous meta-analysis demonstrated that the risk of certain complications can be reduced with the Harmonic technology compared with conventional methods in mastectomy. However, the meta-analysis did not include studies of BCS patients and focused on a subset of surgical complications. The objective of this study was to compare Harmonic technology and conventional techniques for a range of clinical outcomes and complications in both mastectomy and BCS patients, including axillary lymph node dissection.</p></sec><sec><title>Methods</title><p>A comprehensive literature search was performed for randomized controlled trials comparing Harmonic technology and conventional methods in breast cancer surgery. Outcome measures included blood loss, drainage volume, total complications, seroma, necrosis, wound infections, ecchymosis, hematoma, hospital length of stay, and operating time. Risk of bias was analyzed for all studies. Meta-analysis was performed using random-effects models for mean differences of continuous variables and a fixed-effects model for risk ratios of dichotomous variables.</p></sec><sec><title>Results</title><p>Twelve studies met the inclusion criteria. Across surgery types, compared to conventional techniques, Harmonic technology reduced total complications by 52% (<italic>P</italic>=0.002), seroma by 46% (<italic>P</italic><0.0001), necrosis by 49% (<italic>P</italic>=0.04), postoperative chest wall drainage by 46% (<italic>P</italic>=0.0005), blood loss by 38% (<italic>P</italic>=0.0005), and length of stay by 22% (<italic>P</italic>=0.007). Although benefits generally appeared greatest in mastectomy patients with lymph node dissection, Harmonic technology showed significant reductions in complications in the BCS study subgroup.</p></sec><sec><title>Conclusion</title><p>In this meta-analysis of both mastectomy and BCS procedures, the use of Harmonic technology reduced the risk of most complications by about half across breast cancer surgery patients. These benefits may be due to superior hemostatic capabilities of Harmonic technology and better dissection, particularly lymph node dissection. Reduction in complications and other resource outcomes may engender lower downstream health care costs.</p></sec></abstract><kwd-group><title>Keywords</title><kwd>dissection</kwd><kwd>complications</kwd><kwd>ultrasonic</kwd></kwd-group></article-meta></front><floats-group><fig id="f1-bctt-8-125" position="float"><label>Figure 1</label><caption><p>PRISMA diagram for the systematic literature review.</p><p><bold>Abbreviations:</bold> BCS, breast-conserving surgery; LN, lymph node; RCT, randomized controlled trial.</p></caption><graphic xlink:href="bctt-8-125Fig1"></graphic></fig><fig id="f2-bctt-8-125" position="float"><label>Figure 2</label><caption><p>Risk of bias assessment for studies meeting inclusion criteria.</p></caption><graphic xlink:href="bctt-8-125Fig2"></graphic></fig><fig id="f3-bctt-8-125" position="float"><label>Figure 3</label><caption><p>Forest plot of meta-analysis results for intraoperative blood loss (mL).</p><p><bold>Abbreviations:</bold> SD, standard deviation; CI, confidence interval; LN, lymph node; HT, Harmonic technology; Conv Tech, conventional techniques; IV, inverse variance.</p></caption><graphic xlink:href="bctt-8-125Fig3"></graphic></fig><fig id="f4-bctt-8-125" position="float"><label>Figure 4</label><caption><p>Forest plot of meta-analysis results for postoperative drainage volume (mL) from chest wall.</p><p><bold>Abbreviations:</bold> SD, standard deviation; CI, confidence interval; LN, lymph node; HT, Harmonic technology; Conv Tech, conventional techniques; IV, inverse variance.</p></caption><graphic xlink:href="bctt-8-125Fig4"></graphic></fig><fig id="f5-bctt-8-125" position="float"><label>Figure 5</label><caption><p>Forest plot of meta-analysis results for postoperative hospital length of stay (days).</p><p><bold>Abbreviations:</bold> SD, standard deviation; CI, confidence interval; LN, lymph node; HT, Harmonic technology; Conv Tech, conventional techniques; IV, inverse variance.</p></caption><graphic xlink:href="bctt-8-125Fig5"></graphic></fig><fig id="f6-bctt-8-125" position="float"><label>Figure 6</label><caption><p>Forest plot of meta-analysis results for overall seroma.</p><p><bold>Abbreviations:</bold> CI, confidence interval; LN, lymph node; HT, Harmonic technology; Conv Tech, conventional techniques; IV, inverse variance.</p></caption><graphic xlink:href="bctt-8-125Fig6"></graphic></fig><fig id="f7-bctt-8-125" position="float"><label>Figure 7</label><caption><p>Forest plot of meta-analysis results for necrosis.</p><p><bold>Abbreviations:</bold> CI, confidence interval; LN, lymph node; HT, Harmonic technology; Conv Tech, conventional techniques; M-H, Mantel–Haenszel.</p></caption><graphic xlink:href="bctt-8-125Fig7"></graphic></fig><table-wrap id="t1-bctt-8-125" position="float"><label>Table 1</label><caption><p>Study and baseline characteristics for studies meeting inclusion criteria</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="top" align="left" rowspan="1" colspan="1">Reference</th><th valign="top" align="left" rowspan="1" colspan="1">Country</th><th valign="top" align="left" rowspan="1" colspan="1">Interventions evaluated</th><th valign="top" align="left" rowspan="1" colspan="1">n</th><th valign="top" align="left" rowspan="1" colspan="1">Mean age ± SD or (range)</th><th valign="top" align="left" rowspan="1" colspan="1">Surgery</th><th valign="top" align="left" rowspan="1" colspan="1">Included end points</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="1">Anlar et al<xref rid="b5-bctt-8-125" ref-type="bibr">5</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Turkey</td><td valign="top" align="left" rowspan="1" colspan="1">UltraCision<break></break>Harmonic scalpel<break></break>Electrocautery<break></break>Scalpel</td><td valign="top" align="left" rowspan="1" colspan="1">39<break></break>41<break></break>40</td><td valign="top" align="left" rowspan="1" colspan="1">52 (27–74)<xref ref-type="table-fn" rid="tfn1-bctt-8-125">a</xref><break></break>52 (24–82)<xref ref-type="table-fn" rid="tfn1-bctt-8-125">a</xref><break></break>51 (29–68)<xref ref-type="table-fn" rid="tfn1-bctt-8-125">a</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Modified radical mastectomy and axillary LN dissection</td><td valign="top" align="left" rowspan="1" colspan="1">• Operating time<break></break>• Intraoperative blood loss<break></break>• Overall seroma<break></break>• Hematoma<break></break>• Wound infection<break></break>• Necrosis<break></break>• Ecchymosis</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Bohm et al<xref rid="b4-bctt-8-125" ref-type="bibr">4</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Germany</td><td valign="top" align="left" rowspan="1" colspan="1">Harmonic<break></break>FOCUS + electrocautery<break></break>Scalpel and electrocautery with scissors</td><td valign="top" align="left" rowspan="1" colspan="1">54<break></break>52</td><td valign="top" align="left" rowspan="1" colspan="1">56.6±11.5<break></break>59.1±12.3</td><td valign="top" align="left" rowspan="1" colspan="1">BCS (lumpectomy and segmentectomy) and axillary dissection (when indicated)</td><td valign="top" align="left" rowspan="1" colspan="1">• Operating time<break></break>• Postoperative drainage volume of chest wall<break></break>• Postoperative hospital length of stay<break></break>• Overall seroma<break></break>• Hematoma</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Damani et al<xref rid="b32-bctt-8-125" ref-type="bibr">32</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Pakistan</td><td valign="top" align="left" rowspan="1" colspan="1">Ultracision<break></break>Harmonic scalpel<break></break>Olympus electrocautery (monopolar diathermy)</td><td valign="top" align="left" rowspan="1" colspan="1">25<break></break>25</td><td valign="top" align="left" rowspan="1" colspan="1">43.8±6.7<break></break>43.9±7.1</td><td valign="top" align="left" rowspan="1" colspan="1">Modified radical mastectomy</td><td valign="top" align="left" rowspan="1" colspan="1">• Operating time<break></break>• Intraoperative blood loss<break></break>• Postoperative drainage volume of chest wall<break></break>• Overall seroma<break></break>• Hematoma<break></break>• Wound infection<break></break>• Necrosis</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">He et al<xref rid="b6-bctt-8-125" ref-type="bibr">6</xref></td><td valign="top" align="left" rowspan="1" colspan="1">People’s Republic of China</td><td valign="top" align="left" rowspan="1" colspan="1">Harmonic<break></break>FOCUS<break></break>Electrocautery</td><td valign="top" align="left" rowspan="1" colspan="1">64<break></break>64</td><td valign="top" align="left" rowspan="1" colspan="1">48.5 (23–72)<xref ref-type="table-fn" rid="tfn1-bctt-8-125">a</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Axillary LN dissection for breast cancer with mastectomy or BC (lumpectomy) surgery</td><td valign="top" align="left" rowspan="1" colspan="1">• Operating time<break></break>• Intraoperative blood loss<break></break>• Postoperative hospital length of stay<break></break>• Overall seroma<break></break>• Hematoma<break></break>• Wound infection<break></break>• Necrosis</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Iovino et al<xref rid="b7-bctt-8-125" ref-type="bibr">7</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Italy</td><td valign="top" align="left" rowspan="1" colspan="1">Harmonic scalpel<break></break>Traditional scalpel, scissors, ligations, electrocautery</td><td valign="top" align="left" rowspan="1" colspan="1">30<break></break>30</td><td valign="top" align="left" rowspan="1" colspan="1">61 (39–81)<xref ref-type="table-fn" rid="tfn1-bctt-8-125">a</xref><break></break>65 (42–78)<xref ref-type="table-fn" rid="tfn1-bctt-8-125">a</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Axillary LN dissection for breast cancer: conservative surgery (83%) and mastectomy (17%)</td><td valign="top" align="left" rowspan="1" colspan="1">• Operating time<break></break>• Intraoperative blood loss<break></break>• Postoperative drainage volume of chest wall<break></break>• Postoperative hospital length of stay<break></break>• Overall seroma<break></break>• Hematoma<break></break>• Wound Infection</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Khan et al<xref rid="b30-bctt-8-125" ref-type="bibr">30</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Pakistan</td><td valign="top" align="left" rowspan="1" colspan="1">J-Hook<break></break>Harmonic scalpel<break></break>Electrocautery</td><td valign="top" align="left" rowspan="1" colspan="1">75<break></break>75</td><td valign="top" align="left" rowspan="1" colspan="1">50±12.2<break></break>48.5±14.5</td><td valign="top" align="left" rowspan="1" colspan="1">Modified radical mastectomy and axillary LN dissection</td><td valign="top" align="left" rowspan="1" colspan="1">• Operating time<break></break>• Intraoperative blood loss<break></break>• Total complications<break></break>• Overall seroma<break></break>• Hematoma<break></break>• Wound infection<break></break>• Necrosis</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Khater<xref rid="b31-bctt-8-125" ref-type="bibr">31</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Egypt</td><td valign="top" align="left" rowspan="1" colspan="1">Harmonic<break></break>UltraCision shears<break></break>Valley Lab<break></break>Force FX<break></break>Electrocautery</td><td valign="top" align="left" rowspan="1" colspan="1">30<break></break>30</td><td valign="top" align="left" rowspan="1" colspan="1">54.47±7.57<break></break>56.27±9.05</td><td valign="top" align="left" rowspan="1" colspan="1">Modified radical mastectomy and axilia dissection</td><td valign="top" align="left" rowspan="1" colspan="1">• Operating time<break></break>• Intraoperative blood loss<break></break>• Overall seroma<break></break>• Hematoma<break></break>• Necrosis</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Kontos et al<xref rid="b26-bctt-8-125" ref-type="bibr">26</xref></td><td valign="top" align="left" rowspan="1" colspan="1">England</td><td valign="top" align="left" rowspan="1" colspan="1">UltraCision<break></break>Harmonic scalpel with curved blade or hook<break></break>Valley<break></break>Lab<break></break>Force FX<break></break>Electrocautery</td><td valign="top" align="left" rowspan="1" colspan="1">15<break></break>17</td><td valign="top" align="left" rowspan="1" colspan="1">60 (40–76)<xref ref-type="table-fn" rid="tfn2-bctt-8-125">b</xref><break></break>58 (32–86)<xref ref-type="table-fn" rid="tfn2-bctt-8-125">b</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Modified radical mastectomy with sentinel node biopsy, skin sparing mastectomy with immediate reconstruction and wide excision and axillary clearance as part of BCS</td><td valign="top" align="left" rowspan="1" colspan="1">• Operating time<break></break>• Total complications<break></break>• Overall seroma<break></break>• Hematoma<break></break>• Wound infection<break></break>• Necrosis</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Kozomara et al<xref rid="b33-bctt-8-125" ref-type="bibr">33</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Bosnia and Herzegovina</td><td valign="top" align="left" rowspan="1" colspan="1">UltraCision<break></break>Harmonic scalpel<break></break>Olympus electrocautery (monopolar)</td><td valign="top" align="left" rowspan="1" colspan="1">31<break></break>30</td><td valign="top" align="left" rowspan="1" colspan="1">62±17 <xref ref-type="table-fn" rid="tfn3-bctt-8-125">c</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Modified radical mastectomy and LN dissection</td><td valign="top" align="left" rowspan="1" colspan="1">• Operating time<break></break>• Intraoperative blood loss<break></break>• Overall Seroma<break></break>• Wound infection</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Lumachi et al<xref rid="b28-bctt-8-125" ref-type="bibr">28</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Italy</td><td valign="top" align="left" rowspan="1" colspan="1">UltraCision<break></break>Harmonic scalpel<break></break>Scalpel</td><td valign="top" align="left" rowspan="1" colspan="1">38<break></break>38</td><td valign="top" align="left" rowspan="1" colspan="1">55.1±11.8 <xref ref-type="table-fn" rid="tfn3-bctt-8-125">c</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Modified radical mastectomy or BC (lumpectomy) surgery with axillary LN dissection for breast cancer; no immediate breast reconstruction</td><td valign="top" align="left" rowspan="1" colspan="1">• Postoperative hospital length of stay</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Rohaizak et al<xref rid="b8-bctt-8-125" ref-type="bibr">8</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Malaysia</td><td valign="top" align="left" rowspan="1" colspan="1">UltraCision<break></break>Harmonic scalpel<break></break>Value Lab<break></break>Diathermy<break></break>Electrocautery</td><td valign="top" align="left" rowspan="1" colspan="1">20<break></break>20</td><td valign="top" align="left" rowspan="1" colspan="1">53.0±7.0<break></break>53.0±9.0</td><td valign="top" align="left" rowspan="1" colspan="1">Modified radical mastectomy and axillary LN dissection</td><td valign="top" align="left" rowspan="1" colspan="1">• Postoperative drainage volume of chest wall<break></break>• Overall seroma<break></break>• Wound infection<break></break>• Necrosis</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Yilmaz et al<xref rid="b29-bctt-8-125" ref-type="bibr">29</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Turkey</td><td valign="top" align="left" rowspan="1" colspan="1">UltraCision<break></break>Harmonic scalpel<break></break>Scalpel<break></break>Olympus<break></break>EUS 10<break></break>Electrocautery</td><td valign="top" align="left" rowspan="1" colspan="1">29<break></break>27<break></break>26</td><td valign="top" align="left" rowspan="1" colspan="1">52.0±9.5<break></break>50.2±9.3<break></break>48.5±9.8</td><td valign="top" align="left" rowspan="1" colspan="1">Modified radical mastectomy and axillary LN dissection</td><td valign="top" align="left" rowspan="1" colspan="1">• Operating time<break></break>• Intraoperative blood loss<break></break>• Overall seroma<break></break>• Hematoma<break></break>• Wound infection<break></break>• Necrosis<break></break>• Ecchymosis</td></tr></tbody></table><table-wrap-foot><fn><p><bold>Notes:</bold></p></fn><fn id="tfn1-bctt-8-125"><label>a</label><p>Age reported as median (range).</p></fn><fn id="tfn2-bctt-8-125"><label>b</label><p>Age reported as mean (range).</p></fn><fn id="tfn3-bctt-8-125"><label>c</label><p>Only an overall age range was provided by the authors. Abbreviations: LN, lymph node; SD, standard deviation; BCS, breast-conserving surgery.</p></fn></table-wrap-foot></table-wrap><table-wrap id="t2-bctt-8-125" position="float"><label>Table 2</label><caption><p>Qualitative risk of bias assessment summary</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="top" align="left" rowspan="1" colspan="1">Study</th><th valign="top" align="left" rowspan="1" colspan="1">Sequence generation</th><th valign="top" align="left" rowspan="1" colspan="1">Allocation concealment</th><th valign="top" align="left" rowspan="1" colspan="1">Blinding of personnel and participants</th><th valign="top" align="left" rowspan="1" colspan="1">Blinding of outcomes</th><th valign="top" align="left" rowspan="1" colspan="1">Incomplete outcome data addressed</th><th valign="top" align="left" rowspan="1" colspan="1">Free of selective reporting</th><th valign="top" align="left" rowspan="1" colspan="1">Free of other bias</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="1">Anlar et al<xref rid="b5-bctt-8-125" ref-type="bibr">5</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Unclear</td><td valign="top" align="left" rowspan="1" colspan="1">Unclear</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Unclear</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Bohm et al<xref rid="b4-bctt-8-125" ref-type="bibr">4</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Unclear</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Unclear</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Damani et al<xref rid="b32-bctt-8-125" ref-type="bibr">32</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Unclear</td><td valign="top" align="left" rowspan="1" colspan="1">Unclear</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Unclear</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">He et al<xref rid="b6-bctt-8-125" ref-type="bibr">6</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Unclear</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Unclear</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Iovino et al<xref rid="b7-bctt-8-125" ref-type="bibr">7</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Unclear</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Khan et al<xref rid="b30-bctt-8-125" ref-type="bibr">30</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Unclear</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">No</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Khater<xref rid="b31-bctt-8-125" ref-type="bibr">31</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Unclear</td><td valign="top" align="left" rowspan="1" colspan="1">Unclear</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Unclear</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Kontos et al<xref rid="b26-bctt-8-125" ref-type="bibr">26</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Unclear</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Kozomara et al<xref rid="b33-bctt-8-125" ref-type="bibr">33</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Unclear</td><td valign="top" align="left" rowspan="1" colspan="1">Unclear</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Unclear</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Lumachi et al<xref rid="b28-bctt-8-125" ref-type="bibr">28</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Unclear</td><td valign="top" align="left" rowspan="1" colspan="1">Unclear</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Unclear</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Rohaizak et al<xref rid="b8-bctt-8-125" ref-type="bibr">8</xref></td><td valign="top" align="left" rowspan="1" colspan="1">No</td><td valign="top" align="left" rowspan="1" colspan="1">No</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Unclear</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Yilmaz et al<xref rid="b29-bctt-8-125" ref-type="bibr">29</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Unclear</td><td valign="top" align="left" rowspan="1" colspan="1">Unclear</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td><td valign="top" align="left" rowspan="1" colspan="1">Unclear</td><td valign="top" align="left" rowspan="1" colspan="1">Yes</td></tr></tbody></table><table-wrap-foot><fn id="tfn4-bctt-8-125"><p><bold>Notes:</bold> Yes, low risk of bias; No, high risk of bias.</p></fn></table-wrap-foot></table-wrap><table-wrap id="t3-bctt-8-125" position="float"><label>Table 3</label><caption><p>Summary of primary and sensitivity analyses</p></caption><table frame="hsides" rules="groups"><thead><tr><th rowspan="2" valign="top" align="left" colspan="1">Outcome</th><th rowspan="2" valign="top" align="left" colspan="1">Primary analysis</th><th rowspan="2" valign="top" align="left" colspan="1">% Decrease with Harmonic technology</th><th colspan="4" valign="top" align="left" rowspan="1">Sensitivity analyses
<hr></hr></th></tr><tr><th valign="top" align="left" rowspan="1" colspan="1">Exclusion of studies not randomizing device use in breast surgery<xref rid="b28-bctt-8-125" ref-type="bibr">28</xref></th><th valign="top" align="left" rowspan="1" colspan="1">Exclusion of studies not randomizing device use in LN dissection<xref rid="b5-bctt-8-125" ref-type="bibr">5</xref>,<xref rid="b29-bctt-8-125" ref-type="bibr">29</xref></th><th valign="top" align="left" rowspan="1" colspan="1">Exclusion of studies requiring imputation<xref rid="b4-bctt-8-125" ref-type="bibr">4</xref>,<xref rid="b5-bctt-8-125" ref-type="bibr">5</xref>,<xref rid="b7-bctt-8-125" ref-type="bibr">7</xref>,<xref rid="b26-bctt-8-125" ref-type="bibr">26</xref></th><th valign="top" align="left" rowspan="1" colspan="1">Exclusion of “lower” quality studies<sup>8,30a</sup></th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="1">Operating time (minutes) (MD [95% CI]; <italic>P</italic>-value; <italic>I</italic><sup>2</sup> value)</td><td valign="top" align="left" rowspan="1" colspan="1">−5.07 [95% CI: −10.98 to 0.83]; <italic>P</italic>=0.09; <italic>I</italic><sup>2</sup>=83%</td><td valign="top" align="left" rowspan="1" colspan="1">4.60</td><td valign="top" align="left" rowspan="1" colspan="1">Same as primary analysis</td><td valign="top" align="left" rowspan="1" colspan="1">−4.46 [95% CI: −10.92 to 2.00]; <italic>P</italic>=0.18; <italic>I</italic><sup>2</sup>=86%</td><td valign="top" align="left" rowspan="1" colspan="1">−6.87 [95% CI: −13.78 to 0.04]; <italic>P</italic>=0.05; <italic>I</italic><sup>2</sup>=87%</td><td valign="top" align="left" rowspan="1" colspan="1">−5.92 [95% CI: −12.13 to 0.30]; <italic>P</italic>=0.06; <italic>I</italic><sup>2</sup>=84%</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Intraoperative blood loss (mL) (MD [95% CI]; <italic>P</italic>-value; <italic>I</italic><sup>2</sup> value)</td><td valign="top" align="left" rowspan="1" colspan="1">−87.54 [95% CI: −137.07 to −38.02]; <italic>P</italic>=0.0005; <italic>I</italic><sup>2</sup>=99%</td><td valign="top" align="left" rowspan="1" colspan="1">37.59</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">−102.26 [95% CI: −157.68 to −46.84]; <italic>P</italic>=0.0003; <italic>I</italic><sup>2</sup>=99%</td><td valign="top" align="left" rowspan="1" colspan="1">−109.57 [95% CI: −135.06 to −84.07]; <italic>P</italic><0.00001; <italic>I</italic><sup>2</sup>=87%</td><td valign="top" align="left" rowspan="1" colspan="1">−88.20 [95% CI: −143.05 to −33.36]; <italic>P</italic>=0.002; <italic>I</italic><sup>2</sup>=99%</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Postoperative drainage volume of chest wall (mL) (MD [95% CI]; <italic>P</italic>-value; <italic>I</italic><sup>2</sup> value)</td><td valign="top" align="left" rowspan="1" colspan="1">−42.14 [95% CI: −65.90 to −18.39]; <italic>P</italic>=0.0005; <italic>I</italic><sup>2</sup>=87%</td><td valign="top" align="left" rowspan="1" colspan="1">45.77</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">Same as primary analysis</td><td valign="top" align="left" rowspan="1" colspan="1">−46.04 [95% CI: −78.11 to −13.97]; <italic>P</italic>=0.005; <italic>I</italic><sup>2</sup>=91%</td><td valign="top" align="left" rowspan="1" colspan="1">−35.03 [95% CI: −56.91 to −13.15]; <italic>P</italic>=0.002; <italic>I</italic><sup>2</sup>=88%</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Postoperative hospital length of stay (days) (MD [95% CI]; <italic>P</italic>-value; <italic>I</italic><sup>2</sup> value)</td><td valign="top" align="left" rowspan="1" colspan="1">−1.38 [95% CI: −2.38 to −0.38]; <italic>P</italic>=0.007; <italic>I</italic><sup>2</sup>=98%</td><td valign="top" align="left" rowspan="1" colspan="1">22.44</td><td valign="top" align="left" rowspan="1" colspan="1">−1.79 [95% CI: −3.07 to −0.51]; <italic>P</italic>=0.006; <italic>I</italic><sup>2</sup>=98%</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">−1.74 [95% CI: −3.16 to −0.33]; <italic>P</italic>=0.02; <italic>I</italic><sup>2</sup>=98%</td><td valign="top" align="left" rowspan="1" colspan="1">Same as primary analysis</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Total complications (RR [95% CI]; <italic>P</italic>-value; <italic>I</italic><sup>2</sup> value)</td><td valign="top" align="left" rowspan="1" colspan="1">0.48 [95% CI: 0.30–0.77]; <italic>P</italic>=0.002; <italic>I</italic><sup>2</sup>=0%</td><td valign="top" align="left" rowspan="1" colspan="1">52</td><td valign="top" align="left" rowspan="1" colspan="1">Same as primary analysis</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">Same as primary analysis</td><td valign="top" align="left" rowspan="1" colspan="1">Too few studies to inform (<2)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Overall seroma (RR [95% CI]; <italic>P</italic>-value; <italic>I</italic><sup>2</sup> value)</td><td valign="top" align="left" rowspan="1" colspan="1">0.54 [95% CI: 0.43–0.69]; <italic>P</italic><0.00001; <italic>I</italic><sup>2</sup>=25%</td><td valign="top" align="left" rowspan="1" colspan="1">46</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">0.56 [95% CI: 0.41 to 0.76]; P=0.0002; I<sup>2</sup>=30%</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">0.51 [95% CI: 0.39–0.68]; <italic>P</italic><0.00001; <italic>I</italic><sup>2</sup>=43%</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Hematoma (RR [95% CI]; <italic>P</italic>-value; <italic>I</italic><sup>2</sup> value)</td><td valign="top" align="left" rowspan="1" colspan="1">0.57 [95% CI: 0.30–1.10]; <italic>P</italic>=0.09; <italic>I</italic><sup>2</sup>=0%</td><td valign="top" align="left" rowspan="1" colspan="1">43</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">0.44 [95% CI: 0.21 to 0.91]; P=0.03; I<sup>2</sup>=0%</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">0.65 [95% CI: 0.33–1.28]; <italic>P</italic>=0.21; <italic>I</italic><sup>2</sup>=0%</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Wound infection (RR [95% CI]; <italic>P</italic>-value; <italic>I</italic><sup>2</sup> value)</td><td valign="top" align="left" rowspan="1" colspan="1">0.71 [95% CI: 0.32–1.56]; <italic>P</italic>=0.39; <italic>I</italic><sup>2</sup>=0%</td><td valign="top" align="left" rowspan="1" colspan="1">29</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">0.55 [95% CI: 0.21 to 1.44]; P=0.22; I<sup>2</sup>=0%</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">0.78 [95% CI: 0.31–1.98]; <italic>P</italic>=0.60; <italic>I</italic><sup>2</sup>=0%</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Necrosis (RR [95% CI]; <italic>P</italic>-value; <italic>I</italic><sup>2</sup> value)</td><td valign="top" align="left" rowspan="1" colspan="1">0.51 [95% CI: 0.28–0.96]; <italic>P</italic>=0.04; <italic>I</italic><sup>2</sup>=0%</td><td valign="top" align="left" rowspan="1" colspan="1">49</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">0.33 [95% CI: 0.01 to 7.81]; P=0.08; I<sup>2</sup>=0%</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">0.62 [95% CI: 0.31–1.25]; <italic>P</italic>=0.18; <italic>I</italic><sup>2</sup>=0%</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Ecchymosis (RR [95% CI]; <italic>P</italic>-value; <italic>I</italic><sup>2</sup> value)</td><td valign="top" align="left" rowspan="1" colspan="1">0.67 [95% CI: 0.36–1.25]; <italic>P</italic>=0.21; <italic>I</italic><sup>2</sup>=0%</td><td valign="top" align="left" rowspan="1" colspan="1">33</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">Too few studies to inform (<2)</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">Same as primary analysis</td></tr></tbody></table><table-wrap-foot><fn><p><bold>Notes:</bold></p></fn><fn id="tfn5-bctt-8-125"><label>a</label><p>Lower quality study defined as: ≥4 “Unclear” OR one “No” listed in any risk of bias assessment category for Khan et al<xref rid="b30-bctt-8-125" ref-type="bibr">30</xref> and Rohaizak et al.<xref rid="b8-bctt-8-125" ref-type="bibr">8</xref></p></fn><fn id="tfn6-bctt-8-125"><p><bold>Abbreviations:</bold> RR, risk ratio; CI, confidence interval; LN, lymph node; MD, mean difference.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc><affiliations><list><country><li>Canada</li><li>États-Unis</li></country></list><tree><country name="États-Unis"><noRegion><name sortKey="Cheng, Hang" sort="Cheng, Hang" uniqKey="Cheng H" first="Hang" last="Cheng">Hang Cheng</name></noRegion><name sortKey="Clymer, Jeffrey W" sort="Clymer, Jeffrey W" uniqKey="Clymer J" first="Jeffrey W" last="Clymer">Jeffrey W. Clymer</name><name sortKey="Hinoul, Piet" sort="Hinoul, Piet" uniqKey="Hinoul P" first="Piet" last="Hinoul">Piet Hinoul</name></country><country name="Canada"><noRegion><name sortKey="Ferko, Nicole C" sort="Ferko, Nicole C" uniqKey="Ferko N" first="Nicole C" last="Ferko">Nicole C. Ferko</name></noRegion><name sortKey="Cameron, Chris G" sort="Cameron, Chris G" uniqKey="Cameron C" first="Chris G" last="Cameron">Chris G. Cameron</name><name sortKey="Patel, Leena" sort="Patel, Leena" uniqKey="Patel L" first="Leena" last="Patel">Leena Patel</name><name sortKey="Soleas, Ireena M" sort="Soleas, Ireena M" uniqKey="Soleas I" first="Ireena M" last="Soleas">Ireena M. Soleas</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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