Introduction
Surgical management of Hinchey III and IV diverticulitis utilizes either Hartmann’s procedure (HP) or primary resection anastomosis (PRA) with or without fecal diversion. The aim of this meta-analysis is to determine which of the two procedures has a more favorable outcome.
Methods
A systematic review of the existing literature was performed using the PRISMA guidelines. A meta-analysis was carried out using a Mantel-Haenszel, random effects model, and forest plots were generated. The Newcastle-Ottawa and Jadad scoring tools were used to assess the included studies.
Results
A total of 25 studies involving 3546 patients were included in this study. The overall mortality in the HP group was 10.8% across the observational studies and 9.4% in the randomized controlled trials (RCTs). The mortality rate in the PRA group was lower than that in the HP group, at 8.2% in the observational studies and 4.3% in the RCTs. A comparison of PRA vs HP demonstrated a 40% lower mortality rate in the PRA group than in the HP (OR 0.60, 95% CI 0.38–0.95,
p
= 0.03) when analyzing the observational studies. However, meta-analysis of the three RCTs did not demonstrate any difference in mortality, (OR 0.44 (95% CI 0.14–1.34,
p
= 0.15). Wound infection rates between the two groups were comparable (OR 0.75, 95% CI 0.20–2.78,
p
= 0.67).
Conclusion
Analysis of observational studies suggests that PRA may be associated with a lower overall mortality. There were no differences in wound infection rates. Based on the current evidence, both surgical strategies appear to be acceptable.
In addition to the fact that near-total thyroidectomy adds the advantages of total thyroidectomy (no recurrence) to those of subtotal thyroidectomy (low incidence of temporary and permanent hypoparathyroidism), it has a significant positive impact on thyroid-associated orbitopathy.
Aims: To spot the light on metastatic tumors to the breast which represent only 0.5-1.5% of breast malignancies to avoid misdiagnosis as primary breast tumors.
Presentation of the Case: 45-year-old female was referred to the Oncology Department of Meet Ghmmr Oncology Center in November 2017 after total thyroidectomy followed by cervical lymph node dissection for medullary thyroid carcinoma (MTC) 1 year ago at Oncology Center Mansoura University. The panel recommended postoperative radiotherapy. One month after the end of radiotherapy, she complained of frequent headache attacks and abdominal pain. CT was done in February 2018 revealed metastasis to the brain, lung, liver and ovaries. After the fifth cycle of chemotherapy, a progressively enlarging left breast mass appeared, that proved to be metastatic MTC.
Discussion: MTC is a neuroendocrine tumor of the thyroid gland. Breast is an unusual metastatic site for MTC. Consequently, breast masses should be evaluated with caution, especially in the presence of a known primary malignancy. Histopathologic examination is the key diagnostic tool.
Conclusion: Metastasis to the breast should be considered in the differential diagnosis of a breast mass in a patient with a past history of MTC. Histopathologic examination and proper panel of immunohistochemical markers are fundamental for diagnosis to prevent unneeded surgery.
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