Camilos Angelique N, Bowley Schubert Leo C, Castro Marcela P, Nann Silas D, Edwards Suzanne, Stretton Brandon, Gupta Aashray K, Kovoor Joshua G, Marshall-Webb Matthew, Maddern Guy J
Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
Department of Surgery, The Univeristy of Adelaide, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
ANZ J Surg. 2025 Jan-Feb;95(1-2):47-55. doi: 10.1111/ans.19380. Epub 2025 Jan 6.
Due to limited healthcare resources, there is global incentive to maximize efficacy while minimizing patient harm. Given the low rate of cancer diagnoses made via routine histopathological analysis of surgical specimens, a selective approach has been proposed as a viable alternative. This systematic review aimed to evaluate effectiveness of cancer detection and costs with a selective approach.
This study was registered with PROSPERO (CRD42022346535) and conducted according to PRISMA 2020 and MOOSE guidelines. Ovid Embase, Ovid MEDLINE and PubMed were searched from earliest result (1973) to 30 July 2022 for studies evaluating selective histopathology for surgical specimens. Screening, risk of bias assessment and data extraction were completed in duplicate. Statistical analysis used a random effects model.
Searches identified 4194 records, with 11 studies included consisting of 26 126 patients. Eight studies analysed patients who underwent cholecystectomy while three analysed patients who underwent appendectomy, vertical laparoscopic sleeve gastrectomy and neurectomy. In total, 295 neoplasms were detected: 196 malignant, 99 benign. Overall mean proportion of malignant neoplasms is 0.01 (95% confidence interval 0.00, 0.01). Weighted mean projected cost savings were calculated in varying formats, ranging from 6891 Euros per year within one hospital, 712 748 Euros per 10 000 patients, to 875 077 Euros per year within one country.
A selective approach is not associated with a significant proportion of missed cancer diagnoses, and provides considerable cost savings, particularly demonstrated for cholecystectomy samples. Further discussion is required regarding how surgeons will be protected medicolegally without the safety net of routine analysis.
由于医疗资源有限，全球都有在使疗效最大化同时将患者伤害最小化的动机。鉴于通过手术标本的常规组织病理学分析进行癌症诊断的比例较低，有人提出采用选择性方法作为一种可行的替代方案。本系统评价旨在评估采用选择性方法进行癌症检测的有效性和成本。
本研究在国际前瞻性系统评价注册库（注册号：CRD42022346535）进行了注册，并按照PRISMA 2020和MOOSE指南开展。检索了Ovid Embase、Ovid MEDLINE和PubMed数据库，从最早记录（1973年）至2022年7月30日，以查找评估手术标本选择性组织病理学的研究。筛选、偏倚风险评估和数据提取均重复进行。统计分析采用随机效应模型。
检索共识别出4194条记录，纳入11项研究，涉及26126例患者。8项研究分析了接受胆囊切除术的患者，3项研究分析了接受阑尾切除术、垂直腹腔镜袖状胃切除术和神经切除术的患者。共检测到295例肿瘤：196例为恶性，99例为良性。恶性肿瘤的总体平均比例为0.01（95%置信区间0.00, ）。以不同形式计算了加权平均预计成本节约，范围从一家医院每年6891欧元、每10000例患者712748欧元到一个国家每年875077欧元。
选择性方法与大量漏诊癌症诊断无关，并能节省大量成本，尤其是在胆囊切除标本方面表现明显。对于在没有常规分析安全保障的情况下如何从法律上保护外科医生，还需要进一步讨论。
