da Nobrega Oliveira Rachid Eduardo Noleto, D Ambrosio Paula Duarte, Salvador Isabella Cabianca Moriguchi Caetano, Martins Marcelo Albuquerque Barbosa, Campos José Ribas Milanez
Department Thoracic Surgery, Barretos Cancer Center, São Paulo, Barretos - SP, Brazil.
Department Thoracic Surgery, Hospital das Clínicas, Faculty of Medicine, University of São Paulo (HCFMUSP), São Paulo, Brazil.
Ann Surg Oncol. 2025 May 26. doi: 10.1245/s10434-025-17484-6.
Chest wall reconstruction using rigid or flexible materials presents controversial clinical outcomes, particularly regarding complications and mortality. The optimal material for various clinical scenarios remains uncertain. We conducted a meta-analysis to directly compare outcomes between rigid and flexible materials in chest wall reconstructions.
We systematically searched PubMed, Embase, and Cochrane Library until 20 January 2025. Studies comparing chest wall reconstruction with rigid and flexible materials in adult patients were included. The effect measures used were mean differences for continuous outcomes and odds ratios for binary outcomes. Statistical analysis was conducted using random-effects models, and heterogeneity was evaluated with I statistics.
In total, 13 retrospective studies involving 1111 patients were included. Of these, 39.5% underwent reconstruction with rigid materials and 60.5% with flexible materials. No statistically significant differences were found between materials in mortality (odds ratio (OR) 1.87; 95% confidence interval (CI) 0.70-4.97; p = 0.21), rupture (OR 2.02; 95% CI 0.49-8.26; p = 0.33), major complications (OR 1.49; 95% CI 0.84-2.63; p = 0.17), or pulmonary complications (OR 1.26; 95% CI 0.80-1.98; p = 0.31).
Our findings suggest that rigid and flexible materials yield similar clinical outcomes in chest wall reconstruction, though rigid materials were more frequently used for larger defects. Prospective studies with standardized criteria are needed to validate these findings.
使用刚性或柔性材料进行胸壁重建的临床结果存在争议，尤其是在并发症和死亡率方面。针对各种临床情况的最佳材料仍不确定。我们进行了一项荟萃分析，以直接比较胸壁重建中刚性和柔性材料的效果。
我们系统检索了截至2025年1月20日的PubMed、Embase和Cochrane图书馆。纳入了比较成年患者使用刚性和柔性材料进行胸壁重建的研究。使用的效应指标为连续结局的均值差和二分类结局的比值比。采用随机效应模型进行统计分析，并用I统计量评估异质性。
共纳入13项回顾性研究，涉及1111例患者。其中，39.5%接受了刚性材料重建，60.5%接受了柔性材料重建。材料在死亡率（比值比（OR）1.87；95%置信区间（CI）0.70 - 4.97；p = 0.21）、破裂（OR 2.02；95% CI 0.49 - 8.26；p = 0.33）、主要并发症（OR 1.49；95% CI 0.84 - 2.63；p = 0.17）或肺部并发症（OR 1.26；95% CI 0.80 - 1.98；p = 0.31）方面未发现统计学显著差异。
我们的研究结果表明，刚性和柔性材料在胸壁重建中产生相似的临床结果，尽管刚性材料更常用于较大的缺损。需要采用标准化标准的前瞻性研究来验证这些发现。
