Quantification and Effectiveness of Vascularized Neck Lymph Node Transfer for Lymphedema: a Systematic Review and Meta-Analysis
Abstract This study aims to quantify the number of vascularized neck lymph nodes (VLNs) and postvascularized lymph node transfer (VLNT) and summarize the safety and efficacy of neck VLNT for treatment of lymphedema. PubMed, Web of Science, Google Scholar, and Cochrane CENTRAL databases were searched...
Ausführliche Beschreibung
Gespeichert in:
| Autor*in: |
Seth, Ishith [verfasserIn] |
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| Format: |
E-Artikel |
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| Sprache: |
Englisch |
| Erschienen: |
2022 |
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| Schlagwörter: |
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| Anmerkung: |
© Crown 2022 |
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| Übergeordnetes Werk: |
Enthalten in: Indian Journal of Surgery - Springer-Verlag, 2007, 85(2022), 4 vom: 28. Nov., Seite 730-739 |
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| Übergeordnetes Werk: |
volume:85 ; year:2022 ; number:4 ; day:28 ; month:11 ; pages:730-739 |
| Links: |
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| DOI / URN: |
10.1007/s12262-022-03627-6 |
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SPR052765636 |
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| 520 | |a Abstract This study aims to quantify the number of vascularized neck lymph nodes (VLNs) and postvascularized lymph node transfer (VLNT) and summarize the safety and efficacy of neck VLNT for treatment of lymphedema. PubMed, Web of Science, Google Scholar, and Cochrane CENTRAL databases were searched up to March 2022. PRISMA guidelines were adhered to, and the study was registered on PROSPERO. The primary outcome was the quantity of neck lymph nodes, and the secondary outcomes included postoperative cellulitis, Lymphedema Quality of Life Tool (LYMQOL), reduction of the extremity circumference, circumference differentiation, donor site morbidity, and lymphedema recurrence. The raw mean or proportion with a 95% confidence interval (CI) was calculated to conduct a single-arm meta-analysis. All analyses were performed using %$R%$ software v4.0.3. Newcastle–Ottawa Scale was used to assess for quality of included studies. Eighteen studies comprising 510 patients were included in the single-arm meta-analysis. Mean neck VLNs were 3.80, 95% CI [2.48, 5.11], mean postoperative cellulitis was 0.70%, 95% CI [0.22, 1.18], mean postoperative LYMQOL was 6.84, 95% CI [5.39, 8.30], mean postoperative reduction of the extremity circumference 43.57%, 95% CI [27.81, 59.33], and mean circumference differentiation was 11.37%, 95% CI [7.51, 15.23]. The overall proportion of donor site morbidity events was 0.06, 95% CI [0.04, 0.11], and lymphedema recurrence was 0.12, 95% CI [0.05, 0.24]. The neck lymph node flap has an arsenal of lymph nodes present, carries no risk of iatrogenic edema, and has a low risk of other complications. Low donor site morbidity, patient satisfaction with the cosmetic scar, significant lymphedema reduction, and improvement of LYMQOL postoperatively are some positive outcomes that should be considered by surgeons. | ||
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10.1007/s12262-022-03627-6 doi (DE-627)SPR052765636 (SPR)s12262-022-03627-6-e DE-627 ger DE-627 rakwb eng Seth, Ishith verfasserin (orcid)0000-0001-5444-8925 aut Quantification and Effectiveness of Vascularized Neck Lymph Node Transfer for Lymphedema: a Systematic Review and Meta-Analysis 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Crown 2022 Abstract This study aims to quantify the number of vascularized neck lymph nodes (VLNs) and postvascularized lymph node transfer (VLNT) and summarize the safety and efficacy of neck VLNT for treatment of lymphedema. PubMed, Web of Science, Google Scholar, and Cochrane CENTRAL databases were searched up to March 2022. PRISMA guidelines were adhered to, and the study was registered on PROSPERO. The primary outcome was the quantity of neck lymph nodes, and the secondary outcomes included postoperative cellulitis, Lymphedema Quality of Life Tool (LYMQOL), reduction of the extremity circumference, circumference differentiation, donor site morbidity, and lymphedema recurrence. The raw mean or proportion with a 95% confidence interval (CI) was calculated to conduct a single-arm meta-analysis. All analyses were performed using %$R%$ software v4.0.3. Newcastle–Ottawa Scale was used to assess for quality of included studies. Eighteen studies comprising 510 patients were included in the single-arm meta-analysis. Mean neck VLNs were 3.80, 95% CI [2.48, 5.11], mean postoperative cellulitis was 0.70%, 95% CI [0.22, 1.18], mean postoperative LYMQOL was 6.84, 95% CI [5.39, 8.30], mean postoperative reduction of the extremity circumference 43.57%, 95% CI [27.81, 59.33], and mean circumference differentiation was 11.37%, 95% CI [7.51, 15.23]. The overall proportion of donor site morbidity events was 0.06, 95% CI [0.04, 0.11], and lymphedema recurrence was 0.12, 95% CI [0.05, 0.24]. The neck lymph node flap has an arsenal of lymph nodes present, carries no risk of iatrogenic edema, and has a low risk of other complications. Low donor site morbidity, patient satisfaction with the cosmetic scar, significant lymphedema reduction, and improvement of LYMQOL postoperatively are some positive outcomes that should be considered by surgeons. Neck lymph node (dpeaa)DE-He213 Quantitative neck node (dpeaa)DE-He213 Vascularized lymph node transfer (dpeaa)DE-He213 Lymphedema (dpeaa)DE-He213 Meta-analysis (dpeaa)DE-He213 Bulloch, Gabriella aut Gibson, Damien aut Seth, Nimish aut Hunter-Smith, David J. aut Rozen, Warren M. aut Enthalten in Indian Journal of Surgery Springer-Verlag, 2007 85(2022), 4 vom: 28. Nov., Seite 730-739 (DE-627)SPR024596493 nnns volume:85 year:2022 number:4 day:28 month:11 pages:730-739 https://dx.doi.org/10.1007/s12262-022-03627-6 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER AR 85 2022 4 28 11 730-739 |
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10.1007/s12262-022-03627-6 doi (DE-627)SPR052765636 (SPR)s12262-022-03627-6-e DE-627 ger DE-627 rakwb eng Seth, Ishith verfasserin (orcid)0000-0001-5444-8925 aut Quantification and Effectiveness of Vascularized Neck Lymph Node Transfer for Lymphedema: a Systematic Review and Meta-Analysis 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Crown 2022 Abstract This study aims to quantify the number of vascularized neck lymph nodes (VLNs) and postvascularized lymph node transfer (VLNT) and summarize the safety and efficacy of neck VLNT for treatment of lymphedema. PubMed, Web of Science, Google Scholar, and Cochrane CENTRAL databases were searched up to March 2022. PRISMA guidelines were adhered to, and the study was registered on PROSPERO. The primary outcome was the quantity of neck lymph nodes, and the secondary outcomes included postoperative cellulitis, Lymphedema Quality of Life Tool (LYMQOL), reduction of the extremity circumference, circumference differentiation, donor site morbidity, and lymphedema recurrence. The raw mean or proportion with a 95% confidence interval (CI) was calculated to conduct a single-arm meta-analysis. All analyses were performed using %$R%$ software v4.0.3. Newcastle–Ottawa Scale was used to assess for quality of included studies. Eighteen studies comprising 510 patients were included in the single-arm meta-analysis. Mean neck VLNs were 3.80, 95% CI [2.48, 5.11], mean postoperative cellulitis was 0.70%, 95% CI [0.22, 1.18], mean postoperative LYMQOL was 6.84, 95% CI [5.39, 8.30], mean postoperative reduction of the extremity circumference 43.57%, 95% CI [27.81, 59.33], and mean circumference differentiation was 11.37%, 95% CI [7.51, 15.23]. The overall proportion of donor site morbidity events was 0.06, 95% CI [0.04, 0.11], and lymphedema recurrence was 0.12, 95% CI [0.05, 0.24]. The neck lymph node flap has an arsenal of lymph nodes present, carries no risk of iatrogenic edema, and has a low risk of other complications. Low donor site morbidity, patient satisfaction with the cosmetic scar, significant lymphedema reduction, and improvement of LYMQOL postoperatively are some positive outcomes that should be considered by surgeons. Neck lymph node (dpeaa)DE-He213 Quantitative neck node (dpeaa)DE-He213 Vascularized lymph node transfer (dpeaa)DE-He213 Lymphedema (dpeaa)DE-He213 Meta-analysis (dpeaa)DE-He213 Bulloch, Gabriella aut Gibson, Damien aut Seth, Nimish aut Hunter-Smith, David J. aut Rozen, Warren M. aut Enthalten in Indian Journal of Surgery Springer-Verlag, 2007 85(2022), 4 vom: 28. Nov., Seite 730-739 (DE-627)SPR024596493 nnns volume:85 year:2022 number:4 day:28 month:11 pages:730-739 https://dx.doi.org/10.1007/s12262-022-03627-6 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER AR 85 2022 4 28 11 730-739 |
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10.1007/s12262-022-03627-6 doi (DE-627)SPR052765636 (SPR)s12262-022-03627-6-e DE-627 ger DE-627 rakwb eng Seth, Ishith verfasserin (orcid)0000-0001-5444-8925 aut Quantification and Effectiveness of Vascularized Neck Lymph Node Transfer for Lymphedema: a Systematic Review and Meta-Analysis 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Crown 2022 Abstract This study aims to quantify the number of vascularized neck lymph nodes (VLNs) and postvascularized lymph node transfer (VLNT) and summarize the safety and efficacy of neck VLNT for treatment of lymphedema. PubMed, Web of Science, Google Scholar, and Cochrane CENTRAL databases were searched up to March 2022. PRISMA guidelines were adhered to, and the study was registered on PROSPERO. The primary outcome was the quantity of neck lymph nodes, and the secondary outcomes included postoperative cellulitis, Lymphedema Quality of Life Tool (LYMQOL), reduction of the extremity circumference, circumference differentiation, donor site morbidity, and lymphedema recurrence. The raw mean or proportion with a 95% confidence interval (CI) was calculated to conduct a single-arm meta-analysis. All analyses were performed using %$R%$ software v4.0.3. Newcastle–Ottawa Scale was used to assess for quality of included studies. Eighteen studies comprising 510 patients were included in the single-arm meta-analysis. Mean neck VLNs were 3.80, 95% CI [2.48, 5.11], mean postoperative cellulitis was 0.70%, 95% CI [0.22, 1.18], mean postoperative LYMQOL was 6.84, 95% CI [5.39, 8.30], mean postoperative reduction of the extremity circumference 43.57%, 95% CI [27.81, 59.33], and mean circumference differentiation was 11.37%, 95% CI [7.51, 15.23]. The overall proportion of donor site morbidity events was 0.06, 95% CI [0.04, 0.11], and lymphedema recurrence was 0.12, 95% CI [0.05, 0.24]. The neck lymph node flap has an arsenal of lymph nodes present, carries no risk of iatrogenic edema, and has a low risk of other complications. Low donor site morbidity, patient satisfaction with the cosmetic scar, significant lymphedema reduction, and improvement of LYMQOL postoperatively are some positive outcomes that should be considered by surgeons. Neck lymph node (dpeaa)DE-He213 Quantitative neck node (dpeaa)DE-He213 Vascularized lymph node transfer (dpeaa)DE-He213 Lymphedema (dpeaa)DE-He213 Meta-analysis (dpeaa)DE-He213 Bulloch, Gabriella aut Gibson, Damien aut Seth, Nimish aut Hunter-Smith, David J. aut Rozen, Warren M. aut Enthalten in Indian Journal of Surgery Springer-Verlag, 2007 85(2022), 4 vom: 28. Nov., Seite 730-739 (DE-627)SPR024596493 nnns volume:85 year:2022 number:4 day:28 month:11 pages:730-739 https://dx.doi.org/10.1007/s12262-022-03627-6 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER AR 85 2022 4 28 11 730-739 |
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10.1007/s12262-022-03627-6 doi (DE-627)SPR052765636 (SPR)s12262-022-03627-6-e DE-627 ger DE-627 rakwb eng Seth, Ishith verfasserin (orcid)0000-0001-5444-8925 aut Quantification and Effectiveness of Vascularized Neck Lymph Node Transfer for Lymphedema: a Systematic Review and Meta-Analysis 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Crown 2022 Abstract This study aims to quantify the number of vascularized neck lymph nodes (VLNs) and postvascularized lymph node transfer (VLNT) and summarize the safety and efficacy of neck VLNT for treatment of lymphedema. PubMed, Web of Science, Google Scholar, and Cochrane CENTRAL databases were searched up to March 2022. PRISMA guidelines were adhered to, and the study was registered on PROSPERO. The primary outcome was the quantity of neck lymph nodes, and the secondary outcomes included postoperative cellulitis, Lymphedema Quality of Life Tool (LYMQOL), reduction of the extremity circumference, circumference differentiation, donor site morbidity, and lymphedema recurrence. The raw mean or proportion with a 95% confidence interval (CI) was calculated to conduct a single-arm meta-analysis. All analyses were performed using %$R%$ software v4.0.3. Newcastle–Ottawa Scale was used to assess for quality of included studies. Eighteen studies comprising 510 patients were included in the single-arm meta-analysis. Mean neck VLNs were 3.80, 95% CI [2.48, 5.11], mean postoperative cellulitis was 0.70%, 95% CI [0.22, 1.18], mean postoperative LYMQOL was 6.84, 95% CI [5.39, 8.30], mean postoperative reduction of the extremity circumference 43.57%, 95% CI [27.81, 59.33], and mean circumference differentiation was 11.37%, 95% CI [7.51, 15.23]. The overall proportion of donor site morbidity events was 0.06, 95% CI [0.04, 0.11], and lymphedema recurrence was 0.12, 95% CI [0.05, 0.24]. The neck lymph node flap has an arsenal of lymph nodes present, carries no risk of iatrogenic edema, and has a low risk of other complications. Low donor site morbidity, patient satisfaction with the cosmetic scar, significant lymphedema reduction, and improvement of LYMQOL postoperatively are some positive outcomes that should be considered by surgeons. Neck lymph node (dpeaa)DE-He213 Quantitative neck node (dpeaa)DE-He213 Vascularized lymph node transfer (dpeaa)DE-He213 Lymphedema (dpeaa)DE-He213 Meta-analysis (dpeaa)DE-He213 Bulloch, Gabriella aut Gibson, Damien aut Seth, Nimish aut Hunter-Smith, David J. aut Rozen, Warren M. aut Enthalten in Indian Journal of Surgery Springer-Verlag, 2007 85(2022), 4 vom: 28. Nov., Seite 730-739 (DE-627)SPR024596493 nnns volume:85 year:2022 number:4 day:28 month:11 pages:730-739 https://dx.doi.org/10.1007/s12262-022-03627-6 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER AR 85 2022 4 28 11 730-739 |
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10.1007/s12262-022-03627-6 doi (DE-627)SPR052765636 (SPR)s12262-022-03627-6-e DE-627 ger DE-627 rakwb eng Seth, Ishith verfasserin (orcid)0000-0001-5444-8925 aut Quantification and Effectiveness of Vascularized Neck Lymph Node Transfer for Lymphedema: a Systematic Review and Meta-Analysis 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Crown 2022 Abstract This study aims to quantify the number of vascularized neck lymph nodes (VLNs) and postvascularized lymph node transfer (VLNT) and summarize the safety and efficacy of neck VLNT for treatment of lymphedema. PubMed, Web of Science, Google Scholar, and Cochrane CENTRAL databases were searched up to March 2022. PRISMA guidelines were adhered to, and the study was registered on PROSPERO. The primary outcome was the quantity of neck lymph nodes, and the secondary outcomes included postoperative cellulitis, Lymphedema Quality of Life Tool (LYMQOL), reduction of the extremity circumference, circumference differentiation, donor site morbidity, and lymphedema recurrence. The raw mean or proportion with a 95% confidence interval (CI) was calculated to conduct a single-arm meta-analysis. All analyses were performed using %$R%$ software v4.0.3. Newcastle–Ottawa Scale was used to assess for quality of included studies. Eighteen studies comprising 510 patients were included in the single-arm meta-analysis. Mean neck VLNs were 3.80, 95% CI [2.48, 5.11], mean postoperative cellulitis was 0.70%, 95% CI [0.22, 1.18], mean postoperative LYMQOL was 6.84, 95% CI [5.39, 8.30], mean postoperative reduction of the extremity circumference 43.57%, 95% CI [27.81, 59.33], and mean circumference differentiation was 11.37%, 95% CI [7.51, 15.23]. The overall proportion of donor site morbidity events was 0.06, 95% CI [0.04, 0.11], and lymphedema recurrence was 0.12, 95% CI [0.05, 0.24]. The neck lymph node flap has an arsenal of lymph nodes present, carries no risk of iatrogenic edema, and has a low risk of other complications. Low donor site morbidity, patient satisfaction with the cosmetic scar, significant lymphedema reduction, and improvement of LYMQOL postoperatively are some positive outcomes that should be considered by surgeons. Neck lymph node (dpeaa)DE-He213 Quantitative neck node (dpeaa)DE-He213 Vascularized lymph node transfer (dpeaa)DE-He213 Lymphedema (dpeaa)DE-He213 Meta-analysis (dpeaa)DE-He213 Bulloch, Gabriella aut Gibson, Damien aut Seth, Nimish aut Hunter-Smith, David J. aut Rozen, Warren M. aut Enthalten in Indian Journal of Surgery Springer-Verlag, 2007 85(2022), 4 vom: 28. Nov., Seite 730-739 (DE-627)SPR024596493 nnns volume:85 year:2022 number:4 day:28 month:11 pages:730-739 https://dx.doi.org/10.1007/s12262-022-03627-6 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER AR 85 2022 4 28 11 730-739 |
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Enthalten in Indian Journal of Surgery 85(2022), 4 vom: 28. Nov., Seite 730-739 volume:85 year:2022 number:4 day:28 month:11 pages:730-739 |
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Quantification and Effectiveness of Vascularized Neck Lymph Node Transfer for Lymphedema: a Systematic Review and Meta-Analysis Neck lymph node (dpeaa)DE-He213 Quantitative neck node (dpeaa)DE-He213 Vascularized lymph node transfer (dpeaa)DE-He213 Lymphedema (dpeaa)DE-He213 Meta-analysis (dpeaa)DE-He213 |
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quantification and effectiveness of vascularized neck lymph node transfer for lymphedema: a systematic review and meta-analysis |
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Quantification and Effectiveness of Vascularized Neck Lymph Node Transfer for Lymphedema: a Systematic Review and Meta-Analysis |
| abstract |
Abstract This study aims to quantify the number of vascularized neck lymph nodes (VLNs) and postvascularized lymph node transfer (VLNT) and summarize the safety and efficacy of neck VLNT for treatment of lymphedema. PubMed, Web of Science, Google Scholar, and Cochrane CENTRAL databases were searched up to March 2022. PRISMA guidelines were adhered to, and the study was registered on PROSPERO. The primary outcome was the quantity of neck lymph nodes, and the secondary outcomes included postoperative cellulitis, Lymphedema Quality of Life Tool (LYMQOL), reduction of the extremity circumference, circumference differentiation, donor site morbidity, and lymphedema recurrence. The raw mean or proportion with a 95% confidence interval (CI) was calculated to conduct a single-arm meta-analysis. All analyses were performed using %$R%$ software v4.0.3. Newcastle–Ottawa Scale was used to assess for quality of included studies. Eighteen studies comprising 510 patients were included in the single-arm meta-analysis. Mean neck VLNs were 3.80, 95% CI [2.48, 5.11], mean postoperative cellulitis was 0.70%, 95% CI [0.22, 1.18], mean postoperative LYMQOL was 6.84, 95% CI [5.39, 8.30], mean postoperative reduction of the extremity circumference 43.57%, 95% CI [27.81, 59.33], and mean circumference differentiation was 11.37%, 95% CI [7.51, 15.23]. The overall proportion of donor site morbidity events was 0.06, 95% CI [0.04, 0.11], and lymphedema recurrence was 0.12, 95% CI [0.05, 0.24]. The neck lymph node flap has an arsenal of lymph nodes present, carries no risk of iatrogenic edema, and has a low risk of other complications. Low donor site morbidity, patient satisfaction with the cosmetic scar, significant lymphedema reduction, and improvement of LYMQOL postoperatively are some positive outcomes that should be considered by surgeons. © Crown 2022 |
| abstractGer |
Abstract This study aims to quantify the number of vascularized neck lymph nodes (VLNs) and postvascularized lymph node transfer (VLNT) and summarize the safety and efficacy of neck VLNT for treatment of lymphedema. PubMed, Web of Science, Google Scholar, and Cochrane CENTRAL databases were searched up to March 2022. PRISMA guidelines were adhered to, and the study was registered on PROSPERO. The primary outcome was the quantity of neck lymph nodes, and the secondary outcomes included postoperative cellulitis, Lymphedema Quality of Life Tool (LYMQOL), reduction of the extremity circumference, circumference differentiation, donor site morbidity, and lymphedema recurrence. The raw mean or proportion with a 95% confidence interval (CI) was calculated to conduct a single-arm meta-analysis. All analyses were performed using %$R%$ software v4.0.3. Newcastle–Ottawa Scale was used to assess for quality of included studies. Eighteen studies comprising 510 patients were included in the single-arm meta-analysis. Mean neck VLNs were 3.80, 95% CI [2.48, 5.11], mean postoperative cellulitis was 0.70%, 95% CI [0.22, 1.18], mean postoperative LYMQOL was 6.84, 95% CI [5.39, 8.30], mean postoperative reduction of the extremity circumference 43.57%, 95% CI [27.81, 59.33], and mean circumference differentiation was 11.37%, 95% CI [7.51, 15.23]. The overall proportion of donor site morbidity events was 0.06, 95% CI [0.04, 0.11], and lymphedema recurrence was 0.12, 95% CI [0.05, 0.24]. The neck lymph node flap has an arsenal of lymph nodes present, carries no risk of iatrogenic edema, and has a low risk of other complications. Low donor site morbidity, patient satisfaction with the cosmetic scar, significant lymphedema reduction, and improvement of LYMQOL postoperatively are some positive outcomes that should be considered by surgeons. © Crown 2022 |
| abstract_unstemmed |
Abstract This study aims to quantify the number of vascularized neck lymph nodes (VLNs) and postvascularized lymph node transfer (VLNT) and summarize the safety and efficacy of neck VLNT for treatment of lymphedema. PubMed, Web of Science, Google Scholar, and Cochrane CENTRAL databases were searched up to March 2022. PRISMA guidelines were adhered to, and the study was registered on PROSPERO. The primary outcome was the quantity of neck lymph nodes, and the secondary outcomes included postoperative cellulitis, Lymphedema Quality of Life Tool (LYMQOL), reduction of the extremity circumference, circumference differentiation, donor site morbidity, and lymphedema recurrence. The raw mean or proportion with a 95% confidence interval (CI) was calculated to conduct a single-arm meta-analysis. All analyses were performed using %$R%$ software v4.0.3. Newcastle–Ottawa Scale was used to assess for quality of included studies. Eighteen studies comprising 510 patients were included in the single-arm meta-analysis. Mean neck VLNs were 3.80, 95% CI [2.48, 5.11], mean postoperative cellulitis was 0.70%, 95% CI [0.22, 1.18], mean postoperative LYMQOL was 6.84, 95% CI [5.39, 8.30], mean postoperative reduction of the extremity circumference 43.57%, 95% CI [27.81, 59.33], and mean circumference differentiation was 11.37%, 95% CI [7.51, 15.23]. The overall proportion of donor site morbidity events was 0.06, 95% CI [0.04, 0.11], and lymphedema recurrence was 0.12, 95% CI [0.05, 0.24]. The neck lymph node flap has an arsenal of lymph nodes present, carries no risk of iatrogenic edema, and has a low risk of other complications. Low donor site morbidity, patient satisfaction with the cosmetic scar, significant lymphedema reduction, and improvement of LYMQOL postoperatively are some positive outcomes that should be considered by surgeons. © Crown 2022 |
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