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. 2014 Oct 29;2014(10):CD008889.
doi: 10.1002/14651858.CD008889.pub2.

Surgical interventions for treating pectus excavatum

Paulo Eduardo de Oliveira Carvalho  1 , Marcos Vinícius Muriano da Silva, Olavo Ribeiro Rodrigues, Antonio José Maria Cataneo
Affiliations

Surgical interventions for treating pectus excavatum

Paulo Eduardo de Oliveira Carvalho et al. Cochrane Database Syst Rev. .

Abstract

Background: Pectus excavatum is characterized by a depression of the anterior chest wall (sternum and lower costal cartilages) and is the most frequently occurring chest wall deformity. The prevalence ranges from 6.28 to 12 cases per 1000 around the world. Generally pectus excavatum is present at birth or is identified after a few weeks or months; however, sometimes it becomes evident only at puberty. The consequence of the condition on a individual's life is variable, some live a normal life and others have physical and psychological symptoms such as: precordial pain after exercises; impairments of pulmonary and cardiac function; shyness and social isolation. For many years, sub-perichondrial resection of the costal cartilages, with or without transverse cuneiform osteotomy of the sternum and placement of a substernal support, called conventional surgery, was the most accepted option for surgical repair of these patients. From 1997 a new surgical repair called, minimally invasive surgery, became available. This less invasive surgical option consists of the retrosternal placement of a curved metal bar, without resections of the costal cartilages or sternum osteotomy, and is performed by videothoracoscopy. However, many aspects that relate to the benefits and harms of both techniques have not been defined.

Objectives: To evaluate the effectiveness and safety of the conventional surgery compared with minimally invasive surgery for treating people with pectus excavatum.

Search methods: With the aim of increasing the sensitivity of the search strategy we used only terms related to the individual's condition (pectus excavatum); terms related to the interventions, outcomes and types of studies were not included. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, LILACS, and ICTPR. Additionally we searched yet reference lists of articles and conference proceedings. All searches were done without language restriction.Date of the most recent searches: 14 January 2014.

Selection criteria: We considered randomized or quasi-randomized controlled trials that compared traditional surgery with minimally invasive surgery for treating pectus excavatum.

Data collection and analysis: Two review authors independently assessed the eligibility of the trials identified and agreed trial eligibility after a consensus meeting. The authors also assessed the risk of bias of the eligible trials.

Main results: Initially we located 4111 trials from the electronic searches and two further trials from other resources. All trials were added into reference management software and the duplicates were excluded, leaving 2517 studies. The titles and abstracts of these 2517 studies were independently analyzed by two authors and finally eight trials were selected for full text analysis, after which they were all excluded, as they did not fulfil the inclusion criteria.

Authors' conclusions: There is no evidence from randomized controlled trials to conclude what is the best surgical option to treat people with pectus excavatum.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
Study flow diagram.
See this image and copyright information in PMC

Update of

References

References to studies excluded from this review

Boehm 2004 {published data only}
    1. Boehm RA, Muensterer OJ, Till H. Comparing minimally invasive funnel chest repair versus the conventional technique: an outcome analysis in children. Plastic & Reconstructive Surgery 2004;114(3):668‐73. - PubMed
Brigato 2006 {published data only}
    1. Brigato RB. Pectus excavatum: comparative evaluation of the surgical techniques of Robiseck and Nuss [Pectus excavatum: avaliação comparativa das técnicas operatórias de Robicsek e Nuss/]. http://bases.bireme.br/cgi‐bin/wxislind.exe/iah/online/?IsisScript=iah/i... (accessed 24 October 2014):127p.
Coelho 2009 {published data only}
    1. Coelho Mde S, Silva RF, Bergonse Neto N, Stori Wde S Jr, dos Santos AF, Mendes RG, et al. Pectus excavatum surgery: sternochondroplasty versus Nuss procedure. Annals of Thoracic Surgery 2009;88(6):1773‐9. - PubMed
Fox 2007 {published data only}
    1. Fox JP, Schnell JL, Adams TA Jr, Hilton WM, Seyfer AE. Pectus excavatum: comparison of nonprosthetic repairs using multiple techniques. Plastic and Reconstructive Surgery 2007;119(3):33e‐39e. - PubMed
Kelly 2007 {published data only}
    1. Kelly RE Jr, Cash TF, Shamberger RC, Mitchell KK, Mellins RB, Lawson ML, et al. Surgical repair of pectus excavatum markedly improves body image and perceived ability for physical activity:multicenter study. Pediatrics 2008;122(6):1218‐22. - PubMed
    1. Kelly RE Jr, Mellins RB, Shamberger RC, Mitchell KK, Lawson ML, Oldham KT, et al. Multicenter study of pectus excavatum, final report: complications, static/exercise pulmonary function, and anatomic outcomes. Journal of the American College of Surgeons 2013;217(6):2080‐9. - PubMed
    1. Kelly RE Jr, Mellins RB, Shamberger RC, Mitchell KK, Lawson ML, Oldham KT, et al. Prospective multicenter study of surgical correction of pectus excavatum: design, perioperative complications, pain, and baseline pulmonary function facilitated by internet‐based data collection.. Journal of the American College of Surgeons 2007;205(2):205‐16. - PubMed
    1. Lawson ML, Mellins RB, Paulson JF, Shamberger RC, Oldham K, Azizkhan RG, et al. Increasing severity of pectus excavatum is associated with reduced pulmonary function. Journal of Pediatrics 2011;159(2):256‐61. - PubMed
Nasr 2010 {published data only}
    1. Nasr A, Fecteau A, Wales PW. Comparison of the Nuss and the Ravitch procedure for pectus excavatum repair: a meta‐analysis. Journal of Pediatric Surgery 2010;45(5):880‐6. - PubMed
Pan 2009 {published data only}
    1. PAN Zheng‐xia, WU Chun, HE Ling, LI Hong‐bo, Li Young‐gang. Pectus excavatum: Nuss procedure vs modified Ravitch procedure. Acta Academie Medicinae Militaris Tertiae 2009;31(14):1378‐80.
ZENG Qi 2005 {published data only}
    1. Zeng Qi, Zhang Na, Fan Mão‐huai, He Yan‐ru. Comparisson of Nuss procedure and Ravitch procedure. Chinese Journal of Pediatric Surgery 2005;26(8):397‐400.

Additional references

Beiser 1972
    1. Beiser GD, Epstein SE, Stampfer M, Goldstein RE, Noland SP, Levitsky S. Impairment of cardiac function in patients with pectus excavatum, with improvement after operative correction. New England Journal of Medicine 1972;287(6):267‐72. - PubMed
Bevegard 1962
    1. Bevegard S. Postural circulatory changes at rest and during exercise in patients with funnel chest, with special reference to factors affecting the stroke volume. Acta Medica Scandinavica 1962;171:695‐713. - PubMed
Brown 1939
    1. Brown AL. Pectus excavatum (funnel chest). Journal of Thoracic and Cardiovascular Surgery 1939;9:164‐84.
Clark 1962
    1. Clark JG, Grenville‐Mathers R. Pectus excavatum. British Journal of Diseases of the Chest 1962;56:202‐5. - PubMed
Cohen 1960
    1. Cohen J. A coefficient of agreement for nominal scales. Educational and Psychological Measurement 1960;20:37‐46.
Creswick 2006
    1. Creswick HA, Stacey MW, Kelly RE Jr, Gustin T, Nuss D, Harvey H, et al. Family study of the inheritance of pectus excavatum. Journal of Pediatric Surgery 2006;41(10):1699‐703. - PubMed
Dailey 1952
    1. Dailey JE. Repair of funnel chest using sub‐sternal osteoperiosteal rib graft strut; report of a case with four year follow‐up. JAMA 1954;150(12):1203‐4. - PubMed
Deeks 2008
    1. Deeks JJ, Higgins JPT, Altman DG. Analysing data and undertaking meta‐analyses. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. Cochrane Collaboration, 2008. [www.cochrane‐handbook.org]
Denk 1945
    1. Denk W, Kuns H. Cirurgía [Cirurgía]. In: M. Kirschner, O. Nordmann editor(s). Cirurgía del thorax. Segunda. Vol. Quinto, Barcelona: Editorial Labor S. A., 1945:141‐7.
Fayers 2007
    1. Fayers PM, Machin D. Quality of Life: The assessment, analysis and interpretation of patient‐reported outcomes. second edition. Chichester UK: John Wiley & Sons Ltd, 2007.
Feng 2001
    1. Feng J, Hu T. The biomechanical, morphologic, and histochemical properties of the costal cartilages in children with pectus excavatum. Journal of Pediatric Surgery 2001;36(12):1770‐6. - PubMed
Haecker 2006
    1. Haecker FM, Mayr J. The vacuum bell for treatment of pectus excavatum: an alternative to surgical correction? [The vacuum bell for treatment of pectus excavatum: an alternative to surgical correction?]. Eur J Cardiothorac Surg. 2006;29(4):557‐61. - PubMed
Haje 1992
    1. Haje, SA, Bowen, JR. Preliminary results of orthotic treatment of pectus deformities in children and adolescents. Journal of Pediatric Orthopaedics 1992;12:795‐800. - PubMed
Haje 1999
    1. Haje SA, Harcke HT, Bowen JR. Growth disturbance of the sternum and pectus deformities: imaging studies and clinical correlation. Pediatric Radiology 1999;29(5):334‐41. - PubMed
Haje 2009
    1. Haje SA, Haje DP. Orthopaedic approach to pectus deformities: 32 years of studies [Abordagem ortopédica das deformidades pectus: 32 anos de estudos]. Revista Brasileira de Ortopedia 2009;44(3):191‐8. - PMC - PubMed
Haller 1970
    1. Haller JA, Peters GM, Mazur D. Pectus excavatum. A 20 year surgical experience. Journal of Thoracic and Cardiovascular Surgery 1970;60(3):375‐83. - PubMed
Haller 1987
    1. Haller JA Jr, Kramer SS, Lietman SA. Use of CT scans in selection of patients for pectus excavatum surgery: a preliminary report. Journal of Pediatric Surgery 1987;22(10):904‐6. - PubMed
Head 1950
    1. Jerome R Head. A Textbook of Surgery. In: Frederick Christopher editor(s). The Thoracic Wall, Pleura and Lung. 5. Philadelphia: W B Saunders Company, 1950:842.
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327(7414):557‐60. - PMC - PubMed
Higgins 2008a
    1. Higgins JPT, Deeks JJ. Selecting studies and collecting data. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions. Chichester (UK): John Wiley & Sons, 2008:151‐85.
Higgins 2008b
    1. Higgins JTP, Altman DG. Assessing risk of bias in included studies. In: Higgins JTP, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventios. Chichester (UK): John Wiley & Sons, 2008:187‐241.
Higgins 2008c
    1. Higgins JPT, Deeks JJ, Altman DG. Chapter 16: Special Topics in statistics. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions. Chichester (UK): John Wiley & Sons, 2008:481‐529.
Jayaramakrishnan 2013
    1. Jayaramakrishnan K, Wotton R, Bradley A, Naidu B. Does repair of pectus excavatum improve cardiopulmonary function?. Interactive Cardiovascular and Thoracic Surgery 2013;16(6):865‐70. - PMC - PubMed
Khan 2001
    1. Khan KS, ter Riet G, Glanville J, Sowden AJ, Kleijnen J. Undertaking systematic reviews of research on effectiveness: CDR's guidance for those carrying out or commissioning reviews. CDR report Number 4. 2nd Edition. York: NHS Center for Reviews and Dissemination, University of York, 2001.
Kotzot 2009
    1. Kotzot D, Schwabegger AH. Etiology of chest wall deformities‐a genetic review for the treating physician. Journal of Pediatric Surgery 2009;44(10):2004‐11. - PubMed
Lau 2006
    1. Lau J, Ioannidis JPA, Terrin N, Schmid CH, Olkin I. The case of the misleading funnel plot. BMJ 2006;333(7568):597‐600. - PMC - PubMed
Lawson 2003
    1. Lawson ML, Cash TF, Akers R, Vasser E, Burke B, Tabangin M, et al. A pilot study of the impact of surgical repair on disease‐specific quality of life among patients with pectus excavatum. Journal of Pediatric Surgery 2003;38(6):916‐8. - PubMed
Lawson 2006
    1. Lawson ML, Barnes‐Eley M, Burke BL, Mitchell K, Katz ME, Dory CL, et al. Reliability of a standardized protocol to calculate cross‐sectional chest area and severity indices to evaluate pectus excavatum. Journal of Pediatric Surgery 2006;41(7):1219‐25. - PubMed
Lester 1957
    1. Lester CW. The etiology and pathogenesis of funnel chest, pigeon breast, and related deformities of the anterior chest wall. Journal of Thoracic Surgery 1957;34(1):1‐10. - PubMed
May 1961
    1. May AM. Operation for pectus excavatum using stainless steel wire mesh. Journal of Thoracic and Cardiovascular Surgery 1961;42:122‐4. - PubMed
Nakaoka 2009
    1. Nakaoka T, Uemura S, Yano T, Nakagawa Y, Tanimoto T, Suehiro S. Does overgrowth of costal cartilage cause pectus excavatum? A study on the lengths of ribs and costal cartilages in asymmetric patients. Journal of Pediatric Surgery 2009;44(7):1333‐6. - PubMed
Nuss 1998
    1. Nuss D, Kelly RE Jr, Croitoru DP, Katz ME. A 10‐year review of a minimally invasive technique for the correction of pectus excavatum. Journal of Pediatric Surgery 1998;33(4):545‐52. - PubMed
O'Rourke 1989
    1. O'Rourke K, Detsky AS. Meta‐analysis in medical research; strong encouragement for higher quality in individual research efforts. Journal of Clinical Epidemiology 1989;42(10):1021‐4. - PubMed
Paltia 1959
    1. Paltia V, Parkkulainen KV, Sulamaa M, Wallgren GR. Operative technique in funnel chest; experience in 81 cases. Acta Chirurgica Scandinavica 1959;116(2):90‐8. - PubMed
Ravitch 1977
    1. Mark M. Ravitch. Congenital deformities of the chest wall and their operative correction. Philadelphia: W. B. Saunders Company, 1977.
Sanger 1963
    1. Sanger PW, Taylor FH. Deformities of the anterior wall of the chest. Surgery, Gynecology and Obstetrics 1963;116:515‐22. - PubMed
Schalock 1989
    1. Schalock RL, Keith KD, Hoffman K, Karan OC. Quality of life: its measurement and use. Mental Retardation 1989;27(1):25‐31. - PubMed
Shamberger 1988
    1. Shamberger RC, Welch KJ. Cardiopulmonary function in pectus excavatum. Surgery, Gynecology and Obstetrics 1988;166(4):383‐91. - PubMed
Shamberger 1995
    1. Robert C. Shamberger, W. Hardy Hendren III. Congenital deformities. In: F. Griffith Pearson, Jean Deslaurie, Robert J Ginsberg, Clement A. Hiebert, Martin F. McKneally, Harold C. Urschel editor(s). Thoracic Surgery. 1st Edition. New York: Churchill Livingstone, 1995:1189‐97.
Sterne 2002
    1. Sterne JA, Jüni P, Schulz KF, Altman DG, Bartlett C, Egger M. Statistical methods for assessing the influence of study characteristics on treatment effects in 'meta‐epidemiological' research. Statistics in Medicine 2002;21(11):1513‐24. - PubMed
Sterne 2008
    1. Sterne JAC, Egger M, Moher D. Chapter 10: Addressing reporting biases. Cochrane Handbook for Systematic Reviews of Interventions. Chichester: John Wiley & Sons, 2008:297‐333.
Sutherland 1958
    1. Sutherland ID. Funnel chest. Journal of Bone and Joint Surgery. British Volume 1958;40‐B(2):244‐51. - PubMed
von der Oelsnitz 1981
    1. Oelsnitz G. [Anomalies of the chest (author's transl)]. Zeitschrift fur Kinderchirurgie 1981;33(3):229‐36. - PubMed
Weg 1967
    1. Weg JG, Krumholz RA, Harkleroad LE. Pulmonary dysfunction in pectus excavatum. American Review of Respiratory Disease 1967;95(5):936‐45. - PubMed
Welch 1980
    1. Welch KJ. Pediatric Surgery. In: T. M. Holder, K. W. Asheraft editor(s). Chest wall deformities. Philadelphia: W. B. Saunders Company, 1980.
Welch 1989
    1. Welch KJ, Shamberger RC. Chest wall deformities. In: Thomas W. Shields editor(s). General Thoracic Surgery. 3rd Edition. Philadelphia: Lea & Febiger, 1989:515‐23.
Westphal 2009
    1. Westphal FL, Lima LC, Lima Neto JC, Chaves AR, Santos Júnior VL, Ferreira BL. Prevalence of pectus carinatum and pectus excavatum in students in the city of Manaus, Brazil. Jornal Brasileiro de Pneumologia 2009;35(3):221‐6. - PubMed
Yucesan 1993
    1. Yucesan S, Dindar H, Olcay I, Okur H, Kiliçaslan S, Ergoren Y, et al. Prevalence of congenital abnormalities in Turkish school children. European Journal of Epidemiology 1993;9(4):373‐80. - PubMed

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