Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar 27;3(3):CD010993.
doi: 10.1002/14651858.CD010993.pub2.

Skin-sparing mastectomy for the treatment of breast cancer

Bruna S Mota  1 , Jose Luiz B Bevilacqua  2 , Jessica Barrett  3 , Marcos Desidério Ricci  1 , Alexandre M Munhoz  4 , José Roberto Filassi  1 , Edmund Chada Baracat  1 , Rachel Riera  5   6   7
Affiliations

Skin-sparing mastectomy for the treatment of breast cancer

Bruna S Mota et al. Cochrane Database Syst Rev. .

Abstract

Background: Skin-sparing mastectomy (SSM) is a surgical technique that aims to maximize skin preservation, facilitate breast reconstruction, and improve cosmetic outcomes. Despite its use in clinical practice, the benefits and harms related to SSM are not well established.

Objectives: To assess the effectiveness and safety of skin-sparing mastectomy for the treatment of breast cancer.

Search methods: We searched Cochrane Breast Cancer's Specialized Register, CENTRAL, MEDLINE, Embase, LILACS, the World Health Organization's International Clinical Trials Registry Platform (WHO ICTRP), and ClinicalTrials.gov on 9 August 2019.

Selection criteria: Randomized controlled trials (RCTs), quasi-randomized or non-randomized studies (cohort and case-control) comparing SSM to conventional mastectomy for treating ductal carcinoma in situ (DCIS) or invasive breast cancer.

Data collection and analysis: We used standard methodological procedures expected by Cochrane. The primary outcome was overall survival. Secondary outcomes were local recurrence free-survival, adverse events (including overall complications, breast reconstruction loss, skin necrosis, infection and hemorrhage), cosmetic results, and quality of life. We performed a descriptive analysis and meta-analysis of the data.

Main results: We found no RCTs or quasi-RCTs. We included two prospective cohort studies and twelve retrospective cohort studies. These studies included 12,211 participants involving 12,283 surgeries (3183 SSM and 9100 conventional mastectomies). It was not possible to perform a meta-analysis for overall survival and local recurrence free-survival due to clinical heterogeneity across studies and a lack of data to calculate hazard ratios (HR). Based on one study, the evidence suggests that SSM may not reduce overall survival for participants with DCIS tumors (HR 0.41, 95% CI 0.17 to 1.02; P = 0.06; 399 participants; very low-certainty evidence) or for participants with invasive carcinoma (HR 0.81, 95% CI 0.48 to 1.38; P = 0.44; 907 participants; very low-certainty evidence). For local recurrence-free survival, meta-analysis was not possible, due to high risk of bias in nine of the ten studies that measured this outcome. Informal visual examination of effect sizes from nine studies suggested the size of the HR may be similar between groups. Based on one study that adjusted for confounders, SSM may not reduce local recurrence-free survival (HR 0.82, 95% CI 0.47 to 1.42; P = 0.48; 5690 participants; very low-certainty evidence). The effect of SSM on overall complications is unclear (RR 1.55, 95% CI 0.97 to 2.46; P = 0.07, I2 = 88%; 4 studies, 677 participants; very low-certainty evidence). Skin-sparing mastectomy may not reduce the risk of breast reconstruction loss (RR 1.79, 95% CI 0.31 to 10.35; P = 0.52; 3 studies, 475 participants; very low-certainty evidence), skin necrosis (RR 1.15, 95% CI 0.62 to 2.12; P = 0.22, I2 = 33%; 4 studies, 677 participants; very low-certainty evidence), local infection (RR 2.04, 95% CI 0.03 to 142.71; P = 0.74, I2 = 88%; 2 studies, 371 participants; very low-certainty evidence), nor hemorrhage (RR 1.23, 95% CI 0.47 to 3.27; P = 0.67, I2 = 0%; 4 studies, 677 participants; very low-certainty evidence). We downgraded the certainty of the evidence due to the risk of bias, imprecision, and inconsistency among the studies. There were no data available on the following outcomes: systemic surgical complications, local complications, explantation of implant/expander, hematoma, seroma, rehospitalization, skin necrosis with revisional surgery, and capsular contracture of the implant. It was not possible to perform a meta-analysis for cosmetic and quality of life outcomes due to a lack of data. One study performed an evaluation of aesthetic outcome after SSM: 77.7% of participants with immediate breast reconstruction had an overall aesthetic result of excellent or good versus 87% of participants with delayed breast reconstruction.

Authors' conclusions: Based on very low-certainty evidence from observational studies, it was not possible to draw definitive conclusions on the effectiveness and safety of SSM for breast cancer treatment. The decision for this technique of breast surgery for treatment of DCIS or invasive breast cancer must be individualized and shared between the physician and the patient while considering the potential risks and benefits of available surgical options.

PubMed Disclaimer

Conflict of interest statement

BSM: none known JLBB: none known JB: none known. A grant from Hoffman La Roche was awarded to the institution and the work associated with the grant was unrelated to the review topic. MDR: none known AMM: ownership of stock shares in a company that develops breast implant products. JRF: none known ECB: none known RR: none known

Figures

1
1
PRISMA study flow diagram
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
4
4
Forest plot of comparison: 1 SSM versus conventional mastectomy, outcome: 1.1 Overall survival
5
5
Forest plot of comparison: 1 SSM versus conventional mastectomy, outcome: 1.2 Local recurrence free survival
6
6
Forest plot of comparison: 1 SSM versus conventional mastectomy, outcome: 1.5 Overall complications. The events contributing to overall complications by study are: Prabhu 2011 included infection, necrosis, wound dehiscence/prosthetic extrusion; Carlson 1997 included seroma, skin flap necrosis, hematoma, infection, hernia; Giacalone 2010 included breast skin envelope necrosis, marginal LD flap necrosis, hematoma, implant infection, dorsal seroma, marginal back skin flap necrosis; and Kinoshita 2011 included postoperative hemorrhage, skin necrosis, deep vein thrombosis, flap loss, fat lysis of flap with infection, hernia at donor site.
1.1
1.1. Analysis
Comparison 1: Skin‐sparing mastectomy versus conventional mastectomy, Outcome 1: Overall survival
1.2
1.2. Analysis
Comparison 1: Skin‐sparing mastectomy versus conventional mastectomy, Outcome 2: Local recurrence free‐survival
1.3
1.3. Analysis
Comparison 1: Skin‐sparing mastectomy versus conventional mastectomy, Outcome 3: Overall complications
1.4
1.4. Analysis
Comparison 1: Skin‐sparing mastectomy versus conventional mastectomy, Outcome 4: Breast reconstruction loss
1.5
1.5. Analysis
Comparison 1: Skin‐sparing mastectomy versus conventional mastectomy, Outcome 5: Skin necrosis
1.6
1.6. Analysis
Comparison 1: Skin‐sparing mastectomy versus conventional mastectomy, Outcome 6: Hemorrhage
1.7
1.7. Analysis
Comparison 1: Skin‐sparing mastectomy versus conventional mastectomy, Outcome 7: Infection
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD010993

Similar articles

See all similar articles

Cited by

References

References to studies included in this review

Carlson 1997 {published data only}
    1. Carlson GW, Bostwick J, Styblo TM, Moore B, Bried JT, Murray DR, et al. Skin-sparing mastectomy. Oncologic and reconstructive considerations. Annals of Surgery 1997;225(5):570-8. - PMC - PubMed
Gerber 2009 {published data only}
    1. Gerber B, Krause A, Dieterich M, Kundt G, Reimer T. The oncological safety of skin sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction: an extended follow-up study. Annals of Surgery 2009;249(3):460-7. - PubMed
Giacalone 2010 {published data only}
    1. Giacalone P, Rathat G, Daures J, Benos P, Azria D, Rouleau C. New concept for immediate breast reconstruction for invasive cancers: feasibility, oncological safety and aesthetic outcome of post-neoadjuvant therapy immediate breast reconstruction versus delayed breast reconstruction: a prospective pilot study. Breast Cancer Research and Treatment 2010;122(2):439-51. - PubMed
Greenway 2005 {published data only}
    1. Greenway RM, Schlossberg L, Dooley WC. Fifteen-year series of skin-sparing mastectomy for stage 0 to 2 breast cancer. American Journal of Surgery 2005;190(6):918-22. - PubMed
Kinoshita 2011 {published data only}
    1. Kinoshita S, Nojima K, Takeishi M, Imawari Y, Kyoda S, Hirano A, et al. Retrospective comparison of non-skin-sparing mastectomy and skin-sparing mastectomy with immediate breast reconstruction. International Journal of Surgical Oncology 2011;2011:1-9. - PMC - PubMed
Kroll 1999 {published data only}
    1. Kroll SS, Khoo A, Singletary E, Ames F, Wang BG, Reece G, et al. Local recurrence risk after skin-sparing and conventional mastectomy: a 6-year follow-up. Plastic and Reconstructive Surgery 1999;104(2):421-5. - PubMed
Lee 2018 {published data only}
    1. Lee SB, Lee JW, Kim HJ, Ko BS, Son BH, Eom JS, et al. Long-term outcomes of patients with breast cancer after nipple-sparing mastectomy/skin sparing mastectomy followed by immediate transverse rectus abdominis musculocutaneous flap reconstruction. Medicine 2018;97(18):e0680. - PMC - PubMed
    1. Lee SB, Lee JW, Son BH, Eom JS, Kim EK, Lee TJ, et al. Oncologic safety of skin-sparing mastectomy followed by immediate reconstruction in young patients with breast cancer. Asian Journal of Surgery 2019;42(1):274-82. - PubMed
Lhenaff 2019 {published data only}
    1. Lhenaff M, Tunon de Lara C, Fournier M, Charitansky H, Brouste V, Mathoulin-Pelissier S, et al. A single-center study on total mastectomy versus skin-sparing mastectomy in case of pure ductal carcinoma in situ of the breast. European Journal of Surgical Oncology 2019;45(6):950-5. - PubMed
Lim 2010 {published data only}
    1. Lim W, Ko BS, Kim HJ, Lee JW, Eom JS, Son BH, et al. Oncological safety of skin sparing mastectomy followed by immediate reconstruction for locally advanced breast cancer. Journal of Surgical Oncology 2010;102(1):39-42. - PubMed
Min 2011 {published data only}
    1. Yi M, Kronowitz SJ, Meric-Bernstam F, Feig BW, Symmans WF, Lucci A, et al. Local, regional, and systemic recurrence rates in patients undergoing skin-sparing mastectomy compared with conventional mastectomy. Cancer 2011;117(5):916-24. - PMC - PubMed
Prabhu 2011 {published data only}
    1. Prabhu R, Godette K, Carlson G, Losken A, Gabram S, Fasola C, et al. The impact of skin-sparing mastectomy with immediate reconstruction in patients with Stage III breast cancer treated with neoadjuvant chemotherapy and postmastectomy radiation. International Journal of Radiation Oncology, Biology, Physics 2011;82(4):587-93. - PubMed
Simmons 1999 {published data only}
    1. Simmons RM, Fish SK, Gayle L, La Trenta GS, Swistel A, Christos P, et al. Local and distant recurrence rates in skin-sparing mastectomies compared with non-skin-sparing mastectomies. Annals of Surgical Oncology 1999;6(7):676-81. - PubMed
Timbrell 2017 {published data only}
    1. Timbrell S, Al-Himdani S, Shaw O, Tan K, Morris J, Bundred N. Comparison of local recurrence after simple and skin-sparing mastectomy performed in patients with ductal carcinoma in situ. Annals of Surgical Oncology 2017;24(4):1071-6. - PMC - PubMed
Ueda 2008 {published data only}
    1. Ueda S, Tamaki Y, Yano K, Okishiro N, Yanagisawa T, Imasato M, et al. Cosmetic outcome and patient satisfaction after skin-sparing mastectomy for breast cancer with immediate reconstruction of the breast. Surgery 2008;143(3):414-25. - PubMed

References to studies excluded from this review

Park 2016 {published data only}
    1. Park SH, Han W, Yoo TK, Lee HB, Jin US, Chang H, et al. Oncologic safety of immediate breast reconstruction for invasive breast cancer patients: a matched case control study. Journal of Breast Cancer 2016;19(1):68-75. - PMC - PubMed

Additional references

Al‐Ghazal 2000
    1. Al-Ghazal SK, Fallowfield L, Blamey RW. Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction. European Journal of Cancer 2000;36:1938-43. - PubMed
Brierley 2017
    1. Brierley JD, Gospodarowicz MK, Wittekind C, editor(s). The TNM Classification of Malignant Tumours. 8th edition. Oxford: Wiley Blackwell, 2017.
Carlson 1996
    1. Carlson GW. Skin sparing mastectomy: anatomic and technical considerations. American Surgeon 1996;62(2):151-5. - PubMed
Carlson 2003
    1. Carlson GW, Styblo TM, Lyles RH, Bostwick J, Murray DR, Staley CA, et al. Local recurrence after skin-sparing mastectomy: tumor biology or surgical conservatism? Annals of Surgical Oncology 2003;10(2):108-12. - PubMed
Carlson 2007
    1. Carlson GW, Page A, Johnson E, Nicholson K, Styblo TM, Wood WC. Local recurrence of ductal carcinoma in situ after skin-sparing mastectomy. Journal of the American College of Surgeons 2007;204(5):1074-8. - PubMed
Cochran 1954
    1. Cochran WG. The combination of estimates from different experiments. Biometrics 1954;10(1):101-29.
Cochrane EPOC 2013
    1. Cochrane Effective Practice and Organisation of Care (EPOC) Group. Risk of bias. www.//epoc.cochrane.org/sites/epoc.cochrane.org/files/uploads/Suggested%20risk.... (accessed 30 October 2013).
Cody 2001
    1. Cody HS 3rd. Clinical aspects of sentinel node biopsy. Breast Cancer Research 2001;3(2):104-8. - PMC - PubMed
CONSORT
    1. Moher D, Schulz KF, Altman DG, for the CONSORT Group. The CONSORT Statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. JAMA 2001;285(15):1987-91. - PubMed
Cunnick 2004
    1. Cunnick GH, Mokbel K. Skin-sparing mastectomy. American Journal of Surgery 2004;188(1):78-84. - PubMed
DerSimonian 1986
    1. DerSimonian R, Laird N. Meta-analysis in clinical trials. Controlled Clinical Trials 1986;7:177-88. - PubMed
Fayers 1999
    1. Fayers PM, Aaronson NK, Bjordal K, Groenvold M, Curran D, Bottomley A, on behalf of the EORTC Quality of Life Group. European Organisation for Research and Treatment of Cancer. Brussels: European Organisation for Research and Treatment of Cancer, 1999.
Giannotti 2018
    1. Giannotti DG, Hanna SA, Cerri GG, Bevilacqua JL. Analysis of skin flap thickness and residual breast tissue after mastectomy. International Journal of Radiation Oncology, Biology, Physics 2018;102(1):82-91. - PubMed
Giuliano 1997
    1. Giuliano AE, Jones RC, Brennan M, Statman R. Sentinel lymphadenectomy in breast cancer. Journal of Clinical Oncology 1997;15(6):2345-50. - PubMed
GLOBOCAN 2018
    1. Ferlay J, Colombet M, Soerjomataram I, Mathers C, Parkin DM, et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. International Agency for Research on Cancer. CancerBase No. 11 [Internet]. Available from www//globocan.iarc.fr (accessed 29 December 2018). - PubMed
Gordis 1996
    1. Gordis L. Epidemiology. Philadelphia (PA): W.B. Saunders, 1996.
GRADEpro GDT [Computer program]
    1. GRADEpro GDT. Hamilton (ON): McMaster University (developed by Evidence Prime), accessed April 2019. Avaialble at gradepro.org.
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327:557-60. - PMC - PubMed
Higgins 2011
    1. Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1 [updated March 2011]. The Cochrane Collaboration, 2011. Available from training.cochrane.org/handbook/archive/v5.1/.
Horiguchi 2006
    1. Horiguchi J, Koibuchi Y, Yoshida T, Takata D, Kikuchi M, Rokutanda N, et al. Significance of local recurrence as a prognostic factor in the treatment of breast cancer. Anticancer Research 2006;26(1):569-73. - PubMed
Langstein 2003
    1. Langstein HN, Cheng MH, Singletary SE, Robb GL, Hoy E, Smith TL, et al. Breast cancer recurrence after immediate reconstruction: patterns and significance. Plastic and Reconstructive Surgery 2003;111(2):712-20. - PubMed
Lannitis 2010
    1. Lanitis S, Tekkis PP, Sgourakis G, Dimopoulos N, Al Mufti R, Hadjiminas DJ. Comparison of skin-sparing mastectomy versus non-skin-sparing mastectomy for breast cancer: a meta-analysis of observational studies. Annals of Surgery 2010;251(4):632-9. - PubMed
Lyman 2005
    1. Lyman GH, Giuliano AE, Somerfield MR, Benson AB 3rd, Bodurka DC, Burstein HJ, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. Journal of Clinical Oncology 2005;23(30):7703-20. - PubMed
Madden 1965
    1. Madden JL. Modified radical mastectomy. Surgery, Gynecology and Obstetrics 1965;121(6):1221-30. - PubMed
McKenzie 2021
    1. McKenzie JE, Brennan SE. Chapter 12: Synthesizing and presenting findings using other methods. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al, editor(s), Cochrane Handbook for Systematic Reviews of Interventions Version 6.2 (updated February 2021). Cochrane, 2021. Available from training.cochrane.org/handbook.
Medina‐Franco 2002
    1. Medina-Franco H, Vasconez LO, Fix RJ, Heslin MJ, Beenken SW, Bland KI, et al. Factors associated with local recurrence after skin-sparing mastectomy and immediate breast reconstruction for invasive breast cancer. Annals of Surgery 2002;235(6):814-9. - PMC - PubMed
Morrow 2002
    1. Morrow M, Strom EA, Bassett LW, Dershaw DD, Fowble B, Giuliano A, et al. Standard for breast conservation therapy in the management of invasive breast carcinoma. A Cancer Journal for Clinicians 2002;52(5):277-300. - PubMed
Mota 2016
    1. Mota BS, Riera R, Ricci MD, Barrett J, Castria TB, Atallah AN, et al. Nipple- and areola-sparing mastectomy for the treatment of breast cancer. Cochrane Database of Systematic Reviews 2016, Issue 11. Art. No: CD008932. [DOI: 10.1002/14651858.CD008932.pub3] - DOI - PMC - PubMed
Newman 1998
    1. Newman LA, Kuerer HM, Hunt KK, Kroll SS, Ames FC, Ross MI, et al. Presentation, treatment, and outcome of local recurrence after skin-sparing mastectomy and immediate breast reconstruction. Annals of Surgical Oncology 1998;5(7):620-6. - PubMed
Norris 2013
    1. Norris SL, Moher D, Reeves BC, Shea B, Loke Y, Garner S, et al. Issues relating to selective reporting when including non-randomized studies in systematic reviews on the effects of healthcare interventions. Research Synthesis Methods 2013;4(1):36-47. - PubMed
Parmar 1998
    1. Parmar MK, Torri V, Stewart L. Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Statistics in Medicine 1998;17(24):2815-34. - PubMed
Patani 2008
    1. Patani N, Devalia H, Anderson A, Mokbel K. Oncological safety and patient satisfaction with skin-sparing mastectomy and immediate breast reconstruction. Surgical Oncology 2008;17(2):97-105. - PubMed
Pusic 2009
    1. Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plastic and Reconstructive Surgery 2009;124(2):345-53. - PubMed
RevMan Web 2020 [Computer program]
    1. Review Manager Web (RevMan web). Version 1.22.0. The Cochrane Collaboration, 2020. Available at revman.cochrane.org.
Schünemann 2011a
    1. Schünemann HJ, Oxman AD, Higgins JP, Vist GE, Glasziou P, Guyatt GH. Chapter 11: Presenting results and ‘Summary of findings' tables, In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from training.cochrane.org/handbook/archive/v5.1/.
Schünemann 2011b
    1. Schünemann H, Oxman AD, Vist GE, Higgins JP, Deeks JJ, Glasziou P, et al. Chapter 12: Interpreting results and drawing conclusions. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from training.cochrane.org/handbook/archive/v5.1/.
Singletary 2003
    1. Singletary SE, Robb GL. Oncologic safety of skin-sparing mastectomy. Annals of Surgical Oncology 2003;10(2):95-7. - PubMed
Slavin 1998
    1. Slavin SA, Schnitt SJ, Duda RB, Houlihan MJ, Koufman CN, Morris DJ, et al. Skin-sparing mastectomy and immediate reconstruction: oncologic risks and aesthetic results in patients with early-stage breast cancer. Plastic and Reconstructive Surgery 1998;102(1):49-62. - PubMed
Spiegel 2003
    1. Spiegel AJ, Butler CE. Recurrence following treatment of ductal carcinoma in situ with skin-sparing mastectomy and immediate breast reconstruction. Plastic and Reconstructive Surgery 2003;111(2):706-11. - PubMed
Tavassoli 2003
    1. Tavassoli FA, Devilee P. Pathology and Genetics of Tumours of the Breast and Female Genital Organs. World Health Organization Classification of Tumours. Vol. 4. Washington, DC: IARC Press, 2003.
Tierney 2007
    1. Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials 2007;8:16. - PMC - PubMed
Tokin 2012
    1. Tokin C, Weiss A, Wang-Rodriguez J, Blair SL. Oncologic safety of skin-sparing and nipple-sparing mastectomy: a discussion and review of the literature. International Journal of Surgical Oncology 2012;2012:921-9. - PMC - PubMed
Torresan 2005a
    1. Torresan RZ, Dos Santos CC, Brenelli H, Okamura H, Alvarenga M. Residual glandular tissue after skin-sparing mastectomies. Breast Journal 2005;11(5):374-5. - PubMed
Torresan 2005b
    1. Torresan RZ, Santos CCD, Okamura H, Al-Varenga M. Evaluation of residual glandular tissue after skin-sparing mastectomies. Annals of Surgical Oncology 2005;12(12):1037-44. - PubMed
Toth 1991
    1. Toth BA, Lappert P. Modified skin incisions for mastectomy: the need for plastic surgical input in preoperative planning. Plastic and Reconstructive Surgery 1991;87(6):1048-53. - PubMed
Veronesi 1990
    1. Veronesi U, Salvadori B, Luini A, Banfi A, Zucali R, Del Vecchio M, et al. Conservative treatment of early breast cancer. Long-term results of 1232 cases treated with quadrantectomy, axillary dissection, and radiotherapy. Annals of Surgery 1990;3(211):250-9. - PMC - PubMed
von Elm 2007
    1. Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007;370(9596):1453-7. - PubMed
Williamson 2002
    1. Williamson PR, Tudur Smith C, Hutton JL, Marson AG. Aggregate data meta-analysis with time-to-event outcomes. Statistics in Medicine 2002;21:3337-51. - PubMed

Publication types