Thoracic sympathectomy for the treatment of primary axillary hyperhidrosis: systematic review and proportional meta-analysis

Figures & data

Figure 1. Flowchart of literature search.

Table 1. Characteristics of selected studies.

Author	Origin	Period	Number of participants	Sex (M, F)		Follow-up (months)	Sympathectomy level
Boscardim et al. [14]	Brazil	2003/2007	118	26	92	12	T4/T5
Chou [15]	Taiwan	–	28	8	20	35.3	T5
Raposio et al. [20]	Italy	–	9	–	–	15 months	T4
Hsu et al. [16]	Taiwan	1996/2000	171	37	134	22.5	T3/T4_T4_T4/T5
Lin [18]	Taiwan	1997/1998	26	10	16	31.3	T3/T4
Lin et al. [19]	Taiwan	1993/2000	480	–	–	51.7	T3/T4
Munia et al. [10]	Brazil	–	64	14	50	12	T3/T4_T4
Rex et al. [21]	Sweden	1989/1996	93	–	–	26	T2/T4
Ribas Milanez de Campos et al. [22]	Brazil	2000/2005	276	106	170	21.6	T3/T4_T4
Schmidt et al. [11]	Germany	2000/2003	85	23	62	24	T2/T4_T3/T5
Sciuchetti et al. [12]	Italy	2003/2006	51	–	–	13	T3/T4
Leao et al. [17]	Brazil	1999/2003	21	–	–	36	T2/T4
Zacherl et al. [13]	Austria	1965/1996	41	–	–	16.1 (years)	T1/T4

M: male F: female.

Table 2. Newcastle–Ottawa scale.

	Selection				Comparability	Outcomes
Study	Representativeness	Selection of non-exposed group	Investigation	Outcome absent at the beginning	Comparability	Evaluation results	Segment duration	Adequacy of follow-up	Total
Boscardim et al. [14]	*		*	*	*		*	*	6
Chou [15]	*		*	*	*		*	*	6
Hsu et al. [16]	*		*	*	*		*	*	6
Lin [18]	*		*	*	*		*	*	6
Lin et al. [19]	*		*	*	*		*	*	6
Munia et al. [10]	*		*	*	*		*	*	6
Raposio et al. [20]	*		*	*	*		*	*	6
Rex et al. [21]	*		*	*	*		*	*	6
Ribas Milanez de Campos et al. [22]	*		*	*	*		*	*	6
Schmidt et al. [11]	*		*	*	*		*	*	6
Sciuchetti et al. [12]	*		*	*	*		*	*	6
Leao et al. [17]	*		*	*	*			*	5
Zacherl et al. [13]	*		*	*	*		*	*	6

*Presence of the dominion evaluated.

Figure 2. Results of the overall satisfaction outcome. The overall satisfaction rate was 92% (95% CI = 88–95%, I²=47.5%).

Figure 3. Results of the outcome total control of symptoms. The rate of symptom control was 96% (95% CI = 93–99%, I²=48.2%).

Table 3. Analysis of the outcome satisfaction according to the level of sympathectomy.

Resection level
High				Low
Author	Level	N		Author	Level	N
		S	I			S	I
Lin	T3/T4	24	2	Boscardim	T4/T5	109	9
Rex	T2/T4	83	10	Chou	T5	28	0
Ribas Milanez de Campos	T3/T4_T3	256	20	Fox	T4	9	0
Zacherl	T1/T4	33	8
Total		396	40			146	9

N: total number of patients; S: satisfied patients; I: dissatisfied patients.

Figure 4. Forest plot of the outcome satisfaction in high resection levels (A) satisfaction rate 89% (95% CI = 84–95%, I²=47.7%) and low (B) satisfaction rate 96% (95% CI = 89–100%, I²=45.9%).

Figure 5. Interpretation of meta-analysis of the outcome satisfaction. The overlap of the confidence intervals indicates that there were no differences between the groups.

Table 4. Analysis of the outcome control of symptoms according to the level of sympathectomy.

Resection level
High					Low
Author	Level	N			Author	Level	N
		P	A				P	A
Schmidt	T2/T4_T3/T5	79		4	Boscardim	T4/T5	112		6
Sciuchetti	T3/T4	51		0	Chou	T5	28		0
Zacherl	T1/T4	39		2
Total		169		6			140		6

N: total number of patients; P: patients with controlled symptoms; A: patients with uncontrolled symptoms.

Figure 6. Forest plot of the outcome control of symptoms in high resections (A) control rate 96% (95% CI = 89–99%, I²=65.9%) and low (B) 97% control rate (95% CI = 90–100%, I²=46.3%).

Figure 7. Interpretation of meta-analysis of the outcome control of symptoms. The overlap between confidence intervals shows that there were no differences between the groups.

Table 5. Analysis of the outcome compensatory sweating as per the level of sympathectomy.

Resection level
High				Low
Author	Level	N		Author	Level	N
		A	P			A	P
Lin	T3/T4	25	1	Boscardim	T4/T5	96	22
Lin	T3/T4	288	192	Chou	T5	28	0
Munia	T3/T4	2	29	Munia	T4	19	14
Ribas Milanez de Campos	T3/T4_T3	137	139
Leao	T2/T4	18	3
Total		470	364			143	36

N: total number of patients; A: patients without compensatory sweating; P: patients with compensatory sweating.

Table 6. Quality of evidence for the outcomes satisfaction and control of symptoms in video-assisted thoracoscopic sympathectomy for treating pure axillary hyperhidrosis.

Outcome	Study design	Risk of bias	Inconsistency	Indirect evidence	Imprecision	Events	No of participants (studies)	Proportion effect (95% CI)	Quality of evidence
Satisfaction	Observational	Serious^a	Very serious^b	Low	Not serious^c	542	591 (7)	0.92 (0.88–0.95)	⨁◯◯◯ very low
Symptom control	Observational	Serious^a	Very serious^b	Low	Not serious^c	309	323 (5)	0.96 (0.93–0.99)	⨁◯◯◯ very low

CI: confidence interval.

Very low quality: any estimate of the effect of the intervention is very uncertain.

^a Risk inherent to the nature of the included studies, subject to biases of interviewer, memory, performance and confusion.

^b High risk of inconsistencies due to high levels of heterogeneity.

^c The confidence intervals were relatively narrow.

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Data availability statement

The data that support the findings of this study, such as the list of articles found, the articles data, the list of excluded articles and any other are available from the corresponding author, Felisberto Jr G, upon request.