Shen Zeren, Sun Jiaqi, Yu Yijia, Chiu Chiaoyun, Zhang Zhe, Zhang Yuanfeng, Xu Jinghong
Department of Plastic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310003, China.
Economic Operation Monitoring Center, Zhejiang Institute of Industry and Information Technology, Hangzhou, China.
J Plast Reconstr Aesthet Surg. 2021 Feb;74(2):290-299. doi: 10.1016/j.bjps.2020.08.121. Epub 2020 Sep 20.
Currently, breast cancer patients undergoing mastectomy (MA) have three surgical options: MA only and reconstruction at the time of MA ("immediate," IBR) or at a later time ("delayed," DBR). To assess the oncological safety and complication risks associated with different surgical choices, a systematic review with Bayesian network analysis was conducted.
Cochrane library, PubMed/MEDLINE, EMBASE, and the China National Knowledge Infrastructure were systematically searched in November 2019. The odds ratios [OR] were estimated for oncological safety (including disease-free survival, overall survival, local recurrence, and distant metastases) and complication risks (including overall complications, surgical site infection, and lymphedema) among MA, IBR, and DBR groups.
In the included 51 studies (265,522 patients), reconstruction after MA for IBR or DBR was associated with increased overall survival compared to simple MA (DBR vs. MA: OR 4.12, 95% credible interval [CrI] 1.80-10.01; IBR vs. MA: OR 1.75, 95% CrI 1.32-2.32). Additionally, IBR was associated with a decreased distant metastasis rate compared to MA (IBR vs. MA: OR 0.67, 95% CrI 0.51-0.90). However, the risk of overall complications and surgical site infection was higher in the IBR group than in the other two groups (complications, IBR vs. DBR: OR 1.40, 95% CrI 1.01-1.93; surgical site infection, IBR vs. MA: OR 1.77, 95% CrI 1.03-3.13).
Evidence suggested that breast reconstruction, whether IBR or DBR, does not adversely affect oncological safety in the setting of breast cancer. IBR is associated with an increased risk of overall complications and surgical site infection, but technical advances in this surgical procedure have cumulated over time.
目前，接受乳房切除术（MA）的乳腺癌患者有三种手术选择：单纯乳房切除术以及在乳房切除时进行重建（“即刻”，IBR）或在之后进行重建（“延迟”，DBR）。为评估不同手术选择相关的肿瘤学安全性和并发症风险，进行了一项采用贝叶斯网络分析的系统评价。
于2019年11月对Cochrane图书馆、PubMed/MEDLINE、EMBASE和中国知网进行系统检索。估计了MA、IBR和DBR组在肿瘤学安全性（包括无病生存期、总生存期、局部复发和远处转移）和并发症风险（包括总体并发症、手术部位感染和淋巴水肿）方面的比值比[OR]。
在纳入的51项研究（265,522例患者）中，与单纯MA相比，IBR或DBR的MA术后重建与总生存期增加相关（DBR与MA：OR 4.12，95%可信区间[CrI] 1.80 - 10.01；IBR与MA：OR 1.75，95% CrI 1.32 - 2.32）。此外，与MA相比，IBR的远处转移率降低（IBR与MA：OR 0.67，95% CrI 0.51 - 0.90）。然而，IBR组的总体并发症和手术部位感染风险高于其他两组（并发症，IBR与DBR：OR 1.40，95% CrI 1.01 - 1.93；手术部位感染，IBR与MA：OR 1.77，95% CrI 1.03 - 3.13）。
证据表明，无论是IBR还是DBR，乳房重建在乳腺癌情况下不会对肿瘤学安全性产生不利影响。IBR与总体并发症和手术部位感染风险增加相关，但随着时间推移，该手术的技术进步不断积累。
