Department of Plastic and Reconstructive Surgery, University Hospitals Leuven, Leuven, Belgium.
Acta Chir Belg. 2021 Jun;121(3):155-163. doi: 10.1080/00015458.2021.1922829. Epub 2021 May 5.
Breast cancer (BC) treatment traditionally consisted of radical and often mutilating surgery. Advances in the field of BC have led to new remedies, enabling the paradigm shift from radical to conservative surgery. New treatments such as nipple-sparing mastectomy (NSM) are becoming more popular, aiming to improve both oncological and aesthetic outcomes. However, evidence confirming the oncological safety of NSM is currently lacking, hindering its application. This systematic review sought to analyze NSM's oncological safety as an alternative to conventional mastectomy (CM).
A systematic review was performed, respecting the PRISMA guidelines. Pubmed, Embase, and Web of Science databases were consulted and searched for keywords: 'nipple-sparing mastectomy' and 'mammaplasty', or combinations of synonyms. Only original studies published between 2000 and 2020 reporting tumor recurrence and/or survival rates with a minimum of 5-year follow-up were included.
From the 1675 unique records found, 14 studies were included, amounting to 5980 female BC patients who underwent NSM plus reconstruction. Included studies described either only ductal carcinoma (DCIS, = 1), only invasive BC ( = 3) or DCIS and invasive BC ( = 10). The most recurrent oncological metrics were 5-year local recurrence (0-10%), locoregional recurrence (0-7.4%), distant recurrence (1.6-15.6%), and overall survival rate (93.1-100%).
Based on long-term low BC recurrences and high survival rates, NSM is perceived to be non-inferior to CM from an oncological perspective. This identifies NSM plus reconstruction to be a safe curative treatment. Further studies should aim to elicit clear and applicable selection criteria in order to maximize NSM's potential.
乳腺癌（BC）的传统治疗方法包括激进且常致残的手术。BC 领域的进步带来了新的治疗方法，使从激进手术到保守手术的范式转变成为可能。保留乳头的乳房切除术（NSM）等新的治疗方法越来越受欢迎，旨在改善肿瘤学和美学效果。然而，目前缺乏证实 NSM 肿瘤学安全性的证据，阻碍了其应用。本系统评价旨在分析 NSM 作为传统乳房切除术（CM）替代方法的肿瘤学安全性。
进行了系统评价，遵循 PRISMA 指南。检索了 Pubmed、Embase 和 Web of Science 数据库，并使用关键词进行搜索：“保留乳头的乳房切除术”和“乳房成形术”，或同义词的组合。仅纳入 2000 年至 2020 年期间发表的报告肿瘤复发和/或生存率且随访时间至少 5 年的原始研究。
从 1675 条独特的记录中，纳入了 14 项研究，共纳入了 5980 名接受 NSM 加重建的女性 BC 患者。纳入的研究仅描述了导管原位癌（DCIS， = 1）、浸润性乳腺癌（ = 3）或 DCIS 和浸润性乳腺癌（ = 10）。最常见的肿瘤学复发指标是 5 年局部复发率（0-10%）、局部区域复发率（0-7.4%）、远处复发率（1.6-15.6%）和总生存率（93.1-100%）。
基于长期低 BC 复发率和高生存率，从肿瘤学角度来看，NSM 被认为不劣于 CM。这表明 NSM 加重建是一种安全的治愈性治疗方法。进一步的研究应旨在制定明确和适用的选择标准，以最大限度地发挥 NSM 的潜力。
