Greater Glasgow and Clyde NHS Trust, Glasgow, UK.
University of Glasgow, Glasgow, UK.
Ann R Coll Surg Engl. 2022 Jan;104(1):5-17. doi: 10.1308/rcsann.2021.0012. Epub 2021 Nov 12.
Oncoplastic breast conserving surgery allows higher volume excision to achieve oncological safety with minimal aesthetic compromise. The primary outcome of this study was to assess the oncological safety in the setting of volume replacement oncoplastic breast conserving surgery. The secondary objective was to assess cosmetic outcome.
A systematic literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to explore the oncological safety of oncoplastic breast conserving surgery, with particular focus on volume replacement. Resection margin rates, re-excision rates, conversion to mastectomy rates, local and distant disease recurrence, volume replacement techniques, cosmetic outcomes and patient-reported outcome measures were assessed.
The search criteria identified 155 articles, of which 40 met the inclusion criteria. These studies included 2,497 patients with a mean age of 47.8 years (range 38.4-59.6 years), a body mass index of 24.3kg/m (22.1-28.0kg/m), with a mean follow-up of 37.1 months (6-125 months). A variety of volume replacement techniques were used, most commonly latissimus dorsi and chest wall perforator flaps. Whole mean pathological tumour size was 29.7mm (17-65mm) and mean specimen weight was 123.6g (46.5-220g). Mean re-excision rate was 7.2% and completion mastectomy rate was 2.3%. Locoregional and distant recurrence rate was 2.5% (0-8.1%) and 3.1% (0-14.6%), respectively. There were a variety of patient-reported outcome measures employed, with overall good to excellent outcomes.
This review demonstrates that volume replacement oncoplastic breast conserving surgery is a safe option in terms of re-excision, completion mastectomy rates, and local and distant recurrence. Available patient-related outcome measures and cosmetic assessment tend towards better outcomes compared with wide local excision and mastectomy. However, data are significantly limited, with a paucity of high-level evidence, and it is therefore necessary to be cautious regarding the strength and interpretation of data in this review. Further prospective studies are required on this subject.
肿瘤整形保乳手术可在保证肿瘤学安全性的前提下进行更大范围的切除，同时最大限度地减少美容效果的损害。本研究的主要结果是评估容积置换肿瘤整形保乳术中的肿瘤学安全性。次要目标是评估美容效果。
本研究采用系统综述方法，按照系统综述和荟萃分析的首选报告项目进行，探讨了肿瘤整形保乳术的肿瘤学安全性，尤其关注容积置换。评估了切缘阳性率、再次切除率、改行乳房切除术率、局部和远处疾病复发率、容积置换技术、美容效果和患者报告的结果测量。
检索标准共确定了 155 篇文章，其中 40 篇符合纳入标准。这些研究共纳入了 2497 例患者，平均年龄为 47.8 岁（范围为 38.4-59.6 岁），体质量指数为 24.3kg/m2（范围为 22.1-28.0kg/m2），平均随访时间为 37.1 个月（6-125 个月）。研究中使用了多种容积置换技术，最常用的是背阔肌和胸壁穿支皮瓣。全组平均病理肿瘤大小为 29.7mm（17-65mm），平均标本重量为 123.6g（46.5-220g）。平均再次切除率为 7.2%，改行乳房切除术率为 2.3%。局部和远处复发率分别为 2.5%（0-8.1%）和 3.1%（0-14.6%）。采用了多种患者报告的结果测量方法，总体结果为良好至优秀。
本综述表明，在再次切除、改行乳房切除术率以及局部和远处复发方面，容积置换肿瘤整形保乳术是一种安全的选择。与广泛局部切除和乳房切除术相比，现有的患者相关结果测量和美容评估往往有更好的结果。然而，数据非常有限，高级别证据缺乏，因此在本综述中，需要谨慎对待数据的强度和解释。需要进一步开展这方面的前瞻性研究。
