16th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Plastic Surgery Hospital, #33 Badachu Road, Shijingshan District, Beijing, 100144, China.
Anesthesiology Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Plastic Surgery Hospital, #33 Badachu Road, Shijingshan District, Beijing, 100144, China.
Int J Surg. 2022 Sep;105:106814. doi: 10.1016/j.ijsu.2022.106814. Epub 2022 Aug 14.
There is no consensus on the timing of postmastectomy radiotherapy (PMRT) in relation to the exchange procedure in breast cancer patients undergoing the immediate two-stage prosthetic breast reconstruction. This meta-analysis investigated the reconstruction failure, complications, and cosmesis between PMRT to the tissue expander (TE) and PMRT to the permanent implant (PI).
A literature search was conducted in PubMed and Embase databases until February 2022. Studies presenting at least one aspect relating to reconstruction failure, complications, and cosmesis between two cohorts were included. Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias in included studies.
Eleven studies presenting 1447 patients were enrolled. Three studies were prospective controlled research. The risk for implant loss was higher in PMRT to TE cohort (RR 1.75; 95% CI, 1.03 to 2.98; p = 0.04); meanwhile, the PMRT to TE cohort had a significantly lower risk of capsular contracture (RR 0.47; 95% CI, 0.29 to 0.78; p = 0.003). However, the synthesized result should be interpreted sensibly due to heterogeneity in statistical methods and definitions.
Delivering PMRT to PI may reduce the risk of implant loss, while delivering PMRT to TE can reduce the risk of severe capsular contracture. More high-quality studies are warranted for the refinement of clinical practice.
在接受即刻两阶段假体乳房重建的乳腺癌患者中，关于与假体交换相关的乳腺癌术后放疗（PMRT）时机，目前尚无共识。本荟萃分析研究了组织扩张器（TE）和永久性植入物（PI）的 PMRT 之间在重建失败、并发症和美容效果方面的差异。
在 PubMed 和 Embase 数据库中进行了文献检索，检索时间截至 2022 年 2 月。纳入了至少在两个队列之间的重建失败、并发症和美容效果的一个方面进行了报道的研究。使用纽卡斯尔-渥太华量表（NOS）评估纳入研究的偏倚风险。
共纳入了 11 项研究，共计 1447 例患者。其中 3 项为前瞻性对照研究。PMRT 至 TE 组的假体丢失风险更高（RR 1.75；95%CI，1.03 至 2.98；p=0.04）；而 PMRT 至 TE 组的包膜挛缩风险显著降低（RR 0.47；95%CI，0.29 至 0.78；p=0.003）。但是，由于统计方法和定义的异质性，合成结果应合理解释。
对 PI 进行 PMRT 可能降低假体丢失的风险，而对 TE 进行 PMRT 则可以降低严重包膜挛缩的风险。需要更多高质量的研究来完善临床实践。
