Department of Surgery, Bendigo Health, Bendigo, Victoria 3550, Australia; Faculty of Science, Medicine, and Health, University of Melbourne, Victoria 3010, Australia; Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, Victoria 3004, Australia.
Faculty of Science, Medicine, and Health, University of Melbourne, Victoria 3010, Australia.
J Plast Reconstr Aesthet Surg. 2023 Jul;82:186-197. doi: 10.1016/j.bjps.2023.04.007. Epub 2023 Apr 18.
The impact of chemotherapy on complications following breast reconstruction surgery (BRS) is currently inconclusive. This meta-analysis investigates the impact of chemotherapy on complication rates in BRS.
Preferred Reporting in Systematic Review and Meta-Analysis (PRISMA) guidelines was used to search relevant studies published from January 2006 to March 2022. The complication rates of neoadjuvant systemic therapy (NST) and adjuvant systemic therapy (AST) were analyzed via RevMan software 5.4, and a P value of< 0.05 was considered significant. The quality of selected studies was performed using the Newcastle-Ottawa scale for quality assessment.
A total of 18 studies comprising 49,217 patients were included. There was no significant difference in the total complications rate, major complications, or minor complications between NST and BRS or control. The rate of wound dehiscence was higher in the NST group compared with the BRS only group [RR= 1.54, 95% CI, (1.08, 2.18), P = 0.02], and the rate of infection was lower in the NST group compared with the BRS only group, [RR= 0.75, 95% CI, (0.61, 0.94), P = 0.01]. No significant difference in the rates of hematoma, seroma, skin necrosis, and implant loss was detected between NST and AST, or NST with BRS only. No statistically significant differences in total complication rates were observed between flap and implant BRS types (P = 0.88).
No significant differences between AST and NST were detected for complications. Significantly, NST had more wound dehiscence and less infection rates compared with BRS only groups, possibly reflecting selection bias or issues in the design of reported studies.
I.
化疗对乳房重建术后（BRS）并发症的影响目前尚无定论。本荟萃分析旨在探讨化疗对 BRS 并发症发生率的影响。
采用系统评价和荟萃分析首选报告（PRISMA）指南，检索 2006 年 1 月至 2022 年 3 月发表的相关研究。采用 RevMan 软件 5.4 分析新辅助全身治疗（NST）和辅助全身治疗（AST）的并发症发生率，P 值<0.05 为差异有统计学意义。采用纽卡斯尔-渥太华量表对纳入研究的质量进行评价。
共纳入 18 项研究，包含 49217 例患者。NST 与 BRS 或对照组之间的总并发症发生率、主要并发症或次要并发症无显著差异。与 BRS 组相比，NST 组的伤口裂开发生率更高[RR=1.54，95%CI（1.08，2.18），P=0.02]，感染发生率更低[RR=0.75，95%CI（0.61，0.94），P=0.01]。NST 与 AST 或 NST 联合 BRS 组之间的血肿、血清肿、皮肤坏死和植入物丢失发生率无显著差异。NST 与 BRS 类型（皮瓣和植入物）之间的总并发症发生率无统计学差异（P=0.88）。
AST 与 NST 之间的并发症无显著差异。值得注意的是，与 BRS 组相比，NST 组的伤口裂开发生率更高，感染发生率更低，这可能反映了选择偏倚或报告研究设计的问题。
I。
