Lautrup Marianne Djernes, Rindom Mikkel Boersen, Hauerslev Katrine Rye
Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark.
Gland Surg. 2024 May 30;13(5):713-721. doi: 10.21037/gs-23-530. Epub 2024 May 27.
The high prevalence of breast cancer survivors makes it very relevant to investigate late morbidity following the treatment. Oncoplastic breast conserving surgery (OPS) has gained great popularity over the past years, and evidence-based knowledge suggest better prognosis for treatment with breast conserving surgery (BCS) compared to mastectomy. The aim was to investigate if OPS causes late effects on an acceptable level compared to what we know about breast surgery causing late effects.
Using the Medical Subject Headings (MeSH) terms "Breast Neoplasms", "shoulder", "oncoplast*", and "reconstruct*", the databases PubMed, Embase, and Scopus were searched on the 6 of June 2023. The literature search was managed in Covidence. We focused on studies describing late effects especially shoulder function including restrictions in mobility, reduced strength, as well as functional impairment.
Nine studies fulfilled the inclusion criteria. Different kinds of oncoplastic procedures were described-most of them described volume replacement procedures. The knowledge of shoulder morbidity following OPS is limited. The heterogeneity in the selected studies was broad. Some of the studies were small and there was a considerable variation in follow-up time. They described shoulder function based on several different evaluation methods [range of motion (ROM), Disabilities of the Arm, Shoulder, and Hand (DASH), Quick-DASH (Q-DASH), Shoulder Pain and Disability Index (SPADI), health-related quality of life (HRQoL), and non-validated subjective questionnaires]. All studies found acceptable levels of shoulder morbidity.
The requisite knowledge of late effects following OPS is still not available for unambiguous recommendations. This narrative review has elucidated the knowledge and has reached a conclusion based on review of the existing literature of this item. We found that the risk of decreased shoulder function caused by OPS-volume displacement as well as volume replacement-does not exceed the risk of shoulder problems seen after BCS and mastectomy with or without immediate reconstruction. Therefore, OPS can be considered if conventional BCS is not possible. But the knowledge of shoulder function after OPS is limited, and studies comparing shoulder function after OPS, BCS and mastectomy with or without immediate reconstruction are warranted.
乳腺癌幸存者的高患病率使得研究治疗后的晚期发病率具有重要意义。在过去几年中，肿瘤整形保乳手术（OPS）越来越受欢迎，循证医学知识表明，与乳房切除术相比，保乳手术（BCS）的预后更好。目的是研究与我们所知的导致晚期影响的乳房手术相比，OPS是否会在可接受的水平上产生晚期影响。
于2023年6月6日使用医学主题词（MeSH）“乳腺肿瘤”、“肩部”、“肿瘤整形*”和“重建*”在PubMed、Embase和Scopus数据库中进行检索。文献检索在Covidence中进行管理。我们重点关注描述晚期影响尤其是肩部功能的研究，包括活动受限、力量减弱以及功能损害。
九项研究符合纳入标准。描述了不同类型的肿瘤整形手术——其中大多数描述了容积置换手术。关于OPS后肩部发病率的知识有限。所选研究中的异质性很大。一些研究规模较小，随访时间也有相当大的差异。他们基于几种不同的评估方法[活动范围（ROM）、手臂、肩部和手部功能障碍（DASH）、快速DASH（Q-DASH）、肩部疼痛和残疾指数（SPADI）、健康相关生活质量（HRQoL）以及未经验证的主观问卷]描述肩部功能。所有研究均发现肩部发病率处于可接受水平。
关于OPS后晚期影响的必要知识仍然不足，无法给出明确的建议。本叙述性综述阐明了相关知识，并基于对该主题现有文献的综述得出了结论。我们发现，OPS（容积移位以及容积置换）导致肩部功能下降的风险不超过BCS以及有或无即刻重建的乳房切除术后出现肩部问题的风险。因此，如果无法进行传统的BCS，可以考虑OPS。但是关于OPS后肩部功能的知识有限，有必要开展比较OPS、BCS以及有或无即刻重建的乳房切除术后肩部功能的研究。
