Plastic Surgery Department, Royal Free Hospital, Pond Street, London, NW3 2QG, UK.
Division of Surgery and Interventional Science, University College London, London, UK.
Syst Rev. 2024 Jun 7;13(1):153. doi: 10.1186/s13643-024-02564-7.
Breast cancer is the most common malignancy among women in the UK. Following mastectomy, reconstruction is now integral to the surgical management of breast cancer, of which implant-based reconstruction (IBBR) is the most common type. IBBR initially evolved from pre-pectoral to post-pectoral due to complications, but with developments in oncoplastic techniques and new implant technology, interest in pre-pectoral IBBR has increased. Many surgeons use acellular dermal matrices (ADM); however, there is little evidence in literature as to whether this improves surgical outcomes in terms of complications, failure and patient satisfaction. This review aims to assess the available evidence as to whether there is a difference in surgical outcomes for breast reconstructions using ADM versus non-use of ADM.
A database search will be performed using Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Clinicaltrials.org. The search timeframe will be 10 years. Studies will be screened using inclusion and exclusion criteria and data extracted into a standardised spreadsheet. Risk of bias will be assessed. Screening, extraction and risk-of-bias assessments will be performed independently by two reviewers and discrepancies discussed and rectified. Data analysis and meta-analysis will be performed using Microsoft Excel and R software. Forest plots will be used for two-arm studies to calculate heterogeneity and p-value for overall effect.
With the renaissance of pre-pectoral IBBR, it is important that surgeons have adequate evidence available to assist operative decision-making. Assessing evidence in literature is important to help surgeons determine whether using ADM for IBBR is beneficial compared to non-use of ADM. This has potential impacts for patient complications, satisfaction and cost to healthcare trusts.
PROSPERO 2023 CRD42023389072.
在英国，乳腺癌是女性中最常见的恶性肿瘤。乳房切除术后，重建已成为乳腺癌外科治疗的重要组成部分，其中基于植入物的重建（IBBR）是最常见的类型。由于并发症的原因，IBBR 最初从胸肌前演变为胸肌后，但随着整形技术和新植入物技术的发展，对胸肌前 IBBR 的兴趣有所增加。许多外科医生使用脱细胞真皮基质（ADM）；然而，文献中几乎没有证据表明，在并发症、失败和患者满意度方面，使用 ADM 是否会改善手术结果。本综述旨在评估现有证据，以确定在使用 ADM 与不使用 ADM 进行乳房重建方面，手术结果是否存在差异。
将使用 Ovid MEDLINE、Embase、Cochrane 对照试验中心注册库、Cochrane 系统评价数据库和 Clinicaltrials.org 进行数据库检索。搜索时间范围为 10 年。研究将根据纳入和排除标准进行筛选，并将数据提取到标准化电子表格中。将评估偏倚风险。筛选、提取和偏倚风险评估将由两名评审员独立进行，如果存在分歧，将进行讨论和纠正。将使用 Microsoft Excel 和 R 软件进行数据分析和荟萃分析。对于双臂研究，将使用森林图计算总体效应的异质性和 p 值。
随着胸肌前 IBBR 的复兴，外科医生获得足够的证据来协助手术决策非常重要。评估文献中的证据对于帮助外科医生确定在 IBBR 中使用 ADM 是否比不使用 ADM 更有益处非常重要。这对患者并发症、满意度和医疗信托的成本都有潜在影响。
PROSPERO 2023 CRD42023389072。
