Glynou Sevasti Panagiota, Sousi Sara, Cook Hannah, Zargaran Alexander, Zargaran David, Mosahebi Afshin
London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Faculty of Medicine, Imperial College London, London, UK.
BMC Cancer. 2024 Dec 31;24(1):1598. doi: 10.1186/s12885-024-13359-3.
Breast cancer is the leading cause of cancer amongst women in the United Kingdom, with implant-based reconstruction (IBR) using Acellular Dermal Matrices (ADM) gaining popularity for post-mastectomy procedures. This study compares outcomes of different ADMs that are commonly used in women undergoing IBR, this was short and long-term complications.
A systematic search of MEDLINE, Embase, CENTRAL, and CDSR databases was performed according to the PRISMA guidelines, focusing on women undergoing IBR with FlexHD, AlloDerm, Bovine, or Porcine ADMs. A network meta-analysis (NMA) was also conducted.
A total of 51 studies were captured by the search, of which 27 were included in the network meta-analysis. Alloderm was the most used ADM (54%), followed by Porcine (17%), Bovine (11%), DermAcell (11%), and FlexHD (7%). The mean follow-up was 27.8 months. The complication rates varied. Porcine ADMs had the highest rate of seroma formation (10.3%) and of haematoma formation (2.7%). AlloDerm FD had the highest rate of wound dehiscence (3.1%). Implant failure was highest in AlloDerm FD ADMs (11.8%), followed by Porcine ADMs (11.2%). Infections were most common in Porcine (11.2%) and AlloDerm FD ADMs (11.0%). Capsular contracture was rare across all ADM types, with no significant differences observed. In the NMA, AlloDerm FD showed significantly higher risks of infection, explantation, and wound dehiscence compared to AlloDerm RTU.
The overall complication profiles of ADMs used in IBR are similar, except for the higher risks associated with AlloDerm FD compared to RTU. These findings suggest that the choice of ADM may not significantly impact overall outcomes, except in specific cases like AlloDerm FD. Further high-quality, long-term, double-arm studies are necessary to confirm comparative profile of specific ADM types and to account for potential confounding variables through multivariable regression analysis.
在英国，乳腺癌是女性癌症的主要病因，使用脱细胞真皮基质（ADM）的植入式乳房重建（IBR）在乳房切除术后的手术中越来越受欢迎。本研究比较了IBR女性常用的不同ADM的结果，即短期和长期并发症。
根据PRISMA指南，对MEDLINE、Embase、CENTRAL和CDSR数据库进行系统检索，重点关注接受FlexHD、AlloDerm、牛源或猪源ADM进行IBR的女性。还进行了网络荟萃分析（NMA）。
检索共纳入51项研究，其中27项纳入网络荟萃分析。Alloderm是使用最多的ADM（54%），其次是猪源（17%）、牛源（11%）、DermAcell（11%）和FlexHD（7%）。平均随访时间为27.8个月。并发症发生率各不相同。猪源ADM的血清肿形成率最高（10.3%），血肿形成率最高（2.7%）。AlloDerm FD的伤口裂开率最高（3.1%）。AlloDerm FD ADM的植入物失败率最高（11.8%），其次是猪源ADM（11.2%）。感染在猪源（11.2%）和AlloDerm FD ADM中最为常见（11.0%）。所有ADM类型的包膜挛缩都很罕见，未观察到显著差异。在NMA中，与AlloDerm RTU相比，AlloDerm FD显示出更高的感染、取出和伤口裂开风险。
IBR中使用的ADM的总体并发症情况相似，除了与AlloDerm FD相比，RTU的风险更高。这些发现表明，ADM的选择可能不会显著影响总体结果，AlloDerm FD等特定情况除外。需要进一步开展高质量、长期的双臂研究，以确认特定ADM类型的比较情况，并通过多变量回归分析考虑潜在的混杂变量。
