Implant-based versus Autologous Reconstruction after Mastectomy for Breast Cancer: A Systematic Review and Meta-analysis.
Implant-based versus Autologous Reconstruction after Mastectomy for Breast Cancer: A Systematic Review and Meta-analysis.
复制标题
DOI：
10.1097/gox.0000000000004180
复制
发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
Saldanha IJ
中科院分区：
文献类型：
--
作者：
Broyles JM;Balk EM;Adam GP;Cao W;Bhuma MR;Mehta S;Dominici LS;Pusic AL;Saldanha IJ
对于乳房切除术后接受乳房再造的女性，基于植入物的再造（IBR）和自体再造（AR）的比较受益和危害尚不清楚。我们对乳腺癌乳房切除术后IBR与AR的荟萃分析进行了系统评价。我们检索了Medline、Embase、科克伦CENTRAL、CINAHL和ClinicalTrials.gov，以查找从开始到2021年3月23日的研究。我们使用标准方法评估了个体研究的偏倚风险和我们发现的证据强度（SoE）。我们筛选了15，936篇引文，纳入了40项研究（2项随机对照试验和38项调整后的非随机比较研究）。与接受IBR的患者相比，接受AR的患者在临床上显著更好地体验到性健康[汇总校正平均差异（adjMD）5.8，95% CI 3.4-8.2; 3项研究]和乳房满意度（汇总adjMD 8.1，95% CI 6.1-10.1; 3项研究）（两种结局的中度SoE）。在长期随访（1.5-4年）中，AR与静脉血栓栓塞（中度SoE）的风险较高相关，但IBR与重建失败（中度SoE）和血清肿（低SoE）的风险较高相关。其他结果在组间具有可比性，或者证据不足以得出结论。关于IBR与AR的大多数证据均为低或中度SOE。AR可能与更好的性健康和对乳房的满意度以及血清肿和长期重建失败的风险较低有关，但血栓栓塞事件的风险较高。需要新的高质量研究来填补重要的研究空白。
For women undergoing breast reconstruction after mastectomy, the comparative benefits and harms of implant-based reconstruction (IBR) and autologous reconstruction (AR) are not well known. We performed a systematic review with meta-analysis of IBR versus AR after mastectomy for breast cancer. We searched Medline, Embase, Cochrane CENTRAL, CINAHL, and ClinicalTrials.gov for studies from inception to March 23, 2021. We assessed the risk of bias of individual studies and strength of evidence (SoE) of our findings using standard methods. We screened 15,936 citations and included 40 studies (two randomized controlled trials and 38 adjusted nonrandomized comparative studies). Compared with patients who undergo IBR, those who undergo AR experience clinically significant better sexual well-being [summary adjusted mean difference (adjMD) 5.8, 95% CI 3.4–8.2; three studies] and satisfaction with breasts (summary adjMD 8.1, 95% CI 6.1–10.1; three studies) (moderate SoE for both outcomes). AR was associated with a greater risk of venous thromboembolism (moderate SoE), but IBR was associated with a greater risk of reconstructive failure (moderate SoE) and seroma (low SoE) in long-term follow-up (1.5–4 years). Other outcomes were comparable between groups, or the evidence was insufficient to merit conclusions. Most evidence regarding IBR versus AR is of low or moderate SoE. AR is probably associated with better sexual well-being and satisfaction with breasts and lower risks of seroma and long-term reconstructive failure but a higher risk of thromboembolic events. New high-quality research is needed to address the important research gaps.