Implant-based Breast Reconstruction after Mastectomy for Breast Cancer: A Systematic Review and Meta-analysis.
Implant-based Breast Reconstruction after Mastectomy for Breast Cancer: A Systematic Review and Meta-analysis.
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DOI：
10.1097/gox.0000000000004179
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发表时间：
2022-03
期刊：
影响因子：
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通讯作者：
Balk EM
中科院分区：
文献类型：
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作者：
Saldanha IJ;Broyles JM;Adam GP;Cao W;Bhuma MR;Mehta S;Pusic AL;Dominici LS;Balk EM
在乳腺癌乳房切除术后接受基于植入物的重建（IBR）的女性有许多选择，包括IBR相对于放疗和化疗的时间、植入物材料、解剖平面和使用人脱细胞真皮基质。我们进行了一项系统性审查，以评估这些选项。我们检索了Medline、Embase、科克伦CENTRAL、CINAHL和ClinicalTrials.gov的研究，从开始到2021年3月23日，无语言限制。我们使用标准方法评估了偏倚风险和证据强度（SoE）。我们筛选了15,936篇引文。36项主要为高或中度偏倚风险的研究（48，419例患者）符合标准。在放疗之前或之后进行IBR的时间可能会导致相当的身体、心理和性健康以及乳房满意度（所有低SoE），并且可能具有相当的植入失败/丢失或复发风险（中度SoE）。没有研究涉及相对于化疗的时间。硅胶和生理盐水植入体可能会导致乳房的临床满意度相当（低SoE）。植入物是否位于胸肌前或整个肌下平面可能不会影响感染风险（低SoE）。脱细胞真皮基质的使用可能会增加植入物失效/丢失或需要外植体手术的风险（中度SoE），并可能增加感染风险（低SoE）。血清肿和计划外翻修手术的风险可能相当（中度SoE），使用或不使用人脱细胞真皮基质的坏死风险可能相当（低SoE）。关于IBR选项的证据大多是低SOE。需要新的高质量研究，特别是关于种植时机、种植体材料和种植体放置的解剖平面。
Women undergoing implant-based reconstruction (IBR) after mastectomy for breast cancer have numerous options, including timing of IBR relative to radiation and chemotherapy, implant materials, anatomic planes, and use of human acellular dermal matrices. We conducted a systematic review to evaluate these options. We searched Medline, Embase, Cochrane CENTRAL, CINAHL, and ClinicalTrials.gov for studies, from inception to March 23, 2021, without language restriction. We assessed risk of bias and strength of evidence (SoE) using standard methods. We screened 15,936 citations. Thirty-six mostly high or moderate risk of bias studies (48,419 patients) met criteria. Timing of IBR before or after radiation may result in comparable physical, psychosocial, and sexual well-being, and satisfaction with breasts (all low SoE), and probably comparable risks of implant failure/loss or explantation (moderate SoE). No studies addressed timing relative to chemotherapy. Silicone and saline implants may result in clinically comparable satisfaction with breasts (low SoE). Whether the implant is in the prepectoral or total submuscular plane may not impact risk of infections (low SoE). Acellular dermal matrix use probably increases the risk of implant failure/loss or need for explant surgery (moderate SoE) and may increase the risk of infections (low SoE). Risks of seroma and unplanned repeat surgeries for revision are probably comparable (moderate SoE), and risk of necrosis may be comparable with or without human acellular dermal matrices (low SoE). Evidence regarding IBR options is mostly of low SoE. New high-quality research is needed, especially for timing, implant materials, and anatomic planes of implant placement.