背景:术后放疗会影响即刻乳房重建的结果。然而,在乳房切除术后放射治疗(PMRT)的情况下,尚不清楚胸前或胸下乳房再造的使用.我们回顾了接受PMRT的女性胸前和胸膜下乳房重建并发症发生率的证据。
方法:PubMed,WebofScience,和Embase数据库被扫描以比较胸前和胸下乳房重建与PMRT的并发症发生率。将所有并发症进行随机效应荟萃分析,以获得比值比(OR)。
结果:共纳入8项观察性研究。Meta分析显示感染风险无差异(OR:1.2295%CI0.79,1.88I2=0%),植入物损失(OR:0.8695%CI0.50,1.50I2=14%),血清肿(OR:1.0195%CI0.43,2.34I2=50%),血肿(OR:0.4495%CI0.12,1.71I2=0%),伤口裂开(OR:0.9595%CI0.42,2.17I2=0%),皮肤坏死(OR:0.6195%CI0.21,1.75I2=36%),挛缩(OR:0.4695%CI0.15,1.48I2=54%),胸前组和胸下组之间需要进行翻修手术(OR:0.8595%CI0.45,1.60I2=15%)。
结论:观察性研究的数据表明,在适当选择的患者中,用PMRT进行胸前或胸下乳房重建的早期并发症的风险可能没有任何差异。目前的证据受到研究数量少的限制,短期随访和选择偏差。需要对两种方法进行比较的随机对照试验,以获得长期结果的有力证据。
方法:本期刊要求作者为每篇文章分配一定程度的证据。对于这些循证医学评级的完整描述,请参阅目录或在线作者说明www。springer.com/00266.
BACKGROUND: Outcomes of immediate breast reconstructions can be influenced by postoperative radiotherapy. However, there is no clarity on the use of prepectoral or subpectoral breast reconstruction in the setting of postmastectomy radiation therapy (PMRT). We reviewed evidence on the complication rates of prepectoral and subpectoral breast reconstruction in women undergoing PMRT.
METHODS: PubMed, Web of Science, and Embase databases were scanned for studies comparing complication rates of prepectoral and subpectoral breast reconstruction with PMRT. All complications were pooled in a random-effect meta-analysis to obtain odds ratio (OR).
RESULTS: Eight observational studies were included. Meta-analysis showed no difference in the risk of infections (OR: 1.22 95% CI 0.79, 1.88 I2=0%), implant loss (OR: 0.86 95% CI 0.50, 1.50 I2=14%), seroma (OR: 1.01 95% CI 0.43, 2.34 I2=50%), hematoma (OR: 0.44 95% CI 0.12, 1.71 I2=0%), wound dehiscence (OR: 0.95 95% CI 0.42, 2.17 I2=0%), and skin necrosis (OR: 0.61 95% CI 0.21, 1.75 I2=36%), contracture (OR: 0.46 95% CI 0.15, 1.48 I2=54%) and the need for revision surgeries (OR: 0.85 95% CI 0.45, 1.60 I2=15%) between the prepectoral and subpectoral groups.
CONCLUSIONS: Data from observational studies indicates that in appropriately selected patients there may not be any difference in the risk of early complications with prepectoral or subpectoral breast reconstruction with PMRT. Current evidence is limited by the small number of studies, short follow-up and selection bias. There is a need for randomized controlled trials comparing the two approaches to obtain robust evidence on long-term outcomes.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .