-
The British Journal of Surgery Sep 2023Oncoplastic procedures allow excision of larger breast tumours, or unfavourable tumour/breast ratio lesions while achieving a good cosmetic outcome. This increases the...
BACKGROUND
Oncoplastic procedures allow excision of larger breast tumours, or unfavourable tumour/breast ratio lesions while achieving a good cosmetic outcome. This increases the pool of patients eligible for breast conservation over mastectomy, reducing the need for more extensive surgery in older women and potentially improving their quality of life. Nonetheless, studies to date suggest a poor uptake of oncoplastic breast surgery in the older group. This review aimed to establish whether a disparity in uptake of oncoplastic breast surgery exists between older and younger women, and to explore the underlying reasons for this.
METHODS
A literature search was conducted on 17 January 2022 using MEDLINE and Embase. Eligible studies comprised full-text articles of patients who underwent oncoplastic breast surgery for primary invasive breast cancer, and included those aged at least 65 years.
RESULTS
Ten published studies were identified. One study was ranked as providing level 2 evidence, and the remainder were level 3. A total of 567 women underwent oncoplastic breast surgery for primary breast cancer, of whom only 61 (10.8 per cent) were aged 65 years or older. None of the studies directly compared younger with older women, or explored the underlying factors contributing to this discrepancy in uptake.
CONCLUSION
This review has demonstrated a lower uptake of oncoplastic breast surgery in older compared with younger women. Given the increasing number of older women living with breast cancer who may be eligible for breast-conserving surgery, further research into this area is required.
Topics: Female; Humans; Aged; Mastectomy; Breast Neoplasms; Quality of Life; Treatment Outcome; Mastectomy, Segmental; Mammaplasty
PubMed: 37310128
DOI: 10.1093/bjs/znad161 -
Annals of Medicine and Surgery (2012) Feb 2024This meta-analysis aimed to compare the efficacy of preservation of the intercostobrachial nerve (ICBN) versus its dissection for patients who underwent breast surgery. (Review)
Review
INTRODUCTION
This meta-analysis aimed to compare the efficacy of preservation of the intercostobrachial nerve (ICBN) versus its dissection for patients who underwent breast surgery.
METHODS
The authors searched Web of Science, PubMed, Cochrane CENTRAL, and Scopus from inception until March 2023. Records were screened for eligible studies, and all relevant outcomes were pooled as an odds ratio (OR) with the corresponding 95% CI in the meta-analysis models using RevMan version 5.4.
RESULTS
These results from 11 studies (1021 patients) favored preservation of the ICBN over its dissection in terms of anaesthesia and hypaesthesia [OR 0.50, (95% CI, 0.31-0.82); = 0.006] and [OR 0.33, (95% CI, 0.16-0.68); = 0.003], respectively. Whereas the overall effect favored ICBN dissection over preservation in the case of hyperaesthesia [OR 4.34, (95% CI, 1.43-13.15); = 0.01]. Conversely, no significant variance was detected between the two groups in terms of pain [OR 0.68, (95% CI, 0.28-1.61) = 0.38], paraesthesia [OR 0.88, (95% CI, 0.49-1.60); = 0.68], and analgesia [OR 1.46, (95% CI, 0.05-45.69); = 0.83].
CONCLUSION
This meta-analysis revealed that the preservation of the ICBN has a significant effect on the disturbance of sensory parameters of hypaesthesia and anaesthesia when compared to its dissection. Further studies with larger sample sizes are recommended to precisely compare both techniques on a wider range of parameters.
PubMed: 38333310
DOI: 10.1097/MS9.0000000000001622 -
The Oncologist Jan 2024Breast surgery in cases of de novo metastatic breast cancer (MBC) is associated with improved outcomes in retrospective studies, although the results of randomized... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Breast surgery in cases of de novo metastatic breast cancer (MBC) is associated with improved outcomes in retrospective studies, although the results of randomized controlled trials (RCTs) are conflicting. We aimed to investigate whether surgery in this context prolongs patient survival.
METHODS
We performed a systematic review of the literature to identify RCTs comparing surgery of primary breast cancer to no surgery in patients with de novo MBC. Cochrane Library, Embase, Medline (OVID), and Web of Science were searched with latest update in July 2023, while conference proceedings were manually searched. Data concerning patient and tumor characteristics, as well as outcomes, were extracted. A meta-analysis with random effects models was performed considering heterogeneity between trials.
RESULTS
Overall, 3255 entries were identified and 5 RCTs fulfilled all inclusion criteria, which had enrolled 1381 patients. The overall estimation in the intention-to-treat population showed no benefit for patients who had surgical excision of the primary breast tumor (HR = 0.93; 95% CI, 0.76-1.14). No subgroups in terms of receptor status or patterns of metastasis seemed to benefit from surgery, except for younger/premenopausal patients (HR = 0.74, 95% CI, 0.58-0.94). Breast surgery was associated with improved local progression-free survival (HR = 0.37, 95% CI, 0.19-0.74).
CONCLUSION
Surgery of the primary tumor in patients with de novo MBC does not prolong survival, except possibly in younger/premenopausal patients. Breast surgery should be offered within the context of well-designed clinical trials examining the issue.
Topics: Humans; Female; Breast Neoplasms; Mastectomy; Breast; Retrospective Studies
PubMed: 37700450
DOI: 10.1093/oncolo/oyad266 -
Gland Surgery Oct 2023Breast-conserving surgery and mastectomy are standard surgical options for breast cancer. However, some patients experience a local recurrence after the operation. Many...
BACKGROUND
Breast-conserving surgery and mastectomy are standard surgical options for breast cancer. However, some patients experience a local recurrence after the operation. Many factors have been identified as a risk of local recurrence. Extensive intraductal component (EIC) was found as one of the major risks of the recurrence. Nevertheless, there were neither any systematic reviews nor controlled trials focused on EIC. This study aims to identify the impact of EIC on the local recurrence of breast cancer.
METHODS
We searched all relevant studies published between the inception to December 2020. All electronic data from PubMed and Scopus databases were extracted for evaluation of EIC as a factor of the recurrence. Local recurrence was a primary outcome between EIC-positive group and EIC-negative group. Margin status and adjuvant radiation were focused as a subgroup analysis. The Newcastle Ottawa Scale was applied for quality assessment of included studies and RevMan 5.3 program was used to estimate the effect of the results. The odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.
RESULTS
A total of 32 studies, comprising 4,290 and 15,143 patients in the EIC-positive and EIC-negative groups respectively, were retrieved and met selection criteria. All included studies were at low to intermediate risk of bias. There was a statistically significant difference in local recurrence between EIC-positive patients and EIC-negative patients (OR =2.73; 95% CI: 2.42-3.07; P<0.00001). However, there was not any significant difference in patients who had negative margin (OR =1.97; 95% CI: 0.92-4.19; P=0.36) or received any adjuvant irradiation (OR =1.58; 95% CI: 0.55-4.54; P=0.24).
CONCLUSIONS
EIC increases the risk of local recurrence, especially in breast-conserving surgery patients. However, there are a limited number of populations to analyze in subgroup analysis, the rate of local recurrence between two groups is not different in patients who had negative margin or received postoperative irradiation.
PubMed: 38021199
DOI: 10.21037/gs-23-137 -
Asian Pacific Journal of Cancer... Jan 2024Breast cancer surgery related complications are a complex condition influenced by interactions among nerve pathways and the physiological responses to breast surgery.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Breast cancer surgery related complications are a complex condition influenced by interactions among nerve pathways and the physiological responses to breast surgery. The intensity of this complications displays substantial heterogeneity, dependent on individual patient characteristics, the extent of the surgical procedure performed, and various contributing factors.
METHODS
A comprehensive search of electronic databases was conducted to identify relevant randomized controlled trials (RCTs) investigating interventions for post-mastectomy pain syndrome (PMPS). A network meta-analysis was performed to integrate direct and indirect evidence, enabling comparisons of multiple interventions across different outcome measures.
RESULTS
The systematic search yielded a total of 26 RCTs investigating 4 groups of different interventions for PMPS. The interventions included pharmacological agents, nerve blocks, physical therapy, and anesthesia regimens. Nerve blocks (OR: 0.34; 95% CrI: 0.24-0.46) and anesthesia (OR: 0.39; 95% CrI: 0.26-0.56) demonstrated improvements in functional outcomes and quality of life.
CONCLUSION
This systematic review and network meta-analysis provide a comprehensive evaluation of interventions for PMPS, highlighting their varying efficacy in alleviating pain and improving functional outcomes and quality of life. However, further research with large-scale, well-designed RCTs is warranted to strengthen the evidence base and validate the effectiveness of these interventions in managing PMPS effectively.
Topics: Humans; Female; Network Meta-Analysis; Breast Neoplasms; Nerve Block; Mastectomy; Pain
PubMed: 38285764
DOI: 10.31557/APJCP.2024.25.1.9 -
International Wound Journal Apr 2024This meta-analysis evaluates the efficacy of silver alginate dressings (SAD) compared to standard gauze (SG) in enhancing wound healing and reducing scar formation... (Meta-Analysis)
Meta-Analysis
Comparative efficacy of silver alginate dressings versus standard gauze in enhancing wound healing post-mastectomy for triple-negative breast cancer: A systematic review and meta-analysis.
This meta-analysis evaluates the efficacy of silver alginate dressings (SAD) compared to standard gauze (SG) in enhancing wound healing and reducing scar formation post-mastectomy in patients with triple-negative breast cancer. From an initial pool of 1245 articles, five studies met the inclusion criteria. The analysis revealed that SAD significantly improve early wound healing 1 week post-mastectomy, as indicated by lower Redness, Edema, Ecchymosis, Discharge, and Approximation (REEDA) scales (I = 85%; Random: SMD: -7.08, 95% CI: -8.26 to -5.98, p < 0.01), compared to SG. Additionally, long-term scar outcomes measured by the Manchester Scar Scale (MSS) 5 months post-mastectomy showed a notable reduction in scar formation (I = 95%; Random: SMD: -12.97, 95% CI: -16.20 to -9.75, p < 0.01)) in the silver alginate group. The findings support the use of SAD in post-mastectomy care for triple-negative breast cancer patients but highlight the need for further research on long-term safety and cost-effectiveness.
Topics: Humans; Alginates; Bandages; Burns; Cicatrix; Mastectomy; Silver; Triple Negative Breast Neoplasms; Wound Healing
PubMed: 38155417
DOI: 10.1111/iwj.14558 -
BJS Open Jul 2023The role of duct excision surgery is not clearly defined in patients with pathological nipple discharge without other clinical and radiological abnormalities. The...
BACKGROUND
The role of duct excision surgery is not clearly defined in patients with pathological nipple discharge without other clinical and radiological abnormalities. The primary aim of this systematic review was to determine the malignancy rate in patients with pathological nipple discharge after duct excision surgery (microdochectomy/major duct excision). The secondary aims were to determine the recurrence rate of pathological nipple discharge after surgery and to assess breast cancer development after surgery.
METHODS
MEDLINE and Embase were searched from inception to March 2023, using search terms related to 'nipple discharge', 'nipple fluid', 'microdochectomy', 'duct excision', and 'minimally invasive surgical procedure'. Studies reporting data about women who underwent duct excision surgery for pathological nipple discharge without clinical and radiological suspicion of breast cancer, as well as reporting data on women diagnosed with breast cancer after duct excision surgery, were included.
RESULTS
A total of 318 titles were identified, of which nine publications were included in the analysis. This resulted in 1108 patients with pathological nipple discharge who underwent a duct excision. The weighted mean rate of malignancy after duct excision surgery was 8.1 per cent (ranging from 2.3 to 13.5 per cent). Three studies described the recurrence rate of pathological nipple discharge (ranging from 0 to 12 per cent) and two studies reported breast cancer development in the follow-up in a total of three patients (less than 1 per cent).
CONCLUSION
The malignancy rate after duct excision surgery for pathological nipple discharge was low in patients with pathological nipple discharge without radiological and clinical abnormalities and approximately 9 of 10 patients undergo surgery for a benign cause. Improvement of the diagnostic and therapeutic workup is needed to prevent patients from undergoing (unnecessary) exploratory surgery.
Topics: Humans; Female; Nipples; Breast Neoplasms; Minimally Invasive Surgical Procedures; Radiography; Mastectomy, Segmental
PubMed: 37459137
DOI: 10.1093/bjsopen/zrad066 -
European Journal of Breast Health Apr 2024The advent of taxane-based chemotherapy has revolutionized breast cancer care. This advance has helped improve the response to downstaging tumors that might otherwise be...
Does Post-Mastectomy Radiotherapy Confer Survival Benefits on Patients With 1-3 Clinically Positive Lymph Nodes Rendered Pathologically Negative After Neoadjuvant Systemic Chemotherapy: Consensus from A Pooled Analysis?
The advent of taxane-based chemotherapy has revolutionized breast cancer care. This advance has helped improve the response to downstaging tumors that might otherwise be inoperable. It has also helped in rendering clinically (cN+) positive lymph nodes (LNs) pathologically negative (ypN0). The standard of care for cN+ patients included post-mastectomy radiotherapy (PMRT), regardless of the response to neoadjuvant chemotherapy. However, PMRT in patients with 1-3 positive LNs still lacks definitive guidelines. Numerous retrospective results have been inconclusive about the benefit of PMRT on survival in patients with 1-3 positive LNs. This pooled analysis attempts to reach a consensus. The PubMed database was searched through October 2023. The search yielded 27 papers, of which 11 satisfied the inclusion criteria. The locoregional recurrence-free survival (LRRFS), disease-free survival (DFS), and overall survival (OS) for each study were tabulated when given, and two groups were created, the PMRT and NO PMRT, respectively. The results were then pooled for analysis. The total number of patients was 8340, 4136 in the PMRT group, and 4204 in the NO PMRT group, respectively. The LRRFS, DFS, and OS were 96.9%, 82.1%, and 87.3% for the PMRT group and 93.2%, 79.6%, and 84.8% for the NO PMRT group, respectively. There was no statistical significance in LRRFS, DFS, or OS between the two groups ( = 0.61, = 0.61, and = 0.38, respectively). PMRT does not seem to confer survival benefits in patients with pN1 rendered ypN0 for stages T1-3. This pooled analysis's findings should be confirmed prospectively with a longer period of follow-up.
PubMed: 38571693
DOI: 10.4274/ejbh.galenos.2024.2023-12-14 -
Breast Cancer Research and Treatment Apr 2024This review summarizes the available data on the effectiveness of indocyanine green fluorescence imaging (ICG-FI) for real-time detection of breast cancer (BC) tumors... (Review)
Review
Fluorescence imaging for real-time detection of breast cancer tumors using IV injection of indocyanine green with non-conventional imaging: a systematic review of preclinical and clinical studies of perioperative imaging technologies.
BACKGROUND
This review summarizes the available data on the effectiveness of indocyanine green fluorescence imaging (ICG-FI) for real-time detection of breast cancer (BC) tumors with perioperative imaging technologies.
METHODS
PubMed and Scopus databases were exhaustively searched for publications on the use of the real-time ICG-FI evaluation of BC tumors with non-conventional breast imaging technologies.
RESULTS
Twenty-three studies were included in this review. ICG-FI has been used for BC tumor identification in 12 orthotopic animal tumor experiences, 4 studies on animal assessment, and for 7 human clinical applications. The BC tumor-to-background ratio (TBR) was 1.1-8.5 in orthotopic tumor models and 1.4-3.9 in animal experiences. The detection of primary human BC tumors varied from 40% to 100%. The mean TBR reported for human BC varied from 2.1 to 3.7. In two studies evaluating BC surgical margins, good sensitivity (93.3% and 100%) and specificity (60% and 96%) have been reported, with a negative predictive value of ICG-FI to predict margin involvement intraoperatively of 100% in one study.
CONCLUSIONS
The use of ICG-FI as a guiding tool for the real-time identification of BC tumors and for the assessment of tumor boundaries is promising. There is great variability between the studies with regard to timing and dose. Further evidence is needed to assess whether ICG-guided BC surgery may be implemented as a standard of care.
Topics: Humans; Animals; Female; Indocyanine Green; Breast Neoplasms; Predictive Value of Tests; Mastectomy; Mammary Neoplasms, Animal; Optical Imaging
PubMed: 38182824
DOI: 10.1007/s10549-023-07199-1 -
Journal of Plastic Surgery and Hand... Jan 2024There are several techniques for reconstructing breasts after mastectomy, but little scientific evidence for which technique is superior. The aim of this systematic...
BACKGROUND
There are several techniques for reconstructing breasts after mastectomy, but little scientific evidence for which technique is superior. The aim of this systematic review was to compare the cost-effectiveness of implant-based and autologous reconstruction and to evaluate the overall certainty of evidence, as well as the quality of reporting of the included studies.
METHODS
Studies investigating the cost-effectiveness of breast reconstruction with a deep inferior epigastric perforator (DIEP) flap compared to implant-based reconstruction, meeting criteria defined in a PICO (population, intervention, comparison, and outcome), were included. Medline, PubMed, Embase, Cochrane library, CinahL, EconLit, and NHS EED databases were searched. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence, and the Consolidated Health Economic Evaluation Reporting Standard (CHEERS) 2022 was used to evaluate the quality of reporting.
RESULTS AND CONCLUSIONS
A total of 256 abstracts were retrieved from the search, and after scrutiny, seven studies were included. The findings of this present systematic review should be interpreted with caution as the overall certainty of evidence is low (GRADE ƟƟОО). The included studies suggest that DIEP-flaps are cost-effective compared with implant-based breast reconstruction when the applied cost-effectiveness thresholds of $50,000 to $100,000 per quality-adjusted life years are used. It is noteworthy that no high level evidence exists regarding cost-effeciency, to support recommendations and decision in breast reconstruction. Methodological issues that can be improved in future studies are presented.
Topics: Cost-Benefit Analysis; Databases, Factual; Mammaplasty; Mastectomy; Perforator Flap; Humans
PubMed: 38189784
DOI: 10.2340/jphs.v59.19649