J Breast Cancer.  2018 Sep;21(3):321-329. 10.4048/jbc.2018.21.e36.

Comparison of Oncoplastic Breast-Conserving Surgery and Breast-Conserving Surgery Alone: A Meta-Analysis

• Chen JY
• Huang YJ
• Zhang LL
• Yang CQ
• Wang K

• KMID: 2421373
• DOI: http://doi.org/10.4048/jbc.2018.21.e36

Abstract

PURPOSE
The use of oncoplastic reconstruction for breast-conserving surgery (BCS) extends benefits beyond merely minimizing poor cosmetic results. However, the feasibility and oncological safety of oncoplastic surgery (OPS) are controversial.
METHODS
This meta-analysis aimed to compare the short-term and long-term oncological outcomes of BCS alone and BCS plus OPS. Relevant studies published before July 2017 in the Embase, the Cochrane Library, PubMed, and Web of Science databases were screened and collected. The meta-analysis was performed using STATA software (Stata Corp.).
RESULTS
A total of 3,789 patients from 11 studies were included, with 2,691 patients in the BCS-alone group and 1,098 patients in the BCS plus OPS group. The demographics were similar between both groups, and no significant difference was observed in pathological T and N stages between the two groups. Re-excision was less common (relative risk [RR], 0.66; p=0.009) and the positive-margin rate was lower, but not significantly (RR, 0.83; p=0.191), in the BCS plus OPS group than in the BCS-alone group. The local and distal recurrence rates were similar in both groups. Both disease-free survival (hazard ratio [HR], 1.19; 95% confidence interval [CI], 0.96-1.49; p=0.112) and overall survival (HR, 1.14; 95% CI, 0.76-1.69; p=0.527) did not differ between the two groups.
CONCLUSION
A combination of BCS and OPS is preferred over BCS alone for decreasing re-excisions and provides similar long-term survival as BCS alone in patients with breast cancer.

Keyword

Breast neoplasms; Mammaplasty; Mastectomy; Meta-analysis

MeSH Terms

Breast Neoplasms
Demography
Disease-Free Survival
Female
Humans
Mammaplasty
Mastectomy
Mastectomy, Segmental*
Recurrence

Figure

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  Figure 1 Flow chart of the meta-analysis.

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  Figure 2 Forest plot of the distribution of pathological stages. The pathological T (A) and N (B) stages in oncoplastic surgery (OPS) and breast-conserving surgery (BCS) groups. Weights are from random effects analysis.RR= relative risk; CI=confidence interval.

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  Figure 3 Forest plot of margin status difference in oncoplastic surgery (OPS) and breast-conserving surgery (BCS) groups.RR=relative risk; CI=confidence interval.

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  Figure 4 Forest plot of discrepancy of re-excision rate in oncoplastic surgery (OPS) and breast-conserving surgery (BCS) groups.RR=relative risk; CI=confidence interval.

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  Figure 5 Forest plot of tumor recurrence differences in oncoplastic surgery (OPS) and breast-conserving surgery (BCS) groups.RR=relative risk; CI=confidence interval.

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  Figure 6 Forest plot of overall survival and disease-free survival difference in oncoplastic surgery (OPS) and breast-conserving surgery (BCS) groups.HR=hazard ratio; CI=confidence interval; DFS=disease-free survival; OS=overall survival.

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