Locoregional recurrence and survival of breast−conserving surgery compared to mastectomy following neoadjuvant chemotherapy in operable breast cancer

BackgroundThe risk of locoregional recurrence (LRR) and the long-term prognosis of breast-conserving surgery (BCS) after neoadjuvant chemotherapy (NAC) are still controversial. This study aimed to evaluate oncological outcomes for patients undergoing BCS after NAC and determine LRR and survival predictors.MethodsThis study was a retrospective cohort study of patients with locally advanced breast cancer (LABC) who received NAC and underwent BCS or mastectomy from June 2011 to November 2020. LRR, disease-free survival (DFS), and overall survival (OS) were compared in patients undergoing BCS or mastectomy. Univariate and multivariate analyses were performed to determine LRR, DFS, and OS predictors.ResultsA total of 585 patients were included, of whom 106 (18.1%) underwent BCS and 479 (81.9%) underwent a mastectomy. The LRR rate was 11.3% in the BCS group and 16.3% in the mastectomy group, revealing no significant difference(p = 0.200). In patients who underwent BCS, clinical lymph node status, histological grade and pathological complete response (pCR) were independent factors to predict LRR. There was no significant difference in DFS and OS between the BCS and the mastectomy groups. Multivariable analysis showed that lymph node status, histological grade, molecular subtypes, pCR and Miller&Payne (M&P) classification were independent predictors of DFS. Lymph node status, molecular subtypes and pCR were independent predictors of OS. BCS or mastectomy was not an independent predictor of DFS or OS.ConclusionCompared with mastectomy, BCS after NAC may not increase the risk of local recurrence or mortality, BCS can be performed in selected patients with small tumor size and good response to NAC

Forest plot for odds ratio of seroma development between harmonic scalpel dissection and electrocautery in mastectomy used by fixed-effect model.

<p>Forest plot for odds ratio of seroma development between harmonic scalpel dissection and electrocautery in mastectomy used by fixed-effect model.</p

Harmonic Scalpel versus Electrocautery Dissection in Modified Radical Mastectomy for Breast Cancer: A Meta-Analysis

<div><p>Background</p><p>Despite the common use of conventional electrocautery in modified radical mastectomy for breast cancer, the harmonic scalpel is recently emerging as a dominant surgical instrument for dissection and haemostasis, which is thought to reduce the morbidity, such as seroma and blood loss. But the results of published trials are inconsistent. So we made the meta-analysis to assess the intraoperative and postoperative endpoints among women undergoing modified radical mastectomy with harmonic scalpel or electrocautery.</p><p>Methods</p><p>A comprehensive literature search of case-control studies from PubMed, MEDLINE, EMBASE and Cochrane Library databases involving modified radical mastectomy with harmonic scalpel or electrocautery was performed. We carried out a meta-analysis of primary endpoints including postoperative drainage, seroma development, intraoperative blood loss and secondly endpoints including operative time and wound complications. We used odds ratios (ORs) with 95% confidence intervals (CIs) to evaluate the effect size for categorical outcomes and standardised mean differences (SMDs) for continuous outcomes.</p><p>Results</p><p>A total of 11 studies with 702 patients were included for this meta-analysis. There was significant difference in total postoperative drainage (SMD: -0.74 [95%CI: -1.31, -0.16]; <i>P</i>< 0.01), seroma development[OR: 0.49 (0.34, 0.70); <i>P</i> < 0.01], intraoperative blood loss(SMD: -1.14 [95%CI: -1.81,-0.47]; <i>P</i> < 0.01) and wound complications [OR: 0.38 (0.24, 0.59); <i>P</i> < 0.01] between harmonic scalpel dissection and standard electrocautery in modified radical mastectomy for breast cancer. No difference was found as for operative time between harmonic scalpel dissection and standard electrocautery (SMD: 0.04 [95%CI: -0.41, 0.50]; <i>P</i> = 0.85).</p><p>Conclusion</p><p>Compared to standard electrocautery, harmonic scalpel dissection presents significant advantages in decreasing postoperative drainage, seroma development, intraoperative blood loss and wound complications in modified radical mastectomy for breast cancer, without increasing operative time. Harmonic scalpel can be recommended as a preferential surgical instrument in modified radical mastectomy.</p></div

Forest plot for weight mean difference in total postoperative drainage between harmonic scalpel dissection and electrocautery used by random-effect model.

<p>Forest plot for weight mean difference in total postoperative drainage between harmonic scalpel dissection and electrocautery used by random-effect model.</p

Characteristics of eligible studies included in this meta-analysis.

<p>RCT: randomized controlled trials; MRM: modified radical mastectomy; SM: simple mastectomy</p><p>Characteristics of eligible studies included in this meta-analysis.</p

Forest plot for odds ratio of seroma development between harmonic scalpel dissection and electrocautery in mastectomy used by fixed-effect model.

<p>Forest plot for odds ratio of seroma development between harmonic scalpel dissection and electrocautery in mastectomy used by fixed-effect model.</p

Forest plot for weighted mean difference in intraoperative blood loss between harmonic scalpel dissection and electrocautery in mastectomy used by random-effect model.

<p>Forest plot for weighted mean difference in intraoperative blood loss between harmonic scalpel dissection and electrocautery in mastectomy used by random-effect model.</p

Flow diagram of the study selection process for the meta-analysis.

<p>Flow diagram of the study selection process for the meta-analysis.</p