PMID- 36972145
OWN - NLM
STAT- MEDLINE
DCOM- 20230329
LR  - 20240328
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
VI  - 3
IP  - 3
DP  - 2023 Mar 27
TI  - Skin-sparing mastectomy for the treatment of breast cancer.
PG  - CD010993
LID - 10.1002/14651858.CD010993.pub2 [doi]
LID - CD010993
AB  - BACKGROUND: Skin-sparing mastectomy (SSM) is a surgical technique that aims to 
      maximize skin preservation, facilitate breast reconstruction, and improve 
      cosmetic outcomes. Despite its use in clinical practice, the benefits and harms 
      related to SSM are not well established. OBJECTIVES: To assess the effectiveness 
      and safety of skin-sparing mastectomy for the treatment of breast cancer. SEARCH 
      METHODS: We searched Cochrane Breast Cancer's Specialized Register, CENTRAL, 
      MEDLINE, Embase, LILACS, the World Health Organization's International Clinical 
      Trials Registry Platform (WHO ICTRP), and ClinicalTrials.gov on 9 August 2019. 
      SELECTION CRITERIA: Randomized controlled trials (RCTs), quasi-randomized or 
      non-randomized studies (cohort and case-control) comparing SSM to conventional 
      mastectomy for treating ductal carcinoma in situ (DCIS) or invasive breast 
      cancer. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures 
      expected by Cochrane. The primary outcome was overall survival. Secondary 
      outcomes were local recurrence free-survival, adverse events (including overall 
      complications, breast reconstruction loss, skin necrosis, infection and 
      hemorrhage), cosmetic results, and quality of life. We performed a descriptive 
      analysis and meta-analysis of the data. MAIN RESULTS: We found no RCTs or 
      quasi-RCTs. We included two prospective cohort studies and twelve retrospective 
      cohort studies. These studies included 12,211 participants involving 12,283 
      surgeries (3183 SSM and 9100 conventional mastectomies). It was not possible to 
      perform a meta-analysis for overall survival and local recurrence free-survival 
      due to clinical heterogeneity across studies and a lack of data to calculate 
      hazard ratios (HR).  Based on one study, the evidence suggests that SSM may not 
      reduce overall survival for participants with DCIS tumors (HR 0.41, 95% CI 0.17 
      to 1.02; P = 0.06; 399 participants; very low-certainty evidence) or for 
      participants with invasive carcinoma (HR 0.81, 95% CI 0.48 to 1.38; P = 0.44; 907 
      participants; very low-certainty evidence). For local recurrence-free survival, 
      meta-analysis was not possible, due to high risk of bias in nine of the ten 
      studies that measured this outcome. Informal visual examination of effect sizes 
      from nine studies suggested the size of the HR may be similar between groups. 
      Based on one study that adjusted for confounders, SSM may not reduce local 
      recurrence-free survival (HR 0.82, 95% CI 0.47 to 1.42; P = 0.48; 
      5690 participants; very low-certainty evidence).  The effect of SSM on overall 
      complications is unclear (RR 1.55, 95% CI 0.97 to 2.46; P = 0.07, I(2) = 88%; 4 
      studies, 677 participants; very low-certainty evidence). Skin-sparing mastectomy 
      may not reduce the risk of breast reconstruction loss (RR 1.79, 95% CI 0.31 to 
      10.35; P = 0.52; 3 studies, 475 participants; very low-certainty evidence), skin 
      necrosis (RR 1.15, 95% CI 0.62 to 2.12; P = 0.22, I(2) = 33%; 4 studies, 677 
      participants; very low-certainty evidence), local infection (RR 2.04, 95% CI 0.03 
      to 142.71; P = 0.74, I(2) = 88%; 2 studies, 371 participants; very low-certainty 
      evidence), nor hemorrhage (RR 1.23, 95% CI 0.47 to 3.27; P = 0.67, I(2) = 0%; 4 
      studies, 677 participants; very low-certainty evidence). We downgraded the 
      certainty of the evidence due to the risk of bias, imprecision, and inconsistency 
      among the studies. There were no data available on the following outcomes: 
      systemic surgical complications, local complications, explantation of 
      implant/expander, hematoma, seroma, rehospitalization, skin necrosis with 
      revisional surgery, and capsular contracture of the implant. It was not possible 
      to perform a meta-analysis for cosmetic and quality of life outcomes due to a 
      lack of data. One study performed an evaluation of aesthetic outcome after SSM: 
      77.7% of participants with immediate breast reconstruction had an overall 
      aesthetic result of excellent or good versus 87% of participants with delayed 
      breast reconstruction. AUTHORS' CONCLUSIONS: Based on very low-certainty evidence 
      from observational studies, it was not possible to draw definitive conclusions on 
      the effectiveness and safety of SSM for breast cancer treatment. The decision for 
      this technique of breast surgery for treatment of DCIS or invasive breast cancer 
      must be individualized and shared between the physician and the patient while 
      considering the potential risks and benefits of available surgical options.
CI  - Copyright (c) 2023 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
FAU - Mota, Bruna S
AU  - Mota BS
AD  - Department of Obstetrics and Gynecology, Instituto do Cancer do Estado de Sao 
      Paulo (ICESP/FMUSP), Sao Paulo, Brazil.
FAU - Bevilacqua, Jose Luiz B
AU  - Bevilacqua JLB
AD  - Hospital Sirio Libanes, Sao Paulo, Brazil.
FAU - Barrett, Jessica
AU  - Barrett J
AD  - Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, 
      University of Cambridge, Strangeways Research Laboratory, Cambridge, UK.
FAU - Ricci, Marcos Desiderio
AU  - Ricci MD
AD  - Department of Obstetrics and Gynecology, Instituto do Cancer do Estado de Sao 
      Paulo (ICESP/FMUSP), Sao Paulo, Brazil.
FAU - Munhoz, Alexandre M
AU  - Munhoz AM
AD  - Plastic Surgery, Instituto do Cancer do Estado de Sao Paulo - ICESP, Sao Paulo, 
      Brazil.
FAU - Filassi, Jose Roberto
AU  - Filassi JR
AD  - Department of Obstetrics and Gynecology, Instituto do Cancer do Estado de Sao 
      Paulo (ICESP/FMUSP), Sao Paulo, Brazil.
FAU - Baracat, Edmund Chada
AU  - Baracat EC
AD  - Department of Obstetrics and Gynecology, Instituto do Cancer do Estado de Sao 
      Paulo (ICESP/FMUSP), Sao Paulo, Brazil.
FAU - Riera, Rachel
AU  - Riera R
AD  - Cochrane Affiliate Rio de Janeiro, Cochrane, Petropolis, Brazil.
AD  - Center of Health Technology Asessment, Hospital Sirio-Libanes, Sao Paulo, Brazil.
AD  - Nucleo de Ensino e Pesquisa em Saude Baseada em Evidencias e Avaliacao 
      Tecnologica em Saude (NEP-Sbeats), Universidade Federal de Sao Paulo, Sao Paulo, 
      Brazil.
LA  - eng
GR  - MC_UU_00002/5/MRC_/Medical Research Council/United Kingdom
PT  - Journal Article
PT  - Review
PT  - Systematic Review
DEP - 20230327
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
SB  - IM
UOF - doi: 10.1002/14651858.CD010993
MH  - Humans
MH  - Female
MH  - *Carcinoma, Intraductal, Noninfiltrating/surgery/etiology
MH  - *Breast Neoplasms/surgery
MH  - Mastectomy/adverse effects/methods
MH  - *Mammaplasty/adverse effects
MH  - Necrosis
PMC - PMC10042433
COIS- BSM: none known
JLBB: none known
JB: none known. A grant from Hoffman La Roche 
      was awarded to the institution and the work associated with the grant was 
      unrelated to the review topic. 
MDR: none known
AMM: ownership of stock shares in 
      a company that develops breast implant products. 
JRF: none known
ECB: none 
      known
RR: none known
EDAT- 2023/03/28 06:00
MHDA- 2023/03/29 06:05
PMCR- 2024/03/27
CRDT- 2023/03/27 12:02
PHST- 2023/03/29 06:05 [medline]
PHST- 2023/03/27 12:02 [entrez]
PHST- 2023/03/28 06:00 [pubmed]
PHST- 2024/03/27 00:00 [pmc-release]
AID - CD010993.pub2 [pii]
AID - 10.1002/14651858.CD010993.pub2 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2023 Mar 27;3(3):CD010993. doi: 
      10.1002/14651858.CD010993.pub2.