A Meta-analysis Of Endoscopic Breast-conserving Surgery And Conventional Breast-conserving Surgery In The Treatment Of Early Breast Cancer

Objective: Data show that breast cancer has surpassed lung cancer as the most prevalent malignant tumor in the world,and traditional open surgery is highly invasive and has poor cosmetic results.This study used Meta-analysis to investigate the results of endoscopic breast- conserving surgery(E-BCS)versus conventional breast-conserving surgery(C-BCS)in the treatment of patients with early-stage breast cancer and to compare the advantages and disadvantages of the two surgical procedures,so as to provide the best evidence for the rational choice of the procedure by both doctors and patients.Method: A total of eight databases,Pubmed,Embase,Co Chrane Library,Web of Science,China Knowledge Base,Wanfang Database,China Biomedical Literature Database,and VIP Database,were searched by computer,while clinical research information on E-BCS compared with C-BCS for the treatment of early breast cancer was searched by manual review and retrieval of relevant literature or related materials.The Chinese search terms were "breast tumor,breast cancer,endoscopy,endoscopic surgery,surgical endoscopy,lumpectomy,video-assisted surgery,minimally invasive surgery,mastectomy,segmental mastectomy,partial mastectomy,partial mastectomy,focal resection,breast conservative surgery,breast cancer,breast conserving treatment,breast conserving surgery.Breast Conservative Surgery,Breast Conserving Treatment,Breast Conserving Surgery",English search terms “Breast Neoplasms,Breast Tumor,Breast Cancer,Mammary Cancer,Breast Carcinoma,Endoscopy,Mastoscopy,Laparoscopy,Celioscopy,Video-Assisted Surgery,Minimally Invasive Surgery,Segmental Mastectomy,Segmentectomy,Partial Mastectomy,Lumpectomy,Breast-Conserving Surgery,Breast Sparing Surgery”,etc.Data extraction,quality evaluation,and statistical analysis were performed independently by two investigators who were familiar with evidence-based medicine and proficient in using the Meta-analysis software Rev Man 5.4provided by the Cochrane Collaboration.The included study literature was evaluated qualitatively using the Newcastle-Ottawa Scale(NOS).Meta-analysis was performed on 12 indicators,including procedure time,blood loss,length of incision,number of axillary lymph nodes dissection,drainage duration time,total postoperative drainage volume,average duration of hospital stay,postoperative complication rate,postoperative satisfaction,recurrence and metastasis rate,beauty effect excellent rate,and clinical therapeutic effect.The test results were expressed as “forest plot”,and the publication bias was expressed as “funnel plot”.Result: Finally,27 papers including 3317 patients were included,including1279 cases in the lumpectomy breast-conserving surgery group and 2038 cases in the conventional breast-conserving surgery group.Meta-analysis results showed that compared with conventional breast-conserving surgery,The operative time for lumpectomy breast-conserving surgery was longer(MD 32.57,95% CI [11.92,53.23],P < 0.05),but the intraoperative bleeding(MD-25.12,95% CI [-32,61,-17.63],P < 0.05),incision length(MD-8.86,95% CI [-11.45,-6.27],P<0.05),mean length of stay(MD-2.38,95% CI [-3.56,-1.19],P<0.05),postoperative complication rate(RR 0.40,95% CI [0.24,0.65],P<0.05),postoperative satisfaction(RR 1.15,95% CI [1.04,1.28],P < 0.05)and excellent cosmetic outcome(RR 1.24,95% CI [1.15,1.35],P < 0.05)were better than those of conventional breast-conserving surgery,and the difference was statistically significant(P < 0.05).In terms of the number of axillary lymph node dissection(MD-0.08,95% CI [-0.55,0.39],P > 0.05),postoperative drain placement time(MD-0.42,95% CI [-0.85,0.02],P > 0.05),total postoperative drainage(MD-4.35,95% CI [-16.78,8.07],P > 0.05),recurrent metastasis rate(RR of 0.91,95% CI [0,56,1.49],P > 0.05),and on comparison of clinical outcome assessment(complete remission: RR of 1.05,95% CI [0.87,1.27],P >0.05;partial remission: RR of 1.00,95% CI [0.75,1.33],P > 0.05;stable disease:RR 0.73,95% CI [0.50,1.07],P > 0.05;disease progression: RR 0.87,95% CI[0.43,1.76],P > 0.05)The difference between lumpectomy breast-conserving surgery and conventional breast-conserving surgery was not statistically significant(P > 0.05).Conclusion: Compared with conventional breast-conserving surgery for early-stage breast cancer,lumpectomy breast-conserving surgery takes longer than conventional breast-conserving surgery in terms of operation time,but lumpectomy breast-conserving surgery has the advantages of less trauma,faster recovery,fewer complications,higher satisfaction and better cosmetic results,and it has the same therapeutic effects as conventional surgery in terms of lymph node count,postoperative recovery and clinical outcomes,indicating that lumpectomy minimally invasive surgery is a safe,feasible and effective surgical option in the treatment of early-stage breast cancer.