Therapeutic Effect Of Repeat Breast Conserving Surgery For Ipsilateral Breast Tumor Recurrence:a Meta-analysis

Background:There exists controversy about the therapeutic effect of repeat breast conserving surgery or salvageable mastectomy for the ipsilateral breast tumor recurrence.It is difficult to carry out prospective studies or case-control studies because of the low incidence and high heterogeneity of the ipsilateral breast tumor recurrence.Objective : The endpoints of our study are second local recurrence rate,distant metastasis rate and overall survival of the ipsilateral breast tumor recurrence.we used them to assess therapeutic effect of repeat breast conserving surgery for the ipsilateral breast tumor recurrence.Methods:We included the retrospective cohort studies on the therapeutic effect of repeat breast conserving surgery and salvageable mastectomy for the ipsilateral breast tumor recurrence.We searched three English databases including PubMed,Embase,Wiley Online Library and three Chinese databases including CNKI,WeiPu database and WanFang database(from January 1st,1990 to December 1st,2017),included the literature of secondary local recurrence rate,distant metastasis rate and overall survival of the ipsilateral breast tumor recurrence.Two evaluators independently evaluated the methodological quality and extracted the data.We used the Review Manager 5.3 provided by the Cochrane Collaboration and STATA 12.0 for diagraph and data analysis.The data of binary variable were expressed by risk ratio(RR)and 95% confidence interval.Result : The study selected 12 original retrospective cohort studies from 3091 literatures?All 12 studies were judged as low risk bias.Among them,the endpoint of 9 studies was secondary local recurrence rate,and the sample capacity was 274 cases of repeat breast conserving surgery group and 889 cases of salvageable mastectomy group.The endpoint of 5 studies was metastasis rate,and the sample capacity was 498 cases of repeat breast conserving surgery group and 998 cases of salvageable mastectomy group.The endpoint of 5 studies was overall survival,and the sample capacity was 354 cases of repeat breast conserving surgery group and 930 cases of salvageable mastectomy group.The results show that :(1)There was a difference in the second recurrence rate,and the pooled RR(95%CI)was 2.56(1.84~3.55),and the second recurrence rate of Salvageable mastectomy was lower.(2)There was a difference in the metastasis rate,and the pooled RR(95%CI)was 0.59(0.43~0.80),and the metastasis rate of repeat breast conserving surgery was lower.(3)There was no significant difference statistically in overall survival between repeat breast conserving surgery and Salvageable mastectomy,and the pRR(95%CI)was 1.02(0.93~1.11).The overall survival of repeated operative patients with ipsilateral breast tumor recurrence should not be considered to be different between repeat breast conserving surgery and salvageable mastectomy.Conclusion::On the basis of current studies,the second local recurrence rate of repeat breast conserving surgery was higher than salvageable mastectomy,but a lower distant metastasis rate and roughly the same overall survival,.Therefore,it is considered that the therapeutic efficacy of repeat breast conserving surgery for the ipsilateral breast tumor recurrence is not inferior to salvageable mastectomy.When preoperative assessment is detailed enough to assess the situation of ipsilateral breast tumor recurrence,repeat breast conserving surgery with comprehensive treatment can be used as an alternative treatment.