The certainty of the evidence is downgraded by serious risk of bias due to confounding and by imprecise results (wide confidence intervals).
Comment
A Cochrane review [Abstract] 1 included 78 non-randomised cohort studies with a total of 178 813 subjects. Oncoplastic breast-conserving surgery (oncoplastic surgery) involving removing the tumour in the breast and using plastic surgery techniques to reconstruct the breast was compared with standard breast-conserving surgery (standard surgery). There was no difference in recurrence rate or disease-free survival. However, oncoplastic surgery resulted in less re-excision surgery but more complications (table T1).
| Outcome | Relative effect (95% CI) | Risk with control (standard surgery) | Risk with intervention (95% CI) (oncoplastic surgery) | No of participants (trials) Certainty of evidence |
|---|---|---|---|---|
| Local recurrence-free survival(up to 5 years) | HR 0.90(0.61 to 1.34) | 55 per 1000 | 50 per 1000(34 to 73) | 7 600(4) Very low |
| Disease-free survival (up to 5 years) | HR 1.06(0.89 to 1.26) | 98 per 1000 | 104 per 1000(88 to 122) | 5 532(7) Low |
| Re-excision rate: total re-excisions | RR 0.76(0.69 to 0.85) | 134 per 1000 | 101 per 1000(92 to 114) | 13 341(38) Very low |
| Complications | RR 1.19(1.10 to 1.27) | 34 per 1000 | 41 per 1000(38 to 44) | 118 005(20) Very low |
| Recall rate | RR 2.39(1.67 to 3.42) | 100 per 1000 | 240 per 1000(167 to 343) | 715(6) Low |
Date of latest search: 2021-12-15
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