oncotomskСибирский онкологический журналSiberian journal of oncology1814-48612312-3168Tomsk National Research Medical Сепtеr of the Russian Academy of Sciences10.21294/1814-4861-2021-20-2-118-126oncotomsk-1764Research ArticleОБЗОРЫREVIEWSСИСТЕМАТИЧЕСКИЙ ОБЗОР И МЕТААНАЛИЗ РЕЗУЛЬТАТОВ ОРГАНОСОХРАНЯЮЩИХ ОПЕРАЦИЙ ПОСЛЕ НЕОАДЪЮВАНТНОЙ ЛЕКАРСТВЕННОЙ ТЕРАПИИ У БОЛЬНЫХ РАКОМ МОЛОЧНОЙ ЖЕЛЕЗЫSYSTEMATIC REVIEW AND METAANALYSIS OF THE RESULTS OF BREAST-CONSERVING SURGERY AFTER NEOADJUVANT CHEMOTHERAPY IN BREAST CANCER PATIENTShttps://orcid.org/0000-0003-0993-8866БосиеваА. Р.BosievaA. R.

 аспирант отделения онкологии и реконструктивно-пластической хирургии молочной железы и кожи

SPIN-код: 1090-7281

 Россия, 125284, г. Москва, 2-й Боткинский проезд, 3 

 MD, Researcher of the Department of Oncology and Reconstructive Plastic Surgery of the Breast and Skin 

 3, 2nd Botkinsky passage, 125284, Moscow, Russia 

ms.bosieva@mail.ruhttps://orcid.org/0000-0002-4178-9592ЕрмощенковаМ. В.ErmoshchenkovaM. V.

 кандидат медицинских наук, заведующая I онкологическим отделением; доцент кафедры онкологии, радиотерапии и пластической хирургии Института клинической медицины

SPIN-код: 2557-7700. AuthorID (РИНЦ): 555225

Россия, 119991, г. Москва, ул. Трубецкая, 8/2 

Россия, 117152, г. Москва, Загородное шоссе, 18А

 MD, PhD, Head of the First Oncology Surgery Department; assistant professor of Department of Oncology, Radiotherapy and Plastic Surgery 

 8/2, Trubetskaya Street, 119991, Moscow, Russia 

 18A, Zagorodnoye hidhway, 117152, Moscow, Russia 

https://orcid.org/0000-0001-7141-2502ЗикиряходжаевА. Д.ZikiryakhodzhayevA. D.

 доктор медицинских наук, заведующий отделением онкологии и реконструктивно-пластической хирургии молочной железы и кожи; доцент кафедры онкологии, радиотерапии и пластической хирургии

AuthorID (РИНЦ): 701248. SPIN-код: 8421-0364

Россия, 125284, г. Москва, 2-й Боткинский проезд, 3 

Россия, 119991, г. Москва, ул. Трубецкая, 8/2 

 MD, DSc, The Head of the Department of Oncology and Reconstructive Plastic Surgery of the Breast and Skin; Assistant professor 

 3, 2nd Botkinsky passage, 125284, Moscow, Russia 

 8/2, Trubetskaya Street, 119991, Moscow, Russia 

https://orcid.org/0000-0003-0421-4172ВолченкоН. Н.VolchenkoN. N.

 доктор медицинских наук, профессор, заведующая отделом онкоморфологии

 Россия, 125284, г. Москва, 2-й Боткинский проезд, 3 

 MD, DSc, Head of Oncomorphology Department  

 3, 2nd Botkinsky passage, 125284, Moscow, Russia 

Московский научно-исследовательский онкологический институт имени П.А. Герцена – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Министерства здравоохранения Российской ФедерацииРоссияP. Hertsen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian FederationRussian FederationФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский Университет); ГБУЗ «Городская клиническая онкологическая больница № 1» Департамента здравоохраненияРоссияFederal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University); The City Clinical Oncological Hospital № 1 of the Moscow Health departmentRussian FederationМосковский научно-исследовательский онкологический институт имени П.А. Герцена – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Министерства здравоохранения Российской Федерации; ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский Университет)РоссияP. Hertsen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation; Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)Russian Federation202102052021202118126Copyright © Босиева А.Р., Ермощенкова М.В., Зикиряходжаев А.Д., Волченко Н.Н., 20212021Босиева А.Р., Ермощенкова М.В., Зикиряходжаев А.Д., Волченко Н.Н.Bosieva A.R., Ermoshchenkova M.V., Zikiryakhodzhayev A.D., Volchenko N.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.siboncoj.ru/jour/article/view/1764 Введение

 Введение. Неоадъювантная лекарственная терапия (НАЛТ) является распространенным вариантом лечения при раке молочной железы. Одним из основных преимуществ метода является уменьшение размеров опухолевого узла и регрессия метастатически измененных лимфатических узлов.

Цель исследования – анализ литературных данных по результатам органосохраняющих операций после неоадъювантной лекарственной терапии в сравнении с адъювантной лекарственной терапией, включающий изучение ширины краев резекции и частоту повторных операций и рецидивов, объема удаляемой ткани, эстетических результатов.

Материал и методы

Материал и методы. Поиск источников был осуществлен в системах pubMed, Medline, Cochrane Library, из которых получено 1219 оригинальных статей, 1057 были исключены вследствие несоответствия заранее установленным критериям, 162 статьи были изучены на наличие критериев включения: состояние краев резекции, частота реопераций, объем удаляемой ткани и косметические результаты. Заданным параметрам полностью соответствовали 22 исследования.

Результаты

Результаты. В исследованиях, включенных в данный обзор, показаны различная частота положительных краев резекции (2–39,8 %), реопераций (0–45,4 %), объем удаляемых тканей (43,2–268 см3) и вес резецируемых тканей молочной железы (26,4–233 г) после НАЛТ.

Заключение

Заключение. Полученные данные указывают на снижение частоты позитивных краев резекций и реопераций после НАЛТ у больных раком молочной железы (частота позитивных краев резекции после НАЛТ – 5–39,8 % без НАЛТ – 13,1–46 %; частота реопераций после НАЛТ – 0–45,4 % без НАЛТ – 0–76,5 %), уменьшение объема удаляемой  ткани молочной железы (при сT2–3) без негативного  влияния на чистоту краев резекции, что позволяет минимизировать объем хирургического вмешательства и улучшить косметические результаты органосохраняющего лечения. 

Background

Background. Neoadjuvant chemotherapy (NACT) is a standard of care for locally advanced breast cancer patients. One of the main advantages of NACT is the reduction of the tumor size and regression of lymph node metastasis.

The aim of the study was to analyze the outcomes of breast-conserving surgery after NACT compared to adjuvant chemotherapy, including the examination of the width of resection margins and the frequency of re-operations, the volume of tissue removed and cosmetic outcomes.

Material and Methods

Material and Methods. We analyzed 1219 publications available from pubMed, Medline, Cochrane Library, 1057 of them did not meet the inclusion criteria, 162 publications were selected to cover all the following inclusion criteria: surgical margin status, frequency of re-operations, volume of tissue removed and cosmetic outcomes. Finally, 22 studies met fully specified criteria.

Results

Results. Studies included in this review demonstrated a different frequency of positive resection margins (2–39.8 %), reoperations (0–45.4 %), the volume of tissue removed (43.2–268 cm3), and the weight of the resected breast tissue (26.4–233 grams) after NACT.  

Conclusion

Conclusion. The data obtained showed a decrease in the frequency of positive resection margins and re-operations in patients who received NACT compared to patients who did not receive NACT (5–39.8 % versus 13.1–46 % and 0–45.4 % versus 0–76.5 %, respectively), as well as a decrease in the amount of the removed breast tissue without the negative effect on the frequency of resection margins, thus allowing minimization of the extent of surgery and improvement of cosmetic outcomes.

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The authors declare that there are no conflicts of interest present.