Breast-conserving surgery and mastectomy towards quality of life: a systematic review and meta-analysis

Abstract

Background: Breast cancer (BC) is still the most frequent cancer among women. Surgery for BC frequently starts with either a mastectomy or a breast-conserving surgery (BCS). There is still controversy regarding better QoL between them. This study purposed to evaluate the BCS and mastectomy towards QoL in systematic review and meta-analysis. Methods: This review was conducted following the 2020 PRISMA guidelines. A systematic search was conducted on electronic databases (PubMed, ScienceDirect, Springer Link, and Google Scholar). Data extraction and study quality assessment were done using the PICOS strategy and NOS checklist. The mean difference parameter was used to determine differences in group quality scores. The accepted significant p-value is <0.05. Results: 12 studies involving 5311 BC patients undergoing either BCS (n=3254) or mastectomy (n=2057) were obtained. Most of the study designs used a prospective cohort design. There was no significant difference of QoL between BCS and mastectomy group in the breast satisfaction domain (MD 5.96; 95%CI -1.70 – 13.62; p=0.13; heterogeneity, I2=99%; p<0.001), psychosocial well-being domain (MD -0.45; 95%CI -10.27 – 9.37; p=0.93; heterogeneity, I2=94%; p<0.001), and physical well-being domain (MD 3.07; 95%CI -2.05 – 0.20; p=0.24; heterogeneity, I2=98%; p<0.001). However, there was a significant difference in the sexual well-being domain (MD 5.06; 95%CI 0.89 – 9.24; p=0.02; heterogeneity, I2=100%; p<0.001). Conclusion: Patients who had BCS have similar QoL but higher sexual well-being compared to patients who had mastectomy.