Details

Autor(en) / Beteiligte

• Tang, Peng
• Hu, Ying
• Wang, Zi-Han
• Gao, Guo-Xuan
• Qu, Xiang
• Jiang, Jun

Titel

Clinical practice guidelines for endoscopic breast surgery in patients with early-stage breast cancer: Chinese Society of Breast Surgery (CSBrS) practice guidelines 2021

Ist Teil von

• Chinese medical journal, 2021-11, Vol.134 (21), p.2532-2534

Ort / Verlag

China: Lippincott Williams & Wilkins Ovid Technologies

Erscheinungsjahr

2021

Quelle

Free E-Journal (出版社公開部分のみ）

Beschreibungen/Notizen

• The Chinese Society of Breast Surgery (CSBrS) identified the key issues in the clinical practice guidelines for endoscopic breast surgery in China through literature review and expert discussion, evaluated the quality of clinical research evidence according to the grading of recommendations assessment, development, and evaluation (GRADE) system, and developed the CSBrS practice guidelines (2021 edition) with the aim of accessibility in the clinical practice of breast surgery in China. Indications and contraindications for endoscopic breast surgery In the guidelines, endoscopic breast surgery includes: endoscopic nipple-sparing mastectomy ± immediate breast implant reconstruction for breast cancer, and endoscopic axillary or internal mammary lymph node dissection/sentinel lymph node biopsy for breast cancer. 1.1 Indications Indications Level of evidence Strength of recommendation 1.1.1 Imaging data indicate that the tumor has not invaded the nipple, areola, or subcutaneous tissue, and the distance from the margin of the tumor to the margin of the areola is ≥2 cm[2–4] II A 1.1.2 Clinical and imaging examinations of early-stage breast cancer reveal axillary lymph nodes ≤cN1[5] I A 1.1.3 Internal mammary lymph node dissection/biopsy is necessary[6] II A 1.2 Contraindications Contraindications Level of evidence Strength of recommendation 1.2.1 Severe mastoptosis[7] II A 1.2.2 Breast volume >500 mL[8] II A 1.2.3 History of axillary surgery[5] I A 1.2.4 Inflammatory breast cancer[9] II A Recommendation 2: Key clinical issues 2.1 Methods of establishing the operating space Methods Level of evidence Strength of recommendation 2.1.1 Establish the operating space by liposuction and maintain the space with CO2 inflation or suspension[10] II A 2.1.2 Establish the operating space using a non-liposuction method and maintain the space with CO2 inflation or suspension[11,12] II A 2.1.3 Operation under the guidance of entire-course monitoring[4] II A 2.1.4 Prevent hypercapnia through continuous positive-pressure ventilation[13] II A 2.2 Treating surgical complications Treatments Level of evidence Strength of recommendation 2.2.1 Convert to open surgery in cases of intra-operative hemorrhage of unknown cause[14,15] II A 2.2.2 Endoscopic exploration or open hemostatic surgery for post-operative active bleeding[16] II A Discussion Reports state that endoscopic surgery can complete the same breast surgical operation through small and occult incisions, with the advantages of less bleeding, faster recovery, and better post-operative appearance. Based on a literature review, the panel experts re-evaluated the quality of clinical research evidence concerning endoscopic surgical techniques for breast cancer in accordance with the GRADE method, and compiled the guidelines with the goal of accessibility in the clinical practice of breast surgery in China, to provide a reference for the clinical work of Chinese breast surgeons.