45 Pectoral fascia preservation in oncological mastectomy reconstructive results. The systematic (PRISMA) method that was used for this systematic review leads to a complete overview of the current literature concerning PF preservation. Unfortunately, the number of studies on PF preservation is low. Moreover, the current studies are heterogenic and patient groups included are relatively small. The RCT by Dalberg et al reported no significant difference in local recurrences. It should be mentioned that the differences reported might have become significant if more patients were included. On the other hand, there were no cases of local recurrence in both groups in the RCT by Abdelhamid et al, and local recurrence rates were low in both retrospective case series being 4.5% at 5-year FU and 1.1% at 29 months (3 months – 5 year).10, 13, 16 Obviously, tumor invasion into the PF increases the risk of developing local recurrence when preserving the PF, and a risk factor for tumor invasion into the PF is proximity of the tumor to the PF.17-20 Unfortunately, no definite data are available for the minimal safe distance from the tumor to PF. Dalberg et al described that PF removal was performed when the tumor was infiltrating the PF or located close to the PF, but no definition of ‘close’ was provided. The actual distance from the tumor to the PF may be a key factor in determining whether or not to remove the PF. Several studies have shown that PF invasion can occur when tumors are located within 5 millimeters of the PF, and is less likely to occur with more than five millimeters distance.19, 20 The study of Abdelhamid et al supports this view of tumor to PF distance as an important factor. In all cases, the tumor to PF distance was at least five millimeters, and no locoregional recurrences occurred in both study arms (p=1.0).10 In support of this is also the fact that the PF is preserved in Infection Skin slough/necrosis PF preservation PF removal P-value PF preservation PF removal P-value - - - - - - - - - - - - N=5 (2.7%)** Implant loss n=3 (1.6%) - - - - - n=13 (6.4%) Implant loss n=2 (0.9%) - - n=17 (8%) - - 3
RkJQdWJsaXNoZXIy MTk4NDMw