Breast-Conserving Surgery Versus Modified Radical Mastectomy in the Management of Non-metastatic Inflammatory Breast Cancer: A Systematic Review and Meta-Analysis

Inflammatory breast cancer (IBC) is an uncommon yet particularly aggressive subtype of breast carcinoma. The most effective surgical strategy after multimodality therapy continues to be debated, specifically regarding whether breast-conserving surgery (BCS) provides outcomes equivalent to modified radical mastectomy (MRM). This systematic review and meta-analysis assessed survival outcomes between these two surgical options in non-metastatic IBC. Searches of PubMed, SCOPUS, CENTRAL, Web of Science, and Google Scholar up to April 2019 were searched under Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidance. Eligible studies included adults with non-metastatic IBC receiving either BCS or MRM after neoadjuvant chemotherapy (NAC). The data were analyzed with a random-effects model. Six studies with 11,252 patients were included. The combined analysis of overall survival (OS) favored mastectomy (RR = 0.88, 95% CI: 0.79-0.98; p = 0.02) without heterogeneity (I² = 0%). Hazard ratio analysis (HR = 0.89, 95% CI: 0.74-1.07; p = 0.22) and breast-cancer-specific survival (BCSS; HR = 0.89, 95% CI: 0.73-1.09; p = 0.27) showed no significant difference. Overall, MRM remains the preferred surgical approach, though BCS can be considered in highly selected cases showing an excellent response to neoadjuvant therapy. Further randomized trials are necessary to refine selection criteria and validate long-term oncologic safety. The findings support MRM as the standard, with BCS viable for selected patients achieving excellent neoadjuvant response.