Chagpar Anees, Langstein Howard N, Kronowitz Steven J, Singletary S Eva, Ross Merrick I, Buchholz Thomas A, Hunt Kelly K, Kuerer Henry M
Department of Surgical Oncology, Box 444, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
Am J Surg. 2004 Feb;187(2):164-9. doi: 10.1016/j.amjsurg.2003.11.006.
Chest wall recurrence (CWR) in the setting of previous mastectomy and breast reconstruction can pose complex management dilemmas for clinicians. We examined the impact of breast reconstruction on the treatment and outcomes of patients who subsequently developed a CWR.
Between 1988 and 1998, 155 breast cancer patients with CWR after mastectomy were evaluated at our center. Of these patients, 27 had previously undergone breast reconstruction (immediate in 20; delayed in 7). Clinicopathologic features, treatment decisions, and outcomes were compared between the patients with and without previous breast reconstruction. Nonparametric statistics were used to analyse the data.
There were no significant differences between the reconstruction and no-reconstruction groups in time to CWR, size of the CWR, number of nodules, ulceration, erythema, and association of CWR with nodal metastases. In patients with previous breast reconstruction, surgical resection of the CWR and repair of the resulting defect tended to be more complex and was more likely to require chest wall reconstruction by the plastic surgery team rather than simple excision or resection with primary closure (26% [7 of 27] versus 8% [10 of 128], P = 0.013). Risk of a second CWR, risk of distant metastases, median overall survival after CWR, and distant-metastasis-free survival after CWR did not differ significantly between patients with and without previous breast reconstruction.
Breast reconstruction after mastectomy does not influence the clinical presentation or prognosis of women who subsequently develop a CWR. Collaboration with a plastic surgery team may be beneficial in the surgical management of these patients.
既往乳房切除术和乳房重建术后发生胸壁复发（CWR）会给临床医生带来复杂的管理难题。我们研究了乳房重建对随后发生CWR患者的治疗及预后的影响。
1988年至1998年间，我们中心对155例乳房切除术后发生CWR的乳腺癌患者进行了评估。其中27例患者此前接受过乳房重建（20例为即刻重建；7例为延迟重建）。比较有或无既往乳房重建患者的临床病理特征、治疗决策及预后。采用非参数统计分析数据。
重建组和未重建组在CWR发生时间、CWR大小、结节数量、溃疡、红斑以及CWR与淋巴结转移的相关性方面均无显著差异。在有既往乳房重建的患者中，CWR的手术切除及由此产生缺损的修复往往更为复杂，且更有可能需要整形外科团队进行胸壁重建，而非单纯切除或切除后一期缝合（26%[27例中的7例]对8%[128例中的10例]，P = 0.013）。有或无既往乳房重建的患者发生第二次CWR的风险、远处转移风险、CWR后的中位总生存期以及CWR后的无远处转移生存期均无显著差异。
乳房切除术后的乳房重建不影响随后发生CWR女性的临床表现或预后。与整形外科团队合作可能有助于这些患者的手术管理。
