Carlson Grant W, Page Andrew, Johnson Earl, Nicholson Kimberly, Styblo Toncred M, Wood William C
Department of Surgery, Emory University School of Medicine, Atlanta GA, USA.
J Am Coll Surg. 2007 May;204(5):1074-8; discussion 1078-80. doi: 10.1016/j.jamcollsurg.2007.01.063.
The incidence of local recurrence (LR) after conventional total mastectomy for ductal carcinoma in situ (DCIS) ranges from 1% to 3%. Skin-sparing mastectomy (SSM) preserves the native skin envelope to facilitate immediate breast reconstruction. Because DCIS is generally not clinically apparent, there is a potential for inadequate excision when SSM is performed. Risk factors for local recurrence after SSM for DCIS are examined.
A retrospective review of 223 consecutive patients with DCIS treated by SSM and immediate reconstruction was performed. Age younger than 50 years, tumor size > 40 mm, high tumor grade, tumor necrosis, surgical margins < 1 mm, type of biopsy (excisional versus core), and SSM type were examined as risk factors for recurrence.
Mean followup was 82.3 months (range 4.9 to 123.2 months). Recurrences developed in 11 patients (5.1%), including: local (n = 7; 3.3%), regional (n = 2; 0.9%), and distant (n = 2; 0.9%). All seven local recurrences were detected by physical examination. No patients received adjuvant radiation therapy. Two of 19 patients with surgical margins < 1 mm developed LR (10.5%). Univariate analysis showed high tumor grade (p = .019) to influence LR.
The incidence of local recurrence of DCIS after SSM is similar to conventional total mastectomy. Reexcision of close margins should be performed if possible and adjuvant radiation therapy should be considered.
导管原位癌（DCIS）行传统全乳切除术后局部复发（LR）的发生率为1%至3%。保乳手术（SSM）保留了天然皮肤包膜，便于即刻乳房重建。由于DCIS通常在临床上不明显，因此在进行SSM时存在切除不充分的可能性。本研究对DCIS行SSM术后局部复发的危险因素进行了分析。
对223例连续接受SSM及即刻乳房重建的DCIS患者进行回顾性分析。将年龄小于50岁、肿瘤大小>40mm、肿瘤分级高、肿瘤坏死、手术切缘<1mm、活检类型（切除活检与粗针活检）及SSM类型作为复发的危险因素进行分析。
平均随访82.3个月（范围4.9至123.2个月）。11例（5.1%）患者出现复发，包括：局部复发（n=7；3.3%）、区域复发（n=2；0.9%）和远处复发（n=2；0.9%）。所有7例局部复发均通过体格检查发现。无一例患者接受辅助放疗。19例手术切缘<1mm的患者中有2例出现局部复发（10.5%）。单因素分析显示肿瘤分级高（p=0.019）会影响局部复发。
DCIS行SSM术后局部复发的发生率与传统全乳切除术后相似。如有可能，应再次切除切缘接近的组织，并考虑辅助放疗。
