Ueda Satsuki, Tamaki Yasuhiro, Yano Kenji, Okishiro Noritsugu, Yanagisawa Tetsu, Imasato Mitsunobu, Shimazu Kenzo, Kim Seun J, Miyoshi Yasuo, Tanji Yoshio, Taguchi Tetsuya, Noguchi Shinzaburo
Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Surgery. 2008 Mar;143(3):414-25. doi: 10.1016/j.surg.2007.10.006. Epub 2007 Dec 21.
We conducted a retrospective study to assess the safety, cosmetic outcome, and patients' satisfaction after skin-sparing (SSM) and nipple-sparing mastectomy (NSM) for breast cancer with immediate reconstruction of the breast (SMIBR).
The subjects were patients, who underwent SMIBR, breast-conserving surgery (BCS), and total mastectomy (MST) between 2000 and 2004 at Osaka University Hospital. Cosmetic outcome was estimated by 4 reviewers by scoring postoperative photographs of the patients. Patient satisfaction was evaluated with a questionnaire for assessment of quality of life for Japanese breast cancer patients.
Of the 74 patients who had undergone SMIBR, 4 developed local recurrences (5%). The local recurrence rate for SMIBR patients was greater than that for BCS (4/178) and MST (3/178, P = .10). The distant recurrence rate was similar for all three types of patients (5% for SMIBR, 5% for BCS, and 9% for MST). The median averaged score by 4 reviewers for the estimated cosmetic outcomes was 7.8 for the SMIBR and 7.5 for the BCS group (P = .20), and for age-adjusted patients, the corresponding scores were 8.2 and 8.0 (P = .70). There was no difference in cosmetic outcome between the SSM and NSM subgroups (P = .09). Average scores for patient satisfaction (social activity, physical aspects, and general condition) were the same for the 3 groups. For body image, the BCS and SMIBR groups had higher scores than the MST group (p < 0.05). Average scores for questions relating to bodily pain and sexual aspects were higher for the BCS than the MST group, but were not different between SMIBR and BCS groups. Similar trends for the 3 groups were observed when patients were divided into subgroups by tumor size or axillary dissection.
SMIBR is safe with a comparatively low local recurrence rate and the same distant recurrence rate as for BCS and MST. Moreover, it results in objective cosmetic outcome and patient satisfaction as good as those for BCS, and greater patient satisfaction with body image than that for MST.
我们进行了一项回顾性研究，以评估保乳（SSM）和保乳头乳房切除术（NSM）联合即刻乳房重建（SMIBR）治疗乳腺癌后的安全性、美容效果及患者满意度。
研究对象为2000年至2004年期间在大阪大学医院接受SMIBR、保乳手术（BCS）和全乳切除术（MST）的患者。4名评估者通过对患者术后照片评分来评估美容效果。采用日本乳腺癌患者生活质量评估问卷对患者满意度进行评价。
在74例行SMIBR的患者中，4例出现局部复发（5%）。SMIBR患者的局部复发率高于BCS患者（4/178）和MST患者（3/178，P = 0.10）。三种类型患者的远处复发率相似（SMIBR为5%，BCS为5%，MST为9%）。4名评估者对美容效果的估计平均得分，SMIBR组为7.8分，BCS组为7.5分（P = 0.20）；对于年龄调整后的患者，相应得分分别为8.2分和8.0分（P = 0.70）。SSM和NSM亚组之间的美容效果无差异（P = 0.09）。三组患者的患者满意度平均得分（社交活动、身体方面和总体状况）相同。在身体形象方面，BCS组和SMIBR组的得分高于MST组（p < 0.05）。与身体疼痛和性方面相关问题的平均得分，BCS组高于MST组，但SMIBR组和BCS组之间无差异。当按肿瘤大小或腋窝清扫将患者分为亚组时，三组呈现相似趋势。
SMIBR安全，局部复发率相对较低，远处复发率与BCS和MST相同。此外，其美容效果和患者满意度与BCS相当，且患者对身体形象的满意度高于MST。
