Broadwater J R, Edwards M J, Kuglen C, Hortobagyi G N, Ames F C, Balch C M
University of Texas M. D. Anderson Cancer Center, Houston.
Ann Surg. 1991 Feb;213(2):126-9. doi: 10.1097/00000658-199102000-00006.
The surgical morbidity associated with aggressive preoperative chemotherapy in 106 patients with advanced primary breast cancer who had chemotherapy followed by mastectomy was examined. These patients were compared with a group of 91 consecutive patients who had mastectomy without preoperative chemotherapy. Strict operative criteria were used to determine the timing of mastectomy following chemotherapy. Wound infection rates were no different in the preoperative chemotherapy group compared to the mastectomy-alone groups (7% versus 4%; p = 0.62). The incidence of wound necrosis was similar (11% versus 6%; p = 0.29). Seroma formation was decreased significantly in the preoperative chemotherapy group compared to the mastectomy-alone group (15% versus 28%; p = 0.04). Intensive preoperative chemotherapy did not delay the reinstitution of postoperative treatment (30% versus 20%; p = 0.27). However, when delay in instituting postoperative chemotherapy was more than 30 days, there was a significant decrease in overall survival rate (p = 0.04). This study provides evidence that intensive preoperative chemotherapy and mastectomy can be performed without increased morbidity. Furthermore it is important to institute systemic chemotherapy within 30 days of mastectomy to achieve maximum survival.
对106例晚期原发性乳腺癌患者进行术前强化化疗后行乳房切除术的手术并发症进行了研究。这些患者与91例连续接受乳房切除术但未进行术前化疗的患者进行了比较。采用严格的手术标准来确定化疗后乳房切除术的时机。术前化疗组与单纯乳房切除组的伤口感染率无差异（7%对4%；p = 0.62）。伤口坏死的发生率相似（11%对6%；p = 0.29）。与单纯乳房切除组相比，术前化疗组的血清肿形成明显减少（15%对28%；p = 0.04）。强化术前化疗并未延迟术后治疗的恢复（30%对20%；p = 0.27）。然而，当术后化疗延迟超过30天时，总生存率显著降低（p = 0.04）。本研究提供了证据，表明术前强化化疗和乳房切除术可以在不增加并发症的情况下进行。此外，在乳房切除术后30天内进行全身化疗对于实现最大生存率很重要。
