Section of Surgical Oncology, Department of General Surgery, Mayo Clinic in Arizona, Phoenix, AZ, USA.
Ann Surg Oncol. 2011 Apr;18(4):952-6. doi: 10.1245/s10434-010-1406-4. Epub 2010 Nov 16.
We analyzed the margin status and risk factors for inadequate margins among patients who underwent skin-sparing mastectomies (SSM) and traditional total mastectomies (TM).
Patients undergoing mastectomies from 2003 to 2009 were included. Margins of excision were considered positive if carcinoma was at an inked margin and were considered close if such disease was within 2 mm of an inked margin.
A total of 426 patients were identified. The mean age was 60 years and 90% were white. Mean tumor size was 2.6 cm and 44% had multiple ipsilateral carcinomas. Of 426 patients, 177 (42%) underwent SSM with reconstruction and 249 (58%) TM. The rate of positive or close margins on the initial specimen was 29% for SSM vs. 12% for TM (P < 0.01), and the rate of reoperation for margins was 7% for SSM vs. 2% for TM (P < 0.01). Logistic regression analysis revealed that independent risk factors for initial close or positive margins included SSM (odds ratio 2.36, 95% confidence interval [95% CI] 1.05-5.30), multiple ipsilateral tumors (OR 2.12, 95% CI 1.05-4.24), and upper-inner quadrant location (OR 2.58, 95% CI 1.07-6.19). Mean follow-up time was 28 months, and the local recurrence rate was 0.9%. Local recurrence rates were not different for those undergoing SSM (1.1%) vs. TM (0.8%, P = NS).
Mastectomy patients undergoing SSM, with multiple ipsilateral tumors, and/or upper-inner quadrant disease are at significantly higher risk for inadequate margins of excision. These patients warrant more vigilant intraoperative attention to margin status to ensure adequate margins at the end of the first operation.
我们分析了行保乳乳房切除术（SSM）和传统全乳房切除术（TM）的患者中切缘阳性和切缘不足的情况及相关危险因素。
纳入 2003 年至 2009 年间行乳房切除术的患者。如果癌组织位于墨染切缘处，则认为切缘阳性，如果癌组织距离墨染切缘 2mm 以内，则认为切缘接近。
共纳入 426 例患者。患者的平均年龄为 60 岁，90%为白人。肿瘤平均直径为 2.6cm，44%患者同侧有多个癌灶。426 例患者中，177 例行 SSM 加重建术（占 42%），249 例行 TM（占 58%）。SSM 组初始标本切缘阳性或切缘接近的比例为 29%，TM 组为 12%（P<0.01），SSM 组因切缘问题再次手术的比例为 7%，TM 组为 2%（P<0.01）。Logistic 回归分析显示，初始切缘阳性或切缘接近的独立危险因素包括 SSM（比值比 2.36，95%置信区间[95%CI]1.05-5.30）、同侧多个肿瘤（OR 2.12，95%CI 1.05-4.24）和肿瘤位于内上象限（OR 2.58，95%CI 1.07-6.19）。平均随访时间为 28 个月，局部复发率为 0.9%。行 SSM 组的局部复发率为 1.1%，TM 组为 0.8%（P=NS），两组无统计学差异。
行 SSM 且同侧有多个肿瘤和/或肿瘤位于内上象限的乳房切除术患者，切缘不足的风险显著增加。这些患者在第一次手术时需要更密切关注切缘状态，以确保初次手术获得足够的切缘。
