University of Liverpool, UK.
Cancer Treat Rev. 2011 Aug;37(5):353-7. doi: 10.1016/j.ctrv.2011.02.001. Epub 2011 Mar 2.
The elderly population is rapidly increasing, and with cancer, particularly breast cancer, being most prevalent in this group, its management is becoming increasingly important. A major aspect of breast cancer treatment and subsequent quality of life is the opportunity for reconstructive surgery post-mastectomy. This is particularly important as survival rates are improving, so a larger proportion of patients are living with the long term consequences of their treatment. Evidence has shown that age itself is not a risk factor for poor surgical outcomes, but concern over this causes surgeons to be wary of offering elderly patients the opportunity of reconstruction. Elderly patients themselves are also less likely to request or accept reconstruction.
Literature searches using keywords 'breast reconstruction', 'older' and 'elderly' were carried out on Pubmed, Scopus and Google Scholar. Results were limited to English language, and then manually searched to exclude irrelevant articles. Duplicates were removed and a series of articles were reviewed.
Surgery was well tolerated in elderly patients, with complication rates comparable to a younger group. Autogenous tissue produced better outcomes than implant reconstruction. In areas such as social functioning and emotional wellbeing, patients with reconstructive surgery showed better outcomes than those without.
The research on this topic is limited and only available in the form of case series. Direct comparison between these series cannot be drawn. The available series lack a clear assessment of the patient's frailty and do not define which patients should be offered breast reconstruction and which ones should be denied. Despite this, the evidence strongly suggests that it would be beneficial to offer elderly patients reconstructive surgery, dependent on their individual risk. A careful pre-operative assessment allows selecting the appropriate candidate on the basis of fitness, particularly when long and complex reconstructive procedures involving microvascular transfer such as DIEP or free TRAM flaps are considered. Reasons why patients decide to decline breast reconstruction may have altered more recently with wider media coverage and information especially on the internet. There are also real issues with availability of highly trained surgical teams capable of performing microsurgical transfer procedures, theatre availability and constraints due the present economic recession. Thus, there are multiple factors that influence breast reconstruction and patients, even in different parts of a single country, may have variations in the algorithm of options offered for breast reconstruction.
老年人口迅速增加，而癌症，尤其是乳腺癌，在这一人群中最为普遍，因此对其进行管理变得越来越重要。乳腺癌治疗和随后生活质量的一个主要方面是乳房切除术后重建手术的机会。这一点尤为重要，因为存活率正在提高，因此越来越多的患者长期遭受治疗的后果。有证据表明，年龄本身并不是手术结果不良的危险因素，但这一担忧导致外科医生对为老年患者提供重建机会持谨慎态度。老年患者本身也不太可能要求或接受重建。
使用关键词“乳房重建”、“老年”和“老年人”在 Pubmed、Scopus 和 Google Scholar 上进行文献检索。结果仅限于英文，并手动搜索以排除不相关的文章。去除重复项后，对一系列文章进行了审查。
手术在老年患者中得到了很好的耐受，并发症发生率与年轻组相当。自体组织的效果优于植入物重建。在社会功能和情绪健康等方面，接受重建手术的患者比未接受重建手术的患者有更好的结果。
关于这个主题的研究是有限的，只能以病例系列的形式获得。这些系列之间无法进行直接比较。这些系列缺乏对患者脆弱性的明确评估，也没有定义哪些患者应该接受乳房重建，哪些患者应该被拒绝。尽管如此，证据强烈表明，根据患者的个体风险，为老年患者提供重建手术将是有益的。术前仔细评估可根据健康状况选择合适的患者，特别是当考虑到涉及微血管转移的复杂长程重建手术时，如 DIEP 或游离 TRAM 皮瓣。患者决定拒绝乳房重建的原因可能最近有所改变，因为媒体对这方面的报道更加广泛，尤其是在互联网上。能够进行显微转移手术的高技能外科手术团队的可用性、剧院可用性以及当前经济衰退带来的限制等实际问题也存在。因此，有多个因素影响乳房重建，即使在一个国家的不同地区，患者对乳房重建选择的算法也可能存在差异。
