Reddy Sashank, Colakoglu Salih, Curtis Michael S, Yueh Janet H, Ogunleye Adeyemi, Tobias Adam M, Lee Bernard T
Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Ann Plast Surg. 2011 May;66(5):466-71. doi: 10.1097/SAP.0b013e318214e575.
Continuing advances in breast reconstruction have provided surgeons with a multitude of reconstructive options. Concerns remain, however, about the effects of the various reconstructive methods on ultimate oncologic outcome. This study compares incidence, detection, and management of recurrent breast cancer in a large series of patients treated with mastectomy alone or with mastectomy and various forms of reconstruction.
A retrospective analysis was performed on all patients who underwent mastectomy and/or immediate reconstruction for breast cancer at our institution between January 1999 and December 2006. The 921 patients were divided into 2 groups: mastectomy and reconstruction (n = 494) and mastectomy alone (n = 427). All modern reconstructive methods were included. Patients were followed for a mean of 4.5 years.
The total incidence of recurrence-locoregional and/or distant-was 5.9% in patients who had mastectomy with reconstruction and 11.5% in patients who had mastectomy alone (P < 0.0023). The incidence of locoregional recurrence only was 2.2% in patients who had mastectomy with reconstruction and 4.0% in patients who had mastectomy alone (P = 0.1220). Of the 11 reconstructed patients with a locoregional recurrence, all recurrences were detected by self or clinical examination. Median time to detection was the same in both groups: 1.6 years (P = 0.5471).
Reconstruction with a variety of methods does not adversely affect the incidence or time to detection of recurrent breast cancer. Further, our data point to an important role for physical examination in tumor surveillance after mastectomy and reconstruction.
乳房重建技术的不断进步为外科医生提供了多种重建选择。然而，各种重建方法对最终肿瘤学结局的影响仍令人担忧。本研究比较了一系列仅接受乳房切除术或接受乳房切除术及各种形式重建术的患者中复发性乳腺癌的发生率、检测情况及处理方式。
对1999年1月至2006年12月期间在本机构接受乳腺癌乳房切除术和/或即刻重建术的所有患者进行回顾性分析。921例患者分为两组：乳房切除术加重建术组（n = 494）和单纯乳房切除术组（n = 427）。纳入了所有现代重建方法。患者平均随访4.5年。
接受乳房切除术后重建的患者局部和/或远处复发的总发生率为5.9%，而单纯接受乳房切除术的患者为11.5%（P < 0.0023）。仅局部复发的发生率在接受乳房切除术后重建的患者中为2.2%，在单纯接受乳房切除术的患者中为4.0%（P = 0.1220）。在11例发生局部复发的重建患者中，所有复发均通过自我检查或临床检查发现。两组的中位检测时间相同：1.6年（P = 0.5471）。
多种方法的重建不会对复发性乳腺癌的发生率或检测时间产生不利影响。此外，我们的数据表明体格检查在乳房切除术后和重建后的肿瘤监测中起着重要作用。
