University Breast Unit Heidelberg, Heidelberg, Germany.
Ann Surg Oncol. 2012 Feb;19(2):541-7. doi: 10.1245/s10434-011-1947-1. Epub 2011 Jul 15.
Reexcision is a clinically relevant aspect of oncological breast conservation surgery. The influence of reexcision on aesthetic outcome is described differently in the literature. Our aim was to analyze this question in a well-defined cohort with standardized study instruments.
A total of 439 patients from a prospectively followed cohort were included in this analysis. Aesthetic results were assessed by the Breast Cancer Treatment Outcome Scale (BCTOS) aesthetic status. Dates of assessments were shortly after surgical interventions and before surgery. Group comparison was performed between patients with reexcisions (80 cases; 18%) and patients without reexcision (359 cases; 82%). We considered variables of differing distribution between the two groups that could hypothetically influence BCTOS aesthetic status in a nonparametric analysis of covariance (ANCOVA).
The aesthetic status of patients with reexcisions was found to be significantly worse than for patients with a single breast conservation surgery (P < 0.0001) when tested by a nonparametric ANCOVA model. Because patients with reexcisions had more noninvasive tumors (25% vs. 8%, P = 0.0001) and tumors were larger in patients with reexcision (P = 0.01), we included these variables as possible covariates in the multivariate model. The model was adjusted for the BCTOS aesthetic status before and shortly after the first surgery.
Our findings suggest that reexcision in breast conservation surgery impairs aesthetic outcome, at least when assessed shortly after surgery.
再次切除术是肿瘤保乳手术中一个重要的临床方面。文献中对再次切除术对美容效果的影响描述不尽相同。我们的目的是在一个具有标准化研究工具的明确队列中分析这个问题。
共有 439 名来自前瞻性随访队列的患者被纳入本分析。美容结果通过乳腺癌治疗结果量表（BCTOS）的美容状况进行评估。评估日期分别为手术干预后不久和手术前。对接受再次切除术的患者（80 例，18%）和未接受再次切除术的患者（359 例，82%）进行组间比较。我们在非参数协方差分析（ANCOVA）中比较了两组之间分布不同的变量，这些变量可能会对 BCTOS 美容状况产生影响。
通过非参数 ANCOVA 模型测试，发现接受再次切除术的患者的美容状况明显差于仅接受单次保乳手术的患者（P < 0.0001）。由于再次切除术患者的非浸润性肿瘤更多（25%对 8%，P = 0.0001），且肿瘤在再次切除术患者中更大（P = 0.01），我们将这些变量作为可能的协变量纳入多变量模型。该模型调整了首次手术后和手术后不久的 BCTOS 美容状况。
我们的研究结果表明，保乳手术中的再次切除术至少在手术后不久会影响美容效果。
