Roughton Michelle C, Shenaq Deana, Jaskowiak Nora, Park Julie E, Song David H
Section of Plastic and Reconstructive Surgery, Surgical Oncology, University of Chicago Medical Center, Chicago, IL 60637, USA.
Ann Plast Surg. 2012 Sep;69(3):250-5. doi: 10.1097/SAP.0b013e31822afa99.
For patients with small breasts relative to tumor size and for those with tumors in the central or inferior poles, lumpectomy can be aesthetically devastating. The field of oncoplastic surgery has developed to offset the aesthetic pitfalls of breast conservation. Questions remain regarding oncologic safety, potential complications, and patient selection. In this study, we report our institutional, multidisciplinary experience with oncoplastic surgery.
A retrospective review was performed including all patients at our institution undergoing oncoplastic breast surgery between 2003 and September 2009 at an academic medical center. Mean follow-up period was 38 months. All patients were referred by the institutional multidisciplinary breast team.
Forty-five female patients underwent 46 oncoplastic breast reconstructions. Immediate reconstruction was performed in 21 patients, early (within 9 to 73 days of final tumor resection) in 18, and delayed (following completion of radiation) in 6. Three patients (14%) who underwent immediate oncoplastic reconstruction had positive margins on final pathology and proceeded to completion mastectomy. No local cancer recurrence was seen. Two patients developed distant metastatic disease. Twelve complications occurred in 11 patients; by group, 2 (10%) in immediate, 7 (39%) in delayed-immediate group, and 2 (33%) in delayed. Immediate oncoplastic reconstruction, performed as a single-stage procedure, inversely correlated with complication risk (P = 0.059). No other risk factor correlated with complications.
Our review suggests this multidisciplinary approach to oncoplastic surgery is safe. Interestingly, women undergoing immediate oncoplastic reconstruction trended toward a lower rate of complications. The benefit of immediate reconstruction must be balanced by risk of positive tumor margin and subsequent necessity for completion mastectomy. This risk-benefit balance may be best delivered by a multidisciplinary team focused on all aspects of breast cancer care.
对于乳房体积相对于肿瘤大小较小的患者以及肿瘤位于乳房中央或下极的患者，保乳手术可能会对美观造成严重破坏。肿瘤整形外科学领域的发展旨在弥补保乳手术在美学方面的缺陷。关于肿瘤学安全性、潜在并发症和患者选择等问题仍然存在。在本研究中，我们报告了我们机构在肿瘤整形手术方面的多学科经验。
进行了一项回顾性研究，纳入了2003年至2009年9月期间在一家学术医疗中心接受肿瘤整形乳房手术的所有患者。平均随访期为38个月。所有患者均由机构多学科乳房团队转诊。
45名女性患者接受了46次肿瘤整形乳房重建手术。21例患者进行了即刻重建，18例为早期（在最终肿瘤切除后9至73天内）重建，6例为延迟（放疗完成后）重建。3例接受即刻肿瘤整形重建的患者（14%）最终病理切缘阳性，随后进行了乳房全切术。未见局部癌症复发。2例患者发生远处转移。11例患者出现12例并发症；按分组，即刻重建组2例（10%），延迟 - 即刻重建组7例（39%），延迟重建组2例（33%）。作为单阶段手术进行的即刻肿瘤整形重建与并发症风险呈负相关（P = 0.059）。没有其他危险因素与并发症相关。
我们的综述表明，这种肿瘤整形手术的多学科方法是安全的。有趣的是，接受即刻肿瘤整形重建的女性并发症发生率有降低的趋势。即刻重建的益处必须与肿瘤切缘阳性的风险以及随后进行乳房全切术的必要性相平衡。这种风险 - 收益平衡可能最好由专注于乳腺癌治疗各个方面的多学科团队来实现。
