Sriussadaporn Sukanya, Angspatt Apichai
Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Med Assoc Thai. 2012 Jun;95(6):775-81.
Surgical treatment for breast cancer has some special aspects different from other cancers, since surgeons have to concern of both oncologic safety and esthetic outcome. Modified radical mastectomy (MRM) can give the oncologic safety but not esthetic outcome. Breast conserving therapy improves cosmetic but results in more local recurrence than modified radical mastectomy. Skin sparing mastectomy (SSM) with immediate reconstruction for early breast cancer has been reported by several investigators to have comparable outcome with MRM and better esthetic result. The purpose of the present study was to examine patients who underwent SSM with immediate reconstruction at King Chulalongkorn Memorial Hospital.
Patients who underwent SSM with immediate reconstruction by the authors at King Chulalongkorn Memorial Hospital, Bangkok Thailand between May 2007 and January 2011 were studied. The immediate reconstruction was performed with transverse rectus abdominis musculocutaneous flaps or latissimus dorsi flaps. Postoperative early and late complications as well as local recurrence were studied to examine the oncologic safety and esthetic outcome.
Fourteen patients were enrolled into the present study. The age ranged from 33 to 59 years (mean 47 years). The follow up time ranged from six to 50 months (mean 26.5 months). Postoperative complications included wound infection in one patient (7%), seroma at donor site of latissimus dorsi flaps in two patients (40%) and fat necrosis in five patients (55%). There was no skin flap necrosis, no hematoma, no arm numbness, no wound dehiscense, no abdominal wall hernia, and no lymphedema of the arm. No local recurrence was detected
This preliminary report shows that skin-sparing mastectomy with immediate reconstruction is a good alternative in management of early breast cancer. There was no serious postoperative complication. The esthetic result was acceptable. No local recurrence was observed. Long-term follow up with more patients are required to confirm its applicability in early breast cancer patients.
乳腺癌的外科治疗具有一些与其他癌症不同的特殊方面,因为外科医生必须兼顾肿瘤学安全性和美学效果。改良根治性乳房切除术(MRM)可确保肿瘤学安全性,但无法保证美学效果。保乳治疗改善了美观度,但与改良根治性乳房切除术相比,局部复发率更高。一些研究者报告称,早期乳腺癌行保乳皮肤乳房切除术(SSM)并即刻重建,其效果与MRM相当,且美学效果更佳。本研究的目的是对在朱拉隆功国王纪念医院接受SSM并即刻重建的患者进行检查。
对2007年5月至2011年1月期间在泰国曼谷朱拉隆功国王纪念医院由作者实施SSM并即刻重建的患者进行研究。即刻重建采用腹直肌横形肌皮瓣或背阔肌皮瓣。研究术后早期和晚期并发症以及局部复发情况,以评估肿瘤学安全性和美学效果。
本研究纳入了14例患者。年龄范围为33至59岁(平均47岁)。随访时间为6至50个月(平均26.5个月)。术后并发症包括1例患者伤口感染(7%)、2例患者背阔肌皮瓣供区血清肿(40%)和5例患者脂肪坏死(55%)。未出现皮瓣坏死、血肿、手臂麻木、伤口裂开、腹壁疝及手臂淋巴水肿。未检测到局部复发。
本初步报告表明,保乳皮肤乳房切除术并即刻重建是早期乳腺癌治疗的一种良好选择。未出现严重术后并发症。美学效果可接受。未观察到局部复发。需要对更多患者进行长期随访,以确认其在早期乳腺癌患者中的适用性。