Department of Surgery, University of Toronto, Toronto, ON, Canada.
Ann Surg Oncol. 2013 Oct;20(10):3212-7. doi: 10.1245/s10434-013-3116-1. Epub 2013 Jul 12.
Recent studies indicate that women with unilateral breast cancer are choosing contralateral prophylactic mastectomy (CPM) at an increasing rate. There is limited literature evaluating the postoperative complication rates associated with CPM without breast reconstruction. The objective of this study was to compare postoperative complications in women undergoing unilateral mastectomy (UM) and sentinel lymph node biopsy (SLNB) to those undergoing bilateral mastectomy (BM) and SLNB for the treatment of their breast cancer.
The American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) Participant Use Files between 2007 and 2010 were used to identify women with breast cancer undergoing UM or BM with SLNB. Individual and composite end points of 30-day complications were used to compare both groups by univariate and multivariate analyses.
We identified 4,219 breast cancer patients who had a SLNB: 3,722 (88.2 %) had UM and 497 (11.8 %) had BM. The wound complication rate was significantly higher in the BM group versus the UM group, 5.8 % versus 2.9 % [unadjusted odds ratio (OR) 2.1, 95 % confidence interval (CI) 1.3-3.3, P < 0.01]. The overall 30-day complication rate in UM patients was 4.2 % versus 7.6 % in the BM group (unadjusted OR 1.9, 95 % CI 1.3-2.7, P < 0.01). The adjusted OR for overall complications adjusting for important patient characteristics was 1.9 (95 % CI 1.3-2.8, P < 0.01). Independent predictors of overall postoperative complications were body mass index (OR 1.1, P < 0.01) and smoking (OR 2.2, P < 0.01).
For patients with breast cancer, bilateral mastectomy is associated with an increased risk of wound and overall postoperative complications. Discussion of these outcomes is imperative when counseling women contemplating CPM.
最近的研究表明，单侧乳腺癌女性选择对侧预防性乳房切除术（CPM）的比例正在逐渐增加。目前评估不进行乳房重建的 CPM 术后并发症发生率的文献有限。本研究旨在比较单侧乳房切除术（UM）和前哨淋巴结活检（SLNB）与双侧乳房切除术（BM）和 SLNB 治疗乳腺癌患者的术后并发症。
使用美国外科医师学会国家手术质量改进计划（ACS NSQIP）参与者使用文件，于 2007 年至 2010 年期间，确定接受 UM 或 BM 联合 SLNB 治疗的乳腺癌女性患者。采用单变量和多变量分析比较两组患者 30 天内的单个和复合终点并发症。
我们确定了 4219 例接受 SLNB 的乳腺癌患者：3722 例（88.2%）接受 UM，497 例（11.8%）接受 BM。BM 组的切口并发症发生率明显高于 UM 组，分别为 5.8%和 2.9%[未调整比值比（OR）2.1，95%置信区间（CI）1.3-3.3，P<0.01]。UM 患者的总 30 天并发症发生率为 4.2%，BM 组为 7.6%（未调整 OR 1.9，95%CI 1.3-2.7，P<0.01）。调整重要患者特征后，总体并发症的调整 OR 为 1.9（95%CI 1.3-2.8，P<0.01）。术后总体并发症的独立预测因素包括体重指数（OR 1.1，P<0.01）和吸烟（OR 2.2，P<0.01）。
对于患有乳腺癌的患者，双侧乳房切除术与切口和总体术后并发症的风险增加相关。在为考虑 CPM 的女性提供咨询时，必须讨论这些结果。
