Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA,
Ann Surg Oncol. 2013 Dec;20(13):4113-20. doi: 10.1245/s10434-013-3108-1. Epub 2013 Jul 19.
The purpose of this study was to determine if newly diagnosed breast cancer patients undergoing contralateral prophylactic mastectomy (CPM) experience more complications than patients undergoing unilateral mastectomy (UM).
A total of 600 patients underwent either UM or CPM between January 2009 and March 2012 for unilateral breast cancer. Operative complications were classified as minor (aspirations, infection requiring antibiotics, partial flap and nipple necrosis, minor bleeding, delayed wound healing) or major (hematoma or seroma requiring operation, infection requiring rehospitalization, blood product transfusion, total flap or nipple loss, implant removal), mixed (both minor and major complications), or multiple. Chi-square and multivariate logistic regressions were used for the analysis.
Of the 600 patients, 391 (65 %) underwent UM and 209 (35 %) underwent CPM. Across all complication groups, there were significantly more complications in the CPM group versus the UM group (41.6 vs. 28.6 %, p = 0.001). Major complications alone were significantly greater in the CPM versus the UM group (13.9 vs. 4.1 %, p < 0.001). When adjusting for age, body mass index, smoking and diabetes history, AJCC stage, reconstruction, previous radiation therapy, and adjuvant therapy, CPM patients were 1.5 times more likely to have any complication (odds ratio [OR] 1.53; 95 % CI 1.04-2.25, p = 0.029) and 2.7 times more likely to have a major complication compared with UM patients (OR 2.66; 95 % CI 1.37-5.19, p = 0.004).
CPM patients have an increased risk of complications, especially major complications requiring rehospitalization or reoperation. These complications may influence patient and physician decisions to choose CPM.
本研究旨在确定新诊断的乳腺癌患者接受预防性对侧乳房切除术（CPM）是否比接受单侧乳房切除术（UM）的患者出现更多的并发症。
2009 年 1 月至 2012 年 3 月，共有 600 例单侧乳腺癌患者接受 UM 或 CPM。手术并发症分为轻度（抽吸、需要抗生素治疗的感染、部分皮瓣和乳头坏死、轻度出血、伤口愈合延迟）或重度（需要手术的血肿或血清肿、需要住院治疗的感染、输血、全皮瓣或乳头缺失、植入物移除）、混合（轻度和重度并发症混合）或多发。采用卡方检验和多变量逻辑回归进行分析。
600 例患者中，391 例（65%）接受 UM，209 例（35%）接受 CPM。在所有并发症组中，CPM 组的并发症明显多于 UM 组（41.6% vs. 28.6%，p=0.001）。CPM 组的严重并发症明显多于 UM 组（13.9% vs. 4.1%，p<0.001）。在调整年龄、体重指数、吸烟和糖尿病史、AJCC 分期、重建、既往放疗和辅助治疗后，CPM 患者发生任何并发症的可能性是 UM 患者的 1.5 倍（优势比[OR]1.53；95%可信区间[CI]1.04-2.25，p=0.029），发生严重并发症的可能性是 UM 患者的 2.7 倍（OR 2.66；95%CI 1.37-5.19，p=0.004）。
CPM 患者发生并发症的风险增加，尤其是需要住院或再次手术的严重并发症。这些并发症可能会影响患者和医生选择 CPM 的决策。
