Saha Dujata, Davila Armando A, Ver Halen Jon P, Jain Umang K, Hansen Nora, Bethke Kevin, Khan Seema A, Jeruss Jacqueline, Fine Neil, Kim john Y S
Breast. 2013 Dec;22(6):1072-80. doi: 10.1016/j.breast.2013.09.010.
Although breast reconstruction following mastectomy plays a role in the psychological impact of breast cancer, only one in three women undergo reconstruction. Few multi-institutional studies have compared complication profiles of reconstructive patients to non-reconstructive.
Using the National Surgical Quality Improvement database, all patients undergoing mastectomy from 2006 to 2010, with or without reconstruction, were identified and risk-stratified using propensity scored quintiles. The incidence of complications and comorbidities were compared.
Of 37,723 mastectomies identified, 30% received immediate breast reconstruction. After quintile matching for comorbidities, complications rates between reconstructive and non-reconstructives were similar. This trend was echoed across all quintiles, except in the sub-group with highest comorbidities. Here, the reconstructive patients had significantly more complications than the non-reconstructive (22.8% versus 7.0%, p < 0.001).
Immediate breast reconstruction is a well-tolerated surgical procedure. However, in patients with high comorbidities, surgeons must carefully counterbalance surgical risks with psychosocial benefits to maximize patient outcomes.
Level 3.
尽管乳房切除术后的乳房重建对乳腺癌的心理影响有作用，但只有三分之一的女性会接受重建。很少有多机构研究比较重建患者与非重建患者的并发症情况。
利用国家外科质量改进数据库，确定了2006年至2010年期间所有接受乳房切除术的患者，无论是否进行重建，并使用倾向评分五分位数进行风险分层。比较了并发症和合并症的发生率。
在确定的37723例乳房切除术中，30%的患者接受了即刻乳房重建。在按合并症进行五分位数匹配后，重建患者和非重建患者的并发症发生率相似。除了合并症最高的亚组外，所有五分位数组均呈现这一趋势。在此亚组中，重建患者的并发症明显多于非重建患者（22.8%对7.0%，p<0.001）。
即刻乳房重建是一种耐受性良好的外科手术。然而，对于合并症高的患者，外科医生必须仔细权衡手术风险与心理社会效益，以实现患者预后最大化。
3级。
