Department of General Surgery, Medical University of Vienna, Breast Health Center, Währinger Gürtel 18-20, Vienna, Austria.
Department of General Surgery, Medical University of Vienna, Breast Health Center, Währinger Gürtel 18-20, Vienna, Austria.
Int J Surg. 2014;12(4):334-9. doi: 10.1016/j.ijsu.2014.01.012. Epub 2014 Jan 31.
There are no published data on standardized scoring systems for morbidity after breast cancer surgery. Aim of the study was to establish the Clavien Dindo Classification (CDC) as assessment tool and to identify risk factors for morbidity after breast surgery investigating new techniques including oncoplastic surgery and neoadjuvant chemotherapy.
Between 2008 and 2010, data were retrospectively evaluated from 485 women with breast cancer who underwent surgery at a university hospital. The CDC was used to assess the severity of postoperative complications. Multivariable analyses were adjusted by body-mass index, smoking, diabetes mellitus and tumour size.
Overall complications (CDC 1-4) were reported in 28.7%. Second surgery related to major complications (CDC 3-4) was mandatory in 4.7%. Axillary dissection was an independent predictor for CDC 1-4 in all patients (P = 0.008, OR of 1.81, 95%CI 1.17-2.82). We found no independent predictor for CDC 3-4. Oncoplastic surgery increased the rate of wound infections (P = 0.010, OR: 2.94, 95%CI 1.30-6.67) and necroses (P < 0.001, OR: 8.38, 95%CI 3.28-21.4). Axillary dissection elevated wound infection (P = 0.040, OR: 2.07, 95%CI 1.03-4.14) and seroma rates (P < 0.001, OR: 2.46, 95%CI 1.51-4.01). Neoadjuvant chemotherapy had no impact on morbidity.
The CDC is a valid assessment tool for future clinical trials and may be useful for hospital quality control. While axillary dissection and oncoplastic surgery raised morbidity, no single factor predicted for morbidity related second surgery.
目前尚无关于乳腺癌手术后发病率的标准化评分系统的相关数据。本研究旨在建立克利夫兰分类（CDC）作为评估工具，并确定乳腺癌手术发病率的风险因素，包括新的技术，如肿瘤整形术和新辅助化疗。
回顾性分析 2008 年至 2010 年间在一家大学医院接受手术的 485 例乳腺癌患者的数据。使用 CDC 评估术后并发症的严重程度。多变量分析通过体重指数、吸烟、糖尿病和肿瘤大小进行调整。
总并发症（CDC1-4）发生率为 28.7%。需要二次手术的严重并发症（CDC3-4）发生率为 4.7%。腋窝清扫术是所有患者发生 CDC1-4 的独立预测因素（P=0.008，OR 为 1.81，95%CI 为 1.17-2.82）。我们没有发现与 CDC3-4 相关的独立预测因素。肿瘤整形术增加了伤口感染（P=0.010，OR：2.94，95%CI 为 1.30-6.67）和坏死（P<0.001，OR：8.38，95%CI 为 3.28-21.4）的发生率。腋窝清扫术增加了伤口感染（P=0.040，OR：2.07，95%CI 为 1.03-4.14）和血清肿的发生率（P<0.001，OR：2.46，95%CI 为 1.51-4.01）。新辅助化疗对发病率没有影响。
CDC 是未来临床试验的有效评估工具，也可用于医院质量控制。虽然腋窝清扫术和肿瘤整形术增加了发病率，但没有单一因素可以预测与二次手术相关的发病率。
