Rose Michael, Manjer Jonas, Ringberg Anita, Svensson Henry
Department of Surgery, Section of Plastic Surgery, Sydvestjysk Sygehus, Esbjerg, Denmark ; Department of Plastic Surgery, Aleris-Hamlet Hospitaler, Copenhagen, Denmark ; Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden ; Kirurgisk Klinik, Plastikirurgisk Sektion, Sydvestjysk Sygehus, Finsensgade 35, 6700 Esbjerg, Denmark.
Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden ; Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden.
Eur J Plast Surg. 2014;37(4):205-214. doi: 10.1007/s00238-013-0922-4. Epub 2014 Feb 1.
Oncoplastic breast surgery is an evolving discipline in the surgical treatment of breast cancer aimed to improve the outcome.
Oncoplastic breast surgery was performed between January 2008 and December 2010 on 72 women with 74 breast cancers selected from a population of 1,018 primary breast cancer patients. Careful preoperative planning revealed the possibility of partial breast reconstruction with volume reduction, volume displacement or volume replacement depending on breast size as well as tumour size and location. Data were registered consecutively.
The surgical plan was successful in all but one case, where a mastectomy had to be performed during the primary surgery. In 53 cases, a contralateral mammoplasty was performed during the operation to achieve symmetry. During the follow-up period until November 2011, only one patient needed corrective surgery. Final histopathological examination indicated that seven cases required extended resection and three cases required a mastectomy. Five patients experienced delayed wound healing, although complications requiring further surgery occurred for the reconstructed breast in four cases, the contralateral breast in three cases and the axilla after exaeresis in two cases because of haematoma. Such complications led to slight delay in adjuvant therapy for four patients.
This study demonstrates that it is feasible to implement oncoplastic breast surgery into daily clinical practice as a supplement to conventional breast cancer surgery. As such, oncoplastic breast surgery may provide a markedly better outcome than breast-conserving surgery in terms of shape and symmetry without compromising the surgical margins. Level of Evidence: Level IV, prognostic/risk study.
肿瘤整形乳房手术是乳腺癌外科治疗中一门不断发展的学科,旨在改善治疗效果。
2008年1月至2010年12月期间,对从1018例原发性乳腺癌患者中挑选出的72例患有74个乳腺癌的女性实施了肿瘤整形乳房手术。仔细的术前规划显示,根据乳房大小以及肿瘤大小和位置,有可能进行减容、容积置换或容积替代的部分乳房重建。数据连续记录。
除1例在初次手术时不得不进行乳房切除术外,手术计划在所有病例中均成功。53例在手术期间进行了对侧乳房整形以实现对称。在截至2011年11月的随访期内,只有1例患者需要进行矫正手术。最终组织病理学检查表明,7例需要扩大切除,3例需要进行乳房切除术。5例患者出现伤口愈合延迟,尽管4例重建乳房、3例对侧乳房以及2例腋窝在清除血肿后因血肿出现了需要进一步手术的并发症。这些并发症导致4例患者的辅助治疗略有延迟。
本研究表明,将肿瘤整形乳房手术作为传统乳腺癌手术的补充应用于日常临床实践是可行的。因此,肿瘤整形乳房手术在形状和对称性方面可能比保乳手术提供明显更好的效果,同时不影响手术切缘。证据水平:IV级,预后/风险研究。