挑战传统模式：12年自体游离皮瓣乳房重建治疗炎性乳腺癌的经验
Challenging a traditional paradigm: 12-year experience with autologous free flap breast reconstruction for inflammatory breast cancer.
作者信息
Chang Edward I, Chang Eric I, Ito Ran, Zhang Hong, Nguyen Alexander T, Skoracki Roman J, Hanasono Matthew M, Crosby Melissa A, Ueno Naoto T, Hunt Kelly K
机构信息
Houston, Texas From the Departments of Plastic and Reconstructive Surgery and Breast Medical Oncology, the Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, and the Department of Surgical Oncology, Breast Surgery, The University of Texas M. D. Anderson Cancer Center.
出版信息
Plast Reconstr Surg. 2015 Feb;135(2):262e-269e. doi: 10.1097/PRS.0000000000000900.
BACKGROUND
Inflammatory breast cancer is a rare but aggressive breast cancer with an overall poor prognosis. Traditionally, reconstruction has not been offered, because of poor long-term survival, the need for multimodality treatment, and complex treatment sequencing. The authors examined the safety and feasibility of free flap breast reconstruction for inflammatory breast cancer.
METHODS
A retrospective analysis of all patients who underwent reconstruction for inflammatory breast cancer from January of 2000 to December of 2012 was conducted.
RESULTS
Of 830 inflammatory breast cancer patients, 59 (7.1 percent; median age, 48 years; range, 27 to 65 years) underwent free flap reconstruction. All patients received chemotherapy and radiation therapy. Most patients (n = 52) underwent delayed reconstruction. Five patients with a history of prior partial mastectomy and irradiation developed inflammatory breast cancer and underwent immediate reconstruction following completion mastectomy. Two others underwent immediate chest wall and breast reconstruction following resection. Thirteen patients underwent bilateral reconstruction, and seven required a bipedicled abdominal flap for the unilateral mastectomy defect. Thirty-seven patients (62.7 percent) required revision of the reconstructed breast, and 29 (49.2 percent) had a contralateral balancing procedure to optimize symmetry. Complications occurred in 21 patients (35.6 percent), with one total flap loss (1.7 percent). The median length of follow-up was 43.9 months; 49 patients (83.1 percent) were alive without evidence of recurrent disease.
CONCLUSIONS
Autologous free flap breast reconstruction can be performed safely in inflammatory breast cancer patients, with acceptable complication rates and without an increased risk for flap loss. Inflammatory breast cancer should not preclude free flap breast reconstruction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
背景
炎性乳腺癌是一种罕见但侵袭性强的乳腺癌，总体预后较差。传统上，由于长期生存率低、需要多模式治疗以及治疗顺序复杂，一直未提供乳房重建。作者研究了游离皮瓣乳房重建用于炎性乳腺癌的安全性和可行性。
方法
对2000年1月至2012年12月期间接受炎性乳腺癌重建的所有患者进行回顾性分析。
结果
在830例炎性乳腺癌患者中，59例（7.1%；中位年龄48岁；范围27至65岁）接受了游离皮瓣重建。所有患者均接受了化疗和放疗。大多数患者（n = 52）接受了延迟重建。5例有先前保乳手术和放疗史的患者发生了炎性乳腺癌，并在完成乳房切除术后立即进行了重建。另外2例在切除术后立即进行了胸壁和乳房重建。13例患者进行了双侧重建，7例因单侧乳房切除缺损需要双蒂腹直肌肌皮瓣。37例患者（62.7%）需要对重建乳房进行修复，29例（49.2%）进行了对侧平衡手术以优化对称性。21例患者（35.6%）发生了并发症，1例皮瓣完全坏死（1.7%）。中位随访时间为43.9个月；49例患者（83.1%）存活，无疾病复发迹象。
结论
自体游离皮瓣乳房重建在炎性乳腺癌患者中可以安全进行，并发症发生率可接受，且皮瓣坏死风险没有增加。炎性乳腺癌不应排除游离皮瓣乳房重建。
临床问题/证据水平：治疗性，IV级。
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