Madsen Russell J, Esmonde Nick O, Ramsey Katrina L, Hansen Juliana E
From the *Division of Plastic and Reconstructive Surgery, Department of Surgery and †Oregon Clinical and Translational Research Institute (OCTRI), Oregon Health & Science University, Portland, OR.
Ann Plast Surg. 2016 Nov;77(5):513-516. doi: 10.1097/SAP.0000000000000653.
Complications after immediate breast reconstruction pose a significant challenge to the reconstructive surgeon. Known risk factors include smoking, obesity, age, and adjuvant oncologic therapies. Less is known about the association between axillary lymph node dissection (ALND) and the development of postoperative complications.
We conducted a retrospective study of all patients who underwent immediate breast reconstruction after mastectomy at our institution over a 10-year period. Our outcome was an occurrence of a major complication within 90 days postoperatively. For each patient, we recorded data on demographics, smoking status, pertinent medical history, reconstruction type, adjuvant chemotherapy and radiation, tumor pathology, and whether an ALND was performed. Odds ratios (OR) were calculated to estimate the risk of a complication if an ALND was performed.
One hundred eighty-four women, with 270 surgically treated breasts, were identified as having mastectomy with immediate reconstruction between 2002 and 2012. Mean age was 49.4 years (range, 25-84 years). There were 71 mastectomies with ALND performed, with 22 complications, and 199 mastectomies without ALND, with 20 complications (31% complication rate vs 10%, respectively; OR, 3.84; P < 0.001). When adjusted for reconstruction type, smoking history, obesity, age, presence of invasive disease, chemotherapy, and radiation therapy, the OR for complications was 3.49 (P < 0.01). The most common complication was infection in both groups.
Mastectomy with ALND is associated with a 3-fold increase in risk of major complications in women undergoing immediate breast reconstruction, even after adjustment for known risk factors and confounders. Further studies are warranted to elucidate how ALND leads to these complications and what measures can reduce their occurrence.
即刻乳房重建术后的并发症给重建外科医生带来了重大挑战。已知的风险因素包括吸烟、肥胖、年龄和辅助肿瘤治疗。关于腋窝淋巴结清扫术（ALND）与术后并发症发生之间的关联，人们了解较少。
我们对在我院10年期间接受乳房切除术后即刻乳房重建的所有患者进行了一项回顾性研究。我们的观察指标是术后90天内发生的主要并发症。对于每位患者，我们记录了人口统计学、吸烟状况、相关病史、重建类型、辅助化疗和放疗、肿瘤病理以及是否进行了ALND的数据。计算比值比（OR）以估计进行ALND时发生并发症的风险。
在2002年至2012年期间，184名女性（共270个手术治疗乳房）被确定为接受了乳房切除术后即刻重建。平均年龄为49.4岁（范围25 - 84岁）。71例乳房切除术进行了ALND，发生22例并发症；199例乳房切除术未进行ALND，发生20例并发症（并发症发生率分别为31%和10%；OR为3.84；P < 0.001）。在对重建类型、吸烟史、肥胖、年龄、浸润性疾病的存在、化疗和放疗进行调整后，并发症的OR为3.49（P < 0.01）。两组中最常见的并发症均为感染。
对于接受即刻乳房重建的女性，即使在对已知风险因素和混杂因素进行调整后，乳房切除术加ALND与主要并发症风险增加3倍相关。有必要进一步研究以阐明ALND如何导致这些并发症以及哪些措施可以减少其发生。
