与即刻全乳重建相比，肥胖女性保乳手术后行肿瘤整形乳房修复的并发症更少。
Obese Women Experience Fewer Complications after Oncoplastic Breast Repair following Partial Mastectomy Than after Immediate Total Breast Reconstruction.
作者信息
Tong Winnie M Y, Baumann Donald P, Villa Mark T, Mittendorf Elizabeth A, Liu Jun, Robb Geoffrey L, Kronowitz Steven J, Garvey Patrick B
机构信息
Houston, Texas From the Departments of Plastic Surgery and Breast Surgical Oncology, The University of Texas M. D. Anderson Cancer Center.
出版信息
Plast Reconstr Surg. 2016 Mar;137(3):777-791. doi: 10.1097/01.prs.0000479939.69211.19.
BACKGROUND
The authors hypothesized that obese patients would experience fewer complications after oncoplastic breast reconstruction following partial mastectomy than after immediate breast reconstruction following total mastectomy.
METHODS
Complication rates were compared for oncoplastic breast reconstruction versus immediate breast reconstruction (with either implants or autologous tissue) in consecutive obese patients (body mass index ≥ 30 kg/m(2)) treated at a single center between January of 2005 and April of 2013. Logistic regression was used to analyze the associations between patient and surgical characteristics and postoperative outcomes.
RESULTS
The study included 408 patients: 131 oncoplastic breast reconstruction and 277 immediate breast reconstruction patients. Presenting breast cancer stage was similar between the two groups. Oncoplastic breast reconstruction patients were older (55 years versus 53 years; p = 0.029), more obese (average body mass index, 37 kg/m(2) versus 35 kg/m(2); p < 0.001), and had more comorbidities. Nevertheless, the oncoplastic breast reconstruction group experienced fewer major complications requiring operative management (3.8 percent versus 28.5 percent; p < 0.001), fewer complications delaying adjuvant therapy (0.8 percent versus 14.4 percent; p < 0.001), and fewer incidences of hematoma/seroma formation (3.1 percent versus 11.6 percent; p < 0.004) than the immediate total breast reconstruction group. Univariate analysis found oncoplastic breast reconstruction to be an independent protector against major complications (OR, 0.1; p < 0.001) and complications that delayed adjuvant therapy (OR, 0.05; p = 0.002).
CONCLUSION
Oncoplastic breast reconstruction likely represents a safer option than immediate total breast reconstruction following mastectomy for obese patients, particularly for patients who are superobese or present with preexisting medical comorbidities.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
背景
作者推测，与全乳切除术后即刻乳房重建相比，肥胖患者保乳术后肿瘤整形乳房重建的并发症更少。
方法
比较2005年1月至2013年4月在单一中心接受治疗的连续肥胖患者（体重指数≥30kg/m²）肿瘤整形乳房重建与即刻乳房重建（使用植入物或自体组织）的并发症发生率。采用逻辑回归分析患者和手术特征与术后结果之间的关联。
结果
该研究纳入408例患者：131例肿瘤整形乳房重建患者和277例即刻乳房重建患者。两组的乳腺癌分期相似。肿瘤整形乳房重建患者年龄更大（55岁对53岁；p = 0.029），更肥胖（平均体重指数，37kg/m²对35kg/m²；p < 0.001），合并症更多。然而，与即刻全乳重建组相比，肿瘤整形乳房重建组需要手术处理的主要并发症更少（3.8%对28.5%；p < 0.001），延迟辅助治疗的并发症更少（0.8%对14.4%；p < 0.001），血肿/血清肿形成的发生率更低（3.1%对11.6%；p < 0.004）。单因素分析发现肿瘤整形乳房重建是预防主要并发症（OR，0.1；p < 0.001）和延迟辅助治疗并发症（OR，0.05；p = 0.002）的独立保护因素。
结论
对于肥胖患者，尤其是超级肥胖或有基础合并症的患者，肿瘤整形乳房重建可能比全乳切除术后即刻全乳重建是更安全的选择。
临床问题/证据级别：治疗性，III级
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