Lai Hung-Wen, Chen Shou-Tung, Chen Dar-Ren, Chen Shu-Ling, Chang Tsai-Wang, Kuo Shou-Jen, Kuo Yao-Lung, Hung Chin-Sheng
Endoscopy & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, No.135, Nanxiao Street, Changhua, 500 Taiwan (R.O.C.).
Division of General Surgery, Changhua Christian Hospital, No.135, Nanxiao Street, Changhua, 500 Taiwan (R.O.C.).
PLoS One. 2016 Mar 7;11(3):e0150310. doi: 10.1371/journal.pone.0150310. eCollection 2016.
Endoscopy-assisted breast surgery (EABS) performed through minimal axillary and/or periareolar incisions is a possible alternative to open surgery for certain patients with breast cancer. In this study, we report the early results of an EABS program in Taiwan.
The medical records of patients who underwent EABS for breast cancer during the period May 2009 to December 2014 were collected from the Taiwan Endoscopic Breast Surgery Cooperative Group database. Data on clinicopathologic characteristics, type of surgery, method of breast reconstruction, complications and recurrence were analyzed to determine the effectiveness and oncologic safety of EABS in Taiwan.
A total of 315 EABS procedures were performed in 292 patients with breast cancer, including 23 (7.8%) patients with bilateral disease. The number of breast cancer patients who underwent EABS increased initially from 2009 to 2012 and then stabilized during the period 2012-2014. The most commonly performed EABS was endoscopy-assisted total mastectomy (EATM) (85.4%) followed by endoscopy-assisted partial mastectomy (EAPM) (14.6%). Approximately 74% of the EATM procedures involved breast reconstruction, with the most common types of reconstruction being implant insertion and autologous pedicled TRAM flap surgery. During the six-year study period, there was an increasing trend in the performance of EABS for the management of breast cancer when total mastectomy was indicated. The positive surgical margin rate was 1.9%. Overall, the rate of complications associated with EABS was 15.2% and all were minor and wound-related. During a median follow-up of 26.8 (3.3-68.6) months, there were 3 (1%) cases of local recurrence, 1 (0.3%) case of distant metastasis and 1 (0.3%) death.
The preliminary results from the EABS program in Taiwan show that EABS is a safe procedure and results in acceptable cosmetic outcome. These findings could help to promote this under-used surgical technique in the field of breast cancer.
对于某些乳腺癌患者，通过腋窝和/或乳晕周围小切口进行的内镜辅助乳腺手术（EABS）是开放手术的一种可行替代方案。在本研究中，我们报告了台湾一项EABS项目的早期结果。
从台湾内镜乳腺手术协作组数据库中收集2009年5月至2014年12月期间接受EABS治疗乳腺癌患者的病历。分析临床病理特征、手术类型、乳房重建方法、并发症和复发情况的数据，以确定台湾EABS的有效性和肿瘤学安全性。
共对292例乳腺癌患者进行了315例EABS手术，其中23例（7.8%）为双侧疾病患者。2009年至2012年，接受EABS的乳腺癌患者数量最初有所增加，然后在2012 - 2014年期间趋于稳定。最常进行的EABS是内镜辅助全乳切除术（EATM）（85.4%），其次是内镜辅助部分乳切除术（EAPM）（14.6%）。大约74%的EATM手术涉及乳房重建，最常见的重建类型是植入物植入和自体带蒂腹直肌肌皮瓣手术。在为期六年的研究期间，对于需要进行全乳切除术的乳腺癌患者，EABS的实施有增加的趋势。手术切缘阳性率为1.9%。总体而言，EABS相关并发症发生率为15.2%，均为轻微且与伤口相关的并发症。在中位随访26.8（3.3 - 68.6）个月期间，有3例（1%）局部复发，1例（0.3%）远处转移和1例（0.3%）死亡。
台湾EABS项目的初步结果表明，EABS是一种安全的手术方法，美容效果可接受。这些发现有助于在乳腺癌领域推广这种未充分使用的手术技术。
