Oh D D, Flitcroft K, Brennan M E, Spillane A J
Breast and Surgical Oncology, The Poche Centre, 40 Rocklands Rd, North Sydney, New South Wales, Australia.
Breast and Surgical Oncology, The Poche Centre, 40 Rocklands Rd, North Sydney, New South Wales, Australia; Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
Eur J Surg Oncol. 2016 May;42(5):604-15. doi: 10.1016/j.ejso.2016.02.010. Epub 2016 Feb 18.
Older age is associated with lower rates of breast reconstruction (BR) for women requiring mastectomy. The purpose was to assess the available evidence on uptake, outcome and quality of life (QoL) after BR in older women.
A systematic literature review was performed via Medline, Embase and Cochrane databases using the search terms breast reconstruction, breast cancer, and mastectomy. Eligible studies reported rates of BR, rates of different reconstructive techniques, complication rates, and/or patient reported outcome measures (PROMs) of BR in women aged 60 years or older undergoing mastectomy for ductal carcinoma in situ or invasive carcinoma.
A total of 42 eligible studies were included, with 32 of these reporting BR rates, 10 reporting rates of different reconstructive techniques, 10 reporting rates of complications, and four reporting PROMs. The studies reported 24,746 cases of BR in 407,570 mastectomy patients aged 60 years or older from 1987 to 2012. Implant based BR was more common than autologous techniques. Mostly, complication rates were not higher in older women, and QoL outcomes were similar to younger women.
This review confirms that BR rates are lower in older women despite recent studies demonstrating its efficacy. The perception among some surgeons and women requiring mastectomy that the potential risks of BR in older women outweigh the benefits needs to be revisited. Education of consumers and surgeons along with public advocacy for offering BR to all clinically eligible women are the most promising means of changing practice.
对于需要进行乳房切除术的女性，年龄较大与乳房重建（BR）率较低相关。本研究旨在评估老年女性乳房重建术后的接受情况、结局及生活质量（QoL）的现有证据。
通过Medline、Embase和Cochrane数据库进行系统文献综述，检索词为乳房重建、乳腺癌和乳房切除术。纳入的合格研究报告了60岁及以上因原位导管癌或浸润性癌接受乳房切除术的女性的乳房重建率、不同重建技术的使用率、并发症发生率和/或乳房重建的患者报告结局指标（PROMs）。
共纳入42项合格研究，其中32项报告了乳房重建率，10项报告了不同重建技术的使用率，10项报告了并发症发生率，4项报告了患者报告结局指标。这些研究报告了1987年至2012年间407,570例60岁及以上乳房切除术患者中的24,746例乳房重建病例。基于植入物的乳房重建比自体技术更常见。大多数情况下，老年女性的并发症发生率并不更高，生活质量结局与年轻女性相似。
本综述证实，尽管近期研究表明乳房重建有效，但老年女性的乳房重建率较低。一些外科医生和需要进行乳房切除术的女性认为老年女性乳房重建的潜在风险大于益处，这一观念需要重新审视。对消费者和外科医生进行教育，以及开展公众宣传以向所有符合临床条件的女性提供乳房重建，是改变实践的最有前景的方法。
