Frisell A, Lagergren J, de Boniface J
Department of Emergency Medicine and Surgery, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden.
Br J Surg. 2016 Nov;103(12):1640-1648. doi: 10.1002/bjs.10286. Epub 2016 Aug 23.
Reconstructive alternatives should be discussed with women facing mastectomy for breast cancer. These include immediate and delayed reconstruction, which both have inherent advantages and disadvantages. Immediate reconstruction rates vary considerably in Swedish healthcare regions, and the aim of the study was to analyse reasons for this disparity.
All women who underwent mastectomy for primary breast cancer in Sweden in 2013 were included. Tumour data were retrieved from the Swedish National Breast Cancer Registry and from questionnaires regarding patient information and involvement in preoperative decision-making sent to women who were still alive in 2015.
Of 2929 women who had undergone 2996 mastectomies, 2906 were still alive. The questionnaire response rate was 76·3 per cent. Immediate reconstruction rates varied regionally, between 3·0 and 26·4 per cent. Tumour characteristics impacted on reconstruction rates but did not explain regional differences. Patient participation in decision-making, availability of plastic surgery services and patient information, however, were independent predictors of immediate breast reconstruction, and varied significantly between regions. Even in younger patients with low-risk tumours, rates of patient information ranged between 34·3 and 83·3 per cent.
Significant regional differences in immediate reconstruction rates were not explained by differences in tumour characteristics, but by disparities in patient information, availability of plastic surgery services and involvement in decision-making.
对于面临乳腺癌乳房切除术的女性，应讨论重建方案。这些方案包括即刻重建和延迟重建，二者都有其固有的优缺点。瑞典各医疗保健地区的即刻重建率差异很大，本研究旨在分析造成这种差异的原因。
纳入2013年在瑞典因原发性乳腺癌接受乳房切除术的所有女性。肿瘤数据从瑞典国家乳腺癌登记处获取，并通过向2015年仍在世的女性发送的关于患者信息和参与术前决策的问卷收集。
在接受了2996次乳房切除术的2929名女性中，2906人仍在世。问卷回复率为76.3%。即刻重建率存在地区差异，在3.0%至26.4%之间。肿瘤特征影响重建率，但无法解释地区差异。然而，患者参与决策、整形手术服务的可及性和患者信息是即刻乳房重建的独立预测因素，且地区间差异显著。即使是患有低风险肿瘤的年轻患者，患者信息获取率也在34.3%至83.3%之间。
即刻重建率的显著地区差异并非由肿瘤特征差异所致，而是由患者信息、整形手术服务可及性和参与决策的差异造成的。
