Ho Weiguang, Stallard Sheila, Doughty Julie, Mallon Elizabeth, Romics Laszlo
The New Victoria Infirmary, Glasgow, Scotland, UK.
Gartnavel General Hospital, Glasgow, Scotland, UK.
Breast Cancer (Auckl). 2016 Dec 19;10:223-228. doi: 10.4137/BCBCR.S41017. eCollection 2016.
Oncoplastic breast conservation surgery (OBCS) combines the principles of surgical oncology and plastic surgery. OBCS has now become a growing option for the treatment of breast cancer and forms a part of breast-conserving therapy (BCT). We sought to investigate and report our experience in two breast units in Glasgow (Victoria Infirmary and Western Infirmary) on volume replacement OBCS.
Details of patients treated with volume replacement OBCS were identified from a prospectively recorded database from November 2010 to October 2015. The clinical records included in the oncoplastic dataset were analyzed for demographics, tumor, treatment characteristics, and recurrences. The data were analyzed for follow-up to determine the pattern and timing of recurrence up to April 2016. The primary outcome of this study was tumor-free margin resection rates, and the secondary outcomes were locoregional and distant recurrence rates as these correlate with the overall oncological safety of volume replacement oncoplastic breast surgery (OPBS).
A total of 30 volume replacement oncoplastic breast conservation procedures have been carried out in this time period. The mean age of the former group was 51 years. Twice as many patients presented symptomatically than had tumors detected on screening. The mean preoperative tumor size on radiology was 25.4 mm. Patients underwent 13 thoracoepigastric flaps, 5 lateral intercostal artery perforator (LICAP) flaps, 2 thoracodorsal artery perforator (TDAP) flaps, 1 lateral thoracic artery perforator (LTAP) flap, 1 crescent flap volume replacement surgery, and 8 matrix rotations. Two patients had neoadjuvant chemotherapy. Fourteen patients had adjuvant chemotherapy, and all patients were treated with adjuvant radiotherapy. Twenty-two patients were treated with hormonal therapy and four patients were treated with Herceptin. The rate of incomplete excision was 10%. Median follow-up time was 48.5 months. Only one regional recurrence was detected. Eight patients encountered some form of complication.
This study continues to show the relative oncological safety of volume replacement oncoplastic conservations as an option for reconstruction in breast cancer patients. Further research is urgently needed to build robust evidence supporting the long-term oncological safety.
肿瘤整形保乳手术（OBCS）结合了外科肿瘤学和整形外科学的原则。OBCS现已成为治疗乳腺癌的一种越来越受欢迎的选择，并构成了保乳治疗（BCT）的一部分。我们试图调查并报告我们在格拉斯哥的两个乳腺科（维多利亚医院和西部医院）进行容积替代OBCS的经验。
从2010年11月至2015年10月前瞻性记录的数据库中确定接受容积替代OBCS治疗的患者的详细信息。对肿瘤整形数据集中包含的临床记录进行人口统计学、肿瘤、治疗特征和复发情况分析。对数据进行随访分析，以确定截至2016年4月的复发模式和时间。本研究的主要结局是切缘无瘤切除率，次要结局是局部区域和远处复发率，因为这些与容积替代肿瘤整形保乳手术（OPBS）的总体肿瘤学安全性相关。
在此期间共进行了30例容积替代肿瘤整形保乳手术。前一组患者的平均年龄为51岁。有症状就诊的患者数量是筛查发现肿瘤患者的两倍。术前影像学检查的肿瘤平均大小为25.4毫米。患者接受了13例胸脐皮瓣、5例肋间外侧动脉穿支（LICAP）皮瓣、2例胸背动脉穿支（TDAP）皮瓣、1例胸外侧动脉穿支（LTAP）皮瓣、1例新月形皮瓣容积替代手术和8例基质旋转手术。2例患者接受了新辅助化疗。14例患者接受了辅助化疗，所有患者均接受了辅助放疗。22例患者接受了激素治疗，4例患者接受了赫赛汀治疗。不完全切除率为10%。中位随访时间为48.5个月。仅检测到1例局部区域复发。8例患者出现了某种形式的并发症。
本研究继续表明容积替代肿瘤整形保乳术作为乳腺癌患者重建选择的相对肿瘤学安全性。迫切需要进一步研究以建立支持长期肿瘤学安全性的有力证据。
