Ojala K, Meretoja T J, Leidenius M H K
Breast Surgery Unit, Comprehensive Cancer Center, Helsinki University Hospital and Helsinki University, Finland.
Breast Surgery Unit, Comprehensive Cancer Center, Helsinki University Hospital and Helsinki University, Finland.
Eur J Surg Oncol. 2017 Apr;43(4):658-664. doi: 10.1016/j.ejso.2016.11.019. Epub 2016 Dec 18.
Recent studies implicate that oncoplastic breast cancer surgery provides better aesthetic outcome than conventional resection. Several factors have been associated with poor aesthetic outcome. This study aims to compare patient-reported aesthetic and functional outcome after conventional and oncoplastic resection and to evaluate prognostic factors for poor aesthetic outcome in a population-based setting.
637 patients having breast conserving treatment (BCT) due to unilateral primary breast cancer at a single hospital district during 2010 were included. Aesthetic and functional outcome were evaluated using two questionnaires three years after surgery.
Questionnaires were returned by 379 (59%) patients; 293 (77%) of these had conventional and 86 (23%) oncoplastic resection. Patients in oncoplastic resection group had larger tumour diameter (p < 0.001), larger resection specimens (p < 0.001), and more often multifocal tumours (p = 0.032), node positive cancer (p = 0.029) and lower quadrant tumour localization (p = 0.007). Aesthetic outcome according to BCTOS questionnaire was good in 284 (75%) patients; 52 (61%) patients in the oncoplastic group and 230 patients (81%) in the conventional resection group, p < 0.001. Larger tumour diameter (p = 0.033), multifocality (p = 0.022), weight of resection specimen (<0.001) and oncoplastic surgery (p < 0.001) were predicting poor aesthetic outcome, when all patients were included. Tumour multifocality (p = 0.013) remained predictor of poor aesthetic outcome in conventional resection group but not in oncoplastic resection group.
Patient satisfaction to aesthetic outcome after BCT is high. Conventional resection provides good aesthetic outcome in appropriately selected patients. Oncoplastic resection enables BCT in patients with larger and multifocal tumours with favourable aesthetic outcome.
近期研究表明，肿瘤整形乳腺癌手术比传统切除术能带来更好的美学效果。有几个因素与不良美学效果相关。本研究旨在比较传统切除术和肿瘤整形切除术后患者报告的美学和功能结果，并评估基于人群的环境中不良美学效果的预后因素。
纳入2010年在单个医院区因单侧原发性乳腺癌接受保乳治疗（BCT）的637例患者。术后三年使用两份问卷评估美学和功能结果。
379例（59%）患者返回了问卷；其中293例（77%）接受了传统切除术，86例（23%）接受了肿瘤整形切除术。肿瘤整形切除组患者的肿瘤直径更大（p < 0.001），切除标本更大（p < 0.001），多灶性肿瘤更多见（p = 0.032），淋巴结阳性癌更多见（p = 0.029），肿瘤位于下象限的情况更多见（p = 0.007）。根据BCTOS问卷，美学效果良好的患者有284例（75%）；肿瘤整形组52例（61%）患者，传统切除组230例（81%）患者，p < 0.001。当纳入所有患者时，肿瘤直径更大（p = 0.033）、多灶性（p = 0.022）、切除标本重量（<0.001）和肿瘤整形手术（p < 0.001）预示着不良美学效果。在传统切除组中，肿瘤多灶性（p = 0.013）仍然是不良美学效果的预测因素，但在肿瘤整形切除组中不是。
BCT术后患者对美学效果的满意度较高。在适当选择的患者中，传统切除术能带来良好的美学效果。肿瘤整形切除术使更大和多灶性肿瘤的患者能够接受BCT，且美学效果良好。
