Mays Simone, Alabdulkareem Hanan, Christos Paul, Simmons Rache, Moo Tracy-Ann
New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.
New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.
Am J Surg. 2017 Nov;214(5):904-906. doi: 10.1016/j.amjsurg.2017.03.041. Epub 2017 Apr 5.
Approximately 4% of women age 70 will develop breast cancer during the next ten years. Reconstruction has become a standard option for young women undergoing mastectomy for breast cancer, however may not be offered to older women due to the presence of co-morbidities. There is limited data on the outcomes of mastectomy with reconstruction in patient's ≥ 70. This study examines comorbidities and 30-day complication rates in patients ≥70 undergoing mastectomy for breast cancer.
The American College of Surgeons National Surgery Quality Improvement Program database was used to examine co-morbidities and 30-day complication rates in breast cancer patients undergoing mastectomy from 2007 to 2012. Patients were grouped based on age and procedure. Complication rates were characterized using descriptive statistics and Wilcoxon rank sum-test. Variable frequencies were compared using Chi-square or Fisher's exact test.
54,821 patients underwent mastectomy. Among patients ≥70, 11,927 did not have reconstruction, 109 had reconstruction. Among patients <70, 40,755 did not have reconstruction and 2040 had reconstruction. Patients without reconstruction had a significantly higher number of co-morbidities compared to those having reconstruction (P = 0.001). The 30-day complication rate for patients without reconstruction was 4.2% in patients ≥70 compared to 4.4% for those <70 (p = 0.4). In patients with reconstruction, the 30-day complication rate was 6.4% in patients ≥70 compared to 5.6% for those <70 (p = 0.7).
There was no difference in 30-day complication rate between patients ≥70 and < 70 having mastectomy with and without reconstruction. Similar outcomes among women ≥70 years and younger patients undergoing reconstruction may reflect patient selection based on co-morbidities. With appropriate risk stratification, breast reconstruction may be a safe surgical option for women ≥70 year patients undergoing treatment for breast cancer.
70岁的女性在未来十年中约有4%会患乳腺癌。乳房重建已成为接受乳腺癌乳房切除术的年轻女性的标准选择，但由于存在合并症，老年女性可能无法获得该选择。关于70岁及以上患者乳房切除术后乳房重建的结果的数据有限。本研究调查了70岁及以上接受乳腺癌乳房切除术患者的合并症和30天并发症发生率。
利用美国外科医师学会国家外科质量改进计划数据库，调查2007年至2012年接受乳房切除术的乳腺癌患者的合并症和30天并发症发生率。患者根据年龄和手术方式分组。并发症发生率采用描述性统计和Wilcoxon秩和检验进行分析。变量频率采用卡方检验或Fisher精确检验进行比较。
54,821例患者接受了乳房切除术。在70岁及以上的患者中，11,927例未进行乳房重建，109例进行了乳房重建。在70岁以下的患者中，40,755例未进行乳房重建，2040例进行了乳房重建。未进行乳房重建的患者合并症数量明显多于进行乳房重建的患者（P = 0.001）。70岁及以上未进行乳房重建的患者30天并发症发生率为4.2%，70岁以下患者为4.4%（p = 0.4）。在进行乳房重建的患者中，70岁及以上患者30天并发症发生率为6.4%，70岁以下患者为5.6%（p = 0.7）。
70岁及以上和70岁以下接受或未接受乳房重建的乳房切除术患者的30天并发症发生率没有差异。70岁及以上女性和年轻患者进行乳房重建的相似结果可能反映了基于合并症的患者选择。通过适当的风险分层，乳房重建对于70岁及以上接受乳腺癌治疗的女性患者可能是一种安全的手术选择。
