Broecker Justine S, Hart Alexandra M, Styblo Toncred M, Losken Albert
From the *Emory University School of Medicine, †Department of Plastic Surgery, and ‡Department of Surgical Oncology, Emory University School of Medicine, Atlanta, GA.
Ann Plast Surg. 2017 Jun;78(6S Suppl 5):S258-S262. doi: 10.1097/SAP.0000000000001062.
Oncoplastic surgery has been shown to be a good alternative to breast conservation surgery (BCS) alone for patients with breast cancer. Its role in patients with advanced disease is unclear. In this study, we evaluate the safety of oncoplastic BCS (OBCS) in patients who received neoadjuvant therapy (NT) for high stage breast cancer.
The oncologic outcomes of consecutive patients classified as high stage (>T2 or at least N1) who received NT followed by BCS at EUH by a single breast surgeon (T.M.S.) from September 2004 until June 2015 were compared with those who received BCS combined with an oncoplastic reduction. Patients were surveyed using the BREAST-Q to determine their satisfaction after surgery.
A total of 87 patients were included in this series. The mean initial tumor size (4.37 vs 2.56 cm), the weight of the surgical specimen, and the post-NT tumor size were all larger in the OBCS group as compared with BCS alone (1.54 vs 1.29 cm). The mean follow-up was 44 months. The average percent reduction in tumor size in response to NT was slightly greater in the OBCS group (61 vs 52%). Oncologic outcomes were similar for OBCS reduction and BCS groups, respectively: positive margin rate, reexcision rate, completion mastectomy rate, local recurrence rate, and 5-year DSS. Patient satisfaction was similar between the 2 groups.
The oncoplastic approach in high stage patients treated with neoadjuvant systemic Powered by Editorial Manager and ProduXion Manager from Aries Systems Corporation therapy appears to be as safe and effective when compared to BCS alone. Oncoplastic BCS paired with NT broadens the indication for BCS for patients with larger tumor size.
对于乳腺癌患者，肿瘤整形手术已被证明是单纯保乳手术（BCS）的一种良好替代方案。其在晚期疾病患者中的作用尚不清楚。在本研究中，我们评估了接受新辅助治疗（NT）的高分期乳腺癌患者进行肿瘤整形保乳手术（OBCS）的安全性。
比较2004年9月至2015年6月期间在伊拉斯姆斯大学医学中心（EUH）由一位乳腺外科医生（T.M.S.）对连续分类为高分期（>T2或至少N1）且接受NT后行BCS的患者与接受BCS联合肿瘤整形缩小术的患者的肿瘤学结局。使用BREAST-Q对患者进行调查以确定其术后满意度。
本系列共纳入87例患者。与单纯BCS组相比，OBCS组的平均初始肿瘤大小（4.37 vs 2.56 cm）、手术标本重量及NT后肿瘤大小均更大（1.54 vs 1.29 cm）。平均随访时间为44个月。OBCS组对NT反应的肿瘤大小平均缩小百分比略高于单纯BCS组（61% vs 52%）。OBCS缩小术组和BCS组的肿瘤学结局相似，分别为：切缘阳性率、再次切除率、乳房切除完成率、局部复发率和5年无病生存率。两组患者满意度相似。
与单纯BCS相比，新辅助全身治疗的高分期患者采用肿瘤整形方法似乎同样安全有效。肿瘤整形BCS联合NT拓宽了肿瘤较大患者的BCS适应证。
