比较保乳术与预防性保乳术：适应证是否影响肿瘤学和重建结局？
Comparing Therapeutic versus Prophylactic Nipple-Sparing Mastectomy: Does Indication Inform Oncologic and Reconstructive Outcomes?
机构信息
From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health.
出版信息
Plast Reconstr Surg. 2018 Aug;142(2):306-315. doi: 10.1097/PRS.0000000000004548.
BACKGROUND
Initially performed only in prophylactic cases, indications for nipple-sparing mastectomy have expanded. Trends and surgical outcomes stratified by nipple-sparing mastectomy indication have not yet been fully examined.
METHODS
Demographics and outcomes for all nipple-sparing mastectomies performed from 2006 to 2017 were compared by mastectomy indication.
RESULTS
A total of 1212 nipple-sparing mastectomies were performed: 496 (40.9 percent) for therapeutic and 716 (59.1 percent) for prophylactic indications. Follow-up time was similar between both the therapeutic and prophylactic nipple-sparing mastectomy groups (47.35 versus 46.83 months, respectively; p = 0.7942). Therapeutic nipple-sparing mastectomies experienced significantly greater rates of major (p = 0.0165) and minor (p = 0.0421) infection, implant loss (p = 0.0098), reconstructive failure (p = 0.0058), and seroma (p = 0.0043). Rates of major (p = 0.4461) and minor (p = 0.2673) mastectomy flap necrosis and complete (p = 0.3445) and partial (p = 0.7120) nipple necrosis were equivalent. The overall rate of locoregional recurrence/occurrence per nipple-sparing mastectomy was 0.9 percent: 2.0 percent in therapeutic nipple-sparing mastectomies and 0.1 percent in prophylactic nipple-sparing mastectomies (p < 0.0001).
CONCLUSIONS
Approximately 40 percent of nipple-sparing mastectomies are currently performed for therapeutic indications. Therapeutic nipple-sparing mastectomies had higher rates of infectious complications and reconstructive failure. Rates of locoregional cancer recurrence/occurrence are low, but occur significantly more often after therapeutic nipple-sparing mastectomy.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
背景
最初仅在预防性病例中进行，保留乳头的乳房切除术的适应证已扩大。但是，按保留乳头的乳房切除术适应证分层的趋势和手术结果尚未得到充分研究。
方法
通过乳房切除术适应证比较了 2006 年至 2017 年期间所有保留乳头的乳房切除术患者的人口统计学和结果。
结果
共进行了 1212 例保留乳头的乳房切除术：496 例（40.9％）为治疗性，716 例（59.1％）为预防性。治疗性和预防性保留乳头的乳房切除术组之间的随访时间相似（分别为 47.35 个月和 46.83 个月；p = 0.7942）。治疗性保留乳头的乳房切除术发生重大（p = 0.0165）和轻微（p = 0.0421）感染，植入物丢失（p = 0.0098），重建失败（p = 0.0058）和血清肿（p = 0.0043）的发生率明显更高。重大（p = 0.4461）和轻微（p = 0.2673）乳房切除术皮瓣坏死以及完全（p = 0.3445）和部分（p = 0.7120）乳头坏死的发生率相等。每例保留乳头的乳房切除术的局部区域复发/发生的总体发生率为 0.9％：治疗性保留乳头的乳房切除术为 2.0％，预防性保留乳头的乳房切除术为 0.1％（p <0.0001）。
结论
目前，约有 40％的保留乳头的乳房切除术是出于治疗性适应证。治疗性保留乳头的乳房切除术有更高的感染性并发症和重建失败的发生率。局部区域癌症复发/发生的发生率较低，但在治疗性保留乳头的乳房切除术后发生的频率明显更高。
临床问题/证据水平：治疗性，III 级。
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