Ebner Florian, Friedl Thomas W P, de Gregorio Amelie, Lato Krisztian, Bekes Inga, Janni Wolfgang, de Gregorio Nikolaus
Klinik für Frauenheilkunde und Geburtshilfe, Universität Ulm, Prittwitzstr. 43, 89075, Ulm, Germany.
Arch Gynecol Obstet. 2018 Nov;298(5):951-959. doi: 10.1007/s00404-018-4880-8. Epub 2018 Sep 8.
Despite a trend for less radical surgical approaches in breast cancer due to better understanding of tumour biology and new treatment options such as neoadjuvant chemotherapy (NAC) and intra-operative radiotherapy (IORT), seroma production remains one of the main surgical side effects that can result in prolonged recovery, delay of radiotherapy and patient discomfort. The aim of this study is to provide an update on risk factors for seroma production after breast cancer surgery considering the latest treatment options.
A retrospective analysis of seroma production in primary breast cancer patients treated between 01.01.2010 and 31.12.2014 at the Breast Cancer Centre, University Hospital Ulm, was performed. Patients with previous breast/axillary surgery or more than one intervention were excluded. Seroma formation was measured using wound drains placed in breast and axilla.
In total, 581 patients met the inclusion criteria. Median age at diagnosis was 60 years, and median BMI 25.6 kg/m. 60 (10.3%) patients had a mastectomy, 175 (30.1%) patients received IORT, and 72 (12.4%) patients received NAC. Median amount of seroma production was 82.5 ml (range 0-3012.5 ml). Multivariate analysis revealed that most of the observed variation in seroma production was due to type of surgery (mastectomy vs. breast conserving), length of surgery and number of removed lymph nodes. Both NAC and IORT explained a significant but very small amount of the observed variation in seroma production.
The most important factors for seroma production are extent and duration of breast surgery.
尽管由于对肿瘤生物学的更好理解以及新的治疗选择（如新辅助化疗（NAC）和术中放疗（IORT）），乳腺癌手术的激进程度呈下降趋势，但血清肿形成仍然是主要的手术副作用之一，可导致恢复时间延长、放疗延迟和患者不适。本研究的目的是根据最新的治疗选择，提供关于乳腺癌手术后血清肿形成危险因素的最新信息。
对2010年1月1日至2014年12月31日在乌尔姆大学医院乳腺癌中心接受治疗的原发性乳腺癌患者的血清肿形成情况进行回顾性分析。排除既往有乳腺/腋窝手术史或接受过不止一次干预的患者。使用置于乳房和腋窝的伤口引流管测量血清肿形成情况。
共有581例患者符合纳入标准。诊断时的中位年龄为60岁，中位体重指数为25.6kg/m²。60例（10.3%）患者接受了乳房切除术，175例（30.1%）患者接受了术中放疗，72例（12.4%）患者接受了新辅助化疗。血清肿形成的中位量为82.5ml（范围0-3012.5ml）。多变量分析显示，观察到的血清肿形成差异大多归因于手术类型（乳房切除术与保乳手术）、手术时长和切除淋巴结数量。新辅助化疗和术中放疗均解释了观察到的血清肿形成差异中的显著但非常小的一部分。
血清肿形成的最重要因素是乳房手术的范围和时长。
