Virginia Mason Medical Center, Seattle, WA, USA.
John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA.
Am J Surg. 2019 May;217(5):851-856. doi: 10.1016/j.amjsurg.2019.01.004. Epub 2019 Jan 24.
Presence of multiple lesions and/or tumor span ≥5 cm are traditional indications for mastectomy. Patient desire for breast conservation has increased the interest in extreme oncoplastic breast conserving surgery (EOBCS) to avoid mastectomy; however, perioperative outcomes in this population have not been well described.
This is an observational cohort of breast cancer patients with multiple lesions and disease span ≥5 cm who underwent EOBCS. Patient demographics, disease span, margin width, mastectomy and re-excision rates, and cosmesis were evaluated.
One hundred-eleven patients underwent EOBCS between 2012 and 2017. Eighty-two patients presented with multifocal or multicentric disease with an average of 3.2 lesions per breast spanning 57.1 ± 23.6 mm. Eighteen patients presented with unifocal tumors measuring an average of 67.6 mm (range 50-160 mm) on imaging. Eleven patients with an imaging size of <5 cm had a disease span ≥5 cm on final pathology. No tumor on ink occurred in 87 (78.3%) patients. Fifty-seven (51.4%) patients had additional surgery for inadequate margins. Fifteen (12.6%) patients elected to have mastectomy while 42 (37.8%) patients opted for re-excision. Good to excellent cosmetic results were reported in 95% of patients who ultimately achieved breast conservation. Recurrence rate was 1.1% in patients who completed EOBCS and adjuvant radiation therapy.
EOBCS can allow for breast conservation in patients who are traditionally counseled to undergo mastectomy. Although the re-excision rate was significant, most patients ultimately achieved breast conservation with adequate margins. Further study is warranted to determine the long-term oncologic outcomes of this approach.
存在多个病灶和/或肿瘤跨度≥5cm 是传统的乳房切除术指征。由于患者对保乳的需求增加，因此对极端肿瘤整形保乳手术（EOBCS）的兴趣也增加了，以避免乳房切除术；然而，该人群的围手术期结果尚未得到很好的描述。
这是一项观察性队列研究，纳入了 111 例患有多个病灶和疾病跨度≥5cm 的乳腺癌患者，他们接受了 EOBCS。评估了患者的人口统计学特征、疾病跨度、切缘宽度、乳房切除术和再次切除术率以及美容效果。
在 2012 年至 2017 年间，有 111 例患者接受了 EOBCS。82 例患者表现为多灶性或多中心疾病，平均每侧乳房有 3.2 个病灶，跨越 57.1±23.6mm。18 例患者表现为单灶性肿瘤，影像学上平均大小为 67.6mm（范围 50-160mm）。11 例影像学大小<5cm 的患者，最终病理检查发现疾病跨度≥5cm。87 例（78.3%）患者的肿瘤未在墨水上出现。57 例（51.4%）患者因切缘不足而接受了额外的手术。15 例（12.6%）患者选择乳房切除术，而 42 例（37.8%）患者选择再次切除术。最终实现保乳的患者中有 95%报告了良好至极好的美容效果。完成 EOBCS 和辅助放疗的患者复发率为 1.1%。
EOBCS 可使传统上接受乳房切除术的患者保留乳房。尽管再次切除术的比例很高，但大多数患者最终通过足够的切缘实现了保乳。需要进一步研究来确定这种方法的长期肿瘤学结果。
