Blankensteijn Louise L, Crystal Dustin T, Egeler Sabine A, Varkevisser Rens R B, Ibrahim Ahmed M S, Sharma Ranjna, Lee Bernard T, Lin Samuel J
Department of Surgery, Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
Plast Reconstr Surg Glob Open. 2019 May 3;7(5):e2248. doi: 10.1097/GOX.0000000000002248. eCollection 2019 May.
The integration of oncological surgery with reconstructive techniques has gained popularity in the treatment of breast cancer. oncoplastic reconstruction after partial mastectomy can be performed by the breast surgeon or in cooperation with a consulted plastic surgeon. This study aims to objectively assess the differences in outcomes for partial mastectomy and subsequent oncoplastic reconstruction performed by either general surgery alone or in combination with a plastic and reconstructive surgery team.
Unilateral oncoplastic breast reconstruction cases were extracted from the National Surgical Quality Improvement Program databases from 2005 to 2017. Outcomes of cases performed by the general surgery team alone were compared with those in which the partial mastectomy was performed by the general surgeon with subsequent reconstruction performed by plastic surgeons. To account for cohort baseline differences, propensity score-matched analysis was performed.
In total, 4,350 patients were included in this study; 3,759 procedures were performed by general surgery alone versus 591 combined with plastic surgery. The analysis of propensity score-matched cohorts, comprising 490 patients each, showed no statistical difference in the risk for postoperative complications when surgery was performed by either of the 2 specialty services. A longer operative time and length of stay were found in the group reconstructed by plastic surgeons.
This study found no significant differences in adverse postoperative outcomes for oncoplastic reconstructions after partial mastectomy between the 2 groups. The data may indicate collaboration between both surgical specialties in oncoplastic breast care was not associated with increased morbidity in these patients.
肿瘤外科手术与重建技术的结合在乳腺癌治疗中越来越受欢迎。保乳手术后的肿瘤整形重建可由乳腺外科医生单独进行，或与会诊的整形外科医生合作完成。本研究旨在客观评估单纯由普通外科进行保乳手术及后续肿瘤整形重建，与普通外科联合整形重建外科团队进行手术的结果差异。
从2005年至2017年的国家外科质量改进计划数据库中提取单侧肿瘤整形乳房重建病例。将普通外科团队单独进行手术的病例结果与普通外科医生进行保乳手术，随后由整形外科医生进行重建的病例结果进行比较。为了考虑队列基线差异，进行了倾向评分匹配分析。
本研究共纳入4350例患者；单纯普通外科进行了3759例手术，与整形外科联合进行了591例手术。对每组490例患者的倾向评分匹配队列分析显示，两种专科服务进行手术时，术后并发症风险无统计学差异。整形外科医生重建的组手术时间和住院时间更长。
本研究发现两组保乳术后肿瘤整形重建的术后不良结局无显著差异。数据可能表明，这两个外科专科在肿瘤整形乳房护理方面的合作与这些患者发病率增加无关。
