From the Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan.
Department of Breast Surgery, Yunnan Province Cancer Hospital and Third Affiliated Hospital of Kunming School of Medicine, Kunming, China.
Ann Plast Surg. 2020 Mar;84(3):293-299. doi: 10.1097/SAP.0000000000002000.
Despite improvements in the early detection of breast cancer, locally advanced breast cancer (LABC) involving the chest wall exists in developing countries. Surgical resection remains a controversial management option. This study aims to demonstrate the value of chest wall reconstructive techniques for large LABC defects and report long-term outcomes.
We report a 10-years single-unit experience in the reconstruction of large defects (>300 cm). From 2007 to 2017, all LABC cases managed with large surgical resection with immediate microsurgical chest wall reconstruction were included in this study. Herein, we present the demographics, comorbidities, clinicopathological LABC characteristics, surgical techniques (free flap choice, recipient vessels), and outcomes (survival, complication, cosmesis, and patient satisfaction).
Of the 104 LABC cases, free deep inferior epigastric artery perforator flap was performed in 41 (39.4%) cases, free anterolateral thigh flap in 5 (4.8%), free deep inferior epigastric artery perforator combined with pedicled transverse rectus abdominis myocutaneous (TRAM) flap in 23 (22.1%), free muscle-sparing transverse rectus abdominis muscle flap in 30 (28.9%), and free transverse upper gracilis flap in 5 (4.8%). Complications were low. Over a median follow-up of 49.5 months, the 3-year local recurrence rate and distant metastasis-free survival were 13.9% and 84.9%, respectively. In addition, the 3-year disease-free survival and overall survival were 84.2% and 92.0%, respectively. The rate of excellent and good ratings by the esthetic assessment panel was 83.0%, and the patient satisfaction rate was 90.0%.
Wide resection and microvascular free tissue transfer is oncologically safe in LABC with huge tumors and provides versatile solutions for the reconstruction of extensive chest wall defects. With favorable long-term survival and cosmetic outcomes, surgical resection of LABC combined with flap reconstruction may offer a practical approach in difficult and complicated cases.
In this retrospective review, it was demonstrated that wide resection followed by distinct chest wall reconstructive free flaps transfer is oncologically safe in LABC with huge tumors and provides useful solutions for the reconstruction of extensive chest wall defects.
尽管乳腺癌的早期检测有所改善，但发展中国家仍存在累及胸壁的局部晚期乳腺癌（LABC）。手术切除仍然是一个有争议的治疗选择。本研究旨在展示胸壁重建技术在治疗大的 LABC 缺陷方面的价值，并报告长期结果。
我们报告了一个 10 年的单一单位经验，涉及用大的手术切除联合即刻显微外科胸壁重建治疗大的缺陷（>300cm）。2007 年至 2017 年，所有接受大的手术切除并立即进行显微外科胸壁重建的 LABC 病例均纳入本研究。在此，我们介绍了人口统计学、合并症、临床病理 LABC 特征、手术技术（游离皮瓣选择、受区血管）和结果（生存、并发症、美容效果和患者满意度）。
在 104 例 LABC 病例中，41 例（39.4%）采用游离深部下腹壁穿支皮瓣，5 例（4.8%）采用游离股前外侧皮瓣，23 例（22.1%）采用游离深部下腹壁穿支皮瓣联合带蒂横形腹直肌肌皮瓣，30 例（28.9%）采用游离保留肌肉的横形腹直肌肌皮瓣，5 例（4.8%）采用游离横形上骼腰肌皮瓣。并发症发生率较低。中位随访 49.5 个月时，3 年局部复发率和远处无转移生存率分别为 13.9%和 84.9%。此外，3 年无病生存率和总生存率分别为 84.2%和 92.0%。美容评估小组的优良率为 83.0%，患者满意度为 90.0%。
广泛切除和游离组织瓣转移在巨大肿瘤的 LABC 中是肿瘤学上安全的，并为广泛的胸壁缺损提供了多种解决方案。广泛切除 LABC 联合皮瓣重建可获得良好的长期生存和美容效果，为复杂病例提供了一种实用的方法。
在这项回顾性研究中，我们证明了在巨大肿瘤的 LABC 中，广泛切除联合游离胸壁重建皮瓣转移是肿瘤学上安全的，并为广泛的胸壁缺损提供了有用的解决方案。
