Division of Plastic & Reconstructive Surgery, Western University, London, Ontario, Canada.
Division of General Surgery, University of Toronto, Toronto, Ontario, Canada.
Breast J. 2020 Mar;26(3):446-453. doi: 10.1111/tbj.13500. Epub 2019 Sep 17.
In the last decade, there has been an increase in women undergoing immediate breast reconstruction (IBR) at the time of mastectomy. Recent literature suggests a shift in practice: Surgeons are becoming more comfortable with IBR in the setting of possible postoperative adjuvant radiotherapy, despite the known complications. This study sought to investigate, at a population level, the patient and surgeon characteristics associated with the use of IBR and which of these factors were predictive of adjuvant radiotherapy. This retrospective population-based cohort study included all adult women who underwent mastectomy in the province of Ontario from 2007 to 2014. The Canadian Institute for Health Information (CIHI) administrative data base was used to generate patient demographic and clinical data. The Ontario Health Insurance Plan (OHIP) data base was used to elicit surgeon characteristics including clinical experience and volume of practice dedicated to breast surgery. Outcome variables included reconstruction concurrent with mastectomy, alloplastic vs autologous reconstruction, and use of radiation. A total of 25 861 patients underwent mastectomy and 2972 had IBR (11.5%). The rate of IBR after mastectomy increased over time from 7.2% in 2007 to 17.2% in 2014 (P < .001). There was also an increase in the proportion of patients with IBR who received radiation over the time period, from 19.4% in 2007 to 28.2% in 2014 (P = .003). In the first regression analysis, IBR was associated with younger patient age, residing in closer proximity to cancer clinics, absence of malignant breast disease (ie, prophylactic mastectomy), having a younger surgeon performing the mastectomy, and receiving care at a teaching hospital. A second analysis showed that patient variables predictive of radiation after IBR were a younger age and a more advanced cancer stage and no variables specific to surgeon or institution were predictive of radiation in patients with IBR. A significant increase in the rate of IBR as well as the use of radiation occurred over the 7-year study period. Multiple patient and surgeon factors were associated with IBR. Variables associated with radiation in IBR were harder to predict. Given the increase in the use of radiation in IBR, further research is needed to look at long-term outcomes in these patients at the population level.
在过去的十年中，越来越多的女性在接受乳房切除术时选择同期进行即刻乳房重建（IBR）。最近的文献表明，尽管存在已知的并发症，但外科医生在可能接受术后辅助放疗的情况下对 IBR 的接受程度有所提高。本研究旨在通过人群水平研究与 IBR 应用相关的患者和外科医生特征，以及这些因素中哪些因素可以预测辅助放疗。本回顾性基于人群的队列研究纳入了 2007 年至 2014 年间在安大略省接受乳房切除术的所有成年女性。加拿大健康信息研究所（CIHI）的行政数据库用于生成患者人口统计学和临床数据。安大略省医疗保险计划（OHIP）数据库用于获取外科医生的特征，包括临床经验和专门从事乳房手术的工作量。结果变量包括乳房切除术同期重建、使用假体与自体组织重建以及使用放疗。共有 25861 例患者接受了乳房切除术，其中 2972 例（11.5%）进行了 IBR。同期乳房切除术的 IBR 率随着时间的推移而增加，从 2007 年的 7.2%增加到 2014 年的 17.2%（P<0.001）。在这段时间内，接受放疗的 IBR 患者比例也有所增加，从 2007 年的 19.4%增加到 2014 年的 28.2%（P=0.003）。在第一次回归分析中，IBR 与患者年龄较小、更接近癌症诊所、无恶性乳腺疾病（即预防性乳房切除术）、接受更年轻的外科医生进行乳房切除术以及在教学医院接受治疗有关。第二次分析显示，IBR 后接受放疗的患者的预测变量为年龄较小、癌症分期较晚，而患者和机构的外科医生变量均不能预测 IBR 患者的放疗。在 7 年的研究期间，IBR 的比率以及放疗的应用显著增加。多项患者和外科医生因素与 IBR 相关。与 IBR 放疗相关的变量更难以预测。鉴于 IBR 中放疗的应用增加，需要进一步研究，以在人群水平上观察这些患者的长期结果。
