Royal Hampshire County Hospital, Romsey Road, Winchester, Hampshire, SO22 5DG, UK.
Salisbury District Hospital, Odstock Road, Salisbury, SP2 8BJ, UK.
Eur J Surg Oncol. 2020 Jan;46(1):71-76. doi: 10.1016/j.ejso.2019.09.004. Epub 2019 Sep 5.
Extreme oncoplastic breast conserving surgery (eOPBCS) allows breast conservation for tumours ≥ 50 mm, but long-term outcomes are unclear. We investigated early complications and the longer-term clinical and oncological outcomes following eOPBCS to assess the clinical utility and safety of this technique.
A prospectively collected database of all eOPBCS procedures (1993-2016) using LD miniflaps (LDm) and therapeutic mammoplasties (TM) was interrogated and cross-checked with hospital records to establish length of follow up (FU), clinical outcomes (complications, revisions), local recurrence (LR) and survival.
Ninety eOPBCS procedures (62 LDm, 28 TM) performed for large tumours (mean 67 [50-177] mm) were identified, overall FU 80 (10-308) months (LDm 91 [13-308], TM 54 [10-120] months). Forty two per cent were node positive, and 2 were benign (benign cases excluded from LR and FU analysis). Eleven patients required surgery for involved excision margins (LDm 3 re-excisions and 2 mastectomies, TM 6 mastectomies). Surgery for complications and subsequent revision was required in 6% and 37% of LDm and 18% and 7% of TM patients, respectively. Seven patients developed LR (LDm 5 versus TM 2) giving a predicted 5 and 10 year LR rate of 1.1% and 16%.
Long-term FU of this unique series has confirmed that eOPBCS is a safe procedure for patients with bulky tumours normally treated by mastectomy, without risking local control. TM patients experienced more early complications but LDm patients required more revisions over a more prolonged period of FU.
极限肿瘤整形保乳术（eOPBCS）允许对肿瘤≥50mm 的患者进行保乳治疗，但长期结果尚不清楚。我们研究了 eOPBCS 后的早期并发症和更长时间的临床和肿瘤学结果，以评估该技术的临床实用性和安全性。
使用 LD 迷你皮瓣（LDm）和治疗性乳房成形术（TM），对 1993 年至 2016 年期间所有 eOPBCS 手术（n=90）进行前瞻性收集，并与医院记录进行交叉核对，以确定随访时间（FU）、临床结果（并发症、修复）、局部复发（LR）和生存率。
共确定了 90 例大型肿瘤（平均直径 67[50-177]mm）的 eOPBCS 手术，总随访时间为 80（10-308）个月（LDm 为 91[13-308]个月，TM 为 54[10-120]个月）。42%的患者淋巴结阳性，2 例为良性（良性病例排除在 LR 和 FU 分析之外）。11 例患者因切除边缘受累而需要再次手术（LDm 为 3 例再次切除术和 2 例乳房切除术，TM 为 6 例乳房切除术）。LDm 患者中有 6%需要手术治疗并发症，37%需要手术治疗修复，TM 患者中有 18%需要手术治疗并发症，7%需要手术治疗修复。7 例患者发生 LR（LDm 为 5 例，TM 为 2 例），预测 5 年和 10 年 LR 率分别为 1.1%和 16%。
对这一独特系列的长期随访证实，eOPBCS 是一种治疗大肿瘤患者的安全手术方法，通常采用乳房切除术，不会影响局部控制。TM 患者早期并发症较多，但 LDm 患者在更长的 FU 期间需要更多的修复。
