Department of Surgical Oncology, Gulhane Medical School, University of Health Sciences, Ankara, Turkey.
Department of Surgical Oncology, University of Health Sciences AY Ankara Oncology Training and Research Hospital, Ankara, Turkey.
Int J Clin Pract. 2021 Aug;75(8):e14268. doi: 10.1111/ijcp.14268. Epub 2021 Apr 28.
In patients with breast cancer for whom neoadjuvant chemotherapy (NAC) is planned, it is recommended to mark the primary tumour before treatment (planned surgery). However, surgeons may have to perform breast-conserving surgery on patients whose tumours are not marked (unplanned surgery). This study focused on the results obtained with planned and unplanned level II oncoplastic surgery (OPS) techniques applied to patients after NAC.
Patient groups who underwent planned, unplanned OPS and mastectomy after NAC were compared. Surgical margin status, re-operation and re-excision requirements, ipsilateral breast tumour recurrence (IBTR) and axillary recurrence rates recorded. Long-term local recurrence-free survival (LRFS), disease-free survival and overall survival were evaluated.
There was no significant difference between the planned and unplanned OPS groups in terms of surgical margin status, re-excision requirement, and mastectomy rates. During an average follow-up period of 43 months, 5.3% and 4% of the patients in the planned OPS group developed IBTR and axillary recurrence, respectively, whereas these rates were 6.6% and 5.3% in the unplanned OPS group. In the mastectomy group, the rates of IBTR and axillary recurrence were found to be 4.1% and 3.8%, respectively. There was no significant difference between the three groups in terms of IBTR (P: .06) and axillary recurrence (P: .08) rates.
Breast conserving surgery can be applied using level II OPS techniques with the post-NAC radiological examination and marking even if primary tumour marking is not done in the pre-NAC period.
对于计划接受新辅助化疗（NAC）的乳腺癌患者，建议在治疗前（计划手术）对原发肿瘤进行标记。然而，对于肿瘤未标记的患者（非计划手术），外科医生可能不得不进行保乳手术。本研究重点关注 NAC 后应用计划和非计划 II 级整形手术（OPS）技术的患者的结果。
比较了接受 NAC 后行计划、非计划 OPS 和乳房切除术的患者组。记录手术切缘状态、再次手术和再次切除的需求、同侧乳房肿瘤复发（IBTR）和腋窝复发率。评估长期局部无复发生存率（LRFS）、无病生存率和总生存率。
在手术切缘状态、再次切除要求和乳房切除术率方面，计划 OPS 组与非计划 OPS 组之间无显著差异。在平均 43 个月的随访期间，计划 OPS 组分别有 5.3%和 4%的患者发生 IBTR 和腋窝复发，而非计划 OPS 组分别为 6.6%和 5.3%。在乳房切除术组中，IBTR 和腋窝复发的发生率分别为 4.1%和 3.8%。三组在 IBTR（P：.06）和腋窝复发（P：.08）率方面无显著差异。
即使在 NAC 前未进行原发肿瘤标记，也可以使用 NAC 后的放射学检查和标记，通过 II 级 OPS 技术进行保乳手术。
