Qiu Juanjuan, Wen Nan, Xie Yanyan, Feng Yu, Liang Faqing, Lv Qing, Du Zhenggui
Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China.
Clinical Research Center for Breast disease, West China Hospital, Sichuan University, Chengdu, China.
Gland Surg. 2022 Aug;11(8):1383-1394. doi: 10.21037/gs-22-398.
A novel endoscopic-assisted technique (NET) was created by our team for nipple-sparing mastectomy (NSM) and latissimus dorsi muscle flap (LDMF) reconstruction that enables the procedure to be conducted through a single axillary incision. The authors hypothesized that the NET has the advantages of the traditional ET (TET) and a reduced operation time. The purpose of this study is to compare the advantages and disadvantages of NET, TET and open surgery.
A retrospective cohort study was performed on patients who underwent LDMF reconstruction after NSM using open surgery, the TET, or the NET between January 2013 and June 2021. The following outcomes were compared: the operation time, size of the LDMF, the complication rate, hospital length of stay, hospital costs, aesthetic results (the BREAST-Q questionnaire), and quality of life (QoL). The BREAST-Q questionnaire and QoL were underwent preoperatively and 1, 3, and 12 months postoperatively.
A total of 17 ETs (comprising 10 NETs and 7 TETs) and 28 open surgery procedures were identified and analyzed, the baseline characteristics were comparable in terms of age, body mass index (BMI), tumor location, cup size, and disease stage of the three groups. The mean operation time of the NET group (395.8±176.0 min) in the exploration stage was shorter than that of the TET group (531.6±69.6 min) and equivalent to that of the open surgery group (400.9±67.3 min). The overall postoperative complication rates of the ET and open surgery groups were 35.3% and 60.7%, respectively (P=0.09). The aesthetic results in relation to patients' satisfaction with their breasts (P=0.001) and backs (P=0.001) were better in the ET group than the open surgery group beginning at 1 month postoperatively. The ET group had better psychosocial well-being beginning at 1 month postoperatively (P=0.002) and sexual well-being beginning at 3 months postoperatively (P<0.001) than the open surgery group.
LDMF reconstruction after NSM using the ET is associated with lower complication rates, good aesthetic results, and a better QoL than open surgery procedures. The NET is a promising approach, a more convenient procedure, and has a shorter surgery time than TET, however, this conclusion needs to be further validated by randomized clinical trial (RCT) research with a larger sample size.
我们团队创建了一种新型内镜辅助技术（NET），用于保乳乳房切除术（NSM）和背阔肌肌皮瓣（LDMF）重建，该技术能够通过单一腋窝切口进行手术。作者推测NET具有传统内镜技术（TET）的优点且手术时间更短。本研究的目的是比较NET、TET和开放手术的优缺点。
对2013年1月至2021年6月期间接受NSM术后LDMF重建的患者进行回顾性队列研究，这些患者分别接受了开放手术、TET或NET。比较以下结果：手术时间、LDMF大小、并发症发生率、住院时间、住院费用、美学效果（BREAST-Q问卷）和生活质量（QoL）。BREAST-Q问卷和QoL在术前以及术后1个月、3个月和12个月进行评估。
共确定并分析了17例内镜手术（包括10例NET和7例TET）以及28例开放手术，三组患者在年龄、体重指数（BMI）、肿瘤位置、罩杯大小和疾病分期方面的基线特征具有可比性。NET组在探查阶段的平均手术时间（395.8±176.0分钟）短于TET组（531.6±69.6分钟），与开放手术组（400.9±67.3分钟）相当。内镜手术组和开放手术组的总体术后并发症发生率分别为35.3%和60.7%（P=0.09）。从术后1个月开始，内镜手术组患者对乳房（P=0.001）和背部（P=0.001）的美学效果满意度高于开放手术组。内镜手术组从术后1个月开始心理幸福感更好（P=0.002），从术后3个月开始性幸福感更好（P<0.001），均高于开放手术组。
与开放手术相比，NSM术后采用内镜技术进行LDMF重建的并发症发生率更低、美学效果良好且生活质量更高。NET是一种有前景的方法，操作更便捷，手术时间比TET更短，然而，这一结论需要通过更大样本量的随机临床试验（RCT）研究进一步验证。
