Aristokleous Iliana, Öberg Johanna, Pantiora Eirini, Sjökvist Olivia, Navia Jaime E, Mani Maria, Karakatsanis Andreas
Department of Surgery, Endocrine- and Breast Unit, Uppsala University Hospital, 75237, Uppsala, Sweden; Department of Surgical Sciences, Faculty of Medicine, Uppsala University, 75236, Uppsala, Sweden.
Department of Surgical Sciences, Faculty of Medicine, Uppsala University, 75236, Uppsala, Sweden; Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, 75237, Uppsala, Sweden.
Eur J Surg Oncol. 2023 Jan;49(1):60-67. doi: 10.1016/j.ejso.2022.08.021. Epub 2022 Aug 30.
The role of oncoplastic breast conserving therapy (OPBCT) on physical function, morbidity and patient satisfaction has yet to be defined. Additionally, technique selection should be individualised and incorporate patient preference. The study aim was to investigate differences between "standard" (sBCT) and oncoplastic breast conservation (OPBCT) in patient-reported outcomes (PROs) when patients have been assessed in a standardised manner and technique selection has been reached through shared decision-making (SDM).
This is a cross-sectional study of 215 women treated at a tertiary referral centre. Standardised surgical assessment included breast and lesion volumetry, definition of resection ratio, patient-related risk factors and patient preference. Postoperative morbidity and patient satisfaction were assessed by validated PROs tools (Diseases of the Arm, Shoulder and Hand-DASH and Breast-Q). Patient experience was assessed by semi-structured interviews.
There was no difference of the median values between OPBCT and sBCT in postoperative morbidity of the upper extremity (DASH 3.3 vs 5, p = 0.656) or the function of the chest wall (Breast-Q 82 vs 82, p = 0.758). Postoperative satisfaction with breasts did not differ either (Breast-Q 65 vs 61, p = 0.702). On the individual level, women that opted for OPBCT after SDM had improved satisfaction when compared to baseline (+3 vs -1, p = 0.001). Shared decision-making changed patient attitude in 69.8% of patients, leading most often to de-escalation from mastectomy.
These findings support that a combination of standardised surgical assessment and SDM allows for tailored treatment and de-escalation of oncoplastic surgery without negatively affecting patient satisfaction and morbidity.
肿瘤整形保乳治疗（OPBCT）对身体功能、发病率和患者满意度的作用尚未明确。此外，技术选择应个体化并考虑患者偏好。本研究旨在探讨当患者经过标准化评估且通过共同决策（SDM）达成技术选择时，“标准”保乳治疗（sBCT）与肿瘤整形保乳治疗（OPBCT）在患者报告结局（PROs）方面的差异。
这是一项对在三级转诊中心接受治疗的215名女性进行的横断面研究。标准化手术评估包括乳房和病变体积测量、切除率定义、患者相关风险因素和患者偏好。通过经过验证的PROs工具（手臂、肩部和手部疾病-DASH和乳房-Q）评估术后发病率和患者满意度。通过半结构化访谈评估患者体验。
OPBCT和sBCT在上肢术后发病率（DASH评分3.3对5，p = 0.656）或胸壁功能（乳房-Q评分82对82，p = 0.758）方面的中位数无差异。乳房术后满意度也无差异（乳房-Q评分65对61，p = 0.702）。在个体层面，与基线相比，在SDM后选择OPBCT的女性满意度有所提高（+3对-1，p = 0.001）。共同决策改变了69.8%患者的态度，最常见的是使乳房切除术降级。
这些发现支持标准化手术评估和SDM相结合可实现肿瘤整形手术的个性化治疗和降级，且不会对患者满意度和发病率产生负面影响。
