Department of Reconstructive Surgery, The Ohio State University, Columbus, OH, USA.
Ann Surg Oncol. 2023 Mar;30(3):1904-1910. doi: 10.1245/s10434-022-12835-z. Epub 2022 Nov 19.
In breast cancer, coordination of surgical therapy with immediate breast reconstruction (IBR) has been found to significantly delay surgical therapy, which in turn can have an adverse effect on patient survival. The objective of this study was to investigate factors that impact the timeliness of surgical therapy in this setting, which may help to optimize the care of patients with breast cancer.
Patients with breast cancer undergoing surgical therapy for breast cancer and immediate reconstruction were reviewed. Patients were divided into two groups: those who underwent surgery ≤ 30 days (group A) and > 30 days (group B) after diagnosis. Multivariate statistical analysis of demographic, disease, surgical, and process of care factors was performed.
A total of 348 cases met inclusion criteria, of which 255 (73.2%) were in group A and 93 (26.7%) were in group B. No significant differences were identified in clinical stage, oncologic procedure, or type of reconstruction. On multivariate analysis, an increased likelihood of undergoing surgery ≤ 30 days of diagnosis was observed, with shorter time intervals between surgical oncologist and plastic surgeon consultations [odds ratio (OR) 1.3; 95% confidence interval (CI) 1.1-1.6, p = 0.011]. The number of operating days in common between the surgical oncologist and plastic surgeon nor having the same clinic day impacted timeliness.
Patients may undergo both breast conservation surgery and mastectomy with all major types of immediate reconstruction in a timely manner. Early initiation of plastic surgery referrals and surgeon flexibility to work outside the parameters of institutional schedules may help facilitate the timeliness of surgery.
在乳腺癌中，手术治疗与即刻乳房重建（IBR）的协调已被发现会显著延迟手术治疗，这反过来又会对患者的生存产生不利影响。本研究的目的是探讨影响这种情况下手术治疗及时性的因素，这可能有助于优化乳腺癌患者的护理。
回顾了接受手术治疗乳腺癌和即刻重建的乳腺癌患者。患者分为两组：诊断后≤30 天（A 组）和>30 天（B 组）接受手术的患者。对人口统计学、疾病、手术和护理过程因素进行了多变量统计分析。
共有 348 例符合纳入标准，其中 255 例（73.2%）在 A 组，93 例（26.7%）在 B 组。临床分期、肿瘤治疗程序或重建类型无显著差异。多变量分析显示，与诊断后 30 天内接受手术的可能性增加相关，外科肿瘤学家和整形外科医生咨询之间的时间间隔更短[比值比（OR）1.3；95%置信区间（CI）1.1-1.6，p=0.011]。外科肿瘤学家和整形外科医生的手术日数量相同或不在同一天就诊并不影响及时性。
患者可能会及时接受保乳手术和乳房切除术以及所有主要类型的即刻重建。早期转介整形外科医生，并允许外科医生灵活地在机构时间表之外工作，可能有助于促进手术的及时性。
