Department of Surgery, Tufts Medical Center, Boston, Massachusetts.
Department of Surgery, UMass Memorial Medical Center, Worcester, Massachusetts; Universidad Cientifica del Sur, Lima, Peru.
J Surg Res. 2023 Mar;283:1064-1072. doi: 10.1016/j.jss.2022.11.067. Epub 2022 Dec 14.
Oncoplastic surgery (OPS) is traditionally performed using a dual surgeon (DS) approach that involves both a breast surgeon and a plastic surgeon. It is also performed using a single surgeon (SS) approach with a surgeon trained in both breast surgical oncology and plastic surgery. We sought to determine if outcomes differed between SS versus DS OPS approaches.
A retrospective chart review was conducted of all OPS performed in a single health system over a 6-y period by either an SS or a DS approach. Primary outcomes were rates of positive margins and the overall complication rate; secondary outcomes were loco-regional recurrence, disease-free survival, and overall survival.
A total of 217 patients were identified; 117 were SS cases and 100 were DS cases. Baseline preoperative patient characteristics were similar between the two groups as there was no difference in mean Charlson Comorbidity Index scores (P = 0.07). There was no difference in tumor stage (P = 0.09) or nodal status (P = 0.31). Rates of positive margins were not significantly different (10.9% (SS) versus 9% (DS); P = 0.81), nor were rates of complications (11.1% (SS) versus 15% (DS); P = 0.42). Rates of locoregional recurrence were also not significantly different (1.7% (SS) versus 0% (DS); P = 0.5). Disease-free survival and overall survival were not significantly different at 1-y, 3-y, and 5-y time points (P = 0.20 and P = 0.23, respectively) although follow-up time was not sufficient for definitive analysis regarding survival.
Both SS and DS approaches to OPS have similar outcomes with regards to positive margin rates and surgical complication rates and are comparably safe.
肿瘤整形手术（OPS）传统上采用双外科医生（DS）方法进行，涉及乳腺外科医生和整形外科医生。它也可以通过接受过乳腺外科肿瘤学和整形手术培训的单一外科医生（SS）方法进行。我们试图确定 SS 与 DS OPS 方法之间的结果是否存在差异。
对在单一医疗系统中进行的 6 年期间，由 SS 或 DS 方法进行的所有 OPS 进行了回顾性图表审查。主要结果是阳性边缘的发生率和总体并发症发生率；次要结果是局部区域复发、无病生存率和总生存率。
共确定了 217 例患者；117 例为 SS 病例，100 例为 DS 病例。两组患者的基线术前患者特征相似，因为平均 Charlson 合并症指数评分无差异（P=0.07）。肿瘤分期（P=0.09）或淋巴结状态（P=0.31）无差异。阳性边缘率无显著差异（10.9%（SS）与 9%（DS）；P=0.81），并发症率也无差异（11.1%（SS）与 15%（DS）；P=0.42）。局部区域复发率也无显著差异（1.7%（SS）与 0%（DS）；P=0.5）。1 年、3 年和 5 年的无病生存率和总生存率无显著差异（P=0.20 和 P=0.23），尽管随访时间不足以对生存进行明确分析。
SS 和 DS 两种 OPS 方法在阳性边缘率和手术并发症率方面具有相似的结果，并且同样安全。
