Cambridge University Hospitals, Cambridge, UK.
New Victoria Hospital, Glasgow, UK.
Breast. 2023 Oct;71:82-88. doi: 10.1016/j.breast.2023.07.007. Epub 2023 Jul 17.
Partial breast reconstruction with a pedicled chest wall perforator flap (CWPF) enables breast conservation in a higher tumour: breast volume ratio scenario. Since there is limited evidence, this retrospective cohort study aimed to ascertain immediate (30-days) and medium-term (follow-up duration) surgical outcomes.
STROBE-compliant protocol ascertained CWPF outcomes between March 2011-March 2021. UK centres known to perform CWPF were invited to participate if they performed at least 10 cases. Data were retrospectively collected, including patient demographics, tumour and treatment characteristics, and surgical and oncological outcomes. Statistical analysis (R™) included multivariable logistic regression and sensitivity analysis.
Across 15 centres, 507 patients with median age (54 years, IQR; 48-62), body mass index (25.4 kg/m, IQR; 22.5-29), tumour size (26 mm, IQR; 18-35), and specimen weight (62 g, IQR; 40-92) had following flap types: LiCAP (54.1%, n = 273), MiCAP/AiCAP (19.6%, n = 99), LiCAP + LTAP (19.8%, n = 100) and TDAP (2.2%, n = 11). 30-days complication rates were in 12%: haematoma (4.3%, n = 22), wound infection (4.3%, n = 22), delayed wound healing (2.8%, n = 14) and flap loss (0.6%, n = 3; 1 full) leading to readmissions (2.6%, n = 13) and re-operations (2.6%, n = 13). Positive margins (n = 88, 17.7%) led to 15.9% (n = 79) re-excisions, including 7.5% (n = 37) at the planned 2nd of 2-stage surgery and 1.8% (n = 9) mastectomy. At median 23 months (IQR; 11-39) follow-up, there were 1.2% (n = 6) symmetrisations; recurrences: local (1%), regional/nodal (0.6%) and distant (3.2%).
This large multicentre cohort study demonstrates acceptable complication and margin re-excision rates. CWPF extends the range of breast conservation techniques. Further studies are required for long-term oncological outcomes.
带蒂胸壁穿支皮瓣（CWPF）的部分乳房重建可在更高的肿瘤：乳房体积比情况下实现乳房保留。由于证据有限，这项回顾性队列研究旨在确定即刻（30 天）和中期（随访时间）的手术结果。
符合 STROBE 协议的方案确定了 2011 年 3 月至 2021 年 3 月期间的 CWPF 结果。如果已知进行 CWPF 的英国中心进行了至少 10 例手术，则邀请其参加。回顾性收集了包括患者人口统计学、肿瘤和治疗特征以及手术和肿瘤学结果在内的数据。统计分析（R）包括多变量逻辑回归和敏感性分析。
在 15 个中心中，507 名中位年龄（54 岁，IQR；48-62）、体重指数（25.4kg/m，IQR；22.5-29）、肿瘤大小（26mm，IQR；18-35）和标本重量（62g，IQR；40-92）的患者接受了以下皮瓣类型：LiCAP（54.1%，n=273）、MiCAP/AiCAP（19.6%，n=99）、LiCAP+LTAP（19.8%，n=100）和 TDAP（2.2%，n=11）。30 天并发症发生率为 12%：血肿（4.3%，n=22）、伤口感染（4.3%，n=22）、伤口愈合延迟（2.8%，n=14）和皮瓣坏死（0.6%，n=3；1 例完全坏死）导致再入院（2.6%，n=13）和再手术（2.6%，n=13）。阳性切缘（n=88，17.7%）导致 15.9%（n=79）再次切除，其中 7.5%（n=37）在计划的 2 期手术的第 2 期进行，1.8%（n=9）行乳房切除术。在中位 23 个月（IQR；11-39）的随访中，有 1.2%（n=6）进行了对称性手术；复发：局部（1%）、区域/淋巴结（0.6%）和远处（3.2%）。
这项大型多中心队列研究表明，并发症和切缘再次切除率可接受。CWPF 扩展了乳房保留技术的范围。需要进一步研究以评估长期肿瘤学结果。
