Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland.
University of Basel, Petersplatz 1, 4001, Basel, Switzerland.
Eur J Surg Oncol. 2023 Oct;49(10):107032. doi: 10.1016/j.ejso.2023.107032. Epub 2023 Aug 16.
Oncoplastic breast conserving surgery (OBCS) aims to provide safe and satisfying surgery for breast cancer patients. The American Society of Breast Surgeons (ASBrS) classification system is based on volumetric displacement cut-offs (level I for <20% of breast volume; level II for 20-50%). It aims to facilitate communication among treating physicians and patients. Here, we investigate whether the extent of OBCS as classified by ASBrS independently predicts postoperative complications.
This retrospective analysis of a prospectively maintained database included patients with stage I-III breast cancer who underwent OBCS between 03/2011 and 12/2020 at a Swiss university hospital. Outcomes included short-term (≤30 days) complications and chronic (>30 days) pain after surgery. Multivariate logistic regression models were used to identify independent predictors.
In total, 439 patients were included, 314 (71.5%) received ASBrS level I surgery, and 125 (28.5%) underwent ASBrS level II surgery. ASBrS level II was found to be an independent predictor of delayed wound healing (odds ratio [OR] 9.75, 95% confidence intervals (CI) 2.96-32.10). However, ASBrS level did not predict chronic postoperative pain (incidence rate ratio [IRR] 1.20, 95%CI 0.85-1.70), as opposed to age (IRR 1.19, 95%CI 1.11-1.27 per 5 years decrease), and weight disorders (underweight [BMI <18.5] vs. normal weight [BMI 18.5 < 25]: IRR 4.02, 95%CI 1.70-9.54; obese [BMI ≥30] vs. normal weight: IRR 2.07, 95%CI 1.37-3.13).
ASBrS level II surgery predicted delayed wound healing, warranting close clinical follow-up and prompt treatment to avoid delays in adjuvant therapy.
肿瘤整形保乳术（OBCS）旨在为乳腺癌患者提供安全且满意的手术。美国乳腺外科学会（ASBrS）分类系统基于体积位移截断值（I 级<20%的乳房体积；II 级为 20-50%）。其目的是促进治疗医生和患者之间的沟通。在这里，我们研究 ASBrS 分类的 OBCS 范围是否独立预测术后并发症。
本研究回顾性分析了 2011 年 3 月至 2020 年 12 月期间在瑞士一家大学医院接受 OBCS 的 I-III 期乳腺癌患者的前瞻性维护数据库。结果包括短期（≤30 天）并发症和术后慢性（>30 天）疼痛。使用多变量逻辑回归模型确定独立预测因子。
共纳入 439 例患者，其中 314 例（71.5%）接受 ASBrS Ⅰ级手术，125 例（28.5%）接受 ASBrS Ⅱ级手术。ASBrS Ⅱ级被发现是延迟伤口愈合的独立预测因子（优势比 [OR] 9.75，95%置信区间 [CI] 2.96-32.10）。然而，ASBrS 分级并不能预测慢性术后疼痛（发病率比 [IRR] 1.20，95%CI 0.85-1.70），而年龄（每减少 5 岁增加 1.19，95%CI 1.11-1.27）和体重障碍（体重过轻 [BMI <18.5] 与正常体重 [BMI 18.5 <25]：IRR 4.02，95%CI 1.70-9.54；肥胖 [BMI ≥30] 与正常体重：IRR 2.07，95%CI 1.37-3.13）。
ASBrS Ⅱ级手术预测延迟伤口愈合，需要密切临床随访和及时治疗，以避免辅助治疗延迟。
