微创（内镜或机器人辅助）保留乳头的乳房切除术是否不适合大乳房？

Is minimal-accessed (endoscopic- or robotic-assisted) nipple-sparing mastectomy contraindicated for large breasts?

机构信息

Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, Changhua, Taiwan; Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan; Minimal Invasive Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Breast Surgery, Yuanlin Christian Hospital, Yuanlin, Taiwan; Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.

出版信息

Eur J Surg Oncol. 2024 Apr;50(4):108030. doi: 10.1016/j.ejso.2024.108030. Epub 2024 Feb 20.

DOI:10.1016/j.ejso.2024.108030

PMID:38402736

Abstract

BACKGROUND

In the developmental stage of minimal-accessed nipple-sparing mastectomy (MA-NSM), selecting patients with small to medium-sized breasts was common for better cosmetic outcomes and oncological safety. However, the suitability of MA-NSM for large, ptotic breasts remained uncertain. This retrospective study aim to assess MA-NSM outcomes in patients with large breasts.

MATERIALS AND METHODS

This retrospective study included patients receiving conventional NSM (C-NSM) and MA-NSM from January 2011 to September 2022, at a single institution. We analyzed perioperative parameters and clinical outcomes based on breast specimen size, classified as small (≤300 g), medium (>300-450 g), large (>450-600 g), and very large (>600 g).

RESULTS

A total of 728 patients was enrolled. C-NSM was performed in 51% (371/728) of cases, while MA-NSM was done in 49% (357/728). The overall complication rate of MA-NSM was comparable to C-NSM (p = 0.573), but severe complications (Clavien-Dindo, CD III) was significantly reported more following C-NSM, regardless of breast size. During a median follow-up of 52 months, no significant difference in oncological outcomes was observed. Comparing MA-NSM and C-NSM outcomes in large-very large breasts (>450 g), MA-NSM demonstrated significantly less blood loss (p = 0.036) and lower incidence of severe complications (CD ≥ III) compared to C-NSM (p = 0.002).

CONCLUSION

MA-NSM is feasible for large breasts and offers benefits by reducing blood loss and decreasing the incidence of severe complications (CD ≥ III) in this patient group.

摘要

背景

在微创保留乳头乳晕乳房切除术（MA-NSM）的发展阶段，为了获得更好的美容效果和肿瘤安全性，选择中小乳房的患者是常见的。然而，MA-NSM 对大而下垂的乳房是否适用仍不确定。本回顾性研究旨在评估 MA-NSM 在大乳房患者中的应用效果。

材料和方法

本回顾性研究纳入了 2011 年 1 月至 2022 年 9 月在一家单中心接受常规 NSM（C-NSM）和 MA-NSM 的患者。我们根据乳房标本大小分析了围手术期参数和临床结果，分为小（≤300g）、中（>300-450g）、大（>450-600g）和特大（>600g）。

结果

共纳入 728 例患者。51%（371/728）的患者接受了 C-NSM，49%（357/728）的患者接受了 MA-NSM。MA-NSM 的总体并发症发生率与 C-NSM 相当（p=0.573），但无论乳房大小，C-NSM 的严重并发症（Clavien-Dindo，CD III 级）发生率明显更高。在中位随访 52 个月期间，两组患者的肿瘤学结果无显著差异。在>450g 的大-特大乳房中，比较 MA-NSM 和 C-NSM 的结果，MA-NSM 组的出血量明显较少（p=0.036），严重并发症（CD≥III 级）发生率也明显低于 C-NSM 组（p=0.002）。