Ahmed Shahnur, Hulsman Luci, Roth Dylan, Fisher Carla, Ludwig Kandice, Imeokparia Folasade O, VonDerHaar Richard Jason, Lester Mary E, Hassanein Aladdin H
Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, Indiana.
J Reconstr Microsurg. 2025 Feb;41(2):144-148. doi: 10.1055/s-0044-1787727. Epub 2024 Jun 12.
BACKGROUND: Lymphedema can occur in patients undergoing axillary lymph node dissection (ALND) and radiation for breast cancer. Immediate lymphatic reconstruction (ILR) is performed to decrease the risk of lymphedema in patients after ALND. Some patients who ultimately require ALND are candidates for attempted sentinel lymph node biopsy (SLNB) or targeted axillary excision. In those scenarios, ALND can be performed (1) immediately if frozen sections are positive or (2) as a second operation following permanent pathology. The purpose of this study is to evaluate immediate ALND/ILR following positive intraoperative frozen sections to guide surgical decision-making and operative planning. METHODS: A single-center retrospective review was performed (2019-2022) for breast cancer patients undergoing axillary node surgery with breast reconstruction. Patients were divided into two groups: immediate conversion to ALND/ILR (Group 1) and no immediate conversion to ALND (Group 2). Demographic data and operative time were recorded. RESULTS: There were 148 patients who underwent mastectomy, tissue expander (TE) reconstruction, and axillary node surgery. Group 1 included 30 patients who had mastectomy, sentinel node/targeted node biopsy, TE reconstruction, and intraoperative conversion to immediate ALND/ILR. Group 2 had 118 patients who underwent mastectomy with TE reconstruction and SLNB with no ALND or ILR. Operative time for bilateral surgery was 303.1 ± 63.2 minutes in Group 1 compared with 222.6 ± 52.2 minutes in Group 2 ( = 0.001). Operative time in Group 1 patients undergoing unilateral surgery was 252.3 ± 71.6 minutes compared with 171.3 ± 43.2 minutes in Group 2 ( = 0.001). CONCLUSION: Intraoperative frozen section of sentinel/targeted nodes extended operative time by approximately 80 minutes in patients undergoing mastectomy with breast reconstruction and conversion of SLNB to ALND/ILR. Intraoperative conversion to ALND adds unpredictability to the operation as well as additional potentially unaccounted operative time. However, staging ALND requires an additional operation.
背景：乳腺癌患者在接受腋窝淋巴结清扫术（ALND）和放疗后可能会发生淋巴水肿。进行即时淋巴重建（ILR）以降低ALND术后患者发生淋巴水肿的风险。一些最终需要进行ALND的患者是尝试前哨淋巴结活检（SLNB）或靶向腋窝切除的候选者。在这些情况下，ALND可以（1）在冰冻切片阳性时立即进行，或（2）作为永久病理检查后的二次手术进行。本研究的目的是评估术中冰冻切片阳性后立即进行ALND/ILR，以指导手术决策和手术规划。 方法：对2019年至2022年接受腋窝淋巴结手术并进行乳房重建的乳腺癌患者进行单中心回顾性研究。患者分为两组：立即转为ALND/ILR（第1组）和未立即转为ALND（第2组）。记录人口统计学数据和手术时间。 结果：有148例患者接受了乳房切除术、组织扩张器（TE）重建和腋窝淋巴结手术。第1组包括30例接受乳房切除术、前哨淋巴结/靶向淋巴结活检、TE重建并术中转为立即ALND/ILR的患者。第2组有118例接受乳房切除术加TE重建和SLNB且未进行ALND或ILR的患者。第1组双侧手术的手术时间为303.1±63.2分钟，而第2组为222.6±52.2分钟（P = 0.001）。第1组接受单侧手术的患者手术时间为252.3±71.6分钟，而第2组为171.3±43.2分钟（P = 0.001）。 结论：对于接受乳房切除术并进行乳房重建且将SLNB转为ALND/ILR的患者，前哨/靶向淋巴结的术中冰冻切片使手术时间延长约80分钟。术中转为ALND会增加手术的不可预测性以及额外的潜在未计算的手术时间。然而，分期ALND需要额外进行一次手术。
Breast Cancer Res Treat. 2022-12
World J Surg Oncol. 2020-6-1
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