Gaffney Kerry A, Karamchandani Manish M, De La Cruz Ku Gabriel, Wareham Carly, Homsy Christopher, Nardello Salvatore, Chatterjee Abhishek, Persing Sarah M
From the Department of Surgery, Tufts Medical Center, Boston.
Division of Plastic and Reconstructive Surgery.
Ann Plast Surg. 2024 Aug 1;93(2):183-188. doi: 10.1097/SAP.0000000000004018. Epub 2024 Jul 5.
Oncoplastic breast surgery (OBS) is a form of breast conservation surgery (BCS) that involves a partial mastectomy followed by immediate volume displacement or volume replacement surgical techniques. To date, there are few studies evaluating OBS in older patients. Therefore, we sought to determine if outcomes differed between patients 65 years and older versus younger patients who underwent oncoplastic surgical procedures.
A retrospective chart review was performed for all oncoplastic breast operations within a single health system from 2015 to 2021. Patients were stratified by age, with patients 65 years and older (OBS65+) identified and then matched with younger patients (OBS <65) based on BMI. Primary outcomes were positive margin rates and overall complication rates; secondary outcomes were locoregional recurrence (LR), distant recurrence (DR), disease-free survival (DFS), overall survival (OS), and long-term breast asymmetry.
A total of 217 patients underwent OBS over the 6-year period, with 22% being OBS65+. Preoperatively, older patients experienced higher American Anesthesia (ASA) scores, Charlson Co-morbidity index (CCI) scores, and higher rates of diabetes mellitus, hypertension, and grade 3 breast ptosis. Despite this, no significant differences were found between primary or secondary outcomes compared to younger patients undergoing the same procedures.
Oncoplastic breast reconstruction is a safe option in patients 65 years and older, with overall similar recurrence rates, positive margin rates, and survival when compared to younger patients. Although the older cohort of patients had greater preoperative risk, there was no difference in overall surgical complication rates or outcomes. Supporting the argument that all oncoplastic breast reconstruction techniques should be offered to eligible patients, irrespective of age.
肿瘤整形乳房手术（OBS）是一种保乳手术（BCS）形式，包括部分乳房切除术，随后采用即时容积置换或容积替代手术技术。迄今为止，很少有研究评估老年患者的肿瘤整形乳房手术。因此，我们试图确定65岁及以上患者与接受肿瘤整形手术的年轻患者的手术结果是否存在差异。
对2015年至2021年在单一医疗系统内进行的所有肿瘤整形乳房手术进行回顾性病历审查。患者按年龄分层，确定65岁及以上患者（OBS65+），然后根据体重指数与年轻患者（OBS<65）进行匹配。主要结局为切缘阳性率和总体并发症发生率；次要结局为局部区域复发（LR）、远处复发（DR）、无病生存期（DFS）、总生存期（OS）和长期乳房不对称。
在这6年期间，共有217例患者接受了肿瘤整形乳房手术，其中OBS65+患者占22%。术前，老年患者的美国麻醉医师协会（ASA）评分、查尔森合并症指数（CCI）评分较高，糖尿病、高血压和3级乳房下垂的发生率也较高。尽管如此，与接受相同手术的年轻患者相比，主要或次要结局均未发现显著差异。
肿瘤整形乳房重建对于65岁及以上患者是一种安全的选择，与年轻患者相比，总体复发率、切缘阳性率和生存率相似。虽然老年患者队列术前风险更高，但总体手术并发症发生率或结局并无差异。这支持了应向符合条件的患者提供所有肿瘤整形乳房重建技术的观点，而不论其年龄大小。
