Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA.
Department of Biostatistics, Saint John's Cancer Institute, Providence Health System, Santa Monica, CA, USA.
Ann Surg Oncol. 2024 Oct;31(11):7463-7470. doi: 10.1245/s10434-024-15711-0. Epub 2024 Jul 10.
Extreme oncoplastic breast-conserving surgery (eOBCS) describes the application of OBCS to patients who would otherwise need a mastectomy, and its safety has been previously described.
We aimed to compare the costs of eOBCS and mastectomy.
We reviewed our institutional database to identify breast cancer patients treated surgically from 2018 to 2023. We included patients with a large disease span (≥5 cm) and multifocal/multicentric disease. Patients were grouped by their surgical approach, i.e. eOBCS or mastectomy. The direct costs of care were determined and compared; however, indirect costs were not included.
Eighty-six patients met the inclusion criteria, 10 (11.6%) of whom underwent mastectomy and 76 (88.4%) who underwent eOBCS. Six mastectomy patients (60%) had reconstruction and 6 (60%) underwent external beam radiation therapy (EBRT). Reconstructions were completed in a staged fashion, and the mean cost of the index operation (mastectomy and tissue expander) was $17,816. These patients had one to three subsequent surgeries to complete their reconstruction, at a mean cost of $45,904. The mean cost of EBRT was $5542. Thirty-four eOBCS patients (44.7%) underwent 44 margin re-excisions, including 6 (7.9%) who underwent mastectomy. Sixty (78.9%) of the eOBCS patients had EBRT. The mean cost of their index operation was $6345; the mean cost of a re-excision was $3615; the mean cost of their mastectomies with reconstruction was $49,400; and the mean cost of EBRT was $6807. The cost of care for eOBCS patients remained lower than that for mastectomy patients, i.e. $17,318 versus $57,416.
eOBCS is associated with a lower cost than mastectomy and had a low conversion rate to mastectomy.
极限保乳肿瘤切除术（eOBCS）是指将保乳手术应用于原本需要接受乳房切除术的患者，其安全性此前已有描述。
我们旨在比较 eOBCS 和乳房切除术的成本。
我们回顾了我们的机构数据库，以确定 2018 年至 2023 年接受手术治疗的乳腺癌患者。我们纳入了疾病范围较大（≥5cm）和多灶/多中心疾病的患者。患者按手术方式分组，即 eOBCS 或乳房切除术。确定并比较了直接护理成本；但是，未包括间接成本。
86 名患者符合纳入标准，其中 10 名（11.6%）接受了乳房切除术，76 名（88.4%）接受了 eOBCS。6 名乳房切除术患者（60%）接受了重建，6 名（60%）接受了外部束放射治疗（EBRT）。重建分阶段完成，索引手术（乳房切除术和组织扩张器）的平均费用为$17816。这些患者进行了一到三次后续手术以完成重建，平均费用为$45904。EBRT 的平均费用为$5542。34 名 eOBCS 患者（44.7%）进行了 44 次边缘再切除，其中 6 名（7.9%）接受了乳房切除术。60 名（78.9%）eOBCS 患者接受了 EBRT。他们的索引手术的平均费用为$6345；再切除的平均费用为$3615；接受重建的乳房切除术的平均费用为$49400；EBRT 的平均费用为$6807。eOBCS 患者的治疗费用仍低于乳房切除术患者，即$17318 与$57416。
eOBCS 的成本低于乳房切除术，且向乳房切除术的转化率较低。
